We often saw James, an 89-year-old patient, in our endoscopy suite for follow-up of an adenomatous colon polyp. Lilly, his wife had worked in our surgical unit for 35 years and had recently retired to care for her husband. She has always been a jovial sort, who always starts out the day with a funny story or joke. The preparation period and pre-anesthetic assessment proceeded without incident. NPO status was asked three times by the admitting nurse, circulating nurse and nurse anesthetist, and to all James replied, “Nothing since 11:00 PM last night.”
On admission to the endoscopy suite, oxygen and monitors were applied and sedation titrated to effect.   After receiving 1 mg of midazolam and 50-µg of fentanyl, James began to cough. In a matter of seconds his SpO2 dropped from 98% to 72%.  His eyes were wide open, and he appeared to be choking.   

Instead of the usual response of trying to verbally arouse the patient, lift the chin and perform positive pressure ventilations, I instinctively knew that James was choking on something. I opened his mouth and, using a laryngoscope blade and Magill forceps, removed a piece of chewing gum that was lodged between his vocal cords. 

James’ oxygen saturation levels immediately returned to normal, and he was awake enough that I questioned him. He admitted that he had the gum in his mouth since early that morning and had been holding it against his gums. As for me, I knew that it must have been a guardian angel that guided me, showing me what to do at just the right moment. Positive pressure ventilations would have been disastrous, and James could have easily lost his life.

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