Análisis descriptivo

choking narrative.

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Awareness was critical to the beginning of individual choking stories and the choking narrative as a whole. ‘Awareness’ in this study is being defined as being actively alert or attentive to an area of concern and therefore primed to respond. It implies that there is a level of knowledge – an underlying

understanding of the facts or particulars – related to a concern. Exploration of the social context of choking illuminated multiple areas of concern and many pieces of information that required acknowledgement and understanding for awareness to be possible. Lack of awareness or partial awareness of

different concerns and their details was implicated in all parts of the choking narrative (the beginning, middle, and end) as negatively impacting on both at- risk adults and their informal and formal carers.

The contrast between people ‘having’, ‘not having’, or ‘partially having’ awareness illustrated that there were important dimensions to awareness that needed to be acknowledged and addressed, such as: who needed awareness; where awareness came from (how people gained information

about a concern); the kinds of awareness needed (factual, social, emotional); the level of awareness needed (general and/or specific to an individual); the breadth of awareness required (the ability to see connections between

different concerns and their elements); how environment effected awareness; and how awareness was communicated to those who needed it.

The illustrative stories in the beginning of the choking narrative highlight the theme of awareness and its dimensions, while also presenting different aspects of the social context of choking – aspects that are at times distressing and confronting.

Preamble

Jo’s, Glenys’, Estelle’s, and Stan’s stories: The distress of choking

Jo

Jo choking, in his panic “...ran to the kitchen where he retrieved a large

wooden spoon. Terry, a family member observed Jo stick the spoon down his throat in an apparent attempt to dislodge the piece of steak. This did not work.” Edith, Jo’s wife “...tried to ring 000 however only said her address and then hung up.” Terry tried to help Jo; Edith “...in the meantime had contacted her daughter and sister....” Terry “...rang 000 and began following the

operator’s first aid instructions.” (120 Police report). Jo died at age 70; other than his age and the possibility of presbyphagia he had no medical history associated with swallowing problems. No risk had been foreseen, and as a consequence no precautions were in place. Jo was eating a steak dinner with his family. His choking story was brief. His death and the trauma of it

however, may well have had a lasting effect on those who witnessed it. The panic that took place in both Jo and his family, and the need for support in a time of crisis, as illustrated by Edith calling her family, are strong elements of his story.

Glenys

Glenys, a personal carer, came to work not expecting that elements of her day would be recorded in a future coroner’s report. Glenys was on duty with other personal carers when she was confronted with Maxina’s (58 years old with frontal lobe dementia) choking: “…Maxina’s condition rapidly

deteriorated...she started to turn blue...The personal care assistants

recognised that she was choking. Glenys called an ambulance...There were no nurses on the premises that could be called upon to provide assistance [Nursing staff were not present on the weekend]…” (024 Inquest). The following description from the inquest into Maxina’s death describes some of Glenys’ experience of the choking story: “Personal care assistant was

distraught – screaming at the call taker [ambulance call-centre] to help them…[Glenys]...stated ‘I was panicking a little bit and the operator was trying to get me to calm down so I could explain what was going on’” (024 Inquest). Another carer stepped in, taking over the communication with the ambulance call-centre; Glenys went outside to wait for the ambulance. Estelle

“Choking events are distressing and frightening”. “Choking would be a horrible way to die”. These seem safe assumptions based on general

perceptions of choking (Nuland, 1993, p. 160) and the introductory narrative fragments above. Such assumptions contribute to the desire to prevent choking at all cost. The experience of choking however, is not always what might be expected. Estelle, 85, walked down a corridor at the ACF where she lived: “...she approached the two carers without saying anything or drawing particular attention to herself, other than the fact she was gazing at them. They observed her lips to start turning blue...” (094 Inquest). Estelle’s behaviour, while experiencing a severe obstruction of the airway, was the apparent antithesis of fear or distress, as was Stan’s.

Stan

Stan, a 67 year old gentleman with a neurodegenerative disease, died eating his lunch on the couch in front of the television. Three of his family members “...were eating in the dining room, one room away from where Stan was seated on the lounge. From where they were seated all three were able to visually see him from the dining room table”. One of his family members noticed Stan “…sitting upright on the lounge in the TV room with his eyes open. He approached him and sat next to him on the lounge to the left of Stan. Upon seating himself Stan has slouched to the right with his eyes still open, and his head drooped to the right” (108 Police report). The family member noticed Stan’s chest was not moving and checked for a pulse and was unable to find one. Outwardly, Stan did not appear to experience any distress; dying quickly and quietly in the company of his family. He and his family may or may not have considered his choking death a ‘horrible’ way to die. Those with a neurodegenerative disease, experiencing ever increasing loss of physical and mental function, may indeed view, within the context of their total experience, such an event as a ‘good death’.

Estelle’s lack of apparent awareness and distress at obstructing (perhaps due to cognitive difficulties) and the speed and lack of distress evident in Stan’s death, challenge the idea that choking events and death are always frightening and distressing, as appeared to be the case for Jo. An individual’s mental processing abilities and physiology are likely, be it positively or

negatively, to affect an at-risk adult’s experience of choking. The experience of choking for those witnessing such events will, in addition to the particulars of the event itself, be influenced by both their personal connections with the victim, whether they feel confident or not to deal with the situation, and the outcome.

The above are small snapshots of some elements of the choking story; how someone might react to the experience of choking or the witnessing of it, and what a choking death might be like, its speed and other characteristics. These snapshots also hint at other elements of the story, such as the impact

of cognitive problems or lack of health professional support, as evident in Estelle’s and Glenys’ situations respectively. We now enter into a closer exploration of the choking narrative with already a hint of its possible complexity.

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