Her head was down, lost in a puzzle, her usual way of passing a silent meal. She had decided on an easy meal of beans on toast (an old favourite from her childhood) but had jazzed it up with a fancy salad dressed with fruit and nuts to assuage her guilt over the otherwise canned meal.
He ate in complete silence as always. Sometimes, if he doesn't like the meal and is too polite or just rendered mute by the disease, he will be as quiet as death, not moving, not speaking, not eating. It is what dining with a ghost must be like.
Tonight he was happy with the meal, if not the salad. She had been sure to make the toast fairly soft, knowing he can have difficulty with very chewy food now. The beans were easy for him.
He started to cough. Parkinson's patients can have a great deal of difficulty swallowing as the disease progresses but he has had little trouble, eating ravenously at times and putting on weight in recent months. He has never had trouble swallowing his pills either, often gulping down a handful all at once.
But there is that cough. Nearly every meal makes him cough at least a little. She is so used to it that she barely acknowledges it anymore. She tries not to be annoyed by it because, to her jangled nerves, it sounds like he is forcing it sometimes like a small child vying for attention. But she knows he is not capable of such manipulation.
She lifted her head as the cough seemed to worsen, this time sounding loose and rattly. He rose from his chair to head to the washroom to spit out his mouthful but the cough rendered him too unsteady to go more than two steps. He was going to vomit on the floor, she was sure. Now on high alert, she ran to the kitchen to grab a basin, ordering him harshly to stay where he was. The coughing was now uncontrollable. Mucous was running from his mouth.
She ordered him to get down on his knees because he was buckling and in danger of collapsing. She had to assist him down as he seemed deaf to her instructions.
He was now retching loudly but was still breathing and making sound, both good signs that there was nothing stuck in his airway. He just needed to cough up whatever was stuck in there which she thought must be a small piece of pecan from the salad.
A second later he keeled forward landing with his face in the bowl. To her horror she could see he was unconscious; his eyes were open, tongue lolling out. Assuming the particle of food must now be blocking his airway she grabbed him around his waist - no easy task with an inert body - and summoned her learning from a first aid course taken decades ago. The abdominal thrust, as it is now called, was what she attempted, thrusting up into his diaphragm as well as she could in this very awkward position. Nothing. Again. He spluttered, coughed and spat into the basin which was now bloody from a gash on the bridge of his nose from falling flat on his face. All that appeared in the bowl besides lots of saliva was a very small, soft morsel of toast, hardly enough to cause such a fuss.
She assumed the punch in the stomach had dislodged the food but as she thought about the episode throughout the evening she knew that he hadn't really been choking beyond all the loud spluttering and coughing. Remembering a horrifying film shown during her first aid course, she understood that someone choking cannot speak or breathe. In this traumatizing film, the mother of the family simply collapsed and died in front of her useless family members after several minutes of silent but wild gesticulating. Michael was not at all silent throughout the attack. Could there have been a cardiac event causing him to lose consciousness? It was during a conversation with one of her concerned children later in the evening when she concluded that he had probably lost consciousness from a plummet in blood pressure. He had gone rapidly from sitting to standing to kneeling on the floor with his head down, all within a few seconds. His damaged autonomic system, that has caused a similar though less dramatic episode in the past, was probably not capable of making the quick adjustments required to stabilize his blood pressure. But at least the relaxing of the muscles while unconscious stopped the coughing and retching.
He had little memory of the event later in the evening but seemed visibly shaken. So was she. His face maintained a pallor all evening and he was more withdrawn than usual. His blood pressure was very high but by morning had dipped wildly again. All that morning he was more confused and lethargic, still overcoming the shock she assumed.
She has resolved to keep meal times more tightly controlled. That dinner had been delayed by a late telephone call but otherwise she always tries to have the meal on the table by 6 p.m. at the latest. Any later than that and he loses interest in food as his medication wears off. 5:30 at the latest in future. And she will never leave him to eat unaccompanied. She must always be within earshot from now on.
There was a moment when she thought this was the ugly end. There hadn't even been enough time to call an ambulance; it was all over in seconds. She probably should have alerted someone other than her children but we all know how a hospital stay would have worked out. It seemed more prudent to keep him calm and quiet, sitting right next to her all evening. There is a visit to the neurologist very soon so she will broach the subject. She is doubtful anything can be done. Just more vigilance. Maybe more medication.
*Frans Snyder, The Pantry, circa 1620.