Digestion is a complicated series of voluntary and involuntary actions, but once food reaches the throat, the system is largely involuntary. Properly processed food travels from the throat to the esophagus. Insufficiently processed food may enter the trachea instead, causing the eater to choke.
I was in my forties when my next-oldest sister Emily dropped what was to her a small factoid about my childhood but was, to me, profoundly significant. “When you were a toddler,” she said, “Mom and Dad would give you those little Vienna sausages which were perfectly-sized for choking. So, every once in a while, one of us would have to yank you out of your high chair, turn you upside down, and smack you on the back until you coughed it up.”
I was beyond horrified. “Why did they do that?!” I asked. “I have no idea,” she said, in the tone we often use when recalling our parents’ foibles. But besides my alarm at their infant-feeding choices, I was appalled that I had never heard this story before, especially in light of one of my most memorable childhood neuroses.
When I was eleven, I developed a fixation on choking. My fear was—at least ostensibly—triggered by an instructional video on performing the Heimlich Maneuver, shown to us in school for what reason I do not know. For months after seeing the video, each time I put something into my mouth, I was certain that I would choke on it and die.
In my first year of graduate school, I made fast friends with a poet named Jason. We were pals; we went to movies together, got takeout together, complained about classmates together. I had never once considered him romantically or sexually until one day—whoomph—he sat in my living room chair as we discussed the movie we’d just seen, Happiness, and, out of nowhere, the way he crossed one leg over the other, the way he moved his hands and forearms when he talked, the flash of crooked teeth when he laughed, coalesced to form an inexplicable magnet, and I suddenly wanted to climb on top of him.
What followed was months of showing up at each other’s doors (we were, conveniently, neighbors), raising our eyebrows in suggestion, then following the other into their bedroom and shedding clothes without a word. It was sex at first, and then I found myself in some sort of love. We—I believed—found ourselves in some sort of love. He lit up when he saw me; my friends said, “He adores you.” And though our relationship was untitled, I felt happy and something very close to secure.
Then he went off to a writer’s conference; we kissed goodbye, he said he’d miss me. He sent me longing emails for four days or so, followed by radio silence. When he came back, he knocked on my apartment door, but this time, stood still in the doorway, and said, “I can’t do this anymore. I met someone else.”
Fourteen months later, on a Saturday evening, my father kissed my stepmother goodnight and went to bed. Within an hour he suffered a massive stroke. He was taken by ambulance to the hospital, where he lay unconscious. My sister had left two messages on my answering machine before I heard the phone ring on her third attempt. “Dad had a stroke,” her first one said. “The doctors say he isn’t doing too well,” she said in the second, sounding completely disconnected from her words. I flew out of bed, drove to the hospital in a haze alternating between drowsiness and terror.
When I arrived at the hospital, I found him in a curtain-enclosed partition, looking like a man imitating my father. My sister and stepmother had stepped outside to make more phone calls so he was alone. I did not rush over and say, “Dad, I love you! You have to stay with us!” Instead, I stood apart from his bed, awkward, like I was at a party where I knew no one, and not beside the man who had almost single-handedly raised me, as he lay in what would turn out to be his deathbed.
Soon enough, my stepmother and sister were with me, the nurses moved him into a room, and the doctor delivered the news to us, in a quiet though not altogether compassionate tone, that my father would never wake up. “Go home,” she said. “Call your family. He’ll probably hang on another few hours. You have time.” So, we did. Two hours later, she called and said, “Come back. Hurry.” When we returned, he was gone.
Before being propelled back to the throat by the tongue, the food is chewed. The teeth break it down, physically, while saliva does so, chemically. This step is referred to by some physiologists as “Stage I Transport.” It is voluntary but necessary.
Beginning with dinner after my sixth-grade class watched the Heimlich Maneuver video, I began chewing my food slowly and carefully. One bite of burger took roughly twenty rotations of the jaw and as many seconds. I had to get all that substance down to a fine, smooth puree with no un-uniform or misshapen lumps that might get stuck on the way down. Each swallow was like throwing myself in front of a moving car. My mind froze in that moment, unable to focus on or receive new information; I only waited to see if I’d lived through another bite.
My choking obsession caused only shaking heads and raised eyebrows at the dinner table for the first couple weeks. But then, on a road trip to Alabama with my eighteen-year old sister, my neurosis went from annoying to infuriating. Somewhere in Kentucky, her Dodge Omni overheated. We walked a mile or two in the Southern summer sun to a gas station, in a tense silence I dared not break. Finally, we got the car to a mechanic and settled into a motel restaurant late that night. As usual, I chewed my food at what might’ve been called a leisurely pace, except, in my mind, I was preserving my own life. And my sister snapped. “Eat your fucking food, Amanda! I’m exhausted, and we’re not sitting here for hours so you can chew your fucking burger. I want to go to bed! Chew! And swallow!” So, I did. My fear of her superseded my fear of choking, at least for that night. I don’t remember if my obsession just faded afterward, or if it was abruptly extinguished in a motel restaurant in Kentucky.
In the days and weeks after Jason dumped me, I got myself up for the classes I would teach and attend but doing so was—and still is—the most difficult thing I have ever done. I walked, zombie-like, to the bus station, sat in the first empty seat, held back tears, and tried to ignore the loud, eerie laugh of the apparently- psychotic woman whose schedule coincided with mine. When I got off the bus, I walked in the direction of my classroom building, the Tucson sun beating down on me while I cried as quietly and invisibly as I could. When I reached the point on my walk I’d designated as the drop-dead stop-crying point, I wiped my face a final time, took a deep breath, and resumed walking.
After my classes, I’d get on the bus immediately, come home, and break down. I lay on my bed in front of the air conditioner, my cat would hop up and snuggle, and I’d try not to sleep because the jarring recall upon waking was not worth the respite.
In the year after my father’s death, my stepmother frequently made comments like, “Of course you can’t compare grief processes. Losing a spouse is different from losing a father, but they’re equally hard.” Then, within ten minutes or so she’d say, “But you guys haven’t had your daily lives changed so dramatically. I mean I lived with him. So, everything’s different for me.” I nodded along, ignoring the pettiness of her comments, because I felt sorry for her, and maybe also because the contrast she was drawing, her motivations aside, helped me make sense of why I wasn’t as devastated by his death as I thought I should be.
Now that years and years have passed, I see how having to confront his death day by day—hour by hour, really—forced my stepmother to process it in the direct aftermath. You can’t ignore the unused pillow lying beside you.
Once through the esophagus, food travels into the stomach, the initial filter that separates what is safe from unsafe. Food deemed acceptable continues the digestive journey. Food that poses a threat may be forced up by contractions in the diaphragm and travel up from the stomach, into the esophagus, then the throat, and so on.
Vomiting is triggered, ultimately, by the brain. Physiologists speak of a “vomiting center” where neuropathic signals from other organs are sent to be integrated, potentially resulting in additional signals from the brain to the body to perform the act of ejecting food. Unlike choking, vomiting may be voluntary or involuntary.