There are times in the ED when something occurs that can't be translated into the realm of normalaity. Just as with language, some cultural experiences are untranslateable. Something comedic and surreal happened the other night. Ot perhaps it was perverse and terrible. A full code came in. A 41 year old female. Details on the radio painted a fragmented picture--41, female, Downs Syndrome, maybe 5 minutes down before CPR, asystole on the monitor. With each incoming fragment of information I ratchet the needle on my survivability scale up and down accordingly. When she arrives, splayed out across a paramedic backboard, one handed compressions pumping her chest up and down. Medics report she has been down....45 minutes total. The survivability meter plummets downward. I check her airway and, sickeningly, her airway consists of an EOA tube (yuck!) filled with granular yellow white vomiitus. They've been trying to intubate her through a ten inch column of vomitus. The survivability meter bottoms out--there is nothing to redeem here. I give it the old college try. If she is ever going to live she needs oygen and not vomit in her lungs and that requires a real endotracheal tube. I get the equipment, pull the shitty EOA, and dive in. The Yankauer suction (invented by Anesthesiologists) is worthless. I rip it off and using my hand as a scoop try to evacuate the womans oropharynx. It's a Sissphysian task--as I scoop the puke out more bubbles up from deep in her bloated stomach. I look in and deep, deep, deep in this tight oropharynx is a tiny chord flanked passageway. I try to muscle a tube down there, but the geometery is against me. I bail and run a GUM elastic buogie in there. It passes (!) and I push a 6.0 tube in after it. Yes--a real fucking airway! Immediately puke begins bubbling out of it. We suction down the tube and start ventilating. Poor, poor breath sounds. She's gone. We run in a few more meds and we call it. What makes a 41 year old basically healthy woman arrest? Cocaine. And if not cocaine, as in this case, marshmellows. What? Well--at the group home she lied at, she had been put on a diet for the new year. She had a weight problem and had been suffering on a restricted diet for the last two weeks. Then, as she was doing her turn washing the dishes in the kitchen, she saw a bag of marshmellows lying unprotected. Bam!--she leapt on it and started stuffing marshmellows in her face! And--in this happy orgy of forbidden sugar, she sucked in a little puff of marshmellow and plugged her tiny little airway. Death by marshmellow. Tragic. Comedic. Surreal. Unbelievable. I told the Biscuit about it, but I just couldn't communicate the fullness of the experience. The more I tried to express the sick black humor of it the more I saw her glancing worriedly at her engagement ring and glancing out the car window as if calculating her chances of surviving the jump. In other news. Went on a nice discount cruise down to Mexico--4 days for $324 per person. Nice. The puppy is doing....okay. Sleeping in the crate, and doing a pretty good job of evacuating outside. She does, on occasion, piss on the carpet and leave large steaming wet feces in the corners of the room, but...baby steps, baby steps. U-561