The Millimeter of Life




They say that football is a game of inches.

Emergency medicine is a profession of millimeters. There are some situations in which the width of a pinhead in either direction can mean the difference between life and death.

I was on night shift.

She was carried in from triage by her mother. The nurses checking her in knew that something demanded our immediate attention. The sound emanating from the six year-old’s airway was called stridor- a high-pitched squeak made with every breath. It was a very unnatural noise. She sat there, unfazed in her mom’s lap wondering what all the fuss was all about while we nervously circled with our stethoscopes and IV accessories.

The CT scan of her neck revealed the cause. She had been eating sunflower seeds while playing and had aspirated one, which had lodged itself in her upper airway. The shell was no more than one millimeter narrower than her little breathing passage. In that tiny difference in space, air managed to sneak by the obstruction and make it to her lungs. Enough to prevent her from choking to death within minutes. Enough for her to exhibit that whistling stridor. That millimeter was the difference between getting her in time to the pediatric anesthesiologists to remove the obstruction so she could continue life as a first-grader...and her family standing in a cemetery over her gravesite. And she never even knew.

How many times have our lives been determined by one single millimeter of space, the difference between business-as-usual and tragedy, between life and death? Did we even know?

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