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Elia Khensamphanh

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Aug 2, 2024, 9:38:27 AM8/2/24

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There seems to be a trend in Hollywood. If a scene is falling flat, add someone choking. But the Heimlich maneuver is boring and overplayed (and honestly just looks ridiculous). Wait, I know! He's not really choking, he's suffocating! And that means, instead of the boring, vaguely erotic reach-around of the Heimlich, our heroes get to slice someone open.

Sometimes this is used to establish that a character has medical training. Sometimes a note of drama is added because the character performing the techniques does not have the training, but usually he's being talked through it by someone who does. Like other Hollywood medical techniques, this often goes smoothly and without complications...even when performed by non-doctors.

On TV and in movies, this procedure commonly consists of stabbing someone in the throat using a ball-point pen with the ink tube removed. In real life, it would be quite difficult to use an empty pen to break through the skin and internal tissues all the way through to the airway, and you can't just jam it in anywhere. People were tested on their ability to do this, and only one out of ten participants was actually able to get the pen in the right spot and deep enough; it should be noted that this also took over five minutes, more than long enough for someone to suffocate. But if you know where to aim, and use a knife to make an incision first, a pen can indeed act as an improvised breathing tube.

Supposedly, this has led to idiots trying this on people who collapse for reasons that have nothing to do with breathing. This is obviously something you do not want to do without the kind of training that results in a medical doctorate degree. A procedure as drastic as a tracheotomy should only be used as a last resort, since it basically boils down to slitting someone's throat, which can obviously make things worse if performed incorrectly. If it's at all possible, you shouldn't do this until after you've called an ambulance and are sure that it's an appropriate measure to take.

Anime & Manga

JoJo's Bizarre Adventure:
Golden Wind: After Narancia's tongue was bitten off by Squalo's Clash, he begins to choke, and Giorno quickly uses the tube of a pen to stab Narancia in his neck so that he can breathe, until Giorno finishes healing his tongue.
Stone Ocean: During her fight against Kenzo, F.F gets caught by a sneak attack that instantly fills her body with water to shut off her breathing until she pierces a hole into her throat to spill out all the water.
The JoJoLands: After an enemy Stand has Usagi infected by Pulmonary Edema that nearly suffocates him, he has Dragona create a straw via his own Matte Kudasai to force it down near his lung to expel the liquid building up from inside.

Literature

This trope is Lampshaded in Choke by Chuck Palahniuk. The protagonist frequently runs a con where he deliberately chokes on food to get strangers to perform the Heimlich on him; he is terrified that one day he'll encounter an idiot thinking of this trope coming after him with a steak knife and a ballpoint pen tube.
In Codex Alera, this is performed on Ehren when his throat is crushed by an earthcrafter's chokehold. Ambassador Varg quickly makes an incision with one of his razor-sharp claws and sticks a hollow writing quill into the cut to breathe with. This is stated to be only a temporary measure and that without proper care and cleansing of the wound, Ehren would die anyway.
The Dark Hours: After realizing that her punch crushed Bonner's windpipe, Renee Ballard calls her friend Garrett the EMT in a blind panic and has him guide her through an emergency tracheotomy, which is done realistically, with Renee having to use a knife to make the incision. Then, after Bonner regains consciousness and realizes that it's all over for him, he rips the plastic tube she used out of his throat, and dies.
In Hawk, an assassin punches Vlad in the throat and collapses his windpipe, forcing him to perform this procedure on himself with the knife he'd just thrust into his attacker.
In Expendable, of The League of Peoples 'Verse, two explorers start asphyxiating in a strange atmosphere. One gets the idea of a tracheotomy in her spinning head and tries to perform it on her partner, untrained, with improvised tools, while blacking out herself. She wakes up next to the corpse and discovers that the effect is just a momentary symptom of acclimation.
In one Sweet Valley High book, a man uses this procedure to save the life of another person choking at a coffee shop. By doing so, he reveals that he is a doctor, and another patron of the coffee shop recognizes him as the doctor who had recently testified against a mob boss and been forced to go into witness protection. Naturally, the guy who recognized the doctor shouts out his identity to everyone in the coffee shop so that they can all acknowledge the hero by his proper name.
An emergency tracheotomy performed by a non-professional is a key plot event in Three Days to Never by Tim Powers. It's not a neat Hollywood tracheotomy, though, and has serious repercussions.
In Twig, Sylvester gets an amateur one from Candida after he has his throat crushed by the Baron Richmond, and is, bizarrely, able to speak in a whisper afterwards-he explains that he's regularly on the receiving end of an Impromptu Tracheotomy from any number of sources (guard dogs, knives, burrower worms...) and therefore his doctors surgically altered his throat so he could continue to try to talk his way out of it with a slit throat.
In Worm, Tattletale performs one on herself in Interlude 23 after Perdition crushes her windpipe.

Web Comics

Parodied in a Full Frontal Nerdity strip where the writer lists cliches he hates in movies and illustrates it by having the characters perform it on someone who has stubbed their toe.
An important character in The Meek Phe, Luca's wife is poisoned and a tracheotomy is used to attempt to save her life. It's not pretty. And then things go to hell.

Western Animation

Defied in Archer, where he tries to drunkenly perform one on Pam with a switchblade when she's going into anaphylactic shock. Even though she's dumb enough to gorge herself on soy-based fake seafood she knows she's violently allergic to, Pam is smart enough to know an unnecessary tracheotomy will just make things worse, so she fights off Archer's Unwanted Assistance long enough to grunt out the word "Epi-Pen," which is what she actually needed.
In G.I. Joe: Renegades, a tracheotomy is attempted twice in one episode. Scarlett has an allergic reaction to some poison, causing her throat to swell up, and Snake-Eyes prepares to puncture her throat before Tunnel Rat manages to scrounge up some antidote. Earlier, in Snake-Eyes' backstory, his Master is similarly poisoned, and Snake-Eyes tries to do the same with a sharpened bamboo shoot, but he's interrupted and simply makes the master's nephew Storm Shadow think Snake-Eyes was the murderer.

Real Life

Truth in Television: One of the reasons Formula One fans remember the 1995 Australian Grand Prix is what happened during practice: Mika Hakkinen crashed very badly, and the medics had to perform a cricothyrotomy on the side of the track just to keep him alive.
Also happened in 1994 at the San Marino Grand Prix to Ayrton Senna. The outcome was far less happy.
Conspiracy theories suggest FIA ordered paramedics to do it so he could be artificially "kept alive" so they could resume the race. In Italy, it's illegal to finish a race where a driver is killed.
Drama aside, Elizabeth Taylor needed a tracheotomy during a bout of pneumonia in 1960, and Catherine Zeta-Jones needed one as a child, resulting in her distinctive scar.
Stephen Hawking got pneumonia visiting CERN in 1985, and his wife Jane even asked about cutting life support, but instead a tracheotomy was employed to save him, at the cost of his voice. After one year using "choosing letters on a spelling card with his eyebrows" to communicate, Hawking got his famous Robo Speak machine.
This medical paper warns people not to attempt this at home with just any ball-point pen: only a few of them actually work.
One story from the Darwin Awards features a man who, in a bout of Alcohol-Induced Stupidity, stuck a rattlesnake into his mouth, with the obvious outcome. His tongue was so badly swollen that doctors had to perform a tracheotomy. (He survived.)

Unfortunately the first film is not available on Netflix instant view, but luckily you can still enjoy the second one without seeing the first with a little help from yours truly. Pretty much Dr. Phibes is a lot like Mr. Freeze from Batman, except for the fact that he is undead. In the first film Dr. Phibes seeks to avenge the death of his wife Victoria by killing the nine doctors who failed to save her life according to the nine of the Pharaoh's curses that you probably remember from the story of passover.

In the second film, the one you'll be watching Dr. Phibes and his ambiguously supernatural assistant, Vulnavia travel to Egypt in an attempt open the gates to the afterlife where Dr. Phibes can finally be reunited with his dead wife.

The film is super kitschy with plexiglas pipe organs and Phibes's Clockwork Wizards, an inflated animatronic swing band. It's got style, its got flair, its on Netflix instant view, and you should watch it.