Warning: Choking, resus, mentions of nudity, violence
Alex was lounging cross-legged on the sagging couch, earbuds dangling, one of the cords coiled around a finger. The afternoon sunlight slanted across the apartment living room, hitting the linoleum in sharp, dusty streaks. Jamie sprawled across the floor with a phone in hand, occasionally glancing at Alex with a crooked grin. Taylor hovered near the kitchen counter, arms crossed, watching with a detached amusement that was almost clinical.
“Bet you won’t,” Jamie said, voice low, teasing. “I dare you. Swallow it whole.”
Alex lifted an eyebrow, glancing at the small white compressed sponge on the counter, the kind that expanded in water. “Are you insane? That’s… not food.”
“Come on,” Taylor said, voice soft but insistent. “One bite. Just do it. It’s nothing.”
Alex hesitated, the flat sun catching on the fine sheen of sweat on their upper lip. Fingers trembled slightly as they picked up the sponge. Their roommates leaned forward, eyes fixed, phones recording.
Alex put it in their mouth. Chewed mechanically. Swallowed. A moment of silence followed. Then the spasm began.
A cough tore from Alex’s chest, first sharp, then escalating. Hands clutched at the throat, fingers scraping at the jaw and neck. The couch groaned as they rocked forward, hacking, eyes wide and unseeing. Saliva ran down the corners of the mouth.
Jamie stepped forward. “Alex? Hey, hey—what’s—”
Alex gagged again, the sound wet and irregular, the sponge lodged somewhere deep. Their chest heaved violently, shoulders jerking against the couch cushion. Breaths came in short, shallow bursts. The first panic tremor passed up their arms, through the chest.
Taylor knelt beside Alex, lifting their torso slightly, checking the mouth. The sponge was partially visible, swollen, the edges frayed with saliva, pale and gelatinous. It resisted the fingers.
“Spit it out!” Taylor barked, voice brittle.
Alex shook their head violently, coughing into their hands. The choking was relentless. Each breath pulled in a wet, rasping noise that filled the small room, bouncing off the walls. Lips turned bluish at the edges. Fingernails clawed at the air, scraped the couch, the carpet.
Jamie’s hands hovered uselessly. “Do something—!”
But the body was already engaged in unmanageable trauma. The sponge expanded in the esophagus, a tight, immovable plug, pressing against the windpipe. Each attempt at a breath pulled in raggedly, the sound wet and hollow, the chest rising in chaotic jerks. Sweat slicked hair stuck to Alex’s temple, neck muscles rigid under strain. Their vision narrowed, focus blinked in and out.
Taylor yanked at the jaw, fingers slick, teeth exposed. Gag reflex flared violently, projectile saliva sprayed onto the couch. Alex’s legs kicked weakly, thrashing in short bursts, the toes clawing against the rug, nails digging in. Each breath was a wet wheeze, each cough a failure.
Jamie shouted into the apartment phone, dialing 911, voice high and ragged. “They’re choking! They’re—!”
Alex’s hands flailed weakly now, clawing at the chest, throat, couch cushions. Fingers trembled as cyanosis spread across the lips and fingertips. Their eyes rolled slightly, glassy, unfocused. No sound emerged beyond the rasping, wet wheeze.
Taylor’s knuckles went white as they tried to dislodge the sponge with repeated upward sweeps. The sponge resisted, swelling further under saliva and pressure, compressing the airway. Alex’s body arched unnaturally, gasping, arms flailing, fingers digging into the upholstery. The eyes rolled back; the voice was gone.
Jamie’s voice cracked. “Come on, come on—breathe—please—”
But the body no longer obeyed. The struggle persisted, a rhythm of spasms and failed intake of air. Skin grew mottled, cyanotic. The apartment was filled with wet, rasping coughs and the thud of the body rocking against the couch.
The sirens outside had not yet arrived. Time stretched, punctuated only by ragged gasps, wet retching, and the slow, expanding bulk of the sponge pressing mercilessly against the airway. Taylor’s hands shook, covered in saliva, futilely trying to restore the passage of air.
Finally, Alex’s motions slowed, then ceased. Chest twitched once, twice. A faint, wet sound escaped the throat. No more.
Jamie sank to the floor beside the body, face pale. Taylor sat back on their heels, fingers still poised in the air. Silence, except for the hum of sunlight on the linoleum and the faint ringing from the 911 operator still on the line.
The sponge lay half-eaten, slick, grotesquely expanded on the tongue and back of the throat.
Alex was still, except for the faint, shuddering movements of residual panic in the lungs.
Outside, the ambulance sirens screamed closer.
The ambulance doors banged open. Alex was slumped sideways on the couch, still, but not entirely unresponsive. Their chest quivered in tiny, wet spasms. Fingernails were mottled blue. Saliva and sweat coated the face. The sponge—partially dislodged, still grotesquely swollen—pressed into the throat.
Paramedics arrived first: Riley, the taller one, uniform damp from sweat and stress; Morgan, shorter, precise, gloves snapping as they stretched them on.
“Code three,” Riley said flatly, voice low but urgent. They scanned the room quickly: the sponge, the couch, the two other roommates—Jamie pale on the floor, hands clasped together.
“Airway,” Morgan said, kneeling beside Alex. Fingers probed, slick with saliva, attempting to sweep the sponge free. Alex’s hands shot up, clawing at their throat, jerking violently. A wet rasp tore from their chest—a desperate, strangled noise.
Riley lifted the torso slightly, adjusting the head for a jaw-thrust. “Gag reflex intact. Partial obstruction,” Riley noted clinically. Eyes flicked to Morgan.
Morgan tried repeated sweeps. The sponge was resilient, swollen past what fingers could grasp. Alex’s spasms intensified. Legs kicked weakly, heels thudding against the linoleum. Each attempted breath came as a wet, high-pitched wheeze. The cyanosis spread across lips, fingertips, and the exposed earlobes.
Jamie’s voice broke. “Please… don’t—”
“Not now,” Riley said flatly. They snapped the suction tubing into place, inserting it into the mouth with precise movements. A wet, gurgling sound filled the small apartment as foam, saliva, and small clumps of sponge were dragged up. Alex gagged violently, the head snapping back. Their chest arched in a stiff, violent curve.
Morgan grabbed a bag-valve mask. “Riley, clear airway as I ventilate,” they instructed. Pressing the mask over Alex’s face, they began slow, forced breaths. The chest lifted minimally, obstructed still. A rasp escaped with each push of air.
Alex’s hands flailed, clutching the mask for a moment, then slumping against the couch. Tiny tremors ran through the legs. Fingers scraped against the linoleum. The eyes rolled back intermittently, unfocused, darting.
“Give me suction—again!” Riley barked. Fingers plunged, dragging partially dissolved fragments from the airway. Each attempt triggered a violent gag, a wet cough, and sputtered froth. The sound was metallic, wet, and choking.
Morgan adjusted the mask. “BP?” Riley asked, glancing at the monitor.
“Unable to get a cuff reading,” Morgan said, eyes scanning cyanotic extremities. Heart rate on monitor: 130, erratic. O2 sat: 72%.
Riley nodded and reached for the laryngoscope. The blade slid past swollen tissue. The sponge was lodged higher than expected, pressing against the epiglottis. With a quick, forceful motion, Riley attempted to grasp it with Magill forceps. Alex’s body arched sharply, a wet rasp tearing from their throat. The forceps barely held a portion; the rest resisted, jiggling with each attempted removal.
Morgan pressed the bag harder. Each forced breath caused the chest to lift unevenly. The sponge shifted slightly, scraping raw against mucosa. Alex gagged, coughing fluid and bits of sponge onto the linoleum and into the suction tube.
Time blurred into motion: suction, bag-valve mask, repeated sweeps, chest heaving. The sound of gagging and wet rasping filled the room. Cyanosis deepened, fingers stiffened, the tongue coated in foam.
“Let’s prep for RSI,” Riley said. They reached for the medications: sedative, paralytic, emergency intubation kit. “Need to control the airway, or we lose them.”
Morgan nodded, sliding IV into a vein that rolled. Blood flashed briefly beneath the skin. Alex’s body twitched violently with a spasm of choking. Each attempted breath was ragged, wet, almost hollow. The couch groaned beneath the violent rocking.
Jamie flinched back, hands covering the mouth, staring at the metallic, wet chaos unfolding.
Riley gave the sedative. The body went slack, almost unnaturally limp. Morgan performed laryngoscopy again. The sponge had moved slightly with gravity and suction, but only partially. With a sharp, precise motion, a large fragment was extracted. A wet splat hit the linoleum. Alex’s chest heaved once, twice, weakly.
“Bag them. Gentle. Heart still racing,” Riley instructed. Minimal air entered the lungs, chest rising unevenly. Fingers flexed reflexively in the cyanotic hands.
A cough erupted again, involuntary, wet, ragged. The remaining sponge shifted slightly, scraping raw mucosa as it pressed against the trachea. Alex arched, a single, violent motion. Jaw thumped against the couch. Eyes rolled back.
Morgan shouted over the rasping, “Riley—we’re losing O2 fast. They’re crashing.”
The monitor beeped: 58, then 52. SpO2: 65%.
Riley’s hands moved with cold precision. “Prepare to intubate—now. No hesitation.”
The room became a theater of mechanics and noise: suction roaring, bag-valve mask compressing, fingers slick, scraping against wet mucosa, wet coughs tearing from the lungs. Each failed breath, each rasping gasp echoed off the walls.
Alex’s spasms slowed, weaker, chest trembling. Cyanosis spread into ears and shoulders. Fingertips stiffened, nails darkened. Each minute was a battle with gravity, saliva, and the stubborn sponge.
Outside, sirens continued to scream. Inside, the room smelled of antiseptic, sweat, and saliva. The mechanical rhythm of attempted life persisted. But with each wet, ragged gasp, it became clear: this airway was no longer fully salvageable.
The ambulance rocked over uneven asphalt, tires thumping in rhythm with the pounding of sirens. Inside, Alex lay on the stretcher, limp but intermittently convulsing in shallow spasms. Cyanosis had spread from lips to ears, fingertips rigid and mottled. The sponge had been partially dislodged, but residual obstruction continued to resist suction and ventilation.
Riley held the bag-valve mask in place, forcing breaths into the chest. Each compression of the bag caused a wet, rasping wheeze to escape Alex’s throat. Morgan’s hands were slick, fingers coated in residual saliva and mucous as they readjusted IV lines and monitored vitals. Heart rate flickered—120, 118, 115—then dipped sharply to 92. Oxygen saturation hovered precariously at 68%.
Jamie and Taylor followed in the rear, silent, watching the rhythmic chaos of motion and sound. Jamie’s hands clutched the rail, knuckles white. Taylor’s face remained tight, almost clinical, as if studying rather than grieving.
“Transport to ED, full trauma alert,” Riley said into the radio. Their voice was flat, precise, carrying the weight of procedure over panic.
Inside the stretcher compartment, Alex’s body arched slightly, a spasm triggered by a wet, choking cough. Fingers clawed at the mask and chest straps, nails digging into the padded vinyl. The throat convulsed violently; the residual sponge shifted slightly, scraping raw against mucosa. Saliva and froth sprayed thinly, collected immediately in the suction tube.
Morgan adjusted the jaw thrust. “We’re losing tidal volume—need deeper suctioning.” Fingers moved deftly, sweeping and scraping, extracting small fragments. Each attempt triggered a violent gag, chest jerking with reflex.
Alex’s legs flailed intermittently, knees kicking the stretcher sides. Cyanosis deepened, skin mottled in stark contrast under the harsh fluorescent light of the ambulance’s interior.
Riley glanced at the monitor. Heart rate now 78. SpO2: 62%. “Prepare for RSI on arrival,” they said flatly, voice clipped. “We’ll need controlled airway immediately. ICU notified.”
The ambulance hit a bump. Alex’s head snapped back. A wet rasp tore from the throat, coughs bubbling violently. The sponge moved slightly with the shift of gravity. Riley readjusted the mask, pressed the bag firmly. Each compression of the lungs produced minimal chest rise. Fingers flexed weakly, nails darkened.
Morgan grabbed the suction again. A wet splatter landed on the stretcher pad. The sound was sharp in the confined space. Alex’s chest arched once, twice, spasming uncontrollably. Cyanosis crept into shoulders and upper back.
Jamie whispered to Taylor, voice barely audible over sirens and mechanical motion. “Are they… going to make it?”
Taylor didn’t answer. Eyes stayed fixed on Alex’s flailing extremities, the tight arc of the chest, the rasping, wet coughs.
The ambulance turned sharply, momentum throwing the body sideways. Alex’s head tipped, jaw smacking against the rail. A wet gurgle emerged. Riley corrected the position, sliding fingers gently but firmly behind the neck, adjusting the airway, pressing the bag harder. Each compression produced the same shallow, rasping lift.
Morgan tapped at the monitor. Heart rate 70, irregular. O2 sat 59%. “Dropping fast.”
Riley’s eyes narrowed, precise. “Prepare for rapid sequence intubation. This is going to be messy. ICU ready?”
Morgan nodded, hands flexing around suction and airway tools. The stretcher rocked again. Alex arched violently with a wet, choking cough. Saliva, mucus, fragments of the sponge were drawn immediately into suction, but the airway remained compromised. The chest lifted slightly with forced breaths, then sagged back down. Fingers twitched weakly, nails darkened further.
The hospital came into view: pale walls, entrance doors sliding open, lights flashing. Paramedics adjusted the stretcher, tightened straps, checked lines and suction, keeping bag-valve mask pressed firmly.
As the doors opened, Riley and Morgan exchanged a clipped glance. “ICU team ready,” Riley said. “Let’s move.”
Alex remained partially convulsing, cyanotic, body wet with sweat and saliva, airway still precarious. Each movement on the stretcher produced wet rasping sounds, the faint scraping of the residual sponge against mucosa. The mechanical rhythm of forced breaths and suction continued, uninterrupted, clinical, detached.
The gurney rolled through fluorescent hallways, alarms intermittently shrieking from monitors in distant rooms. Alex’s chest arched again, a weak, wet cough escaping. Cyanosis stretched into the neck and shoulders. Hands twitched feebly against the restraint straps.
Riley called out to the ICU team. “Airway critical. Partial obstruction. Need immediate intubation and suction. Bagged prehospital. Prep RSI.”
Morgan adjusted lines and suction. A fragment of sponge had shifted, scraping raw against mucosa. Alex’s spasms increased briefly with reflexive coughing, fingers clawing weakly, then slowed as exhaustion overtook them.
The ICU was too bright. Overhead lamps spilled white across every metal surface — the rails, the instrument trays, the curve of the ventilator mask. Alex lay in the center of the light, a pale outline against sheets that were already creased from the weight of hands and movement.
Riley and Morgan rolled the stretcher straight to Bed 3. The waiting team had already gathered — nurses in lead aprons, a respiratory therapist with tubing in hand, a doctor pulling gloves tight against the wrists. Orders flickered between them like static.
“Partial airway obstruction. Sedated. Bagged in transport,” Riley reported, voice low but crisp.
“Dropping en route. We’re not moving air efficiently.”
The team closed around the bed. The sound of the room changed — a shift from street sirens and hallway echoes to the electronic hum of the ICU, where everything had rhythm. Monitors clicked into place, sensors adhered to skin, and the screen filled with jagged green.
Alex’s chest moved irregularly, each rise shallow, delayed. The ventilator test breath produced a soft hiss, like air escaping a tire. One of the nurses adjusted the pressure, eyes on the monitor, lips pressed thin.
“Bag-mask off,” said Dr. Chen, the attending. “Let’s see what we’ve got.”
The mask came away. Alex’s jaw hung slightly open, lips parted but motionless. A faint rattle of air slid through the throat — a dry, resistant sound that didn’t belong in the living.
“Suction,” said Morgan, stepping back to make space.
The respiratory therapist passed the line forward. The hum of suction started, steady and low. Chen watched the screen, eyes moving from waveform to waveform. “Pressure is low. We’re perfusing poorly.”
The nurse, Anita, began pressing fluids into the IV line, slow and deliberate.
For a moment, nothing changed. The beeping continued — fast, shallow, regular. Then a tremor ran through Alex’s chest, subtle but visible, like a muscle twitching under ice. Another followed, stronger. The hands, resting loosely against the sheet, flexed and jerked.
“Seizure?” someone asked.
“No,” Chen said. “Hypoxia. They’re trying to breathe.”
The tremor became a convulsion. Alex’s spine arched, neck tightening against the mattress. The sound that followed was not a gasp or a word but something between — a muffled, dragging intake of air that cut itself off halfway through.
“Airway still obstructed,” Riley said, stepping forward again. “We can’t oxygenate like this.”
“Okay, let’s intubate. Prep.”
The team moved with mechanical precision. The laryngoscope’s metal flashed under the lights. A nurse handed over tubing, cap removed with a quick twist.
“Hold steady,” Chen said. Morgan braced Alex’s shoulders. The blade slid past the tongue; the doctor’s face stayed expressionless. “Visualizing cords…”
A pause. Then, quietly: “Tissue’s swollen.”
The monitors began to scream. Oxygen saturation dropped. Heart rate — 78, 64, 52.
“Code blue,” Chen said evenly.
The phrase hit the room like an impact. A nurse pressed the alarm. A second team arrived within seconds, pushing the crash cart. The air thickened with motion: gloves snapping, drawers opening, instruments sliding across trays.
Riley climbed onto the stool beside the bed. “Starting compressions.”
Hands interlocked, steady, rhythmic. The bed shuddered under each push.
Morgan handed off syringes. Adrenaline, saline, epinephrine. Orders came fast, answered faster.
“Then keep ventilating. Alternate with compressions.”
The ventilator hissed; the rhythm of the bag matched the cadence of the chest compressions. The sound was mechanical, unhuman — breath forced, chest pressed, breath forced again. The monitor’s tone rose and fell in a warped pattern, somewhere between a heartbeat and static.
Outside the glass, the hallway had filled with silhouettes — staff from other wings, watching through the transparent barrier. Their reflections layered over the room like ghost images, doubling every motion.
Inside, time had narrowed to a pulse.
Chen’s voice remained calm, the only still point in the noise. “Riley, rotate out. Anita, take over compressions. Keep rate steady.”
Riley stepped back, chest heaving from exertion. Anita took position, elbows locked, shoulders above her hands. The bed moved under her weight.
Alex’s body responded only in motion — the blunt rise and fall, the slight shift of the head with each compression. The pupils were dilated, still. The ventilator hissed again.
“Pulse check,” Chen said.
Hands froze. The room fell silent except for the long electronic hum.
The rhythm began again, relentless.
Morgan glanced at the clock, murmured, “We’re eight minutes in.”
“Continue,” Chen said. “Prepare atropine.”
Jamie and Taylor stood outside the glass, watching. The light from the ICU turned their faces gray-blue. Jamie’s eyes were wide, unfocused. Taylor’s hands were in fists against the window ledge, not touching the glass, just hovering.
Inside, the movements stayed precise. Compressions. Ventilation. Medication. The entire sequence repeated with surgical monotony.
Chen inserted a second airway, a smaller tube this time. The ventilator tone changed pitch slightly — a higher hiss, sharper.
“Minimal improvement,” the respiratory therapist reported. “No spontaneous effort.”
The monitor beeped irregularly — a few spikes, then a flat space, then another spike.
“Sinus brady,” said Morgan. “Maybe a pulse.”
Fingers to the carotid. A beat — faint, then gone.
Time became elastic. Ten minutes, then fifteen. The team worked without speaking now, the routine so ingrained that communication was muscle memory.
Anita’s arms shook from fatigue; Riley replaced her silently. The crash cart drawers stood open like ribs.
Another round of medication. Another set of compressions. The bed creaked. The monitor continued its erratic stutter.
Chen finally said, “Let’s pause. Rhythm check.”
The ventilator hissed one final time. Everyone froze.
The screen showed a faint, wavering pattern — not a line, not yet a rhythm, just a fragile movement of light.
“Electrical activity. But no pulse,” Morgan said.
“Continue for two more rounds,” Chen replied.
The motions began again, slower now, steadier. Riley counted under his breath, each number matching the shift of the shoulders, the mechanical lift and fall of the chest.
Outside the window, the hallway had emptied. The spectators were gone. Only the reflection of the ICU lights remained, stark rectangles in the glass.
Inside, the only sounds were the soft thump of hands against bone, the hiss of the ventilator, and the faint hum of electricity in the overhead fixtures.
After the next pulse check, there was no change. The line on the monitor stayed faint, flickering like something half-remembered.
Chen didn’t speak for a long moment. The team waited, hands still, gloves creased and shining under the lights.
“Keep monitoring,” she said finally. “Don’t disconnect yet.”
Riley stepped back. Morgan adjusted the tubing, wiped condensation from the mask. The ventilator exhaled softly, the sound almost indistinguishable from breathing.
For the first time since the code had started, the room was quiet. The air smelled faintly of antiseptic and heat.
Outside, the corridor lights dimmed for the night shift.
The machines kept running.
And in the middle of the room, Alex lay motionless under the bright light, as if the world were still deciding whether to let go.
