The Prisoner of Malta

It was a hot August night in the ED. The air conditioning pumped out tepid air and one could build a sweat just washing your hands. The asthma room was quiet, a welcomed relief from the usual standing room only crowd. I was near the end of my shift and looking forward to a shower and some homemade grub when Jenny, a third-year resident poked her head from behind a cubicle curtain.

“Dr. D, can I show you something?” I hopped off the stool that barely had time to make a dent in my derriere. Sitting anxiously on the stretcher was Maria, an 8-year-old girl. She held a bottle of soda in her mouth. Her mother stood by her side, also anxious.

“She can’t get it off,” Jenny said.

I looked closer. It was a bottle of Malta, a malt-flavored soda popular in the Spanish community. The bottle was short and stocky, with a wide mouth. Stuffed into that wide mouth was Maria’s tongue.            “She sucked the air out of the bottle and now it’s stuck,” explained her mother.

The girl watched me like a cornered squirrel. Her tongue was beefy red and swollen, but it was hard to tell much else through the brown glass. The weight of the bottle pulling down on her tongue was painful, so she was raising it up into her mouth. She was a mouth breather so positioning the bottle was tricky; not too far into her mouth so she couldn’t breathe but enough to take the weight off her tongue.  When one arm got tired she switched to holding the bottle with the other.

I delicately took a hold of the bottle and applied minimal downward traction. It didn’t budge but Maria’s eyes did, they bugged out. She looked weary and what concerned me was that her breathing was somewhat labored.

Several residents stopped by to see what was going on, sharing suggestions such as breaking the bottle with a reflex hammer or heating until it expanded and dropped off. The tongue is perhaps the most sensitive and vascular organ in the body.  We rejected both those ideas.  Instead we retrieved from the supply cabinet an infant feeding tube. About the size of a cocktail straw and made out of soft plastic, we used feeding tubes in the ED as urine catheters. The intended use was to supply nutrition for premature infants who had not the strength to suck. Jenny applied sterile lubricant to the tube, and gently attempted to insert the tube between the glass rim of the bottle and Maria’s tongue. It was a little like trying to push a lace that has lost its plastic tip through a sneaker eyelet.  It took several attempts and we had to steady Maria so she wouldn’t jump off the stretcher or pull the tube out once we had it in. Eventually Jenny got the tube in place. Nothing happened. The tube should’ve released the vacuum but it was pinched closed by Maria’s tongue against the glass. We went to plan B. Jenny reached for a 3cc syringe.

“You are going to need a bigger one,” I advised her.

“She started to unwrap a 10cc syringe.

“Bigger still,” I said.

 Jenny settled on a 20 cc syringe and attached it to the end of the feeding tube. Maria watched with trepidation. Jenny slowly pumped air into the bottle like a flat tire. After the second 20 cc the bottle slid a little and Maria jumped.  After 20cc more of air the bottle shot off into Maria’s lap with a pop and a puff of malty smoke. We examined her tongue, soaked it some cool water and after an hour or so Maria and her mom were sent on their way, with a promise to lay off the Malta or use a glass.