On the large animal surgery rotation, my colleagues and I got to help treat a mare in her late thirties who was suffering from an episode of choke. Choke, a colloquialism used to refer to an esophageal obstruction poses a very dangerous threat to horses, as it prevents them from swallowing food, can irritate the esophagus, and may cause severe electrolyte abnormalities. Helping her during her hospitalization was difficult. We had attempted to relieve her choke (hay densely packed into a 3-centimeter-long obstruction) by passing a nasogastric tube and using an endoscope and “grabbers” to pick out hay, one piece at a time for a cumulative period of twelve hours over the course of four days. In all honesty, I was quite skeptical that our intervention would resolve the choke. The largely magnified bits of hay seen on endoscopy appear huge on the screen despite seeing how small they actually are when they are removed.
To me, the excruciatingly long process brought to mind the story of the Terrible Trivium, a demon from the novel The Phantom Tollbooth. He convinces the main characters of the book to engage in ridiculous acts of transferring a pile of sand to another pile using only a tweezers to move one granule at a time, digging a hole through a cliff using only a needle, and moving water out of a well using only an eyedropper. One of the main characters calculates that this would take over 800 years to achieve.
By the fourth day, one of the clinicians finally had grabbed a sufficient amount of hay that she was able to lavage the rest through to the stomach, and the primary problem of the horse was finally solved. This goes to show that in a Gestaltic sense, little bits of ingesta add up to be more than the sum of their parts and that a little bit of patience and the appropriate tools can help address this serious condition.