By the Neck

Laura Johnsrude

         

          I’ve always worried about our necks. 

          Rednecks. 

          Roughnecks. 

          Rubbernecks.

          So many vital structures reside in the neck, all the highways that keep us alive, upright, sentient—an airway tube, a spinal cord cocooned in bone, and those magnificent vessels transporting blood to the brain. 

          Which is why children shouldn’t wear dangly necklaces while playing soccer, or chew gum while bouncing on trampolines, or suck lollipops while riding bicycles.  Why athletes shouldn’t bench press without spotters, why football players shouldn’t use their heads as battering rams, why swimmers shouldn’t dive into shallow pools.  And why Isadora Duncan shouldn’t have worn that long scarf while riding in an open convertible.

          Breakneck. 

          Neck-and-neck. 

          Scruff of the neck.

          One afternoon in my pediatrics office, I opened the door to see my next scheduled patient, and found a teenaged boy sitting on the exam table.  He’d been to the emergency room, he said, a couple of weeks prior, because he’d shot himself in the neck. The boy wore a look of incredulity on his face, surprised that he had lived.  We probably shared the same expression.

          Risk your neck.

          Scrawny neck. 

          Your neck of the woods.

          Another time, a young boy came in with rope marks around his neck. He and his dad told me that they liked to play this roping game where the dad tried to lasso his kids. All in good fun, they assured me, the dad looking sheepish. As I described the tubes and blood vessels inside the son’s neck and what terrible outcome might have happened, the dad became quiet and the boy’s eyes widened with disappointment. There’d be no more family room rodeos. No more ropes flung across sofas. 

          Hang by the neck.

          Crick in the neck.

          Gooseneck.

          There was this time on a beach in Mexico when my friend’s son, Jeffrey, was playing in rough surf and was knocked down and caught by a thick rope tethered both to the beach soil, on one end, and to an anchored floating ocean buoy, nearby. The rope held him by his neck, like a hooked fish in the sea, until the waves slipped away. A purple wound wrapped diagonally down the side of Jeffrey’s neck for days, while I nursed a stomach ache, imagining what might have been. 

          Wryneck.

          Wring your neck.

          Dead from the neck up. 

          If pierced by a bullet, the neck’s great vessels will quickly empty you of blood. If obstructed by a large hematoma, say, after being “roped,” then you could easily suffer a stroke with permanent brain damage due to inadequate perfusion.   

          The neck’s airway tubes, the tracheas, are quite narrow in young children. Which is why every pediatrician cringes when she hears the barking of croup or sees a toddler pick up a marble. 

          One night during my residency training, the emergency responders wheeled in a terrified little girl who was leaning forward, rasping, and drooling onto her chest. This was before the Hib vaccine, when Haemophilus influenzae type B could swell the epiglottis and seal off the trachea. We all stood in a half-circle around the little girl, coaxing her to hold on until the pediatric anesthesiologist arrived who could sedate her and carefully intubate her so she could breathe.

          Pain in the neck.

          Immobilize the neck.

          Breathe down my neck.

          Even earlier in my training, when I was still in medical school and on a rural medicine rotation, I was paged to the local hospital delivery room at, like 2 a.m., and found myself beside a nurse at the feet of a laboring woman whose baby was about to come out of her body. The actual doctor wasn’t there. I was it, alone. 

          The nurse said something like, “Oh, good, you’re here. She’s ready to deliver.” 

          Then, she stepped back from the patient. 

          I remember that movement so clearly because my impulse was to yell, “No!” and rush forward and put my palm up against the patient’s perineum to keep the head from coming out.

          I must have shouted, “Where’s the doctor?” But I don’t remember being able to speak. Maybe it was, “Wait for the doctor,” because I know the laboring mother’s retort was some version of, “This is my fifth kid and there’s no stopping it now.” At that moment, I earnestly believed the baby shouldn’t be allowed to come out of her body without a real doctor in the room but I couldn’t think of a way to stop it.

          Suddenly, the baby’s head was in my hands and I saw the umbilical cord wrapped around the baby’s neck—the neck, oh my, with all those critical bits of anatomy. I held that big slippery baby head in my left hand and slid a couple of fingers under the purple rope and lifted it loose and then the infant slipped out of the mother, into my arms. Finally, the baby could breathe. I could breathe.

          Stick my neck out. 

          Up to my neck. 

          Save my neck.

          I still worry about our necks, balancing those ten-pound heads between our shoulders, just north of our hearts. Those vessels and tracheas and spinal cords are only couched by muscles and tendons and bone, inside that stump of tissue, that scrawny neck. Tiltable, flexible, huggable, kissable, and accountable for those cardinal pathways which shouldn’t be torn or severed or twisted or obstructed or crushed or strangled or choked. 

          Such a narrow tunnel, really.  

          Just a stem to skull and brain.