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Rachel Cook/ The Californian

Retired pulmonologist Thomas Farrell Jr. said his friend Dr. Royce Johnson used this knife that Farrell usually carries in his pocket to perform a tracheotomy on former Kern County supervisor and valley fever activist Pauline Larwood at a restaurant Monday evening when she choked on a piece of meat.

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Casey Christie / The Californian

Pauline Larwood. Photo courtesy of the Kern Community College District.

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Henry A. Barrios / The Californian

In this 2012 photo, Pauline Larwood and her husband, Dr. Tom Larwood, lead the way during a Valley Fever Awareness walk at the Kern County Museum.

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Dr. Royce Johnson, professor of medicine at UCLA and Kern Medical Center's chief of infectious disease, answers a question during a community forum on valley fever held Monday.

A local doctor is being hailed as a hero after he used a folding pocket knife and pen to perform an emergency tracheotomy on a former Kern County supervisor at a downtown Bakersfield restaurant Monday night.

The dramatic incident took place at a restaurant where top officials had gathered after leaving the landmark symposium on valley fever held in Bakersfield on Monday and Tuesday. Some of the nation’s most accomplished physicians were in the room.

Pauline Larwood, who was Kern County’s first female supervisor and currently serves as a community college trustee, was eating dinner at The Mark restaurant with some of the doctors, experts, politicians and others in town for the symposium when she began choking.

After the Heimlich maneuver failed to open Larwood’s airway, witnesses said, Dr. Royce Johnson, professor of medicine at UCLA and Kern Medical Center’s chief of infectious diseases, used a friend’s knife to make an incision in Larwood’s throat to allow the insertion of the hollow cylinder of a pen as a breathing tube.

The procedure succeeded and Larwood was rushed to Mercy Hospital Downtown.

By Tuesday, her son said, she was doing fine.

Johnson had appeared onstage Monday at the valley fever conference with Dr. Thomas Frieden, director of the Centers for Disease Control and Prevention, and Dr. Francis Collins, director of the National Institutes of Health.

The CDC chief monitored Larwood’s pulse during the incident. Collins was also present at the dinner.

Following a forum and survivors reception, about 55 people dined together in the downtown restaurant’s banquet room, including farming and business moguls Lynda and Stewart Resnick, and Rep. Kevin McCarthy, R-Bakersfield, said The Mark’s General Manager Ro Fernandez. At least two members of McCarthy’s security detail were also present.

The entrees had just been served — steak, chicken or salmon — but Fernandez said he wasn’t sure which dish Larwood had chosen.

Assemblywoman Shannon Grove, R-Bakersfield, said she was seated at a table with the Larwoods when the incident occurred. She said her husband, Rick Grove, and state Sen. Jean Fuller, R-Bakersfield, were seated on the other side of the table.

Grove said her husband suddenly jumped up, ran to Pauline Larwood and tried to perform the Heimlich maneuver. He called for a doctor and Johnson attempted the technique as well.

“She had already started turning a real like blue, her fingers and her lips,” Grove said.

As Grove called 911, she watched in amazement as Larwood was laid back in a chair and Johnson began performing the emergency procedure.

“He didn’t scream; he just said, ‘I need a knife,’” Grove said.

Grove called Johnson a hero.

“It was really unreal how calm (the situation) was,” she said.

The folding knife Johnson used came from Dr. Thomas Farrell Jr., a retired physician and friend of Johnson’s, who said he always carries the knife.

Farrell said Larwood’s skin turned blue and she lost consciousness. Her teeth were clenched so tightly he could not work to clear the blockage.

As several physicians gathered around Larwood, Dr. Paul Krogstad, a professor of pediatrics and pharmacology at the David Geffen School of Medicine at UCLA, said someone called for a pen, and when one was handed to him, he broke it in half and placed it in the incision Johnson had made.

“I was sort of looking at her breathing, Royce is blowing into this tracheotomy that he performed and the CDC director (Frieden) is checking her pulse,” Krogstad said. “She came around.”

"She was fortunate that somebody as bold as Dr. Johnson jumped in,” he added. “By the time I got there, he already had a plan going and Dr. Frieden and I just assisted."

Nevertheless, the doctors worked as a team.

Frieden called out that Larwood did not need chest compressions and that she had a good pulse, Krogstad recalled.

“I've never seen that done in public before but it made good sense,” Krogstad said of the tracheotomy.

It was ”a pretty drastic measure,” he added, but “everyone knew what they were doing.”

Before the ambulance even arrived, Larwood was sitting up, talking and fully conscious, Krogstad said.

“She pinked up, her skin looked good pretty quickly,” said David Larwood, Tom and Pauline Larwood's son.

Throughout the incident, Tom Larwood remained absolutely calm.

Johnson declined to comment.

David Larwood said his mother was taken to Mercy Hospital, where she stayed overnight. He said his father was with her Tuesday and she would probably be able to go home later that day.

Larwood, 71, served on the Kern County Board of Supervisors from 1983 to 1994. She currently serves on the Kern Community College District’s board of trustees, another elected position.

Meanwhile, on Tuesday, Fernandez complimented McCarthy’s security detail for keeping people calm and allowing rescuers to do what they needed to do.

The crisis and the arrival of an ambulance brought an early end to the evening, Fernandez said. But everyone was relieved that Larwood appeared to be OK.

“It must have been quite an evening for all of them,” he said.