CHICAGO - Fred Y. Sasaki put on a red tie and his gray suit.
He was not a man who typically dressed up, but tonight was special. At 80 years old, Sasaki had built a successful career as a dry cleaner. He had just spent the day with his grandson. And now he was headed to his favorite restaurant, Yoshi's Cafe.
When he sat down at the table, he said: "I feel great."
Across from him was his financial adviser. The two men had known each other for nearly 20 years. And tonight, Sasaki relished the chance to pay for dinner.
He was a frugal man with a sensitive stomach, but tonight he ordered wine and oysters. And, of course, he would have New York strip steak -his favorite.
The men talked and laughed, enjoying the food and each other.
Suddenly, Sasaki began to choke. He couldn't speak. His friend didn't know what was happening; he told Sasaki to put his hands above his head. Sasaki tried, but it didn't help. He drank water, but it just came up. An attempt was made to administer the Heimlich maneuver. No one was sure if Sasaki was having a stroke or a heart attack.
Sasaki died later at the hospital, one of about 4,000 people who die every year after choking on food or other objects, according to the Centers for Disease Control and Prevention. When Maureen Oleskiewicz, a 28-year-old teacher from Palos Heights, Ill., died after choking at Wrigley Field this month, it was heavily covered in the news. Sasaki's death didn't make the papers.
Yet, the cases are striking in their similarity. Both occurred in public places, in front of many people. And in both cases, bystanders either didn't realize or weren't sure if Sasaki or Oleskiewicz were choking. Neither of the victims put their hands to their throats to signal they couldn't breathe.
That scenario is far too common, said Dr. Patricia Lee, head of emergency medicine at Illinois Masonic Medical Center, where Oleskiewicz and Sasaki were treated. Even when bystanders do recognize what is happening and attempt to intervene, they often wonder if they could have done more. Lee said too few have undergone training in CPR and the Heimlich maneuver.
"There is a lot of survivor guilt that goes on," Lee said. "People say, 'I meant to take a class.' People say that all the time when they come in with their loved ones."
It is a tragic twist that choking often catches people off guard in moments when they are happy and relaxed. Oleskiewicz, a dedicated Cubs fan, was at Wrigley Field. Sasaki was at his favorite restaurant.
"It's always a little more of a risk when you're having a good time," Lee said. "You're laughing and drinking. You might laugh and take a big breath so that the food goes down your trachea."
That food can act like a plug. "It's very sudden," Lee said. A person will not be able to speak, cough or make a sound. There is just silence and panic. Oxygen is blocked, and without it, a person will quickly lose consciousness and go into cardiac arrest.
"You have minutes," Lee said. "It's not enough time to sit back and wait for the ambulance."
Choking deaths are the fourth-leading cause of accidental deaths in the nation, according to the National Safety Council. Although children under 12 months are vulnerable, it is older adults who are at the greatest risk. Factors that increase a person's vulnerability include an older age, dentures, alcohol consumption and physical disabilities.
For most age groups, however, the risk of choking fatally is low. A 2007 study found that among 513 choking cases reported in California's San Diego County over a 17-month period, only 3 percent were fatal. In most other cases, the Heimlich maneuver was used to treat the victim, with a very high success rate.
Choking "is a common thing that can happen. It can affect a person you know," said Terry Vanden Hoek, who heads the department of emergency medicine at University of Illinois at Chicago. He said people don't need to sit through a four-hour class to learn the Heimlich maneuver. They can watch a video on YouTube. "Knowing what to do is quite simple," he said. "It takes a few minutes to learn."
The mother of Maureen Oleskiewicz, who died at Wrigley Field, hopes her daughter's death will raise awareness about the dangers of choking and perhaps inspire more people to take a class in CPR.
Her daughter had been at a place she loved when she died. "They were throwing balls into the stands," Margaret Oleskiewicz said. "She went (to Wrigley) as often as she could. If she couldn't go, she would sit and watch the games with her friends at home. But what she really loved was being at the field."
As for the family members of Fred Sasaki, they are planning his memorial service for today, which would have been his 81st birthday. His son stood in his apartment recently, going through his father's possessions. "I know how preventable a choking death can be," he said, "but I've tried not to dwell on that."