I had just started dinner when a new speech pathologist popped her head in.
Fortuitously, as it turned out, because she wanted to talk about swallowing and tracheostomies. Indeed, we got to do swallowing practical 101 rather than just theory.
But first, the tracheostomy. It’s a pipe inserted through an incision in my neck directly into my trachea. Around the tube is what they call a cuff, a circular balloon that they blow up to the appropriate pressure according to the pressure pump that hangs down from the external part of the tube.
At first, she said, the cuff will be blown up to prevent saliva going down my windpipe. You swallow about a litre of saliva a day. The operation and swelling will affect my swallowing. While I’ll be kept propped up in bed and much of the saliva will go down my esophagus by force of gravity alone, some will build up above the cuff. Nurses will regularly need to suction the saliva out through the trache tube. It’s uncomfortable and invasive.
As the days pass, maybe around day three, they’ll begin to see how I go starting to swallow on my own. They reduce the pressure in the cuff and give me sips of water. At that stage too, some air may pass up from the windpipe through my vocal cords and I may have a faint voice.
They will start with reducing the cuff pressure for short periods of time and gradually increase the time I must swallow on my own. It will take concentration and require work before I can do it at night asleep on my own.
I may move up to the ward before the tracheostomy is removed, but will need to stay propped up in bed.
Once the tracheostomy is removed, I can move from swallowing water to clear broth to liquid food. They will probably squeeze it into my mouth with a syringe. Eating, to the extent it can be so called, will take time and effort.
When you swallow food normally, she explained, you close your mouth and the tongue pushes forward and dips at the back like a slippery dip. What you are eating is propelled down your pharynx into your esophagus to your stomach. At the same time, the epiglottus closes off your airway to some extent to stop the food going down the wrong way.
I won’t be able to chew and I will need to use different muscles, particularly my tongue, to swallow food. My neck will be swollen from the mandibulectomy and neck dissection.
I am off to sleep now after chatting with my night nurse. I’m due in theatre around 7.30am, she said, and they expect the porter will come to whisk me away around 7am. The nurse will wake me at 5.30am for final preparations, including washing with the delightful chlorohexidine body wash I also had for the biopsy and dressing in a hospital robe, red cap (to show I have an allergy) and long socks.
I can leave my belongings in my room as it should remain mine even while I’m downstairs in intensive care. I just need to pack a small bag of belongings for intensive care, like my iPad, paper and a pen.
Good night and good luck.