Captain Pike's Ship Log II

One of the problems of being on a ventilator is that you can't yawn. You can't just have a nice deep yawn, or sigh or even just hold your breath for a moment. Otherwise, the machine will begin squawking, sounding its alarm, I suppose, to alert the nurse or somebody that something's not just right with your breathing. It's funny though, how easily the staff gets desensitized to these kinds of alarm sounds. I remember coming back on the ICU in my wheelchair after I had gotten quite a bit better. I had come back on the ward just to visit. Hearing the more or less ignored bleats from the many ventilators reminded me of the individual worlds of trauma into which newly conscious patients have found themselves. It's the new deal: so you're not dead but breathing has become your number one priority. I can remember, again and again almost dropping off to sleep only to be rudely awakened again by the relentless retort of the ventilator. When you're in the world of the squawking ventilator, it's hard to imagine wheeling around in a comfortable new wheelchair, wearing ordinary clothes, visiting nurses in the ICU.

One of the good things about the ventilator is, however, that not only is it keeping you alive -- keeping the air going in and out of you, but it does stuff like measure the CO2 coming out, so that it knows that your body is doing the right thing with the air that it's supplying. There was definitely a time when I could really rest, assured that going to sleep would be okay -- that I'd live through it, that the ventilator would keep the air flowing in and out of me properly. I don't know how long it was that I remained connected to the ventilator. I know the next thing they began to talk about was using this thing called the heated trach collar. It's basically just a little mask that is loosely fitted around your neck which brings oxygen to the vicinity of your trach fitting. This trach fitting I'm talking about is a hole in your throat just like those guys have who have throat cancer. If they place this weird buzzer thing there, they can talk, but it sounds real funny. So the tube brings oxygen there, but you have to do the breathing -- in and out on your own. You still can't really talk, but your mouth is freed up to be able to mime things at least, or even to taste something wonderful like a popsicle. Now, you're able to yawn or sigh as you wish. It's funny the things that seem a big deal when you've stopped being able to do them.

Another funny thing about having a tracheostomy is that, in order to speak, you have to cover the little hole, so that air can be forced past your larynx up into your mouth. If the air flowing to and from your lungs is passing out through a temporary hole in your trachea (a tracheostomy) then no air is passing over your voice box so you can't talk. With me, they began with quite a large "trach". When you have breathing difficulties, having access to your lungs through this type of opening is a great advantage when you need to be suctioned. Having your lungs suctioned is a terrible thing when you're conscious. If you aren't able to cough up your own phlegm, it can become a big problem. Typically, a respiratory therapist must insert a catheter through your trach hole, down into your lungs and suction out the crap in there. As you recover, they replace the trach tube with successively smaller ones. One of the intermediate sized trach pipes I had, had this little plug that went in the hole. This stopper was tethered by a little cord so that you wouldn't lose it while it was out. With the plug in, air passes by your larynx, you can talk; with the plug out, hanging, most of the air passes out through the trach pipe so that you can't speak. After the danger was over, and it seemed as though I would live for a while, my wife would do a funny thing when people were visiting. I'd be talking on and on, as I usually do if I can get an audience. She would wait until an opportune moment arose during my discourse and simply pluck the stopper out, effectively silencing me in mid sentence. My mute button! It always got quite a laugh. She could now "get a word in", for the first time in years.