15 May 2018
Growing up, I was that little 5
year old girl who used to catch bugs in a little transparent jar, and examine
them through a magnifying glass. It excited me to discover new animals and organisms,
and examine them, play with them… make new friends. As I grew older, and
learned that this was not the norm, that these things could potentially be harmful
or gory, and I became cautious of these things – afraid of bugs, disgusted by
touching unusual fluids and objects, and scared of blood. I became the normal
teenage girl who squeals and screeches when touching strange textures or when
bugs come too close.
As a Speech Therapist, we see all
kinds of things. Working in a hospital exposes you to things not many people
would ever imagine –bodily fluids, bad breath, infected wounds, dirty people,
exposed genitalia, burst catheter bags, to name a few. One thing is for sure, I
take my hat off to the nurses.
On this particular day, I had a patient
who was diagnosed with myasthenia gravis, had a tracheostomy tube in situ, and
was dependent on a ventilator to breathe. Myasthenia gravis is an autoimmune
disease in which a weakening of the skeletal muscles responsible for breathing
and movement occurs. Essentially, an overall weakness occurs, making breathing,
moving and even blinking or opening your eyes difficult. The result of this
weakness often leads doctors to insert a tracheostomy tube (see the image
below) – a tube inserted into the lower soft part of the throat, that helps
keep the airway open and allows for easier breathing. This patient was
dependent on a ventilator because he was unable to breathe on his own.
This patient was referred to
Speech Therapy to do a swallowing evaluation on him – is he allowed to eat
orally? He had a naso-gatric (NG) tube in place through which they were feeding
him. This is a tube that is placed through the nose, down into the stomach.
Generally, when we do swallowing
evaluations, we start with a bedside evaluation and end with a videoswallow at
X-Rays. A bedside evaluation here was our only option, as this patient was on a
ventilator and we could not transport him to x-rays. Often patients who have
tracheostomy tubes in place have a decreased sensation in the airway, so the
natural cough reflex when something enters your airway might not be there. This
makes a bedside evaluation not as reliable as a videoswallow. In these cases,
we do what we call a blue-dye test. Blue is the only colour not excreted by the
body, so we take blue food colouring and mix it into water and sometimes yoghurt,
making it a hideous bubble gum-blue colour. The patient drinks 3 sips of blue
water, and we then suction their lungs through the trache to see whether any of
the secretions are blue, in which case we know that they have aspirated.
I am the type of person who I
think you could term as physically, physiologically and emotionally
sympathetic. I can physically feel what other people must be going through, and
I get similar sensations to what people describe they are experiencing. Now
because I had never done a blue-due test before, my boss had come along to the
swallowing evaluation to teach me how to do the test. This patient was in
isolation for an infectious virus, so we dressed up in the appropriate attire –
gown, mask, head cap, gloves, shoe protectors, and in we went. My boss
explained the procedure to the patient, and began the study. He took the sips
of water, and they waited a couple of seconds. When that suction pipe went into
his airway, he started coughing. Imagine having something shoved into your
airway and kept there, you are unable to get it out by coughing, so you cough
to the point where you gag from the sensation.
The look on this man’s face
whilst they were suctioning… his face went instantly red, agony painted like a canvas
in his expression, and coughing, coughing, coughing. Coughing until he gagged,
in which case vomit had come up through his NG tube. It was then that I could
no longer watch. I could feel what he was going through… the pipe being forced
into my lungs, being unable to get it out. Tears streaming down my face purely
from the sensation which I wasn’t really experiencing, I stepped outside. This
was where my boss found me after the swallowing assessment – standing flat against the wall, head tilted
back breathing deeply, mask in hand having torn it off my face, and my gown
(which was resting just a little too tightly against my throat) half torn off
my body.
Being a Speech Therapist, it is a
part of my duty to perform this test, as no one else is able to do this. I have
since taught myself to zoom in on the suctioning pipe and focus on finding that
speck of blue, instead of allowing all other environmental stimulation to
register in my brain… The patient choking, slime coming out of the suction
pipe, agony across the patient’s face, or any other sounds that might cause an
unfavorable reaction on my part. I can proudly say that I have successfully
mastered the ability to independently perform a blue-dye test.
So you learn to desensitize
yourself to experiences which may not be most pleasant. A very specialized
skill to have I’d say…
Later 😊
Xxx
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