Saturday, January 16, 2010

The Speaking Valve


            After the fever subsided, life has returned to normal, or rather, its new normal—routine days in the hospital, working on breathing, physical therapy, socializing with friends, and letting the wounds keep healing.   Of course, it’s not entirely normal or even the new normal, since the three bags of antibiotics are still hanging from the IV pole and we’re still on general alert.  But things are much better, and the wounds are indeed healing. 

            The new thing is the speaking valve.  Of course, Brooke has been working on the speaking valve for maybe six months, maybe even longer, but it’s only recently that he’s been beginning to take off with it.   When he started, it began with the same sensations that trach mask began with—panic, anxiety—but he has gradually worked up from five minutes, then ten minutes, then twenty minutes—now he’s at forty-five.   The speaking valve—we’ve described it a bit earlier on—is a small purple plastic cap device that fits over the opening at the end of the trach.  It’s got a membrane that’s a one-way valve—it lets air in through the trach, but not out through the trach.  Instead, on the out-breath, you have to push the air out through your mouth or nose. 

You begin by making simple sounds, Brooke says like aaaaaaah,  ohhhhhhhhhhh, ummmmmmm.  These sounds were very indistinct at first—I could count to five, maybe, but that’s all.    I’m working with a speech therapist who gives constant reinforcement—it’s very easy for your mind to get in the way and you say things like  I can’t do it  and I hate this and when I get off this valve I won’t be able to continue with the trach mask trial, and indeed sometimes you can’t keep going at all.   But you do keep going, breathing in and then holding your breath for two or three seconds, and then breathing out for three or four seconds, until every last bit of CO2 is exhaled.  You suck your breath back in through your nose, breathe out through your mouth, then back in through your nose.  The anxiety that you feel is held very tightly in the shoulders and the neck, which need to relax as much as possible—this is more difficult than it sounds.  Imagine an opera singer who must work with his or her diaphragm to produce extraordinary sounds, often at great length—this takes an amazingly strong diaphragm and great control, both physical and psychological.  You have to relax the whole upper body.  There’s an analogy to what is going on in this process—imagine if you’re giving a speech or teaching a class, the same applies: if you’re tense your voice sounds constricted, unnatural; if you’re relaxed, your voice comes out with natural intonations.  But for me this process as it goes on is constantly being interrupted by voices, almost literally voices inside one’s brain, like cries for help, don’t do this to me, don’t put me through this.    

When Peggy happened to come in, this is what she saw: a man in the throes of anxiety, trying to do aaaaaaah, ohhhhhhhhhh, ummmmmm, but it was obviously really hard.  Then the speech therapist asked Brooke to think of the calmest, most peaceful scenes—for instance, he recalls, the time when we swam in Lake Florence, up under Lake Blanche, up in the mountains above Salt Lake; it was autumn and the water was almost warm.  We floated separately and together, and the whole forest around us was reflected in the perfect stillness of the lake.   Then we got up on the bank and lay on the grass with nothing on but the sun on our skin, one of the most delicious moments of my life, says Brooke, and mine too adds Peggy.  The speech therapist asked Brooke to feel the sun again and the sensations of the water.   Thinking of things like this are classic meditation and calming techniques, but what is not classic is that you’re breathing off the ventilator using a diaphragm that has atrophied, but is now beginning to regain strength.   This is what the speech therapist has been trying to accomplish, calming and relaxing so that speech becomes more and more natural off the vent, and she has been doing it wonderfully well.   The aaaaaaaaaah, ohhhhhhhh, ummmmm are indeed exhausting, but then Brooke and Peggy tried doing them together, Brooke eventually holding the sounds almost as long as Peggy could, a matter of great progress.    And they morphed into Om, Ah, Hung, the sacred syllables taught by the lama and posted on the wall so that we could chant ommmmmm, ahhhhhhhhh,  huuuuuuuuuuuung together. 

The speech therapist left us alone together when she had to go on to another assignment—that reawakened the panic, even though Peggy was in the room with Brooke, but repeating ommmmmm, ahhhhhhhhh,  huuuuuuuuuuuung succeeded in restoring calm.  Brooke finally finished the session after an hour and forty-five minutes, a new record, a full hour longer than the previous speaking-valve time.  It’s one more step not only in strengthening the diaphragm but towards normal breathing and speaking function, something the rest of us all take for granted but for Brooke has to be entirely relearned.

In the meantime, however, he uses his vent-voice most effectively: when Peggy arrived this morning she found him teaching English to one of his favorite Spanish-speaking aides, one who gives him the most gentle and understanding care.  The aide’s English is already pretty good, but Brooke was pronouncing exquisitely carefully for him all the various difficult English words in a talk he was preparing to give. Here, Brooke’s vent-voice was virtually perfect and the aide’s English genuinely enhanced, and it was a moment of genuine exchange between two people mutually caring for each other even if in different ways. 

3 comments:

Domonique said...

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Sara & Greg Pearson said...

Hi Brooke and Peggy,
Once again my attempt to post a blog in the prescribed manner has
failed, so I'll have to ask Sara to relay this one, too. I haven't
communicated with you for a long time, but that's not because Sondra
and I haven't been thinking about you. We read your reflections and
talk about them. The catastrophe in Haiti has prompted me to reflect on
your remarks regarding JOB. JOB is always a relevant book, but
catastrophes like Brooke's accident and the earthquake compel us to see
the world as Job sees it, without the mediation of canned wisdom. The
comforters cling to their canned wisdom and are sustained by it. What
happened to Brooke, like the earthquake in Haiti, can't be reconciled
with any comprehensible benevolent cosmic design. They are
incomprehensible disasters inflicted by what appear to be, from a human
perspective, malevolent powers. Only a lobotomized moron like Pat
Robertson would see them otherwise. You can see why Manichaeism is such
an attractive heresy. At moments like this, it seems the wrong god is
in charge of the world.
Job is a tragic hero because he maintains his integrity and refuses to
seek refuge in lies that might make his suffering more tolerable. The
injustice of what has happened to him makes him angry. Tragic heroes
always suffer well beyond anything they've deserved, and this makes
them angry. MENIS, anger, is the first word in the ILIAD, the first
word in western literature. The Greeks understood so well how rage can
either magnify you and make you strong, like Achilles and blind
Oedipus, or it can diminish you and make you pathetic. It's all in how
you focus it. Oedipus gets it right in the COLONUS. His anger is
focused on his sons but also on the gods who've victimized him
unjustly. The gods seem not to be offended. They summon him to join
them in the next world. In the same way, Job vents his anger at the
palpable injustice of Yahweh, and Yahweh commends him for it.
The comforters are like Pat Robertson and bring condemnation on themselves
by attempting theodicy.
You guys know all this. I'm not trying to preach to the choir, just
sharing my thoughts generated by your recent entries and the ongoing
catastrophe in Haiti. Brooke's level of understanding, like that of Job
and Oedipus, is clearly so much higher than that of anyone who hasn't
suffered so much, and the rest of us can only try to learn from him. I
always used to tease him about imposing literary paradigms, and now I
see how illuminating they can be.
Something too much of this. Sondra joins me in sending love.
As always,
Geoff

ed ranney said...

Great to find that posting by Greg, and the account of your strengthening the diaphram, Brooke, with the resonating sounds. Keep it up. I love imagining the interchange between you and the fellow working on his english pronunciation, how wonderful for you both!

Snow falling here in NM and I imagine you are getting a bunch too from the same series of storms coming from the northwest. Good moisture for us, finally, though it is very sloppy, as it is quite warm.

I've just had a wonderful phone conversation with Rackstraw Downes, english fellow who was at Hotchkiss for one year when we were freshmen, and who I saw intermittently at Yale, as he was in the art school when I was an undergrad. He's been producing wonderful paintings for years, based in NY, now also in Texas on the Mexican border during the winter, but planning a trip to Peru next fall, so I'm giving him feedback on ancient places he'd like to see, that aren't too difficult to get to. Also just had the relief of seeing an advance copy of "Monuments of the Incas", quite nicely reprinted after a year of worrisome suspense and exchanges,
with John Hemming's new text additions quite successful in the final analysis.

I love seeing that text of Domonique, and wonder if you can read it? very mysterious...

love from all her
Ed