I walked onto the trach and vent unit, ready to see my patient. I’d done a chart review, looked at the patient’s treatment goals, and how good she was doing at meeting them. I was pretty excited about this one. 80 plus year old lady who went into respiratory failure, was transferred from an out-of-state hospital, and was already eating and tolerating a Passy Muir speaking valve for 15 minutes at a time. I spoke with the respiratory therapist, who told me she was having a good day, and that he thought she had a chance of being weaned off of the vent. Excellent prognosis despite a few significant drawbacks, and this made me giddy and hopeful.
I knocked on the door, announced “speech therapy” as is protocol, and walked in. Tiny little lady in a big bed surrounded by vents, suction machines, and feeding poles. As soon as she glanced at me, I flashed her a big smile and introduced myself, holding her frail, wrinkly hand. I explained what I was in her room to do, she grinned and nodded slightly letting me know she was familiar with what I was about to do, and that it was ok for me to be in her space.
“If you don’t mind, I’d like to get right down to business. You’re doing so great, and I want to get to work. Sound good?” She smiled and breathed a little chuckle.
I put the pulse oximeter on her finger, sats at 97%. Perfect. I deflated her trach cuff, and she took her first deep breath, which immediately elicited a wet, congested cough. Totally normal. I suctioned around her trach opening, cleaned it up a bit with a warm rag. Sats still normal.
I got her voicing valve from its box. “You ready?”. She nodded, and I looked at the time. I put the valve on the trach, and she took a few breaths, getting used to exhaling through her mouth. Sats still normal, she looks uncomfortable for two seconds, and then she relaxes. I let her get acclimated to the valve for a few seconds and then I smile and say “Hi.”
“You feel alright?”
“Yes. My feet are cold.”
45 minutes later, she’s starting to get sleepy on me and our time is near up. She’s done such a good job and I’m feeling like it’s been a 45 minutes very well spent. She asks if she can keep the valve on, but I let her know I’d rather her not wear it while she’s sleeping. “Keep it up, and soon enough you may be wearing it the whole time you’re awake, and not just when speech therapy is around.”
“That would be nice.”
“That’s what we want for you. I have to go now, I’ll leave your call light right here, here’s your pen and paper, and I’ll let your nurse know you want some pain meds. Is there anything else you want, need, or want to say?”
She takes a second to think, “No, I’m fine.”
“Ok. It’s been such a pleasure talking with you. Thanks for working so hard, you did great.”
“Nice talking to you to. Come back now.”
“Oh I will, don’t worry.”
“Talk to you soon.”
“Talk to you soon.” and I remove the voicing valve. A minute later I hold her hand and whisper “Thank you”.
“Thank you”, she mouths. Only one of many rewarding situations that occur while I’m at work.
Now I lay in bed, with a knee stiffened and sore after being prodded and attacked in surgery. Recovering from surgery can be so frustrating, and often times I distract myself by thinking of the patients I work with, and how lucky I am to do what I do for a living. It makes me want to be all better now, so I can go back to work.