I'm still finding material to write about regarding my experience in the hospital, and working it in as I have time. In this post I’ll address several sources of discomfort that I experienced while recovering in the ICU. It does seem to me that there is a host of people who have experienced all these discomforts and many worse ones – so who am I to write with any authority about this? What I do have is a growing passion that thoughtful and thorough information on any given medical issue be made available and actively presented to patients. I’ll hope to make my small contribution to the information and perspective available on the internet, encouraging potential patients to learn about what they are in for and ask questions of their surgeons, to help prepare as best they can.
To start, I’d like to follow up on a post I recently made in which I discussed some ways I've experienced feelings of suffocation in the past, and talk about how I drew on this experience as I was waking from my surgery. Once again I found myself struggling with similar feelings of suffocation and other problems with breathing, though now with a larger set of complicating factors.
First, as I woke up the morning after my surgery I was acutely aware, intellectually if not tangibly, of the intubation that I knew had been threaded down my nose, through my vocal cords, and into my trachea to ensure the flow of oxygen through the surgery and initial recovery period. I had had conversations with my surgeon and anesthesiologist in which I expressed unease with intubation, specifically with the possibility of damage to my vocal cords. I understood that intubation was necessary and wasn't at all arguing against it; I was just expressing my concern to the professionals involved. I was appreciative that my anesthesiologist, hearing my concern about my voice, offered to use the smallest size tubing to help make less impact on the vocal cords.
I believe that at least some of my unease came from 'anecdotal' information about damage to vocal cords (especially for singers), which I probably didn't understand fully and certainly couldn't tell you the source for, and also from a lack of knowledge about intubation itself. As a pro-active patient who usually informs himself very carefully, I am surprised now at the degree to which I remained ignorant and fearful on this topic. Looking into it now, I see that vocal cord damage is listed in reputable sources as a possible result of intubation. But though there is cause for caution, I have no information about how often it happens or the degree of damage, and it’s possible that if I had researched it more deeply before the surgery, I still would not have been able to gather enough information to feel more confident about that aspect of the procedure. I believe I did what I could in expressing my concern to the surgeon and anesthesiologist, that they responded to my concern, and that I’ve come out the other side with no apparent damage done. But, there in the recovery room, coming out of anesthesia, I remained frightened and uninformed.
As I woke up in the ICU, I only became aware of myself and my parts gradually - so that, though I was awake at 7:30 a.m., I didn't realize I had a tongue until 9:30, became aware of the roof of my mouth a couple of hours later, sensed the length of my tongue a little later, and discovered the back of the pharynx later still. Like in those dental appointments of the past, I became aware of water, blood, or saliva that I felt I needed to do something with, but now didn't know what to do with it. I was afraid to try to swallow it because I knew that would force the vocal cords to try to close over the tube, since part of their function is to close off the trachea from anything being swallowed. It was only later that I learned of the balloon cuff near the end of an intubation tube which forms a seal preventing anything from getting into the trachea and the lungs (except the air flowing through the tube itself). At the time, I could feel the liquid rattle of something vibrating on my vocal cords – a deeply disturbing feeling, because I “knew” that meant I was in danger of breathing something liquid into my lungs. I couldn't cough it up and swallow it, and I couldn't do anything else about it either. Now, I understand that the cuff was preventing the liquid from entering my lungs – but I didn’t understand it then, and thought perhaps my breathing was compromised. I was able to write a note to the nurses about this fear, and they were able to set my mind at ease to some degree, though I still didn’t know about the balloon cuff. Also, when that liquid was present, the nurses would run another small tube into my other nostril and all the way down to the larynx (I think), where they could suction it out. My surgeon had carefully taught the ICU nurses how to do this when I came out of surgery (as Lorraine looked on), taking my pharyngeal flap into consideration and carefully maneuvering past it. I found that I could cooperate with this procedure by taking a very slow, careful, long breath and then coughing the liquid up, which helped collect it where it could be suctioned up more effectively.
As time went on, I began to notice that different events made me fearful and likely to tense up. Using my Alexander Technique training, I often gave myself directions to release the tension as much as I was able, and even at times to inhibit the inclination to tense in the first place.
- At some points while I was intubated, I felt like I was suffocating because I couldn’t breathe right. I had to settle myself down, think through it, and realize that the air was coming in through the tube, and that I had nothing to fear. I also had to inhibit any intention to phonate, and even had to inhibit a tendency towards curiously "checking" whether I could feel the tube anywhere. ("No, Adam, you really don't want to feel that.")
- I had a blood pressure cuff on, which tightened to take my blood pressure every hour on the hour. I don't like the feeling of a tight cuff anytime, and in the circumstances (as I was somewhat out of it) I wondered if the pressure was cutting off the blood to my arm and even somehow interfering with blood flow in my whole body.
- Both arms were restrained to the bed, as I had three IVs and the intubation, and it was important that I not inadvertently disturb any of them. Most of the time I was at peace with the restraints, but every once in a while I felt restrained and was disturbed about it.
- Throughout the night (after I was extubated), while I was trying to sleep, it seemed that every time I felt myself starting to slide into sleep, a monitor beeped near my head. A nurse invariably appeared within a few seconds, checked the readouts, and turned off the alarm. I was thankful to be under such careful observation, but wished the darn alarm would stop going off just when I was finally starting to drift off.
- My extubation (taking the intubation out) was a singularly unpleasant experience. I couldn't believe how long the tube was as the doctor drew it out of me. I don't know how you would prepare yourself for this. The (other) ICU doctor holding my hand comfortingly helped. It felt as if my soul was being pulled out of my stomach through my nose. (And Lorraine said it reminded her of the alien-coming-out-of-the-stomach scene in Alien.) Enough said.
In many of these circumstances I was able to calm myself in short order. But each occasion that I experienced panic or fear was exhausting, physically and emotionally. I have wondered if it would have been helpful for me to have known more about what I was experiencing in advance. Something like "Your Guide to Staying in the ICU!". Maybe that exists on the internet - everything else does - but I haven't gone looking for it, and certainly hadn't before the surgery. Well, as with other posts I've written, perhaps reading this will prompt a patient to ask questions in advance, and learn a few answers to help him or her find a little more ease during the recovery. All this said, I would like to affirm again - and briefly discard anonymity - to say that the ICU staff at Overlake Hospital in Bellevue were tremendously helpful, competent, and caring for me when I was there.
Dr. Adam Burdick has been a professional musician for over two decades. Teaching, conducting, and performing in various music genres, he is also a perpetual student with interest in a wide range of topics. He loves to ponder and share his discoveries with anyone interested!