A Fox Lake Blog

Learning To Breathe On My Own

Terrifyingly I actually already knew that the above heading was a song title by Nerina Pallot, which only goes to show either how full of utterly random junk my brain is or an extremely questionable iPod collection – possibly both.  If you google this phrase (and I have – no stone left unturned on this research front) you will find that it is indelibly associated with freedom, independence and a oneness of body and soul.  It is also portrayed as a peaceful and enjoyable experience.  In my case this is half true.  Attached as I had been to a) one half-hearted ventilator, b) one over-enthusiastic ventilator and last by by no means least c) one murderously silent ventilator that kept trying to kill me, the concept of literally learning to breathe on my own definitely heralded freedom, independence and the inevitable mixed emotions inherent in parting from the dessert spoon that had saved my life.  It could not, by any stretch of the imagination however, be described as ‘peaceful and enjoyable’.

(It wasn’t the most painful experience I had in hospital though.  That honour was taken, by some considerable margin, by the experience of having my hair brushed after being in the ICU.  If I tell you that its competition includes having holes drilled into my skull, inserting screws and hanging weights from them to put my neck into traction and straighten it out, that might give you some idea of the scale of the pain. Two weeks of lying down, thrashing my head about and sorely neglecting my grooming routine left my hair tangled, knotted and matted with God knows what.  No less than three members of staff descended on me armed with comically named ‘detangling’ combs in one hand and bottles of some kind of unguent in the other.  I was liberally squirted with liquid and then they set to.  Out of the kindness of their hearts they were trying to save me having to have the whole lot shaved off but after three or so hours of having my hair tugged and pulled my scalp was screaming and I would have willingly waved goodbye to the whole bloody lot if – as ever – I had been able to speak and make my wishes known.)

The first attempt in removing me from a ventilator actually came very shortly after the accident.  Before I had gone into the op to stabilise and rebuild my neck, I had been able to breathe unaided – hence why I had survived the 24 hours between hitting the ground and being wheeled into theatre.  Intubation from the surgery was not a viable long-term solution so I either needed to go back to breathing solo or go back into theatre to have a tracheostomy.  The attempt to do the former was carried out with military efficiency and a corresponding military ‘cuddle factor’. Drugged up to the eyeballs I was roused from my induced coma, someone loudly instructed me that I was to breathe and, without further ado, my tubing was pulled out.  I tried to suck in air.  Nothing.  I tried to suck in air again.  Still nothing.  I sat with my mouth comically opening and shutting like a landed fish to much the same effect.  “Come on, come on.  Breathe!” admonished the consultant on duty as though I were merely being recalcitrant in failing to supply my lungs with critical oxygen. “Try harder!” he instructed.  I miserably failed again.  The consultant tsked at me and unceremoniously the tubing was shoved back down my throat.  

As it turned out, operating on or around the spinal cord, however carefully done, can cause more trauma and shock post surgery and this is what happened to me.  I went in able to breathe, move both arms and use my right hand.  I came out completely paralysed from the neck down with both hands curled into unusable fists.  The day after my landed fish impersonation a hole was cut into my trachea through my throat (the aforementioned tracheostomy) and the ventilator tubing attached to that rather than being through my mouth and down.  I can report though that this was done with anaesthetic and a scalpel by a proper doctor and not violently with a Bic biro by an untrained but yet bizarrely knowledgeable action protagonist like in most movies.

Cut to nearly four weeks later and it was time for take two.  This version was hugely aided by the fact that I was now fully conscious and grimly determined to rid myself of my ventilator.  My one ambition in intensive care had been to be able to take a lungful of air – it’s extraordinary not to mention sobering how much the horizons of your desires contract in extremis – and I hung onto this thought as the nurses prepared to disconnect me intentionally this time.  The plan was that I would build up my capacity in five minute segments twice a day meaning that, on the first attempt I had only to manage for five minutes with a nurse right beside me.  As it turns out, the secret to learning to breathe on your own is to not try too hard.  It might not look great on an inspirational tea towel but it is effective.  Calmer and under control in a lit room, I found that I was able to breathe very shallowly as long as I didn’t get panicky or greedy and try and suck in too much air.  The panic however still hovered at the edges.  Trying to activate intercostal muscles that had not been used for weeks was exhausting as was employing the willpower required.  I lay grimly watching the clock on the opposite wall tick away the slow minutes, determined not to give in early but also very eager to get to the end so I could stop. 

The rest of the week went the same way and by the end of it I was happily disconnected from the ventilator for more than half an hour twice a day.  I then upped the ante, jumping straight to an hour as my next target.  I was spurred on by the news from a consultant that, on average, this process took around three weeks before people could breathe unaided all day so I worked hard – if sucking in air grimly whilst watching a clock can be classified as ‘working’ – to get to the full day goal in under two weeks. There was also one other major advantage to being able to inhale on my own – at least, to me if not anyone else – I got my voice back.  This was done by means of what’s known as a ‘one-way speaking valve’, an accurate term in my case as, once I started talking again after nearly a month of enforced silence, no-one else was getting a word in edgeways.  However, the ‘one way’ bit is supposed to refer to the fact that the valve only opens to let air in.  When you breathe out, the valve closes thus forcing the expired air to pass out the only other available exit – up the trachea and over the voicebox, enabling speech.  It doesn’t look like much, resembling a type of grey, plastic plug that goes into the tracheostomy hole but oh boy did it mean a vast amount to me.  Not only did it restore my power of speech but as well as my similar inability to negotiate stairs, it gave me a voice like a dalek.  In these creepy tones I immediately took to cross-examining my mother (who happened to be the first unfortunate visitor present when they put the valve in) as to just what the hell had happened to me since I fell off the horse.  I was astonished to find that I had effectively ‘lost’ three weeks of my life and that we were now well into August, disappointed to learn that there had been no party in the ICU involving plastic bananas and a giant pair of scissors (or so she claimed), heartened to be able to actually start reasserting a tiny amount of control over my circumstances and vitriolic about the food.  The speaking valve also helped enormously with my breathing exercise since whilst rabbiting incessantly I stayed distracted and relaxed so the time off the ventilator flew by.  No doubt my interlocutors had an inverse experience and I suspect that some may have entertained thoughts about hiding the valve at times but, in my defence, I did at least demonstrate a greater conversational range than Clucking Man, if not his sense of timing and occasion.

Unfortunately all this chatting and breathing did not mean that I could remain off the ventilator overnight – sleep apnea is common with cervical injuries and I was too much of a newbie at this breathing lark to be allowed to stay nocturnally unconnected for another week.  I WAS, however, able to bid goodbye to the spoon at this point.  I’d like to tell you that we had a small party with champagne in paper cups and an impromptu speech encompassing the spoon’s best bits but what actually happened is that, much like a dodgy ex-boyfriend, it didn’t get bandaged into my hand one night and disappeared without trace, leaving no forwarding address.