Tuesday, January 19, 2010


I'm not really sure when the "flop sweats" became a clue of anxiety for me. Any time my anxiety level starts to move higher than the five it normally is, I start to sweat (women perspire, men sweat). I've been sweating a bit lately. In my new life of leisure the most likely source of this sweating is Marty.

Over the last 3 or 4 days Marty has been hacking, coughing and wheezing a lot. Normally coughing is good for her. This coughing is hard, loud, frequent and probably painful. We have done all of the stuff we normally do: trip to the Great and Wise, blood drawn, steroid shot, sputum collected and being cultured. Now we wait and see what comes of the tests. It could be an infection, it could be exacerbated asthma from the coughing, or it could be a new thing we need to handle. We will see. In the meantime we treat the symptoms.

Treating the symptoms, easy to say. This entails more breathing treatment, steroids, chest percussion, nasal lavages (very gross) and worst of all deep suctioning.

I've written a bit about deep suctioning but I'm not sure I've ever really managed to quite grasp the ugly essence of this particular procedure. No one likes to do this, certainly not Marty. It's painful, its' uncomfortable, it's invasive in the extreme. You have to insist that experienced Respiratory Therapists do it or they won't because it is so uncomfortable. It is the only procedure done on Marty where I simply had to leave the room. I finally found a nurse to come to the house and she showed me how to do it. I now do it and the only person who hates it more than Marty is me.

First you need the equipment. You need a suction pump with all of the assorted hoses and canisters. You must have sterile gloves (not easy to find size large). You must have the suction catheters which are long, thin sterile tubes, 14 French for adults. And, of course, you need sterile lube.

After you get everything prepared, don the sterile gloves, stretch the end of the catheter a bit to soften it, you then coat the bottom end of the catheter with the sterile lube. Marty lies flat on her back, we have found this works best for her. The caregivers sit on the bed with her and hold her right hand. Marty insists that they stay and hold her hand and provide tissues. It's the only thing she really demands.

I then take the end of the catheter and slowly insert it into Marty's left nostril, the right side bleeds too much. This is where she starts to say, "Oh, Oh, Oh" and coughs and gags. The gagging generally gets a bit worse as I snake the catheter down, twisting a bit as I go, through the sinuses. If I meet any resistance at all, I stop, pull back slightly, twist some more, and continue to insert the tube trying not to scratch her throat or her sinuses. I push the catheter down through the sinuses into her throat with her coughing and gagging until I find some resistance, the epiglottis.

There we start a routine where I ask Marty to blow in my face as hard as she can. This process gets her to take a deep breath and open the airway. If I time it just right I can then get past the epiglottis as it opens and into the airway and start suctioning. I know the tube is where it's supposed to be if Marty's face starts to turn red, she starts coughing really hard, and sputum is sucked into the tubing. If I don't get it the first time, we keep trying until we get it. Marty and I do this like a practiced dance; we do it together and are generally pretty successful, it takes a long time and multiple tries to get it right. But, to say this whole process sucks doesn't really do justice to the invasion of the body.

Think about having someone cram a tube down your nose. Think about the times the Doctor has gagged you checking your tonsils and then multiply that level of discomfort. Think about having the wind knocked from you as you are trying to cough thick crap out of your lungs. Then ask someone who really loves you to do all of that to you. Maybe that's why I sweat.

Last night Marty was really having a hard time getting to sleep. I had basically avoided the whole suctioning thing last night hoping to wait until morning. I had asked Marty what she thought, she agreed, wait until tomorrow. About midnight she was trying really hard to clear her chest and lungs by coughing hard, over and over. We really couldn't wait until morning or sleep would never come for any of us.

We suctioned. She was tired, I was tense and it was harder and took more attempts than normal. It wasn't easy, but we got it done. After suctioning it always takes her a few minutes to get her breath back and for her to get her composure back. If she talks it's always very raspy and breathy. Marty looked at me, reached for my hand and said, "I love you very much." Trying not to tear up myself I said, "I love you too". It's a hell of a way to show it.

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