Every Note Played(37)
The muscles of his tongue and palate have further atrophied, making them weak and lazy. Most dangerous, his epiglottis is slow to close off his larynx while swallowing, which means that food can be aspirated into his trachea and lungs. This is what likely happened with the makowiec on Christmas Eve. While liquid milk shakes won’t lodge in his windpipe like poppy-seed cake, they can drain down the wrong pipe and drip into his lungs, causing aspiration pneumonia. Anything that goes into his mouth now could easily kill him.
Not yet ready to surrender to dying, he surrendered to a feeding tube. He had the surgery the day after Grace returned to school. The twenty-minute procedure was straightforward and routine for his surgeon. Dr. Fletcher fed an endoscope through Richard’s mouth, down his esophagus, and into his stomach. He then threaded a thin plastic tube through the scope and out a small hole incised in Richard’s abdominal wall.
Karina waits a good ten minutes after the first 250 cc for his stomach to settle before delivering the rest. When given too rapidly, he gets too full too fast, nauseous, and vomits. Liquid Gold has a foul, acidic, nutty flavor on the way up that makes him cringe just thinking about it. That stuff was never meant to be tasted. Thankfully, Karina takes her time.
When Friends is over and the final food syringe is emptied, Karina dissolves his evening meds in water and delivers that through the syringe as well. The water feels cool and refreshing and weirdly quenches his thirst without ever touching his lips. She then flushes the tubing two more times with water, recaps the MIC-KEY button, and lowers Richard’s lifted shirt. There. Done with dinner or his nightcap or his feeding or whatever this is called. His stomach is now filled with five hundred calories in a half liter of liquid. He can’t say that he’s hungry, but he’s hardly sated. Although the service was impeccable, he’d give the meal itself a one-star Yelp rating.
He remembers when he first started touring, he ordered steak from room service every night. By maybe the eighth or ninth night, he couldn’t stomach even the thought of one more steak. He’d had his fill. He ordered pizza and didn’t touch another steak for months. The only item on the room-service menu now is Liquid Gold, every meal for twenty-three days straight and counting. What he wouldn’t give now for a medium-rare dry-aged New York strip.
He tries not to think about food. For one, it’s torture to imagine what he can never again have. Second, like Pavlov’s dog anticipating the steak his master is about to plop in its dish after the bell is rung, remembering food makes Richard’s mouth water. While the PEG tube eliminates the potential threats of eating and drinking, he still has to contend with his own saliva, which, like any liquid, can go down the wrong pipe when swallowed.
Even with the help of the glycopyrrolate, his drool, which has for some reason become the consistency of Elmer’s glue, is constantly accumulating, either spilling over his bottom lip and hanging from his chin in shimmering, stringy ribbons or gurgling at the back of his mouth. Thinking about steak turned the faucet on. He’s gurgling.
Karina flips on his new suctioning machine, pokes the wand into his mouth, and slides it around in there, vacuuming between his teeth and gums and under his tongue, slurping up his excessive spit, drying out his flooding mouth. He feels like he’s at the dentist every time she does this.
The second big discovery at his clinic appointment was the treacherous state of his breathing. His forced vital capacity, the amount of air he’s able to forcibly exhale, was down to 42 percent. Over the past three months, he’d started to notice that he was regularly out of breath when walking from room to room, that he had to pause every four or five words when talking because he was out of air, and that he was speaking only on the exhales.
“Are you waking up throughout the night?” asked his doctor.
“Yes.”
“Are you starting the day already fatigued?”
“Yes.”
“And do you have a headache when you wake up?”
He did, almost every morning for weeks.
“You’re hypoventilated during the night. You’re not getting in enough oxygen, and you’re retaining too much carbon dioxide. I want you on a BiPAP.”
He had no idea that his insomnia and morning headaches were due to a continual lack of air throughout the night. So now he sleeps with a mask attached to a machine by a long tube. It’s ten o’clock, and the only thing left on his exciting daily itinerary is getting hooked up to the BiPAP.
Karina fills the humidifier and plugs it in. Richard watches her weary but focused eyes as she works. She applies Vaseline with her pinkie to the many raw sores on his face. The moist air and prolonged contact of the mask against his skin every night have caused it to break down, creating a painful rash. He tried switching to nasal pillows instead of a full-face mask, but he couldn’t keep his mouth closed while sleeping and found wearing the chinstrap to keep it shut too aggravating. So he wears the full mask and endures the sores. Karina wipes her hands on a towel, turns the BiPAP on, then secures the mask over his nose and mouth.
The relief is instantaneous. Initiated by his own inhale, air is forced in. His lungs fully inflate, and his rib cage expands. When he exhales, the machine inverts the pressure, and air is forced out as if his lungs were a pair of bellows and the machine were pressing the handles together. Every night, in this moment when Karina seals the mask onto his face, he realizes exactly how labored and shallow his breathing has been all day, as if he’s been wearing a tight corset around his lungs since morning and Karina finally released it. With the mask on his face, he breathes an abundant flow of sweet oxygen in and carbon dioxide out, and a deep tension lifts out of his body like steam rising off a hot cake. He won’t suffocate in the night.