Sneezing, coughing and yawning can offer surprises. To start with, sneezing is a complete waste of time, but the reflex is still there, so you just have to get on with it. I used to love a good sneeze... But with a 'trachy' it fails completely in its original purpose of clearing the nose of course, since there is no longer any connection to the nasal cavities. Yawning too seems to fail - in whatever its purpose was originally in evolution, since it gets no more oxygen into the system, and only just succeeds in opening the Eustacian tubes...
Coughing, and the cough reflex, is a problem. Sometimes, if there is a 'tickle in the throat', the tickle needs clearing by swallowing or drinking rather than coughing. And coughing without the explosive relief given by a sudden opening of the vocal cords is frequently less than satisfactory and at best sounds rather like a startled goose. At eight weeks after the operation there is still a fair amount of mucus to be cleared, needing a good supply of tissues. The ciliated epithelium of the trachea certainly does its job efficiently, and produces a uniform ring of mucus around the entrance of the tracheostomy. The makers of 'Super-Glue' might do well to look at the characteristics of this secretion: it is much more tenacious than you would expect...
Snoring: now there's a thought. My goode wyfe has put up with all the varieties of my snores; peaceful, fearful, passionate, just plain bored, for over thirty years. A permanent tracheostomy offers a guaranteed cure. Can we see private clinics making a fortune out of the operation? Hmmm.
I await with considerable interest my first cold. Sniffing just doesn't work any more. I suppose I can move a few cubic centimetres of air by depressing the base of the tongue and sort of snorting with the palate. But dew-drops on the nose are already a problem with the approach of autumnal mornings. And blowing the nose just isn't on any more: there's no air pressure to blow it with... A cold is going to offer quite a challenge to the makers of 'ultra-strong' tissues, or whatever is being promoted this winter with fluffy puppies or red-nosed secretary birds. Since I've not smoked since houseman days, I assume my bronchial tree is in excellent condition, and with the added benefit of the reduction in 'dead space' afforded by the tracheostomy, I should be able to continue with a good pair of lungs without the threat of bronchitis.
But coughing, as I've mentioned, leaves a lot to be desired. Let me digress for a moment. As it happens, I keep a pair of Chinese geese as watchdogs, and family friends. Sampson has just passed his 20th birthday. He and his daughter Hester are very vocal creatures. They tend to make their feelings very obviously known. During the time I was in hospital recovering from my list of -ectomies, they remained weirdly and stoically silent. Each morning my goode wyfe would let them out from the goose-house and prepare their morning feed. And they would stand and make little muttering sounds to each other. It was not until I emerged from hospital care that they started honking in earnest again. And when all I could do was make coughing-wheezing noises through the tracheostomy, old Sampson just regarded me with a beady eye and returned to his normal conversation. He seemed to think my goose-like cough was an advance on my previous attempts at goose-speak.
My human conversation is now accomplished by the quite extraordinarily simple - yet apparently almost unknown by most of the medical profession - use of a little buzzer gadget which acts instead of the vibrations of the vocal cords and enables really very effective speech using all the rest of the muscles of the mouth, tongue, palate and lips to form the words. It is the size of a small torch and is held against the base of the neck where the larynx used to be. A membrane on its end vibrates on pressing a button, mimicking the vocal cords, albeit only on a monotone. It produces a voice somewhat like a Dalek, and has an electrifying effect upon children, and a very useful effect on barmaids across a crowded bar which provides instant service...
So, denied the possibility of 'oesophageal speech' (I ain't got no oesophagus either...) this little gadget has returned me to normal society, even, rather surprisingly, over the telephone, though it does take a little getting used to. There is a possibility in the future of the installation of a Blom-Singer or Provox valve between the remains of the upper trachea and the oro-pharynx. By obstructing the outlet of the tracheostomy, air can once more be directed into the back of the throat and turned into a hoarse whisper of speech. But I understand that results with the stomach anastomosed to the base of the tongue, as in my case, are unpredictable to say the least.
I'm sticking to my little buzzer for the time being. The effect of my extra-terrestrial voice upon children leaving 'Star Wars' a few weeks ago in the semi-darkness of the cinema was wonderful to behold!
Dr Alan G. Gray