Expectant mothers of course are renowned for extravagant flights of imaginative fancy long after the effects of the oysters have passed. The smell of frying bacon is said to be able to break even the hardest hunger strike: a fresh-baked crusty loaf would tempt the most ardent slimmer: and I am told that after eight pints of lager, thoughts of chicken vindaloo are all but irresistible.
But I find myself in none of these extreme situations: I am in an even more curious position, but one which appears to give a rare insight into the workings of the human appetite.
Following a certain amount of rearrangement of the plumbing of the throat and stomach recently after the discovery of nasty little cancer cells making their presence felt at the upper end of the oesophagus, I am in the gourmet situation of, quite literally, having my stomach in my mouth. It is cobbled (extremely skilfully, let me reassure you) on to the base of the tongue so that anything ingested meets the stomach lining immediately. This phenomenon appears to govern the appetite 'yen' demand in a way whose connection with pregnancy - or even lager-drinking - remains somewhat obscure...
The sudden demand of the yen in this situation lends itself to equally rapid satisfaction.
Cheddar cheese and pickle have never 'hit the spot' so accurately. The shining silver promise of a cocktail onion can be instantly released. A freshly picked tomato sprinkled with a little salt becomes the essence of a summer day. And a pint of suitably dark stout never even notices the stomach at all on its way to the liver.
But there are accompanying disadvantages to oesophagectomy. The stomach, dragged from its cosy spot under the left hemi-diaphragm and cobbled up to the base of the tongue is now squeezed into the confines of the mediastinum and certainly does not have the capacity to buffer eight pints of lager and a chicken vindaloo. A fairly thin sandwich, or a child's portion of a meal is about as much as it can take. And fullness of the stomach does not equate with repletion of the appetite. It is supremely frustrating, after the initial quenching of the yen, to feel hungry still, yet unable to eat anything more for fear of the dreaded reflux. You see, with little in the way of any sphincter at the top of the stomach, in view of the removal of most of the musculature of the throat, there is nothing except gravity preventing the reappearance of anything recently swallowed. Only once, whilst still in hospital, did I make the mistake of bending down to retrieve my slippers from under the bed. The effect was immediate and dramatic: never to be repeated...
The vagaries of Head 'n' Neck surgery interfered with various parts of the complicated nerve supply of what remains of my neck anatomy. The posterior third of the tongue was somewhat devoid of sensation. Those circumvallate papillae so beloved of worried mums peering into infant throats threatened never to work again. But gradually, and probably anatomically impossibly, taste has returned with a vengeance. Smell - so intertwined of course - is a little hampered by restriction of the flow of air into the upper confines of the nose: remember, there's a tracheostomy diverting all airflow directly into the lungs. But little wafts of flavour do reach the nose during the normal movements of chewing, so contrary to my initial expectations, and the warnings of the surgeons, eating is gradually becoming pleasurable once more, rather than a chore necessary to keep my weight up.
The total oesophagectomy left me without most of the vagus nerve. The vagotomy has interesting effects: gastric emptying has been helped by a pyloroplasty, but is variable to say the least. I wonder what happened to the sympathetic nerve supply during mobilisation of the stomach. That's probably gone too. Certainly acid is produced, so the thought of achlorhydria leading to B12 problems is no worry. The acid makes itself known in the middle of the night if I slip down off my several pillows. Neat gastric juice in the naso-pharynx cannot be taken lightly. It's bad enough in the mouth, and as for my long-suffering teeth, they're giving up rapidly.
However, I am delighted to find that eight weeks after the operation the black or amber liquid now appears to pass almost directly into the duodenum. But solid food can make itself unexpectedly known many hours later. It's just like my old Granny used to remark: "Cucumbers are no good to man nor beast: they talk to you for hours afterwards..."
But somehow, only 11 and a bit out of 12 cranial nerves seems a disability. I wonder if the remains of the upper reaches of the vagus would still produce a cough if the outer ear was tickled in the right spot, but that hardly makes up for the gastro-colic reflex. I see from my revision in the anatomy books that the vagus certainly extends into the proximal colon, so the reflex here can't all be mediated via the sympathetic system. In any case, mine's gone, and expeditions to the loo at unlikely times of the night have replaced a predictable morning visit...
Dr Alan G. Gray