It's Christmas. Eat!

I was working the graveyard shift out of Dysphagia Division. You know how it is before a holiday: the cases pile up, like rhinoceros waste when the zookeepers go on strike. There were so many concerns about people swallowing that I was getting choked up. No recourse existed, but to see all the people I could before being shooed away by managers for the Christmas time off.

I started the day shift (yes; I was asked to cover another shift) helping a lady eat, who was not aware she was having problems. The method was simple: present the spoon to her line of sight, wait for her to open her mouth and accept the utensil, then press lightly down into the tongue body as the spoon is being withdrawn.  The person served had the best chance to swallow her meal without clinical signs of aspiration (CSA). Staff were shown how to pace their feeding style to the strengths of the patient.

There was, then, a woman who was struggling after a diagnosis of cancer to get anything down, even liquids. All material were coming out of her nose, at least 75% of the time. First, the decision was made to change the liquid consistency from THIN to NECTAR, so that the patient might more easily maintain liquid flow in the pharynx. The patient also demonstrated 7 seconds mean duration for expiratory pressure, measured in "blowing bubbles" through a straw into a glass of water, with nostrils pinched shut. There was barely a 1 second duration of bubbles sustained, when nostrils were NOT pinched shut. Luckily this patient had been maintaining her weight through PEG tube feeding.

I barely had time to punch out, after the last case had been completed; dash to my car and head to the international airport, to make my flight to Cancun for the holiday.. Just my luck: someone at the table in the airport restaurant, while I was waiting to board, started to choke on a burger. Someone hurrying, just like I had felt myself hurrying all day to see these swallowing cases. Someone too pressed for time to be in the moment; to listen to her/his body and eat/drink within the limits of her potential. I suffered through the sensations of my own GERD, before talking to each patient about GI PEACE.  Heckuva job, swallowing police. It never stops.