Launching Lifesavers w/ M. Elwer

Let’s be honest: as candies go, Lifesavers seem innocuous enough. A sugary halo of nostalgia, lightweight in both texture and guilt. Five calories apiece, maybe. Small enough to forget—unless you’re a speech-language pathologist trying to teach a man how to cough again. This was no ordinary coughing session. This was Mr. H., a retired jazz pianist with bulbar-onset ALS and the wry humor of someone who’s played too many smoke-filled clubs to take much seriously anymore—including me. And yet, there we were, him eyeing me suspiciously as I held out a single cherry Lifesaver and said, “Put this in your mouth. Don’t chew it. Now blow it across the room.” “Blow it?” he croaked, eyebrows rising so high they almost met his hairline. “Lady, are you trying to kill me or save me?”

Honestly, I didn’t know the answer to that in the moment. It was absurd on the surface: giving hard candy to a person with a compromised swallow? In most clinical scenarios, this would have been malpractice, if not suicide. But desperation and science often meet in strange places—and this was one of them. Research had emerged—Plowman and colleagues again—suggesting that expiratory muscle strength training (EMST) could preserve, and in some cases even improve, cough and swallow function in early-stage ALS. The concept wasn’t new, but its application was still uncharted territory. We weren’t chasing miracles—we were chasing milliseconds of preserved function. And sometimes, milliseconds matter. So yes, we launched Lifesavers. I set up a towel runway on the tile floor, marked by neon tape. I positioned Mr. H. comfortably in his recliner—spine neutral, head resting back, feet planted wide like he was bracing to play a power chord. The goal wasn’t candy ejection, per se—it was abdominal engagement. Diaphragm activation. The art of a well-supported cough disguised as something playful, even ridiculous.

“Take a breath into your belly,” I said, miming the expansion with my own hands. “Now—BLOW HARD. Send it flying. You can’t let this candy beat you.” He rolled his eyes. Then he blew. It went about six inches. We laughed. He cursed. We tried again. By the sixth attempt, the Lifesaver hit the tape. By the ninth, it cleared it. On the tenth? It ricocheted off the coffee table leg like a tiny red puck, earning a fist pump and a raspy cheer from Mr. H. And then—something extraordinary. As I leaned down to retrieve the candy, I heard him say, almost clearly: “Don’t waste a good one. That was cherry.” It was the first spontaneous, intelligible sentence his wife had heard in weeks. You can’t always measure success in meters or milliliters. Sometimes, it’s measured in shared laughter, a candy skimming across the floor, or a whispered flavor preference breaking through the fog of disease. Sometimes, what looks like nonsense is the deepest kind of therapy. And sometimes—just sometimes—spitting candy can help someone reclaim their voice.