Tuesday, March 17, 2009
Oh, for trach's sake
I was standing over the kitchen sink Monday night, about to rinse out a syringe for a G-tube feeding, when my trach slid out of my throat and nearly got swallowed up by the garbage disposal.
My first reaction was: "Hotch cha cha cha cha! Now I know what I'm gonna write about for tomorrow's blog!"
The second thing that popped into my head was: "Gee, that lil' piece of plastic is helping to keep me alive. Something tells me it shouldn't just drop out of my throat so easily."
Actually, it wasn't the trach itself that landed with one end in the basin and the other sticking in the garbage disposal; it was the trach's inner cannula.
The cannula –not to be confused with cannoli, the pastry that the Mafia capo refuses to leave behind in the car after Rocco whacks Paulie in "The Godfather"– is the slim arc-shaped tube that fits inside the trach, and can be removed for cleaning.
A nurse at Kaiser on Monday offered to replace my trach after she tried cleaning it with a suction machine. She told me that the secretions in the trach were too thick, and that it would be best to start with a fresh one.
My old trach was the same one that was installed during my tracheotomy surgery in January. I had been cleaning the trach's cannula daily –occasionally a few times a day– but didn't realize that I needed to deep-clean the trach, too.
So I was grateful that the nurse could take care of that for me. And the nurse not only replaced it and the cannula, she attached the trach to a new collar and wrapped it around my neck.
After wearing the old collar for two months, the new one gave me an instant sense of freshness and renewal.
Why, I felt like a brand-new dog!
But the new cannula that the nurse slid into my trach didn't match the old one exactly. It didn't lock into place. Sooner or later, it was bound to fall out.
Like every other mini-crisis in my cancer odyssey, this one easily could have been worse.
What if the cannula had fallen without me realizing it?
What if the cannula slipped out in the shower, or fallen into the toilet?
What if I had lost it over a platter of cannolis? I could get whacked for pulling a stunt like that.
Fortunately, the nurse at Kaiser on Monday encouraged me to keep my original trach parts to use as spares. So I lifted the new cannula out of the sink and cleared my kitchen table for a session of D.I.Y. sterilizing.
Everything I needed was on hand. I've piled up enough medical supplies in my apartment over the past few months to outfit a small M*A*S*H unit, with all of the goods delivered to my doorstep by Kaiser's Durable Medical Equipment Department.
Kaiser would cut off my supply if they knew they were delivering their goods to what could pass for Fred Sanford's junkyard. But what they don't know won't get me in hot water, so I make do amid all of the clutter and dust bunnies.
By now, I've cleaned my trach enough times I can do it with a single hand and blindfolded, if necessary.
First, I snap on a pair of disposable nitrile gloves. I have a box of blue and a box of lavender, so I usually put on one of each.
The next step is opening one of my Tracheostomy Care Kits, carefully removing the brush, pipe cleaners, cotton swabs and gauze, and laying them on a sterile surface.
Finally, I unscrew the cap of a 500 ml bottle of .9% Sodium Chloride Irrigation fluid and pour it into the empty tray of the tracheostomy kit. I need a prescription to get my hands on this juice, and at 10 bucks a bottle, this product is about 10 times more expensive than the best bottled water on the market.
Once all of the tools are ready, trach cleaning is all about applying elbow grease.
I didn't want to toss out the brand-new cannula, figuring that the two-second rule applies to kitchen sinks as well as kitchen floors.
All the cannula needs, I thought, was a darn good scrubbin'. After soaking the cannula in the sodium chloride solution, I held the cannula with my purple hand and a small cleaning brush with my blue hand and got to work.
I forced the brush all the way inside the cannula. But when it emerged out the opposite end, the cannula's clear, round plastic cap popped off and spun across my apartment like a microscopic Frisbee!
After 10 minutes on my hands and knees, I finally found the cannula cap in my living room but I felt very queasy about its reliability. Rather than continue to clean it and pop it back into my trach, I figured I was better off just scraping all of the dried gunk off of the original cannula.
When I finished, I turned the cap of the cannula clockwise till I heard that reassuring click.
I looked up at the heavens and gave the Big Fella upstairs a thumb's up.
From now on, I'm gonna clean my trach –the cannula, the collar and the trach itself– with much greater diligence and not leave the dirty work to Kaiser's nursing staff.
And the cannolis? Eh, I'll leave 'em to Don Corleone's capo. I've got enough on my hands as it is.