Hard To Swallow

Emergency colon surgery, complications from that surgery that ruined my legs, and a couple of life-threatening infections had quickly transformed extremely independent me into someone not very independent at all.

I’d been in a hospital bed for five weeks, just the start of three and a half months in medical facilities. Early on, a tube down my throat allowed me to breathe, albeit rendering me unable to speak. Bags attached to my midsection permitted me to evacuate myself without conscious thought. My motor skills were shot; suddenly being unable to write was a rather rude awakening for a writer. I could not walk and would not be able to, with the help of prosthetics, for another 4.5 months. And I received all my nutrition via an intravenous tube.

Week six, deemed more stable, I was transferred to another hospital for further recuperation. Weaning me off the nutrients IV became an important goal. Illness had caused me to drop about 35 pounds. Pre-hospitalization, my shorts started falling off, even with my belt pulled to the last hole. So I knew something was wrong. And now I was downright gaunt. The path to normal eating would be: clear liquids, then pureed foods, and finally, solid foods. Sounded pretty straightforward.

But first I had to remember how to swallow.

I was assigned a speech language pathologist. The throat tube had been removed, and my ability to talk had returned. So why a speech language pathologist? To improve my Liverpudlian accent? Turns out that swallowing, and swallowing disorders known as dysphagia, also fall under the purview of these specialists.

She placed a finger to my throat and asked me to swallow. Which, theoretically, should not have been a problem. Had been swallowing all my 47 years: food, liquids, my pride, etc. But now, summoned to deliver a command performance, I choked. (Don’t worry, not literally.) It was just that… nothing happened. She asked me to try again. Still nothing. I desperately tried to remember how to do this. Could I fake it by saying “gulp”? It was frustrating and scary. Had I lost the ability forever? Would I be connected to an IV tube forever?

The pathologist said she’d return the next week, and we’d continue to work on it. My friend Ilmar who was visiting suggested that I pretend I was drinking a nice cold beer. Which I certainly could’ve used right about then.

One thing about me is that it really annoys me to fail. (Oh, you too?) Which is not to say that I don’t fail; I do on a regular basis. And I suppose sometimes I actually don’t mind failing, because it makes for a better story. But I dreaded failing in front of the pathologist again. So I practiced, and practiced, and practiced. Pretended, pretended, pretended. Ah, this imaginary beer sure goes down smooth. And then suddenly, something clicked. Some throat muscle decided to show up for work that day. I didn’t know if it was a swallow, but it was… something.

When the pathologist did return, finger again to throat, she was impressed. “You’ve been practicing,” she surmised. I must admit, I was proud. But I couldn’t gloat for long. A yogurt-like substance she had me try made me cough and tear up. I still had a very long way to go.

And then came George. He was another speech language pathologist. George was a young fella (though in my 40s, everyone seems young), clean cut, dark hair, with dark-rimmed glasses. George was bright and exceedingly pleasant. Nothing against the female pathologist; she’d been very helpful. But to me, George seemed like a white (lab-coated) knight riding in to save the day.

I noticed an interesting thing about myself while hospitalized. In those early weeks, I was variously catatonic, confused, depressed, angry, and exhausted. But when visited by anyone clever, anyone who I admired, I tried like hell to summon my old Jackness. To be my sharp, witty self, albeit with insanely unkempt hair and whiskers, and in a hospital gown. George immediately inspired this “best possible me” behavior. I wanted to make him laugh. I wanted to be a fellow smart guy.

Maybe it made me a better student as we worked through pureed items. It was not a style of food I’d experienced since the Gerber days, and I found it incredibly bland and uninspiring. There were an exception or two; applesauce suddenly became the most delicious thing I’d ever tasted in my entire life.

George introduced a methodical approach that I found quite appealing. Take a bite of food, then take a sip of water to help wash it down. Then take another sip of water to catch anything I might’ve missed. Food, water, water, repeat. Nosh and rinse.

George did not suggest this next part, but I began visualizing the scene inside my mouth, in pretty abstract terms. I pictured a hole on the right back side of my mouth. My goal was to get the food in that hole. And then flush it down with water. It was a game of sorts.

One day, at the end of a particularly successful swallowing session, George said he had a surprise for me. I hadn’t been cleared for solid food yet, but, he figured I was ready…. George pulled out a packet of off-brand Nilla Wafers in one hand, and a packet of graham crackers in the other. Which would I like? Solid food! Cookies! My eyes widened as I attempted to suppress a huge smile. Play it cool, man. I tried to be my old your-needs-are-more-important-than-mine self: “Oh, whichever you have more of is fine with me,” I ho-hummed. George indicated that he had plenty of both varieties. “Nilla Wafers then,” I replied immediately. I was soon ripping open the package, taking a bite of cookie, taking a sip of water, taking another sip of water…. I was delighted. I was eating. Nilla Wafers replaced applesauce as the most delicious thing I’d ever tasted in my entire life.

Soon enough, I was approved for solid foods, and I strictly adhered to George’s methodology: bite, sip, sip. I became obsessed with having a full pitcher of water on my tray at mealtimes. “I need water,” I’d anxiously tell any number of nursing assistants. “I can’t eat without it.” I had to cut my food into small pieces, and sometimes I needed help with this, due to leverage issues. It’s humbling to be a 47-year-old and have someone cutting your food.

My appetite wasn’t much, and just the process of eating would really tire me out. This was quite frustrating for me as well. Though by no means a foodie — I’ve always been far too picky for that — I’ve had a lifelong love of food. When I was a little tiny guy, at the Catskills hotel my family ran, I remember my grandma Anna saying over the loudspeaker, “We’ll have hamburgers just like McDonald’s makes, which Jack loves so much.” As I grew to adulthood, I became known for having a bit of a cast-iron stomach. (Who else among you would eat “three-way chili” at the Cincinnati airport just before boarding a flight?) Friends on social media came to love my before-and-after photos of a specialty food item, and then a totally empty plate. And for several years I wrote roadside restaurant reviews for the New Jersey section of the New York Times.

Now it was back to square one. It would take time, bite by sip by sip, before I could eat bigger pieces. Before I could finish more than half of the food put in front of me. (Maybe hospital food wasn’t the ideal medium to train with.) Before the nutrients IV was finally removed from my arm. Before the process of chewing, swallowing, and eating became automatic once more.

When I was a little further along in my healing, my physical therapist accompanied me as I maneuvered a wheelchair down the hospital halls. By the nurses station was George — the glasses, the lab coat, the works. I hadn’t seen him in weeks, and I truly felt like a new person since last we’d met. There was so much I wanted to say, yet I could only manage a meek hello. I felt a bit embarrassed. He’d been there for me when I was so vulnerable and afraid. George was so patient and caring with me, and I have so much appreciation for him. Can never thank him enough. George taught me how to eat. It’s a wonderful gift.