*Primary Progressive Aphasia, a degeneration of the part of the brain that affects speech.

Tuesday, June 5, 2012

The Screening Room

“Looks good!” says the speech pathologist. She is viewing an x-ray of my husband’s head.

I’m watching the same picture. A second pathologist, on the other side of the wall is giving Tommy instructions. He is compliant.

An apparatus is pointed at him as he swallows a spoonful of stuff. The viewer and I watch the screen as a snake-like strip wriggles unimpeded from his mouth to his throat and down into his esophagus.

“Next!” she calls out beyond the wall. The feeder nods her head.  She dips a spoon into a plastic cup and offers my husband another dose of barium-laced food.

These doctors have assured me the amount of radiation used in this test is small and not harmful, and will only take about 10 minutes. I am happy to hear this because I can see Tommy is antsy.

“Are you comfortable?” the feeding pathologist asks my husband. He nods “yes” but soon rises from his chair to see what’s going on behind our wall.

“No, no, sit down,” the two doctors shout as the screen suddenly blanks.

He sits, then looks straight at the machine that is targeting his head. The feeder offers my husband another spoonful -- thicker this time --  while the viewer and I turn our focus back to the x-ray.

“Good,” she says.

With each “good,” my hopes rise. If  Tommy gets all “goods” it will mean he, and I, will be saved from moving to a new, and unwelcome path in caregiving. If he flunks this Cookie Swallow Test, I’ll be directed to change his diet. I’ll be forced to blend his food, monitor consistencies of each dish, and have someone at his side as he eats.

With each swallow, I teepee my hands in prayer because I also wish to keep my husband from sliding further down the role of “patient.”

This test was initially sparked by a a conference for caregivers. When a nurse reported a case of a choking, I thought, Tommy sometimes coughs when he eats, is this “choking?”

“Slow down” became my new command at the table. “One bite at a time,” I’d say.

I tried to explain. “Honey," I said, "that condition that makes it hard for you to speak might mess with your swallowing. I don’t want you to choke. Please chew and swallow before you take another bite.”

In long-distance calls to my daughters I confessed, “I hate this. It’s taken all of the pleasure out of eating.”

“Think of the alternative,” they said. “Tommy choking, you trying the Heimlich, you panicking. Is that what you want?”

“No,” I said. “I’ll talk to his doctors.”

Although they discounted the nurse’s report, and said they’d never heard of a patient choking, the doctors concurred a Cookie Swallow Test might be a good idea.

So here I am watching Feed, Swallow, Wriggle, Smooth Passage. As the spoonfuls proceed, I think about our mealtimes, which until recently, had been a peaceful part of our day.

Ten years ago Tommy and I tried vegetarianism. Our switch came after hearing friends credit their improved health and energy to their plant-based menus. And, after reading "Diet For A Small Planet," our own mantra became, "nothing with a face," and "nothing that has a mother."

I lasted six months. A diabetes test (it runs in my family) convinced me the amounts of carbs I'd been consuming -- primarily pasta -- put me at risk. And even when the results turned out to be false, I admitted I longed for forbidden foods.

Not Tommy. He has remained a vegetarian since his first bite of tofu. He never complains nor envies when I'm downing fried chicken or burgers. He happily eats his vegetarian meals, including those plucked from store freezers and microwaved.

“He did fine,” says the speech pathologist. She is happy, too. My attention snaps back to the x-ray.  “I don’t see anything that would cause me to suggest a change of diet.”

“His coughing?” I ask. “What about that?”

“Not a problem,” she says. “In fact, tell him to clear his throat occasionally. That helps the food go down.”

I race around the wall and grab my husband. “You passed, Honey, you passed!” I say, elated as the parent of a Harvard grad.

That evening at the dinner table, Tommy and I indulge in a guilty pleasure we've enjoyed throughout our marriage: we disdain talk in favor of watching television.

Now, as we dig into our dishes: soy meatballs and spaghetti for Tommy, take-out rotisserie chicken for me, we fix our eyes on the set and a Law & Order re-run.  The only words, the only commands, come from the screen. 


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