When I Couldn't Eat Solid Food After My Traumatic Brain Injury

Salad. Especially salad. Salted and crisp. Painted gingerly with Thousand Island dressing with cherry tomatoes scattered like the drops of dew that condensate on container lids in the refrigerator. This is what I was barely able to see lying in wait beyond a counter that was almost tall enough to eclipse this beautiful image from my eyes. And yet, I could not eat it. I could barely see beyond the counter because I was in a wheelchair due to a several month long coma which caused my quadriceps – my thighs – to atrophy; in other words, while I was resting precariously in my coma, my thighs (with other muscles, I’m sure) were hard at work degenerating muscle mass for conversion into food. It wasn’t that the hospital didn’t feed me, it was just that the hospital didn’t feed me enough. I was fed through a tube inserted into my gastrointestinal tract known as a G-tube that pumped a calorie dense formula known as Nutren into my arteries.

Nutren isn’t really food – it’s baby formula, quintessentially. It is meant to keep be just enough to keep one alive; when I say it is “just enough” to keep you alive, I mean precisely that. For instance, when I was fed Nutren, my already slim body at 5’11″ was 10 pounds under the minimum weight I should have been. All of the bones in my back were on display; all of the ribs on my rib cage were present and accounted for in a twisted and contorted image. I was fed Nutren because I was involved in a nearly fatal motor vehicle accident on Route 3 in Hooksett, NH.

On Sunday, October 29, 2006, I was just coming back from a day of paintballing at a park about 40 miles away in Barnstead, NH. Ironically, I was complaining to my brother, who was driving the car that dreary and rainy day, to stop by Wendy’s to pick up a good amount of Jr. Bacon Double Cheeseburgers off the dollar menu. I often joke that food got me “shitcanned,” to a rehabilitation hospital; in other words, I attribute the cause of my MVA to my ardent love of a meal more than I could ever blame my brother.

Immediately after the MVA, I was sent to an acute care facility; the hospital nearest me. Medical professionals at this place performed a tracheostomy. In other words, I was not breathing on my own following the accident – I breathed through a plastic tube. When I awoke from my coma some months later, I couldn’t speak. Air couldn’t get to my mouth where it would be morphed into different words through the movement of my lips and tongue; the air came in and out of the trach, not the mouth or nose. And as unfortunate as it was not being able to speak, the trach came with the added bonus of not being able to eat. Super.

My life had become a silent movie; my lips would move, but no sound came out. To communicate, I had to spell my desire out word by word, letter by letter, including spaces, on something called a letter board, which is a sheet of laminated paper with the entire alphabet on it. This piece of paper became my method for creating subtitles, returning to the silent movie simile I used earlier. Even when I could communicate, I was still at the mercy of the dietician of the rehabilitation hospital. She determined the portions based on my weight, which was rather low when I was first admitted there on December 13, 2006.

I can remember the first thing I ate after I had my trach taken out. It was a 4-ounce container of chocolate pudding from a box of Hunts Pudding Pack. In the rehab center I was housed in following my coma, I attended speech therapy sessions. One tends to lose their voice when one undergoes a tracheostomy, and speech therapists assess and treat swallowing difficulties arising from a variety of causes, including acquired disorders after a stroke or injury. I remember the feeling of the pudding as it went down my esophagus – it was so cold. The chocolate flavor came after the temperature sensation. When my speech language pathologist finished spoon-feeding me – I could not feed myself due to my physical condition — I found I liked the temperature of food going down more than I liked the taste. For instance, when I was an inpatient, I enjoyed the cool temperature of a salad. I believe William Carlos Williams wrote a poem that articulates the feeling I’m describing better than I can ever express it:

I have eaten
the plums
that were in
the icebox

and which
you were probably
saving
for breakfast

Forgive me
they were delicious
so sweet
and so cold

I also recall a time in the rehabilitation hospital when I gained 40 pounds eating two frozen yogurts a day. I didn’t realize the saturated fat content was particularly high – I just liked the temperature and the way it felt moving along my esophagus. I didn’t have “normal people food” when I woke up out of the coma – I had to be eased into the transition thereof. First, I was placed on an all-puree diet – everything was placed in a food processor so I could swallow without choking to death on the only thing I loved at the time: food. Then next came a series of diets involving what size the food was – the next diet was a chopped diet. Everything was minced for me to eat. After that came the ground diet, which was basically the same as a chopped diet, but different. But then after that diet came a diet that allowed me to experience food the best way I could – cutting it into small pieces. Finally was the Holy Grail of diets – the coveted full diet – anything and everything was up for grabs.

It was the same way for drinks; I had to be eased into drinking them. The rehabilitation hospital used a drink thickener in my beverages so I wouldn’t aspirate, or choke on them. Why might one choke on something that goes down so smoothly? As a result of the plastic tubing from the tracheostomy being in my throat for so long – a tracheostomy is only supposed to be performed to keep a patient alive long enough to get to a hospital more personalized to their injury – my vocal folds developed paresis, or weakness. Simply put, with the vocal folds, it’s either you use them or lose them, literally. With paresis in my vocal folds, they only closed partially when creating sound, which gave me the voice that is now distinctly mine. To give perspective, I cannot be understood, or even heard sometimes, if there is background noise. The vocal folds are also used to direct liquids from going to the esophagus, and not the windpipe. Remember the idiom, of “going down the wrong pipe” when you drink something? I found the amount of drink thickener that the rehabilitation hospital put in my drinks wasn’t enough; it helped, but I still aspirated sometimes. So I took it upon myself to request something with my letterboard:

M
O
R
E
-space-
T
H
I
C
K
E
N
E
R

The LNAs understood and thickened my beverages to a slush-like consistency. It was so thick, an LNA had to spoon-feed me my drink.

Drinks in of themselves are not food. The food I was fed through the G-tube was not food. The food I was fed at the rehabilitation hospital was not food. I remember the first time I saw real food – the kind of food that is bad for you, but it tastes devilishly dark and delicious, as if it had been forbidden by God. I distinctly recall one time when I was still in a wheelchair and my parents came to visit. They wheeled me to the staff dining hall of the rehabilitation hospital I stayed at. I don’t remember much of that day, but what I do remember about that day in particular was my reaction to seeing food I was familiar with – golden brown French fries, chicken tenders, delectable chicken nuggets, juicy popcorn chicken – and how it seemed as if I had the power to rise up out of my wheelchair and walk to get something to eat. My mother says she’ll never forget the look on my face when I saw real food for the first time. The stench of fried food was overwhelming and pungently savory to the pores on my skin that seemed to be begging for trans fatty acids.

I also remember being infuriated because I did not wind up having any of the food I saw that day. Why tease me? At the time, it was beyond cruel to me. Now, seven years later, I look back on this particular incident with the notion of forgiveness – it really wasn’t that hard to forgive them. I realize now it was a terrible move, but in the scheme of things, it doesn’t matter. It takes time to forgive. Time mends all.

But then the damndest thing happened another day in inpatient rehabilitation. My parents wheeled me to the dining hall, got food, found a table, parked me nearby facing them as if to see my reaction to what they were going to do next. They proceeded to eat right in front of me! I’m not a fan of cursing, but when I saw that, I spouted off a stream of mental curses at the time (I still had the trach). What was going on? Why where they doing this? Had I died, gone to Hell, and as punishment for the wicked life I must have led to endure this twisted form of sadism? Very funny, God; good one. In Greek mythology, a strikingly similar thing happens to Tantalus in Tartarus: as his punishment for the life he led prior to his death, he sees fruit dangling above him from low-hanging tree branches, but they recede when he reaches for them. He sees water, but it rushes back when he goes to drink it. I felt his pain, or perhaps more accurately, I felt his hunger pains. I learned a few years later that I did not look conscious – that is, I looked as though I was brain-dead, although intellectually I was very much present.

This got me thinking about the nature of character, where it is said that character is who you are when no one is watching. In a sense, I wasn’t watching – I looked brain-dead. I believe my parents knew I was still me, but they chose to eat in front of me that day, perhaps assuming I was out-of-it at the time. I remember an argument I had with my father a few years later on the very same subject. He started talking to his friends about the vegetative people of the rehabilitation hospital – a number of them were in a vegetative state, or in other, more offensive words – “vegetables.” I consider myself a part of the vegetative community because medical documents around the time I was in a coma indicate I was in a “permanent vegetative state.”

People have the tendency to refer to people in comas or vegetative states as vegetables. It bothers me; by labeling them as a “vegetable” they take away the thing that makes them human: their name. Even our dead still have the privilege of being referred to by their name. During the argument, I distinctly remember him yelling, “You didn’t even know what was going on!” Suffice it to say that we all are different people when we think no one is watching. I include myself in this, but beware of being sure no one can see or know what you are doing. It just might surprise you how many can.