“Please, put my head up!” her mind desperately
cried out as she choked and gasped for air. She
couldn’t speak because a stroke had taken her voice
a few months earlier, so she pleaded with her eyes,
wide with fear, to anyone who cared to help.
Nobody did, not even when her body rocked
violently as she continued to strangle.
“Why is this happening to me?” But she already
Her body hadn’t been positioned in a 45-degree
angle and her lungs were filling with fluid.
“Please!” she mouthed again and reached out a
shaky hand for someone to give her assistance.
Luckily, my mother and I walked in, just as a CNA
rushed past us down the hall to attend another
patient. We stared in disbelief as she laid there,
wheezing and clutching her throat as mucus oozed
from her mouth. Horrified, I immediately called 911,
but pneumonia soon set in, then six weeks later,
Nannie, as she preferred to be called, was my
beloved grandmother and she had dysphagia, a medical
condition where the muscles of her throat were weak
and caused her to aspirate (inhale) food, water, or
saliva into her lungs. Because of the stroke, she
had difficulty swallowing, so solid foods were
pureed (blended or grounded into small pieces) and
her water was thickened to a honey-like consistency.
Whenever she ate or drank, her head had to be at a
90-degree angle and 45-degrees the reminder of the
time. When we entered her room that morning, she was
flat on her back.
This all began when my grandmother was sent to a
rehabilitation center for abdominal feeding tube
therapy. From the start, her head wasn’t properly
elevated while the feeding machine was on, and
incredulously, it wasn’t put on hold or turned off
when she was repositioned or changed. Only her
second day at the facility, Nannie aspirated.
How did we know? She had vomit on her
nightgown. Other symptoms of dysphagia include:
difficulty breathing, a gurgly or weak voice,
coughing; discharge from the nose, drooling, weight
loss, or burping. In some cases, there are no
obvious signs: what is referred to as silent
aspiration. In my situation, Nannie exhibited most.
When we reached the ER, the attending physician
said she’d definitely aspirated because the X-rays
showed a significant amount of fluid inside her
lungs. Unfortunately, it came as no surprise, for
we’d stressed the importance of keeping her in an
upright position at all times only to be ignored. As
a reminder, a nurse even posted a sign on the wall
directly behind Nannie’s bed.
The administrator had it removed. When we
asked why, we were told it was policy. A patient’s
medical condition couldn’t be made “public
knowledge” due to laws about confidentiality.
Understandable; nevertheless, I did see several
signs throughout the building.
“Oxygen In Use”
“In Isolation-Do not enter”
Why would one that
merely stated, “Please keep head at 45°”, which was
written by the charge nurse under a doctor’s direct
order, be any less significant?
Many elderly patients are unable to speak for
themselves, and family members are often
unavailable, so it goes without saying that CNA’s
(particularly new ones) would undoubtedly appreciate
a little reminder that keeps them and, most
importantly, the patient out of trouble.
heated discussion, the administrator hung it on the
closet door (on the inside, mind you), and assured
us the staff would know where to find the
They didn’t. Most of the
CNAs unintentionally forgot, so Nannie’s head went
down and her lungs filled up.
wasn’t dysphagia that killed my grandmother, but
human negligence. With simple precautions and proper
treatment (such as medications, exercises to
strengthen the throat muscles, or surgery),
dysphagia is manageable and often curable. It’s just
a matter of deciding which one will make eating
In the end, if my grandmother
had been treated less like a room number and more
like a person, she’d still be making me laugh with
her funny wisecracks. (“If it was raining soup, I’d
be stuck holding a fork!”)
Nannie may have left
this world lying on a bed, but in my heart, I know
she sped into heaven riding on her motorcycle. She
didn’t swallow her pride, but held her head up high
and that’s how I’ll always remember her.
Hall was born and raised in Virginia. She lives in
Boones Mill, a quaint town nestled among the
beautiful Blue Ridge Mountains. She has a Bachelor’s
of Social Work and used her advocacy skills to be
her grandmother’s caregiver and, most importantly,
voice. She’s happiest when she’s writing (and
drinking sweet tea).
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