Aphasiac

Chapter Thirteen

Nelson Residence

Dr. Jonah looked very at home and relaxed in his casual khaki pants and plain button-down shirt. He had accepted the juice and muffins Paula offered him with a smile. They sat in the Nelson's living room, laughing and talking like old school friends at a class reunion.

The fun quickly turned to seriousness when Paula brought up the baby. "How did our baby get cancer?" she asked.

"The possibilities are endless. It could be in your genes or something from the environment. In experimental animals cancer can be produced by many aspects including certain chemicals, hormones, viruses, and radiation so it's possible any of these could have had to do with it. Tobacco and alcohol seem to be big causes as well. Do you smoke or drink?"

Paula shook her head.

"Those are the top two causes of this kind of cancer," Jonah told her.

David entered the conversation. "Can you explain why the baby will have no voice?" he asked.

"We're going to have to perform total laryngectomy and without a larynx a person can't speak. We call this aphasia."

"How does the larynx control the voice?"

Dr. Jonah pulled some papers out of the briefcase beside him. Diagrams. Paula and David moved to sit beside him so they could see. He pointed as he talked. "This is the larynx: the cartilaginous voice box between the root of the tongue and the windpipe in the front. These two yellow bands here are the vocal chords. They are elastic tissues stretching across the inside of the larynx. These tissues can open, close, stretch, and shorten producing sounds of various pitches. During speech the two vocal chords come together, leaving just a small space. When expired air strikes the chords they vibrate and produce speech."

"So, our baby won't have any of that?"

"Right." Dr. Jonah circled an area on the diagram with his finger. "We have to remove all of this. No voice, no crying, no loud screaming in the middle of the night."

"If the baby can't cry out loud, how will I know when it's hungry?" Paula asked.

"You're going to have to make a feeding schedule. In the beginning you'll have to do it every two hours during the day and at least once in the night, probably twice. Eventually the schedule will adjust to your baby."

"Is the surgery dangerous? Could the baby die?"

"We're all mortal, Paula," Dr. Jonah said, "but it's not at all probable. When laryngectomy was first performed in the late nineteenth century most of the patients did die. But now, with good anesthesia, control of infection and better techniques, even unfit patients can tolerate the procedure and make a good recovery. There is a very low mortality rate. Your baby is perfectly healthy aside from the tumor, so I don't think you have anything to worry about."

"So, after the operation it's over?"

"No. It will be necessary to fit your child with a tracheostomy filter."

"A what?"

"Tracheostomy filter. Patients without a larynx inhale unconditioned air. This filter will work almost like the real thing."

"Is it hard to do?"

"Paula, you have nothing to worry about. My life is about this stuff. You're dealing with a professional." He winked, took another muffin off the tray, and pealed the wrapping off. "If you're concerned I could find you a video about the process. It's all very simple."