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(Image courtesy of NHS Choices)

I’ve been wondering whether there is a link between tracheostomies and the more paranoid conspiracy hallucinations.

‘A tracheostomy is a surgical procedure where the surgeon creates an opening in the neck at the front of the windpipe (trachea). A tube is inserted into the opening and connected to an oxygen supply to assist with breathing. Fluid that has built up in the throat and windpipe can also be removed through the opening.’ (NHS Choices)

‘Nobody explained to me that I had a tracheostomy, I just thought someone had taken my voicebox out and that I wouldn’t be able to speak again…  Nobody actually put two and two together and said ‘you know, the reason you can’t speak is not because you can’t speak, it’s because you’ve got this tube…’ All I could feel was this thing – like a plastic tube round my neck. And I had these images of my little voice literally trapped in a box. Which effectively it was, if you think about it.’ (Interview with L)

‘Trachys’ are vital, but they are not benign. Often the procedure happens without the patient’s knowledge, whilst they are unconscious. In one case, no-one explained it had happened – ‘I thought I’d had my voicebox removed… It must have been about a week later they explained’. And the suction process to remove fluids can be a horrendous experience for the patient. Even the sound of it is disturbing to a listener.

But leaving aside the nastiness of the physical situation, if you add an inability to speak – to communicate – to the list of prerequisites for delirium (isolation, sensory deprivation, drugs etc) this seems in some cases to tip the hallucinations into a different zone; terrorists, staff attacks, bombs, car chases.

Finding a way of dealing with communication is something everyone I have spoken to refers to, directly or obliquely.

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