So There I Was...

Setting up patients for radiation treatments to the head and neck must be done very precisely. There are so many critical structures in the area that if targeting is off even by millimeters, the effects can be devastating. To keep this from happening, the patient must remain completely still during treatment. This is achieved by creating a device called a mask that is custom-made on the patient’s first visit. The mask is comprised of a frame and plastic netting, which is heated and molded to the patient’s face and neck as they are lying down. The frame of the mask is locked down to the table and the netting hardens and conforms perfectly to the patient’s anatomy. Treatment marks are then placed on the mask to further ensure set-up accuracy during treatment. Once the mask had been made, it is used on a daily basis throughout the course of the patient’s treatment.

Mr. Johnson was smiling as usual when I brought him back to the treatment room one Wednesday morning. My co-workers, Shelly and Kevin, had already gone into the room to set things up and were standing on the opposite side of the treatment table when we walked in. Mr. Johnson started coughing a little bit as I motioned for him to sit down on the table. Concerned that he might have a coughing fit as he lay locked down to the table, we asked him if he was okay. He gave us a thumbs up, so I asked him to go ahead and lay down. Shelly put his mask on and locked it down securely. We moved the table into the treatment position and began lining him up. He coughed yet again, and this time you could hear a little rattling from down in his chest through his tracheostomy. Kevin asked him if he needed to sit up, but he gestured that he was fine.

We began making our final adjustments and were getting ready to turn around and walk out of the treatment room when Mr. Johnson really started coughing. Since the mask was already fastened down, his head remained still as his body bounced up and down on the table. A fine mist started sprayed forth from his tracheostomy, accompanied by a hissing sound and more rattling with each cough. There was obviously a giant collection of muck down in his chest and it needed to come out badly. Recognizing that he desperately needed to sit up, I reached over towards his mask to unlock it as quickly as I could. Just before I was able to unfasten the last lock, there was a mighty cough followed by a small eruption. The head of a loogie bubbled up from the tracheostomy but then quickly disappeared.

The look of horror on Shelly and Kevin’s face was priceless. They both had weak stomachs for sputum and I could tell they were about to gag. They stood back fearing that another eruption was eminent.

As I tried again to release the last latch, a really intense gurgling started from the tracheostomy. There was no time, I had to go on the offensive a major eruption was about to take place. I turned around, reached for the laundry cart and grabbed a washcloth. Then it happened, all in slow motion. Mr. Johnson’s chest heaved, he hacked violently and with a geyser-like sound, a gigantic yellow glob spewed forth from the tracheostomy. It launched two feet straight up into the air. I could see Kevin gagging and Shelly go down to the floor.

With my lightning fast reflexes and washcloth in hand, I lunged for it as it sailed. I felt a thrust in the washcloth as it met my hand in mid-air just before it peaked — Victory was mine! I had stopped it from returning from whence it came and it would terrorize this man no more! The loogie was not going home: not on my watch!

As I surveyed the room, Mr. Johnson was now breathing normally and lying still on the table. Kevin had his head in the trashcan puking and there was no sign of Shelly. When the table is raised to treatment height, there is actually enough room for someone to crawl underneath. That’s exactly where Shelly was. I looked down through the clear Mylar sheet on the tabletop and could see Shelly’s eyes wide open, staring up at me.

I tried, but I was having a hard time controlling my laughter. To make matters worse for Kevin, as he pulled his head up out of the trashcan and looked my way, I unfolded the washcloth in his direction, showing him the flattened gooey captive. He immediately jammed his head back down into the trashcan and began convulsing again. It was hilarious!

We all eventually gained our composure, lined Mr. Johnson back up and were able to treat him. As he was getting up off of the table afterwards, Mr. Johnson shook his head, smiled, and patted me on the back. He couldn’t say it, but I could tell he was pleased with my act of heroism.