28 September 2013


Concession: you probably don't want to read this. It's long, poorly-written, and not lighthearted at all. It's... Well, it's a lot of things. If you're not grading me - and you have a bizarre concept of "reading for pleasure" - enjoy?


Hey there!

So I've taken some time off from writing this summer-ish. It's been a bit forced. Health has not been my forte for a bit, and while my positive medical/health-related escapades are occasionally mildly amusing - I am indeed many standard deviations beyond normal in that regard - I still get sick like everyone else. It just sends me to the hospital every time. Nobody wants to read vom stories, so I've kept mostly to myself. So it goes. Moving on...

I suppose I do have a vom tale to spew sloppily all over your reading medium. More accurately, it's a non-vom novella. A couldn't-vom-if-you-wanted-to compilation. An emesis-eluding explication. An... NG!

Nasogastric intubation, ohsoappropriately abbreviated "NG", is the practice of placing and implementing a connecting tube that runs - surprise! - from the nose to the stomach. Odd pathway, indeed. Point A to point B is not exactly a straight shot: the first trajectory is up. The "flexible" plastic tubing eventually traverses down the back of the throat to the stomach via the esophagus, but the real excitement is the initial curvy jaunt through the head's nasal passages. For me, a lengthy individual, the total internal voyage is almost 90 cm. I promise to you, the length is irrelevant.

When the insertion party is over, the tube might be connected to suction equipment (if not being used for short-term feeding purposes), and then the waiting game begins! I'm not going to comment with much authority on all the reasons why this medical monstrosity is ever used because I'm not about to relive the joy extraneously by looking it up, but you can! The general purpose is to empty the stomach and probably keep it that way, whether it's an acute stomach-pumping instance - too much vodka or Drano - or a prolonged implementation, to pause the constant activity of the stomach for whatever reason. No matter the justification, everything in the stomach is coming out.

Anyway, go read a medical textbook; I'm done playing gastroenterologist. Here's the reality of the NG tube experience: it is one of the worst things I've been through in the hospital without any medication or other assistance to make the brute force cranial attack any less... Brutal. Follow me, dear masochists.

They're coming to invade your face. You know it's coming, and you've probably tried to talk your way out of it. Maybe being horribly, unstoppably sick is better? You're not convincing anyone! Eventually (in my experiences, por lo menos) one will come with some syringes to say, "ok, I'm going to give you [every medication you have that stands a chance of holding your hand], and we'll be back in ten minutes!"

Interminably, yet not enough later, a small swarm returns to enhance your digestive system with waaay too much clear plastic tubing and some approximately-useless lubricant.

I've learned that there are two adult sizes of NG tube: "that doesn't go there" and "you're kidding, right?" The 1-2 mm difference in diameter is significant. However, it's negative infinity versus negative infinity plus one. Which one you get really just demonstrates how gracious your nurses are.

Not a single inch of the insertion process is smooth sailing. They've already covered you with towels - I never have (yet), but you're expected to throw up all over - then told you to stay as relaxed as possible and to keep swallowing hard. Ha! Once that mile-long, greased-up pencil approaches your nose, all bets are off. It just doesn't fit. Also, all that lubricant is rubbing off in your nostril. Enjoy that gift for the next few days.

Right away is the first of (at least) three stopping points, and it's the worst. Just a few inches into your nasal cavity is a brick wall. It feels like the tube is trying to crack its way into your brain. There's nothing you can do here; the only way to get through this first line of defense is to keep bashing away until your sinuses open up. If you're unlucky, they'll pull everything out, wait a minute, then attack again. If you're really unlucky, they'll yank it and give it a go violating the other side too.

Once they destroy the first barricade, a bizarre feeling begins. After all, there's a now-slightly-abrasive snake slithering through your skull, taking the scenic route from nose to throat. It's cold. It obviously doesn't belong there. If you've recovered from breakthrough number one (you haven't), you might have a split second to take in just how otherworldly the sensation is. Don't worry, though; if you miss it at that instant, it'll still be there for every second that tube is moving.

Checkpoint number two is Epiglottis Station! Unstoppable force, meet immovable object. Now is when trying to swallow becomes frantically pivotal - from this moment on, you're trying to eat that tube. Swallow swallow swallow and hopefully it will hit the right hole, beating the dangerous odds of entering the airways and causing some serious damage. From there, just keep gulping and peristalsis should logically drag that tube down to your stomach like a scrumptious plastic snack.

Let's sidetrack for a second (me, sidetrack? never!) to think about peristalsis in this situation. The process moves food/drink down your esophagus in blobs, pushing each nom-unit down like squeezing a hose and sliding your hand along to move water. It's dependent on the "blob" part, though. I don't believe it helps at all in moving the tube (GI folks, feel free to disagree). The tube is not a blob: it doesn't have a "back" end - that part is in the fists of the nurse deemed sadist for the day. Alas, peristalsis needs the trailing side to push against in order to have any effect. Imagine, s'il vous plaît, two same-length hoses, one running inside the other. Using the same grab-and-slide maneuver, you'll make trivial progress moving the inner hose through the outer one. NG peristalsis is just that, a tube inside another, one petting the other.

Further and more obviously, peristalsis is not what's setting the pace! Lest we forget, there's a medical professional providing plenty of propulsion on the naso-end of that plumbing. And, while your own system can deliver pie to your pie storage unit in short order, the intent (but not the reality; more on that later, perhaps) is to get that tube down there even faster. The natural push from your slippery innards is irrelevant to the muscles of the nurse. Point made yet?

Circling back around...

The action is to coax that tube into and down your throat. The equal and opposite reaction is your body's struggle to reject it. Pronto. When the tip of that plastic exits your brain, it immediately strikes gag reflex gold. Foreshadow: it stays there. For the duration of insertion, the friction of that no-longer-lubricated tubing will grate at your vom trigger. To add to the rebellion, your esophagus is fully aware that there's a foul plot afoot. If you're managing to swallow maniacally (you're not), then peristalsis has your esophagus clamped shut at at least one point. If the tube isn't at that closure yet, it's very likely right behind it, trying to bash its way through the lining tissue. Stoppage of play. If the tube already exists at the point of contraction... Well, again with the petting. Know what swallowing really feels like? Now you do!

Here we have the real reason for all the swallowing, je pense. You're obviously not pushing that tube down. That part is under someone else's control. However, you're keeping your system from pushing up. You've thrown up before - that's a powerful activity. Your stomach isn't empty (yet) either, so you indeed have some cannon fodder. While swallow-swallow-swallowing won't guarantee the halt of rebel forces (again, common vom-knowledge), it's what you can cling to during this ordeal.

Pro tip: with any luck, sometime during the esophageal traversal your heart will seem to stop. You have to take a break from gulping, yet your innards don't immediately turn upwardly mobile. For a split second, everything stops, relaxes. Slurp! The NG tube slides right down. If you are a Zen master and can somehow control this armistice, you will save yourself quite the trouble.

Your entire body is burned out. You've likely monogrammed all of those artfully-placed towels in front of you. It's been either thirty seconds or an hour. You're almost there! You know, wherever "there" is.

The third arrest is GE Junction. That is, Mr. Tube is knocking on the door to your stomach. This is really the minor of the pauses - it doesn't exactly hurt, and it doesn't last long. It does, though, give enough pause to cause thought of trouble. This synthetic serpent is in essence a giant catheter, and when catheters try to bully their way into organs, they cause bleeding. Stomach bleeding is a big problem, and can be grounds for tube removal at a minimum. Then you'd be sicker(!), and who knows what could happen next. Panic!

Of course, that's unlikely to happen, just as it's unlikely your sinuses will be permanently damaged, and unlikely they'll accidentally intubate your lungs. (Sufficiently comforting?) No, everything has probably gone according to plan... The sick, twisted, demented plan. Stage one complete.


Monsieurs, madames et mademoiselles, that is enough for now. There is more written - much more to the tale, for we haven't even not thrown up yet! But let's not burn it all up at once, shall we?

Been through something awful? Feel like making fun of my whining, or lack of research/proofing/revision? Got something irrelevant to contribute? Comment away!