After 5 nights in the surgical step-down unit, I was ready to go home. I was given a prescription for some pain killers and sent on my way on August 15th. I got out of bed after 5 days and plopped into my wheel chair and my mother and my aunt Barbara brought me to the Park Ave apartment in a cab.

The following few days were a blur. I got home and rested for the next few days. After the first night in the apartment, and a lot of still-needed rest, I woke up in the middle of the night and decided to write Dr Miles an email to thank him and ask a few questions:

From: Cavin Balaster [mailto:[email protected]] Sent: Wed 8/17/2011 5:17 AM
To: Miles, Brett
Subject: A few questions

Doctor Miles,
Thank you for doing such a great job on my surgery. It is so nice to talk finally! My voice is a little off. What can I do about that? I’m trying to not talk much. I was also curious about cleaning. When I shower, I’ve been covering my surgery scar with cellophane to keep it dry. Is that necessary. I don’t plan on scrubbing it! I was wondering if I could let it get wet and gently clean it? I was also expecting to meet with you next week and it looks like we aren’t scheduled until the following week. While I do miss witnessing your witty remarks and extremely talented handiwork, I was hoping to eat something… Anything close to human food. It’s been about three months and I’m dying to swallow real food. I know overdoing it could really complicate things, so just a bit of pudding would be something better than a liquid diet of old people formula poured into a PEG tube directly into my stomach. It’s crushing my spirits. If I need to do a swallow test I’d love to do that immediately. Could we schedule a test ASAP? Again, Brett, thank you so much. This may have been the most pivotal and important surgery in my recovery and I am so thankful that such a great team performed it. Thank you and please let me know when I can eat.

With the utmost gratitude,
-Cavin Balaster

I was extremely thankful for yet another miracle that was performed by someone who has studied and perfected their trade to save the lives of others. This may have been the first time that I’ve truly experienced the feeling of overwhelming thanks towards a doctor for simply being good at his or her job. He even wrote back that same morning, within a few hours:

On Aug 17, 2011, at 8:18 AM, “Miles, Brett” wrote:

1. Don’t worry about your voice at this point…I want you to heal more before we start some speech therapy.
2. You can shower and get the incision wet, it won’t hurt anything at this point.
3. Regarding swallowing, you can sip a little water/broth/juice, but if there is any coughing, stop immediately. I can’t stress enough that the tracheal repair is weak for the first 2-3 weeks after surgery and coughing can be a disaster. We will get you eating soon enough, just give it another week to heal, then we can start to advance the diet. I don’t want you to have a setback and rushing forward can set you back significantly if we have problems with the repair.
See you soon…

Brett A. Miles, DDS MD
Assistant Professor of Otolaryngology Head and Neck Surgery
Assistant Professor of Oral and Maxillofacial Surgery
Head and Neck Oncology and Microvascular Reconstructive Surgery

Department of Otolaryngology Head and Neck Surgery

Dr Miles’s instructions were clear, but the primal instincts of hunger and the psychological effects of not eating conventionally for months overrode rationality. All I wanted to read was “YOU CAN HAVE WATER/BROTH/JUICE.”

From: Cavin Balaster [mailto:[email protected]]

Sent: Wed 8/17/2011 1:55 PM
To: Miles, Brett
Subject: Re: A few questions

Brett,
Thanks for your speedy reply. I appreciate it. I am a bit unclear about how much and how often liquid is ok. Could I have an 8 oz glass of juice? I have-not swallowed anything for months so I assume my swallow reflex is weak, so I did aspirate a tiny bit of water and coughed and stopped. Can I try again later today? Thanks again.

-Cavin Balaster

I still didn’t fully grasp just how fragile my throat was.

Dr. Miles again responded within the hour.

On Aug 17, 2011, at 2:32 PM, “Miles, Brett” wrote:

If you are coughing, I would stop and I will schedule you for swallow evaluation….as I stated coughing is dangerous at this point. Don’t try to rush at this point.

Brett A. Miles, DDS MD
Assistant Professor of Otolaryngology Head and Neck Surgery
Assistant Professor of Oral and Maxillofacial Surgery
Head and Neck Oncology and Microvascular Reconstructive Surgery

Department of Otolaryngology Head and Neck Surgery
Mount Sinai School of Medicine

Another testament to what a professional Dr. Miles is: he scheduled a swallowing evaluation the following day with an amazing speech and swallow specialist named Tamar Kotz.

I went in to see Tamar at Mount Sinai. When my mother and I walked into her office, she said “I don’t know why you’re here, but Dr. Miles asked me if I could see you before I leave for vacation tomorrow, and I’ll do anything for Dr. Miles.” My mother explained my history and my current situation (as it was too much effort for me to talk much). Tamar sat me down, poured me a cup of water, and said “I’m not set up to do an official barium swallow test, but I can do a quick evaluation.” She placed her fingers on my throat and instructed me to take a few sips of water. Between each sip I was to say “ah” and count to five. I brought my chin down when I was swallowing (which makes swallowing easier), and was able to take a few sips. I didn’t aspirate or cough!

She told me that my swallowing seemed ok, and that if she wasn’t leaving the next day, she would begin working with me to advance my diet. She told me that I could have “non nutritive trials” of pudding, liquids and purees for “quality of life.” So although I was still getting almost all of my nutrition from my PEG tube, I could enjoy a cup of pudding, or a small cup of coffee, juice, or broth. She also said that she didn’t think that returning to swallowing was going to be a problem; it was a symptom of brain injury rather than a sign of an injured swallowing mechanism.

This was such good news to me! Eating was definitely a huge part of “quality of life” for me. It had been the first thing on my mind for months. We left Tamar’s office and went straight to the Starbucks in the atrium of the hospital. I had a few sips of my mom’s cappuccino, wearing the biggest smile that anyone had seen on my face since before the accident!

We made our way back downtown to the apartment. I had a cup of pudding and every bite was just heavenly. Snack Packs are amazing! I wanted more. I had a few more questions about foods that I might eat… particularly cheesecake:

From: Cavin [mailto:[email protected]] Sent: Thu 8/18/2011 6:20 PM
To: Kotz, Tamar
Subject:

Tamar,
Thank you so much for the good news! I had a few sips of coffee in the atrium right after. I was wondering about cheese and cheese cake for snacking? Also coffee cake with coffee. Again thank you for keeping me sane through this!
-Cavin Balaster

Her professionalism was as impressive as Dr. Miles’s, demonstrated by her prompt response:

On Aug 18, 2011, at 7:34 PM, “Kotz, Tamar” wrote:

You’re welcome, but let’s just stick with the foods we talked about. I think cheese and coffee cake may be a bit adventurous and you don’t want to take any steps backwards.

–Tamar

Kind of a bummer for me, but I was just so thankful that I was assessed to be allowed to eat anything at all… even if I couldn’t have cheesecake yet.