Seven days of silence: a chatterbox's lament

A vocal cord surgery has forced me to stay quiet for an entire week. How will I sound when I finally open my mouth? More importantly - who will I be?

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I wake up in the surgical recovery room with my limbs uncontrollably shaking, an emergence reaction from anesthesia. I’m staring at a bright light shining down from the ceiling and I think: Don’t say it. Don’t say you’re cold. Don’t ask for a blanket, for your mother, for your mother to bring you a blanket, for someone to tell you what’s going on. Because the tableau seems similar to every alien abduction movie I’ve ever seen, where the human is beamed up and laid out in the sterile science lab, I also think: Don’t even ask to be spared the probe. Anesthesia is disorienting, but I remember the one rule I’ve been repeating in my head since I was wheeled back for surgery: keep quiet and stay quiet, for the next seven days. If I don’t, I risk impairing my voice for life.

Not being able to speak would be hard for almost anyone, but, if there were a support group for people who love to talk, I’d be the first to share at the podium, and it’d be difficult to get me to give up the mic: Hi, I’m Bess, and I’m a chatterbox (Hi, Bess!). I don’t possess an internal monologue, maybe because my external monologue is so busy. I speak, therefore I am. So when I schedule a vocal cyst surgery that will force me to be silent for a week, I expected problems.

It’s not that I don’t have thoughts¹, but for me “thought” seems to be a by-product of talking,² like tailings are the waste products of mining. Most of the time I find out what I really think by saying it, which is risky, and occasionally socially problematic, but so far hasn’t resulted in arrests or libel lawsuits. 

Don’t misunderstand—the inside of my head isn’t quiet. There’s all sorts of action: flashing lights, fractals, animals on the loose, plumes of flame rising, chemical reactions creating heat, projected images and clattering noise. It’s the kind of chaos that precedes thought, but it takes a physical, aural act to make thought spring forth like Athena from the head of Zeus. Which is to say that sometimes the chaos of proto-thought gives me a terrible headache, unless I can open an oral release valve and experience the relief of speech.

My husband, Jake, has idly wondered if not speaking causes me physical pain. This week, we tested the theory.

On Monday, I had a cyst removed from my right vocal cord. To prevent permanent scarring I haven’t been, for almost seven long days, allowed to say a word, make a sound, cough or clear my throat. I’ve attempted vocal rest before, but, admittedly, always emitted a word or two, like a guest at a silent retreat who interrupts her meditations, because if she dissolves her own ego, then who’ll she chat with?

It’s not that I’m uncomfortable with or afraid of quiet, but I equate speaking with being, as if bringing forth words is responsible for my existence. When I’m not speaking, I feel diffuse, unsettled, unsure of myself, unsure if I even have a self. This isn’t an uncommon concept. Though I lean atheist-agnostic, the New Testament says “In the beginning was the word,” and many religions associate the beginning of existence with a sound.

If speech was how I came to exist in the world, then the cyst affected who I was in it: I hated how it made me unreliable. How often I spoke, how long I spoke, what social events I could say “yes” to, all depended on the mercurial cyst. It was like a minor, but insistent, house deity requiring financial and social sacrifices. I was sometimes loud and gregarious. Other times, I cut phone calls short, and showed up to hang out only able to nod or write notes. The inconsistent cyst sometimes seemed less like a pathology and more like an excuse. Who wouldn’t be a little skeptical when some days I was so desperate to hang out that I forced myself to talk through pain, while others I claimed mutism?

The cyst has been lurking for many years, though it was misdiagnosed as a nodule for most of them; it is, or rather was, a smooth round marble nestled beneath fragile mucosal lining, impeding my vocal cord’s ability to vibrate. I’ve learned to compensate by overusing the muscles of my throat to better align my vocal cords and by speaking loudly—sometimes startingly so, if the response of dogs and babies is any indication—which pushes my vocal cords together, past the cystic barrier, to produce a clearer sound. But these strategies are the vocal equivalent of donning ankle weights every time I want to casually walk. The cyst constantly asserted itself as hoarseness, muscle strain, vocal fatigue, and pain.

The swelling caused by cyst-induced trauma—imagine stubbing your toe against the leg of a coffee table every time you take a step, but with your larynx—also changed my vocal quality from a clear alto to something rather suggestive: husky, breathy and low. Sexy? Maybe, in the right setting. But what about the wrong one?

A few years ago, I worked as a doc at an Urgent Care that required the morning shift to call patients whose send-out test results had returned. Because our shifts rotated, the patients had usually been seen by a different doc and hadn’t met (or heard) me. The send-outs were most frequently STI testing. I’d call the patient and, in a voice better suited for a phone-sex operator than a medical professional, say, “I’m so sorry to have to tell you this, but you have…gonorrhea³.” This, inadvertently, in a tone you’d also use to breathily invite the patient back up to your apartment. Except, maybe in this specific example you wouldn’t, because they have the clap.

Patients were understandably confused by the incongruence between tone and content as I launched into antibiotic options. A few patients complained, and a few more requested things from me that aren’t (or probably shouldn’t be) done at a medical facility.

The Emergency Department, where I’ve spent most of my working life, demanded less vocal quality as it did quantity. NYC EDs are overcrowded and loud, and ED department chairs are most interested in a warm, willing, inexpensive body to meet staffing needs. In many EDs, patient beds are in the hallways and “rooms” are curtains separating beds. Crying, screaming, and beeping (so much infernal machine beeping) are constant background that needs shouting over. Though no one insisted I sound a particular way, the need for speech was constant and unrelenting: interviewing patients, coordinating with consultants and nurses, teaching residents—for twelve hours a day. Two 12-hour shifts in a row would leave me almost mute. I was often forced to eke out a third, because it was NYC and there were bills to pay,⁴ but also because, in medicine, scheduling accommodations for something as ridiculous as your own health and wellbeing are balked at. 

“Please, I go mute if I work more than two shifts in a row,” is, in the view of most hospital administrators, hardly a reason to not be scheduled for three or four straight shifts if that’s where the holes in the schedule are. If you’re looking for empathy, or, at the least, looking to not be resented for being a human being in a human body, I suggest a field other than medicine.

I tried all sorts of therapies, many not terribly evidence based: vocal rest, speech therapy, myofascial release, red-light therapy, massage, acupuncture, acupuncture with electrotherapy, cryogenics, going to the Russian shvitz to inhale warm steam, and, embarrassingly, various woo-practitioners which included a craniofacial energy healer who barely touched me, smelled like he’d been dunked in a vat of patchouli tinged with burned sage, and didn’t appreciate me laughing uncomfortably when he broke out the didgeridoo. A wildly restrictive anti-reflux diet forced me to give up onions, garlic, eggplant, anything spicier than salt and tomatoes—so, flavor—on the off chance that, despite my never once having had heartburn, “silent” reflux irritating my larynx would be resolved. Clearly, I was desperate. Silence is one thing, but silence and no garlic is a different league of deprivation.

If working in healthcare led me to internalize the belief that forcibly overcoming a physical limitation was directly correlated to my work ethic, the misdiagnosis of vocal nodules—which are caused by vocal overuse and misuse—also put the blame for those limitations on myself. The fact that I couldn’t simply learn to better use my voice and change my life felt like a deep, personal failing. A sabotage I couldn’t understand. If my words made me who I was, I felt like I wasn’t doing a very good job at being.

It wasn’t until 2022 that I learned that I actually had a physiologic cyst, which is formed by a clogged mucous duct. Its presence causes trauma, not the other way around. Nothing resolves a cyst like mine except surgery. The feeling of absolution was unexpected, the afternoon when my new ENT snaked a scope up my nose and down my throat, showing me a video of my vocal cords as I tried to sing “eeee” under a stroboscopic light. He had me sing louder, and, as my vocal cords pressed together, my voice became clearer. “That’s the culprit,” he said, pointing to the pale yellow cyst. “The swelling on the other side isn’t a nodule, it’s just local edema from where the cyst strikes it.”  

I’d held on so long to the idea that I’d caused the problem by being myself, that I felt disoriented. Rather, “myself,” especially the loud voice I use which improved vocal cord vibration around the cyst, and my associated large personality, might be a side effect of my pathology; I am a side effect. Did the cyst not merely affect my identity, but form a large portion of it?

And now, an ENT surgeon was going to cut it out.

It takes about ten seconds after coming-to from surgery before I break my promise to keep my mouth shut. Despite remembering that my prime directive is silence, I’m also drugged out of my gourd and disoriented; coherent, linear thought is a lost cause. Beyond the disorientation, I can’t control my shaking, although there’s also a whiff of leftover paralysis from the paralytic Rocuronium needed to keep me perfectly still. Rocuronium is needed for delicate microsurgeries like mine, but Rocuronium also makes my trembling limbs feel weighted by sandbags.

I don’t recall the attempt I made at speech; the surgeon told me about it later. “I don’t remember doing it, I was on drugs” isn’t a great defense in court, but for me it was true.

Whatever I might have asked for, I got Demerol, an old school pain med which is as close to magically flipping off the post-op tremor switch as we have in medicine, and said Demerol silenced me pretty quickly while also disposing of conscious thought for another hour.

As I came to for a second time, much more gently, I thought: maybe this week will be like a forced silent meditation retreat. One that I was kidnapped and brought to after being knocked out with chloroform. Not a great start, but still, good for personal growth. I’d be Zen, in the way I’m not in every day life. I don’t even wholly know what “being Zen” means except in a pop-culture sense.

You know what isn’t Zen? Lying to myself about my capacity for Zen. I was horribly anxious about messing up. Speaking might permanently affect my healing. Coughing might permanently affect my healing. Growling in frustration almost certainly would permanently affect my healing, no matter how badly I had the urge to. I tried to imagine reconnecting to a quieter self, a self who existed independent of speech. I also tried to imagine growing wings, discovering I possess magical powers, and inventing an alchemical technique for turning things into gold. All things seem equally possible.

In the first 24 hours, I further disobeyed the surgeon’s orders when I reflexively said I love you to, separately, my Dad, my Mom, and Jake. Other times I messed up are less defensible: I apologized to a chair I banged into. I whispered a passage I was reading in a book aloud, then looked around, wondering where the sound had come from. “You idiot,” I thought, “will you be permanently hoarse because you couldn’t read quietly to yourself?” Except I didn’t think it, I want to say I thought it, but I whispered that, too. When my kindergarten teacher complained about my inability to  read silently, I never realized how vital a piece of feedback that would be one day. Had the surgery been a terrible mistake? I appeared to have the impulse control of an unsupervised six-year-old at a chocolate fountain. 

Being quiet didn’t lead to internal quietude. Steroids made sure of that. The tremors I’d awoken with after surgery departed but my nerves seemed to shake with excess energy from the high dose of Prednisone, which was meant to decrease airway swelling, and I experienced tremendous focus. “I’ll write,” I thought. Words on the page could replace words from my mouth, something I’d always wanted them to do. I’d use text-to-speech, I’d chat with friends on messenger, I’d work on my novel. Almost immediately, however, I sprained my right wrist and couldn’t type or hold my phone comfortably to text, and lost access to words entirely. I was like one of those African Gray parrots left in a cage without enough stimulation who plucks all their own feathers out for want of something to do.

I tried blowing off some energy by running left-handed errands outside the house. First, I walked to the grocery store, which was next to a PetSmart. A small, slightly disgruntled looking mutt with an underbite and a neck cone walked out of the store and made eye contact with me. He opened his mouth and all that came out was a high pitched, squeaky, cough-like sound. He looked pissed off about it and tried again. Same sound.

“I’ve also been debarked,” I wanted to tell his frustrated little face in solidarity, but his owner yanked him forward and he trotted off quietly. Would a choke collar on myself also disincentivize speaking?

Attempt two was a walk to get a cup of coffee. Inside the shop, an unfamiliar barista said hi. He started making small talk, upon which I pointed to the drip coffee maker, pointed to my mouth, and held up a single finger, signaling for what I hoped was a black coffee. I’d manage here or to-go questions with a thumbs up or a thumbs down. Instead, he excitedly launched into an impressive exhibit of American Sign Language, the contents of which I couldn’t follow. When he was done, he looked at me expectantly. I couldn’t explain myself. I don’t know the signs for “I’m not deaf, I just can’t speak.” I tried to look apologetic, while also glancing longingly at the coffee maker, which I once again pointed to, then back at myself.

“You don’t sign?” he asked. I shook my head “no.”

“You’re not deaf?” he said, incredulous, as if I had tried to pull one over on him, and he gave me a look of frustration similar to the little dog. I gave him a pathetic thumbs up as he handed me my cup. I took the coffee to go.

After that, I stopped any attempts at communicating with strangers, but communicating with Jake also turned out to be a challenge.

Jake says we have an eternal golden braid between us that leads to a deep, almost spiritual understanding of one another, but it turns out that the eternal golden braid doesn’t translate into winning at charades. I’d point to something I wanted that was beside him, and then pointed at myself, which I thought was the universal signal for “hand that to me, please.” If I pointed to a cup of water, Jake would pick up the pen next to the water, the book next to the pen, walk around the counter to the package of dried beans behind the cup and then start looking through the cupboards, as if he’d developed a visual agnosia but only for the things I wanted. This theory held across all sorts of items including books, blankets, food, and light switches. Pointing more vigorously at an object only resulted in Jake requesting that I “not yell at him.” He'd try to ask me more complex questions like what I wanted to read or eat for dinner and then assign each answer a number 1 or 2, for which I could demonstrate my preference by holding up the numbers on my left hand. But the steroids made me a little forgetful…okay, I’m a little forgetful at baseline…and I’d routinely mistake which number correlated to which option.

Jake isn’t a big talker, and wasn’t even before he lost his tongue to cancer,  and so we quickly settled into a steady, mostly silent rhythm. Maybe it’s easier to feel like you still exist in the world without words, when you live with someone who really sees you, voice or no. By the end of the week I’d reached an unexpected equilibrium.

It’s day seven now, and I expected not talking for this long would be a bigger identity crisis than it’s turned out to be—enough that I’ve started to wonder if I’ve gotten myself wrong. So, maybe it’s an identity crisis after all. Or at least, an identity re-evaluation. There’s so much I want to say, all the time, but after a week of not being able to, I question how much has actually been worth saying and how much is distraction. Instead of talking, I took walks, read, let the chaos in my brain run amok until I started to recognize patterns of thought amidst the fray, and found, a little to my shock, that I still was by the seventh day. Maybe the wildness of my mind can find a way to tell the story of myself without speech. Maybe that’s what I’m doing right now, in writing.

This week, I’ve thought a lot about what speaking has cost my voice, but also what it’s cost me.  Not only wondering who I’d have been without the limitations it placed on me, but what haven’t I heard while I was busy making sound? People are terrible at listening, and yet listening is as important a skill when trying to connect, if not more so, than making yourself heard. Maybe the “me” I speak into being from here forward doesn’t need to say so much to assert her place. Or say it so loudly, since I’ve realized that what I used to think was a private sotto voice was actually a normal speaking volume, and I’ve spent years broadcasting semi-private comments to the entire room.

I text my surgeon to get the go-ahead to try purposefully speaking tomorrow. He responds with a thumbs-up emoji, and I have an unexpected reaction: a sensation in my throat, like a tight, cold squeeze where I feel pain and restriction when I talk too much. Part of me is afraid that it’ll hurt when I speak, or that I’ll sound damaged. But mostly, I wonder less what will come out when I open my mouth tomorrow, than who?

Finally, I’m allowed to speak. Except, for the first time in my life, I’m not sure I need to.

If you’ve gotten this far, consider the Go Fund Me that’s funding my husband Jake’s ongoing cancer treatment.

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1. We speak of both “having” thoughts and “having” sex, yet those two verbs are very differently had, are they not?

2. That “thought” and “talk” are slant rhymes is interesting but probably not relevant.

3. There’s a gonorrhea vaccine on the way! Which is great because drug-resistant gonorrhea is on the rise and the good people of Brooklyn were not, at least in the neighborhood I worked, wrapping it up.

4. NYC and environs have tragically been underbuilding housing for decades, resulting in needlessly high housing costs that impede human flourishing. Tragically, a state-level plan to give property owners greater freedom to increase the housing supply was defeated in the state legislature. We all pay the high cost of housing limits.