Undergoing the Knife: One Vocal Year Later

June 26, 2020

 

One year ago, I had vocal surgery with Dr. Steven Zeitels to remove a mucoid polyp and a recurring hemorrhage.

 

I’m sharing some entries from the journal I kept throughout the experience. Please feel free to share this with anyone going through a vocal injury.

 

If this is TLDR, read my piece, Silence the Shame, about the importance of de-stigmatizing vocal injury within the theatre community.

 

 

 

*t-shirt from the NYU Voice Center

 

June 25th, 2019: Today, the day of the surgery, Ben (my husband) and I woke up in Boston bright and early at 4:45am. I chugged two water bottles of water because after that, I wouldn’t be allowed to drink anything until after surgery. I brushed my teeth, rinsed my face, and off we went to Mass General. After checking in, a nurse took me to a holding room to change into my hospital gown and get hooked up to an IV. The anesthesiologist, Evan, came in and introduced himself. I told him my greatest fear was waking up in the middle of the surgery. He smiled and said, “That’s my greatest fear too.” And then I laughed, and he put some kind of miracle elixir in my IV that makes you feel like you’re that happy drunk, 2 cocktails in. He told me I’d forget everything after that point because whatever the drug is erases short term memory, but luckily, I remember most of it. I got wheeled down the hallway and then the nurse asked if I’d be able to transfer myself onto the OR table, which I did. At that point, Evan’s counterpart came over to introduce himself, and I gave him a hard time about not being as attractive as Evan (see note about being 2+ cocktails in). Dr. Zeitels’ fellow, my friend from college a cappella, Dr. Brandon Jackson-Baird arrived. I guilt tripped him into helping me serenade the OR in case I woke up and could never sing again. Everyone was cracking up listening to our mash up of Diana Ross’ and Marvin Gaye’s “Ain’t No Mountain High Enough”. Dr. Z arrived, and it was go time. I got a breathing mask put on my face, breathed in a few times, and the next thing I knew, I woke up in the holding room. Surgery was over and home I went to nap, start my pain killers, and crush some popsicles and mashed potatoes.

 

June 26th: At this point, and really since I woke up from surgery, it just feels like my throat is on fire. At my post-op appointment, I told Dr. BJB (and by told I mean typed into my Text-to-Speech voice reader app and made "Sharon", my voice (She's 'Sharon' on behalf of Jenna...get it?) say in her sultry British accent, that it feels like I incorrectly smoked a giant blunt and lit my throat on fire. He stifled a laugh while professionally explaining that this was a normal sensation to feel because of the intubation and the laser. At the same time, an avalanche of mucus is continuously falling down from my nose, and I can’t clear my throat. FYI, the hard swallow is bullshit. I’ve mostly found ICE COLD WATER or hot tea to be helpful in this painful predicament. I’ve also had a pretty bad headache- can’t tell if it’s because of the pain killers, surgery, or my sudden coffee withdrawal.

 

Dr. Zeitels came in and showed me the video of my operation which was THE COOLEST THING I’VE EVER SEEN. The video showed him removing the polyp and zapping the risky blood vessels.

 

***Voice nerd alert: He used these tiny plier/alligator arm things to lift up the epithelium of my vocal fold and scrape out the clear goo from underneath that made up the polyp. He explained that the clear goo he removed is fibrovascular trauma tissue. It’s soft tissue that gets built up over time. He said that the surgical key is to hold the membrane (which looks transparent and translucent like saran wrap) and remove the redundant piece (the polyp/goo) and then allow the membrane to lay back on top carefully so that the edges line up. You keep removing the tissue (clear goo) until you’re satisfied that the membrane will lay flat. He said you don’t remove anything from the vibrating outer layer of the vocal fold. The alligator tool he uses is one millimeter long and it’s controlled with his fingertips. He said you have to match the breathing patterns of both the patient and the doctor because the instrument and the tissue don’t stay static. Dr. Z showed me that he ended up removing some goo from both sides (more on the right than left…reactionary polyps developing because of the initial polyp is common). Then he put the epithelium layer back down to cover the area. Lastly, he used a laser to blast any potentially problematic vessels from my right vocal fold since that’s where I had the hemorrhage. Check out the National Geographic episode with Steven Tyler of Aerosmith- that’s exactly what he did with him, and you can watch it in real time.

 

June 28th: My SLP Ellen Lettrich suggested I get a boogie board. Highly recommend it. It’s like an etch-a-sketch but a note pad so you can write and then delete whatever you write. That and my text-to-talk app are keeping me sane. I went on a walk yesterday around the park- a brief walk- they said walking every day will help. But nothing else. No raising of the heart rate until I’m cleared at my next check up. GAH!

 

This morning was the last time I took an oxy. I decided pooping and not getting addicted to pain killers was worth the potential suffering, so I’m moving over to Tylenol and took 2, 3 times. My throat is still in a lot of pain, and I had to fight off a simultaneous coughing and anxiety fit also while stifling laughter at this whole predicament. How am I going to make it until July 22nd?!?!

 

July 1st: Here we are day 7. Ben asked me what time it was this morning, and I accidentally whispered “Almost eight.” I said two words out loud. OOPS. Immediately, I corrected myself when he asked again and I showed him eight fingers, but I have to stay rigorous with my behavior!!!!

 

I have to say that maybe it was finishing Atomic Habits yesterday, or maybe it’s the silence, but I’m realizing how awful I’ve treated my voice over the past few years. I have NOT put my priorities in order regarding vocal use. The book mentions that successful people are the ones who show up, day after day, and they fight through monotony and boredom so that they can see the fruits of their labors. I thought about this regarding my own practice. Did I warm up every day? No. Why? Because it was boring. Because I didn’t make time. Because I didn’t make it a habit. Will I from now on? YES. The author, James Clear, says it’s not necessarily about how good the work out is but about the fact that you showed up for the work out, and I really liked that line. It’s about building consistency. He also says you can’t make something your identity. That will prohibit you from exploration. Instead of saying, “I’m an army captain”, you say, “I’m someone who works well under pressure, is physically strong, mentally tough under stress, and a team player.” I loved that. So instead of me saying, “I’m a performer and a teacher”, I can say, “I’m someone who loves putting herself in other people’s shoes, who is a great listener, a leader who expands limits, a community builder, and someone who’s fluent in the language of music.”

 

July 2nd: Day 8. Here we are. I went to a restorative yoga class this morning. Let me tell you- it felt freaking fantastic to stretch and slowly move like that. I had gone on long walks the previous two days but this was MONEY, people! And today, my throat doesn’t hurt at all! FIRE BE GONE! It feels a little tight when I swallow, but nothing compared to the pain of last week.

 

July 5th: Update of the past few days: Nothing much to report. The pain in my throat has fully subsided. The bruising around my IV on my arm is almost gone. Everything generally feels pretty normal. I am meditating every morning now- can’t say I’m getting good at it yet, but I do find it tolerable/enjoyable/interesting when I get to that quiet mind place. Ben has been absolute trouper. He’s getting very good at reading my wonky hand signals. I’m glad that I married someone who can talk to a brick wall about anything. Talia (our dog) now responds to me clapping or snapping at her. Winnie (our cat) doesn’t give a shit about me one way or another...Nothing’s changed.

 

July 9th: HOLY SMOKES WE’VE MADE IT TO THE SILENT HALFWAY MARK, Y’ALL!!!!!

 

July 10th: Day 14. Officially over the hump today. I spoke with Dr. Brandon today to ask him about why you’re not allowed to work out while you recover. He said, “Anything that gets the heart rate up could cause a bleed. Also, some people have increased vocal fold movement while exercising.” I went on to ask him why Dr. Z prescribes three weeks of silence. He said, “He’s always done two weeks for simple excision and three weeks with laser. Some studies have shown even as quickly as three days is sufficient; however, every surgeon has their own protocol.” I asked if there’s a risk of additional muscular atrophy the longer you go without speaking. He said, “Not to the degree that it would have significant impact. However, some people need help getting back into the swing of things, which is why Z sometimes pairs them with a speech therapist when his post-ops come back.” So, we’ll see what happens!

 

July 15th: Today, I’d like to reflect on some things that I’ve learned from this experience that I hope to continue even when I can speak again.

  1. I don’t always have to be the entertainment. I don’t always have to stifle whatever potential social anxiety I might feel with the sound of my voice. I don’t need to do all of the talking. It’s okay for me to not tell every story or every joke I know. It’s okay to just listen and ask questions. In fact, it’s GREAT to listen and ask questions. People really open up and dig in when given the opportunity and the space.

  2. Some people are really bad at change. I’ve noticed certain friends are unable to cope with the fact that I can’t talk. It makes them feel awkward. It’s been really comforting to be around the people who can modify accordingly and step up to take charge when I can’t.

  3. It’s made me generally less angry about small things. When you’re alone in your head, there’s no point in being mad. There’s no point in being upset if you just have to live with it alone in your head. I’ve learned to let things go. I’ve learned to appreciate silence. I’ve learned to look at each person and listen more instead of fill it with unnecessary banter or small talk.

  4. It’s helped me eliminate distractions. I’ve actually loved the excuse this has given me to hibernate this summer and spend less time stressing out about how to fit it all in. It’s been great not eating out. It’s been great not drinking. It’s been great reading books and listening to podcasts. It’s been great walking in nature every day. It’s been okay not working out. It’s given me a chance to hear what my body is saying a little bit more. My back feels better from not having to carry around the weight of the world in my backpack every day.

July 19th: I am nervous, that’s for sure. Nervous about what will come out of my mouth on Monday. But whatever it is, I know I will get through it. If I have to learn to sing again, I can do it. I will do it. I must. And people are way more forgiving than I recognized before. They will forgive whatever weaknesses I might have as I get back on my vocal feet.

 

July 21st: Here I sit on the train, fittingly in the quiet car, on my way up to Boston. My appointment is bright and early at 9am tomorrow. My plan is to get to my hotel, go to sleep, perhaps wake up early enough to hit a yoga class before my appointment, go to my appointment, get breakfast, and then speak to everyone I know. Just kidding. :-)

 

July 22nd: THE SURGERY WORKED! I’M HEALED!!! I went into the doctor’s office this morning and officially spoke my first words: “WOW! What a WILD experience!” Overall, my voice felt breathy/unstable/wobbly at first. It sounded so light (kind of like I was on helium) in my head. I had trouble clearing away the mucus from my folds when they were scoping me because I hadn’t cleared my throat in so long. The new fellow, Dr. Elizabeth Burckardt, (Dr. BJB left for his new position at U Chicago) told me that my epiglottis was sitting pretty far back which was making it difficult to get a full picture of my folds. She said that it’s normal to have some throat tension after not speaking for so long. As the exam went on, the tension began to release.

 

As soon as Dr. Z walked in, he took one look at my strobe video, grinned, and asked me to stand up and sing. “You can sing!” he said, “Sing!”. WAIT LIKE SING NOW?!?! “Yes! Sing me something I know.” I decided to go with “Ain’t No Mountain” to bring this thing full circle. It sounded pretty good! Not super strong but *clear*. I was shocked to hear so much clarity. He was very excited and kept saying how great my folds looked and told me that I healed quickly. He said as long as I take care of myself, it’s fixed. Whatever got the polyp there could get it there again, so I will go see Joan Lader, my voice teacher, and hope that whatever behaviors did influence their appearance will be ameliorated.

 

July 23rd: Yesterday, I saw Joan. She said she was pleasantly surprised at how normal my speaking voice sounded already since many people come back with a very high pitch due to commonly occurring post-recovery throat tension. We did some resistance band work and officially confirmed that most of my problems with head voice/soprano come from postural issues, not vocal fold issues (now that we got the extra tissue out of the way). I told her it did feel different singing high notes. It felt like I didn’t have to think about it as much for the sound to come out. It feels like, without the polyp in the way, I don’t have to work as hard at the vocal fold level, so now my body is free to concentrate on engaging other muscles that it couldn’t concentrate on feeling before. I’d say overall, things feel slightly disjointed, and my voice gets fatigued more quickly than it used to, but given the circumstances, I am pleased with being able to phonate across my range.

 

August 22nd: It's a month post-beginning to speak again, and I sit here writing before going into teach some voice lessons. My mindset has shifted from defeat to drive. My voice feels way more consistent and reliable at this point. It feels rounder, richer, and my laryngeal masseuse, Christine Schneider, told me I have more room in my thyro-hyoid space. So that’s good! It does still feel like it fatigues easily, but I also wonder if that’s because I’m overly excited about the sounds coming out and am working harder than I need to. A month later, I am 100% happy that I elected to do the surgery.

 

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June 25th, 2020: One year later. Wow, I am still so grateful for my 27 days of silence. When people ask what it was like, I always say that I truly learned to listen during that time. I learned to slow down, meditate, think clearly, and let go. I learned to better see people in the present moment and acknowledge their energy rather than let my own anxieties get in the way of truly seeing them.

 

In the past year, I’ve learned to appreciate my instrument and my unique musicality more. I’ve learned to say no and prioritize opportunities. I’ve learned to streamline client requests and teach people how to treat me. The whole experience helped me create boundaries in all facets of my life- something I’m still absolutely not perfect with, but something I am working on getting better at creating and maintaining every day. I also learned to start sharing my work more often. Even when it’s not perfect, just ship it. I learned that it’s okay to look vulnerable and ask for help. People, even strangers, like to help when given the opportunity. I have a newfound appreciation for the inherent good hidden in humanity.

 

A full year later, my voice feels great. She feels so much more reliable than ever before. I rarely worry about whether or not a note will come out and/or if it’ll hurt when I sing. I look back on my pre-surgery schedule and see how unsustainable it was- vocally, physically, mentally, and emotionally. I prioritize my vocal health now way more - must protect "the gift"!!! I feel more stamina, control, flexibility, and possibility with my instrument now. It feels like I can truly sing whatever I want, and my job now is to concentrate on perfecting how it sounds and the style/vibe I want to create instead of worrying about how to get through the song or the role or the run of the show. When presented with the decision again about whether or not to have surgery, I would absolutely elect to have it again. I recognize that it’s not as successful for all people, and everyone’s experience post-surgery is different. For me, the reduction of vocal anxiety in my life has absolutely been one of the greatest game changers of the past year. Without it, I am free to feel the music flow and course its way through my body. My creative, artistic, unique, storytelling vessel is ready for use to promote change and healing wherever she goes.

 

Until the pandemic ends, I'll be in Brooklyn, patiently (not always that patiently...) waiting to get back on a stage and share my voice with live audiences again. 

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