This post is part of this week's Normal Sinus Rhythm, a blog similar to Change of Shift or Grand Rounds. Go check out the other bloggers and leave a comment if you have the time!

She tries to speak, but she's slurring her words. What she wants to tell me is that she took the sleeping pills on purpose because her husband doesn't love her anymore. She told me this earlier, when her speech was clearer, but she feels the need to reiterate, even though her mouth can't shape the vowels and her tongue can't add the necessary staccato to the consonants. They stick in her mouth and I'm reminded of myself as a toddler, my own mouth heavy with impediment.

Sitting next to her on the bench seat, I watch her tongue. It flaps pathetically in her mouth, trying to remember the form it should take, but failing. It flickers up and down like a tiny flame in the breeze. I get lost in its movements, willing it to take shape and tell me she's okay, that it was all just a big joke, that she could run a marathon now.

But instead, I look on helplessly as her tongue gives up, making one final movement. It slips back into her cavernous mouth for the last time, and she closes her eyes.

His tongue is lying on his cheek when we arrive, his eyes glassy and pointed at the ceiling. He's not breathing and he has no pulse.
"One and two and three and four and," I hear my partner say as he starts CPR. The tongue moves with each life-saving thump he receives. Moving his tongue, I insert an oral adjunct to keep his airway open as I breathe for him.

An ALS provider comes up behind me with laryngoscope in hand. He bends the stylet to his preference, and I move as he attempts the tube. He sweeps the man's tongue out of the way, as it has become nothing but a hindrance to him. After the tube is secured, no one thinks of his tongue any more.

We load our dialysis patient into the back carefully, making sure her arms are secured to each other to keep them from falling off the stretcher. She has had dementia for years now, and I wonder if she even knows of her own existence anymore.

Her mouth stays open, her tongue pushed perpetually forward. I always talk to her on these runs. She might not be able to hear me, but it's her tongue that compels me to do so. I watch it as I speak, thinking that maybe if it twitches just a bit, somewhere deep in the recesses of her mind she's trying to answer me. It falls out of her mouth a little bit more, and I pause, waiting for a response. It never comes, so I sigh and push myself back further on the bench like I always do. That stupid tongue.

He can't be more than three months old. As he wails, his tongue stays perfectly in the middle of his mouth, flapping as the pitch of his screams change. His mother looks panicked, but I explain to her that crying is a good sign. A screaming baby is the only kind I like on my ambulance. I watch that little tongue form its perfect shapes and smile as I get him a teddy bear.

His eyes shift into a look of curiosity, and he licks his lips, cooing as he paws at it. His mouth falls open and his tongue sits motionless within his mouth as he explores the feel of the bear's fur as compared to its beady glass eyes. His tongue contorts as he pulls on the tiny ears, and the screaming returns.


Rogue Medic said...

You know that you are beginning to take this assessment thing a bit far. :-)

It is good to be always learning from the information the patient's body presents to us. Not just the machine generated vital signs, nor just the manually obtained vital signs.

Nice work.

Epijunky said...


You've outdone yourself.

Brilliant. And it's about tongues. :)

Evil Lunch Lady said...

Tongues are good:)

John-Michael said...

Wonderfully insightful and sensitive perspective, beautifully presented. I am stilled and quieted with this piece. Well done, indeed.

Lovingly ...

Anonymous said...

Touching, very touching!

Polar Doc said...

Neat motif. Ever seen a "geographic tongue"? The tongue is the only muscle in the human body that is attached at only one place to bone.