The morning after his surgery, still wrapped, and giddy, and numb, Sam woke to find his mother sitting in the visitor’s chair beside him, a magazine splayed open across her lap. At first she was little more than a blur, a brown smudge undulating on a sea of orange. He had to blink several times, slowly, to clear the stickiness from his eyes, watching the smears resolve into a thin cotton dress, hair pulled back in a loose bun, and her face, drawn but smiling.
His entire body felt somehow tender and deadened all at once, his lips cracked and dry, his neck throbbing beneath its bandages, his mouth tethered to a plastic tube. His nose itched. Right on the tip. But it was covered in tape, pinned by another, thinner hose, and his arms were still too heavy to lift. His hair was stuck to his forehead. His temples were pounding. His mother inched forward. Katie lay asleep on the floor, curled up under his mother’s jacket.
‘Oh, Sammy,’ his mother whispered. ‘You’re here. You’re with us. You’re home.’
But he wasn’t home. He wasn’t sure why she’d said that. He was pinched beneath stiff sheets. His muscles were thick and soupy. He could feel the sheen of fluorescent lights above him on his flesh. Could hear how scrubbed clean the air was, voices echoing along concrete walls and lino. He blinked and lay in place. Feeling his nose itch. Already beginning to feel the pain that was to come rising in the back of his throat.
It had started when he was nine years old, after his father moved to Perth. Sam was having trouble swallowing and kept getting a sharp pain in his ear. When he was ten, by the time his father stopped sending postcards, he was bald, silent and blistered. Every other day for two months he had treatments—chemotherapy that made him tired; radiation that gave him mouth ulcers, turned everything he ate into a tasteless mush and condensed his saliva into snot. Long before anyone began talking seriously about surgery, a doctor had explained his condition by showing him a goofy cartoon filled with sneering blue monsters and sword-fighting white blood cells. But as Sam sat in the consultation room, feeling the tremble of his mother’s hand as she rubbed his back and tried to smile through her tears, the animation became a jumble of colours dancing, and he forgot what all of it was supposed to mean.
As the weeks passed, as his hair grew back, a little patchy at first, his mother joked about how important he must be to have so many specialists wanting to see him—and at times Sam did indeed feel tall in their waiting rooms when the nurses remembered his name and slipped him lollies as he said hello. After an upper endoscopy that made him gag, two CT scans that made him feel like he was in a submarine, four ultrasounds, blood tests and an oral surgeon who kept prodding his neck and dipping his grey-flecked eyebrows in disapproval, the doctors decided at last. He was stage two. It meant the cancer had spread and he would have to lose his voice.
A week before the operation he’d almost won a class alphabet game by spelling the words ‘larynx’, ‘lymph nodes’, and ‘laryngectomy’, although Mrs Fletcher made him sit down when he began describing the procedure with a red marker and a diagram of where the incisions would go. The day before, his mother had taken him and his sister to Wonderland where he screamed as loud as he could on every ride. And on the morning of the procedure, before a gas mask slid over his face, Sam’s final words were, ‘Batman, because he doesn’t have any superpowers.’
Now, on the other side of it all, as his mother talked gently about how well everything had gone, as the machines around him huffed and groaned, he had a strange realisation: he wasn’t breathing.
He felt his chest rising and falling. There was air getting to his lungs. But he wasn’t breathing in and out. Not like usual. His mouth, his itchy nose, none of it was moving. There was no sensation of wind across his lips. The air wasn’t passing through them.
It was his stoma—a word the surgeon had used that Sam had forgotten until that very moment. The stoma. The hole in his neck. A hole that he would breathe through now. Permanently cut into the bottom of his neck. That would never heal shut. That he’d once drawn for Miss Fletcher in red marker. A hole where his voice had once been.
Batman, because he doesn’t have any superpowers.
That was the last thing he’d ever said.
His mother was still talking—Aunt Dettie would be by later, she was saying; the soccer coach sent his best wishes—and Katie, on the floor, was starting to stir, but all Sam could think about was his final line. Batman. He found himself repeating it over and over again in his mind. Staring at the wall, struck by the stupidity of it. What a dumb thing to mention—let alone be the last sentence he’d ever speak. The surgeon had warned him. He wouldn’t have a voice anymore, he’d said. But somehow Sam hadn’t actually realised it until that moment.
And all he wanted was to say something simple. To say, ‘Mum’, or ‘Hi’ to Katie, whose eyes were tracing fearfully along the tube that led from his throat to the machine helping him breathe.
He felt cocooned in plastic and crisp cotton. Even his mother’s voice, soothingly familiar, became just a wordless hum. He closed his eyes, letting his nose itch, letting the drip in his wrist sting. The distant, smoky feeling in his head swept up and over him—through his shoulders, his head, his eyelids—and he slept.
He was woken by a doctor and nurse, and the slow whir of the electric bed raising him up. Once he was adjusted gently into place with pillows, the doctor looked him over, listening to his chest and scratching around on his chart, while the nurse busied herself plugging in some new instrument to the wall. Katie was gone—she was with Aunt Dettie, his mother explained—and the room seemed smaller than it had before, less filled with light and sound. The doctor went about his examination, talking to no one in particular about the discomfort Sam would feel in the next few weeks. Sam’s mother sat on the edge of the same chair, twisting a clutch of tissues into a rope and nodding deeply, even though the doctor wasn’t saying anything that needed a reply. Eventually, he slipped on a glove and began opening the bandages around Sam’s neck.
At first there was only a peculiar, faraway sensation as the latex-covered hand moved near his skin, like the anticipation before a tickle, but the moment the breathing tube was peeled aside a whip of pain scored Sam’s body. He jerked back, pinned in place, and failed to shout.
‘Oops. Yep. That’s all going to be sore for a while,’ the doctor said. ‘We’ll have to get a little something more to help with that.’ The nurse nodded and made her own note on a small piece of paper.
Something was hissing. Something close. Ragged and deep and hollow near Sam’s ear.
‘Now, we’re going to clean this out a little,’ the doctor continued, ‘but we’re going to be very gentle, okay?’
It was the stoma. The sound was his breath through the hole in his neck. A wet hiss, quivering at the sting. His mouth and his nose, still taped, weren’t breathing at all, but his chest was heaving and the stoma was letting it out.
Sam stayed stiff as the nurse suctioned around his neck with a small tube. He felt his mother’s hand clutching his arm, and closed his eyes until it was over. The pain was not so bad as it had been at first, and faded to an ache that flared only when they rewrapped his hose. More than the pain, though, it was the silence that had shocked him. Not a shout. Not even a moan. Just his snuffling, hollow hiss as he shrank from the touch. He had felt his entire body flash, but couldn’t scream out.
The nurse unplugged the machine with the hose and wheeled it off into another room, leaving the doctor to go on talking to nobody. Eventually, he was saying, Sam could get an electrolarynx. Or he could try mouthing some words, if he really needed to. The process involved taking a mouthful of air and letting it out in a special way. Taking a breath, shaping the sounds; one at a time, and slowly. It might make him a little lightheaded at first, he said, but it would become natural. They could pass on the names of a few people who could help him learn.
‘You’ll have to plan out what you’re going to say,’ he said. ‘But that, and a notepad, should see you through for a little while.’
The nurse returned, fished from the pocket of her scrubs a selection of pamphlets that she spread out on his dinner tray, and began administering an injection into the drain on his wrist. There was a brochure on the daily cleaning of his stoma, one on post-operative physiotherapy, and even one on learning sign language titled ‘Your Voice, Your Choice’.
Sam looked down at the pamphlets, feeling the tender cold on his throat, hearing his oxygen tube hum. His mouth, he realised, was open. Unable to speak, unable to breathe, his jaw hung slack. Pointless. With all the drips and cords he wasn’t even going to be using his mouth to eat for a while.
With an effort, his lips crackling, he eased it shut.