Strangled

by Megan McIntyre

“Over there.”

I make my way to the bed he’s gesturing to with his outstretched hand. I wonder if he ever played the piano: long fingers, big hands. His manner is a blend of polite and assertive, like he has always known exactly what he was meant to do in life. Those hands control my future. Lying down, the chill of the bed’s covering ripping through the sheet, my spine shivering. Someone positions the itchy blanket over me.

People come and go. Eyes look beyond me. I don’t move. Voices speak in hushed tones to him only. As I stare at the ceiling, thoughts rush at me. What happens next? What happens to my voice? To me? My brain is buzzing. My throat, increasingly constricted.

I need to speak now; he’s expecting it. Summoning all my energy, I push the air from my lungs, forcing it over the golf ball wedged in my throat.

I shrug and raise my hand to the nearby window. “Wha-what’s with the s-s-sign?” The words are barely audible, arriving as a strangled whisper into the crowded room. With bars on the outside, and spikes jutting from the window ledge, the window and its surroundings are clearly designed to keep creatures at a distance. Ever curious, the sign intrigues me—words printed, faded, on the paper with dirtied tape barely holding its edges in place. ‘Don’t open the window. Protect patients and pigeons.’

He smiles. “A lady woke up once to find a pigeon sitting on her chest. They used to come in through the windows, so now we keep the windows closed so there won’t be any shock visitors when you wake up.”

Glancing between me and Chris, my husband seated by my side, the specialist asks if we have any questions about what’s next, pigeons excluded. I shrug and push a stray strand of hair away from my face. Chris slowly shakes his head.

“It’ll be done in no time,” the specialist placates. I nod, squeak my affirmation.

“It’s just a quick injection into your throat. For a couple of days, you won’t be able to speak and may need to be careful drinking, but everyone reacts differently. I’ll check in again when you’re out of surgery.”

As I’m wheeled away, I recall a speech I gave almost two decades earlier aged fifteen, ending with the promise that dreams really can come true. I squeeze Chris’ hand and muster a smile, daring to dream the surgery will return my vocality.   

Five years earlier, I’m at that age where suddenly the year seems to fly by. It never felt like that as a kid—summers used to stretch forever. The 52 weeks between each birthday seemingly took an age. But now, in my late 20s, months roll together, crashing as one big wave hitting the shore before running back into the ocean, carrying another year with it. It’s the age where you need to make diary appointments months in advance to see your best friends. Three or four times a year, we gather in a karaoke bar, singing voices ready to go after a few drinks in a nearby bar as starters.

“Why is there only ever one John Farnham song? And there’s a disturbing lack of Kylie.” I flick through the catalogue, even though we all know it by heart.

My friends groan. They’re used to my playlist review every time we enter the basement rooms and don an array of glitter wigs and novelty sunglasses, armed with blow-up guitars.

“Here, have a drink.” Katie passes me a glass full of lukewarm white wine, which I grab with a smile and a wink.

For the next two hours, our group of five blast out our favourite tunes. My husband can sing. The rest of us have our moments but usually the more we drink, the better we think we sound.

Tonight, I’m in full voice, belting out a power ballad. I’d come prepared: my favourite 80s and 90s tunes noted down to ensure I don’t miss one, and my hair tied up in a carefully positioned ponytail, high on my head to facilitate maximum swing as I jump around the room, microphone in hand. 

The evening ends as it always does—knowing the clock is against us, we all start shouting a Bon Jovi song before the staff member opens the door for a second time, pointing at their watch and the giant clock on the wall. We cast off the accessories, down our drinks and dance out to the street before heading home.

Standing up, I smooth my skirt and flick my hair over my shoulders.

It’s my one vanity in life, my hair. For each of my almost thirty years, it’s made me feel like Samson, my strength solidified in its unique natural colours: blonde in the summer sun, tinged with strawberry in winter. I am at my most powerful when it flows beyond my shoulders. Chris called it ginger for years but now does so only when he wants to annoy me. ‘Strawberry blonde and proud’ is my mantra. I refuse to dye it; it’s the strongest connection I have to home, half the world away. I’ve lost my Australian accent, but at least I still have my freckles and, most importantly, the strawberry blonde Aussie tint.

I step into the spotlight of the ballroom at the hotel I work at and lower the microphone, touching my hair once more. It’s a routine I can do in my sleep. Conferences. Staff meetings. Training sessions. Put me in front of a crowd and I feel at home. Confident. I can’t understand people who claim they don’t enjoy public speaking. The sea of eyes spurs me on. There’s a challenge in every crowd—to reach that person who appears not to be looking. Can I convert them? Can my words draw their attention away from wherever their thoughts have taken them? Draw their attention back to me? Whether in London or Australia, the challenge has been the same.

My hair smoothed and in place. The microphone, perfectly positioned. My voice amplifies around the room as I run through sales figures, marketing campaigns, customer feedback. Whatever the topic, this—speaking under a spotlight—is where I feel at home.

I can’t recall exactly when it started. But it’s been happening for a while when I eventually ask my GP about it.

“I can hardly speak,” I mutter, barely audible above the whirring of the GP’s computer. “It’s like my voice has the volume turned down.”

The GP asks some quick questions about my job, my life. Doesn’t look at my throat or investigate in any depth. I tell him I’ve stopped going to karaoke as after the most recent singing session, I hadn’t been able to speak for three days. Not even a murmur.

My throat feels sore, raw at times. And I am tired all the time. I come home from work, having fought the central London commute, and fall asleep on the sofa within an hour of being home. I am exhausted and I don’t know why.

“Stress,” the GP throws out his diagnosis. “You said you have a busy job. You just need to find a way to not stress so much, as it does funny things to people. For you, it sounds like it hits your voice. Just relax and it will fix itself.”

I return home and tell my husband. “It’s stress,” I recount. “So you need to help with more housework as I need to relax more. I need to make sure I’m sleeping and resting properly, and have massages on my neck and shoulders. And then I’ll be back in the karaoke booth in no time!”

Months pass. I feel relaxed. I’ve been sneaking out of the office to act as a ‘test body’ for the hotel’s spa therapists when they’re looking to practice their neck and shoulder massages. It seems the ideal way to ease the tension in my muscles, just what the doctor ordered to revitalise my voice.  

But my voice still isn’t right. I can’t shake the exhaustion after a day of meetings. I’ve never drunk so much water before, each glass supposedly helping to lubricate my voice and throat from whatever stress is throwing at it. Even my hair is letting me down; it’s lost its usual shine and for the first time in my life, split ends are creeping in.

Chris is torn between feeling delighted that I can no longer turn up the volume enough to scream at him to put the oven on from upstairs, and wondering what is going on as he puts me to bed as I fall asleep on the sofa yet again. Close friends have started expressing concerns. I shrug them off but can’t help feeling strained at the situation. I don’t feel stressed. So why is my voice not improving?

It’s time for another staff meeting. They’re happening quarterly now instead of twice a year as business ramps up at the hotel. Standing to give my regular overview, I tuck my hair behind my ears—my superpower freshly cut in a sleek new bob to reflect my growing workplace responsibilities and professionalism. Smooth down the skirt. Move the microphone. Pat the hair one last time. The routine that never fails.

Partway through, I hear myself stuttering. Some of the words stick in the back of my throat. My voice squeaks, its high pitch amplified by the cutting reverb of the microphone. Without realising it, I start twirling my hair around one of my fingers as I fight through the remaining slides.

Returning to my seat, I catch the eye of another manager. His face contorts as he shrugs at me. My friend, sitting next to me, whispers as the general manager stands to share his update.

“Need some water?”

I shake my head, not sure what has just happened. I’d sounded nervous—which I wasn’t. My voice high-pitched and squeaky in places. The feeling of having to push words up from my throat and out my mouth.

“You okay, honey?” asks one of the housekeepers after the session. “You sound like you’ve had a bad cold. Don’t you work yourself too hard.”

The office phone rings. I know my voice is having a bad day—I’d tried to speak at the morning team meeting and couldn’t get any noise out. But I’ve drunk a lot of water since then and my throat doesn’t feel as dry. So I pick up the phone and eke out a quiet greeting.

“It’s Pete from A Magazine. How are you doing today?”

“Fffff-ine, thanks.” It takes me a good ten seconds to spit out two words, pain rising in my throat as I push the sounds to my mouth and out, down the line. I feel vulnerable. Frustrated. Impotent. With my free hand, I instinctively reach towards my head, grabbing a fist full of hair and running it through my fingers. 

“Ah shit, sorry love. I wanted to chat with you about buying advertising in our next issue but it sounds like I’ve caught you in some hormonal moment. I can’t handle crying women. I’ll call back another time.”

He hangs up before I can eek out another word. The silence from the prematurely ended call cuts me like a knife. Why can’t I easily throw back a reply to his comments? A witty retort is there, lodged in my throat. I can’t make a sound to break the silence. I return the phone to the receiver and stare at it, both hands pulling at my hair.

When he rings back, my team field his call. I don’t buy his ad space.

My voice has been strangled for over three years by the time I embark on a dream journey to Uganda. Having loved elephants since I was gifted a stuffed toy by my godmother at just a few days old, I finally have the chance to see them in their natural habitat. Chris’ friend Sandy lives in Kampala so we stay with familiar faces before our safari starts.

A speech pathologist, Sandy asks me over drinks one night what is wrong with my voice. Most people don’t ask, but she does. I assume her directness is based on professional intrigue. I start to recall the years of it sneaking up on me, looking to Chris to fill in gaps when my voice gives way.

“It’s not stress. I don’t know what it is, but I guarantee it’s not stress,” she says after the tale of years of frustration and my GP’s thoughts.

She arms me with the tools on how to navigate the NHS, how to insist on seeing an Ear, Nose and Throat specialist. She gives me the belief to give voice to what I know deep down. That my voice—squeaky at best, non-existent at worst—isn’t normal. And it isn’t getting better.

Sitting in my GP’s office, I manage to speak, requesting a referral to an ENT specialist. The belief that an end to this could be on the horizon has given me strength.

Two weeks later, I’m at the hospital with a camera being squeezed up my nose, down my throat. The specialist tells me my throat is redder than it should be, most likely caused by acid reflux, and sends me out the door armed with a prescription I never fill. “Your heartburn will go away with this. Come back in a month,” she says, pushing me towards the door. I don’t have the strength to speak with this stranger, to tell her I don’t have heartburn or any of the other symptoms she’d described.

The next few weeks pass in a blitz of pain and frustration. My voice struggles, more than ever, to be heard and my hair, like me, is a mess. Its once constant shine has been replaced by a tangle of knots, each one taking a lengthy battle to resolve. 

I’ve taken to leaving notes around the house and office when I need to communicate. There’s even written answers to regular questions prepared and scattered around within easy reach. In the kitchen, there’s a selection of dinner options scrawled on a rainbow of Post-its. Pasta, yellow. Chicken, pink. Stir fry, green. Take-away, orange. Blue are blank for days I’m feeling culinarily creative and want an undetermined menu choice.

I return to the specialist. Another camera up the nose and down the throat. Self praise from the specialist for the good work her medicine has done in reducing the redness in my throat. When I manage to speak, informing her I didn’t take them, she refuses to believe me, claiming the reduction could only come from the medication. Seemingly with no other ideas on how to treat me, she refers me to speech therapy.  

Conversations with my family back in Australia are tricky. We text more than we speak—even before my voice went we did that, making it easier to bridge the time differences and ensuring we share news when it’s fresh in our minds. Mum still struggles to work out the time zones, even after more than a decade apart. On occasional video calls, I grow frustrated as I can’t push the words out.

The phone rings. Mum’s picture fills the screen. It’s evening in London; my voice weak after a day of budget meetings. 

“Have you told them you’re using a fake voice?” Mum asks when I manage to tell her about my upcoming speech therapy. “You know, that you used to sound so different? So Australian. Not all English like you do now. I’m pretty sure that will be behind some of it. You need to tell them.”

I nod. I have already mentioned to my GP and the specialist that my accent changed over a decade earlier, and assure Mum I will do so again when I meet the speech therapist. I should have avoided Mum’s call but we hadn’t spoken for almost three months so I felt compelled to hit the green button. But I’m tired. Today’s not a good day.

On good days, my voice sounds raspy, like I’ve smoked a year’s supply of cigarettes in an hour or have been shouting out 80s power ballads for hours on end. Some days, it is audible, albeit like the lovechild of Marilyn Monroe and Minnie Mouse. But today, a bad day, it’s at its most strangled, struggling to push out any noise audible to me, let alone across a video link to the other side of the world.

“Maybe the speech therapist can find your voice again. The Australian one. You used to be so good at speaking.” Squinting at the screen, Mum touches her head. “What have you done to your hair…?” She’s noticed the short bob, the first time she’s seen my shorter haircut.

I lie, squeaking at her that my dinner is ready before quickly waving goodbye and hanging up, tears in my eyes as I think back on what it was like to be confident. To have a voice.

In an attempt to remove the last stressful piece of the puzzle that is my life, I apply for a job closer to home. The commute into London makes my blood boil—people crammed like ants into carriages which are too hot in summer and too cold in winter. Everyone ignoring those next to them, even when pressed up closer to strangers than I’d get to Chris some days. The wall of noise from other people’s headphones and phone conversations. The delays. The annual price increases for the privilege of living like a battery hen for 75 minutes each way each day. Even if stress wasn’t the cause of my vocal problems, the commute was something I had had enough of.

My new job involves a short drive, against traffic, to an idyllic countryside golf and spa resort. I have an extra hour to myself in the morning, and dry my hair with the car’s air vents as I drive. I’m convinced it has regained its shine and the air vents give it extra volume. Any lingering stress has certainly evaporated. Supportive bosses. A team I recruited. A product I believe in. And speech therapy at the hospital just ten minutes’ drive from the office. 

I’ve been fervently practicing my speech therapy toolkit since starting the sessions almost a year earlier. Blowing bubbles through straws. Relearning how to breathe. Slowing down my speaking. Umming and ahhing and other noises to warm up the voice. I’d seen another specialist, with another camera wriggling down my throat, but received no further answers.

My voice sounds stronger. It still isn’t perfect, but I’m hopeful one day it will return to full volume. I’m careful, protecting my voice wherever I can. No more shouting from the bathroom for Chris to bring more toilet paper, instead WhatsApp’ing him emojis to send the same message. No more back-to-back meetings, spacing them out to ensure my voice can rest. Drinking what feels like buckets of water a day. A ban from singing—not just the quarterly karaoke sessions, but in the car or shower. I feel stronger. My hair sits neatly on my shoulders; the split ends long gone.

I’m at another hospital. My late 20s have long faded; the first half of my 30s have passed in near silence. My speech therapist, who has helped me muster a consistent squeak, rising to a solid sound on good days, has sent me here. Dejected at the ‘two steps forward, one step back’ dance with my vocal ability, I’ve agreed to see another specialist.

At our last appointment, my speech therapist said she felt she’d exhausted all options. “Your voice function was worse than some throat cancer patients when we first met,” she said. “On a good day, it’s now around 60% of normal but it should be better. I’m not sure I can do anything more.” Tears formed in my eyes. Shock that no one had told me it had been that bad. Frustration that what I thought were good days were, in reality, still medically ‘bad’ days.

So here I am, sitting in another hospital about to meet another specialist. Chris beside me, holding out hope. Me, anxiously twisting my hair around my finger as I watch other patients come and go. Aside from an occasional trim, I’d been growing my hair ever since the short bob, certain its extended length was recouping my voice’s strength. Watching other ENT patients garble words to the nurses, I start to think my half-voice—a squeak and a squawk, no singing or screaming—is now my life.                                          

My name is called. Chris stays seated; he’s not great with doctors so I don’t push him to join me, even though I’d like someone there so I can squeeze a hand at the pinch of a moment when the camera jumps from nose to throat. I walk towards the nurse and follow her to another room, full of equipment that to the uninitiated resembles Frankenstein’s lab. But I’m an expert by now, spotting the scope equipment near the dental-type chair.

The ENT specialist enters. He explains how he’ll do the scope. I take the hair tie off my wrist and stretch it around my hair in a low, no-nonsense ponytail; its summer golden hue is safer out of the way of the camera and its tube.

Up the nose. Over the ‘hump’ and heading down the throat. This time, my throat and vocal cords show on a large TV screen next to me. They’re not a pretty sight; all bumps and lumps and lubricating saliva. With the camera loitering inside, the specialist asks me to say a few sentences, testing a variety of sounds. I push a few noises out and, as quickly as that, the camera is removed.

Swivelling from screen to face the specialist at his desk, I wait to hear what happens next. I’m ready to retell my story, explain all the changes I’ve made to reduce stress and manage my voice. Instead, he delivers one whopping gift: “You have Spasmodic Dysphonia.”

Before heading to the hospital, I’d taken it upon myself to play Doctor Google. Not a good idea when you are resting at home with a cold. An even worse idea when you are trying to find why your voice, so closely linked to your identity, has failed you.

I’d stumbled across Spasmodic Dysphonia and knew it was incurable. A neurological condition similar to the brainwaves that cause people’s eyes to twitch from time to time but targeting the vocal folds. ‘Strangled voice’ it was called in medieval times; they didn’t have the cameras and other medical gadgets to know more, but the name was apt.

I’d stopped listening to the specialist, a feeling of relief enveloping me. No known cause. Treatment that can relieve symptoms but only temporarily. No cure. The treatment he recommends to restore my voice—botox injections into the affected vocal folds, needed quarterly for life, the first one under general anaesthetic; future ones a quick jab to the throat. I let it all wash around me. There’s no solution but all I feel is relief. I finally have an answer as to why my voice keeps failing me.

My voice might remain strangled, but I feel free. I feel heard.

I open my eyes, the room slowly coming into focus. A pigeon peers through the window above my bed, its gentle coo bouncing around the silent room. A nurse bangs on the window, scaring it away.

Chris reaches out and hands me a chalkboard. “Don’t speak. The specialist said don’t try to speak for a few days, definitely not today. And I’m not just saying that to cling to my peace and quiet.” Passing me some chalk, he nods at the board. “I know you’ll never be silenced but at least use the board for a bit.”

As the anaesthetic wears off, I’m furnished with drugs and lengthy home-care instructions, and sent on my way.

When home, away from the buzz of public transport, I test my voice. Nothing. I try to drink and forget the advice to take small sips—the botox’s numbing effect can cause problems swallowing. Spluttering up the water, I feel like I’ve been rescued from drowning. Chris gets me a straw.

Each morning for a week, I tentatively assess my voice. From near-silent whispers to squeaks and then, finally, a solid sound on day six. The next few weeks I call on all my speech therapist’s advice: No back-to-back meetings. No karaoke. Plenty of water. Vocal warm-ups to rival a pop star’s before they go on stage.

Life now includes a regular cycle of specialist visits for top-up treatments, each preceded and followed by a week or two of softening voice as the botox wears off and kicks in.

The occasional act of forgetfulness between injections leads me to shout on a netball court or call out a reminder to Chris to bring the laundry downstairs; my voice at ease in the moment, before my mind remembers it at its worst. Self-preservation kicks in, forcing me to quieten down. My mother, dismayed that my restored voice (still) sounds British, checks in after every treatment “just in case it’s worked this time”, determined the botox will one day wipe away the vocal impact of half my life lived abroad.

I’ve stopped chasing pigeons out of my yard, aware they need somewhere to rest their wings that isn’t an NHS hospital window.

My hair shines and reaches down my back, uncut for almost five years.


Image by Sneha

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