Restoring a Patient’s Voice is About Restoring Choice, Control and Connection
We sat down with Sarah Wallace OBE, a Consultant Speech and Language Therapist (SLT) at Wythenshawe Hospital in Manchester an honorary Professor at the Universities of Manchester and Leuven (Belgium), about memorable experiences she’s had working with ICU patients over the years, which highlight the importance of the SLT role. Below is one of the stories Sarah shared about an anonymous patient, who we will call James.
James found himself in the intensive care unit (ICU) after having had a heart transplant. Despite initially successful surgery, he suffered a lot of complications and deteriorated medically. He was now critically unwell, and his prognosis began to look grave. Despite the best medical care, it became clear that James was dependent on the ventilator and tracheostomy to help him breathe, and was extremely unwell. His care transitioned to a palliative, comfort-based approach.
Even though James was awake, due to the machines and equipment being used to keep James alive (including the ventilator, and cuffed tracheostomy), he was unable to use his voice or speak. He tried to communicate by mouthing words, but this was exhausting.
Losing your voice after intensive care is not uncommon. Not being able to communicate your needs, fears or desires to anyone around you can be extremely distressing and disorientating. In James’ case, he was mentally very alert and present, and mouthed to the team that he wished to speak with his mum. James’ mum, despite being in her 80s, visited her son every day - she was always friendly to the team, and it was clear she had a strong relationship with James. Aware that James may have limited time remaining, Sarah and the SLT team were keen to facilitate enabling them to share final conversations. The importance of expressing love and gratitude, sharing memories, offering comfort and expressing wishes are extremely important but require a voice.
Sarah decided to try a technique called Above Cuff Vocalisation, which is used when it is deemed unsafe to deflate the cuff of a tracheostomy tube, to help patients speak by sending a gentle flow of air through the vocal cords and voice box. Whilst James' mum was visiting, the technique was trialled. “Let’s see if we can get a little bit of voice so you can talk to your mum, shall we?” Sarah said to James.
“It was a very emotional session,” Sarah told us. “He was fully alert but very weak, but he was able to get a bit of voice, and I was there to facilitate the airflow, so he and his mum could have a conversation for the last time.”
James’ mum told Sarah afterwards that it was “just marvellous” being able to hear her son’s voice, and that even though she knew their time together was limited, she would treasure that final conversation they had forever.
“It is such a privilege to be able to give somebody back their voice. To me, it’s about restoring humanity, dignity and personality. To be able to offer this to patients experiencing the most difficult time of their lives is an honour and it makes a huge difference to their suffering and quality of life." The technique was used to help James communicate with the medical staff, to state his wishes and to make decisions about his own care and withdrawal of the ventilator.
James’ story is just one of countless experiences we hear at the ICS of the incredible work that intensive care professionals do, often with very little recognition. It is an example of the impact Speech and Language Therapists have in intensive care every day. While many associate communication difficulties with stroke or neurological conditions, SLTs in ICU play a crucial role in supporting patients to communicate, and swallow safely. Communication enables them to take part in discussions about their care, connect with family and staff, and better engage in their own recovery and rehabilitation.
For patients like James, that support can mean much more than just speaking. It can mean honouring relationships, expressing wishes, regaining some control and maintaining dignity in life’s most challenging moments.
It is a reminder that intensive care is about more than treating illness. It is about caring for the person holistically and helping them stay connected to the people who matter most to them. Every patient deserves to be heard.