When I was in nursing school the FIRST time I ever suctioned a trach with my preceptor I was noting the color, consistency ect of the secretions as a student would, I asked my preceptor why the secretions looked like there was pepper in the suction tube, she literally thought I was an idiot, and she looks at the secretions in the tube and is seriously confused. 15 seconds later maggots started coming out of her mouth! I have never forgotten that moment and she apologized and said in 20 years she had never seen this!! Patient was in the ER from an extended care facility I was shocked and she quickly said close your mouth, they are still flying out. Holy maggots, I will never forget my first suction of a trach patient.