not a pretty picture, but real life.
I put the arrows in to explain. The trach hole was closed shortly after this picture was taken. Since it was allowed to remain open so long, it had to be sutured. Usually trach holes close up on their own.

The hole in his neck is the surgical result of a tear in his esophagus that he acquired during his hospital stay. The tear caused a fistula which brewed until he had a major infection. He suffered >sore throats, couldn't eat, nausea and vomiting. The physical therapy staff accused him of faking it to get out of therapy. They documented that Jake was 'non-compliant'.

As a result of the tear/fistula he was "nothing-by-mouth" for almost a year. He ate and drank through a tummy-tube.