Ahem.
*cracks wrists, flips chest tube over shoulder*
I had planned on blogging this month about something mundane, like “How Midpoints Are the Most Misunderstood Plot Point,” but then my left lung woke me up in the middle of the night, screaming (in the voice of Miette), “YOU HAVEN’T PAID ENOUGH ATTENTION TO ME, MOTHER.”
Which is fair. I have given my left lung very little thought throughout my life, and I’ve always played favorites with its opposite-sided twin, anyhow.
If you’re curious to know what it’s like to have your lung go, you know, honestly, I’ve worked hard all my life, put up with far too much cat dander and seasonal pollens—I deserve a little vacay, read on! If you’re squeamish about pain, needles, and fluids…well, consider this free exposure therapy.
How It Started
I am an idiot.
“Don’t be so hard on yourself!” you may be retorting—or not. Maybe you’re already sagely nodding and thinking with relief, she figured it out on her own.
But trust me, dear reader, I will not disappoint you with my promised idiocy.
For the past couple of months, insomnia has chopped up my nights, carving out the wee hours of 2-4 am for ceiling staring, NYT puzzles, and internalized screaming about work. To support myself writing, I day trade* and, uh, well, the job is dumb and stressful, and they say redheads don’t gray unless they’re trying to trade triple-leveraged 20-year treasury ETF options into FOMC. As such, I have a history of popping awake at 3am, half-way into a panic attack.
*I’m technically not a day trader, but trust me when I say you do not want me to explain the differences between types of stock-option trading, unless, you too, suffer from insomnia and would like a miracle cure.
Two weeks ago, I thrashed awake at 2:20 am, heart hammering, thoughts on full red alert, lungs playing club bouncers to all the desperate breaths trying to sneak inside. My chest felt as if Clifford, the Big Red Dog, had dug up my ribcage and was not going to let anyone take away his new favorite chew toy.
I never fell back asleep.
And I never went to the doctor, because I blew the whole thing off as a panic attack.
Six Days of Idiocy
The chest pressure and shortness of breath continued, despite my attempts to resolve via journaling why I was stressed out AF. To the shock of the entire medical community, I am sad to report that you cannot journal your way out of pneumothorax.
Despite working in medicine for nearly a decade, having a nurse as a mother and a dentist as a father, I am one of the most doctor-avoidant people you’ll meet. It wasn’t until I started having fever hallucinations that I went to get antibiotics for my strep throat in college. I had to be convinced not to stitch up my own hand after having fallen into a pile of glass shards. My only medical care for a stingray-mauled foot was letting a lifeguard stick it into multiple buckets of near-boiling hot water for 2 hours.
So, of course, I waited six days before going to urgent care. In the meantime, I hosted my D&D game, applied to editing jobs, and continued to clutch to the idea that it was simply a panic attack and not something important, like the continuing function of a major bodily organ.
Except that I couldn’t lie down or bend forward without a spike in chest discomfort. My shortness of breath also prevented me from walking around the block (and as someone who regularly-ish works out, this was my final, very scary clue that this couldn’t have been from a panic attack). Every internet search I did kept insisting that the most likely cause was a sinister event called a “heart attack.”
Mkay.
I’ve heard those are bad.
Doctor, I’m Sorry, But You Must Be Mistaken
My partner hauled my stubborn ass over to urgent care, having finally won the week-long battle of LET ME FREAKING TAKE YOU TO MEDICAL CARE (bless him and his infinite patience with me). When I told the nurse my symptoms, her face visibly tensed. Suddenly, I was being placed at the top of all the queues to be seen, treated, x-rayed, etc., and my desperate hope that this would be a minor issue began to plummet while my blood pressure tried to beat its old high score.
The urgent care doctor came in and did a live read of the chest x-rays with me. He pointed to a line that demarcated my lung, pushed far away from my chest wall.
“You have a lung puncture,” he said.
“That’s impossible. How?!” I could not think of a single explicable moment of trauma. Not a single hard sneeze, stubbed toe, or an elbow banged into a doorframe.
“It can happen spontaneously,” the doc replied.
Bullshit. (Narrator: It was not, in fact, bullshit.)
My partner then politely, delicately, graciously suggested that perhaps the urgent care doctor should double-check with radiology about his read, because what the ever living—
He checked, and radiology confirmed: It’s a collapsed lung. And a big one too!
(Sometimes I wonder if radiologists take selfies with notable x-rays, like guys on dating profiles do with large fish.)
The door swept open and the nurse pushed a wheelchair into the room. They were punting me over to the ER.
If only I had the breath to argue how they must be terribly mist–
What Physical Torture Feels Like, ER Edition
I was immediately admitted to critical care in the ER. I kept trying to get out of the wheelchair, because I could walk just fine, dammit. But apparently, doing so is how not to get an “A” in being an ER patient.
Nurses set me up on a bed and attached a pulse oximeter, a blood pressure cuff, an IV-line, ECG leads, and a nasal cannula to me. An ER doctor had a long chat with me about what a spontaneous pneumothorax is and what the treatment plan would be.
Here’s the drive-by explanation of a spontaneous pneumothorax:
- A pneumothorax is when air leaks out of your lung via hole and into your chest cavity
- The air then accumulates and eventually collapses your lung (partial or total)
- A pneumothorax can be spontaneous or secondary to a disease process
- The causes of a spontaneous pneumothorax are not well understood, but they’re believed to be caused by “lung blebs” (air sacs) growing then popping without warning
- Treating one requires getting that air out of your chest cavity and making sure that hole closes
- Conservative treatment would be doing nothing and seeing if it self-resolves
- Moderate treatment would be sticking a chest tube in to aspirate out the air
- Significant treatment would be video-assisted surgery and a terrifying procedure called pleurodesis, where your pleural cavity is eliminated by literally scratching the hell out of it so your lung permanently sticks to it (I like to think of this as “hot gluing” your lung)
- If you have one, you have upwards of a 50% chance of it happening again
- There is quite literally nothing you can do to prevent one from happening (trust me, I interrogated every single doctor I encountered)
I advocated for going the conservative management route (waiting and seeing if it’d self-resolve), but the thoracic surgeon said (and I’m paraphrasing): Abso-freaking-lutely NOT.
The next part is where I feel mildly vindicated about having tried to avoid all this.
I’m a natural redhead, and in case you didn’t know, redheads genetically, via our unique MC1R gene, have weird relationships with pain and pain medications. Our pain thresholds also tend to be skewed either higher or lower depending on the type of pain we receive, compared to non-redheads. I’ve also learned the hard way that my body metabolizes lidocaine faster than a 5-year-old getting their next sugar high by woofing down pop rocks.
Then there’s my extreme response to fentanyl. I’ll get to that in a moment.
The ER doctor informed me he was going to place a tube in between my lateral ribs to air out my chest cavity. The chest tube would have a Heimlich valve, which would only allow air and fluids out and not back into my pleural space. The process would involve threading in a wire, dilating the hole open, and slipping the tube inside me.
He warned it’d be painful, but that’s why he’d give me either fentanyl or morphine (neither of which I’ve ever had before). He’d also be numbing up my skin with lidocaine, and I told him it needed to be a bunch of lidocaine (he assured he’d inject extra). I also warned him that I have a lipoma (a benign tumor) in the area he wanted to punch through. He assured me it wasn’t in the way.
(Narrator: It was very much in the way.)
And one more thing: we were going to have an audience during the procedure.
Apparently, since this was going to be a teaching moment, my body decided it ought to be a memorable teaching moment.
The ER doctor prepped for the procedure, numbed the area up with lidocaine, and told the nurse to load me up on fentanyl. If you’ve never had fentanyl, you should know it works immediately. A warm, relaxing wave of CORPOREAL CLAUSTROPHOBIA AND RAW TERROR strangled my suddenly foreign-feeling body.
Because I’m a properly raised lady, I began thrashing, hyperventilating, and sobbing in front of six strangers all while a strip of masking tape stuck across my boob desperately tried to preserve my last modicum of modesty. Several nurses shot forward to hold me down.
The doctor then gave me a few minutes to recover myself. As I trembled, a nurse instructed me to take some deep breaths.
SIR. We would NOT be here right now if I could take deep breaths. …is what I would have quipped if I hadn’t been hyperventilating on a collapsed lung.
Dear reader, I really wish that had been the worst part.
The Worst Part
After administering ambrosia from the teat of a goddess morphine, the ER doctor proceeded with the chest tube implantation.
Or, at least, he tried to.
Three times.
Over the course of an hour.
While three nurses continued to hold me down to prevent me from writhing about in pain.
The dilation portion was so nerve-shearingly painful despite the morphine AND the fentanyl, I began yanking my own hair to distract me until a nurse intervened and held my hand. Each attempt failed, despite the ER doctor consulting another physician for guidance and taking multiple x-rays at the bedside to pinpoint the problem. I have no pithy little quips about this part because it’s a hazy, Vaseline-glazed memory at this point.
Giving up, the ER doctor left to consult thoracic surgery. Long story short, a thoracic surgeon resident came to do the procedure; except this time, he placed the tube on my upper chest instead of my lateral ribs (where I checked, and yep, the ER doc had been trying to go through the lipoma). The procedure hardly hurt. I even quipped to the resident that I needed one of these tubes for my kombucha bottling at home.
Naively, I thought that’d be it for the painful parts.
Then he turned on the suction.
I doubt you’ve ever wondered what it’d be like to have an Oreck hotel vacuum accidentally run across your lung, but lemme tell you: I now consider vacuuming up spiders to be an act of monstrous cruelty and violence.
After 12 hours between urgent care and the ER, they discharged me home. I couldn’t lift my left arm after the four procedures to dress myself, and since I reacted poorly to opioids, I was discharged only with ibuprofen.
Living with My Kazoo of a Chest Tube
As I’m writing this, I’m on Day 10 of living with a 2-foot-long chest-tube that dangles down to my waist. Much to my four cats’ collective chagrin, it is officially The Forbidden Cat Toy.
Charmingly, the Heimlich valve makes a kazoo sound when I cough or sneeze.
Less charmingly, it expels liquids into a bag that I have to empty.
I was originally supposed to have the tube removed after five days, but I had failed the “water seal test” (coughing while the end of the valve is stuck in a cup of water; if it bubbles, it indicates the air leak is still present). My thoracic surgeon wanted to give me another week to see if my bratty little lung would stop throwing a hissy fit before proceeding to the next step: video-assisted thoracoscopic surgery (VATS) and pleurodesis (scratching up the lung to basically hot glue it to your chest wall) followed by a couple nights in the hospital.
Presently, I’m expelling liquids at the same frequency as my mother’s old GMC Sierra would spray oil (which is to say daily; please forgive her, Mother Earth, for it was the 90s…) and still kazooing away.
In order to avoid delays, the surgeries have already been scheduled for the same day that I do the second water seal test.
So, stay tuned. Either I pass the test and that’s the end of this medical drama…or there’s a part two to this blog entry. …Assuming I don’t die, go into a coma, or transform into a radical new life form after having been inseminated in the lung by breathing in alien semen-spores. Though, I promise, I will try my best to still blog about the latter even if I only have slimy green suckers for phalanges.
Qapla’!
The Update & Why My Lung Is Now A Pincushion
While I did not turn into an alien, I did ultimately end up having a second pneumothorax three days after I passed the water seal (bubble) test and had my chest tube removed. I returned to the ER, where I was admitted to the hospital for lung surgery. The thoracic surgeon ended up cutting off the top of my lung, stapling it, and coating my chest cavity with talc powder to effectively “hot glue” my lung to my chest wall forever. Total hospital stay ended up being for five nights, though two of those were pre-surgery.
I will confess: this was !@#$ing painful as all $@!&. While I maxed out all pain meds available to me immediately after the surgery, I was shockingly able to quit everything (including ibuprofen) a week after the surgery. Within a day discharge, I was back to walking 1.5 miles daily, and within about 3 weeks, my lung capacity was almost normal. My surgeon did a terrific job, and my hospital stay was almost…pleasant? My nurses and doctors kicked ass.
And now I’ll leave you this fun factoid that I discovered after the surgery: when surgeons say they’re going to “staple” your lung, it’s not one single metal staple to close your lung like a neatly tucked envelope. NOPE. IT’S ALMOST 200 TINY TITANIUM STAPLES that get to stud my lung like a Hot Topic belt from the early aughts for the rest of my life.