Tuesday, June 9, 2015

The Beginning

September 2014. We live a mile away from my youngest son's elementary school. On Thursday afternoon, my 2 year old and I set out with the stroller to walk to a group of 6 neighborhood kids home from school. Half way there, I started to feel an ache in my upper back, at the bottom of my left shoulder blade. It had been a busy day of errands and constantly getting a toddler in and out of an SUV in hot weather, so I figured I had pulled something earlier in the day and was just now feeling it. Not one to be deterred by something like a pulled muscle, I continued on to school. By the time I pushed my daughter's mammoth jogging stroller up to the elementary school's main doors (requiring a climb up a small hill, of course), the ache had increased substantially. The entire left side of my chest and back was in pretty serious pain, from the bottom of my rib cage, radiating up my shoulder and neck, to the bottom of my jaw. I stood in the shade waiting for the kids, trying to stretch out those muscles, thinking this must be what it feels like to throw out your back. In doing so, I realized that the shortness of breath I figured was a result of pushing a stroller in the summer heat had not subsided, but was getting worse. By the time all the kids were out, I was also experiencing dizziness, nausea, heart palpitations, and try as I might, I could not seem to regulate my breathing. I didn't want the kids to worry, though, so we set off for home. It was all I could do not to pass out. It felt like someone was sitting on my chest and I couldn't take a deep breath no matter how hard I tried, but we walked the entire mile back to our neighborhood. When I got home, I laid down on the couch, but that seem to cause the pain to intensify, so much so that I couldn't get my body back into a sitting position.

Now I have to interject here and let the reader know that I am tough. Like, REALLY tough. My tolerance for pain is quite astounding. I've given birth with failed epidurals and little more than a wince and an "ouch." For my kids to see me in so much pain was concerning, and my oldest son called my husband, Tyler, who promptly came home. After quickly Googling my symptoms, he wanted me to at the very least go to InstaCare (because Google said I was having a heart attack), but I refused and asked him to get me some ibuprofen and let me rest for a bit. A couple hours of rest later, I got up and pulled together the dessert I had been assigned to take to a baby shower that evening. I decided against attending the baby shower, but I did go about my evening as normal -- helping with homework, putting kids to bed, watching TV with my husband, etc. I promised Tyler I'd make a doctor's appointment in the morning if I didn't feel better when I woke up. I didn't sleep at all that night because I just couldn't get comfortable and the pain seemed to get worse the moment I laid down. By morning, not only was I still having chest pain and shortness of breath, but I could feel something -- literally feel something -- when I bent over. My husband could feel it, too, simply by placing his hand on my back. It felt like a muscle or something was catching on itself or my ribs when I bent up and  down. This was especially puzzling, so I reluctantly made a doctor's appointment.

I got the kids off to school and Tyler went to work, then I dropped my daughter at the sitter's and drove myself to the doctor. They looked at me a little cross-eyed but performed an EKG to make sure I hadn't had a heart attack. It showed I was tachycardic, but no heart attack. The doctor came in and asked a few questions. I was so short of breath I had a hard time talking, but I'm a pretty perky patient so I was joking and smiling though the whole appointment. The doctor said she was concerned I might have a blood clot in my lung and suggested I head to the ER. So I got back in the car and took myself to the hospital. I had a full day of mom-stuff scheduled. Both of my boys had half-days at school and I was supposed to be watching someone else's kid that afternoon, so I called Tyler and asked if he could take care of all that for me as I would likely be a few hours in the ER. My doctor had called ahead, so upon arrival to the ER, they rushed me right in -- prime-time television style -- and in a flurry of activity, did another EKG, took a bunch of blood and gave me a chest x-ray. After a good, long wait, the ER physician eventually came in and said, "Well, you don't have a blood clot. However, the x-ray shows that you have a significant pneumothorax." "A what?" "Your left lung is collapsed by at least 50%." I figured that was better than being on blood thinners for the next 10 years, so I was relieved. He explained that while unusual, lungs can collapse spontaneously, and marveled at the fact I had waited almost 24 hours to bring myself to the ER. Apparently most people with that size of a collapse would have called 9-1-1. He gave me the run down: I would need to have a chest tube inserted in order to get the air out and allow my lung to re-inflate. "How long will that take?" I asked, "Because I have a babysitter scheduled for tomorrow and dinner reservations to celebrate my birthday." He laughed and told me that most people require a hospital stay anywhere from 3 days to a week in order for the pneumo to be resolved. I was pretty peeved.

Two delightful guys from radiology came and got me. In between the jokes and chit chat, they explained that having a chest tube placed is a torturous process -- way worse than child birth. It has to be done while the patient is awake, strapped to a table, underneath an x-ray, and while they do their best to numb the insertion site, that does nothing to help the pain that occurs inside the body. I asked for (and was given) morphine before they began. One of the guys held my hand and both of them kept talking to me as the radiologist was doing the procedure: An incision is made between the ribs and the tube is pushed into the chest until it rests along the lung. The chest tube is connected to a plastic box called a pleurovac, which collects and measures any fluid that drains from the lungs. The tube is also connected to suction to help drain the fluid and get the air out so the lung can re-inflate and any assumed hole in the lung can heal itself. While it definitely didn't feel good, I was able to keep my composure, most likely thanks to the morphine. One of the guys marveled, "You didn't even flinch!" He probably said that to everyone, though.

When it was over and they were getting ready to take me back to the ER while I waited to be admitted, they asked, "Do you have someone here waiting that we can go update?" "No, I'm here by myself." "You brought yourself to the ER with a pneumothorax?" They got a kick out of that. I eventually made it to my room and had to call home to get supplies for my unanticipated stay. While I was alone (because my poor husband was trying to find someone to take our kids so he could visit his poor wife), I quickly became somewhat of a celebrity among the nursing staff. -- not only because I'm young and so healthy and don't fit the profile of a spontaneous pneumothorax, but because of the circumstance surrounding it. I told my story at least 10 times during my stay.

They started off by giving me hydrocodone for pain relief. Yeah, right. There was a tube inside my chest. Every movement I made was painful. And the worst part about having such a high tolerance for pain is the fact that I consequently do not respond to pain medications. I require the heavy stuff to make a dent. Luckily, nurses stepped in and provided me with morphine so that my muscles could relax and I could sleep as much as possible, because even sleeping was painful. I've read other accounts where patients were allowed self-administered morphine...lucky dogs.

I was given a chest x-ray every 4 hours or so to check on my progress. Luckily, I am a ridiculous over-achiever, so 24 hours after being admitted, my chest x-rays showed I was improving at a fast enough rate not only to go home, but to have my chest tube removed before I was discharged. When it was time, I was told to sit on the edge of the bed, exhale, and then inhale, hold my breath, and bear down, at which point the guy yanked the tube out. I can't even describe that feeling -- chest tubes don't slide out, they are literally yanked followed by resistance. I swear I saw stars when it happened, but boy did it feel good to have that thing out of my chest! They put a water seal dressing on it and sent me on my way with no other follow-up instructions that basic wound care. The doctor said there could not have been a better, more textbook outcome in any way. My nurse said that in 12 years, she'd never had a patient with my diagnosis go home sooner than 3 days.

I still had about a 10% collapse when they sent me home, so I was told to take it easy for at least a week. When I got home, I went straight to bed and slept for 18 delicious hours. It felt wonderful. I had some residual pain from the chest tube that didn't last incredibly long, though the incision site was too tender for me to wear a bra for a couple weeks. I felt like it took a solid three weeks before I was no longer easily winded and could go about my day without any issues.

As we were leaving the hospital, the doctor warned us that once someone had one spontaneous pneumothorax, the chance of recurrence was very high, especially within the first year. For a short while after returning home, I worried about that. Should I change my lifestyle? Was I a ticking time bomb? It didn't take too long for reality to take the wheel, though, and I plunged head-first back into my chaotic life. A month later, I had a tiny little scar that was hardly noticeable, and I was functioning at 100%.

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