[whytheheckme]

As per request of some PMs, I am attaching a description of most of the entire experience. This was originally intended for my history teacher....


On the morning of December 4th (approximately an hour and fifty-six minutes before your class) I stepped out of the shower, and began to brush my teeth. I took a deep breath, and felt sudden, excruciating pain in my left chest. Having a pneumothorax before, I knew this pain all too well. Knowing that I had about three breaths left before the pain became unbearable, I held my breath and ran upstairs to quickly get changed and wake up my mother. I was in the car by the end of the three breaths, at which point the pain became unbearable, and I started to break down. Approximately twenty-seven minutes later, my mother's car pulled in front of the Emergency Room at Connecticut Children's Medical Center, where I literally ran inside, with no shoes or coat on. I was immediately checked into the emergency room, where my vitals were taken, and after approximately twenty minutes (after it was determined based on my history of having a pneumothorax that this again, was most likely a pneumothorax), I was put on oxygen, which was a great relief. While I still had very excruciating pain, I was still awake and in a stable mode. An X-Ray was taken of my chest, which showed that I did indeed have a pneumothorax. If you aren't familiar, a pneumothorax is when there becomes a hole in your lung, allowing air to escape into the cavity around it. When the air can't find it's way back into the lung (the hole is really tiny), it puts pressure on the lung, because the cavity is of a fixed size, and can't expand. After enough air has escaped into the cavity, enough pressure builds up against the lung, that it collapses. Looking at the X-Ray, it could clearly be seen that my left lung did not fill the entire cavity space, and that there was a significant amount of air above the lung. Fortunately, there wasn't so much air that my heart was in danger (as the lung and heart share the same cavity), as it was the last time I had a pneumothorax. After about another hour, I was brought into the OR to have a 'pigtail' chest tube installed through the front of my chest. I had the choice of being sedated, which I chose to do (last time, I didn't, and it was a very odd experience.) After the tube was installed, it was put to suction, to pull all of the air out of the cavity, and allow the lung to re-inflate. An X-Ray an hour later showed that my lung had come up significantly. Due to heavy pain medication, and the fact that my lung wasn't collapsed any more, I was in much less pain.

The profile for someone to have a spontaneous pneumothorax is a tall, skinny, teenage, white male (kinda sounds like me.) Although this isn't always the case, a person with that profile is most susceptible to a spontaneous pneumothorax. There are two major 'causes' of a spontaneous pneumothorax, both of which are very unknown. The first 'cause' is that it 'just happens', and they don't really know why. The second 'cause' is that there are 'blebs' or blisters (kind of) on the surface of my lung, which pop, allowing air to escape. The reason these blebs are there, how they got there, and why they are usually only seen among people of my profile is completely unknown. The only way to tell if you have blebs on your lung or not (without going in surgically to look after the first pneumothorax,) is if you have another pneumothorax on the same side. This means that the cause wasn't the first, where there a no blebs present, but most likely the second, where blebs are present, and another popped. People who don't have surgery to remove the blebs have been known to have multiple pneumothorax', up to 4 or 5 times before they agree to have the surgery done. I decided to have it done right away, because I didn't want to risk having another pneumothorax (on the left side), and experience that pain again. The doctor told me that the pain of having a pneumothorax is one of the only natural pains that a male can experience that is greater than that of natural childbirth.

After the pigtail was put in, I was checked into a room on the 6th floor. I stayed the night, and was woken early the next morning. I was brought down to the OR, where I was put to sleep yet again, when the surgery was performed. The surgery was done through three small incisions on my left side; One incision was for the video camera (so the surgeons could see what they were doing inside of me,) and the other two were for the surgeons to use their tools inside my chest cavity. If they were unable to remove the blebs using the camera, they would have had to go to an open surgery, which would have been much more painful. The surgery consisted of three major functions. The first was to remove the blebs on the top of my lung, therefore making a pneumothorax much less likely, and the second was to 'stick' the top of my lung to my chest cavity, making it so that if another hole did form, the air would not be able to escape, because my lung would be stuck to the side of my chest cavity. This process is done by irritating both surfaces, and sticking them together. The cavity wall was mechanically irritated, using a material similar to sandpaper, while my lung surface was chemically irritated, using something similar to an antibiotic (a mechanical irritation of my lung would not be good, as it could create another hole, and yet another problem.) The third purpose was to remove the original chest tube (which was relatively small, about a quarter inch in diameter) and put a much larger chest tube into my side (about the size of a penny looking at a cross-section.) I awoke from the surgery later that day, very soon wishing that I hadn't. The pain after the surgery was much worse than the pneumothorax itself, even with the six pain medications they were dumping into my bloodstream (including morphine, and another drug approximately nine times more powerful than morphine.) I was also on drugs to prevent my body from reacting to the other drugs. I was also on nausea medication, because I am known to have an upset stomach to heavy pain medications. They also gave me a button to hold in my hand, in which by pressing it, would dump even more than the steady stream of drugs into my blood system on a need-basis. For almost two days, I was holding the button down, and still in very very heavy pain.

I was in the hospital for a total of eight days. By the last three days, I could walk around the floor, carrying my water-seal. Immediately after the surgery, the chest tube was hooked back to suction, allowing my lung to be expanded, and allowing the hole to heal. The idea is to allow the hole to heal for a few days with no risk of the lung collapsing, and then removing the suction to see if it is indeed actually healed. After four days after the surgery, the doctor removed the suction and hooked me to a device called a water-seal. The premise behind a water-seal is that the tube that goes into me is 'capped' with a column of water, not allowing air in or out of my lung cavity through the tube. It's as if the tube was removed, without actually removing it. The typical procedure is to take an X-Ray before you are put on water-seal, stay on water-seal for twenty-four hours, and then take another X-Ray to make sure the lung hasn't gone down (if I'm not already in excruciating pain after five minutes of being off of suction.) After the typical one day, my X-Ray was taken, and evaluated by a resident doctor. The resident doctor determined that my lung had gone down some, and that I should be hooked back up to suction. This was a great disappointment, because that would mean that I'd be in the hospital for at least an additional four days. Later that day, my actual doctor came into the hospital, looked at the X-Rays, and determined that the resident doctor made a mistake, and that my lung had actually not gone down. He opted to do the procedure of removing the chest tube the next day, and then waiting a day after the tube was out to send me home. The procedure was done, and everything looked good.

I was sent home on Thursday the 13th, during that terrible storm. It took over two hours to get home. Finally I was home, safe and sound. I slept for a few days, and have been very groggy since. I have been writing this e-mail over the past few days, adding to it each day. I guess I intended it to be a brief summary, but it turned out to be a full blown story.

Anyway, if you actually did read all of that, congratulations for not falling asleep in the middle : ) . Some of the writing isn't the best; It's amazing what pain medication can do to you. I am slowly recovering, doing a few more things each day. My days now typically consist of either laying in bed or on the couch, listening to calm music (although I can walk, and I'm improving my balance and coordination.... slowly.)

Jacob