Monday, March 17, 2008

More is how you live...

Long silences on cancer blogs are bad. Not as bad as the e-mail titled "Down for the Count" I once sent a close friend, but bad anyway. The day after I'd exposed my little nicks and cuts from chest tube misery -- before, even, I'd managed to take a shower -- I went to work and started feeling a little funny. A chest x-ray seemed smart. So I left work, got the X-ray, and checked into the hospital. Another pneumothorax to add to my collection of pneumothoraces.


It's been a while, and I can't really get into the details of the hospital stay now because other stuff has happened, but the whole experience was tough. The standard treatment for recurrent pneumos is a procedure called pleurodesis. 

Backing up, your lungs are essentially double bagged. In between the two "bags," or pleura, is an open area called the pleural space. When a lung "collapses," this generally means that it springs a leak and starts shooting air into the pleural space, raising the pressure in such a way that the lung can't reexpand. But close the space by sticking the inner "bag" around the lungs to the outer "bag" attached to the chest wall, and your problems with pneumothoraces are, hopefully, over.

Problem is, this process sucks. The simple way to do it is to get a bit of morphine and then have a doctor inject a small amount (50ccs or so) of talc slurry through your chest tube into the plural space. You swish the talc around by lying on your bed for a while, then, a few hours later, an inflammatory process starts that closes the pleural space. This hurts a little, but you manage it with analgesia. In my case, the process went down like this: Morphine, OK; talc, oh my god! I felt as if a concrete slurry was being pumped into my lungs, hardening around them instantly and choking with within. The pulmonologist tried to back off a few ccs as I started thrashing and weezing and hurling imprecations in a classic respiratory-impaired-bad-guy voice. Then, somewhat stunningly, the dude leaves! The concrete continues to harden and block my breath, and LA asks, "Do you need help?" And I sort of choke out an affirmative.

And this is where the doctors and nurses begin "managing my pain." This is a key principle in the onc ward in the cold state, one that I am greatly appreciative of. The staff is good at it, and I never really thought there was a downside to, you know, not being pained. But reality is more complicated than that, as I'll explain in a bit.

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