"It can't collapse - its not possible!"
After undergoing surgeries on both lungs in high school, I was told that both of my lungs were fixed forever. I had returned to a normal life and was an extremely active athlete, a swimmer and diver, who trained vigorously for over three hours a day. So when I turned 19 and my lung collapsed again, I was shocked. I was in the middle of an early morning swim practice at Lower Merion High School when I experienced the familiar, very sharp pain in the back of my lung. Even though my surgeon, Dr. Kaiser, had told me unequivocally my lung would never collapse again, my body told otherwise. Years later, after this incident, my swim coach Paul Speicher told me that as I climbed out of the pool in pain, I told him "I think my lung is collapsed - but it can't collapse - it's not possible!" This was how strongly I believed my doctors back then.
"Get out the rib spreader"
Two hours later, an X-ray in the ER at HUP showed a small lung collapse of 5 percent. By nighttime, however, a follow up X-ray revealed a 40 percent collapse and doctors immediately rushed into my room to insert a chest tube. As I chronicled earlier here, a chest tube insertion is a unforgettably painful experience. While I was fortunate on this occasion that the doctor seemed much more knowledgeable than on my previous chest tube insertions, a new element was introduced to the shenanigans. After making an incision and getting a closer look at my ribs, the doctor turned to his assistant and said "Get out the rib spreader." The assistant quickly left and came back with a rib spreading device in hand. While I imagine this medieval-looking apparatus made it easier for the doctor to insert the chest tube between my ribs, it was rather unsettling to see this large and bulky tool protruding over a foot from my chest as they worked to cram a hard plastic chest tube inside me. It was even more upsetting to see the doctor and his assistant crank the two handles on the rib spreader to spread open my chest. My brother Fred was in the room at the time and witnessed the procedure first hand. He later told me it took all of his will not to go running into the bathroom throwing up. I wouldn't have blamed him if he did. For months, Fred and I would insert our twisted inside joke "Get out the rib spreader" into any and every conversation possible. Having trouble getting the lid off of a jar of peanut butter? Get out the rib spreader! You get the idea.
Unfortunately, a chest tube is only a temporary solution. It doesn't actually heal the lung. Rather, it prevents the lung from collapsing in the hopes that the lung will heal and begin to function properly on its own. People like me, whose lungs collapse repeatedly, are usually not lucky enough to have their lung heal on its own. Once a person's lungs have collapsed two or three times, repeat collapses are so common that a more serious, corrective surgery is usually advised.
Partial Pleurectomy + Chemical Pleurodesis:
A week after the initial collapse and chest tube insertion, my former surgeon, Dr. Kaiser, turned me over to the care of his partner, Dr. Friedberg. Since the previous Pleurodesis surgeries hadn't been enough to prevent my lungs from collapsing, I underwent a more intensive, two-part surgery known as a Partial Pleurectomy with a Chemical Pleurodesis. My surgeon Dr. Friedberg told me that he removed part of the lining of the lung, known as the pleura, in order to cause significant bleeding and scarring, which in turn would result in a "stronger" lung. The second part of the procedure was known as a "chemical pleurodesis". Dr. Friedberg inserted the antibiotic Tetracycline onto my lung in order to burn the lung's surface. Again, the goal is to cause scarring and further damage so that the lung can no longer collapse. As with any lung surgery, I had two chest tubes in me for about five days and was released from the hospital 6 days after the surgery.
I should note that the recovery period for this surgery was longer than I expected. It took a lot more out of me and I'd say it was three to six months before I was back and fully active again. By contrast, after my earlier surgeries (the Pleurodeses), I recovered very quickly and was back to full activity within a month.
Complications:
While recovering in the ICU/recovery room post-op, my lung remained collapsed for a considerable length of time due to improper stitching and shoddy bandaging. I was literally breathing through a hole in the side of my chest. I learned later that medically this is known as a "sucking chest wound". I could hear air whizzing in and out of my wound and I felt immense pain and pressure due to the air leak. I knew that my lung was completely collapsed, but I was largely dismissed as a complainer when I desperately tried to explain the situation to any nearby doctor or nurse. About 30 minutes later, a nurse who was checking my vitals heard the sound of wheezing coming from my bandages and realized that I had air leaking from my chest cavity through one of the surgical incisions. A team of doctors and nurses sprang into action to patch me up, properly re-stitch and re-bandage the wound, and re-inflate my lung via chest tube. The most intense pains and pressure subsided quickly but the mental scars remained. Seven years later, when I underwent my next lung surgery, I made my new surgeon Dr. Houck swear to me that he would make sure my wounds were properly closed after surgery.
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