The Mystery of the Hole in My Lung: The Doctor Becomes the Patient!

It was precisely 20 days ago that I was at work. It was a Monday morning and I had just finished a busy weekend admitting medical patients from A&E. The Sunday was slightly trickier than usual – I felt like I’d slept in a funny position and my right ribs ached. Still, nothing like a steady stream of patients to focus the mind, and so on I cracked for the 12 hour shift. That night when I got home, however I could hardly breathe. Bent over double on the bed, panting like an expectant mother, I looked to my girlfriend with a glance that said “What the hell is all this about!” I am after all a fit, young(-ish) 32 year old with no medical issues. After failing to convince me to go back to A&E at 1am that morning – my argument being that I’d just spent 12 hours there and I am under no circumstances going back tonight – some knock-me out painkillers, shot of whisky and the classic of all medical inventions – the hot-water bottle (thanks, Mum), I fell asleep….albeit with a breathing rate of 30 per minute.

The next morning things were no better. Being the stubborn mule I am, I still refused to go to A&E – after-all we were short of team-members on the ward. Sadly however, once my registrar saw me hunched over like Golem from Lord of the Rings, puffing away at 30 breaths a minute, I was sent packing down to A&E. I had failed.

Now there are not many perks to being a doctor. With that said, that Monday three weeks ago, I was exposed to one of the greatest cornerstones of the NHS – comradery. You see as soon as I wondered down into A&E, had a quick word with the A&E registrar on the shop-floor saying that I needed an X-Ray to exclude a collapsed lung (that, since I am tall and skinny – well I prefer athletic! – a spontaneous pneumothorax was the most likely cause of my breathlessness), I was whisked into an A&E cubicle. Over the next few hours I had seen 2 A&E consultants, 2 A&E registrars, had a chest X-ray and CT scan, been squeezed into a respiratory clinic that afternoon to be seen by a Respiratory Consultant, and had the on-call medical team drop in to see if there was anything they could do. I was utterly humbled by the togetherness and sense that within the NHS, we look after each other. Now I say all the above not to anger people – and I appreciate some may dislike the fact that I had what is, yes, preferential treatment – but these people whom saw and treated me where my colleagues (for I had spent 4 months working in A&E) and my friends. Throughout the entire process, I spent my time wondering how I could repay them, to show my gratitude for their timeliness in treatment and kindness.

Now not one to be a debby-downer on the situation, let me tell you my two highlights of that day spent in A&E, CT scans and outpatient clinics. The first was the utterly bemused look on one patients face who saw me donned with a cannula in my arm, hospital gown on, being wheeled down the corridor – for I had been the doctor who had treated him only the night before! The second musing was the locum puzzled nurse (who didn’t know I was a doctor) who came in to see me in the A&E cubicle to insert a cannula, only to find me with my own stethoscope listening to my own chest, before defiantly stating that I will insert my own cannula thanks – though as it turns out that isn’t so easy, so I had him do it in the end. Being a patient was a huge eye-opener – you are devoid of control – something that as a doctor, I have a lot of. It brought a definite new respect for what it is like to be a patient. Plus, cannulas bloody hurt!

Anyway, we digress. It turned out that I didn’t have a collapsed lung. In fact it turned out that I had a 2.7cm hole in my right lung – described as a cavitating lesion. Now it is fair to say that this came as a surprise to the A&E team – and to me. What can cause a cavitating lesion like this?  Well, many things including infections like tuberculosis or a fungus. And yes, cancer can as well. This latter diagnosis kept me up for a few hours on that first night I got home befor, at around 4am, I decided that I should stop being an idiot – a 32 year old man who has never smoked, has no risk factors and no other symptoms of malignancy – does not have cancer. And so I put it from my mind from then on.

CT

[CT Scan]

The initial X-Ray

[Initial Chest X-Ray which we expected to show a collapsed lung)

Of course we still didn’t know what it was. The reward for not knowing was an investigation called a bronchoscopy. This is a way to look into the lung and take some tissue to look under a microscope. Now the best way to describe it is this: picture sitting upright in a chair, a little drunk, and then having someone funnelling a slowly leaking hose-pipe down your windpipe and your lungs….all while telling you to “just relax and breathe” in a tone that would be a hit in any yoga retreat. Let me tell you, it is NOT possible to relax…and as for the breathing…well, you feel as though you are drowning. Thank God for midazolam. It was fair to say this sedating drug did its job – I didn’t even recall the first conversation with the respiratory consultant after the procedure.

Post bronch

[Post bronchoscopy – Oh course, I have no recollection of this picture. Bad hair day..!]

Of course from that day that I went down to A&E to get that ‘quick’ x-ray, I have not been back at work. Why? Well, if I did have tuberculosis, I would be a huge infection risk – particularly as I am now moving into paediatrics – and those little people have far weaker immune systems than you or I. As such, while the hospital doctors that are treating me wait to see what bugs grow in the Petri-dish to see if it is tuberculosis or something else, I have to be at home.

Three weeks at home may sound like a luxury. It was hell. I felt a fraud, lacking in purpose, lost even. You see I felt well in myself after a week of antibiotics and guilty that I wasn’t at work. It made me realise how much I value my job as a doctor, how it is part of my identity and that I love that. I am after all, proud of being a doctor and working with such brilliant healthcare teams. Although, it is true that I became a very good house-husband over that time, the itch to return to work never left me. And finally after three weeks of waiting and waiting, I have finally been given the all clear to return.

After all that has happened, two questions do still remain: what IS that hole in my lung? And how can I possibly thank all the people that cared so much for me while I was converted from the doctor to the patient.

Only time will tell…

Nick

Advertisements