Last January is when I began to have episodes in which I couldn’t catch my breath. The first time I had two events in one day. At the beginning of the shift we were all being introduced to the new whiteboard we would have to fill out for our hospital administrators. I was trying to hang on for the explanation but suddenly felt a hot wave come over me and felt like I might pass out. I remember sitting in a nearby chair and that it was observed by a coworker who checked to make sure I was ok. Not having had any such problems before I thought that it was sleep related or a minor cold and shrugged it off as that I felt better a few minutes later. That evening I asked someone to watch my patients because I felt like I simply could not catch my breath despite not running around that much. I sat in the back managers office for about 30 minutes and still couldn’t stop breathing quickly. I have periodically had these spells after my chest surgery when it seemed like my chest was mad but I hadn’t done anything to provoke it this time. My manager wanted to take me down to the emergency room but didn’t find me particularly receptive to the idea. I later found out that a large part of her concern was due to the color of my face being as white as the bedsheets. I did go eventually (only under mild protest which I expressed through ardent refusal to be put in a wheelchair) but by the time I made it through triage I was back to feeling normal. The Physicians Assistant said she wasn’t sure what to do with me and asked if she should try IV fluids. I let her know that I came down it was out of respect for the experience of my coworkers but by that point nothing seemed actionable and I felt normal so it seemed fine to me to discharge and watch on my own. The ER doc came in and felt like it was a reasonable plan so he discharged me. I can still remember seeing the judgmental look of disgust from a male ER nurse as he watched me leave. I suspect he felt like I had wasted their time and room in this frivolous exam. Despite my immediate inclination to suggest he go impregnate a porcupine I decided to keep that pearl of wisdom to myself. When I returned to work I gave my manager a thank you card I had made in which crude stick figures of the two of us were walking to the ER. The figures were made on a slider so that the farther they went the more you could see one of them wishing the other would just get in the damn wheelchair.
The second trip the following month was more eventful. My pulmonary doctor had been telling me that I had a trapped lung related to a prior surgery and that it needed surgical intervention. His plan was to discharge me from his service and have his friend in a local hospital system open it up with an endobronchial ultrasound (EBUS) procedure. As I tried to set up an appointment I found out that I had initially been referred to the wrong department. Once I navigated through that issue I learned it would be May before I could even be seen. The previous pulmonary doctor had given me several spiriva inhalers and emphasized me needing to use them as well as prescribing an antibiotic called azithromycin. I had found one surgical textbook through our hospital library that supported the use of those two drugs in conjunction with surgery for the treatment of trapped lung. I also noted it said nothing about EBUS but seemed to point more towards another thoracic surgery. A few days later I found I was unable to move quickly, my heart was racing for everything I did (walking across the room) took me immediately into the 130s which I could hear and I had 7 episodes of not being able to catch my breath. I called a physician I had worked with who helped care for me during my hospitalization and asked him for his advice regarding if I should go to the same hospital I had been going to that already had my records or the other system where the EBUS wielding doctor worked. He told me to just come to the same system and that see what the could figure out.
I don’t think that my Uber driver particularly appreciated me using his services that day. He reminded me (several times in fact) that there was a closer ER around the corner. I politely thanked him and let him know I really needed the one I had asked for.
As I walked up to the reception desk I could hear my heart racing and I was gasping again. The intake nurse sent me back for vital signs and an EKG. Upon seeing that my heart rate was in the 150s (from the difficult task of walking 25 feet) and my respiration rate was in the mid 30s the ER immediately made me a sepsis alert and got me back into a bay. My new nurse (who was a real treat and needs to spend some time herself in a hospital bed) overheard me responding to the ER doctor’s question about my profession being in critical care. Her immediate two cents: “You work in ICU and you’re breathing like that? You should be ashamed of yourself!” If breathing had not been such a challenge for me I really felt like she and I could have a truly meaningful dialogue. I had told the ER doc between and through broken breaths that within a few moments I would likely be breathing normally again and sure enough I was.
The ER doc felt that I needed a cardiac work up due to my fast heart rate and would suggest a pulmonary consult to the admitting physician. During said cardiac stress test I had to walk up an progressively increasing incline with faster and faster speeds. About 7 minutes into it they had all the data they needed. It would initially felt good to be exercising again but I quickly went into another episode of gasping. “Do we need to call for help?” Asked one technician. “No, this is just my party trick” I replied. A few minutes later I was back in my hospital room and Catherine had just arrived. She quickly inquired: “What’s wrong with your hands?” I looked at them and they were a striking combination of white and gray. More fun.
Shortly afterwards I was greeted by Ed, a pulmonary doctor I have worked with for a while. This meeting was significant in that he was the first doctor to say:
“We need to talk about your exposure to burn pits.”
This had my attention. I had been asking for 10 years if if they might be a problem for me but that had always been dismissed as anxiety. I was so out of it that it was extremely hard to keep a focus or retain information.
Ed stated that he had looked over everything and was concerned about the burn pit history. He also did not agree with the trapped lung diagnosis:
“If you want to follow up with this surgeon you can but your lung opens up just fine and I have a very low suspicion that EBUS will do anything to help you.”
After my discharge home from I was looking through my online records. My cat scan of my chest showed all of the holes in my chest that had been made in it like a fingerprint. The third entry caught my attention:
‘Diffuse mosaic attenuation’
Not having seen this reading in any of my patients I looked up related conditions:
-pulmonary hemorrhage
-chronic pulmonary embolism
-constrictive bronchiolitis
Seeing the third entry I immediately felt like I had been hit by a wrecking ball.
********** (Looking back at all of this)
There are many kinds of doctors. Some are great. Some need to retire. I’m not interested in attacking my first pulmonary doctor but a few things about his office trouble me:
1: I seldom saw his face. I have a distinct memory of what the side of his head looks like. He almost always spoke to the computer.
It would be easy for me to blame him for treating the computer before me. In reality I think it is more likely a symptom of our fractured healthcare system. Doctors are over booked. Insurance demands notes be typed with certain metrics. People become cattle.
2: There were multiple posters and magnets for Spiriva. I don’t know if his office has a financial agreement with them or not. I did find spiriva as a treatment recommendation in a surgeon textbook. It just doesn’t sit well with me.
3: The performances his nursing staff was underwhelming.
-When the first nurse I met there asked me if I knew how to use an inhaler I immediately thought back to my first time picking up a rescue inhaler at a local but national drug store. I remember asking them if I needed a spacer to which I was told I did not (all of the respiratory therapists I work with would be cringing or yelling right now.) I later looked it up online and saw that the recommendation is to breathe in slowly over 10 seconds and hold your breath for another 10 seconds, then wait 1 minute before next dose. I decided to see if she had anything to add. She simply looked at me like I was an idiot, pointed the inhaler into the air and sprayed it. Pathetic.
-The nursing staff tried to document my blood pressures in the hypertensive range. Many nurses try to take blood pressures as if it is a race. I’ve seen this act before. The one that day recorded that I was 135/127 or something close to that. The practitioner in the office that day wanted to speak to me about hypertension. I reminded her that having a number like that was physiologically impossible unless I was in an unusual condition like cardiac tamponade in which case my blood pressure should be dangerously low. She repeated the reading herself and came up with 115/75. My normal reading.
There are all kinds of nurses. I got a feeling from the attitude of these nurses that they either didn’t want to work or wanted to be working in a hospital where their real futures would await them beyond their outpatient occupational purgatory.
Purgatory can keep them. As long as they work like that I don’t want them anywhere near my patients.
Burn pits, Sand and IEDs 