>So I looked it up and apparently the guideline is actually a 2 hours fast for clear liquids! 2 hours![7] The hospital staff, however, hardened their hearts. Nurses said to ask the surgeons. The surgeons said to ask the anestheologists. It wasn't until 7am that the anestheologists said, yep, you can drink a (small) glass of water.
Ah, this takes me back to my medical officer days. No junior doctor ever got into trouble for telling a patient to fast a bit too long, and many do for having a heart and letting them cut it short. It is also likely the least consequential thing we can bother the anesthetists about, and it's not going to kill anyone to wait longer (usually).
Knowing the local demographic and behavioral tendencies on LW, I think it might worth noting that ozempic/semaglutide and other GLP drugs can cause delayed gastric emptying. As a consequence, even the standard fasting duration might not be adequate to fully empty your stomach. If you're scared of getting aspiration pneumonia, it's worth mentioning this to your surgeon or the anesthetist. The knowledge hasn't quite percolated all the way up the chain, so you can't just assume they're aware.
Nice writeup! Spontaneous pneumothorax in tall, skinny guys is one of those things they teach in EMT school. Frankly I'm surprised that an ambulance crew didn't notice something wrong if they listened to your lung sounds, like they're supposed to do as part of the secondary assessment?
Also, for suspected cardiac, the ambulance should have stuck sticky wires all over your chest (typically 3, 4, or 12 of them) as soon as they arrived. If you're hooked up to one of those machines and a paramedic is looking at its readout without getting worried, and there are no alarms going off, that's a good sign your heart is doing ok.
Good job on the self-advocacy -- it really is essential in navigating any medical system. This kind of advocacy is also something that a friend or family member can provide if you're not in a good enough condition to do it for yourself. Before I even had any medical training, when a dear friend was hospitalized, his IV site was getting red and itchy, and he didn't want to bother the nurses with it... I happened to be there and made sure to point it out very clearly to the nursing staff as a "hey I don't think it's supposed to be that color" thing and they fixed it promptly. When nursing staff is working long shifts and spread between a lot of patients, it genuinely does help them to be clear and specific about exactly what needs their attention.
A joy to read Logan (aside from knowing how scary and uncomfortable this experience was for you.) Something I've learned and that I think is most valuable to be gleaned from your article is to always speak up and advocate for yourself when something doesn't seem right. Had you not done this in several instances, not only could it have caused undue discomfort, but it could have caused injury to yourself or others. It is important to advocate for yourself in every situation: work, under someone else's care, in personal relationships.
I woke up Friday morning w/ a very sore left shoulder. I tried stretching it, but my left chest hurt too. Isn't pain on one side a sign of a heart attack?
Chest pain, arm/shoulder pain, and my breathing is pretty shallow now that I think about it, but I don't think I'm having a heart attack because that'd be terribly inconvenient.
But it'd also be very dumb if I died cause I didn't go to the ER.
So I get my phone to call an Uber, when I suddenly feel very dizzy and nauseous. My wife is on a video call w/ a client, and I tell her:
"Baby?"
"Baby?"
"Baby?"
She's probably annoyed at me interrupting; I need to escalate
"911. This call is being recorded. What’s your emergency?"
"I think I'm having a heart attack"
They ask for my address, my symptoms, say the ambulance is on the way.
After a few minutes, I heard an ambulance, which is weird to realize Oh, that ambulance is for me.
I've broken out into a cold sweat and my wife informs me my face is pale.
Huh, I might actually die here and that's that.
After 10 long minutes, they arrive at our apartment. They ask me my symptoms, ask to describe the pain, ask if moving my arm hurts. They load me up on the gurney, we bump the frame of my front door a lot getting out, and we're on our way.
The paramedics didn't seem too worried, the hospital staff didn't seem too worried. They just left me in a room when I arrived.
Don't some people die from a heart attacks pretty quickly? Well at least I'm at a hospital.
The resident surgeon doesn't think it's a heart attack.
"But I felt dizzy and nauseous and broke out in a sweat"
"And his face was very pale"
"Sounds like a vasovagal syncope", the doctor assured us.
They take an ECG to detect irregular heart rhythms and it's all fine! They take some blood & take a CAT scan of my chest just to make extra sure though.[3]
And then we wait.
So I google "What's a vasovagal syncope?"
Oh, the thing where people see blood/needles and faint. So that explains those symptoms, and maybe I just slept on my arm weird?
I still don't know what caused the vasovagal response, but maybe I was just that worried about the potential heart attack?
The doctor comes in and tells us that my heart is fine, but he's saying it in a "but there's something else wrong" tone.
So what's wrong?
He said I had pneumothorax, which means there's air in between my lungs and chest lining (where it shouldn't be). So they'll need to do a procedure to suck the air out.
"Sucking the air out makes sense. How did the air get in there in the first place?"
Oh, there's a hole in my lungs.
Why is there a hole in my lungs? Well obviously because:
I'm a tall, skinny male
Apparently, being a tall, skinny (& devilishly handsome) man isn't the cause of having spontaneous pneumothorax, but it is highly correlated. I'm actually not tall[4], but have a taller torso, meaning a taller lung, which means my lungs produced little air-filled sacs (blebs) by existing. It's "spontaneous" because it wasn't caused by physical trauma. Here's an image search for blebs (which can be gross, you've been warned!)
Procedure
The resident surgeon described to me how they're going to put the tube in my chest in gruesome details. This probably freaked me out cause I started feeling nauseous and breaking out into a cold sweat (ie another vasovagal response). Within 30 minutes, we had the two resident surgeons supervised by the expert attending starting the procedure.
They put a blue tarp on me, only exposing my left ribs for them to operate on. A doctor remarked that I was the calmest person he's seen w/ a pneumothorax.
This was local anesthesia, so I'm still aware the whole time. The attending was giving a lot of advice to the resident +surgeons, but the one thing she stressed over and over again is "It needs to be above the nipple".
Which they did. The local anesthesia felt weird and warm. Near the end of the procedure, I started to have another vasovagal response, sweating profusely. My back became very tense, causing a lot of pain.
They finish up and I feel very nauseous and extremely uncomfortable. Luckily I can just tell them that and they'll give me something for the nausea and pain meds.
But the pain meds take time, so I watched Instagram Reels w/ my wife until they started to kick in.
Me, pre-procedure, living my best lifeMe, post-procedure with a tube in my lungs. This is the best face I could manage (I was in a lot of pain here actually).
They later wheeled me and my new best friend to a higher floor for in-patient care, with a much more comfortable bed.
Me and my new best friend. A Suction Master 3000 (with port and starboard attachments), which filtered my fluids while slowly sucking in the air from my chest-cavity. We've been inseparable ever since!
A Small Mistake
On Sunday, the nurse said my x-ray from that morning looked great & they took me off suction. I told them I don't remember an x-ray from that morning, and they said they'd check up on it.
At 2pm, they were supposed to give me another x-ray. At 2:30 I buzzed them asking them about it. At 2:40, a thoracic surgeon came in.
"Your x-ray is looking really good so we'll get that tube out of you soon"
"But doc, I didn't get an x-ray taken today at all."
"..."
When an x-ray technician comes in, they're supposed to follow protocol. They need to ask:
"What's your name? What's your date of birth"
Just to make sure they've got the right person. The x-ray technician failed to do that twice, scanning my neighbor, who apparently has very healthy, non-collapsed lungs.[5]
When they scanned me again, my lung was still partially collapsed. I wasn't healing quick enough. I needed another procedure.
Take 2
I was told not to eat or drink anything past midnight. My friends and I ate indian at 11pm, but I made the mistake of not drinking enough water.
I woke up at 3:30am very confused and very thirsty. Like very thirsty (probably from indian food and from taking bupropion[6]). Sadly I couldn't drink.
Finally at 4:30am, I ask them if there's anything else they can do (like fluids through an IV?), which they can't. I decide to just deal with it... for 30 only minutes cause I honestly can't stop thinking about how thirsty I am!
So I looked it up and apparently the guideline is actually a 2 hours fast for clear liquids! 2 hours![7] The hospital staff, however, hardened their hearts. Nurses said to ask the surgeons. The surgeons said to ask the anestheologists. It wasn't until 7am that the anestheologists said, yep, you can drink a (small) glass of water.
[Note: there are several situations that do require longer than 2 hour clear liquid fasts. Pregnancy is the big one, but there are others. Do consult your anestheologist first because aspiration sounds like a horrible way to go]
The new surgery they'll be doing is VATS (Video Assisted Thoracic Surgery) pleurodesis where they'll put a few more holes in me, intentionally cause inflammation in the lung so it'll adhere to the chest lining when scarring, which prevents lung collapse. Pretty cool! Additionally they'll "trim a little off the top" of my lungs, where there are most likely other blebs that could cause another pneumothorax.[8]
They wheel me down, inject a very long, local anesthesia needle to numb my nerves in my side, then start wheeling me somewhere else and then...
I wake up in my bed post-surgery, lol.
However, I was wearing underwear before the surgery and now I'm not(!?)
It's hard to see, but that's my undergarments in a "Biohazard" bag. Let's just leave it at that.
The next few days, I've just been recovering. Getting my blood drawn in the mornings. Coughing for them to check if my lung is healing properly. Eating some really great and really bad food. Taking walks. Taking lots of drugs.
And then it's finally Thursday morning, and I'm getting my tube removed.
I hear in the hallway,
"Have you ever done of these before?" "No" "Okay I'll do this first one and assist you in the next"
Luckily I was the first one.
The doctor asks if it's okay for a few students to watch and learn. Yes of course. They prep. He says it's important to not breath in when pulling the tube out, so I need to hum.
He tells me we're going to do a "practice round" where I'll hum and he'll "pretend to pull", ya, right.
But that's exactly what happened.
Then we did it for real.
"Take a deep breath. 3, 2, 1 start humming."
I didn't even feel it come out. Now I'm just sitting here w/ my wife, packing up, smiling, polishing up this post, ready to get discharged:)
Lessons Learned
Note: these were true in the hospital in the US that I was at. YMMV
Whether you or a loved one finds themselves in my position, here's my advice.
The Squeaky Wheel Gets the Oil
Whatever issue you have, you can bring up the problem to the staff and they'll work with you.
"I'm cold" --> Blanket "I'm feeling some pain" --> Pain meds "I'm constipated from pain meds" --> Prune juice/Laxatives
I made a few mistakes such as leaving the door open and light on the first night, messing up my sleep. Turns out I could've just asked and they'd fix it.[9]
You can also ask for advice on how best to recover, which my nurse recommended taking walks and doing this breathing exercise w/ this tube thing.
The monitors I'm plugged into were initially terrifying until I realized all the false alarms. A nurse can actually change the settings to stop all the unnecessary beeping.[10]
Make yourself comfortable.
Get someone to bring your chargers, snacks you like, bathroom stuff, shampoo, whatever!
Usually people spend time on their phones or watching tv, but it can get depressing always receiving, as opposed to interacting. You can order from amazon mechanical puzzles, soduko, a rubiks cube, color by numbers, etc usually by the very next day.
Do something with your time (like writing blog posts!)
Short Form Videos Are for Not Wanting to Exist
When the pain was too bad & I'm just waiting for the meds to kick in, watching short form videos really does help distract myself. This is one of the only times I'd recommend scrolling.
Point Out Anything Suspicious
When they discussed good-looking x-rays I didn't take, I was able to point it out, fixing an extremely important error.
They also mixed up my breakfast, which ended up important because the other person had kidney issues and shouldn't have been able to order [tomato soup]. Fortunately, they fixed the orders after I pointed it out.
Ask and Follow Up by Setting Timers.
When we told my nurse I didn't get the x-ray in the morning, he said he'd check up on it. We never heard back from him (probably because he checked and there was indeed an x-ray in my name, just not of my chest). We should've set an alarm to follow up.
In general, I suggest setting timers (10-30 min) after asking for something and then following up.
Write Questions Down
There isn't any set time that the resident surgeons, doctors, etc will arrive to check on you & answer your questions. I'd just be sitting there on my phone, and they'd just walk through my door!
Later, I'd realize I forgot to ask certain questions (eg "Do I need to wait to fly when recovering?"[11]).
Write those questions down!
Look Up Terminology
They know their jargon and will use it. You can ask them about it and google it yourself, which can help you communicate your needs.[12]
Putting On a Brave Face
I was unaware that my wife was putting on a brave face, suppressing her tears and worry. It wasn't until our friends visited and asked her how she's doing that she broke down crying. We've since talked about it, saying it's okay for her to cry and be comforted even if I'm the one undergoing the surgeries.
The Hospital Staff
Really a bunch of normal people. The two resident surgeons who did my first procedure were talking right outside of my room saying: "Was this your first time doing a pigtail catheter too?" "Yeah, it was also different than [other version that supervising attending claimed was similar]. This one was a pop, nick, wire in, dilate, dos-si-do, pile-drive into an RKO" (okay those last 3 were made up)
In the hallway, a lot of the staff were laughing, gossiping, one nurse was sobbing for quite a bit.
The food lady always had a bright, charming attitude.
The student nurses cared maybe a little too much.
Some nurses were very loose w/ the rules, making room for pragmaticism, while others were sticklers for the rules.
I remember every one of their names and am so grateful for them.
Gratitude
I am so grateful to be alive and healthy. I am so happy that there's a hospital with experts who can fix my collapsed lung, who can give me pain meds to make me more comfortable, who take the time to explain and answer all of my questions.
I'm so grateful for my friends who came to visit. Bringing me flowers, making jokes, and playing games w/ me.
He's feeding me food here saying "Here's Mario, going down the pipe!"Pico Park was so much fun and beginner friendly. We just hooked up a few controllers to my laptop & played local co-op. So many hilarious moments; it was such a blast:)Special thanks to @scottviteri for this mechanical puzzle. Even though he didn't know I was hospitalized, this kept me occupied for a good 30 minutes.
Most importantly, I'm so thankful for my wife, who took off work (& worked remotely at the hospital) to always be by my side, who took walks with me, wrote so many questions for the doctors, always reminded me to do my breathing exercise, for bringing me food (especially the pastry I craved (brownie w/ chocolate chips) to celebrate my second procedure), for washing my hair to help me feel clean, for bringing me clothes and the laptop I'm typing on now, for all the hugs and kisses, and for laughing at all of my jokes.
Jo, you have such a pure heart, so practical and competent. You have made me feel so incredibly cared for. We've only been married a few weeks and the whole "in sickness and in health" part kicked in a bit earlier than I expected, haha. But I couldn't have asked for a better wife.
My wife's great. She came to my help so fast, she didn't even leave the Zoom call. I could still hear them "Did she say her husband is having a heart attack?" "I sure hope not!"
This x-ray was from a guy who'd crack a few jokes. When my wife needed to stay outside the x-ray room he said, " No one's going to kidnap him, he's too ugly", which was an okay joke but kind'of old? Imagine instead:
I know he's very good looking, but I'll make sure no one kidnaps him.
Which breaks expectations more because I am ugly.[13]
Well I did say I was 6' 3'' (190cm) when the medical staff asked my height, which I had to quickly tell them I was joking when they started writing it down. Apparently it's easier to lie about your height when you'r lying down.
Mine kept beeping about st-1 or st-N levels which is ECG related measurements for detecting irregular heart rhythms. They performed a full ECG on me to verify it was indeed false alarms, which we could then silence those beeps.
For example, my IV in the crook of my right arm didn't ever bother me Friday or Saturday. Sunday, my nurse cleaned up the dressing around it & it started hurting (a lot) to bend my arm. I asked about this, and they "flushed" the IV (ie injecting saline/ salty-water that's compatible w/ your blood), showing that it works. I said it started hurting since he fixed the dressing, and he said it's perfect. He did say the night staff can change it for me (which would be another 2 hours cause he sure wasn't going to do it).
Turns out, "infiltration" is a problem where fluid leaks into surrounding tissue so fluids accumulate under your skin. This causes swelling & pain, and is very bad. Nurses are very aware of this problem. The IV was "perfect" as in it wasn't causing infiltration; however, the dressing was too tight(?), causing the catheter to not bend naturally(?). I'm unsure. I just think I could've said "I know you've ruled out infiltration as a problem, but it could be a more mundane thing such as the tape being in a bad spot"
No, I don't think I'm ugly or especially attractive to most people (although one girl said I looked like a twink, which was exactly her type, lol). I do have a winning personality, am extremely funny, and especially humble.
