I almost killed a nun today. She wasn’t feeling well, but couldn’t describe what was wrong. So I generically lumped into the “weak and dizzies” category. A typical “weak and dizzy” workup includes an EKG, a chest x-ray, and some basic blood work…usually you come up with a big fat nothing and send the patient home, releived but disapointed at the same time that you couldn’t figure out what was wrong with them.
Well, Sister had a chest x-ray that nearly jumped off the screen at me. Both lungs were full of fluid, effusions that were compressing her lung tissue. I compared these to the ones she had in December, and they had grown. I really felt that this was causing her to feel so lousy and be short of breath, so I explained the process of “tapping” the lung to drain off the fluid. First, I knew it would make her feel better and second, the fluid could be tested to determine what was causing it…cancer, TB, some other infection? “Whatever you think needs to be done, doctor, you’re the doctor, not me.”
I drained the fluid without any trouble. A smooth plastic catheter glided over the tip of a needle that was inserted between two ribs into the fluid. Straw colored fluid poured out of her chest cavity that gradually become darker and bloodier as it drained. A hemorrhagic effusion. Afterwards, I got a 2nd chest xray. Now, instead of fluid around her lung, there was air apparently compressing the lung. Hmm…I just gave a nun a pneumothorax…do you think I’ll go to hell for that? I told her that she’d have to stay in the hospital overnight. “Oh, that’s OK, you know what’s best for me. Thank you so much for taking care of me.”
I received a phone call from the cardiothoracic surgeon asking me to tell him about the nun’s case. Well, she’s stable now, breathing better than when she came in, even with a pneumothorax. He explained to me that people with chronic effusions…sometimes their lungs just won’t reexpand, the space once filled with fluid fills with air instead, and he doesn’t know where it comes from. You mean…I didn’t just almost kill a nun? Thank God!
Sometimes, I just wish I lived in a pineapple under the sea.