Friday, June 4, 2010

Pockets of Resistance

I'm sitting on the bed in the enclosed examining room at the back of the Chemo Day Care Center, my feet dangling over the side and my head resting on the surface of a pillow that's been placed on top of the table beside the bed.

My back has already been sterilized and injected with a local anesthetic.

"You shouldn't feel this," the doctor said as she inserted the long needle between my ribs and into my pleurae.

There are two pleurae, one around each lung. The pleurae act as a protective wrapping, fitting snugly over the lungs. Pleurae are made up of two layers. Normally, there is no space between the inner and outer layer. The layers are joined at the edges, so that the pleura might be compared to a closed balloon, completely empty of air and wrapped tightly around the outside of each of the lungs.

Normally, there is nothing but a thin layer of fluid between the inner pleural lining and the outer one. The smooth pleura linings and lubricating fluid allow the lungs to move freely in your chest, as they do in normal breathing.

In my case this space has fill up with fluid that is restricting the movement of my lungs. Crushing them, in effect.

A large bottle suddenly appeared beside my nose, filled with what looked like a fine ale, or light urine. Take your pick.

"Here's the fluid that was around your lungs. It looks clear. So, luckily no infection" the doctor went on.

"So we're trying for a litre?" I ask.

"Well, lets see what we get," she said.

And, about ten minutes later, she had three bottles full, a little over a litre and a half, when the flow ran out.

"Your lung has been cramped, kind of like a sponge, for the past couple of weeks, now it's time for it to expand into the space we've just created." she went on. "Do you notice any difference in your breathing?"

But I didn't.

So it was down to X-ray to see what was going on.

Half an hour later I'm back up in Chemo Day care, two doctors now pondering my latest chest X-ray. There is the possibility my lung may have collapsed during the procedure, in which case I'll be admitted to the hospital overnight while they re inflate it.

But something very different is going on, and at least as problematical.

"In a few people," the doctor explained, "The space between the inner and outer walls of the pleurae isn't just one empty space, but is divided into pockets. And you happen to be one of those people. We thought we'd removed all of the fluid around your right lung, the one that was the most problem, but it seems we've only tapped into one of the pockets. A large one, but a pocket none the less. The rest have remained filled with liquid. And that's also likely the case with your left lung as well. So there is still a significant amount of fluid trapped against your lungs and your lung can't expand to the extent we'd hoped."

"I am experiencing some relief," I told her. "I seem to be thinking more clearly and haven't coughed in about an hour."

"Well, you're seeing the thoracic surgeon on Tuesday. The fluid we've removed should make life more comfortable for you until then. You should be able to sleep better and have less of a cough. But, well, the problem will remain. The symptoms will just be less intense."

And so I'm home again where the symptoms are less intense and more tolerable, and I'm waiting until Tuesday.

As is Lindsay who hasn't had a good run with me for over three weeks now.