THE PNEUMOTHORAX INTERLUDE

Treating a collapsed lung.

THE PNEUMOTHORAX INTERLUDE.

The woman in the green and cream room, obliquely called Cubicle 1, was small of stature and dressed in a grey sweat top and matching loose-fitting trousers. She wore no make-up; her dark red hair and pale skin differentiated her from the crowd as did the bruise on her cheek and the handcuffs and chain attached to her wrists.

I’m not sure that she was allowed outside of Cubicle 1, but she emerged quite often, walked around a little and by doing so introduced another woman as tall and as blonde as she was dark and small. This new woman wore a crisp white uniform shirt with navy blue epaulettes that matched the dark uniform trousers. Introduced I say, but somewhat reluctantly, as she was attached to the other end of the three-metre chain.

They went together, I presumed, to the toilet. When the tall uniformed blonde left Cubicle 1 on a different errand the chain was secured to a ring bolt in the wall and a uniformed man, outsourced I think, summoned to stand outside.

Holding my wife’s hand, I observed all this in grateful detail as I sat on a hard bolted-down chair trying to breathe. Grateful because I did not have to think about the pain in my chest and my inability to breathe.

Earlier I’d been to the Bike Shed Show at Tobacco Dock in London’s East End. With my two good friends Bill and Steve we’d ridden across the Capital, swooned over café racers and all things RoKKer and rode gently back home along the great River Thames, taking in our forgotten history. The only thing spoiling a perfect day was that the nagging pain in my upper left chest had moved to the centre and increased in velocity. It worried me a little that this might just be dead centre.

To bed then, in the early evening. And by the time my wife had finished watching Liverpool lose to some European team in Kiev and came up to bed, I had read almost of all of the internet, in both English and American.

The subject of my reading was, of course, chest pains, and how to overcome them. I added some sidebars to the search; smoking, lack of breath, tiredness.  My conclusion was that I might be having or had just had severe indigestion, heartache (I am selling my Moto Guzzi Stelvio after all), a heart attack or any one of the other illnesses written in Latin.

So I said “Darling, I have a bit of a pain. Not sure I can ride the bike there; could you possibly drive me to the hospital? Please?” Which Darling did, with alacrity and some speed. Except we were slowed, in our town, by hordes of multicoloured fairies riding on bicycles. My wife opened her window and said in a slightly louder voice than usual, "Could you move over please, I am trying to rush my husband to hospital." The fairy on the bicycle next to us said in a flat and female London accent "Sorry love, we're with the Cancer." This was the first I'd heard on hierarchical illness.

But we made it to the hospital before I expired so let us return to our front row seat outside of Cubicle 1. My name is called; my wife stands to remind me who I am, and we progress to the first step of the journey. I am asked, by a black female doctor in clean dark green scrubs, for the first of twenty times over the next twenty-four hours, my name and date of birth. Later I was asked for my address, so I asked if they needed this to send the invoice. But, American friends, I knew that the invoice was a trick suggestion for my life was already in the hands of the NHS, which is free at the point of need, but strangely, not at the point of death. In Britain, we usually have to pay separately for death. Most cards, except American Express, are accepted.

Meantime I’ve answered my name and birthdate correctly and a needle is plunged in my arm, a litre or so of blood removed for testing before I’m walked to CXR (I understood later this means Chest X-Ray)

I found that if I put my chin over the top of the X-Ray machine I could just hang there resting, no need to stand on my feet. A few minutes of hanging and buzzing and I am back in the front row of Cubicle 1; but now there is a different cast.

With slack jaws we watched the new entertainment; a song and dance act comprising of a short, pallid, mean-faced youth who may, or may not yet, have vomited on his stained green jumper and was almost dancing and singing. The almost dancing was because two tall policemen, immaculate in starched white shirts and black trousers with a crease, had the youth suspended from his armpits between them; said youth could not quite touch the floor to dance. The almost singing was not quite a song, more a soliloquy on how he would run both the Police Service and the Government. Apparently, to be more efficient, both institutions require wild, and more, sexual congress.

But because I cannot breathe I am fast-tracked. My name is called, and I do not see the end of the show.

On a narrow silver painted bed with the sides folded down I am laying with a gentle brown faced doctor, born on the sub-Continent of India, who is feeling for a space between my ribs. I am pleased that my area is sectioned off with stiff blue curtains, for now there is a crowd summoned to watch me for their entertainment.

The soft-voiced Doctor has shown me the X-Ray; around my ribs is a sac full of air which is not so gently compressing my lungs to the point of collapse. I breathe in, the air leaks into the sac and increases the pressure. The cure is either I stop breathing altogether, or the pressure is released, and my lungs re-inflate. Earlier, when we discussed the problem and its outcome I asked if I might leave now and book in on Tuesday as it was my eldest daughter’s birthday party on Monday and I didn’t want to miss it. My wife leaned forward and told me this was a hospital, not a hotel, and the operation was needed now. No option but to accept.

There is no mention of how or why this may have happened. But I know, deep down, the root cause is smoking. I am aghast at the state my addictions have brought me to now. The Doctor has found a suitable gap in my ribs and asks the Surgeon if he would like the point of penetration painted in red or white. My suntan is that of a country farmer, restricted to my arms and face whilst the rest of my body is a dull and unattractive white. The engineer won the bet in my head and called for the red.

The crowd consists, from right to left, of my wife, seated, a male Agency Nurse from Africa wearing dark blue scrubs and sporting a jolly head of dreadlocks, two female Chinese Junior Doctors in smart casual clothes as befits their rank, and a male Chinese Surgeon in collar and tie, an Indian Registrar in a striped business shirt and crumpled grey trousers, an Indian Engineer/Surgeon who is now donning green surgical scrubs and the soft-spoken Doctor who laid with me earlier.

I have named the Surgeon in Green, the Engineer. I named him Engineer because of the pulling and pushing he first warned me of, and will soon implement.

Lights are up high, the Engineer is rubbing the left-hand side of my ribcage with a slimy lotion that has no added fragrance. It is good, I think, that my wife is present and that I am still wearing my 14oz RoKKer denim jeans. I asked if there would be a whistling sound when the lung cavity was pierced. He replied with the tug of a grin, “Are you medically cleared for this information?” I am asked my name and birthdate, I answer correctly and someone intones “Little prick” and before I can protest a needle is thrust into the rib cage and a cool sensation spreads.

We had discussed, the Registrar and I, about the use of medication earlier. I had said ‘anything’, except morphine, it’s derivatives or any other opiate, due to my addictive genes. So right now, as I had answered my name and birthdate correctly he was shooting up liquid paracetamol. After a five minute wait for the drugs to work, and, although neither the Surgeon nor I had moved, name and birthdate were requested again and answered, and the drilling commenced between my ribs with what I am sure was a corkscrew.

With such an audience observing my every reaction I could not faint from the pain. But then the Engineer said “I am going to insert the drain; there could be a little pulling and pushing” From the pain I knew he was inserting not just a drain, but a manhole cover too.

“Thank God I’m not pregnant” I cried. “I could never stand childbirth” And then the drugs kicked in and the pain dropped from agony to merely severe. Smiling I said, “Terrific, thank you everyone, you’ve been wonderful, may I go now?”

It was not to be. A giant blue see-thru bucket with a sealed lid, such as you might buy children at the seaside, had been attached to the drain. Water fills the bottom tenth, to trap and monitor the air which will hopefully escape.

“Deep breath” the team shouted. “Cough”.

Pain upswung to higher levels and applause was dimly heard. Air had been seen bubbling down the tube into the bucket. This, evidently, was a good thing.

Bandages are packed and lashed around my wound, which, I noted with pride, was more or less the same position that Christ was impaled by the Centurion. More minutes passed, the crowd disperses seeking newer entertainment and my wife and I hold hands in the darkened emergency room.

With a suddenness of a good theatre all the lights come on at once and new actor enters, pushing a large machine that closely resembles a Praying Mantis. There is nothing good about a Praying Mantis that I know of, but the new man introduces himself as Kevin, the mobile X-Ray man. Kevin is Irish from Ireland, not to be confused with the Six Counties of the North who, even now, are holding up the Brexit plans. Kevin doesn’t care about Brexit. He’s Irish, and staying in.

The Mantis is manoeuvred for a close-up, Kevin and my wife disappear into the dark recesses of the room and several clicks, bangs, and flashes take place. Kevin is back, the Mantis is away to eat someone else and my wife seeks out my hand once more.

We sit quietly for twenty minutes and a Doctor appears, he of the soft-spoken voice. He has looked at the X-Ray, air is being nicely expelled into my bucket and all is apparently going well. But I will have to stay here in the hospital for a couple of days to observe me more.

He leaves and a new nurse plus helper arrive with a much larger bed on wheels. They line both beds up to be parallel, adjust the heights and slide me across to newer comfort. It must be one of those super cool mattresses they advertise – ‘free for 100 days and we’ll take it away if you don’t want to pay’.

Its 4.30 a.m. and my loving wife departs for some restless sleep. As she drives home her car's engine management light switches itself on although it’s been repaired in the last two weeks. She ignores it, gets home and calls the vehicular AA later that morning for assistance. She must wait, misses Mass, but feels it is OK because of the pressing urgency of a husband still laying in the Major Accident Ward who won’t do as he is told and is probably still wearing his RoKKer Jeans. (He was)

Vehicular AA complain because they have advised and treated the engine management light previously. Wife ignores the whining and, wearing a smile that could be termed as stiff, still tips the mechanic, packs pyjamas for me and is off to the Hospital.

Where I lay in bed, in jeans, in pain. A nurse is summoned, pain discussed and once my name and address are given correctly I am served with painkillers – now uprated to codeine, which, I know, is associated with fringe opiates – but I hurt. The need to urinate is greater than the pain and I am brought a tube-like receptacle of recycled cardboard. I am not sure what to do with it, but I unzip my jeans, slowly wiggle the jeans around my hips recording multiple winces as the drain, still attached to the bucket, is pulling against the bandages and my lung. I place the tube between my legs, my penis in the tube but nothing happens. After ten minutes I ask my wife to draw the curtain so that I have privacy from the hoi polloi and ask her if she might vacate the space too. When she’s gone I slide to the edge of the bed with the agony factor reaching new heights, slip my jeans down to my thighs and, standing, urinate into the receptacle. The relief is wondrous but now I am stuck with a cardboard tube full of urine in my left hand, the side with the wound, too painful to lift and balance on the side table; the drain bucket seems to have caught around my feet and on the other side of the curtain the Healthcare Assistant is announcing breakfast.

I moan, as one would.

My wife slips past the curtain, removes the receptacle from my grasp, gently swings my legs onto the bed and says, “Would you like to take your jeans off now?”

I give my name and address and laughing she removes them.

I missed breakfast so asked for two cups of tea, one for my wife. The Health Care Assistant – who is not English but maybe Portuguese, is horrified at my request. She will no doubt throw away the excess tea and food; but it cannot be given or offered to non-patients. I gave her my best quizzical through-the-pain smile and she gave a second cup of tea.

Some hours pass, interspersed with painkillers. But we both have good books to read, so apart from the moans of others and the woman next door, who is evidently and regrettably senile and continuously asks passing personnel to raise or lower her bed, it is a restful period.

Imogen, my eldest daughter and her husband Jon arrive. I see the relief on their faces as they note I am not yet a corpse; concern, though, at the pipes, wires, bandages and bleeping things attached to my body. Texts have been heard incoming and outgoing on my wife’s phone for some time; it is difficult for loved ones to assess progress and pass accurate forecasts of future longevity. Better to come and assess for oneself. So they did and I am truly pleased to see them. We discuss the birthday party that I am to miss. The weather forecast was wholly inaccurate; outside in the world the thunderstorms had transmuted into a beautiful early summer morning. Cancelled guests would be re-invited and urgent emergency shopping for food and booze would commence as soon as their visit had finished.  They depart with good wishes and familial love strengthened anew.

More painkillers are cheering me up and as I am pushed down the corridors in my bed – we are off to a lesser emergency ward - I find myself smiling and nodding to people, with the occasional light wave as successfully developed by the good Queen herself.

Not to a ward do we arrive. We are progressed directly to a room. With air conditioning, great views and separate toilet and shower.

The care assistants and porters have gone, and from a large bag, my wife unpacks supermarket shelves of fresh fruit.

Commotion at the door and in walk my youngest daughter Eloise with her husband Luke. Both of my daughters are strikingly beautiful, their men are good, caring and strong of character. I feel, as I always do when I see them, very blessed. Eloise and Luke have arrived hot foot from a Car Boot Sale, having extracted £221.56 from the passing crowds. They are in great good form with tales of our grandson, aged five, working like an experienced trader. And, evidently, the ever delightful Rosabella, our two-year grand-daughter, had worked the crowd as an added attraction. Before she rightly fell asleep.

Time moved forward, an uprepared but delightful family interlude. Eloise had recieved some instructions from Imogen to gather more food, my wife had to go homne and collect Imogen's birthday present so suddenly they are all up and away and I am left with the charming nurses, a good book and some residual pain. 

With their departure, a new Care Assistant, of Polish origin, enters the room and smilingly presses the dinner menu in my hand asking me for my choice. Whilst I study the menu she writes her name, and those of two Senior Nurses, up on a board where I can read them. She presses a small plastic object with two buttons in my hand. One button is to summon assistance, the other to control the lighting.

My wife, briefly to the party before she returns and me to sleep. With wake-up calls for drugs by a super kind and careful Senior Nurse who just so happens to be English, and now in her second career having graduated with her nursing degree a few months earlier. She wears a white uniform dress striped with soft grey and quiet flat-heeled shoes. Her face shines with the love of her vocation and the patients in her care.

In the evening and later in the night I’d worked out how to carry my drain and bucket to the lavatory for minimum pain urination. The only note of exasperation was from the male Portuguese Night Porter who attended me twice in the night because I rolled over onto the service button by mistake. And as I was awake,  took my blood pressure and blood for diabetic testing.

In the morning with my wife, who has returned for the finale. I am to be checked by the Head Chest, and if up to snuff, an X-Ray and then discharged.

Head of Chest is from India, in his early forties, tall, dark hair good looking and wearing jeans and a blue button-down shirt. He speaks in high class accented English to his two junior Doctors. He asks my name and birthdate and deigns to address me as Mr. Mansfield. The Juniors, both attractive English girls, smile and giggle at his comments, take notes and make solemn promises to follow up his instructions.

My bucket has had no further activity; all excess air expelled. Pain is reduced – “An X-Ray,” he says, “and you could be good to go.”

He and his entourage sweep out of the room but there is no mobile X-Ray operator available. Into a wheelchair, bucket gripped firmly between my thighs, an English Porter pushing and a male Nurse, from Ghana, in attendance in case the bucket is dropped.

In lifts and down long corridors we traverse. I am not waving or nodding quite so much as the drug regime has been changed for simpler paracetamol and I am in haste to leave. The X-Ray is taken; this time I stand and do not hang from the frame. I am wheeled back to the room and, with my wife, contemplate dressing for departure.  Except that the drain with the bucket is still attached.

I open my book; my wife reads hers. Lunch arrives. My wife travels to the end of the hospital to find an inferior sandwich although I offer her a share of roast chicken salad and Rhubarb crumble pudding. And then the grapes which she bought with her.

Another hour and a Senior Nurse bounces in. She is slim, mid-thirties, of Caribbean parentage, born in England, a big smile in a wide face and glasses perched on the end of her nose. She wears a front buttoned dress of deep blue with a white trim. “Did they tell you can go?” she exclaims. “No.,” we say, shaking our heads, for I am attached still to a bucket and wearing hospital pyjamas.

“Aaah,” says the Senior nurse “Let’s get rid of that.” She fetches scissors, wound dressings and other paraphernalia. I sit in a chair, she sits in front of me and pulls up my pyjama jacket to look at my wound. Somehow my knee has disappeared under her dress and I can feel her thigh tensioning as she removes first the dressing and then the drain. I am too excited to feel immediate pain, but once she is standing and dressing the wound I feel that I am still stabbed, but at least the blade has been removed.

She leaves, we are about to leave when I remember the needle with the cannula still stuck in my hand. I press the service button, point to my cannulated hand and a happy blonde Polish Health Care assistant removes it with the minimum fuss and pain.

And home. Feeling better now than I have for months.

The treatment I received from the staff of the NHS is second to none. From life threatening illness to feeling better than I have for months in just two days seem to me to be magic. It is not. It is dedication and training at all levels that saves lives and makes people comfortable.

I have noted, where I can, the uniforms of staff. The more formal the uniform, the more the person wearing it is likely to be from an Agency and more expensive, as opposed to directly employed by the NHS. But then... the higher up the ladder, the more casual the clothes.

I have also noted where I can the gender and nationality of the people who treated me. Come Brexit, the NHS may lose these wonderful people and could be in a very sorry state very quickly.

Meantime, to the staff of St Peter’s Hospital, Weybridge…. A huge thank you for saving my life.

And my best wishes also to the entertainers and my hopes they may be released from prison in due course.

As for smoking. Well, this addiction too has now run it's course. One day at a time I will smoke no more.

If you enjoyed this true story take a look at my books here 

 Water fills the bottom tenth, to trap and monitor the air which will hopefully escape.






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