Just Hang In There — Part 1

I’m 36 and I have stage IV lung cancer. I’ve never been a smoker, didn’t grow up breathing second-hand smoke, never worked with chemicals, didn’t grow up or live near a coal plant or a toxic-waste dump site… I just have cancer. What caused it is a bit of a mystery, just like how long it’s been around, since (from what I’ve read) it takes five to 40 years for a tumor to grow… so it kind of just showed up out of the blue. This story will have to be told in sections because details are tedious little buggers and make a story very long, and I want to include all the details I can remember. Sorry if it’s boring, but it’s not really for you… it’s for me.

I’d been having some trouble breathing for about a month or six weeks when I finally went to the doctor. I’d been shrugging off the shortness of breath and occasional pain as some kind of illness that would eventually fix itself and pass — like you do when you’re (relatively) young and immortal. At first I thought I’d just gotten super lazy and lost my lung capacity since I’d recently quit a basketball team and had given up on half-assedly training for my fourth half-marathon. When I got to the third-floor landing of the stairs at work and couldn’t catch my breath, I figured I was lazy. When I got to the first floor landing and couldn’t catch my breath, my boyfriend insisted I go to a doctor. So I went. First thing Monday, I saw a new GP who listened to my chest, checked my blood oxygen level and blood pressure and hooked me up to an EKG. She said my blood oxygen level was good, but that my heart was working awfully hard to keep it that way. My EKG was textbook-perfect. No heart issues. She then asked me a lot of questions about sitting and traveling long distances, hinting that there may be a blood clot. She ordered a clot test and told me to go to the lab. I went to work instead because I was running late and I’m overly-anxious about that kind of thing. On Tuesday morning I woke up feeling so tired, so thoroughly wiped out that I decided to stay home from work and fight whatever bug was surely about to pounce. I slept probably 10 hours that day, and developed a slight fever so I called my doctor’s office to tell them the developments, just in case they were relevant to an as-yet unconsidered illness. I didn’t hear back from my doctor. On Wednesday, I felt a little worse and I vomited a couple of times — nothing spectacular, just not great. I finally got ahold of someone at my doctor’s office, mentioned to them the possibility of walking pneumonia (another good boyfriend-idea) and a different doctor in the same practice ordered a chest xray as my doctor was out. I couldn’t make it down that evening because I felt so terrible, but I asked my roommate to take me in the morning on her way to work. The xray was supposed to be done in the same office building, but I was told that tech wouldn’t be in for hours so I had to walk down the street — about one full city block — to another building to have it done. I walked pathetically slowly as I had no breath, and barely any food in my stomach and therefore: no energy. The tech was a nice, 30-something woman who efficiently shuttled me into a changing room, positioned me in front of the xray panel and shuttled me back into the changing room. Putting my bra and shirt on in that tiny room made me feel so alone, scared and lost that I cried. When I walked out I was still huffing and crying (all that constricted breathing was compounded by the tightness of sob-throat) and the tech sweetly asked if I was okay. I insisted I was, that I just needed to calm down, but she said no, she would get a wheelchair and take me back up to the office building. I again insisted I would be okay, she again insisted I would not. She won and I was wheeled.

I waited for the xray results in my doctor’s office for what felt like forever, some crotchety older man glaring at me from time to time while he, a vision of perfect health in dirty sweatpants, waited for a flu shot. I thoroughly expected to be told I had pneumonia, be given a prescription for antibiotics and get sent home, but when my doctor called me back she calmly told me I had a large-scale pleural effusion that needed to be drained TODAY and that she was sending me to the ER. Basically, I had a huge amount of fluid sitting on my lung, preventing me from breathing well, and it was so bad I needed immediate relief before my lung fully collapsed (it had already partially collapsed). Since I’d already sent my roommate home, and I couldn’t walk to the hospital (though, please know, it was maybe five blocks away — normal-me could’ve walked A-OK, no problemo) she left to call an ambulance to transport me. I called my boyfriend to update him, “I have to go to the ER to have fluid drained from my lung.” I misinformed him. (I would later understand there was fluid built up in my pleural space — the pleura are membranes around your lung and in your chest cavity — not actually in my lung [hence, no cough].) He was, of course, worried and concerned, but focused on keeping me calm as I was crying and starting to panic. Then the door opened and five Beverly Hills Fire Dept. EMTS came into the room. I quickly got off the phone as they hooked me up to an EKG, an O2 monitor, administered a finger-prick blood sugar test and asked me lots of questions. Then, after I anxiously threw up the two saltines and small amount of Gatorade I’d had that morning, they wheeled me outside, loaded me into the ambulance and within five minutes we arrived at the emergency room at Cedars Sinai Medical Center, one of the best hospitals in Los Angeles.

I was triaged and placed in a private room to wait to see a doctor. I called my mom to explain what had happened and she got in the car to drive the 80 miles to come see me at the hospital. It was starting to feel surreal, lying in a hospital bed, fully clothed and shoes on as I waited to find out what was going to happen next. I was visited by a nurse practitioner who explained the procedure to drain the fluid. I anxiety-barfed again, while she was speaking to me, oops, and was given some lovely anti-nausea medication to calm my stomach. When the RN came in with consent paperwork for me, I again asked to see the nurse practitioner since I realized I didn’t actually understand the procedure. It’s called a thoracentesis, and it’s when a needle is inserted between the ribs into the back and the fluid that’s collected in the pleural space is drawn out. I was pretty frightened, and asked the LPN if I had to do this. She said yes, and asked if I wanted to see my xray. It was shocking to see my left lung entirely clear and open, and my right lung cloudy nearly to the top. As I’d mentioned before, my lung had already partially collapsed under the pressure, and I was in danger of it collapsing completely. I had no choice if I wanted to continue to breathe, and she did her best to reassure me that the team who performed this procedure were excellent at their job, and did that, just that, all day long. I signed the consent and waited. Dr. A and his nurse showed up about an hour later. Dr. A looks like the kind of character actor you recognize, but can’t place. His nurse was both warm and no-nonsense at the same time. The procedure uses ultrasound to guide the needle into the pleura and so they wheeled in a cart with a laptop, oddly playing French cafe music — literally, floating Amelie-style accordion tunes. They assured me they would talk me through every step so there would be nothing to worry about, no surprises. I was asked to sit on the side of the bed, feet on the floor, and lean over with arms crossed in front of me on a tray they’d pulled over. Like heads-down time in school, but much higher. My back was sterilized and I was given a small shot of lidocaine to numb the area. I was told I would feel some pressure and might hear a “pop.” There was no pain when the needle was inserted, only pressure, and the drain was going very well until I started to lose consciousness. I have come to discover (through practice!) that I have a fairly consistent vasovagal response and I think that’s what happened here. Luckily, I am able to give medical professionals a bit of a heads up when I’m losing it so they can take measures to keep me from hurting myself or be stabbed by an errant needle. As I started to fade, the accordion music played on, and the nurse helped me lie down sort of awkwardly on my side. They tried to make small talk with me to keep me alert, and swimmily I joked about pretending I was in gay Paree, enjoying a latte. The nurse brightened with “Yes, it’s the French Cafe station on Pandora!” My consciousness came back, and my first feelings of pain and discomfort quickly followed. One bag of fluid had been filled — two liters — and another was attached. They told me they would drain for as long as I could stand it and I was doing my best to hang in there. The discomfort feels like all of your breath being sucked out of you sort of like if your breath was water in a washcloth and someone was wringing that washcloth totally dry. I tapped out after another .2 liters had been drawn and they sat me up again to remove the needle and put on a bandage. I was gasping, I could not breathe, and I was in pain, but they told me it would get progressively better as the minutes passed and my alveoli popped back open after having been compressed shut. Dr. A gleefully asked “Do you want to see it?!” I said yes (duh.). He held up a bag of watery, reddish liquid and proudly announced “Almost 4 pounds!” as the music continued to play.

I’d had 2.2 liters/4 pounds of liquid constricting my right lung and it had finally been removed. And now we had to figure out why it had accumulated in the first place.

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