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From A to DD

Every procedure done in a hospital has risks. You even have risks going into a hospital. It’s a pretty germy place, seeing as how people usually go there when they are ill. And even the most seemingly innocuous treatments or procedures can lead to more problems. IV sites can become infected and phlebitis can occur. You may have allergic reactions to the medications that are routinely administered for your condition.

Some people just have bad luck, I guess. We recently had a patient, a very elderly woman, who fell and needed surgery. While doing a workup for surgery, all kinds of labs and tests are done to make sure that the patient will survive anesthesia. Of course, this is usually the point at which some elderly people are diagnosed with a plethora of conditions. She did have some issues with her bloodwork and while correcting those issues, she had a bad reaction to the treatment. This reaction was the reason she came to ICU.

We worked to correct her imbalances but it became clear that she would not be able to go to surgery that day. She was in a lot of pain, which we tried to manage as best we could. The pain medicine made her itch. The other pain medicine we tried made her confused.

When she finally had surgery, it was determined that she would need invasive lines to monitor pressures in her heart and lungs. I shall qualify this by saying that she weighed about 100 lbs … and putting invasive lines into someone so thin runs the risk of puncturing a lung.

Where do you think this is going?

She did fine after surgery, was extubated in the recovery room and returned to our unit (with invasive monitoring line still in place) on nasal cannula. A few hours later, however, she developed respiratory distress. Another chest x-ray was done and it showed a very large pneumothorax. Her lung had been punctured. Yet another doctor was consulted to put a chest tube in.

She certainly wasn’t thrilled by the prospect of having a doctor come to insert a large plastic tube into her pleural space, but if it would help her breathe more easily, then… well… how could she say no?

The chest tube insertion went smoothly and we all expected things in that room to calm down. And they did. I kicked the family out and the patient napped off and on and seemed more comfortable overall, although still not as comfortable as I’d expected. The post chest x-ray showed that the chest tube had gone more towards her back than up towards her collarbone, but the doctor was hoping it would work well enough.

A few hours after all the drama, my patient put her light on. When I went to answer it, she said that she felt as though her “boob was bigger.” Her chest wall on the tube side definitely looked a bit larger and had the rice crispie characteristics of subcutaneous emphysema, which can be a complication of chest tube insertion.

I notified the doctor and was told that she was elbow-deep in someone else’s chest in surgery. As my patient was not in any distress, we agreed to keep an eye on it for the time being.

Another hour went by and I went to check on my patient, who appeared to be napping calmly. She awakened when I smacked her bedside table with my leg (ow) and I casually looked at her chest again. The swelling had definitely increased and it was very visible on her small frame. She appeared as though she’d been bench pressing, but on that side only. I called the doctor again, who still couldn’t come. I called her partner, but he was far away at another hospital. My patient still wasn’t in much distress, so I just decided to get another chest tube setup ready to go for when the doctor could get there.

The next time I went to check on my patient, I could see from the door that her chest was still bigger yet. We discussed how she was feeling and she looked down at her chest and said…

“Well, you tell those doctors that they have another thing coming if they think that I’m going to pay for this implant!”

Even though she’d endured complication after complication (and complications from the treatments for the previous complications), she still had a sense of humor. I love patients like that!

I called the doc again and informed her that our patient had gone from an A cup to a double D and that she really needed to come and fix her. She came over as soon as she could, still in surgical cap, shoe covers and face mask. We got another chest tube in the patient and she was finally 100% comfortable with her breathing (well, as well as you can be with two large plastic tubes sticking out of your chest.)

I was off for a few days after that, and when I came back to work I noticed she had been transferred.

Hopefully she got out alive.

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Comments

now that’s what i call being a caring and assertive advocate for the patient! :)

i hope she’s doing really well now. at least she’s experienced a few moments (hours?) of boob air- implants. ;D

it’s always interesting to hear about what happens after a patient leaves us in the operating room. i’ve seen chest tubes put in, but never heard of a complication like this!

Great story! I loved the little popups, too. Stories like this give me a better perspective on what to expect in the Real World. So much different than the lab.

That’s great that she continued to have a wonderful sense of humor. It helps with the outcomes. I hope she did well afterwards..

We just covered chest tubes at school. That was never mentioned as a complication, But I’ll sure as heck remember it now.
Thanks

Almost 28 years of nursing and I have never heard of iatrogenic boob inflation. This was both scary and hilarious at the same time. I have got to tell this story next time I go to work!

Yikes, hope she’s okay, probably not a side effect she was looking for her at her stage in life… btw, do docs ever give discounts to patients who get weird results like this? Wouldn’t really make sense though, since no one did anything wrong, just the patients’ body reacting. I once had a reaction to novicane in which my heart-rate pretty much doubled for a number of minutes and I thought I was going to die. Never thought to blame the dentist, although it freaked me out considerably. Anyway, thanks for the story, these help us non-health-professionals get a glimpse of what it’s really like for nurses.

Great story!

The popups are fantastic. And I’m rooting for her, too.

hi, i’m a nursing student who is about to begin my med-surge clinicals next semester. i just wanted to say that reading your blog is inspiring and provides me with some sort of direction. thank you.

-that poor woman….that’s so sad! I bet that the subcutaneous emphysema didn’t tickle, either, let alone all the other extra procedures they had to do. Wonder who pays for all that mess. Probably that poor woman’s insurance.
You are right-thank God she managed to get out of the hospital alive. The community hospital I work at has patients like the woman described….your heart goes out to them.
(I’m a RT, btw….neat blog!)



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  • profileI am Gina. I have been a nurse for 15 years, first in med/surg, then CVICU, inpatient dialysis, CCU and now hospice. This blog is about my experiences as a nurse, and the experiences of others in the healthcare system - patients, nurses, doctors, paramedics. We all have stories!

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