My First Lung Collapse, Part 1

I want to start out by reiterating that a lung collapse as a result of asthma is not common. I don’t want anyone to panic about that. The lung collapse itself (each time) was a secondary response as a result of the severity of the asthma episode but not the direct cause.  Though I certainly anticipate that I will have asthma symptoms to a degree for the remainder of my life, I don’t anticipate that it will reach this level again, based on proper nutrition, better treatments (homeopathic), more effective medications where necessary and the strength that I build in my lungs and body through consistent exercise.

Shortly after graduating from high school, I headed for sunny Southern California. I knew I would be putting myself through college, but I had no idea what I wanted to do or study; I was interested in so many things that I found it impossible to narrow it down. I worked at the Hayden Lake Country Club throughout high school and was offered a job at another country club in a warmer climate during our off-season. It seemed like a good step. I was excited and ready to jump into the unknown. I loaded up my yellow Volkswagen Bug with all of my worldly possessions, including a papasan chair. (It really is amazing what you can fit into a Bug!) I had $200 in my pocket and a job waiting for me in the Anza-Borrego Desert at Ram’s Hill Country Club in Borrego Springs. The job came with immediate full medical and dental benefits, $8 per hour to start (rolling in the doe in 1987!), and room and board which we affectionately dubbed “The Bungalows.”  The part that sealed the deal was the full medical benefits. My asthma was considered a pre-existing condition and medical coverage for it was hard to come by on new insurance policies.  There was (and still is in some cases) a waiting period for coverage, but that didn’t apply in this situation. I figured I’d start out by getting some life experience, have some adventure, and save money while deciding my next steps. I lasted a year in the desert climate and then moved to Long Beach to start working on that college degree. I had friends who lived there so figured it was a logical place to start. I took a job at the Hyatt Regency and made it through the waiting period imposed for coverage for the asthma without any major episodes. Turns out, it was just in time.

Around Christmas that year, I picked up a cold/flu bug that had been making its rounds. For many asthmatics, colds, sinus infections and the like are a major trigger and in my case, a potential visit the hospital. In fact, every single hospital stay for my asthma was originally triggered by a cold.

Christmas Eve 1988

I showed up at the ER at Los Alamitos hospital. When I get to this point, it’s bad; really bad. But I know how this works. In my experience, there is a very narrow window period of time for seeking effective treatment, regardless of what I already know I need based on a lifetime with this illness. More often than not, if I go in too early I will receive minimal treatment and be sent home, only to return later with more severe symptoms and then I’ll be admitted.  If I take that extra time to let it get to the point where they will admit me anyway, I will be scolded for waiting too long. The final outcome is the same; the time it takes to get there is completely dependent upon machines versus what the patient is telling the doctors about their condition, even if experience is evident and documented. In medicine, they typically have to make decisions based on data; I get that.  However, there is something to be said for a patient who knows the linear progression of their illness better than anyone else, and in particular, has a very keen sense of when this is going to decline rapidly, based on a clear and consistent history. I know when my prescribed medications aren’t working anymore. I know when I have reached the point where this is going to get much worse before it gets better, is out of my hands, and if I am not where I am being monitored, the worst can happen. In America, 3200 people die from asthma each year. I don’t wish to be one of them. It is of the utmost importance to know and exercise your limits with asthma.  I have mastered this. It is intensely discouraging when those efforts are thwarted. More often than not, I am forced to play the game, thereby allowing my illness to progress until something shows up on a test.  By then, it’s out of control. Fact: You can have normal pulmonary function or clear lung x-rays and still be in the midst of a serious asthma episode. The first problem is in the airways. The only exception to this struggle with treatment that I had found personally was Kootenai Medical Center in Coeur d’ Alene, Idaho.  I walk in; they admit me. Not because they remember me, but because they get it.

But I wasn’t at KMC, so given that this would be my first visit to this hospital, I had to be prepared for either scenario while hoping for the best. I knew it would be important for them to see some data. I generally gauge my peak expiratory flow as a guideline for when to make the trip to ER.  This is a measurement of a person’s ability to breathe out air, which in turn is an indication of how much obstruction exists in the airways. On a great day, my peak flow meter will top out around 460. Doctors have told me that anything below 200 is dangerous and I should go in and expect to be admitted. This is my magic number. I figure if it’s below 200, that’s enough for them to understand what I already know and admit me. Once my peak flow meter registered at 210, I decided to chance it and go in.

I cannot express to you how greatly relieved I was when the doctor on duty said the following to me that night: “You are the expert here. You know your condition better than anyone else. It is important that you communicate with me and let me know exactly what is going on so that we can help you.”  Wow! He actually said that! What a comfort to hear a doctor acknowledge that at our first meeting. By then my peak flow was down to 180 (after a bit of time in the waiting room), but I felt safe and knew that I would be okay and back to health in a few days.

So imagine my surprise when after four hours of breathing treatments, which raised my peak flow to a whopping 190, he said to me, “You don’t really want to be here on Christmas Eve. I’m sending you home.” Are you kidding me? I don’t care what freaking day it is. I can’t breathe! What happened to ‘I am the expert?’ Even your own equipment shows that I’m still in the danger zone after treatments and you’re sending me away? I’m below the magic number!!

I was terrified to leave.

With the help of friends I ended up at another hospital for a week. Once released and back to health, I paid a visit to an administrator at Los Alamitos Hospital. I complained, referencing my week-long stint at another hospital, in the hopes that this was enough proof that his actions were negligent.  But I was young and inexperienced at this. I was ill prepared for making my case effectively. I wanted to ensure that no other patient would have a similar outcome.  I could have died. He effectively did nothing for me, though in the eyes of the doctors at another hospital, I clearly needed to be admitted. She at least agreed that what he said to me initially seemed incongruent with his actions and agreed to talk with him. But I would have no idea if that would actually happen and I left feeling as though she did not understand the gravity of the situation.

Fast-forward to one year later. I now lived just four blocks down the street from that same hospital and I was in the midst of another bad episode. I was scared to return, but it seemed silly to drive an hour to another ER and my friends weren’t available.  I was better at advocating for myself now so I went for it.

A few years before, another doctor informed me during a hospital visit that I had a pneumothorax. That is, an abnormal collection of air in the plural space between the lung and the chest wall. More on this later but essentially, I had coughed so hard and for so long that it caused a hole to develop in my lung and air was escaping. It can lead to a lung collapse or even a heart attack, depending on how large the air pocket gets and where it lodges in the chest cavity. There was no telling how many I had had in the past as they are often small enough to not have a significant impact and can in fact heal on their own.  But I was to be on high alert during bad episodes and he showed me how to know if I had one developing. It feels like Rice Krispies under the skin when you press lightly around the upper chest area. Thankfully I wasn’t noticing one.

Yet.

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