Wednesday, 25 June 2008


I saw a lot of these today - mostly confined to xrays and CTs, but one set I got up close and personal with... Sitting in a bronchoscopy theatre watching them thread a black snake down someone's throat so that we could get a glimpse of what literally lies beneath as Mr 88 choked and gagged on his own mucus.

Lungs are funny creatures, wet, spongy, fun to squeeze in a dissection lab. There is absolutely nothing that feels the same, though it is somewhat similar to the sensation of squeezing out a stiff sponge. Lungs if they're healthy are kind of pink, and sit in well defined tiny bunches of grapes around branches of bronchi(oles) that track back up into the smooth hollowness that is the trachea. THey're moist, as you'd expect them to be, but patent or open, and mostly just look slightly shiny. The pinkness is a healthy glow or should be, kind of like the inside of a baby's mouth as you follow the contours down with the scope.

The lungs I saw today did not look like that.

Imagine I took these healthy but delicately membraned lungs and stood on them - with shoes that were covered in fragmented glass. Then for good measure I tipped some sand down the trachea and shook it up for a while so that they got some internal dermabrasion. Lather with mucous inducing smoke for a while and then rest. The result is not pretty.

When you can't see your lungs it's pretty easy to take them for granted. Which is kind of stupid really because knock them off and you're fucked because well, humans haven't perfected intracolonic gas exchange... The human body however anticipates our antipathy and is an incredibly clever invention. Knowing how vital the lungs are, we actually have a surplus for what is required for just general slothful living. A redundancy plan that is set up for emergencies. So if for example you decide to inhale a peanut, you may not feel too flash, but you should be able to keep on living (unless you're allergic) because it's likely to drop down into your right main bronchus leaving most of your lungs to operate business as usual.

Also, if you happen to live in a dusty area and hence sandpaper your lungs everytime there's a duststorm simply through the crazy act of breathing, you're actually going to be ok so long as ou keep a proportion of your lungs working. And if you're unlucky enough to get a growth in your lung, you can have a whole lung removed and aside from looking a litle lopsided you should be right to keep on going.

The problem arises with this redundancy plan in that because of all the back up, we can't tell taht our lungs are compensating. So when you have your boozy smoke filled nights out, you can't see the permanent damage you're doing to your interstitium and you probably can't feel it either aside from the fact that you're hacking up a bit of mucus. So you spend you glorious adulescence smoking (even though you fully plan to give it up when you have kids and settle down etc) and rolling your own joints and hey, you feel foine. But like the ads say - every cigarette is doing you damage.

Now for some people, Christy Turlington springs to mind, you only get a couple of years worth of heady living before it comes back that your lungs have had enough and just can't cope with the deception any more. But for the vast majority it happens in their late 50s, early 60s. For those that grew up and stopped smoking when they got married, settled in the burbs and got respectable add 10 years to those ages. Suddenly, through age, accumulated shitting on them and the fact that they're clogged up with mucus, your lungs don't work properly any more and there's not enough of them left to cover up this sad fact. Your cilia - the little hairs that line your airways are screwed (especially if you're still smoking) and so the mucus that you're producing in abundance (another coping mechanism if you're a smoker) just sits there and can't get out. Gradually it builds up, sometimes blocking off a bit of lung altogether until it collapses or becomes infected.

Because less of your lungs can process gas exchange, and because they're now less compliant due to damage, the blood pressure goes up in the lungs and your heart has to beat harder and stronger to keep up. Your right heart gets larger and stiffer, at first, like the lungs coping, until it starts to fail as well. Now not only are you drowning in your own mucus but your heart is getting tired as well. You start getting fluid build up in your peripheral tissues making you look bloated and if you wear socks the indents will stay there for quite a while to the fascination of medical students. We call this cor pulmonale. You become a bag of fluids that aren't where they should be.

So you start a cocktail of medications to try and remove the fluid (all with fun side effects), and we put you on oxygen so that it's a bit easier for your remaining lung to get some oxygen into your body, maybe via the ever attractive nasal prongs to start with, but as we go along and both lungs and heart start giving up you may be moved onto the lovely CPAP/BiPAP which forces your lungs open (so they don't collapse down on themselves) as well as deliver oxygen. You'll most likely be in hospital at this point, swollen, struggling to breathe and drowning in your own secretions. You will literally gasp for air. Every cold will send you to hospital. Every cold could be the one that knocks you off for good. On one of these trips to hospital you get exposed to MRSA which is Methycillin Resistant Staph Aureus, which means that everyone who comes into your room gets to wear a gown and mask.

The best bit: this in and out of hospital; this drowning/gasping sensation; this lying in bed watching terrible television and waiting for the revolting food that you can't smell (which is good because it means you can't taste) to break up the monotony; your vistors dressing up like you're a pile of infectious pus; this can go on for years. About 12 in my grandmother's case, longer in my grandfather's. Years of drowning yourself, sleeping on 3+ pillows, waking to cough green brown sputum into a cup you keep beside the bed. Occasionally you get blood too, because coughing that much is really irritating. Or sometimes it's because everytime you get well enough to get out of bed you pull your IV trolley with you outside so you can suck back on some glorious tobacco smoke. The effort of walking outside turns you blue though, and you struggle the 20m back to the hospital entrance, sitting down to "catch your breath" before struggling back to bed.

Then you lie back on a table as someone sticks a snake down your throat to confirm that after 10 years of drowning, you've developed a cancer and you've probably only got a few months to live.

But hey, you've got to die of something right.


Anonymous said...

Oh now that would have made me give up smoking for sure...if I were a smoker, which I am not...any more.


hissychick said...

Mmmm yummy.

Glad to have never been a smoker. Mr hissychick on the other hand had a habit that started at 10 (!) and was finally kicked for good by 35.

Wonder what the future holds?

Nina said...

Hi Jenn,
I just wanted to let you know that I printed that out and gave it to someone very close to me. That person has gone without a cigarette today, so here's hoping you may have got through to them. A great piece of writing, very persuasive. Thank you :)

Anonymous said...

I was actually thinking that you should print that and hand it to your smoking patients Jenn. It's very confronting but in a factual, non judgemental way and I really think it could be the catalyst to helping some people quit.

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