Chest Fluid and Post-Surgical Asphyxiation

The body is stupid.  Unlike the brain, it has not learned to vary its tricks to suit new situations.

Take how the body responds to wounds, for example.  Say you have a cut or a scrape on your knee.  Even if it resists infection, you’ll notice that it purges a small amount of clear, faintly yellowish fluid.  (If you’ve ever pressed a bit too hard on scab, you’ll know what I’m talking about.)  On external wounds, purging is a pretty good design concept.  It washes potentially infectious crap out of the wound.  Once the injury seals over, it creates a buffer zone between the wound and the scab.  All in all, pretty clever.  But the same system that works so well on the body’s surface becomes a liability if your wound is on the inside.

To be fair, there are some places in the body where a little fluid buildup is no big deal, the leg for instance.  You may get a bit swollen, but the blood will carry the unwanted liquid off to your bladder eventually.  The chest cavity, however, is another matter.

One of the stranger byproducts of heart surgery is chest-fluid purge created by the body in response to the incisions.  If left to its own devices, it will fill all the available space inside the chest cavity.  This is bad for a couple of reasons.  For one, the same fluid that washes wounds clean on the outside becomes a stagnant, bacterial soup on the inside.  For another, it can compress the lungs, making it difficult to breathe.  This is why surgeons leave drainage tubes sticking out of patient’s abdomens.

Really Big Needle

Those tubes, of course, have to come out eventually.  Sometimes, they come out too soon.  Purge continues to accumulate.  When that happens, you have to get the fluid out with a needle.  A very big needle.

I’ve had this done exactly twice, and it is a surreal and frightening experience, even for an adult.  The needle is inserted into your back.  Despite the Novocain, you can feel it punching through the chest wall.  They syringe attached to the needle is ridiculously large, like something out of a Warner Brothers’ cartoon.  Purge fluid is slowly siphoned out of your chest and squirted into an IV bag.  This can go on for thirty minutes or more.  Sometimes you need more than one bag.  The fluid itself is cola brown with a hint of cherry.  You know you’re done when you feel the tip of the needle prick your lungs.  The entire procedure hurts like a son of a bitch, but it beats being strangled slowly from within.

The last time I went through this, my surgeon removed one and three quarter liters of fluid from my chest.  I didn’t quite beat the record for my hospital, which was two and a tenth.  So you see, the body is stupid.  Unlike the brain, it has not learned to vary its tricks to suit new situations.  It will kill you if you let it.

Dave Hurwitz

Huang Chuncai recovers after surgery – visits home

After first writing about Huang Chuncai (April 20 and June 27) I had no idea how little information there was on this man. His first surgery is well documented. However, the information following this is scarce. My previous attempt at an update led me to glom onto two photos that were not accurate. A comment by “racliu” gave me a website in Chinese. This was what I needed. i used Google to translate this into English. Then I grabbed a bit of text that had Huang Chuncai’s name (in the original Chinese) and searched it using Google. I was able to uncover several photos for when Huang visited his home town between the first and second surgery. Also, I’ve done my best to transcribe/translate the Chinese text into a coherent story of the man.

Huang Chuncai was born in 1976 in the village of Yulan, in China’s southern province of Hunan. He has four brothers and sisters, and is the second oldest. Even at a month old, his father, Huang Bao, noticed that the head was distorted. Otherwise the boy was no different form other people.

He first developed his sarcoma, or malignant tumor, when he was four. The physical deformity taxed his spirit, and the other villagers became shy around him. He attended elementary school up to the age of seven, third grade. As time went on, the other students alienated him, calling him a monster.

By ten-years-old, he was abandoned by the people of the villiage and ridiculed. Huang left home less and less often. He recalls being terribly bored at home. Sometimes he sould take a stroll around the village or go fishing at the river. However most of his time was spent locked inside his home. By 21, he had spent most of his life indoors.

By 31-years-old, Huang’s tumor drooped almost to his navel. The weight of the 15 kg sarcoma curved the spine in his back, causing a hunch. His left eye was lost as the tissue surrounding it sagged down his face. His left ear hung down near his shoulder. The upper and lower jaw cannot bite together. Huang kept his teeth up to 20-years old. But by age 25, they had been stripped. Today, the 31-year-old Huang has almost lost all hearing and capability of speech.

A reporter brought a tape measure and found the tumor to be 57-centimeters long (97 cm in circumference). Take into consideration that Huang was only 135 cm tall.
Finally the Fuda Hospital, in Guangzhou, agreed to do several operations for free. Huang’s first surgery was in July 2007. After removing 15 kg of tissue, Huang was released and allowed to return to his home.

After and eight hour journey, Huang was exhausted. Family members were excited to see his return. The villagers said that the tumor appeared smaller and that he looked much better. Huang was concerned with the next step of the surgery, which had greater risk. This was to remove the roots of the tumor with abundant blood vessels.

Even though the operation was free, Huang was concerned over the cost. The hospital and the contributions of the staff covered the 140,000 yuan (about $20,000) operation. The second surgery would be more complex and cost even more.

Huang arriving home after his first surgery

Huang Chancai with his father, Huang Bao

Huang with one of the doctors who performed the operation

Huang sitting with a child

Huang did go back for a second surgery in January. On February 28, the Guangzhou-Cancer Hospital announced that it was a success. The doctors were able to remove about 4.5 kg of the tumor. British BBC television, the Philippines television, “The Vietnamese Times”, and The Associated Press reported the news to the world.

Dr. Niu said the success of this operation means that their treatment has been a complete success. Huang only gradually recovered from the operation. He is considering a third operation. After recovering, Huang Chuncai returned to his village.

Judging by the size of the tumor, I believe this photo was taken after his second surgery.

Tim Kane

Strange Perils of Surgery

It’s happening again. The right side of my chest is swelling up. My right armpit feels bloated too, like I suddenly gained a pound of fat and it all went there. The whole area is sensitive, tender to the touch. I’ve been sleeping on my left side for a week now.

The last time this happened, I wound up looking like an Amazon. A massive, bulging bruise formed on my chest, shifting gradually from purple to black to yellow. Once that was gone, the swelling subsided over a period of weeks. It took forever just to figure out what the Hell was going on. I underwent a wide range of tests. Blood work. Echocardiogram. (Very painful on sensitive skin.) Even, humiliatingly, a mammogram. But it was a plain old X-ray that finally revealed the cause.

Open heart surgery requires that the sternum, that central meeting place of the ribs, be cracked in two. Clearly, this is not a state it should be left in, so before the patient is sewn up the two halves of the sternum are wired together. On my X-rays, the two loops look just like twist ties from the grocery store. Or at least they usually did. One of these loops––no doubt overstressed by tai chi, marital sex, and regular visits to the chiropractor––had snapped. One of the loose ends had sliced it’s way into the muscles of my chest, causing a small amount of internal bleeding. With nowhere to go, this blood lingered in my body, gradually pulled toward the skin by gravity. Slowly and painfully, it went the way of all bodily waste.

The scary thing is, once I knew the cause, I could remember the exact moment it had happened. I had woken up late one Saturday morning. As I yawned and stretched my shoulders, I felt a small pop near the middle of my chest. Wondering vaguely what it was, I had gotten up and gone about my day.

This time I didn’t notice when it happened, though I suspect all the coughing from my recent cold may be to blame. I’m not freaking out this time. I’m just wondering how swollen I’ll get and how long it will take to go away. Mostly I feel annoyed. I’ve seen exactly one doctor, my general practitioner, for antibiotics and an X-ray.

On the whole, I consider this a small price to pay for not being dead. I’m nothing less than grateful to the men and women who crack my sternum open from time to time in order to keep this show on the road. Still, it has to be said, I wish they’d mentioned this in the sales pitch.

What happens to the wire? That stays put until my next round of surgery. It’s not going anywhere, and the grief involved in digging it out would be absurd. I expect it’ll come out in about five years, when my pacemaker leads need replacing.

I’d like to close with a little story my G.P. told me during my visit. This happened during his residency days. His supervising doctor had asked him to remove a drainage tube from a post-op patient. He gripped the tube and pulled with what seemed to him to be the necessary amount of force. Nothing happened. The tube refused to budge. He pulled ever so slightly harder, and still the tube stayed put. Resisting the urge to give the tube a violent tug, he summoned his supervisor and confessed that it seemed to be stuck. To make a long story short, an X-ray eventually revealed that one of the wires holding the man’s sternum together had snapped. One end had punched clean through the drainage tube, pinning it in place. If my G.P. had pulled any harder, he would literally have torn the patient’s chest open. I’m not normally squeamish, but I had to shudder when I heard this, as I vividly remember one surgeon who braced a foot against my bed, gripped one of my drainage tubes with both hands, and yanked.

David Hurwitz