Wednesday, August 29, 2007
The Lung Way Home
If you can imagine squeezing pink cotton candy, and if in your mind you can make it not sticky or sweet-smelling, you may have an idea of what a lung feels like. It's the coolest thing.
I found myself inside the chest more frequently in training than in practice, but it still happened often enough (almost always to work on the esophagus) to refresh my senses -- that airy texture; spongy and light. The way it conforms to a touch and molds itself, like a memory foam mattress; except in the case of the lung, the imprint becomes purple. And stays that way until the next breath.
When operating in the chest, not on the lung, we frequently impose upon the anesthesia person to use a special split breathing tube that can inflate one lung at a time, allowing the deflation of the one in the side of the chest in which one is working. It gets it out of the way very nicely. As it collapses (we may speed the process by pressing on it) the color of coral is replaced by that purple as it shrinks, leaving pink pockets here and there, looking empty and irregular. Later, watching the reinflation is the witnessing of a magical metamorphosis.
(Let me say here: a normal lung is fairy-tale pink, baby-cheek smooth -- a soft pillow and puffy. Clean, inspiring (pun intended), and as described, sadly rare. Even if a non-smoker, any city-dweller picks up enough crud from the air to deposit black spots throughout, changing that bubble-gum beauty into charcoal-pocked travesty. In a smoker: well, let's not even imagine it today. It's the opposite of beauty in the way steel wool is the opposite of creme brulee.)
It's when the critical part of the operation is over and the lung gets re-filled that the real thrill happens. Slowly and irregularly the lung expands, like a beaten fighter staggering to his feet, arms and legs not quite responding. Here and there the pink appears, pushing the purple crevices outward nearly randomly, erasing them, like strawberry milkshake bubbling up, filling them one by one, here, then there. As the anesthetist gives the breathing bag an extra long and extra forceful squeeze, you watch as the lung pops its way full: it's the opposite of crackling bubble-wrap. "OK, that's it," you say, and the breathing gets reverted to mechanical and regular. You can't resist touching the lung again, as it strains stiffly between the ribs; it both repels the touch and gives way, then refills the spot. If there were a soundtrack to the expansion, it would be like that of a wave receding over a gravelly shore.