The Grisly Tale of a Chest Tube Insertion

Although I've had 14 chest tubes, only four of them were inserted while I was awake. The other ten were inserted while I was under anesthesia, undergoing surgeries. It is very uncomfortable to wake up and feel two chest tubes protruding from your chest, but it is even worse to have a chest tube inserted while awake. Each time I had a chest tube inserted while I was awake, it was unforgettably painful. I vividly remember each of the four experiences, and having since talked to many people who have gotten chest tubes, it seems we all do. One particular chest tube insertion, though, stands out as extraordinarily awful.

In 12th grade, my right lung collapsed and I was seen in the ER at the Hospital of the University of Pennsylvania, in Philadelphia. My thoracic surgeon, Dr. Kaiser, wanted to operate on my lung. However, since I had gotten a bad concussion three days earlier, Dr. Kaiser felt it wasn't safe to put me under anesthesia. Doctors instead decided to insert a chest tube with a Heimlich Valve to temporarily patch up my lung. I had been through one chest tube insertion before and knew I was in for an unpleasant experience, but I was ill-prepared for what happened next.

As during every chest tube insertion, an intern in the ER first used a scrubbing brush to clean my entire chest with antiseptic liquids. He also numbed my chest with injections of novacaine. The intern then used a scalpel to make a small incision on my pectoral muscle on the right side of my chest. After that, unfortunately, the process turned from fairly painless to preposterously arduous.

During a chest tube insertion, a doctor's task is to insert a thick, hard plastic tube between the ribs of a human rib cage. The tube, however, is thicker than the space between two ribs. A chest tube insertion always requires a lot of pushing and pressure, causing significant pain and distress to the patient. Unfortunately, on this occasion the intern simply could not get the tube to go into my chest, despite an enormous amount of pushing and prodding. After several sustained efforts at forcing the chest tube through my incision and into my chest cavity, the intern left the room, frustrated by his lack of success. He returned moments later with a large, metal tool that looked like a giant pair of scissors. This was bad news. Instead of a pointed edge, however, the end of the "scissor tool" was slightly blunted. With both hands, the intern grasped the handles of the tool and placed the blunted end inside my incision. He then bore down with the full of his weight upon me, trying to dig a hole through my chest. I believe his intention was to create a hole in my chest with his scissor tool, and then use the hole as a place to insert the chest tube. As if he were digging a beach umbrella into the sand on a hot summer day, the intern swayed the scissor tool from side to side, and sometimes in a circular motion, all the while digging it with vigor into my chest. The young man, now sweating heavily, had cut his way through my pectoral muscle but could not get his scissor-tool to penetrate my rib cage.

Needless to say, the pressure caused by the scissors digging into my chest was by far the worst pain I had ever felt. I was relieved each time the intern ran out of energy and needed a break, temporary respites during which I would look questioningly over at my dad as if I expected him, a cardiologist, to have some sort of explanation or answer to how this could be happening. When the intern decided he could not insert the tube alone, a second doctor was summoned. The two men, I believe they were an intern and a resident, grabbed hold of the scissor tool as they placed it into my incision. The intern and resident then, I kid you not, prepared a countdown: "one, two, three!" - Both men gripped the scissor tool tightly and pushed down with the force of their combined weights. After ten seconds of their sustained push, I felt an additional spike of seemingly unbearable pain and heard an uncanny "popping" sound.

I assumed and hoped that the popping sound signaled success but I wasn't sure. I remember a sense of shock over the new pain, stunned that my already excruciating pain had actually gotten worse. I don't remember much after that but at some point the tube was inserted, fairly easily, into the newly formed hole in my chest. A procedure which should have lasted 10 to 15 minutes had gone on for 45. No pain medicine or sedative was ever offered or administered. Novacaine was my only barrier of protection, but novacaine does not reach deep enough to offer much help. Ten minutes after the procedure ended, I was finally given Dilaudid, which I was told is five times stronger than Morphine. The acute pain and burning in my chest subsided and I learned for the first time what it felt like to get high.

I knew that things didn't go smoothly, but I hadn't realized how inexperienced my intern was. Months later my father, now a retired cardiologist, told me the intern who inserted the tube basically had no idea what he was doing. Unfortunately, this is sometimes the case in a "learn on the job" environment such as the ER. On three other occasions I have had chest tubes inserted while awake, and although they were very unpleasant, the procedures were certainly much quicker and easier than the one done on this particular occasion.

After the tube was successfully inserted, the intern attached it to a Heimlich Valve which prevents a lung from collapsing. I had the chest tube and accompanying Heimlich Valve strapped to my chest with surgical tape for two weeks and even went to school with it every day. It didn't hurt or bother me at all although it did cause one slightly humorous situation. One day while taking a physics exam, I coughed and blood splattered all over my exam. My coughing had forced blood from inside my chest to exit my tube, go into the Heimlich Valve, and splatter right onto my test paper. My physics teacher was not pleased and to add insult to injury, I failed the test, highly disappointed that my blood-stained, concussion-induced efforts did not warrant any extra credit.

After my head injury subsided, my thoracic surgeon Dr. Kaiser performed a Pleurodesis surgery to repair my right lung.