Suzanne - A Day in the ER

I spent the past week shadowing doctors in ER of the Santo Espirito hospital here in Angra do Heroismo. On Thursday, a burly 25 year old man with lots of tattoos came in complaining of shortness of breath and pain in his chest area. The doctors ordered an X-Ray, which showed that the man had pneumothorax. (Pneumothorax is a condition in which the pressure in the interpleural cavity of the lungs is compromised by a hole in either the visceral or parietal pleural membranes.) Although due to the language barrier (I don't speak any Portuguese and the doctors do not usually speak perfect English) it is always slightly hard to tell exactly what the doctors are trying to communicate to me, especially when they are explaining medical conditions or procedures, I believe they said Pneumothorax can occur spontaneously in young people, especially young men who smoke heavily. To fix his condition, they decided to put a chest tube in. The tube was HUGE for something that they were going to stick between his ribs. The circumference of the tube was probably larger than a dime. By the time they finally were ready to place the tube into his chest, there was an audience of approximately 5 nurses and 6 doctors watching, so the room was very crowded. This made it somewhat hard to see what was going on, and no one in the room spoke English well, but I believe they just gave his three shots in rapid sucession and then top the scalpel and made a cut in his side. The main doctor then took scissors and begin cutting and tearing the hole to make it bigger and bigger. Then, she was handed the tube and begin to press it through the hole into his lungs. While she was doing this, I looked at the man's face and his expression was horrific. I thought they had given him local anesthesia, but from the look on his face it seemed they literally just stuck the tube in there without any pain medication at all. The look on his face was much harder to stomach than either the cutting or tearing of the hole for the chest tube.