Robbie Maakestad

A Most Fragile Organ

In the middle of an intramural basketball game during my sophomore year of college in rural Indiana, my left lung collapsed. In a state of misguided machismo, I didn’t seek medical attention for two days even though each intake of breath felt like a broken bottle was being stabbed into my chest. I figured the pain would disappear if I pushed through, that it couldn’t be anything too serious since I’d been healthy throughout life until then. My friend threatened to call my mom after he watched me wince my way to class and spend all remaining time lying on my couch. And so I ended up at a hospital in the middle of Indiana corn fields: a tiny facility with five rooms for patients and a patient processing area that doubled as an operating room, cordoned off from the hallway by a curtain.
       A surgeon drove in from Muncie and described lung collapse treatment options: with proper bed rest, the rupture might heal naturally over several weeks; however, most collapses, including my own, required immediate surgery. He continued: he would force a sharp tube the diameter of a man’s pinkie into an incision in my chest, through the cartilage between my ribs to release the leaked air. This tube would attach to a vacuum chamber to pull escaped air from between the lung’s pleural membranes, and the negative pressure would inflate the lung. The surgeon couldn’t use anesthesia, just a local painkiller, because I would need to hold my breath to fully pressurize the pleural lining for the tube to break through; also, if he numbed within me, my heart and healthy lung would cease function. To pierce the cartilage, the surgeon leaned his entire bodyweight on the tube, pressing me down into the hospital mattress, which seemed like it was enveloping me. When the tube broke into my chest, it felt like being pitted on a razor-tipped kebab skewer, but my lung inflated almost immediately.

When your lung spontaneously collapses, it causes you to question your own body. It’s one thing for an organ to cease function due to external trauma or disease. But an unprompted lung collapse is different. A lung collapse is personal: a betrayal by an organ with which you’ve happily coexisted since nine weeks before birth. A reflex that you depend on quits, without turning in notice. See, that’s what is most interesting about a collapsed lung—the unexpectedness. One minute, you’re living life as normal; the next, you’re gasping for breath, wondering what the hell is wrong and why it feels like your chest has been impaled.
       Pneumothorax is the medical term for a collapsed lung; the seemingly uncaused variety is assigned the descriptor “spontaneous.” Sufferers of spontaneous pneumothorax fall into two classifications: primary, the absence of known lung disease; and secondary, the result of serious diseases such as tuberculosis, Marfan Syndrome, lung cancer, or cystic fibrosis. Though the cause of pneumothoraces differ, the single commonality is reversal of pressure in the chest cavity. When a lung fissures, air escapes out into the pleural cavity: a space between the two membranes that line the lung’s exterior. The pressure of air between the membranes forces more air from the lung, shriveling the organ like a deflated balloon. Should this happen, each lung has a separate pleural membrane, allowing the other to maintain function. It’s possible to survive on one lung, but breathing grows shallow, leaving victims gasping; and yet, gasping causes the broken bottle to twist sharply within—an inescapable duality that leaves sufferers panicking.

On hospital day two, my lung collapsed a second time. This time, the surgeon gave me morphine, but he couldn’t directly address the nerves within my chest. He poked a thin metal rod down the center of the chest tube, leveraging it to a different spot. As soon as the rod poked down into the tube, pain tightened every muscle in my body; my legs pressed so hard against the baseboard that three nurses held my arching waist and shoulders down against the mattress. While he wiggled the rod, I squeezed the bed rail so tightly that I thought it’d shatter. A fourth nurse mopped sweat from my forehead with a towel while telling me to imagine I was lying on a warm, sunny beach. This didn’t help.
       When he finished, my fingers remained locked around the railing, frozen in a grip I couldn’t release for several minutes. I lay in a literal puddle of sweat but wouldn’t let the nurses move me for thirty minutes while I mentally recovered. My mind felt fuzzy from the abated pain, yet my body felt whole—as if expunged of all flaws—a bizarre sensation I couldn’t wrap my mind around. Five days later, my dad wheeled me to the car so I could recover at home. The cool spring air washed over my body and smelled like moist earth. Five days was the longest I had ever gone without my lungs filling with fresh air.

After your lung has recently collapsed, people often bring it up in conversation, like, “Sorry to hear about your lung. How’s it doing?” It’s impossible to tell how your lung is doing. Pre-collapse, a lung was something you rarely paused to consider. It chugged silently, doing its job without making a scene. Post-collapse, you can feel your lung at all times. Something is . . . different. It doesn’t hurt. But you’ve gained an awareness. “How’s it doing?” you say. “It’s not currently collapsed. So, well, I guess.” You say this as a question.

With most primary spontaneous pneumothoraces (PSPs), the victims are tall, thin white males and persons who avidly smoke and who have a family history of lung problems. While I certainly fit the first category, I had never smoked, and though one of my dad’s lungs hurt for a month or so during high school, he didn’t seek medical attention and hasn’t had any issues since. Based on demographics, I should have been a healthy breather.
       Nearly two months after my initial hospital stay my lung collapsed a third time.

Like the crinkle of a torn candy wrapper, you hear air escape. You can feel it leave your lung—a sharp pain that jolts your body upright, a pain that makes you press your chest with both hands, though this doesn’t accomplish anything. When this happens, you can’t help but laugh at the ludicrousness. Which hurts. You’ve been sitting on your dorm room couch eating apple slices and peanut butter, and you can’t believe it. You look up to your roommate who has just climbed into the top bunk and say, “Dude, my lung just collapsed again.” You walk to your RA’s room, and he drives you halfway to Indianapolis where your parents live. You spend the entire car ride taking rapid shallow breaths, trying not to hyperventilate. It’s almost midnight by the time your mom gets you to the ER. This hospital is well-regarded. It has thoracic surgeons who don’t drive in from Muncie. You wonder how you’ll pass your classes with two weeks left in the semester. You wonder if you’ll see your friends before they leave for summer. You try not to think about tubes and metal rods.

It takes an amazingly long time to register at a new hospital. Even when I walked into the ER and said that I thought my lung had collapsed, the front desk workers were in no rush to take my info. Their eyes said, “Sure it’s collapsed.” Eventually, they escorted me to an exam room where an ER doctor said my oxygen levels were normal. I told him this happened the first two times, but I could see he didn’t believe me. How can a lung feel like it is being cheese-grated, while its oxygen levels remain stable? After a chest x-ray, the ER doc returned and shook his head. “Collapsed. Seventy-percent functionality. You must have strong lungs . . . that are actually weak.” I didn’t laugh.
       It was 1:30 a.m.—my usual bedtime—but I was exhausted from oxygen depletion. Within an hour, I’d been transferred to an operating room and met the night shift doctor, who was bald and wore glasses. “Now, I’m no lung surgeon, but I know how to do these procedures. It’ll probably be pretty similar to the one you had before. Was it a tube and vacuum like this?” He held up a miniscule tube no thicker than a toothpick and a cylinder the size of a photographic film canister. I explained that the other hospital inserted a tube the thickness of a finger.
       “Were you awake for that?” His eyes bugged out when I nodded. “That’s like, third-world medicine. We’d do a larger tube for a serious collapse, but we’d put the patient out.”
       When I relayed how they’d inserted a rod to move the tube, the man stood up from his chair and cleaned his glasses. “Sue them for malpractice. That’s inhumane.” He grinned. “You’re lucky you’re here, kid. I’ll insert this tiny tube with this . . .” He held a syringe aloft. “It’ll hardly hurt. No incision. Just like a vaccination. But better because morphine!” He grinned wider. “This little vacuum chamber will get your lung kicking in no time.”

On hearing that your first surgical experience didn’t adhere to medical ethics, dark thoughts course through your mind. Thoughts of sticking a metal rod into your first surgeon’s chest and telling him to picture a beach. But your mind doesn’t stay there for long, as a morphine drip dulls your world. Soon the surgeon prances about the room making sure he has the necessary tools for the surgery, flirting with the nurses, who follow him, attempting to tie his surgical scrubs. “Look how women follow me,” he says. “Look how they flock wherever I go.” You wonder whose mind has been affected by the morphine—his or yours.
       The surgeon leans over your bare chest, which a nurse splashed with iodine. “Remember how I said I wouldn’t have to cut you?” You nod. “I lied.” He smiles. You smile back. You’re on morphine. He picks up a scalpel and points to the surgical scar next to your left nipple. “I’m going to slice next to this. A tiny incision. Let me know if you feel anything and we can up the meds.” You avert your eyes as scalpel meets skin. “Ow,” you moan because you can feel it. “I lied again,” he says. “We can’t up the meds so just hold tight. Almost done.” You can still feel the scalpel slicing, ice hot—the skin rending on either side of the blade.
       “Done. See, not so bad, right?” You nod even though it was so bad. He points a syringe into the incision. “Deep breath and hold for ten seconds.” When you inhale and hold, he plunges the syringe down hard between the ribs, through cartilage, and into the lung cavity. A sharp, piercing second of pain. Even with morphine, you feel your lung inflate—like a balloon, suddenly bursting with helium. Once the tube is in place and you’re breathing easier, the surgeon grabs the collar of his scrubs and rips, rending the garment while screaming, “INCREDIBLE HULK.” He tosses the scrubs into a trash can and winks at you. “Drives the women crazy.”

The fourth time my lung collapsed was on day two of this second hospital stay. A pulmonologist clipped the tube to see if the lung could hold without the vacuum chamber pressure. Over the course of an hour it became a struggle to breathe. An x-ray showed another collapse. He tried this again on day three. My lung collapsed a fifth time.
       Three lung specialists stopped by to discuss options. From the scans, they could tell that my lungs had blebs—miniscule deformities, pockets of air protruding up from the organ’s surface like bubble wrap. Because I’m 6'4" and thin, as I grew, my lungs elongated to fit my torso. Like a water balloon at max capacity, the tissue at the top of the organ had stretched under the weight of the lungs below, causing a large bleb to fissure. The first two specialists advocated waiting for it to heal itself. The third disagreed. “You can wait it out, but what’s to say you won’t be waiting here for weeks or that it won’t re-collapse in a couple days or even in a month?”
       I agreed. But was there another option?
       He explained that a procedure called pleurodesis essentially glues the lung to the ribcage: “We abrade the pleural membrane with a tool akin to steel wool, as well as the inner lining of the ribcage. Then an acidic talc powder is applied to both raw surfaces to generate an enormous amount of scar tissue.”
       With pleurodesis, the acidic talc is left to react on the tissue for a while and then most of the powder is vacuumed out before the patient is sewn up. The resulting scar tissue supports the lung so it cannot stretch further under its own weight, adhering it to the ribcage while the remaining acid reacts over the next six months to strengthen the bond between ribcage and organ. What little talc remains is permanently sealed between lung and ribs, constantly causing irritation and regenerating scar tissue. In some cases, patients experience talc pain for the rest of their lives though for most discomfort is negligible.
       He went on: if I chose pleurodesis, I would first be put out with general anesthesia. Then the surgeon would insert a jack between my ribs to ratchet them apart, reach his hand within the chest cavity, squeeze the lung to find the hole, slice away the bleb-pocked section, and staple the organ back together—I’d recover over several weeks. Depending on the location of the blebs, they might have to turn me over mid-surgery, re-incise through my back, and break ribs to reach the necessary area. This version would cause a month-long recovery if I was lucky—probably longer. If I chose pleurodesis, I wouldn’t know how serious a surgery I’d had until I awoke.
       “But this will fix me for good?”
       “Definitely,” he said. “There’s only a ten percent chance of recurrence, and the surgeon here at the hospital is one of the best. He was on the team that developed talc pleurodesis.”

As you research further online, a website rates this surgery as one of the most painful recoveries possible because the lungs cannot be directly medicated. You reason that the surgery will fix you; that you won’t have to worry anymore. Any residual pain would be worth avoiding a lifetime of lung collapses. After discussing with your parents, you opt for pleurodesis.
       The surgeon has an open slot in three days, so you wait in the hospital, bedridden. The hours drag on. Friends visit. you watch TV. The surgeon’s assistant stops by. He is jittery and fidgets uncontrollably. His hands shake. He removes his wedding band twenty times while talking with you and your parents, putting it back on, taking it off. He repeats everything he says two times. He repeats everything he says two times. No matter how long of a sentence he speaks. No matter how long of a sentence he speaks.
       The night before surgery, your mom offers to spend the night in the hospital, but you tell her to go home, that you’re OK. You try to sleep, but lie awake fixated on the severity of the surgery. You know you have to go through with it, but you don’t want to. You make peace with the possibility that you may die. It’s a small chance, but there’s still a chance. Then, you realize that if this happened even ten years earlier, this surgery did not exist—you would have had to rest until the lung healed itself. If it healed. Thirty years earlier, who knows? Fifty and this would be a death sentence. Or at least make you an invalid for whatever life you had left. Somehow, you find it comforting that medicine has advanced so recently. Pondering this, you drift off to sleep.
       In the morning, the anesthesiologist recommends a selective nerve block epidural. Having never been pregnant, you ask what that is. Though injecting an anesthetic into your spinal cord sounds horrific, he assures that it’s standard procedure and will block torso nerves post-surgery, though it won’t affect the upper two thirds of your chest. You meet the surgeon and a new assistant who replaced the one you previously met. Neither of them fidget nor repeat sentences. The surgeon is gruff and answers your questions with single-word answers. He has a mustache and unkempt greasy, gray hair that swirls around a bald spot like a hurricane. You like this surgeon less than any other medical practitioner with whom you’ve interacted.
       Your hospital bed is wheeled into the coldest room you’ve ever been in. It’s so empty. Nothing like those on TV. Much bigger. It’s bright and cold and clean. The cleanest room you’ve ever been in. A nurse asks you to mount a thin metal, padded table at the center of the room that looks like a dentist’s chair folded flat. Climbing onto it is harder than you’d expected in an open-backed hospital gown, which tangles around your legs. Modesty has been forsaken. At least they let you stay in your boxer briefs. Sitting there, you joke with the nurses because humor is your crutch when you get nervous. Your jokes are actually pretty funny. You should be this nervous all the time. Everyone would love you.
       The anesthesiologist enters, sets a thick padded pillow on your lap, asks you to bend forward with your chest on the pad. You do. He’s a kind, gentle man. You can tell this from the tone of his voice and the way he makes sure you know what he’s about to do. He starts a morphine drip in your arm ahead of inserting the epidural nerve block into your spine. Morphine courses through your veins. You can mentally trace its progression throughout your body. Placing a mask over your face, he says, “OK, I’m going to start the hard stuff now. Count to ten.” You count slowly—“One, two . . . .” At “six,” the world fades.

When I awoke post-surgery, I emerged from the fog of anesthesia to see my aunt sitting in a chair. Puzzled, since I didn’t know she was coming, I greeted her, then glanced down at my chest, my eyes glossing over my body. No visible three-to-five inch incision. Only two stitches where the tiny chest tube had been. My aunt left to get my mother. Confused by a thick chest tube feeding into my side, I raised my arm to look closer, but the tube disappeared into a gauze bandage that obscured where it entered my body. Again, I looked for an incision but came up empty.
       “Honey, what’re you doing?” my mom asked as she entered.
      “Where’s my incision?”
       “It’s on your back.”

Your mind is too fuzzy to be concerned about the incision placement. “Can I have a hamburger?” you ask. When your mom says no, you protest. you haven’t eaten since the previous night, and it’s almost noon, but you don’t know that. All you know is that you’re hungry. Then, it hits you. “IT’S ON MY BACK?” You almost shout, realizing this means they broke your ribs. Your mom says that though the surgeon had to incise your back, you still had the lesser surgery, with no broken ribs. Contented by this, you ask a nurse for a hamburger. “I’m not sure,” she says to your mother. “This is the ICU . . . so patients don’t really eat. I can ask the surgeon though.” In fifteen minutes, you’re eating a cheeseburger that tastes divine.

The recovery was as bad as the specialist had warned. My chest felt like acid powder was reacting on raw tissue, which it was. On the max dosage of morphine and Vicodin, the pain was nearly unbearable. In middle and high school I’m certain that I fractured my foot, broke fingers, and chipped my kneecap, but I played soccer and basketball through them, not telling my parents or coaches so I wouldn’t have to sit out the rest of the season. I knew I could make it the last few games; I could heal during the off-season. But this was pain at a whole new level.
       In the hospital bed, no position was comfortable, though propping myself up at a 130-degree angle somewhat alleviated my chest’s spear- pierced sensation. The three-inch incision was sealed by a thick glob of glue and scab that protruded nearly an inch out from my back, making it uncomfortable to lie down and forcing me to tighten my shoulders when sitting to avoid putting pressure on it. For the first two days, I was able to maintain a cheerful façade, but by day three, my patience had grown thin. Bright-pink fluid constantly drained from my side through the tube into a large negative pressure vacuum that burbled contentedly at the side of my bed. The lung specialist assigned to me post-surgery turned the vacuum off on day three.
       On day four, when my lung held overnight, nurses pulled the tube from my side—a searing pain that overwhelmed my brain for a split second before being replaced by tremendous relief. The length of tube within me had been over a foot long; how had it fit within my chest? The nurses taped gauze over the tube hole and soon I was home on the couch. Waking up after a seven-hour nap, I moved to a rocking chair and watched NBA highlights on ESPN. Suddenly blood trickled down my side, splattering the chair. I called my mom, who mopped up with a towel and stared at the gauze—soaked through. It needed to be changed, so she pulled it from my side and gasped. She sprinted to the phone and called the surgeon.
       I looked but couldn’t see, so I staggered to the bathroom, raised my arm, and turned in the mirror. There, in my side, was a round hole the size of a quarter, open to muscle and fat layers, the tissue an angry pink. Walking back to the chair, I overheard my mom saying, “There’s a hole. A hole with no stitches!” The doctors reassured her that this was standard—a tube hole of this size could not be sutured; rather, the hole needed to slowly grow back together, covered with gauze and antibiotic ointment—something they’d neglected to tell us.
       Two days later, I returned to school, pretending to be healthy so my parents would let me finish finals. I was off Vicodin and didn’t even need ibuprofen after the fifth day—a development that left me thankful that I showed no sign of residual talc pain. But I had to carry my backpack in my hands, or have someone else carry it for me, stopping halfway to class to rest and catch my breath. It was like all previous exercise had been sucked out of my body when the talc was vacuumed out, leaving me huffing at what had previously been everyday life.
       Now, I had to depend on my dorm mates. I slept in a friend’s room because the bed in my room was lofted high, and he had a bed on the floor that I could fall into. Each morning, my next-door buddy woke up with me to change my gauze because I could not easily reach to do so myself. There’s nothing more intimate than slathering ointment across an open window into a friend’s torso—an act of service for which I was extremely grateful. Slowly, the hole grew smaller, but it took two months to fully close.

When recovering from pleurodesis you notice that your lung has become stationary. No more bouncing up and down when you jog, like your other organs—something you now can feel in comparison. The lung is glued to your ribs, the only one that does not move. Twisting to the side is uncomfortable for many months, so your movement becomes somewhat robotic. You cannot fall asleep on your side anymore—only on your back. Breathing feels different, as if one of your lungs is compensating for the other, though you can’t tell which one is doing so. Your chest feels numb, a tingly sensation like a leg fallen asleep. The specialist later says this is related to nerves that were exposed and torn when the “steel wool” roughed up the chest wall and pleural membrane. This numbness eventually fades when after a year, your nerves have mended their connection to the nervous system.

The following two years were jam-packed with major life events: I met my future wife, Ashley, at school; studied abroad for a semester in Israel; graduated college with an English degree; worked a summer unloading semis at a hiking boot warehouse; proposed to Ashley; and enrolled in Ball State University’s MA Creative Writing program where I taught composition. I’d all but forgotten about my repaired lung, adopting the normality of how it now felt. I lived unfettered by lung worry, which had faded amidst the busyness of life—a dim memory, a joke that people made about my past fragility.
       Two weeks before I finished my first year of the Master’s program, my lung collapsed again—collapse number six. It happened at 8:30 p.m. during a visit with some college friends three dorm rooms down from where it had last collapsed. I was sitting on a couch when all of a sudden, crackling air and pain; this time, I hopped in my car and drove myself the hour to the Indianapolis hospital. I called Ashley to let her know, and she met me at the ER, as did my parents. It was 10 p.m. when I arrived.
       I walked in and told the receptionist that I knew my lung had collapsed because I’d been through this so many times. They bustled to hook me up to oxygen. My lung specialist arrived—he happened to be working the night shift. He viewed the x-rays and confirmed what I already knew. “I don’t know how this could have happened,” he said. “It’s so unlikely. Yes, a ten percent chance but with your surgeon there is much, much less chance of recurrence. I’m so sorry.” So friendly and comforting. Soon, he inserted the hairline tube, and my lung inflated. He didn’t flirt with the nurses. He didn’t lie. He didn’t split his scrubs like the Hulk.
       My specialist said that because I’d had pleurodesis before, the lung might heal itself more easily than normal, that the lung had not torn completely free, that the remaining ribcage support might assist the lung’s reinflation. This proved to be the case as the next day they clipped the vacuum tube and the lung held. That night, I transferred to a different wing of the hospital, two floors down and several over. Instead of wheeling me, the nurse suggested I walk the stairs. I figured it would be a decent lung test. Thirty minutes after I’d settled into my new bed, my lung failed the test and collapsed a seventh time.
       Unlike previous instances where I’d experienced sharp pain and shortness of breath, this time I really struggled to breathe. It felt like the space I inhabited was constricting—the air dancing away from my open mouth. Protocol required a specialist to give nurses permission to turn on my lung vacuum and the sole pulmonologist on duty, who was in some distant part of the hospital, couldn’t give said permission without first observing me. So I lay still, waiting for his arrival, taking in short, choppy breaths; the more I gasped, the more my body demanded the oxygen it couldn’t receive.

At times like these, you snap at the nurses. You snap at your mom. All they have to do is flip the vacuum switch. But they cannot. Since you can barely breathe, you start to have a panic attack. You realize that your lung has super-collapsed this time, not just partially. What if this had happened while driving the hour to the hospital?
       After what seems like a month, but is probably only fifteen minutes, the pulmonologist walks in, takes one look at you, plugs the vacuum into the wall, and flips the switch. As the water in the vacuum bubbles to life, your lung expands immediately—a primitive response to the negative pressure, yet it feels miraculous. Like life itself has returned to your being. And it has.

This time, my greasy, mustachioed surgeon met with me the day before surgery. No fidgeting assistant. He remained icy, but I could see he was surprised to see me again. Perhaps he felt responsible. The surgery he’d helped invent hadn’t held its end of the bargain. He recommended trying it again because surely it would work this time. “Or,” he said, “There’s another option.” He explained a pluerectomy—essentially the same procedure as pleurodesis, only this time, rather than abrading the pleural lining, they’d rip it out. They’d still cut up the inside of the ribcage, but this time they’d rough up the lung itself, gluing the raw organ directly to the chest wall. “Believe me,” he said with the first smile I’d seen from him, “It’ll create a LOT of scar tissue. The pleural lining is rife with nerves and blood vessels, which will be torn and exposed. This surgery has a one percent chance of recurrence, but recovery’s also ten times more painful than pleurodesis.”

When your surgeon tells you that your options are a surgery that’s previously failed or a surgery that’s ten times more painful, again you have questions. Big questions. Like, what have you done to deserve this? Why does this keep happening? Will it ever end? you find surgical video footage on YouTube. You can only stomach the first thirty seconds. You wonder if you can handle something ten times more painful than a surgery whose pain already tested your will.
       This time, when you come out of anesthesia, you’re being whisked out of the operating room. Your near-naked body shivers uncontrollably, your heels chattering up and down on the cot they’re wheeling you on. “I’m cold,” you say to the nurse. “So cold.” When you wake again, you’re in a bed, enveloped in the fuzziest blankets, which feel like they’ve just come out of an oven. Your body still jolts about. Shivers so deep they feel like a seizure. You lift the blankets to see a chest tube inserted next to your old scar. Then your fiancée is there. You don’t remember what Ashley says, but you know she’s there. Then your mom and aunt and younger brother. Your future parents-in-law. Then a cheeseburger. Apparently you ordered it just after awaking. It’s delicious.
      As you eat, you talk to your brother. He makes fun of the catheter that you now realize has been leaking into a hanging bedside bag. “The surgery took longer than they’d thought,” he says. You smile and whisper, “I’m peeing while eating lunch.” You find this endlessly funny. Later, you find out it wasn’t a whisper and that your mother and future mother-in-law heard. This is not the sort of joke they appreciate. Thankfully, you can blame the anesthesia.

My recovery amazed the doctors. I checked out of the hospital after two days when they thought I’d be there a week. I didn’t even need Vicodin a day after surgery. My second day at home I didn’t even need over-the-counter pain meds. It was mystifying. Wasn’t this supposed to be ten times worse? Not ten times easier? It was as if my body realized I had already put in my dues, that this time it could respond with resilience.

When your lung recovers quickly from the most intense lung repair possible, the surgeon meets with you after a week to check in. When you marvel at the absence of pain, he smiles, crosses his hands atop his round belly, and shrugs. “Sometimes, the body responds in inexplicable fashion.” He says that you can resume whatever activities you want. “Just no scuba diving. Your lung will collapse immediately from the pressure. You’d die. Also, no smoking. Ever. One cigarette will collapse it. Lungs are the most fragile organ.” You’ve never had interest in scuba diving or smoking, so you’re fine with this. What you’re not fine with is your complete loss of lung capacity. Even walking a staircase sucks away your breath. Pre-pneumothoraces you played sports, but now you struggle to sprint one hundred feet. You can’t sleep on your back. Or your sides. Now you have to sleep on your stomach with one arm folded beneath your chest. Not a comfortable position but you get used to it. Uncomfortable sleep is better than no sleep at all.

Three weeks before my wedding, a cloud of dust tickled my nose while I moved furniture into our new apartment in Muncie. I stifled the sneeze by closing my mouth and letting the pressure explode within my sinuses because my hands were carrying a box. Post-sneeze, I felt the familiar lung crackle. This time, the escaping air did not hurt, and I had no loss of breath. However, when I lay down or sat up, I felt air moving within my chest cavity. “I’m going to marry you even if I get wheeled in on a hospital bed,” I told Ashley with a laugh—an attempt to lighten the situation. She didn’t find it funny. And I didn’t either when it came down to it. This situation: a constant unspoken fear come true. Three hours later I was back at the Indianapolis ER. After the doctor x-rayed my chest, he proclaimed that I was fine. “No collapse.” I was shocked. I knew what I felt. But maybe I was paranoid.
       The next morning my lung specialist called and said he’d seen the x-rays and agreed with the ER doctor but that he’d like to check things out in person, just to be sure. Two days later, he took my oxygen levels. “One hundred percent,” he said. Then he showed me the x-ray. “See,” he said. “You can see the lung is completely glued to the ribcage. No collapse.” He pulled up an x-ray from my previous hospital visit, the lung shriveled away from the ribs, indented as if someone had used an ice cream scoop to shear away the top corner—a vast distinction.
       “When you compare the two, you can see that—. Hold on a second.” He pulled out his glasses as he set the x-rays against a light monitor. He looked closely at them side by side. “I am so sorry. It actually is collapsed.” Collapse number eight. “I didn’t see it before. Escaped air usually flows to the top of the lung, but look here.” He pointed to a dark strip lining the underside of the organ. “Your lung is bonded to the ribcage, which is exactly what we wanted—the pluerectomy worked. But it appears there is nowhere for escaped air to go except under the lung. I’ve never seen anything like this. Very strange.” He went on to explain that because the surgery had worked, it would allow my lung to heal itself without fully collapsing. “This will probably be a pattern—minor lung collapses here and there for the rest of your life, with your body slowly absorbing escaped air. This surgery should take the weight off the lung and keep it from ever fully collapsing again.”

W hen a specialist tells you that your lung will collapse sporadically throughout life, it’s not what you want to hear. A perpetually collapsing lung changes the way you live. You don’t often twist your waist. You don’t exercise all that much. You try not to cough. You’re wary of how much weight is in your backpack. You make sure not to stifle any sneezes. But despite these adaptations, fear is not what characterizes your existence. Really, you aren’t afraid at all. Your lung has dragged you through hell, but it’s a hell you know you can handle should it recur. Instead, you’re thankful; thankful for medical advances that 99% of humankind couldn’t have accessed, for surgeries that have kept you alive and able to live your life relatively unencumbered, allowing you to marry your best friend and continue teaching college. You’re thankful for the feeling of your lungs stretching, filling, and holding with each intake of breath and then for the feeling of a clean exhale; you know what it’s like to be unable to do so.
       It’s been almost six years since the eighth collapse, and you haven’t had any other issues with your left lung. But it’s something you think about every day. You’re cognizant of air moving within your body. Gurgles and crackles that you otherwise wouldn’t notice. The slightest pain or stiffness within your chest causes you to straighten your back, shift your weight, and wonder if it happened again. But it hasn’t. Or at least you haven’t noticed that it has.