[Medical Human Story: Episode 61]-At the Brink of Breath, Unseen Pressure_3

 


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A medical human story centered on supine tension pneumothorax, detailing the emergency management, diagnostic process (CT, PET-CT, biopsy), surgical treatment (VATS, lobectomy), and recovery of a patient with COPD and lung cancer, combining emotional storytelling with in-depth medical insight. 

Part II: The Direction of Pressure

Pressure Always Moves Toward the Weakest Point


I stood once again in front of the CT screen.

The noise of the emergency room still surrounded me,
but my gaze was fixed on a single point.

The right lung, upper lobe.

A small, irregular nodule.

It was not just a shadow.

It was a structure with meaning.

“The chance of this being incidental is low.”


I called the resident over.

“Do you see this?”

He leaned closer.

“Yes… it looks like a nodule.”

I spoke slowly.

“The problem is the shape.”

A Lesion with Blurred Margins Does Not Lie

Benign nodules usually have well-defined borders.

But this was different.

The edges were irregular

It subtly blended into the surrounding tissue

Fine spiculation was present

I murmured to myself.

“This… is highly suspicious for malignancy.”

Another Reason He Couldn’t Breathe


Kim Doyoon’s dyspnea might not have been caused by pneumothorax alone.

If that nodule was malignant—

his lungs were already fighting on two fronts:

Structural destruction (COPD + bullae)

Cellular rebellion (cancer)

“Thoracic surgery has responded.”


The surgical resident arrived.

“I’ve reviewed the patient. Given the persistent air leak, we should consider surgery.”

I nodded.

“I agree. But…”

I pointed at the CT scan.

“We need to address this as well.”

Surgery is both a treatment and a diagnosis


The thoracic surgeon studied the screen for a long moment.

Then he said briefly,

“We can handle both at once.”

That meant—

Bullectomy (removal of bullae)

Simultaneous tissue biopsy

“But can the patient tolerate it?”


That was the real issue.

Kim Doyoon was already:

Hypoxic

With reduced lung function

In an acute condition

General anesthesia and surgery in this state
posed another serious risk.

I Reassessed His Breathing


His SpO₂ had risen to 94%.

But it was still unstable.

From the chest tube, bubbles continued to rise.

The air leak persisted.

“We don’t have time.”


I had to make a decision.

Wait—
or intervene.

Pressure Changes Direction


In tension pneumothorax, pressure fills the thoracic cavity.

But now—

that pressure was acting in another way.

The patient’s life.
Time.
Decisions.

Everything was pressing against each other.

“Let’s proceed with surgery.”


I said it.

Short. Clear.

A Brief Conversation Before Surgery


I approached the patient.

He was still wearing an oxygen mask.

His eyes were clearer now.

“Mr. Kim, can you hear me?”


He nodded weakly.

“There is a problem with your lungs. You need surgery.”

A moment of silence.

Then, with effort, he asked—

“…Do I… have to?”

Doctors Sometimes Have to Deliver Cruel Choices


I looked into his eyes and said,

“If we don’t do it now, it could become more dangerous.”

This was not an exaggeration.

It was the truth.

He Closed His Eyes, Then Opened Them


And said—

“…Please…”

The Road to the Operating Room


The stretcher began to move.

As we passed beneath the fluorescent lights,
his face flickered—bright, then dim, over and over again.

Watching him, I thought:

Every human being walks the same path in the end.

But the speed of that journey—

sometimes, we decide it.

The Operating Room — Another Battlefield


The operating room is always different.

If the emergency room is chaos,
this is controlled tension.

Everything is planned,
and every movement has a reason.

“Induction of anesthesia.”


The anesthesiologist spoke.

The patient’s consciousness slowly faded.

I watched him.

There is always something strange
about the moment consciousness disappears.

VATS — A Technique to See the Invisible


Video-Assisted Thoracic Surgery.

A camera is inserted through a small incision
to directly visualize the thoracic cavity.

I fixed my gaze on the monitor.

And then—

“Confirmed. Bullae rupture.”


The lung on the screen was more damaged than expected.

A massive bulla.

And the rupture site.

Air was leaking out.

<h2>But That Was Not the End of the Problem</h2>

The surgeon said,

“Let’s check the right side as well.”

I held my breath.

The Camera Turned to the Opposite Lung


And in that moment—

I knew.

That Nodule Was Not an ‘Incidental Finding’


A small lesion.

An irregular surface,
with subtle connections to the surrounding tissue.

The surgeon spoke.

“…Proceeding with biopsy.”

Two Battles Were Unfolding at the Same Time


On one side:

Removing the air

Restoring the lung

On the other:

Obtaining tissue

Diagnosing the future

A Thought Crossed My Mind


Medicine is a discipline that saves the present
while simultaneously predicting the future.

The Surgery Was Successfully Completed


Bullae removed

Chest tube maintained

Biopsy in progress

The patient was transferred to the intensive care unit.

But the Story Was Not Over


The real problem had only just begun.

I Stood Outside the Intensive Care Unit


I looked at him through the glass.

His chest was moving with the assistance of a machine.

His Breath Had Returned


But how long
that breath would last—

no one knew yet.

The Results Would Come in a Few Days


The biopsy.

That single word
can completely change a person’s life.

I Asked Myself Again


What are we fighting right now?

Is it a pneumothorax?
COPD?
Or—

cancer?

And I Waited for the Answer


Doctors always want to know.

But at the same time,
we fear the moment of knowing.

To be continued, Part III: Collapsing Boundaries

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