On November 3, 2021, it was a Wednesday, and I went for my annual unit checkup. In my mind at the age of 38, the annual physical examination is just a formality.
At 12:00 noon, I finished the final chest CT, and planned to go home at noon to make lunch for the child, go to the unit early in the afternoon to sort out the work, in the evening the child has an art class without rushing to pick up, go to buy some eggs after work... The phone rang at 5 p.m., and the physical examination hospital informed me that the CT results did not look very good, and it was best to go and get it immediately.
My ordinary and ordinary life
The pause button was pressed violently
In the office, the doctor's computer showed a CT image of my chest, and she quickly sat me down and said, "You don't have to be afraid first, your lungs have a nodule, I took your film from the past three years to compare, it was not before." ”
She explained to me as she enlarged the film: "You see this nodule, there are burrs and pulls on the edges, and the shape is not very good... Hurry up and check it out, but don't be too afraid..."
I took the film with a confused look on my face, said thank you, and wondered why I was afraid while dashing downstairs. I planned to go to a hospital closer to home and do a simple review without delaying my work.
The next day I got up early and asked my daughter's classmate's mother to help take care of the child at noon and prepare for a 1 p.m. errand. My husband, who has been working overtime for a month, apologetically said that he could not take a leave of absence to accompany me to the hospital, and I said that I was so strong, this problem would not drag someone to accompany me.
I hung up the respiratory medicine specialist number of the largest hospital in the province and rushed to the hospital early in the morning. Even during the epidemic period, the hospital is still crowded, I took the number and sat in the waiting hall, bored to open the WeChat of the little partner Swallow, want to chat a few words to pass the time.
"I found a nodule in my lungs during my physical examination yesterday and said it didn't look good, so I came to XX Hospital for further examination."
"Who? You? Whose number is hanging? ”
"Me, do you still have a study of the lungs?" Do you know experts? ”
"Didn't I tell you about my friend's lung cancer?" I know! ”
"Lungs... Cancer? Does this have anything to do with lung cancer? ”
I also wanted to ask, swallow called directly. After her 5 minutes of "output", I started to feel a little flustered. From the phone, I learned that one is that there is a possibility of lung cancer in the lung nodules; the other is that it is best to let the thoracic surgeons take a look directly and be more sure; the third is that one of the best experts in the province is in this hospital, only sitting on Thursday morning, and today is just right.
I immediately changed my number and walked briskly toward the thoracic surgery department. Soon it was my turn, and I took out the film and briefly described the medical examination. The expert took the film and looked at it very seriously, while watching it, he said to the young doctors next to him: "Although this nodule has burrs on the surface, it is not regular, and although the edges are pulled, they are not solid inside, or it may be caused by inflammation." ”
He gave me two choices: one is direct surgery, do pathological biopsy during surgery, benign is fine, malignancy will expand the scope of resection; second, puncture to do biopsy, benign to do anti-inflammatory treatment, malignant direct surgery.
I say everything to listen to the doctor's arrangement! He thought for half a second and said, "Let's pierce first!" ”
After I came out of the hospital, I began to hesitate inside - there are no symptoms of discomfort now, and there is still work in the afternoon... I called Swallow to tell me about her hesitation, and after Swallow described to me in detail the process of her friend's discovery of lung cancer, I learned that early lung cancer is usually symptomless, and if there are some symptoms to find lung cancer, it is generally in the middle and advanced stages.
I was a little panicked, called the leader to report, and then rushed to the inpatient department alone for hospitalization. Before that, the word "puncture" was like giving me a shot, but that's when I learned that puncture was actually a minor surgery.
Because there were no beds in Thoracic Surgery, I was placed waiting in a temporary bed in urology downstairs. During the epidemic, hospitals strictly prohibit patients from going out. I stood in the hallway, called my husband to ask what time to pick up the child, what online classes the children had at night, what small tasks the children needed to complete before going to bed...
Soon I was called over by the nurse: "Let the patients come by themselves!" ”
Me: "Patient? I am the patient! ”
Nurse: "What about your escort?" ”
Me: "No. ”
The nurse handed me a series of checklists and told me to save some money and not to leave the hospital. I stood in the hallway talking to Swallow on the phone, talking about the boring and oppressive environment of the hospital, watching several patients around me pacing hard...
My originally busy life was suspended.
I desperately took oxygen, but I couldn't breathe
The day after I was hospitalized, I started various tests, and because of my own small mistake, the most important lung enhancement CT could not be completed on Friday day. At 9 p.m., the tube bed doctor contacted me, and if the CT was not done well, the puncture could not be completed on Saturday morning and would not be completed until the next Monday. I told him I could finish it the next morning, so he helped me get the puncture until 10 a.m. on Saturday. At this point, I was even planning to go to work on Monday, so I definitely couldn't wait.
Early Saturday morning, I finished my augmentation CT and went to the piercing room, where the doctor asked me where the wheelchair was.
"Wheelchair? My family didn't come, can I? ”
"There must be family members!"
I hurriedly called my husband, who was on leave with the children at home, and told him to hurry up. He hurriedly placed the child at his grandmother's house and cried. It turns out that we have all "entered the state".
Because the tube bed doctor is resting on the weekend, he has not yet seen my freshly baked enhanced CT results. There was a tense atmosphere outside the piercing room, and I suddenly felt a pang of fear and called him to ask: "Or should I wait for Monday to pierce again?" Wait until you watch the film and then do it? What if the physical examination is misdiagnosed? What if I don't have to do it? ”
The doctor thought for a moment and said, "You go to Dr. X in the CT room, he is very good at watching the film, let him help you watch it first." If he also said he was going to do it, I suggest you do it first, because the result of the puncture will take about four days. ”
I stared carefully at Dr. X's face as he watched the film, afraid of missing a tiny expression. After watching the film, he frowned slightly, and then nodded his head firmly: "Must be done!" ”
The entire puncture is done on CT equipment. When I was told I couldn't move when I lay down, I immediately instigated it. Usually" wind and fire, the sky is not afraid", I am actually a little trembling.
I was covered with a layer of cloth, and after the anesthesia, I felt a cold thing pierce the back and go deep into my chest, which was not too painful, but I still involuntarily "snorted". One doctor was directing another, advanced XX, re-entered XX, I couldn't understand it at all. Then I heard a sound like a toy gun pulling the trigger "snap, snap, snap" in my left back. The more I didn't understand, the more afraid I became, and I did my best not to shake and try to control my body from moving.
Finally I heard the doctor say it was over and told me to turn over and lie flat. But just as I was about to roll over, a stream of liquid came up in my throat, and I "wow" spit out a mouthful of blood, and suddenly felt that my chest was tight and I couldn't breathe. Several doctors gathered around me and told me not to move, put an oxygen tube on my nose, and kept asking me how I felt. At this time, a nurse came and gave me 3 injections directly on my ass and quickly inserted indwelling needles.
I gasped and asked, "What's wrong?" An older doctor smiled and said to me, "It's okay, relax, I told your tube bed doctor about your situation, he will deal with it, a bit of a chest reaction, should not need to be catheterized." Then my husband was called into the piercing room and helped me get up and sit in a wheelchair. At this time, I already felt shortness of breath, but I was full of thoughts about whether I could be discharged tomorrow, and I had no patience to wait for the result of 4 days in the hospital environment.
I had trouble breathing and asked, "Doctor, can I be discharged from the hospital tomorrow morning?" ”
"Discharged? This one...... You don't have to think about it! Ct's doctor said very firmly. Is the problem serious? I was a little uneasy.
The atmosphere in the urology inpatient department was quiet and peaceful, and when I returned to the ward, I was pushed into the intensive care unit, but I still felt tightness and shortness of breath. I sent a message to the bed tube doctor to tell him about my situation and got a "first observe" reply. At this time, I already had the appearance of a "patient", and I no longer wanted to be discharged from the hospital, and I could not watch the books I usually loved to read and the dramas I loved to chase. After a while I received a call from the tube bed doctor informing me to go to the doctor's office at three o'clock in the afternoon for a preoperative conversation.
Preoperative conversation? My whole being was instantly bad... Didn't the doctor say he was resting today? Doesn't it mean that surgery is not necessary if the results are good?
Struggling to wait until after 2 p.m., my husband pushed me in a wheelchair to the doctor's office of the thoracic surgeon upstairs, and three other people were waiting. When I knew that the doctor who had been resting on the weekend had not come specifically for me, I relaxed a little.
I was scheduled in the second conversation. The tube bed doctor called up the results of my lung enhancement CT, told me about the lung nodules, said that the results did not look very good, and gave "left lung lower lobe nodules, malignant possible?" "Diagnostic opinion.
Enhanced CT results 丨 Courtesy of the author
Before I could feel the emotions, I quickly asked the doctor, how likely is lung cancer? If it is malignant, how likely is it to be early? What are the risks of subsequent surgery? The impact on life after surgery, recurrence rate, survival time...
The doctor replied that he could answer, and the others only said that I would be at ease and wait for the result. Finally he said: "There is still a benign possibility, after all, you are not very old..."
Back at the hospital bed, there were snowflakes floating outside the window. The first snow of 2021 came so early. I imagined a family of three jumping in the snow, but now it's all not about me anymore.
I tried to adjust my mindset, but I couldn't be optimistic, and an emotion that I had never felt before lingered in my heart, and my chest was getting more and more stuffy. At 8 o'clock in the evening, even if I desperately inhaled oxygen, I still felt out of breath. I gradually became short of breath, and even felt that I could not breathe, and my husband quickly called for doctors and nurses.
I had pneumothorax, which is one of the complications of punctures.
The tube bed doctor came down from the upper floor and said that just when something else came to work overtime, he would personally send me to the chest tube. In the urology ward, there is only one mouth to inhale oxygen, and because I have difficulty breathing, I must also bring oxygen on the way to the catheter, so the nurse needs to fill an oxygen bag from the place where I originally sucked oxygen, and I also need to temporarily "give up" the oxygen mouth. As soon as I left the oxygen tube, I began to have difficulty breathing, and while opening my mouth and inhaling heavily, I called the doctor next to me: "Quick, I don't feel like I can't do it... Can't breathe..."
When I arrived at the morning piercing room with the nurse's panicked and unfilled oxygen bag, several doctors were already waiting for me inside.
The doctor who did the piercing for me during the day happened to be on duty today, and he quickly covered my upper body with a cloth, and I felt that the placement process was completed in 10 minutes, but then my husband said that he waited outside for 30 minutes. When I got up, I had an extra tube coming out of my chest and a carrying box.
The tube that comes out of the chest cavity 丨 Author courtesy of the author
On the way back to the ward, I told the bed tube doctor that I was lucky today, and he happened to be there.
Days of waiting for pathological results
The patients around me changed two waves
On Sunday, I was told I could transfer to a thoracic surgery bed. Thoracic surgery is separated from urology by a floor, but the atmosphere is completely different, and it is "lively" at six o'clock in the morning. The doctor's office is full of doctors, family members, nurses busy shuttling through the rooms, and there are many patients in the corridor who are constantly pacing with intubation boxes. The floor mat in the corridor is being put away, which is where the patient's companion sleeps at night and must be cleaned up at 6 o'clock in the morning.
Most of the patients in Thoracic Surgery have the same disease, and I quickly chatted with them. When they first met me, they all looked at me curiously and said I was young. Soon I knew that most of the people around me didn't have any symptoms, and they had a physical examination of lung nodules, and I came to the hospital just to make sure I was okay, but the doctor recommended that I be hospitalized immediately when I saw the film, and I was only recommended to puncture.
I had a little hope in my heart, but I didn't dare to light up too much. I am not a particularly optimistic person, but I am not pessimistic, until this time I have not shed a tear, nor have I gone to the Internet to check a little information about "lung nodules, lung cancer". I don't want to scare myself, but I also tell myself to prepare for the worst.
I sat in the doctor's office, behind the crowded patients' families, listening to the doctor talking to the family before the operation, the post-operative conversation... I learned that early lung cancer cure rates are high, as is the 5-year survival rate. I keep pumping myself up, trying to wait as calmly as possible for the results and adjust my mindset.
Because the puncture results will not wait until next Wednesday, other people in the ward will start the operation one after another, and after the operation, they may be transferred to other wards, and I will have new patients in my ward. I just went back and forth and watched them change two waves.
In the waiting, I will suddenly wake up in the middle of the night and can no longer sleep; I will wait anxiously after acquaintances enter the operating room, until 10 o'clock in the evening she returns to the ward to sleep; seeing that there are not enough family members who come back after the operation, I will urge my husband to hurry to help "lift people" and let him learn postoperative nursing knowledge in advance; when I see the big sister crying in the neighboring bed who is going to the operation, I will also be emotionally tied to cry with her, which is the only time I shed tears... But after wiping away my tears, I readjusted my mindset and felt that I had to face it positively no matter what, and this time it was also my opportunity to set an example for my 7-year-old daughter. At this time, I think that the most valuable qualities of human beings should also include being able to face various setbacks in life positively and optimistically.
During the days of waiting for the results, my husband, who has always been fragile and timid, accompanied me the whole time, and every time he came back from outside, his eyes were red and he was smiling. I knew that the doctor's words that day were indeed a big blow to him. I told him that even the worst outcome would not be hidden from me, and that they would face the rest of the matter together.
Once, when walking downstairs, my husband asked, "If it is vicious, do you think that heaven is unfair and why are we so unlucky?" ”
I replied to him, "I never thought there was anything unfair, and I didn't think I was unlucky." You see, in the middle of the night on the day of the pneumothorax, my attending doctor and the doctor who did the puncture during the day happened to be there, helping me deal with it together, am I not lucky? There is nothing unfair, maybe God thinks that I usually don't care enough about myself and give me a test? There are too many painful things in life, and they always have to face! At least we don't have to worry about the money for medical treatment for the time being, and we don't have to run to see a doctor like patients in other places. If this is benign, I would like to thank this experience for giving me the opportunity to feel life and let me know what is most important. ”
The night sky was taken while walking downstairs, and the air was particularly good at night in November. 丨 Courtesy of the author
In such daily small talk, the days pass by day, and "next Wednesday" is just after one night. I suddenly thought, what kind of mentality should I look at the results? Do you have the courage to look? I remember seeing a sentence in an article before: "Do the examination to let the time pass quickly, you don't have time to be afraid, and the result is more painful than the illness itself." At this point, I suddenly understood.
It's dangerous! Lung cancer passed me by
On Wednesday morning, after the doctor had finished his room, my legs involuntarily ran to the doctor's office, through the crowd, to his side. He looked up at me, opened the medical record in the computer and looked at it and said, "Your results have come out, and no cancer cells have been found at present, this news is good, let's continue to wait." ”
I wasn't quite sure what he meant by keeping waiting, but it felt like "good". I happily ran to the ward and told my sad husband the good news, and his expression did not change much, but became more serious. I asked again and again, and he hesitated to say that he had asked in the pathology department, and the answer was that a result had been passed on to the doctor, and further tests would be done in the future, and he would have to wait another day. To test further, he wondered if there was a worse outcome.
"If there are no cancer cells, you must continue to check the cause of the disease!" I blurted out.
While sending a message to the tube bed doctor who went to the operating room, I was anxious to run to the doctor's office every hour and ask other doctors to help me see the results.
By the afternoon, my doctor finally replied to me – benign!
Not cancer! Not cancer! Not cancer!
I don't know how to describe the mood at that time, it was a bit "Venus in the eyes". In a trance, I heard my husband call my parents, brothers and sisters-in-law to report that he was safe, and his face was in a relaxed state that he had never seen before.
The next day, after checking the room, the doctor smiled and asked me: "What are you going to do?" Continue to transfer treatment? Or do you leave the hospital and go home? ”
"Listen to you!"
"Transfer to The Respiratory Department!"
Accidental Cryptococcus pneumococcal infection
Soon, I was sent to the respiratory ward in another building, and it was a different atmosphere. After a while, I met with the respiratory tube bed doctor and got the final result - cryptococcus infection.
Pathological diagnosis report 丨 Author courtesy of the figure
The doctor carefully communicated with me about the condition, and I checked all kinds of information about Cryptococcus.
The doctor said that cryptococcus infection is rare in the north, mostly in the south, and asked me whether there were birds at home or in neighbors' homes, such as pigeons and parrots. After I denied it, I mentioned the pigeons in the square near my house, the parrotS I had seen in the zoo, the little hamster in the house that I never paid attention to; and my personal love of gardening, often turning over the flowers and plants in the house... The doctor said that the possibility of transmission through these channels is not ruled out.
The doctor asked me to be hospitalized for 3 days and gave me a follow-up treatment plan: go home and take medicine for 6 to 12 months, and regularly review and follow up to observe the lung conditions. At this time, I feel how lucky I am to be able to stop and feel life before the arrival of the "not confused" year.
The treatment is not good, readjust the mentality
After being discharged from the hospital, I took the fungal infection treatment drug "fluconazole" every day according to the doctor's instructions, and regularly went to the liver and kidney function review. Fortunately, there were no abnormalities in each inspection. I reviewed my chest CT a month after I was discharged from the hospital, and it was suggested that the nodule had shrunk by 2 mm from before, and everything looked very good. I confidently continued my medication, although I was already feeling sick with my stomach.
Fast forward to the end of March 2022, more than 4 months after being diagnosed with Cryptococcus pneumococcal infection, and the chest CT was reviewed again, but the results showed no significant change from the last time.
Review of chest CT results 丨 Author courtesy of the author
Because of the time, I hung up the results of other doctors in the same hospital, and the doctor shook his head and said, "It should be resistant!" After taking the medicine for more than 4 months, what are you going to do next? Hospitalization or continued oral observation for a month? It takes about ten days to stay in the hospital each time, and it may take several more stays. ”
Hospitalization takes time, I don't, and I really don't have much patience to re-hospitalize. I carefully asked the doctor what might cause the drug resistance, and the answer was related to my own immunity. I think that after I was discharged from the hospital for more than a month, I did start a life of self-release again– I started staying up late, not drinking water, not exercising, and so on.
Tangled up again, I chose to continue to take medicine and observation, and began to adjust my work and rest, increase the amount of exercise, and look forward to continuing treatment with improving autoimmunity plus taking drugs. In any case, the light is always ahead.
Doctor reviews
Chen Zihao | Attending physician of Department of Thoracic Surgery, Shanghai Changzheng Hospital
The author's cryptococcosis is a class of fungal infectious diseases that may be unfamiliar to everyone. Cryptococcus is widely distributed in soil, humus and poultry manure (especially pigeon dung), and people are infected mainly by inhaling aerosols containing fungal spores in such environments.
Most patients with Cryptococcus pulmonary coccus have cough, chest pain, and fever, which are not specific, but some patients, like the authors of this article, are only found during physical examination. In terms of CT manifestations, cryptococcosis also has no obvious specificity, so it is difficult to diagnose by imaging data.
The first-line drug for the treatment of cryptococcosis is fluconazole, and it is worth noting that the authors have a poor treatment effect after taking the drug 4 months later, and it is necessary to consider fluconazole resistance. This is also an important reason for the failure of treatment of this disease. Surgery has certain therapeutic significance for cryptococcosis of the lungs, but surgical treatment is also risky, so it is recommended to carry out standardized treatment under the guidance of a professional doctor to obtain the best treatment effect.
Reviewing the patient's medical journey can also help us understand the diagnosis and treatment process of lung nodules, a common disease in thoracic surgery. Among them, the most important link is to determine the benign and malignant nature of the lung nodules. One thing we need to realize is that most lung nodules are benign lesions, and the most common case is lung inflammation, such as the author's final diagnosis of "Cryptococcus infection", in addition to which it may also be benign lesions such as tuberculosis and granulomas. However, to determine whether it is benign or malignant, clinicians need to find sufficient evidence in the process of diagnosis and treatment.
First of all, it is necessary to find evidence through medical history, such as gender, age, work environment, whether to smoke, etc., and to know whether the patient has a history of other diseases or tumors, and whether there is a family history of tumors (especially lung tumors). If a patient's father dies of lung cancer and he himself has been smoking heavily for a long time, it is more likely that the doctor will consider the patient's lung nodules to be malignant. Based on this history information, combined with the disease characteristics of lung tumors, clinicians can assess the risk of developing lung malignancies.
Secondly, according to the performance of imaging, the most conventional is the imaging characteristics of the lung nodules in chest CT, such as the size and number of nodules, whether the edges are smooth, whether there are burrs, etc., and at the same time, combined with the doctor's reading experience, to judge the tendency of benign and malignant. In layman's terms, it is to see whether this person is a good person or a bad person according to his appearance, but since he says that he is a "face", it is certainly not absolutely correct, and there is both the possibility of wronging the "good person" and the chance of letting go of the "bad person".
Third, it is based on the patient's follow-up changes to find evidence, for example, a patient with a lung nodule, in the process of follow-up chest CT found that the nodule is significantly enlarged, and there are imaging features on the CT that suggest malignancy, then according to the change of this lung nodule, it is more likely to consider malignancy.
Finally, the pathological evidence is the "gold standard" for the diagnosis of lung nodules, which is "much more reliable" than the three types of evidence described above, and can play a decisive role. In this paper, the author completed a puncture biopsy, and the final pathological prompt was cryptococcus infection, which is evidence of pathology.
In general, if the physical examination finds a lung nodule, although it needs to be paid attention to, there is really no need to be afraid, and it is the right way to strengthen the understanding and cognition of the disease, treat it rationally, and seek medical treatment in time.
Sharing personal experience does not constitute a diagnosis and treatment recommendation, can not replace the doctor's individual judgment of a specific patient, if you need to go to a regular hospital.
Author: Lemon wheat grass
Editors: Yuan Qiyang, Li Xiaoqiu
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Why do children read so much, but they still can't learn Chinese?
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