The nurse started an IV and explained each step of the procedure. She talked fast, but it still took 15 minutes to cover everything. I did some research about it last night so I had a general idea of what to expect. But my heart started beating a little faster as some things came to light that I wasn't expecting. Such as the fact that I would only have a mild sedative and would be aware of nearly everything, realizing that the size of the bronchoscope tube was about the size of my pinky, and that they would be going through my nose instead of my mouth. She also mentioned that family members tended not to do well when observing the procedure, since the patient often looks like he's gasping for air and coughing and experiencing extreme physical discomfort. Well, that doesn't sound so good. I asked how long the procedure took. I was hoping maybe a couple of minutes, 5 at the max. When she said 20 minutes I realized that this might not be a walk in the park.
Next, a bunch of people filed in including the doctor, a resident, the technician, and another nurse, for a total of 5 staff. The doctor and resident were pretty serious, probably because they had to drive over from UW and were annoyed about the snow conditions. :) They weren't too keen on joking around.. With Dr. Goldberg, we sing songs like "I wanna be sedated" and generally have a pretty good time, even during a bone marrow biopsy. Or maybe I'm just that easily entertained. So including my family we had 9 people in the room. Everywhere I looked, doctors and nurses and technicians were standing at their little stations, ready to go, each tending to their carefully organized medical tools. It was a little intimidating.
First, I gargled a foul-tasting liquid for 3 minutes, essentially liquid lidocaine, to numb up my vocal cords. Since the bronchoscope would be fed through my nose, the doctor inserted a long Q-tip covered with more lidocaine to numb up my nasal passages. Now, I've never had anyone clean out my sinuses, so I've never experienced the sort of painful but tickling sensation of having a q-tip pushed 5" up your nose. My pinky finger only fits half an inch up there. I thought I was doing pretty good staying relaxed, but with the coffee, the number of people in the room, this Q-tip sticking out of my head, and the fact that I was going to be awake for most of it must have triggered some adrenaline response since my heart began to beat really hard. A bunch of alarms started going off and the doctors all stopped what they were doing and watched the heartbeat machine behind me that I couldn't see. Great. The next thing I knew, an EKG machine was rolled into the room by another nurse, and the doctor was on the phone ordering additional blood work for me (I had already been poked that morning). So we drew some blood, got an EKG reading, and by the time all that was done I had returned to normal on my own. Whew! The doctors suspected that it was a result of the change in medications I'd had recently. I think it was just nerves. So after that I focused on getting into a good mental state.
We started over with the long Q-tip. He then inserted the bronchoscope into my nostril and pushed it as far back as the Q-tip, and then removed the Q-tip. Every few inches, another technician would squirt lidocaine from the tip of the bronchoscope to numb the area. When he got to my vocal cords, he had me say "eeeeeee" and then squirted lidocaine on them, which felt really weird and instantly shut me up. From then on I could only give a thumbs up or thumbs down. Obviously you have an urge to cough since you have this massive foreign object in your lungs. But they are able to suppress the urge by administering fentanyl, apparently 80 times more potent than morphine, and the doctor and IV nurse worked in conjunction to balance it all out. After that it was pretty smooth sailing. To determine the infection, they then squirt saline into the lungs and the vacuum the fluid back out. It's called BAL, or bronchial alveolar lavage, and they did this 3 times. This beats the alternative of doing a biopsy, where they would actually cut a small chunk out of the lungs which has the risks of bleeding. Johanna took a video of the view from the bronchoscope camera, and you can clearly see the trachea and forks in the bronchial tubes along the way, and the times when they squirt the lidocaine. It's really amazing. Oh, and at the end I even smile and give a thumbs up :)
Video of the bronchoscope monitor
I think I'm more scared than I realize when I need to have a procedure that I've never done before. But the bronchoscopy turned out to be not so bad. I only really coughed a few times, and once the sedative kicked in it went by pretty quickly.
Oh, since my procedure wasn't until 11:45 am, I tried to take the bus downtown with Johanna so that I could spend some time walking around Cap Hill and hanging out at coffee shops, but after waiting an hour we gave up and called my dad, who chauffeured us down there in his nice A6 Quattro (all-wheel drive rules) with heated seats. Ahhh. After dropping Johanna off at work, I hung out at a Starbucks for a bit to warm up, then hiked over to Denny, closed because of the snow, and walked up to Cap Hill. The weather was clear and there were hardly any cars. It felt great. I love the way snow completely changes a city. I walked down Roy and over I-5 which drops you right into the SCCA campus.
Here are some of the pictures: