Thank You Dr Riley

The lung clinic at the City Hospital is always jammed with people, many are coughing and spluttering. It is beside the front entrance of the hospital, where you usually see patients in dressing gowns smoking fags with portable drips in their arms. Yesterday I went there for a review of my lung functioning with Dr Riley, my consultant.  At our previous review, a year earlier, no breathing tests had been done because I was still experiencing significant pain in my ribs after the major operation to repair my left diaphragm in September 2017. Indeed, this pain from damaged nerves had only recently eased. I was also hoping that the large mesh patch in my diaphragm was now secure enough for me to safely try the strenuous breathing tests.

I was taken to another room by a nurse who sat me next to a machine with a bellows and a large display screen. Coming out from the machine was an arm which held various tubes and ended in a mouthpiece. I would be doing two tests. In the first my lung capacity and flow would be tested. In the second my ability to transfer oxygen and carbon dioxide through my lungs into and out of my blood would be tested.

I sat forward in the chair, took hold of the mouthpiece and breathed normally. The rise and fall of my lungs made a wave pattern on the display screen. At her command, I took in a sharp, deep breath and immediately pushed it out as fast as I could and carried on exhaling hard. Keep going, she shouted, gazing at the display screen. I kept exhaling. Keep going, she shouted. I kept exhaling, even though I couldn’t feel any air coming out. Keep going, she shouted. I began to get a little lightheaded. That’s it, she shouted, and I let go of the mouthpiece and began to breathe normally.

Now we need to do it again, she said. I smiled, very pleased that I’d managed to do the test and that my ribs hadn’t felt sore. We’ll select the best of three attempts, she said. But take your time, we’ll only go again when you feel ready.  I took a minute and then repeated the test. Both my next attempts felt much the same as the first. Then we turned to the second test, which was done on the same machine but involved a different setup.

This time I took in a deep breath and held it for 8 seconds before breathing steadily out. On the inhale, the machine gave me a small dose of test gas (a mix of carbon monoxide and helium) which would mark the transfer of oxygen and carbon dioxide in the capillaries of my lungs. Despite the apparent complexity, this test was a good bit easier to do than the first. The only real challenge was to take in a large enough breath, it had to be at least 90% of your lung capacity for the test to be done accurately. It was again the best of three attempts.

I was given a printed report with two sets of figures on it and went back into the clinic. Dr Riley was very pleased. We don’t often see results like this, he said. My overall lung capacity had increased by 50%, measured against the tests I had done before the operation. I had some minor airway narrowing, due to having been a regular smoker from 14 to my mid-30’s, but this would not require any medication. My lung functioning was at 123%, measured against the average for my age, weight and height, while my oxygen and carbon dioxide transfer was entirely normal. I would now be discharged from the clinic.

I was, of course, delighted. Then I confessed to him that last year I had stopped using the inhalers I’d been given because I didn’t feel they were doing me any good. Dr Riley smiled knowingly. I thanked him for all his help and advice over the past six years. This was no lip service, I genuinely had a great deal to thank him for. It was he who had advised me to take the surgical option as a last resort, because it could only be known if a repair of my diaphragm was possible after I was opened up. Furthermore, it was his prompt action of sending me for a urgent scan after I complained of a pain in my abdomen whilst he was examining me in 2015 that resulted in a large, malignant tumour being found which required emergency surgery.

Thank you again, Dr Riley. Despite the pressures of the NHS, you are doing a fantastic job.