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Welcome back to Nat’s passion blog! This week, I want to talk about an intense story from my time in the hospital. Fair warning, I will describe exactly what happened during this procedure in detail, so read at your own risk! As I mentioned last week, one of my jobs in the lab was to coordinate biopsies for pathology, which would basically handling the specimen from the second it leaves the patient until the pathologist receives it to analyze. We do at least a few biopsies every week, which normally just requires me to hang out in radiology or ultrasound for about 30 minutes, chat with the techs and interventional radiology nurses, make some slides, and show them to the pathologist. However, this story is a little different.

Collectively, our least favorite biopsy to find on the schedule is an Endobronchial Ultrasound, or EBUS. To put this in layman’s terms, for an EBUS, the surgeon will stick a scope down a patient’s windpipe and take small samples of their lymph nodes in their lungs to test for cancers such as lymphoma. This biopsy requires me to go up the operating room (OR), get in full PPE (which includes a full hazmat-style suit, hair net, booties, and an N95 mask doubled with a surgical mask), and obtain the specimen while the patient is under anesthesia. It usually lasts at least an hour, and it’s an uncomfortable position to be in for a long time, so we all dread it when an EBUS is on the schedule.

A few months ago, I saw an EBUS on our schedule. The patient was a 56 year old man with a history of smoking, but no other notable comorbidities. Should be a piece of cake! We normally do these biopsies on older patients, mostly in their 70s, who have COPD, heart disease, diabetes, or other difficult chronic conditions, so we are always relieved to see a younger patient, since their biopsies are much easier (even though it’s terrible to see a young patient with lung cancer, don’t get me wrong). I packed up my cart, stocked full of glass slides for the microscope and a brand new Hematoxylin-Eosin stain line, and headed up to the OR.

The first half of the procedure went as expected. The surgeon collected a few passes, and I sent them down to pathology to be read before the patient leaves the table. As always with this particular surgeon, we did not have enough diagnostic material (lymphocytes) to make a diagnosis, since almost all of his passes consist of blood and epithelial tissue (lymph node lining). However, when he went in for another pass, I noticed something strange about the patient’s vitals.

His O2 saturation started dropping, plummeting from near 100% to in the 60% within seconds. All of a sudden, alarms started blaring, and nurses began scrambling to figure out what had happened. I moved my cart into the back corner of the OR to make room for all of the new people in the room, and just observed the pandemonium that had just erupted. It became clear rather quickly that the surgeon performing the biopsy had pushed the needle in a little too far, puncturing the lung and inducing a massive pneumothorax (excess air outside of the lung in the chest and abdomen). Before long, the patient went into a full code, meaning that his heart stopped beating. I rushed out of the OR to make room for the crash cart, ultimately deciding that the biopsy was probably done given that the patient was coding on the table.

Thankfully, the patient survived, only spending a night in the ICU before being discharged. What a crazy experience to watch! It was nothing like Grey’s Anatomy or Scrubs. Definitely an experience that I will never forget, and hope to never watch again.