Thoracentesis are procedures done frequently for many reasons, in mesothelioma often patients have them at the beginning of their journey, and sometimes at the end of their journey for comfort. They can be done for diagnostic reasons, the fluid is sent for testing, or for therapeutic reasons for the comfort of the patient. The procedure is usually done with local anesthesia only and patients feel better afterwards. A thoracentesis is a relatively quick procedure which can take 50-60 minutes. It is ideal if the patient can sit up The proceduralist then uses an ultrasound machine to find the fluid and inserts the needle under visualization. In the institution that I work in we usually limit the fluid draining to 1000cc’s. The needle is inserted into the pleural space between the lung and the chest wall. The goal is to remove excess fluid – usually there is approximately 30 cc in this space.
Mr. W. had one other thoracentesis in December of 2016. He was having one now because he was feeling short of breath. He was quiet and had a beautiful smile. It was evident without any questions or conversation his disease was taking over. As we explained the procedure we talked about his life and his family. He proudly told us he had 4 children. His eldest recently purchased a restaurant and was a big success. The pride he wore on his face was undeniable. He spoke of his daughter who would graduate from college, and planned to come home and stay with him this summer because he did not know how much time he had left. The silence in the room at this time was deafening. He continued to tell us how proud he was of his other two children and how he loved his wife. He told his story with humor and grace.
At this point, the young resident that was assisting with the procedure, asked him a simple question. How is your family doing with all this? Usually we think of these questions but they are not asked. People don’t like to talk about death and dying it can become the elephant in the room. He was at ease with this question and almost seemed relieved that someone was willing to listen to him. He spoke how he was a different man now than he was 3 months ago. His physical appearance had changed and he was dealing with more physical obstacles. He is not always able to do the tasks that he used to do around the house. He has grown weaker. His appetite is poor and he is unable to maintain his weight, and requires a lot of rest. He was stating these changes as facts. He has high hopes for this procedure to improve his quality of life. Being short of breath and feeling tired he said gets old and is limiting.
For Mr. W. the procedure was a success, he felt better and was going to be headed home. He was anxious to get home with hopes that his quality of life improves.
Sometimes the simplest questions are the hardest to ask but do the most good.