The Story of Mr. P And His Uncontrolled COPD Part 1

“Oh bummer, my last clinic patient has uncontrolled COPD.” This is exactly the words that I thought when I picked up Mr. P’s medical chart. (Yes, this was before electronic medical records during the first year of my Pulmonary/Critical Care fellowship.) It was Christmas Eve at 6:30 pm — already two hours after the clinic ... Read more

The Story of Mr. P And His Uncontrolled COPD Part 1

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“Oh bummer, my last clinic patient has uncontrolled COPD.” This is exactly the words that I thought when I picked up Mr. P’s medical chart.

(Yes, this was before electronic medical records during the first year of my Pulmonary/Critical Care fellowship.)

It was Christmas Eve at 6:30 pm — already two hours after the clinic was due to close for the holiday.

Mr. P had a particularly complicated patient panel:

  • very severe COPD
  • noncompliant with most recommended therapies
  • still smoking
  • rarely wore his oxygen
  • used his rescue (albuterol) inhaler between 42 and 48 puffs per day
  • adamant about not reducing his prednisone dose below 20mg per day

I entered the room and saw a frail man in a wheelchair with his wife sitting next to him.  He smelled of smoke and he was not wearing his oxygen.

Am I Going To Die?

When I introduced myself, Mr. P abruptly said, “Will you just tell me if I’m going to die in the next two months? Because if I’m still going to be alive, we’re getting a divorce!”

Needless to say, I was rather taken by surprise by him.

“I’m not sure any of us will be alive in two months because we could die in a car wreck or any accident any time,” I replied. “But I don’t see anything in your chart that makes me believe you will die within the next two months.”

We then discussed his current issues related to COPD — anxiety, depression, malnutrition, ongoing smoking, excessive use of albuterol, and his poor compliance with supplemental oxygen and other therapies.

According to Mr. P and his wife, his symptoms and clinical status had further deteriorated since his previous pulmonary clinic visit six months ago.

His head and both hands visibly shook as he puffed his albuterol six times in a row. And tears streamed down his face as he described how miserable his life was in the past year.

Since the start of my medical training, I dreaded trying to take care of patients with COPD because they often appeared to be miserable. They had difficulty breathing, a significant cough, and feelings of anxiety, depression, and hopelessness. I found it nearly impossible to help them.

My Mission of Infusing Hope

This time, though, something was different when I listened to Mr. P and his wife. I felt a sense of hope! I had hope that I could really make a difference in this couple’s lives.

So, I decided to spend part of my Christmas Eve spreading this hope to Mr. and Mrs. P.

Then and there, I started my Mission of Infusing Hope.

I then started to share the things that we could do starting that day to improve Mr. P’s quality of life.

Please read next week’s blog to discover what happens next for Mr. P…