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Mrs. Yancey (not her real name) looked tired and weak as she walked down the hallway to the exam room. She was lead by the medical assistant who purposely slowed her pace and held Mrs. Yancey's arm to steady her. She struggled with each step.
With pursed lips, she forced, "Good morning, Nurse Carrie."
I welcomed her to the pulmonary clinic as I had many times before. This time was different though; it was obvious that her lung disease was definitely getting the better of her that day.
During the past 3 years, Mrs. Yancey had become a familiar face to our Ambulatory Clinic. She had been diagnosed with idiopathic pulmonary fibrosis 7 years earlier, but was unable to receive treatment because she was uninsured. When she finally received financial assistance from the county, she started coming to our pulmonary clinic.
Idiopathic pulmonary fibrosis (IPF) is a condition where there is scarring throughout the lungs. Pulmonary fibrosis can occur as a result of chronic inflammation, infection, or environment factors. In some cases, radiation, autoimmune diseases or certain medications can cause pulmonary scarring as well.
In Mrs. Yancey's case, her previous medical records indicated the possible cause was hypersensitivity pneumonitis. In this condition, scarring is a result of a heightened immune response to dust contaminated with bacteria or fungus. The pulmonary doctor repeated her CT scan and pulmonary lung functions (PFTs) every 3 to 6 months to monitor her lung function.
Unfortunately, the regimen of prednisone and methotrexate was no longer maintaining her lung function. Her shortness of breath worsened with the slightest exertion even on continuous oxygenation. She was out of options. Her lungs would soon fail. She would need a lung transplant to survive.
As the doctor revisited the discussion of needing a lung transplant, her response was no surprise to me. She refused, of course. Mrs. Yancey was strong in her faith and immediately shook her head at the doctor's medical solution. She faintly whispered, "No, that is not possible. I am one of His Witnesses." She affirmed that she would not receive blood or foreign products to her body.
Sadness filled my heart. I had seen this once vibrant strong woman transformed to a weak and fragile woman. Ambulatory nursing provides a unique opportunity to form long-term relationship with patients, and I had been privileged to see this sweet woman interact with other patients and her daughter on many occasions. She always had a smile and an extended hand for a soft greeting handshake.
She was promised to have her Lighthouse pamphlets at her side and never failed to share her faith with at least one other person in her path. She was never overbearing or confrontational - just kind and gentle.
It was evident that Mrs. Yancey brought life wherever she went. Now her life was in jeopardy. I longed to help her. I wanted to convince her to try the treatment the doctor offered. A past conversation sprang to mind. The baby! What about grandbaby that was on the way? Just last visit she shared of her happiness that her daughter was expecting a baby girl. Mrs. Yancey had longed prayed for a grandchild. It was one of her greatest desires. Wasn't that enough to reconsider choosing life rather than religion?
It was difficult not to persuade, but I resisted. I contemplated my own religion and faith. We did not share beliefs, but I could understand her convictions. I offered empathy and respected her decision. The doctor conceded and instructed her to return in a month. As I gave her and her daughter the discharge instructions, I couldn't help but wonder if I would ever see Mrs. Yancey again.
It was 3 weeks later when I received the call of a kind voice acknowledging my nursing assistance and kindness for her mother. The arrangements were made for the funeral and an invitation was given for me to attend. I thanked her for the invitation and offered my condolences.
Although Mrs. Yancey holds a dear part of my heart, I did not attend the funeral. I couldn't bring myself to go. Selfishness is partly a factor. I wanted to remember Mrs. Yancey the way my heart and mind knew her. Already my eyes saw enough fragileness. I wanted to preserve the vibrant image of Mrs. Yancey. I believe that is the way she would prefer it.
Carrie Coronado is an ambulatory care clinical nurse at Tampa (FL) General Hospital.
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