AllFreeNovel
Share Us
Joel grimaced. ‘Fifteen to twenty a day. I listened to her chest and she had some basal crepitations and a wheeze so I’ve given her some antibiotics and asked her to make an appointment with you for spirometry.’
‘Would she stop smoking, do you think? We could ask Janice to see her.’
Janice, the other practice nurse, ran the stop-smoking clinic and she and Lucy worked closely together.
‘Well, I’ve suggested it, but I’m not sure if she’ll do it,’ Joel said, a resigned expression on his handsome face. ‘What we really need to find out is whether this is asthma or COPD. It can be pretty hard to distinguish between the two, as you know, but it’s important because the management is different.’
‘Yes, absolutely.’ Lucy nodded. ‘Has she made an appointment with me?’
‘This afternoon.’
He stood up and gave her a brief nod before leaving the room, steeling himself not to look at the swell of her breasts or the curve of her hips.
Margaret attended for her spirometry testing that afternoon and Lucy started off by talking her through her history. She established that Margaret had no history of chest problems or wheezing illness in childhood, and that she’d been fit and active.
‘And what sort of work did you do, Mrs Patterson?’
Lucy was aware that COPD was associated with some occupations, but as the patient ran through her career history it was obvious that there was nothing that could be held responsible for her current breathing problems.
‘Call me Margaret, please. As for having trouble breathing, I only really notice it when I get colds,’ Margaret told her. ‘It doesn’t keep me awake at night, although I do cough in the morning, but I’ve always assumed that was because of my disgusting habit. I don’t really understand why I have to have this test. I’ve had my peak flow measured before. Isn’t that enough?’
Lucy shook her head. ‘What we’re trying to do is work out whether you have asthma or something called COPD. That stands for chronic obstructive pulmonary disease. It’s another form of obstructive airway disease and it’s closely related to smoking. A single peak-flow reading won’t really show us if the air flow through the small airways is reduced. What we need to do is measure what we call the forced expired volume in one second—in other words, the amount of air you can blow out after you’ve breathed in deeply.’
Margaret gave a resigned shrug. ‘All right, then, let’s get on with it. Where do I blow?’
Lucy smiled. ‘Not so fast. First I need to check your weight, height and blood pressure. I enter some of the data into the spirometer to enable us to calculate the test results.’
Margaret obligingly rolled up her sleeve and Lucy took the necessary recordings.
‘All right.’ Lucy entered the data into the spirometer. ‘Now I need you to hold it…like this… Great.’
Lucy explained how Margaret should use the spirometer, but as the patient blew into the machine she had an uncontrollable fit of coughing.
‘Oh, I’m so sorry.’ Margaret broke off as another fit of coughing took hold of her and Lucy fetched her a glass of
water.
‘Here—try this. Don’t worry about it. People often can’t do it when they’ve had a chest infection. What we probably need to do is leave it two weeks to give the antibiotics time to work. In the meantime, I’d like you to record your peak flow several times a day. That will help us decide on the best method of treatment.’
Margaret sank into the chair and ran a hand over her forehead. ‘I never thought I’d hear myself say this, but I think I need to talk to someone about the smoking.’ She slumped in the chair, looking worn out and defeated. ‘To be honest, I thought I was too old to give up, but this cough has been awful. I don’t want to have another infection like this one.’
Lucy was sympathetic. ‘It is really hard giving up smoking, but people do succeed, Margaret, particularly if they’re really motivated. Having a severe chest infection just might be the trigger for you.’
Mary looked resigned. ‘So what’s the most effective way of going about it?’
Lucy smiled, pleased that she was even considering it. ‘You need to talk to my colleague, Janice. She runs a stop smoking-clinic and she’s had some amazing successes. Basically, it’s a mixture of counselling in groups, individual sessions and nicotine replacement. She’s done a booklet on it for the practice. I’ll get one for you on your way out.’
She talked to Margaret for a few more minutes and then walked with her back to the waiting room and found her the booklet. Then she went to find Joel.
She found him in his consulting room, on the internet.
He glanced up with a smile as she walked into the room. ‘Where did we get our information before the internet?’
Relieved that he seemed more relaxed than he had earlier, Lucy walked round behind him so that she could see the screen, watching with fascination as he searched for the information he wanted.
‘That’s amazing. I confess I’m not that confident about using the internet,’ she said, her eyes widening in surprise at the quality of the information he’d managed to access. ‘That’s fantastic. Can anyone go on that website? Is it free?’
He nodded. ‘This particular one is free, but it’s password protected so it isn’t open to the public. I had to register. But there are plenty of good medical websites, and lots of the journals have their own websites with archives that you can search. I can’t imagine wading through books and paper any more.’
