Six months ago I was on duty when a compromised COPD patient came to the clinic via emergency medical service.
The patient, aged about 50 years, smoked two packs a day for many years and was in big respiratory trouble. I provided the highest level of care I could while we waited for a Medevac flight to the nearest hospital 900 miles away.
To be sure it was not pneumothorax or severe pneumonitis causing his distress, I ordered an x-ray. Then, I performed an ECG to be sure he wasn’t having cardiac problems.
All signs pointed to chronic obstructive pulmonary disease (COPD), so I gave him nebulizer treatments, IV steroids, and “just-in-case” antibiotics, all the while monitoring him and seeing improvement in his oxygen saturations. I sat with him for more than 24 hours, alternating with another physician assistant.
I gave the patient information about how his smoking would likely cause his death due to the severe respiratory problems he was experiencing on arrival. I warned him that, in the future, he might not respond to treatments. I disclosed that I had quit smoking 15 years ago.
The Medevac had still not arrived due to weather, and the patient’s condition had improved to the point that I cancelled the request. I discharged the patient with a few days of additional steroids, switching to oral inhaled steroids and a taper of prednisone. I instructed him on rescue inhaler use, and provided him with an albuterol inhaler.
This month, I spoke with a colleague and found that the patient has remained cigarette-free, is doing well, uses his bicycle, and reports feeling better than he has in years.
Maybe it helped when I disclosed to the patient that I had successfully quit smoking. Whatever the reason, he is doing well, and I feel proud to have possibly helped him make a life-changing decision. Some days, we do make a difference. I’ve been a PA for 31 years now, and love what I do.