Never leave an angry asthmatic in front of their blog site on a temptingly close Mac Book. They may be inclined to make rash promises, disguised as New Year’s resolutions (arrrgh) such as to blog every week for a year during 2017, to tell any interested readers that they have been going to the gym for over four months now and they are sticking to it – and this wilful disclosure is because they are on some form of prescribed medication.
Yes, as well as New Year, it’s the month of the chest infection for those amongst us who are seasoned asthmatics. It is indeed the Winter of our Discontent. You may recall that I told you a bit about this last year when ruminating on the effects of steroids I don’t mean the ones that body builders use! (Briefly, steroids help you breathe, but they also make you hungry, mad-eyed and emotional – and in my case, I look like a hamster after a course of them). A nocturnal hamster that can’t stop eating.
Adult asthmatics are, to some extent, a fascinating bunch. I have often thought that there is an interesting study to be made on “The Psychology of Asthma”, and how the condition impacts on adult patients, or young patients and their families. Don’t all rush at once, wannabe Consultant respiratory physicians!
As emergency adult patients, we’re usually quiet (if we can’t breathe, we can’t talk much either, so lack confidence) and that, in turn, makes us compliant. We have usually put up with the condition for so long, that we get used to trying to manage it and we take our magic “rescue packs” away with us, ready to deploy at a moment’s notice. Forget an i-phone, we’re never without an inhaler, or three.
When we do have to go to A & E to puff on a nebuliser and press up against the cold x-ray plate if we get lucky after being transported in a backward facing wheelchair under blanket, in a flimsy gown, we’re cautious; prepared.
We take a book – no magazines from reception due to infection control – a fully charged phone, and if we have them, our health insurance details for the often unhelpful call to the private health insurer who says that if it was a broken leg, they could cover you, but, as it’s a pre-existing condition…. In short, if we can, we go in prepared. I believe we’re known as a “Code Orange” in the game, so we’re really thankful to be seen swiftly and we know how lucky we are – you don’t mess around with breathing.
Most importantly, we’re cautious and polite. As we’re clean, with no broken bones and not bleeding (and usually not just drunk, like some of the other attendees to A & E), we also tend to apologise because we don’t look ill enough. “Sorry, I just wondered if I could, umm, be nebulised, as I, err, can’t breathe. Sorry.” We tend not to trouble our families about going to hospital until we’re there, or back home if we’re lucky, because what’s the point of saying you sat in a cubicle for a couple of hours earlier?
I am often moved to tears by the kindness of the hospital staff, especially when it’s late at night and I’m three nebulisers in, as the evil crackle in my chest just won’t go away. They ask if you want a cup of tea even though it’s late and remark that they haven’t seen you for a while.
Today was one of those days. Inhalers, steroids and antibiotics not working, I went to A & E and puffily checked in whilst a woman whose mother had just been taken in by ambulance hovered close by with bags of her mum’s things. The lady who checks me in is calm and efficient, but there is (only ever) one of her and she always disappears before she sits back down to deal the next patient. Asthma brings about a quiet panic; you just try not to show it. But you’re counting the seconds, because you just want to breathe easily again – and the relief when your name is called is palpable. As some might say, you don’t know what to do with yourself.
In triage, I soon felt like I was told where to go. We go through my symptoms, my meds and my SATS (always 97%) and my peak flow score, which was falling. Having always been somewhat anxious about putting objects in my mouth and puffing on them, I still get embarrassed by blowing (yes indeed) into a peak flow metre to show how bad my lungs can get.
Anyway, I digress. “I was just wondering” asked the Sister, “why you’ve come here and not gone to your GP.” I was slightly astounded by this, given that I can’t breathe very well, that the advice is generally to go to A & E if your medication isn’t working – and I’m already taking everything my doctor can offer – unless there is something new on the market that I have missed. I explain it’s because I need a nebuliser. “There’s no bed free at the moment.” Anyway, I don’t want a bed, I just want a chair in a corner somewhere.
In fairness, I am soon in a cubicle with an Asthma Information leaflet (ooh, there is a Puffer Fish on the front) and I am in tears. Why? Because the doctor I see doesn’t seem to think that anything is wrong with me, that I’m not wheezing enough and in her “clinical opinion”, it’s only a “mild attack” as I can speak in sentences.
At this stage, I simply feel like a fraud – and I say it. Steroids can also make you direct. I also feel hopeless and aged, because when you have a bad day with asthma (and I imagine, with any illness), you don’t think you will ever have a good one again. To go where you usually get help, somewhere you pay your social security contributions towards, are polite and grateful to be – and then to be doubted, (because that is how it feels) is worrying – and embarrassing. You don’t have to be wheezing to feel like you have concrete in your chest.
I have to explain that this is the “danger time” of year for me, and that my two most severe attacks, each resulting in three nights in hospital last winter and the one before that, started like this. I don’t want to take up one of their beds, I don’t want to block a space that someone else needs. I just would like to puff on a nebuliser for a few minutes and to feel my chest clear so that I can get back to work.
Anyway, I get my mask and magic concoction – and it’s such a relief. But, just the one. I feel too awkward to ask for another nebuliser, and it’s not suggested as my peak flow has risen slightly. Happily my sister arrives and I talk to her through my Yoda-like mask before I shuffle off with a medical certificate that I don’t want. Of course, I say thank you because asthmatics have good manners.
So, what does an asthmatic who is too embarrassed to go back to A & E do in the short term? She visits Amazon, orders a nebuliser of her very own (nothing like an early birthday gift) and makes an appointment with the GP (and I am so grateful that I can get an appointment for the next day, I could cry – again) to see if the doctor will prescribe the magic medicine so that she can breathe easily, once more.
I’m glad I got that off my chest – thank you for reading. As I have said before, asthmatics favour etiquette, even when they run out of puff. Until next time.
Sarah Nibbs 