Correspondence to: Dean Gianakos, MD, FCCP, Associate Director, Lynchburg Family Practice Residency, 2097 Langhorne Rd, Lynchburg, VA 24501; e-mail: firstname.lastname@example.org
Sometimes adding another medicine is not the answer—even in asthma management.
“I don’t understand it, doc. I’m on all this medicine—and still wheezing.”
Is she fighting with Bill again?
“What else can we try?”
“We’ll talk about it, Betty. First, let’s review a few things.”
Once again, I tell her to take her medicines every day. Once again, I show her how to use her inhalers.
“Good. It sounds like you’re using your steroid inhaler on a more regular basis. Your inhaler technique is improving. How about you and Bill. How are things going?”
“Bill’s Bill,” she says. “When things are good between us, they’re really good. When they’re not, well, everything falls apart, including my health.”
When things are bad between them, she doesn’t take her medicines.
“Betty, you and I have talked many times about counseling. What are your thoughts today?”
“Oh, you know Bill won’t go for that. I’ve told you before. He doesn’t understand this asthma stuff.”
She came in a year ago, depressed about her relationship. She said Bill didn’t understand why she couldn’t do the things she used to do. Specifically, why she couldn’t make love to him the way they once had.
“Have you recently talked to him?”
“Yes and no. He’s not interested.”
She’s right. Bill’s also my patient. His primary interest is Bill.
“I know how frustrating it must be for you.”
I raise my hand into the middle of the air, keeping it horizontal to the floor.
“Betty, I usually live at this level of stress. Some weeks I’m up here; other weeks I’m down here. Most of the time I’m right in the middle. Approximately where are you—up here, down here, or right here?”
“I’m always under pressure. Today, I’m probably in the middle.”
“What’s the biggest stress in your life?”
“Living with asthma. Living with Bill.”
She’s making progress.
“Maybe the three of us should talk.”
“Maybe we should. I’ll think about it.”
“You let me know.”
“Right. By the way, that new medicine you gave me last month. I promise to take it every day.”
I’ve heard this before. I repeat: she takes her medicines on good days. “Good days” mean good days with Bill.
“Great. And I’ll see you back in 6 weeks, Betty. Keep at it. You’re making progress. You really are.”
I’m hopeful. She seems to have more insight today.
Betty did not follow up as scheduled. Six months later, she wrote to say that she had moved to California.
“P.S. The weather is great. Asthma much better!”
“P.P.S. Regards to Bill.”
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