As a nurse, I knew Id care for all types of patients throughout my career. But one day, I found myself caring for a unique patient Ms. Griffin, an elderly patient who lived in my home. She had become a vital part of the family and had spent most of her adult life with me.
Her surgical history was significant only for an abdominal hysterectomy and surgery to remove a benign growth from behind her ear. Her only medical hospitalization was for an inner ear infection.
About five years ago, however, she began to experience geriatric incontinence during stress or deep sleep. The doctor started her on hormonal replacement therapy (HRT), which did not correct the problem. What helped was a generic form of Dexatrim, the weight reduction medication.
Ms. Griffin also began to experience mild dyspnea upon exertion that resolved with periods of rest. In June 2006, she developed severe dyspnea, which quickly progressed to respiratory distress. She collapsed and was transported to an ED. Ms. Griffin was diagnosed with laryngeal paralysis. This condition results in closure of the glottis and decreased oxygen to the lungs during periods of stress or exertion.
The treatment options included surgically tacking the floppy glottis in the open position. This option was rejected because of the increased risk for aspiration pneumonia. We opted instead for symptomatic treatment. She was prescribed diazepam (Valium) to decrease anxiety during laryngo-spasm episodes.
Ms. Griffin quickly adopted a more sedentary lifestyle. The laryngo-spasm episodes were unpredictable any level of exertion could lead to severe respiratory distress. They could occur after she walked up a flight of stairs or even when she became excited or yawned. This often progressed into severe respiratory stridor.
The wheezing and severe stridor could be prevented with alprazolam (Xanax). But because of the unpredictability of the episodes, this was not always possible. What seemed to help ward off an attack was small spoonfuls of ice cream. Swallowing would help open the airway and relieve the impending respiratory distress.
As the months passed, I made adjustments to Ms. Griffins lifestyle to accommodate her condition. Her diet was changed to mechanical soft, and activities inside and outside the home were well monitored. Despite all this, she remained upbeat.
In January 2007, Ms. Griffin suddenly developed ataxia, nystagmus, and profound vomiting. She had developed geriatric acoustic syndrome. At the hospital, she was diagnosed with malignant lung cancer. Although previously undiagnosed, extensive tumors throughout her lungs were revealed by chest X-rays. Aggressive chemotherapy or radiation therapy was not an option, and she was sent home with palliative measures in place. Two portable oxygen tanks were delivered to the house for emergency use.
Once at home, Ms. Griffins movement was monitored. At night she was assisted and often had to be carried to bed. Over the next two months, the frequency of the episodes increased.
On March 30, 2007, Ms. Griffin experienced a severe respiratory attack. I promptly administered oxygen but soon realized the episode was not resolving. I watched as she grew pale. I cradled her in my arms as she lay on the floor and died at home, in familiar surroundings.
Ms. Griffin was my 16-year-old Gordon Setter, who I had raised from a puppy. She had far exceeded the life expectancy of a large breed dog and had provided me with a lifetime of memories. She was a valuable member of my family. I was glad to be able to use my nursing skills to care for her.
After a period of mourning, I became the owner of a 5-month-old Gordon Setter, Shannon, who is now beginning her own odyssey of memories with me.