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NP & PA Student Blog

Battling the CPAP

Published November 4, 2013 1:17 PM by Caroline Pilgrim
G.F. was a brilliant patient. She was exactly who I want to be when I'm 91. I met G.F. while on pulmonology consults last month. She was sitting up in bed with a CPAP machine on. Her daughter was sitting in the room, so kind and matter-of-fact, explaining how her mom was suddenly short of breath yesterday and was brought in. 

G.F. came off her CPAP long enough to explain that on Sunday she was at the church potluck, and the day before that she took the city bus to go shopping because she, "hates waiting for rides." And then she just felt so bad all Monday and called her daughter to come to the hospital.

G.F. had pneumonia and by the time I saw her, she was being treated but just couldn't seem to keep her O2 sats up. We, as the consult team, decided that perhaps if we cleared out the pneumonia we could take her off the CPAP and her breathing would resume to normal. 

I saw G.F. the next couple days, always so pleasant in the morning, and her lung sounds improved each time. She just still couldn't wean off the CPAP. And she was having a hard time eating in between breaks from the machine.

The primary team had established G.F.'s code status. G.F. had decided that she did not want to be intubated or get chest compressions, only the defibrillator. Then on Thursday rounds, my attending had a frank conversation with G.F. and her daughter: "She's 91. When we get pneumonia things are different. When someone like your mom gets pneumonia, we worry. We will do the best we can, but she can't seem to tolerate room air and these are bad signs."

I was surprised at his tone. She seemed so well, relatively. Last week she was just living her life. People get over pneumonia all the time. 

I saw her on rounds the next day. She was chugging Ensure like a champ -- still on CPAP. I went home for the weekend. I make it a habit to check on my patients Sunday night before I go back to see the events of last week. I pull up EPIC, click on G.F.'s chart and this message pops up, "The patient whose chart you are accessing is deceased."


Good post, Caroline.  I enjoyed your story about G.F. and like you, probably, wish we knew more.  I relish your clinical tales as I slog through didactic.  Keep writing!

Marjorie Shanks November 30, 2013 9:21 AM

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