‘I’ve been blowing into that funny little machine, just as you said,’ she said briskly, delving in her bag for her chart. ‘And so far, touch wood, I’ve been fine. I haven’t even had one of my chests this winter.’
Lucy scanned the peak-flow readings carefully. ‘Well, you had the flu jab, Mrs Lambert, and the pneumonia jab so those will have helped. And we increased the dose of your puffer.’
‘I never had jabs before this winter.’ Mrs Lambert sniffed. ‘Frankly, I thought it was all a load of nonsense. But I was so ill last winter that Dr Richard gave me a telling-off. Bullied me into having them, he did.’
Lucy smiled, knowing full well that Annie Lambert adored Richard Whittaker.
‘Well, they’ve made a difference, Mrs Lambert,’ she said quietly, ‘so perhaps it’s just as well he bullied you. These readings are good. No problems, then?’
‘None at all, but I do think this asthma thing is all nonsense. I’ve said it before and I’ll say it again. I don’t wheeze, for goodness’ sake!’
‘You don’t necessarily have to wheeze,’ Lucy told her. ‘Small children with asthma don’t always wheeze. Sometimes their only symptom is a cough. In older people the only symptom may be breathlessness.’
Mrs Lambert looked unconvinced. ‘I’m seventy,’ she reminded Lucy stoutly. ‘I’ve never had asthma, or any other sort of illness come to that, until the last few years. How can I suddenly have asthma now?’
‘Sometimes people are diagnosed with asthma for the first time later in life,’ Lucy explained. ‘And the reason that Dr Richard encouraged you to have the vaccinations is that in older people it can be triggered by flu, colds or other viral infections.’
‘Well, I was certainly very breathless last winter, when I had my awful chest,’ Mrs Lambert told her. ‘But I wasn’t very co-operative when Dr Richard tried to start me on all sorts of inhalers.’
‘Don’t worry about that now.’ Lucy gave her a warm smile and handed her chart back to her. ‘All that matters is that you’re doing really well, and you are.’
She talked to Mrs Lambert for a few more minutes and then called her next patient.
It was Margaret Patterson, who had returned for her repeat spirometry.
‘I’ve stopped coughing now,’ she told Lucy with a smile, ‘so perhaps we’ll have more success this time. I wrote down my peak-flow results, by the way.’
She handed the piece of paper to Lucy, who scanned it quickly.
‘OK, I want to do the spirometry now.’ She handed the machine to Margaret and this time she was able to blow without coughing.
‘That’s great.’ Lucy recorded the results and then asked her to inhale a drug that would dilate her airways. ‘The results we get after you’ve taken this drug will help us decide if it’s COPD or asthma.’
But the results weren’t what she’d been expecting, and later on that day she tracked down Joel, trying not to think about that kiss.
‘Her spirometry showed a moderate airflow obstruction, but then I did reversibility testing with 5 mg salbutamol.’ She showed Joel the results and he whistled with surprise.
‘That degree of reversibility is sug
gestive of asthma.’
‘But her serial peak flow readings suggested COPD.’
He grinned. ‘Who ever said medicine is an exact science?’
Despite herself, she found herself responding to that smile. ‘So now what?’
Joel inhaled deeply and gave it some thought. ‘We give her a trial of high-dose inhaled steroids. I’ll give her beclomethasone for six weeks. Get her to come back at the end of that time and we’ll test her again. If her lung function is back within normal limits, we’ll know that it’s asthma, not COPD. Send her into me when you’ve finished with her.’
Lucy returned to her treatment room and explained the results of the tests to Margaret.
‘So I need to see Dr Whittaker again?’
Lucy nodded. ‘He’ll give you a prescription. He’s free now, so you can pop straight over to his room.’
She worked her way through to the end of her asthma clinic and then looked up as Joel walked into the room.
‘What are you doing at lunchtime?’