Valerie Golding was in desperate shape when she arrived by ambulance at Novant Health Matthews Medical Center on Mother’s Day 2018. It would be her first of four admissions for the same condition – respiratory failure connected to a lifetime of smoking.
After her grown children left earlier that Sunday evening, she went outside for a cigarette. The Matthews woman had been smoking as much as two packs a day for 44 years. She came inside and told her husband, Steve, she couldn’t breathe. It was a turning point. “That was the start of my recovery,” she said.
Golding, who recently turned 60, was experiencing an extreme flare-up of her stage IV chronic obstructive pulmonary disease, better known by its acronym – COPD. The term refers not to one disease, but to a group of lung diseases that can interfere with normal breathing. More than 15 million Americans suffer from COPD, and it kills 120,000 Americans each year.
The protocol for treating someone in respiratory failure may include steroids administered through an IV, antibiotics and placement on life support called a BiPAP, a non-invasive ventilator. (It’s similar to a CPAP, but it provides “assisted breath” in addition to keeping the airways open.) In severe cases of respiratory failure, patients may be intubated, which means they’re put on a machine that breathes for them.
In addition, smokers are given nicotine replacement therapy (a patch, lozenge or gum) during their hospital stay and may get a prescription to treat anxiety. At Novant Health, patients are also assigned a pulmonary disease navigator. These individuals help patients and families understand their diagnosis and treatment options.
For Golding, that person was Polly Janos, who became a vital partner on her journey.
Janos recalled her first encounter with Golding: “Her anxiety was through the roof. In respiratory failure, you can’t catch your breath, and that sends you into panic mode, which then makes you breathe harder, which increases your heart rate and anxiety. It’s a vicious cycle.”
Golding met pulmonologist Dr. Navneet Arora when she was in ICU. “He came into my room, larger than life,” she recalled. “He said, ‘You’re either going to hate me, or we’re going to become friends.’”
Arora remembers it well: “It was a scary time. I told her how sick she was. But she wanted to live. She loves life and has fought her way back.”
Today, Golding calls him her “No. 1 hero.” Beyond his work as her physician, Arora intervened on Golding’s behalf when her insurance company refused to pay for medical equipment she desperately needed. His advocacy helped her get a portable ventilator, a life-saving device that delivers oxygen and sucks the carbon dioxide from her lungs. She doesn’t need a continuous flow of oxygen – just a steady pulse. She’ll need it for the rest of her life.
She not only became friends with her doctor, she’s now close pals with Janos. The two meet for coffee regularly. They’ve found they have a lot in common.
A template for quitting
“Being a former smoker gives me ‘street cred,’” Janos said. “I’ve been there, and I can say to my patients: ‘You can get through this.’”
Before Janos tells patients her own story, though, she asks if it’s OK to discuss smoking. No one quits until they’re ready.
Golding was ready. “I’d never been this sick before,” she said.
Once Janos and her fellow navigators have a patient’s permission to discuss smoking cessation, they can offer resources and make referrals – to the QuitlineNC, for instance. It’s a free service.
“Smokers know they need to quit,” Janos said. “They don’t need to be told. What they do need is a sympathetic ear – someone who will listen and provide encouragement.”
It wasn’t easy for Golding to give up the habit. Remember, she had three more ER visits over the summer. Arora said smoking is one of the toughest addictions to break. “It’s not just the withdrawals,” he said. “A smoker’s brain tells her not to quit.” After Golding’s first ER visit, she was able to step down to just three cigarettes a day.
Her second ER visit was the scariest. She was home alone when, suddenly, she couldn’t take a deep breath. She called 911 but was unconscious by the time EMTs arrived. “I don’t remember anything,” she said. “I must’ve unlocked the door before I passed out … I woke up in the ICU two days later.”
That’s when she gave up smoking for good.
She hasn’t had a cigarette since her second hospital stay. Not that she hasn’t craved one. Hard candy and gum don’t satisfy her cravings, as they do for some. Golding has another trick. “I think about my children and my 4-year-old grandson,” she said. “I want to be around for them.”
She has loads of support from her family, particularly her husband, whom she calls “an inspiration.” Arora said family support is key to overcoming an addiction to smoking. “Patients cannot do it alone,” he said. “Valerie’s husband is excellent. He comes with her to every visit and reinforces our messages at home.”
She gets support from her Novant Health family, including phone support from two other pulmonary disease navigators, Wendy Malizia and Margo Bell. She cites Dr. Souheil Abdel Nour and Dr. Amit Asija as being extremely important members of her care team, too. As Arora said, “This is a team effort. Without the support of every person on this team, there would be fewer successes.”
Arora has a message of hope for any smoker who’s trying to quit: “This is a patient-driven disease. If you do what your team asks of you, you can stop smoking. It starts with understanding that this is a problem. Many patients don’t realize that. (For smokers), the difficulty in breathing isn’t a normal part of aging. It’s related to smoking.”
“Valerie has done everything we asked of her,” he continued. “She’s been an excellent patient. But we have many other success stories like Valerie’s.
Golding is a realist. She doesn’t pretend any of this has been easy. “I miss my cigarettes,” she said. “But I’d miss living more. I’ve got too many people backing me and encouraging me.”