April 3, 2014

Megan Rushton



My friendship with Phyl began some forty years ago when I started my first job as a legal secretary in a Sydney city law firm.  In those days Phyl was already the most senior of secretaries in the firm, working for one of the two senior partners.  She was in her early 40’s when I commenced with the firm and to me, still in my late teens, she seemed soooooo old!  Despite the almost 23 year age gap, nonetheless that was the start of a most beautiful and enduring friendship and one that has come to mean a great deal to me.

From the time I met Phyl, she was always a smoker.  She loved smoking and, looking back over the years, I can sincerely say it was the only ‘vice’ she had.  Always a very gentle and caring person, she was, above all, always a lady.  In the whole time I knew her, I can never recall her having a bad word to say about anyone.  She had lost the one great love of her life very early and so she had become a fiercely independent lady at an early age.  She lived in a very modern unit in a Sydney suburb which she had purchased and paid off all on her own; she had travelled the world and she managed all her personal finances and affairs magnificently, right up to the day she died.

But I often wondered whether her fierce independence would ultimately be her downfall.  As a child she had been diagnosed with a kidney problem and her parents were informed not to expect her to live beyond age 40 but by the time she reached that age she had come under the care of a wonderful professor who successfully operated on her and removed the threat of an early death.  Thereafter, over the years, Phyl survived a broken ankle, a myriad of skin keritosis and breast cancer, as well as having an overactive thyroid and painful arthritis.  During all her hospitalisations she was able to get by without smoking; however, the minute she stepped foot in her home again, she was back into her old habit.

By the time she was in her mid-seventies, she had developed a thick cough.  While she put in place home cleaning and maintenance services, as well as regular gourmet food deliveries, it appeared that she could manage quite well around her home although I noticed that it had started to become harder for her to manage her weekly shopping trips down the road.  She didn’t own a car but her home was located a very short walk from a major shopping centre and she was of the view that she was maintaining her independence by being able to go to the local supermarket once a month and make a large purchase of supplies which would be home delivered.  My offers to do her shopping for her were always resisted and I used to worry incessantly about her trips to the bank to get cash out (as she would never use an automatic teller machine).  Her height had shrunk, she had lost a lot of weight and I feared she would have been an easy target for a mugging.  At that stage I lost count of the number of times that I had discussed the possibility of her giving up her beloved cigarettes but I was never able to succeed.  Her most favourite pastime of all was to sit on her enclosed balcony in the sunshine, watching the coming and goings in her building or reading a great book with cigarette in hand, slowing burning her life away.  We had often discussed the possibility of her relocating to a hostel situation at some time in the future but she always resisted taking this step maintaining that she was fine at home.  Looking back, I suspect she feared that if she did move to retirement accommodation she wouldn’t be able to smoke, a prospect she simply couldn’t face.

A year or two later, her favourite, younger brother with whom she was very close passed away suddenly and that hit her very hard.  She had been the eldest child in her family and now all her siblings had passed on.  So, being the practical woman that she was, she decided that she should appoint me as her legal guardian and she set about arranging for all legal paperwork to be drawn up and executed.

For many years I had accompanied her to medical appointments with her GP or other medical professional who were all located within walking distance from her home.  We always walked to those appointments but over time I noticed that it became a slower and slower journey to cover short distances.  Subsequently her GP advised her that she had early stage emphysema and she was constantly reinforcing to Phyl that she would feel far better if she could stop smoking.   As Phyl was always one to follow doctors’ orders to the letter she was well-regimented in her daily intake of medications:  Prednisone and Spiriva and antibiotics for her ‘cough’; drugs for post breast cancer treatment; thyroid tablets; blood pressure pills and arthritis medication.  Nonetheless, on many occasions she tried so very hard to stop smoking using the nicotine patches, etc. but each time she would only last for a few weeks before she couldn’t resist the temptation any longer and she would be back smoking.  Of course, over that time she seemed to quite easily pick up the flu or whatever other respiratory bug was going around and it always laid her low, taking several rounds of antibiotics to get her over it.

By early 2010, it became almost impossible for Phyl to walk any great distance and she became very slow in doing even the most simplest thing around her home.  Her GP decided that it was time she referred Phyl to a respiratory specialist as well as a heart specialist.  I will always remember our first visit to the respiratory specialist because there, on the waiting room wall, was a huge poster outlining ‘COPD’.  It was the very first time I had ever encountered the expression COPD so I passed the time in the waiting room reading up on it.  By the time we went in for our appointment with the specialist, I had a pretty good idea of what COPD meant.  The specialist asked to look at Phyl’s hands and I noticed her fingertips were very dark blue – a sure indicator that lack of oxygen in her blood was present.  He also conducted various other tests and then stated he would like her to undertake a spirometry test as soon as possible which he would arrange at Concord Hospital.  Following the consultation and while Phyl was attending to payment of the fees, the specialist came over to me and very quietly said “You know, this lady has very advanced COPD”.  All I could manage to respond was “Yes but I suspect she knows it too”.  Following this we went to see the heart specialist who, following more testing, advised me that Phyl’s heart was struggling to cope with the lack of oxygen in her body.

After those specialist visits and our visit to Concord Hospital for the spirometry testing, her GP started to discuss with us the fact that Phyl would benefit enormously from a home oxygen supply but in order to achieve this it was imperative that she stopped smoking.  She even went as far as stating that if Phyl smoked anywhere near the oxygen cylinder she could cause an explosion which none of us wanted.  I suspect that at this point Phyl knew she probably didn’t have any other option so she very reluctantly accepted that she would not be able to smoke at all and gave her undertaking to stop smoking.  She did, however, say to her doctor “Why can’t I simply have a carton of cigarettes and a bottle of whiskey and just be left alone to enjoy myself?”  To which her doctor responded “Because, Phyl, you will no doubt enjoy the carton of cigarettes and the whiskey but the problem is when they have gone you won’t feel any better!”

We never made it to the home oxygen supply. Only a week or two later, one morning Phyl couldn’t move to get out of bed at all.  An ambulance was called and she was admitted to hospital and placed on oxygen.  Right to the end, while her body might have been failing, her brain remained as quick and alert as ever and she was still able to make decisions for herself.  While at the hospital, the doctor came to me and said that Phyl had told him she did not want to be resuscitated or her life prolonged unnecessarily and I was able to confirm that what she had told him was absolutely correct and they were her wishes.  I remember the doctor saying at the time he felt there was certainly nothing wrong with her brain!

Phyl passed away the following day, still labouring to breathe even though she was on oxygen with just a touch of morphine and just a few months short of her 83rd birthday.  Her Death Certificate stated Cause of Death as being Chronic Obstructive Pulmonary Disease.

Phyl had always maintained that despite knowing the possible or probable consequences, she enjoyed smoking.  Nonetheless, while I know she sincerely meant this, I also know that she would never, ever recommend that anyone else should ever take up the habit!  And I have often wondered ever since, had I heard of the term ‘COPD’ long before I did in that specialist’s room that day, whether the outcome of this story might have been different.

The one thing I can do now though is help The Australian Lung Foundation spread the word and help increase the general population’s knowledge, awareness and understanding of what COPD is – so for me, Phyl’s story is just the start…