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I loved Lucy: My favorite noncompliant patient

She never heeded medical advice, but her physician came to love her—and learn from her—anyway.

Rachel Scott, MD
Family Physician / Eveleth, MN

Lucille (not her real name) came to our clinic late in her life, with advanced emphysema. A confirmed two-pack-a-day cigarette smoker, she saw no reason to change her habits. Nothing her son, daughter, or I could say would motivate her to even think of quitting.

For several months, I treated her successfully with a combination of medications. Then came the day when home oxygen was necessary. Still, she wouldn’t—or couldn’t—stop smoking.

In time, her lungs began to fail. Even with 10 liters of oxygen and a nonrebreather, she could barely maintain adequate oxygenation. Lacking the energy to do more than lie in bed and breathe, she was transferred to a nursing home, where I visited her frequently. Through her oxygen mask, she complained that we had the technology to put a man on the moon, but we couldn’t put her out of her misery. How much longer, she gasped, would she have to go on like this?

I’ve never been able to reconcile myself to the idea of euthanasia. Life and death are still ultimately up to God, whose wisdom is far greater than mine. Besides, all Lucille needed to do to end her life was pull the oxygen mask off her face. She’d be dead within minutes. Yet, despite her plea for an end to her misery, she hung on to life. In my experience, people always do.

During another visit, I listened to her complaints, examined her chest and heart, and sat talking with her for a time. Despite her self-destructive behavior, she was a favorite of mine. I guess I admired her spirit, independence, and toughness.

As we discussed her declining health, I couldn’t help remarking, "Of course, it would have helped if you’d stopped smoking."

"Oh," she said between gasps for air. "Smoking didn’t do this."

"It didn’t?" I asked, amazed. "Then what did?"

"Acid rain," she gasped.

Lucille died a few weeks later. Her son and daughter came by the clinic to talk about her, and to thank me for my care. I told them their mother had claimed she was a victim of acid rain.

"That’s Lucille!" her daughter said fondly, shaking her head and laughing.

Lucille remained courageously herself to the end. Although my medical advice had fallen on deaf ears, that made her no less lovable. It was my privilege to know her and her devoted children.

I learned from her to accept people as they are, and that good medical treatment isn’t always a matter of imposing one’s best professional advice. In Lucille’s case, seeing her gracefully through her last days was enough. When medications can no longer sustain life, the presence of a caring physician is still the most powerful medicine we have to give to a dying patient and her family.

Rachel Scott. I loved Lucy: My favorite noncompliant patient.

Medical Economics

2002;7.