She Had Been Coughing for Two Years. The Cause Was a Surprise.

The voice on the phone was crisp and efficient. The 75-year-old woman listened, speechless. Her much-anticipated surgery to repair the crumpled vertebra in her lower back was canceled. The caller informed her that her chest X-ray, a routine pre-procedure test, was abnormal. She should see her doctor, and when her X-ray was normal, she could reschedule the operation. She summoned a polite response and hung up the phone. She could feel her heart racing and sat down.

She had had a cough for two years. It started not long after the pandemic descended on New York City and down the length of Long Island, even into the sleepy village of Quogue where she had moved to at the end of a busy career in Manhattan. After hacking away for several weeks — longer than any normal cough should last — she went to see her primary-care doctor. The doctor immediately tested her for Covid and sent her for an X-ray. When both were normal, doctor and patient were reassured. Her doctor suggested she get rid of her feather pillows and down comforter, in case they were causing an allergic reaction, and she did. It didn’t help. Occasionally she considered going into the city to see a pulmonologist but knew the doctors there would be drowning in Covid cases. People were dying, and all she had was a cough.

But a year and a half later, she still had the cough. It was her constant companion, with her all day long, and according to her daughter — who moved back in with her when the pandemic struck — it was there all night as well. And it was a disgusting-sounding cough, as if she was coughing up something awful. Even worse, over the past couple of months she noticed that exercise was harder. She used to be a big walker — she and her dog could stride for miles on the beach and through the village. Now even a short walk could leave her out of breath. Not gasping but winded in a way she had never been from simply walking. Sometimes just making her bed would make her breathe a little harder than she should. Sure, she was 75, but she was a healthy 75. At least she thought she was.

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It was when she noticed that she’d lost weight — more than 20 pounds — that she became worried. That’s when she went to see an ear, nose and throat specialist, who examined her and put a camera down her throat. Everything looks fine, he told her. He thought it could be reflux and prescribed a medication for heartburn. When that didn’t help either, she just let it go.

But now, just a few months later, this routine X-ray showed that there was something wrong with her lungs. She called her primary-care doctor once more. The doctor looked at the X-ray and immediately ordered a CT scan of the woman’s chest. The results were posted in her electronic medical record within a day. The patient scanned them anxiously. She didn’t understand a lot of the language, though it was clear the scan wasn’t normal. She used the internet to try to understand what she was reading. Each page she read led to more searches and newer and stranger terms. Did she have interstitial lung disease? And exactly what was that? Finally, she found a sentence that put an end to her search: “The most common form of interstitial lung disease, idiopathic pulmonary fibrosis (I.P.F.), has a life expectancy of approximately three to five years.”

Terrified, she called her old doctor, who had taken care of her for years when she lived in New York City. “Am I going to die in three to five years?” she asked her, as calmly as she could. She read the CT scan results to the doctor. She too was concerned by the radiologist’s findings and suggested the patient see a pulmonologist. She knew a good one: Dr. Lester Blair at Weill Cornell Medicine in New York City. The older woman thanked her, then called his office immediately. She got an appointment for the following week.

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