Case Study Mrs. L. is a 60-year-old retired female teacher with stage IIIA
squamous cell carcinoma of the lung, status postchemoradiation. She recently developed
radiation pneumonitis, which was managed conservatively, and she did not require
steroids. Mrs. L. has noted some progression of her underlying
dyspnea. She is monitoring her oxygen saturation at home, and most of the time it is in the range of 94% to 96%. On one occasion only, her
oxygen dropped to 88% and rapidly improved to the mid-90s. Her
cough has improved for the past 4 to 6 weeks. She denies sputum production, congestion, or
fever. Mrs. L. does not require a walker and uses a wheelchair only for long distances. She has occasional, slight
dysphagia. A recent CT scan shows stable disease, and she is to return to the clinic in 2 months for restaging and possible further
chemotherapy. Mrs. L. and her husband have been married for 33 years, and they have been very close. Until recently, they have continued to be sexually active and very intimate with each other. Since Mrs. L.'s diagnosis, and during treatment, the couple have become extremely stressed and psychologically spent. The act of sexual intercourse has ceased, yet they have attempted to remain close and maintain open communication. In addition to Mrs. L.'s increasing
dyspnea, she has also suffered a great deal of
fatigue and depression, along with
alopecia and vaginal
atrophy, due to the
chemotherapy and
radiation treatments. Both Mr. and Mrs. L. are very distressed over the change in their sexual lives. Mr. L. has mentioned that he now feels more like a "nursemaid" than a husband or lover. Mrs. L. has made concerted efforts to maintain intimacy with her husband, but her
fatigue is profound. She has taken to sleeping in the living room, sitting up on the couch, as it relieves her
dyspnea to some degree.