Martha Sturdivant Case Story and Case Study: Background

Martha Sturdivant’s Story and Case Study: A Focus on Interstitial (Idiopathic) Pulmonary Fibrosis

Martha Sturdivant is a 53-year-old black woman who has had a progressive decline in her health over the last 5 years. Upon exercising, she has been short of breath with her tolerance declining to the point that she was evaluated in the Emergency Department three years ago. She was admitted for presumptive pneumonia with several ground glass areas visualized on chest x-ray with accompanying hypoxia. Ultimately, an evaluation revealed Interstitial Lung Disease, more specifically Idiopathic Pulmonary Fibrosis. Although she never smoked, her father was a heavy smoker, and she was exposed to second-hand smoke during her early life. She was raised on the family farm and was exposed to pesticides, fertilizers, and other chemicals.

Martha is a widow, with an 18-year-old son, Jason, who lives in the home and helps with some housework and assists his mother with activities of daily living. He was 15 years old when she was first diagnosed and hospitalized. He will graduate from high school this year; however, his school performance has been impacted by the stress of his mother’s illness, as well as his learning disability and moderately severe Attention Deficit-Hyper Activity Disorder (ADHD), for which he has been prescribed medication.

A year after her diagnosis, Martha was awarded disability benefits through Social Security and has had Medicaid healthcare intermittently. She will qualify for Medicare Part A after she has been on disability for 2 years. She is unsure she will be able to pay for co-insurance of Medicare. Jason had to change school districts when they moved to a section 8 housing apartment last year during the middle of his junior year. At times he is angry and withdrawn. Betty, Martha’s sister, lives in the same town. She is married and is busy working and raising her own children. Betty has been a certified nursing assistant for 10 years in both local hospitals and nursing homes.

One month ago Martha contracted flu despite having received vaccination. Her condition worsened rapidly and she was admitted to the hospital. On day 2 of admission she was electively intubated for respiratory failure. She was empirically treated for community-acquired pneumonia but over the last 2 weeks has been diagnosed with antibiotic resistant Pseudomonas. She has very high oxygen and Positive End-Expiratory Pressure (PEEP) requirements. She is awake at times and able to communicate with lips and limited writing. Her medical team has recommended a tracheotomy and PEG due to prolonged intubation. She wishes to continue mechanical ventilation (MV) but refuses the tracheotomy. The team is distressed because they believe her chances of coming off MV are unlikely and are being further eroded by continued oral intubation and inadequate nutrition support.

Martha had worsening hypoxia despite MV and aggressive treatment of all underlying illness. She had a pulseless electrical arrest (PEA) and now has evidence of hypoxic brain injury but does not meet brain death criteria. The team and family will discuss withdrawal of MV (compassionate extubation versus no escalation of treatment).

Case Study Participants Martha Sturdivant is a 53-year-old widow who has Idiopathic Pulmonary Fibrosis which is progressive over the last 5 years. She struggles to be independent and is a single mom.

Jason Sturdivant is Martha’s son. He was ~ 15 years old when his mother became ill. He is now a senior in high school and has struggled in school due to the stress of his mom’s illness and her frequent hospitalizations. He has been supportive but is overwhelmed much of the time.

Betty Marshall is Martha’s younger sister. She has been supportive of Martha and helps as much as she can as her sister’s ability to be independent is impaired as her lung disease worsens. Betty is also close to her nephew, Jason. However, she is working and caring for her own family.

Julie Tribble is a Chaplain on the Palliative Care Team. She sees patients both in the hospital and also in the outpatient Palliative Care Clinic.

Harri Walker is an Advanced Practice Nurse with the inpatient Palliative Care Team.

Bob Sanderson is the Social Worker on the Palliative Care Team. He sees patients both in the hospital and also in the palliative care outpatient clinic.

Rhonda Rodriguez is a Bachelor’s prepared Nurse in the palliative care outpatient clinic.

Elizabeth Hendrix is a psychologist who works part-time in the palliative care outpatient clinic.

Jeanie Olds is the lead palliative care physician.

Mark Abadi is the pulmonologist.