My mum tells me that when I was two years old, I would regularly go blue, particularly when I was walking my sister to school on a cold, windy day. Alongside this, I coughed incessantly. My parents took me to the doctor’s surgery multiple times, and their concerns were dismissed by the GPs, or a course of antibiotics given.

One day when I was particularly unwell, my mum was unable to get a doctor’s appointment but was able to see one of the practice nurses. The nurse identified intercostal recessions and immediately got a doctor to examine me. The doctor asked my mum how long I had been asthmatic; that was the point at which I finally received the diagnosis that linked me into a nurse-led clinic for long-term monitoring.

The nurse was Mr. Pierce*, a man who initially seemed to me scary, authoritative, and old. His voice boomed and filled his modest consulting room. He always pushed open the door to the patient waiting room with considerable energy and vigor, loudly announcing patient names, a habit which made me jump without fail.

Trusting the patient’s expertise.

Mr. Pierce was very much ahead of his time in terms of acknowledging patients’ expertise in their own health. He listened to my account of symptoms, asking my parents to stop talking on my behalf. I always left his room with at least one sticker, and often a colorful new leaflet or peak flow diary.

From a young age, probably around seven or eight, I was given autonomy over when to take my reliever and preventer inhalers. That meant instead of needing a trip to the asthma nurse for permission to increase my preventer, I already had permission to take it four times a day until I felt “better.” The knowledge that I was being trusted by someone I admired gave me huge confidence in my ability to manage my asthma.

When teachers (and the school care taker on one occasion!) wouldn’t allow me access to my inhaler—stored on a high shelf in my classroom—Mr. Pierce wrote a letter saying I needed to carry my inhaler on me at all times. As girls’ school skirts and dresses did not have pockets at that time, I was given permission to wear a “bum bag” at school. I chose one that was luminous blue and pink, which I thought was outstandingly cool.

Conveying confidence.

Towards the end of primary school, when my asthma was unstable, I was prescribed a tablet by Mr. Pierce. I got upset and embarrassed when I had to tell him I couldn’t swallow tablets. He burst out of his room, making me jump as always, and came back with the young doctor who had recently joined the practice. The doctor examined my neck and throat and told me that I could definitely take tablets and that all I needed to do was “drop and plop”—take a “drop” of water in my mouth and “plop” the tablet in before swallowing. Again, the confidence of Mr. Pierce and the doctor allowed for no doubt—I took the tablets without issue because I’d been told that I could do it.

I don’t remember my last appointment with Mr. Pierce as anything out of the ordinary. He told me that he was retiring and that it was now up to me to make sure I kept up the good work that kept my asthma under control. I was around 13 or 14 and absolutely confident in my management plan and my ability to put it into practice.

Over the 20 years since Mr. Pierce retired, I’ve been a patient at five other GP surgeries. I haven’t had the same rapport or trust from any of the asthma nurses; I can only remember two of them. One of them, Ms. Davies, was good, but she retired and when my breathing deteriorated again, the GPs were unwilling to increase my medication. This resulted in my first emergency ambulance and a trip to A&E for an asthma attack, age 34. I required five nebulizers, a magnesium drip, and a course of steroids. Mr. Pierce would never have refused to tweak my medication when I told him I was poorly controlled.

Since then, my asthma has been rediagnosed as a form of systemic allergies (mast cell activation syndrome). However, getting to that diagnosis has required me to be an expert patient, strongly advocating for myself with a large number of doctors.

When an experienced nurse really listened to what I, initially a scared five-year-old, had to say, he taught me so much more than how to manage my asthma. A few years ago, my mum told me that she had read his obituary in the local paper. I wish that I had told him how important he was—and still is—in maintaining the stability of my airway.

By Aimee Grant, PhD, independent scholar, Cardiff, UK

*not his real name

Editor’s note: A number of terms used in the UK have been retained, including A&E (emergency department; ED), “surgery” (physician’s office), and several others. Their meanings should be clear from the context. A few spellings have been changed.