Ruby Mae Davis
46 · Jackson, TN
- ProfessionUnemployed caregiver
- AccessMedicaid · transport barriers
- ExposureAgricultural dust
- AdherenceInconsistent
- MotivationExtrinsic · her children
Deep Dive
A caregiver to her mother and children who can't afford to be sick — and whose own health "usually gets pushed to the back." Medicaid still leaves copays that force a choice between inhalers and groceries; a broken car and no bus turn every refill into a favor asked of a neighbor.
Interesting Insights
- Diagnosis was overwhelming and shaming — anger for her kids, and a sense she'd "done something wrong," despite never being a heavy smoker.
- She chooses between copays and groceries, stretching her inhaler or using less than prescribed — and feels guilt for it.
- Faith and church community give real comfort and practical help (rides, meals), but can't solve the systemic problems of money and transportation.
- A key barrier is forgetting inhaler technique and a reluctance to rely on medicine — preferring to "tough it out" or save doses for when it's severe.
- Her most effective adherence strategy is external prompting from her daughter, who sets alarms and checks in.
- Agricultural dust severely exacerbates symptoms, restricting her ability to even go outside; rehab is inaccessible on distance plus embarrassment in a group.
Barriers by Stage of Change
Jobs To Be Done
Aspirational
- Be a reliable caregiver for her kids and mother
- Regain a sense of control over her health
- Live a life not fully restricted by illness
Functional
- Get through daily activity without breathlessness
- Obtain and afford medication consistently
- Use inhalers correctly and remember them
Emotional
- Alleviate the "heavy," overwhelming weight
- Feel less burdened and embarrassed
- Draw strength from faith and community
Social
- Avoid being a burden to family and church
- Maintain independence
- Receive supportive reminders from family
+ Read the full interview transcript · September 2025
1 · When you first learned you had COPD, what was that experience like?
I found out about the COPD maybe... it's been about three years now. I kept having this cough that just wouldn't leave, and I was getting more tired than usual, even just folding laundry or walking out to the mailbox. I sorta shrugged it off, figured it was allergies or just some bug. But my daughter kept bugging me to go to the clinic. When the doctor told me it was COPD, I honestly didn't know much about it. It felt heavy. Part of me was mad — mostly for my kids, 'cause I'm all they got at home. Then there's this bit of shame, too, like maybe I did something wrong, even though I was never much of a smoker. I got kind of overwhelmed. Bills already hard, work's dried up, I take care of my mom. Now I got this new mess to deal with?
2 · What challenges do you face with your transportation and financial situation?
Getting to the doctor's or pharmacy is a headache every time. I don't drive — the car's been busted — and there's no bus that comes out this far, so I rely on my neighbor or a cousin. That means sometimes I miss appointments or wait too long to pick up my inhalers. Money's another problem. Even with Medicaid, some meds got copays, and when you're choosing between that or groceries, it's a real choice. I've stretched my inhaler or used less when I was worried about running out before I could pay for more. It's tiring, juggling the appointments, the rides, the money, and looking after my mom and kids — some days I just push it all aside 'cause I feel like I can't keep up.
3 · How do your religious beliefs or community connections influence your COPD management?
My faith is a big part of how I get through all this. I pray about my health every day. There's comfort in believing God's got a reason or a plan. The church folks help in ways I don't always talk about — some ladies check in on me or bring by a casserole, or offer a ride if they're headed near the clinic. It means more than they probably know, 'cause it's not easy to ask for help. But honestly, sometimes all the prayers and community can't fix the real problems, like not having a car or money for meds. Faith gets me through the day, but it doesn't make it all go away.
4 · Walk me through a typical day and how breathing affects it.
Most mornings I wake up feeling like I barely slept. My chest gets tight before I even get out of bed, especially if it's humid or someone's kicked up dust in the fields. Getting everybody ready — me, my mom, my youngest — is already a struggle. Simple stuff like making breakfast or taking out the trash, it's slow going. I have to stop and rest after a few steps. Chores pile up. On bad days, stuff just don't get done and I feel like I'm letting the house slip. Walking to the mailbox can set off a coughing spell. Everything takes more planning and twice as long as it should. It makes me feel older than I am.
5 · How has your experience with inhalers been, and what makes consistency hard?
Using the inhalers, it's not as simple as they made it out. When I got the first one, I kept forgetting the steps, or didn't know if I was doing it right. Sometimes I'd skip it, telling myself I'd remember later, but the day just gets away from me. It feels weird relying on medicine all the time — part of me wants to tough it out or save it for when it's really bad, since I worry about running out. Having to pay even a little for refills stresses me out. There's times I've dropped it or lost it under the couch and let it go for days. Sticking to the schedule feels impossible some days, with rides, cost, and forgetting all playing into it.
6 · What happens when you're exposed to agricultural dust?
When the farmers work the fields, there's dust in the air — sometimes you can see it floating. Soon as I breathe it in, my chest feels tighter, like someone's sitting on me. It's a deeper cough that keeps coming, and no matter how much I cough, I still feel like I can't get enough air. I start wheezing, and it burns in my lungs. On bad days, just walking to the mailbox means I've gotta stop and rest. I try to keep the windows shut, but dust still gets in, and we don't always have money for filters or fans. Afterwards I stay tired for hours and my chest hurts. It makes me not want to go out at all.
7 · Tell me about a time your symptoms were at their worst.
Last summer was the worst spell I had. It was hot and muggy and the farmers were baling hay across the road — dust came right through the window screens. I started coughing more than usual but figured it'd settle. Instead, by the next day I could barely get around. I tried my inhaler but it didn't do much. I got scared when I couldn't catch my breath after just walking to the kitchen — dizzy, felt like I might pass out. My daughter got really upset and called my cousin, who drove us to the hospital. They gave me oxygen and medicine through a machine. I stayed overnight. I kept thinking about the cost and whether my mom and daughter were okay. It took days to get back to even half of normal.
8 · Tell me more about first learning you had COPD.
Getting told I had COPD kind of knocked the wind out of me. Before that, I just thought I was tired from doing too much, or it was my allergies. I went to the clinic mostly 'cause my daughter wouldn't stop worrying. When he said COPD, I had to ask if that was like asthma or something else. I went home scared and pretty lost. My worry was mostly for my kids, 'cause I'm the one looking after everybody. It was embarrassing, like maybe I brought it on myself. I cried a little that night. It made everyday things feel heavier, 'cause now when I struggled to breathe, I knew it wasn't going away.
9 · What strategies help you remember your medications?
Remembering meds ain't my strong suit, but I've tried a couple things. I leave my inhaler on the kitchen counter next to the coffee pot since I go there first every morning. If I see it, I'm more likely to use it — though sometimes if I'm in a rush I walk right past. My daughter set alarms on my phone, so it beeps; sometimes I just hit snooze, but on focused days it jogs my memory. I jot reminders on scrap paper for the fridge, but if the house gets busy I forget. Honestly, what works best is when my daughter checks in and asks, "Mama, did you use your inhaler today?" That push from her gets me to do it. Nothing's foolproof, though.
10 · Tell me about the rehab or breathing exercises recommended to you.
The doctor and nurse talked to me about "pursed-lip breathing" — slow the breath down and blow out through your lips. It did seem to help when I was feeling tight, but it's not something I remember to do regular, especially chasing after my mom or the kids. They mentioned pulmonary rehab classes, but those are all the way over in the next county with no way to get there steady and nobody to watch my mom. The thought of working out in front of other people is embarrassing — I get self-conscious if I'm coughing or have to sit down. Even at home there's always a distraction. I get frustrated and think, "What's the use?" when nothing feels better right away.
