Smoking

She smoked. There was always a pack of Lark cigarettes on the kitchen table next to a half-empty cup of lukewarm coffee. I couldn’t stand the smell of coffee for years because it was comingled in my nostrils with curling cigarette fumes. I had to beg her not to smoke in the car, where the combination of motion and tobacco smoke nauseated me until I had to yell to my father to stop the car, just in time to open the door and throw up on the side of the road.

A friend of mine once jokingly chided her mother for smoking around her when she was a baby. Her mother defensively stated that her doctor had actually smoked with her! We’ve come a long way since then, but despite progress in our understanding of the hazards of smoking, a significant proportion of the population continues to smoke.

Let’s call her Doris (though that was not her real name). She was as lovely as could be last winter. She had been up on the fifth floor for weeks, but just couldn’t wean herself off less than 8 liters oxygen to go home. She made no excuses; her lifetime of smoking had left her lungs both restricted and obstructed. On rounds, we started to discuss the likelihood of her going to a facility, rather than seeing her new grandbaby, a choice she understandably can’t fathom.

As a family physician for over forty years, I’ve dedicated enormous time and effort to ending tobacco use through a non-finger-wagging approach to patients in the clinic and the hospital, as well as through the use of humor and parody to students in middle schools and high schools.

Few conditions demand more of patients and their physicans than the journey, the odyssey, to becoming a former smoker.

Hello. My name is Sharon and I am an addict. My drug was tobacco. Exposed early, by smoking parents, I tried tobacco in high school and was quickly dependent. It calmed me. It gave me something to do with my hands. I smoked out my window at home and, when I could, other places. I was not alone. This was 1964.

In the mid-1970s, as a preschooler, I used to stare at a poster in the waiting room of my pediatrician’s office. This poster depicted a disorderly person, dark hair unshorn, snarling and puffing on a cigarette. The poster’s caption: Smoking Is Very Glamorous.

Several months ago, I was in an appointment with “Richard.” Richard was a 45-year-old Italian-American construction worker, a father of three (four if you counted Gerald, his family’s new labradoodle puppy—which I did), and a devoted husband to his wife, Sherri, his high-school sweetheart. Unfortunately, none of these descriptors explained why he and I were in the same exam room. That was because I am a medical oncology scribe. I write notes for an oncologist. Richard was our patient: a former smoker receiving treatment for Stage IV lung cancer.

When I was a third-year medical student in 1972, the young attending physician on my cardiology rotation said smoking was okay. Actually, he said that he had wanted to do something to manage the stress of his work and had looked carefully into the options that were available at that time. He told us that smoking a pipe seemed like the safest option, so that is what he did.

I was looking forward to seeing her in my clinic that morning. Marsela was a 60-something-year-old Albanian grandmother whom I had been following for her chronic anemia. At first, the visit went as I expected. Her bloodcounts were stable, and she had no new symptoms.

Buzzzzz!  I looked up from charting temperatures and checked the call board. It was Mr. Anderson again. Geez, I thought, this is the fourth time he’s rung his bell, and it’s only 4:20! We have a long way to go till it’s 11:00. When I walked into his room, he was sitting straight up in bed with his legs on top of the covers. His face was drawn up in a tight scowl. “What can I do for you, Mr. Anderson?” I asked.

Throughout my adolescence, I yearned to be a member of the in-crowd. However, as a self-defined nerd who preferred hot Ovaltine over a cherry Coke or typing my school notes over watching American Bandstand, I wondered if I would ever meet the criteria for being cool: mastering the jitterbug; being pretty, perky and petite; and smoking.