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Smoking Lives

Smoking Lives
Smoking Lives
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One of the things you learn in medical school is when you ask someone “Do you smoke?” and they say “No,” you always follow up with: “Did you ever smoke?”  The answer can be surprising, as in, “I quit yesterday.”  And they quit yesterday because they couldn’t catch their breath either due to a pneumonia or bronchitis. I always joke that patients get no brownie points for not smoking when they can’t breathe. They do get brownie points when they’re back to breathing, sort of, like the rest of us humans, and still don’t smoke. Unfortunately, most, to the delight of the cigarette companies, go back to smoking.


Of course growing up in Ireland smoking was the norm, really.  My parents smoked.  And like all parents back then they smoked in the car with us kids captive in the back seat.  Unbeknownst to my parents, and millions more like them, their back seat captives were sucking in the nicotine, the carcinogens and all the other cigarette muck that they were.  But perhaps in smaller doses.  Remember, the belief back then, and until really recently, was the stupefying, ridiculous concept that second hand smoking was safe as in, “no problem.”  Don’t worry about it.  An idiotic concept but one that cigarette companies sold and we bought for decades.


My parents had five of us, four girls and a boy. Of the five of us, three smoked, one crazily still does, and two of us never did.  The two who didn’t, me and my younger sister, are both asthmatic. Isn’t life grand?  How much did “my” second hand smoking contribute to my asthma?  Nowadays, most pediatricians would say, parents smoking around a child, let alone when they’re captive in a car’s back seat, is a factor.  But this is now, that was then. Needless to say, not smoking would’ve been better for their lungs too.  My mom, all of 86, has COPD, Chronic Obstructive Pulmonary Disease, also known as smoker’s lung disease. Luckily for her it’s relatively mild.  My dad passed in his early sixties from a heart attack.  Dropped dead walking down the street.  Sudden death is always devastating for the surviving family.  No easier when you’re a doctor, I assure you.  Apart from his age, smoking was his biggest risk factor for a heart attack. That’s the fun thing about smoking: it has lots of ways of killing you.


Not through choice, but dealing with the effects of smoking has become a theme in my life.  As a young doctor, all of 24, the first person I ever told that their life was going to be significantly shorter than they realized or was fair, happened to be a cab driver named Joe.  You see, Joe came in for a quick surgical procedure to remove a burrowing skin cancer on his face.  As a conscientious intern I noticed his nails were clubbed, a change in nail curvature, hinting his cigarette smoking might have caught up with him.


Sure enough, his chest x-ray showed a large mass.  Subsequent work up proved it to be an inoperable lung tumor.  Amazingly enough it fell to the lowest member of the team – me, Dr. Joe – to tell Joe the Cab Driver the news.  So I sat down beside him and told him how it was in simple, every day Dublinese.  He took it about as well as anyone I’ve ever seen and the moment lives with me to this day.


All he wanted was to get back to his life or what was left of it.  No maudlin for Joe. He didn’t want me to tell his wife.  She didn’t like the “white coats,” he said. They scared her.  He understood he’d have to bring her into the know.  This wasn’t something he could hide, he knew.  He’d tell her himself though.  In his own way.  In his own time.  And I had respect for that.   Unfortunately, Joe wasn’t the last person I had the “conversation” with and there’ll be more.  Did I mention I hate smoking?


So it’s 2015 and smoking lives while Joe, the cabdriver, is long gone. Sadly, when it comes to what kills us, smoking still tops the charts.  It’s the single most preventable cause of death here in America.  Killing 480,00 of us each and every year. And let’s not forget that COPD affects more than 5% of the population.  That’s one in twenty people, so if you don’t suffer from COPD you know someone who does.  Fortunately for them we can certainly manage COPD better now than ever, but a cure remains beyond us.


In my own family, of my three sisters who smoked, two have COPD. On the smoking front, one has quit but maddeningly the other is in denial.  “You have to die of something,” is her favorite response.  Indeed you do, but do you have to gasp miserably for decades beforehand?  There is no other answer but “No.”  Hopefully, she’ll read this and cop on.  Forgive me if I don’t hold my breath…


PS: For the full skinny on COPD, smokers’ lung disease, check out my upcoming article: “What is COPD?


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