[ Post a Response | The Sublime Desire of Cigarette Smoking ]
Posted by M G F on March 25, 2007, 6:32 pm One day, after helping a 70-some year old man through a bout of coughing and seeing him comfortably at rest, I went on scheduled break and joined a couple of colleagues on the roof for a couple of cigarettes. We discussed work and a couple of patients who we are sure, despite their lungs not having even a fraction of the resiliency they need to efficiently expel the excess mucus, despite being dependent on inhalers to keep their bronchioles open, and despite being out of breath to some degree after just getting out of bed and walking to the restroom, will probably resume smoking as soon as they are discharged. All three of us agreed that we would like to believe that were we in the same condition, we would do whatever was necessary to quit smoking, but acknowledged that we might not. Why should we think we would be any more likely to quit smoking then than now? All of us know the facts and all of us have felt the small changes in our stamina, yet we aren’t giving serious consideration to quitting any time soon. I drew on my cigarette and inhaled, and as I felt my lungs expand as I filled them with smoke thought of my patient and had a keener appreciation of the Risk I was taking The experience also rewarded one of my particular facets of the DS fetish: witnessing the lungs amazing ability to heal. All smokers experience this every day when we find ourselves coughing a little as the cilia in our bronchial tree begins to recover and “sweep” the secretions upward. We experience it in the excess mucus that accumulates as we sleep. We experience it in our lungs continuing to function day in and day out even as we corrupt them day in and day out. It is an ongoing dance, our lungs and immune system unrelentingly trying to stay ahead of the unrelenting abuse our addicted bodies demand. Eventually, though, something has to give. All of my patients, even those with the most advanced cases of emphysema, conditions improved the longer they went without smoking. Granted, the supplemental oxygen, assorted medications, breathing techniques, and other measures all contributed, but at the base was the human body’s ability and desire to heal itself. I found that I identified most closely with one patient in particular, a 43 year old woman who was recovering from the most severe case of pneumonia I (and the doctors) have ever seen. It had progressed much to far before she sought medical attention and her life was genuinely at risk when she was admitted. She has been a smoker since her late teens and consumes a little over a pack a day. As we discussed her condition and what she was experiencing as her condition improved, we naturally discussed the role smoking had played. Her lungs, weakened by roughly 30 pack years of smoking, were fare more susceptible to severe infection and were far less able to combat it and to cleanse themselves. Her condition, with treatment, including three days on 75% oxygen, improved rapidly; but even when her breathing was no longer labored and she was able to walk the length of the hallway at a normal pace with only moderate breathlessness, there remained the matter of getting rid of the congestion and fluid. It wasn’t just congestion from her pneumonia she was trying to expel, it was also mucus that resulted from her having, until a few days before, been a committed smoker. After another five days, each of which involved respiratory rehabilitation therapy, she was discharged. The physician reviewed what she would need to do to continue to recover and, of course, that included not taking up smoking again. I was left with her to make sure she understood correct operation of her inhaler and spirometer (for self monitoring). I explained that if she resumed smoking, it would probably be reflected to some extent in her daily test results, and a decline in the pace of her improvement. I then asked her point blank if she planned to start smoking again. Her paraphrased response: “It’ll probably be the first thing I do when my friend picks me up. I know I shouldn’t. I know I just dodged a bullet. But I’ll just have to hope I can do it again if necessary. I’m sure you understand.” Yes, sister, I do. Believe me, I do.
In order to maintain a couple of professional certifications, I recently had to work 6 weeks in the pulmonary section of the hospital. I have worked with pulmonary cases in the past, but this shift was the most intense and prolonged period of doing so. I have had opportunity to do it in the past, but have always delayed doing so. I wasn’t sure how I would react to being surrounded by vivid evidence of one of smoking’s most devastating consequences. Would it change how I regard smoking, how I regard the Risk; if so, how? The majority of the patients were smokers or former smokers and almost all of their pulmonary problems were from smoking. Most were in their 60’s and 70’s although there were a few in their 50’s and 80’s. Every day I was witness to the cumulative effects of smoking on the body: The need for supplemental oxygen, constant shortness of breath, even when at rest, dependence on inhaled anti-inflammatory steroids, and the wracking coughs that rarely produced anything but left the patient exhausted and gasping for breath; all of it was there for me to see in vivid detail. In the past colleagues who have “pulled” similar shifts have decided to quit smoking, and have done so for admirable periods of time. All, however, have eventually returned to their lover. The further one gets from the evidence, the more reasonable one’s denial becomes, it seems. My experience was different. I did not find myself any more interested in quitting than I have ever been. Instead, my awareness of the Risk was heightened and it became more tantalizing in some ways.
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