At one point in the conversation, I began to wrap up the visit. I don't recall exactly what I said, but it prompted the father to lift his shirt and show me a long scar that extended the entire length of his sternum. "Aortic aneurysm," he said. "I also have COPD and emphysema." Which are the same entity, by the way.
I knew it! He had one of those "smokers' voices", that deep, raspy voice that is so distinctive, I was certain he was a smoker--but at the last visit, when my medical assistant asked about secondhand smoke, both parents said no. I asked him if he was currently smoking.
He told me he quit a few years ago, but looked embarrassed and admitted to recently "sneaking a few". He told me not even a pack a day, and he didn't smoke around the baby. I chose not to focus on that, but instead talked about his health. Both parents used to be heavy smokers, he told me, but the mom quit a few years ago. They had been trying for a second child for years, but it wasn't until she quit that she was able to conceive. The dad was convinced that quitting smoking was the reason she got pregnant.
Ok, so why "sneak a few"? He couldn't answer me when I asked him that very question. We talked about how addictive cigarettes were, I get that, but with his health problems, why start back up? I asked him if he's tried the nicotine gum, the patch. He told me he tried everything, but he still wanted to smoke. I empathized with his addiction. I've shared stories I've heard about big tobacco putting substances in cigarettes to make them more addictive and he nodded in agreement. He seemed to think, though, that since he survived the aneurysm, that he dodged some sort of a bullet. I didn't use the "C" word--cancer--or go into a discussion about the progression of emphysema/COPD. Clearly, he'd heard everything I said before.
Finally, I held up his beautiful, perfect baby boy and asked him if he wanted to be around to see him grow up. To see him graduate from high school, college. "And get married," he said.
Nobody said anything after that. I looked down at the ground. Trying to think of the right thing to say and not pass judgement, I caught a glimpse of my boot. As a distance runner, the idea of smoking is so foreign to me--I had a hard time figuring out what to say next. As an NP talking to a father who has experienced first hand some terrible health consequences of smoking, yet is still smoking--clearly, nothing I could say would stop him. I needed to wrap up the visit, so I let the silence finish our discussion and made plans for follow up in a month.
|The quintessential smoking stud of the 70s.|
My high school had a "smoking lounge" outside behind the school. If you wanted to be able to smoke, your parents had to sign a permission slip. The idea was to deter students from smoking in the bathrooms. Which didn't work. I hated going to the bathroom during passing time--for sure, girls would be in there lighting up. My freshly washed hair, using "Gee Your Hair Smells Terrific Shampoo", was ruined. Every. damn. time.
|This would never happen to me!|
My mother-in-law was a heavy smoker. One time I rode up to my father-in-law's cabin in Wisconsin with her. A 3 hour ride, she smoked the entire way. One cigarette after another. I staggered out the car when we arrived, nauseous. My husband asked if I was ok. "You look green", he said.
When I was a new staff nurse, in the 1980s, I had a job working on a medical oncology unit. It was the only job I could find at the time. I learned a lot, and I learned that I didn't want to take care of adults. But when I look back on that experience, what really stands out was that patients were allowed to smoke while hospitalized! And they did--even while receiving chemotherapy. Contrast that with now--you can't even smoke on hospital grounds! One hospital I worked at said they would fire employees who were caught smoking anywhere on hospital property, even if they were sitting in their own vehicles.
As a home health nurse, I did take care of some adults. One memorable experience was a visit to see a man with tongue cancer. He was dying, and I was there to hook him up to a morphine pump for pain control. No one prepared me for what to expect, which would have been nice. When I walked in, he was sitting in a chair, blood dripping out of the corners of his mouth, his tongue the size of a steak. Not only was I completely nauseated after seeing that, I couldn't eat beef for weeks after that experience. But the best part of the visit? His wife was in the corner of the room, you guessed it, SMOKING!
|And yes, I took care of a few people who smoked through their tracheostomy.|
A few years ago, one of my neighbors, a mom who was my age, was diagnosed with stage 3 lung cancer. She called me to talk about a persistent cough that wouldn't go away. Her doctor kept prescribing antibiotics, which didn't sound right to me. Although I don't take care of adults, I recommended that she go to see a pulmonologist. After being diagnosed with cancer, she told me that both her parents were heavy smokers. She herself never smoked. She did not survive this illness.
So, so many stories about smoking. In my practice as a pediatric nurse practitioner, I do my best to deter adolescents from smoking. But they've heard all the health risks and since thinking they are invincible is part of adolescence, me talking about the risks doesn't do much. So I talk about the cost. Sometimes that makes a dent. Other times, not. A lot of kids tell me they get cigarettes from their friends.
Or as the dad today told me, teenagers get money from their parents for all kinds of things. Lunch money, whatever, if they want to smoke, they'll find a way to do it. Just like sex....
Today's visit made me sad. Smoking is such an unhealthy addiction that affects more than just the smoker's health. As runners, we joke about our addiction to running. Ok sure, I have a broken foot, and I've been joking about how exercise is bad, but in all seriousness, the other health benefits of running--lowered cardiovascular disease, diabetes, obesity...outweigh the risks of physical injury. Would it really be so hard to trade one addiction--smoking--for another, healthier option? Those endorphins sure keep me coming back for more. And I'm pretty sure I won't die from them.