async="src="/ Taking the Long Way Home: A healthy addiction and a trip down memory lane

Tuesday, June 3, 2014

A healthy addiction and a trip down memory lane

Today in my clinic, I saw one of my newborns for a weight check. Although this wasn't a first baby for these parents, their other child was 18 years old and mom was trying to breastfeed, so I wanted to check in with them sooner rather than later. The baby looked fabulous, had gained 9 ounces in 5 days (!), and the parents were definitely more at ease than the last time I saw them.

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.

This encounter really got me thinking. I will never understand smoking--I never had any desire to start. When I grew up, almost every adult I knew smoked. Even my mom smoked! My grandma smoked! We had ashtrays in our house for when smokers came over. Some of those ashtrays were prized pieces of pottery. There were candy cigarettes for kids, which we begged my parents to buy for us, and when we blew through the paper wrapping on them, a puff of powder came out of the end. Smoking was glamorous. At least that was what the American Cancer Society tried to tell us.

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.


  1. As a previous smoker of nearly 20 years, my heart goes out to this man...this family. It's hard to understand addiction when you aren't in it knee deep...but as someone who got off the bus from Air Force Basic training and was handed a cigarette, I can empathize. It is a tough battle to win, and to this day I can't lie and say I don't miss smoking from time to time. But I do my best to do the right thing, which isn't always easy. It's easy to say, "just give it up" "do something healthier" but when it has become a way of your life-it isn't always that easy. Prayers sent that he finds his niche, and is able to give it up. It sure is tough!!

    1. And that's why I don't judge. I'm so glad you quit and chose a healthier addiction!

  2. Ha! Fine pottery ashtrays. We had them in the house growing up too. When I'm out running, SO many are still out in their cars smoking. I've had friends and parents of friends continue to smoke through lung cancer. Truly it is a fierce addiction. I think the key is never to start. I'm hoping/praying my kids will be smart enough to make the right choice.

    1. I'm pretty sure my kids won't smoke, because none of their friends do. That seems to be the biggest influence out of everything teens do. Both my boys have asthma, so I sure hope they don't smoke!

  3. I want to bring every single smoker to see my pulmonary patients on oxygen, barely able to walk 20 feet without their oxygen saturation dropping to 79% even on 10 liters. The mucus production. The meds....It's horrible. I just don't get smoking at all.

    1. Yeah, I agree with you but the addiction is so strong..that wouldn't probably deter most of them!

  4. Just hoping and praying that your conversation with him...and the silence, will have a positive impact on him!

    A precious child for whom to live: No Better Reason! :)

    1. I'm hopeful. These parents really seem to like and respect me...hoping to have a positive influence. But with such a strong addiction--its hard to override that.

  5. Good of you to spend time with the family talking about the big picture, that's how it should be done. And I'm sure it is hard not to judge when it's an addiction you've never experienced yourself (and I have not, either), but it is a notoriously hard one to quit. Logic alone doesn't work well. Did you refer him to some smoking cessation resources? I'm guessing yes. Our state has a stop-smoking phone line and lots of billboards-- I'm glad we didn't use the tobacco lawsuit settlement money for something else as many states did.

    1. Actually, I didn't refer him...I'm certain that with what he went through medically, he knows all the resources. He knows how bad this is for him--that's what's so hard for me!