Tobacco use is killing our patients, our colleagues, our friends, and our loved ones. If we don't stop it, we're part of the problem.
Monday, I diagnosed lung cancer in a patient of many years; the disease likely was caused by second-hand tobacco exposure at home from her husband and at work. She is a wonderful woman, and her prognosis is very guarded; she is not likely to survive 6 months, and I shall strive to make things go as well as possible for her and for her family. She will be in a care facility for the rest of her life.
Tuesday, a patient whose care I had assumed at the skilled nursing facility died of lung cancer, surrounded by family. He had come to the emergency department less than 2 months earlier with cough and congestion, the terminal diagnosis having been made then. As supportive and as loving as his family was, my thought was that I wished they had gathered for a happier event.
Thursday, a dear patient of mine died in a care facility after months of chemotherapy and radiation therapy for widespread lung cancer. She had been a long-time smoker, and I was able to get her to stop-too late, sadly. She told me I had been right and that she should have listened to me sooner, words that only made me feel worse.
Friday, I had another session of an ongoing dialogue with a patient who continues to smoke after treatment for throat cancer. He enjoys smoking, he told me, and he has no plans to quit.
"When are you docs gonna give up on this smoking thing?" he asked.
"We'll quit when you do," I told him.
Sunday morning, my son picked me up at the airport after a brief trip. Coming out of the building, I saw a man smoking under a large no smoking sign.
I stopped and asked him whether he could read the sign. He looked at it, and then he said to me "It says mind your own G-damn business.' "
"No," I told him. "It says there are people who love you and care about you, so please stop smoking."
He swore at me, but then he put out the cigarette. Did what I say make him a non-smoker? Probably not, but if it moved him one step forward along the path of becoming tobacco-free, it was worth it.