Here’s (Cough) Looking at You, Kid
Call me irresponsible but sometimes I can’t help but marvel at cigarette smokers who attempt to rationalize their years of pure smoking pleasure with their newly diagnosed lung cancer. Taking up the coolest habit of the cool all those years ago must have left them trembling with excitement as they learned how to light up and hold a Marlboro like Robert DeNiro. Now they sit humbly on an exam table in my office while I lean into the x-ray viewbox, silently despairing at the grotesque blotches of metastases splattered all over the CT scan. Peering at the black and white shadows I can see their future slip away like a capsized rowboat sinking slowly under the waves.
Part of the initial interview is to determine the patient’s history of smoking - calculated by multiplying the number of packs smoked per day times the number of years smoked. This result, called pack-years of smoking gives oncologists an idea of a patient’s risk for developing tobacco-related cancers. For example, four packs smoked per day times 50 years (200 pack-years of smoking!) pretty much guarantees a patient will develop a malignancy - if they should live so long (cf. coronary artery disease). When I ask a patient about their smoking history I do it in a straightforward and non-judgmental manner. I don’t see any point in scolding someone about the reason why they are visiting me today - they know the truth of the matter. What is amazing is some of the answers I get from smokers as they try to wiggle out of the desperate situation they find themselves in, as if one could extricate oneself from a barbwire coffin without receiving a scratch.
The Cheerful Oncologist would therefore like to inform all smokers that one does not get a kinder, gentler form of lung cancer for having been less than a full-blown chain-smoking Humphrey Bogart. For example, I have heard the following comments when asking about a patient’s love of Nicotiana tabacam:
“Doc, I only smoked short cigarettes.” (Is this the same thing as using only a small caliber revolver?)
“I quit smoking years ago.” A variation of this answer is “I only smoked on and off.” (Achtung! Cancer, once on the scene, doesn’t give out warning tickets to reformed smokers!)
“I only smoked in social situations.” Or, “I only smoked when I was drinking.” (Hey, this is America - last time I checked every man, woman and child was jabbering with friends!)
“I never inhaled them.” (I’ve heard this before somewhere…)
And of course, that all-time favorite: “Doc, I just laid ‘em down and let ‘em burn up in the ashtray.” (This seems to be a variation of the “Gee, Officer I have no idea how fast I was going” excuse).
Feeling magnanimous, let me also inform smokers that we oncologists don’t give a hoot when we hear that Uncle Jesse smoked three packs a day his entire life and is 92. Uncle Jesse ain’t here in the room wheezing like a chimpanzee playing a violin, and no partial credit is given to lung cancer patients who have smoking relatives who look like James Bond! All this braggadocio means is that your favorite uncle will likely be around when it comes time to don his Sunday best and climb into a black limo while you are taking a horizontal ride to the grassy knoll.
So, dear lovers of what the beloved Wodehouse character Bertie Wooster calls “gaspers” - don’t try to kid yourself about smoking. Even if you smoke “just a little“, you can get cancer. Please keep that in mind the next time someone offers you a cigarette, or the next time you feel the urge to light one up, or the next time you see a pack of ultra-lights in the grocery store, or the next time you see someone on the silver screen dangle one from the lips, or the next time you smell smoke on your teenage son or daughter.
This has been a public service announcement from your friendly neighborhood doctor.
Ok, Dr. Cheerful,
I am a little annoyed with you at the moment. I feel personally offended. let me remind you that there are people such as myself, who have NEVER EVER smoked ONE cigarette and get lung cancer. I can blame genetics, my parents who smoked, and all the other smokers who filled my lungs with their wayward garbage, the pollution, radon, or just the luck of the draw.
I have stave IV adenocarcinoma of the lung, now doing extremely well, with a great response with shrinkage of tumors via Tarceva. I am obviously, of the sub-group of folks who respond to this little marvel of a little white pill. I am also a Bernie Siegel method believer and practicer (is that a word?), and I am determined to do all I can to find the dragon that came to slay ME. If nothing else, let this disease become a chronic, manageable disease, and may the stigma of smokers be removed so that the appropriate amount of research will be done to see progress in the treatment of this disease. After all, some of us who have it, like me, did not smoke. Stop haranging the smokers, because of their sin, because the attitude does nothing to help me, the non-smoker with lung cancer, does nothing to increase the interst in lung cancer research because of the blame aspect, and possibly prevents the compassionate desire to improve the recovery odds.
By the way, I am not a statistic, I am thriving, and I confess that when I see a smoker I am angered. There they are, asking for it, and I did nothing, and I am the one with the white and black patches on my x-rays and CT scans.
Life just ain’t fair, is it. But no one ever said it was.
I feel a little better. A rebuttal?
Comment by Feisty — June 29, 2005 @ 3:43 am
You’re right Doc, there is no need to scold. Addicted people aren’t grounded in reality. People smoke because they’re addicted and they think they will be the one who escapes cancer.
Comment by Kate\'s Mom — June 29, 2005 @ 3:55 pm
personally, i wasn’t offended in the least, and my beloved dad died of cigarette-induced lung cancer when i was a tender 21. his doctor told him to quit and he did so - cold turkey. never had another smoke. died within ten years.
the CH obviously cares about his patients… enough to blog about them.
i think, aside from a healthy vent of frustrations, he was only trying to say “smoking is bad, nnkay?” hence the public service announcement.
Comment by ashli — June 30, 2005 @ 2:47 am
don’t mind the public service announcment, but perhaps you can see why I might feel emotional about the subject.
I want to see a light shone on lung cancer research, because there are people who have it and don’t smoke, and there are people addicted and can’t quit.
If constant negativity surrounds the disease, the hope for a cure may be delayed.
I know he cares, and I suspect he’s angered by the fools who smoke (ME TOO),
but please help the cause of research…
Comment by Feisty — June 30, 2005 @ 4:02 pm
Dr. Unfriendly,
Is it just me or is the C.O. not quite as C. lately?
Being from a family which seems to have some sort of genetic predisposition toward developing lung cancer, I’ve steered clear of the cancer sticks myself. A few of my family members have died from lung cancer, some smokers, some not.
I can understand somewhat, your dismay, at treating patients who you believe have made themselves sick.
Imagine, if you will, my dismay at having physicians prescribe Risperdal for my autistic child and then finding out that it has caused him to have some sort of movement disorder that he now has to take another drug for. And now I read that they suspect Risperdal as a cause of pituitary tumors.
Imagine, also, my dismay at having allowed my child, when he was still an infant, be injected with vaccines that contained mercury, which the pediatrician neglected to tell me about. It would have been child abuse apparently for me to not shoot my child up with vaccines.
Thanks to Dr. Bill Frist, the drug companies are no longer responsible for any harm, including autism, caused by their vaccines.
Doctors really don’t know much about autism and so they muddle through, make things up and cover up for each other when they make a mistake. They make a lot of money from snake oil treatments (i.e. secretin) and bullshit advice.
I feel let down by the medical community. I suppose in the same way that you feel let down by smokers who develop lung cancer. Well, except that you’re getting paid.
Comment by gl — July 1, 2005 @ 7:53 am
I’m one of those ‘morons’ as you say who chooses to smoke. That’s why it’s a choice. And it’s mine. I don’t ‘think’ I’m going to be the one not to get Cancer. I don’t ‘think’ or worry about what the cause of my death is going to be because I am busy living the life I have. Anyone who is diagnosed with lung cancer doesn’t need to be judged. They are there for treatment. Are you going to treat a smoker or ex-smokers cancer differently than a non-smokers cancer of the same type? Actually, I see doctors do this illegally all the time. You place your best medicines and treatment in reach of those who haven’t ‘ASKED FOR THEIR DISEASE’ all the time. Why are you a doctor? If the magical world of no sins came into play tomorrow, you would be out of a job.
I’ve quit a hundred times. And I’ll keep on quitting until it sticks. In the meantime, all you whiners need to get on living with the choices YOU make and stop trying to dictate to the rest of the world. If I die tomorrow, you’ll never know the difference and it isn’t like I’m costing anyone but myself a dime, so that lame argument doesn’t need to be rehashed either.
You chose oncology so you should expect to see cancer all the time..and it makes no difference HOW the cancer got there. Face it, you can’t prove without doubt that anyones cancer is caused by any ONE thing anyway, so get off your high horses and stop speaking as if you can.
Comment by radtec — July 1, 2005 @ 7:17 pm
Over on this side of Atlantic the Scottish Parliament has of two days ago voted 97-17 in favour of a complete ban on smoking in all public places Bars, Restaurants, etc (even in theater plays where it part of the script, apparently).
This to take effect from March 26 next year.
No more puttting all your clothes in the wash when you come back from a night out in the bars of Edinburgh. Whoopeeee…
Enjoy your very informative Blog.
PS Cheer Up !!!
Comment by Jamboesque — July 2, 2005 @ 3:49 am
Thank you for reinforcing the notion that doctors judge all of their patients. This attitude encourages people to lie to their physicians about their habits. In your next post, perhaps you can wax poetic on alcoholics who develop laryngeal cancer; do they deserve voice-preservation treatments as well? Strong work!
Comment by TRO — July 3, 2005 @ 4:46 am
Boy, did this dredge up painful memories. Both parents were heavy smokers, my mother even more than my father. I remember taking her to the doctor after her first bout with what she thought was bronchitis. She was told by the doctor that she had a pre-cancerous throat condition and that she needed to stop smoking. The first thing she did when we got back to the car was to light up. She never did die of throat cancer . . . but that was only because she died of lung cancer at the age of 57 first. That was
in 1981. I thought I’d gotten over it, but apparently it was only scabbed over. I find that I’m not really that different from my mother, though, in that I, too, have neglected my health and am now living with a bleeding ulcer
that may require surgery to resolve. Another blog termed it suicide by procrastination, which pretty much fits the situation. Thanks for the reality check. We might not like what we’re told, but that doesn’t make it any less truthful.
Comment by Catherine — July 3, 2005 @ 2:55 pm
If his comments make someone quit smoking or otherwise destroying their health, well, fine, but to belittle the smoker, when SOME OF US HAVEN’T SMOKED….makes people like me who are NOT TO BLAME FOR OUR DISEASE…feel as if secretly our oncologist might think we’re lying or covering out habit. I have never smoked one single cigarette, though others around me have. i am suffering because OTHERS SMOKED!!!!
Comment by Feisty — July 3, 2005 @ 5:57 pm
i’m sorry for my apparent insensitivity, feisty. i assure you, i’m not neutral or passionless on the subject of cigarette smoking as my dad died of related lung cancer and, i believe, my mother, who did not smoke, died four years later of cancer that may have been “helped along” by the second hand smoke from dear ol’ dad’s constant coffin nail puffing.
hang in there, feisty.
and hang in there, co. i hear what you’re saying, and you have a right to say it. this is a blog and not a hallmark card. i get it.
p.s.
i lost a child due to bad medicine. while i’m livid about that, i also have the presence of mind to know that the co is not responsible for my situation or the sundry and myriad problems that arise from HMO’s and inept practitioners. it must be somewhat difficult to have the kind of responsibility that the co has and to see so many patients slip through his fingers. naturally, it would tend to wear. i sympathize also with the fury and pain that those of us experience due to issues in medicine. i pray that we all find comfort and peace.
Comment by ashli — July 4, 2005 @ 4:24 pm
I’m always amazed by the contrast between the way the media treats smokers who have contracted cancer (”they deserved it”) with people who have contracted AIDS from imprudent sex or drug practices (”let’s raise some more money and wear another ribbon for them”). If anyone can point out a justification for this difference in attitudes, I’d like to hear it.
Comment by Redman — July 5, 2005 @ 6:05 pm
Maybe I missed something, but I don’t see the doctor judging anyone in this article. He is simply pointing out the fact that you don’t have to be a 10 pack a day smoker to get lung cancer and I can’t see a thing wrong with that. Many smokers think that if they hold it down to just a few a day they are safe and that is simply not true. The fact that some people get lung cancer without being smokers doesn’t seem to negate this important fact.
Oh, and rad? You didn’t quit a hundred times. You just took a long break between smokes. If you had quit, you wouldn’t be smoking as you read this.
Comment by TWM — July 5, 2005 @ 6:47 pm
You did make a good point…. he cautioned light smokers not to trust that because they smoke few, that they are immune. Excellent point.
Comment by Feisty — July 5, 2005 @ 11:12 pm
One of the astronauts. Michael Collins, a reformed smoker, said: “Self-inflicted cancer - what an obscenity!”
Comment by Bruce Small — July 6, 2005 @ 2:46 am
check this out!
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Comment by elsa — July 8, 2005 @ 2:28 pm
Ouch! I turned a pal on to Quit-net.com as she has been diagnosed with non-small cell sarcoma and have set a quit date for myself. It’s a choice as you said and I may still have to wrangle with disease after I quit. My dad died of lung cancer after smoking for fifty years. I still rationalized my decision as do all addicts. There are no easy answers. I chose to dance with the devil and fully realize I will in some way have to pay the piper. It is what it is…. Penny
Comment by Penny — July 8, 2005 @ 3:49 pm
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Comment by Anonymous — July 10, 2005 @ 2:20 pm
In my opinion, many doctors today are WAY TOO P.C. and not judgemental ENOUGH. Just because it’s a judgement doesn’t mean it’s not fair, as long as it is based on the individual’s circumstances.
Sometimes being aware of the problem is not enough. You need to hear it out loud from your doctor.
My personal pet peeve: Doctors who don’t tell patients that they are overweight & eating too much fat and sugar, assuming that the individual is aware of the problem.
Comment by Anonymous — July 11, 2005 @ 6:06 pm
Ahem, so much for making a trip to the fridge in the midst of composing a weblog comment.
Strike the last 9 words of my previous response.
Comment by Anonymous — July 11, 2005 @ 6:22 pm
ok, this post really pisses me off. basically, you’re telling any of us who made the wise decision to quit that we’re basically ###### anyway. or those of us who’ve stopped for years but smoked one, say, when a parent died, because i didn’t know what else to do, was just asking for it.
do i wish i’d never started smoking? you bet. but i was 17, what the #### did i know. i’ve felt good for quitting, tried not to chastise myself when i’ve fallen off the wagon because MOST doctors tell you that stopping can save your life.
i know, i’m at risk because i smoked for a long time. but as an adult i made a smart choice to quit and this posting of yours basically makes me feel like a failure.
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Comment by Anonymous — July 24, 2005 @ 12:47 pm
I smoke too because it is my choice. I know I am going to die sometime, might as well enjoy myself before the time comes. And, I might add, if things get too tough, I’ll check out before then. So if I get the Big C, big deal.
Comment by Heidi — July 10, 2007 @ 2:57 pm
well
Comment by och aye the noo etc etc — August 7, 2007 @ 1:26 am
As I was saying..! Both my parents smoked until I was about 14 and then my Dad stopped. My Mum still smokes heavily. She has ruined her skin, probably beyond repair and her lungs will no doubt be a tribute to the delicately named ‘Silk Cut’. I remember the advertising for cigs and now, at 30, think it is shameful that it was ever allowed. Sometimes I wish my Mum had some otehr more ‘noticable’ addiction which she couldn’t ‘hide’ from guests in her house (she actually thinks they won’t notice the yellow windows and smoke filled carpets). In other words, no-one seems to understand the pain and embarrassment the children of smokers now feel. I’m delighted that Scotland (and now England) have banned it in public, wish it had been in force years ago when I worked in very smoky bars/restaurants. However, the ban in some ways forces people like my mother even more ‘underground’. When I visit her I may complain about the smell that is going on to my fresh hair (trying to delicately not be over-dramatic and say I am worried about my lungs) but she retorts that it is her house. She acts like a 12 year old if I ever try and talk about it. I have begun to think she won’t get to see any children I have. I think she does about a packet a day, but that has been for 45 years, and I’m sure I picked up that the length of time you smoke is important. I have said she will end up, if lucky, an old lady standing in doorways puffing and wheezing away. She is so addicted she doesn’t care. Having given up my Dad is subjected to her smoke, even though he has concerns over his heart and cholestoral.
I don’t know about anyone else out there but I have never seen much advice or help to the relatives of heavy or stubborn smokers. I have threatened my Mum, bought her herbal ciggies, tried to show her how good she would feel and how much she could recover, to no avail. It is like a very, very long suicide and I feel like there is something ‘wrong’ with her which children of non-smokers may not understand. It is so frowned upon (good) that people who live with or love a smoker may feel that they have done something wrong, or that they are to blame (bad). In otehr words, by telling everyone how filthy it is (in schools etc), how do the young people feel whose parents are doing that very ‘bad’ thing. I mean you wouldn’t stand in front of an assembly of kids and say ‘alcoholics are bad and they are goimg to kill themselves, it is banned and that is great for us all’, yet I have heard this said in a school about smoking. When I was younger I felt like if only I behaved better or helped mum out then she would stop (didn’t help that she often said she would stop when we left home as it was ’stressful’ having 4 kids - she then didn’t stop). to all the people above who are saying they smoke because it is their choice, yes it is. But it is a choice taken by many adults which stilll affects the quality of life of their offspring and that seems wrong. I want to cry when I see the way my mum used to look and when I hear her wheezing goimg up teh stairs. Hardly makes me enthusiactic about looking after her at 70, she’s only 60 now. And as for all those drives, us all squeezed in athe car with them puffing away - no wonder I used to feel headachy!
Smokeing should be banned fullstop. It is as addictive as class A drugs and ruins lives, many times of those who never chose to smoke. Only good thing to come out of my mum’s addiction is that all her children hate smoking. The smell of it makes me sick.
Sorry for this ramble.
Comment by och aye the noo etc etc — August 7, 2007 @ 1:46 am
BTW - in relation to this page (which is what I meant to comment on above, just went all tangenty!), my Mum’s particular wheeze which I can imagine her saying to her Dr is that her parenst both lived to a ripe old age (only grandpa smoked, cigras and not many but he ended up with bronchitis and a weird yellow phlegm he sometimes had to spit out).
She also claims to smoke about 5 a day to anyone who asks. She tries to prevent me from mentioning it (the secrecy - the denail - the pretence - all mentioned by this blog) to any of my friends or any other relatives. Again, the parent-child reversal which I can almost imagine her doing in any hospital.
Anyone she meets who still smokes becomes her instand ‘friend’, they could be the nastiest person on earth. And she is DELIGHTED if she finds out anyone fanous smokes, telling me each time ‘ The Duchess of Cornwall smokes’ . YES MUM, but she has
a) a horrible cat’s bum mouth as a result and
b) clearly not as many as you and anyway, last I heard, she gave up probalby as her highly expensive DR told her to.
At 1 wedding my Mum was practically doing cartwheels when she saw a Dr puffing on a cigar (his one for that year probably). She came back from a wedding in Spain and shoved the photos under my nose going ‘look, they gave out cigars, not chocolates’.
Go and live in spain then, Mum, ah I forgot, you couldn’t stand the slightly ‘dodgy’ Spanish people who live there.
Wonderful.
I think I will print out this blog and then report back on my Mum’s response, probably in denial or somehow trying to ‘excuse’ herself or differentiate herself from other smokers.
THis blog really touched a nerve and I don’t think it is meant to ‘judge’ smokers. I think it is saying that it is so upsetting to see sane, otherwise fit and healthy people trying to convince themselves that their smoking was either worth dying for or that it was unavoidable - that they were just ‘unlucky’. After all, just like my Mum, they probaby only smoked 5 a day…
Comment by och aye the noo etc etc — August 7, 2007 @ 2:03 am
Wow..this is a great site…and a real wake up call for myself and my smoking hubby who is in real denial and wheezing up a storm lately!
I was raised in a smokers household and surrounded by smokers and now I myself am one of those “social smokers”.
I know better, am more educated and yet…it is a nasty stupid habit and yet allow myself to fall into a trigger to light up…behavioural addictions at its best!
So enough of my excuses…I am quitting NOW and forcing hubby to see the light..not the lighter.
Thanks The C.O. to your kick in the butt…I needed it!
Good Work!
Comment by Sayit — October 30, 2007 @ 10:28 am
To all of you that say: “I’m going to die sometime, it might as well be from cancer.” I ask this: do you think it’ll be like shutting off a light? You’ll die a long, drawn out, painful death. No thank you.
Comment by Arthur — July 3, 2008 @ 4:51 pm