So when George, a middle-aged smoker, returned for each follow-up office visit, which was maybe two or three times a year, he would sit without shame on the exam table with a pack of cigarettes tucked neatly in his shirt pocket. Because he had early COPD and I repeatedly advised him on previous visits to stop the habit, I never took this shameless display to be provocative behavior.
After listening to his heart and lungs with the stethoscope, and hoping not to hear the characteristic sounds of a lung cancer, or the gallop sounds of a failing heart, I would, with my index finger thump the pack tucked in his pocket and ask, "Have you heard these things are bad for your health?"
He'd laugh and say that he did.
Unless one has been living on another planet most everyone who smokes knows that smoking increases one's risk of getting one of several cancers, heart disease, or even worse -- wrinkles. The exception might be young teens who pick up the habit; I think it's safe to say though that adult smokers are well aware of the health risks of smoking tobacco.
Because of the extensive anti-smoking advertising campaigns, as well as numerous municipal ordinances, one would think it unnecessary for a doctor to remind a smoker to stop the habit. I've had doctor friends share with me they consider it almost a waste of time, more or less, to vocalize the admonishment to an established patient, a smoker, who is well aware of the health risks and continues to smoke.
But these same doctors, those despairing of the success of such advice, now have evidenced-based science that shows that it indeed makes a difference for the doctor to vocalize to his or her patient to stop the nasty habit.
A few years ago, there was a study from the University of Oxford in England, led by reviewer Lindsay Stead, showing that doctors who actually vocalize to patients words to the effect to "stop smoking, it's bad for your health", that in so doing there is a 3% increase in the smoker's chance of quitting for good.
Ever since learning of this study I've always thought it odd that it indeed makes a difference. Like many other doctors I've given advice, many times to the same patient, advice that's obvious and well-known, that is ignored or rebuffed by the patient, sometimes for no good reason. The psychology at work with these patients and those who continue to smoke is very interesting. It's interesting that with respect to smoking tobacco it matters.
And so it would always go with George.
George, the burly retired welder, six foot four, two hundred and sixty pounds, who repaired and rented houses on the side. George the patriarch and consummate decision maker. Always self-assured, and in control. George, the man to whom his grown children and grandchildren would freely ask for advice on matters ranging from buying a car, to travel plans, to what kind of insurance to purchase.
It was this George, and I, who went on like this for years until one day he came in without the pack in his pocket. I asked him where it was and he shared with me that he'd quit smoking. My jaw dropped. At first I thought he was kidding.
So George proceeded to share with me how he stopped the habit.
One evening his son, daughter-in-law, and their two children, came to visit. Amy, his 7-year old granddaughter climbed in his lap, as she routinely did, to read the comic strips together. After a few minutes the second-grader paused, looked up and asked, "Paw Paw, why do you take drugs?" George said he was taken aback. He told her he never took drugs. She said, "We learned at school that cigarettes is a drug and when you take drugs that it makes you sick and you can die. And I don't want you to die." At a loss for words the best response George could muster was that he didn't consider it a drug, that he'd smoked for years, felt great, and that he would be okay and for her not to worry.
George said his wife later that night reminded him that it would be a shame if he were to get cancer or die from a heart attack. Or that he might not get to see Amy graduate from high school -- or get married -- or have a family -- or that he might not even get to see additional grandchildren.
George quit not so much to improve his own health as he did to enhance his chances of living in his granddaughter's future. Statistically, he put himself in a group of people who having quit smoking tobacco increased their chance of living a longer life without cancer.
Which is why one week later I was shocked to read George's obituary in the newspaper.
I'd received a request from the coroner for George's medical records. As it turned out he died during his sleep in his recliner. He had stayed up to finish watching a football game. His wife awoke in the middle of the night, noticed he was not in bed, and found him dead in the recliner.
The autopsy revealed he had suffered a sudden, massive heart attack. For the most part the remainder of his postmortem was unremarkable for a man of 62 years, save for the incidental finding of a small nickel-sized cancer located in the very periphery of his right upper lung -- yet too small and too far from the center of the chest to cause symptoms.