Cigarettes or Me

Gloria lay in bed in the surgery ward recuperating from removal of a lung tumor which to everyone’s surprise was not malignant.  A plastic tube in her stomach exited through her nose draining yellow liquid into a plastic bag under the bed.  In addition over her nose and mouth was a transparent mask delivering oxygen.  Gloria’s husband, Philip, sat at her bedside, tears in his eyes, for endless hours following the operation.  In the ensuing days he remained there except for quick visits home for a shower and a change of clothing even after the surgeon reassured him that Gloria was out of danger.    Having witnessed Philip’s quiet crying both before and after Gloria’s surgery and the outburst of sobbing when I told him that the tumor was benign, I could only empathize with his terror from the possibility of losing his cherished wife. 

Gloria was tiny with wavy, blond hair, Phil, tall with thick, gray hair.  She was my patient; both were my personal friends.  Despite all my admonitions, she smoked two to three packs of cigarettes a day.  I pleaded with her, appealing to her zest for life and to the needs of her four children.  Even with a deep cough and worsening shortness of breath, the threat of severe emphysema had no impact, even less so, the high risk of lung cancer.  She remained recalcitrant.  She mulishly refused all suggestions for joining support groups that might help break her addiction.

It was the second day after her surgery.  The stomach tube was to be removed.  That morning I put my hand on Phil’s shoulder.  “Tell me, Dear Friend, what can I do for you?”

“Do you have time to talk now?”

“Certainly,” I replied and led him to a vacant patient room.  Philip closed the door behind him.  

“First, tell me,” he started, “how much worse will Gloria’s breathing be after having had part of a lung removed?”

“That’s an easy one.  Probably not at all.  We just took out a small lump of tissue, which hadn’t contributed to her lung function anyway.”

“Okay, Dave, since this tumor was benign, does that say something about a lower risk of developing lung cancer in the future?”  Both questions validated my assessment of Phil as a perspicacious scientist – he was a research biochemist.

“I’m almost certain the answer is, ‘No,’ but I must admit I’ve never considered the question.  And certainly if Gloria asks me that question, I’ll be less equivocal and say that cigarettes caused the first tumor and that the next one could well be cancer.  Philip hesitated to speak.  “What’s your next question?”

“I don’t know how to say this but sometime in the next few days, certainly before Gloria is discharged, I intend to deliver an ultimatum about her smoking.  It will include a threat.  I need you only to tell me when she’ll be strong enough to handle it.  And I would feel better if you are there at the time, if necessary, to pick up the pieces.”

On day six after surgery I told Philip that he could fire away at his pleasure.  Already after only eight days of a nicotine-free existence plus cool mist inhalation and chest percussion to facilitate expectoration, Gloria was less short of breath.  At an agreed time for meeting Philip in her room I sat inconspicuously off to the side.  Without a moment’s delay – as if gazing at her would cause him to back down – Philip lashed out, “Babe, I’m telling you in all seriousness.  You either give up cigarettes now or I’m leaving you.  I refuse to sit around and watch you kill yourself!” 

This time the tears were only in Gloria’s eyes.  “Please, Phil, Dear, don’t do this to me.  I was a smoker when you married me and you didn’t raise any objection then.” 

“Well, thirty years later we know better and maybe I love you more now than I did then.”

“I’ll switch to the least harmful brands and I’ll cut down.  You’ll see.  That will be enough.”

“No.  There is nothing to negotiate.  It’s cigarettes or me!”

“But…”

“No buts.  I’m leaving for the day.  Dave is here if you need him but frankly, I don’t think anyone can help you.  I’ll be back tomorrow for your decision.  When you are ready to be discharged, I’ll be here to take you home but if you decide in favor of smoking, my clothes will already be out of the house.  For the time being you can count on me for financial support but that’s it.”  And out he walked.

If ever I had witnessed an example of tough love, this was it.  And in my head as I waited for Gloria to ask for my help, a calypso song Marcia and I had heard on our honeymoon was repeating itself in my head; Never interfere with man or wife – when they’re fighting –.  Oh, just offer sympathy.

Gloria, without looking at me, waved me out of the room.  Had she attempted to involve me, it might have been another example of a physician failure from having our families so intimately involved.  She was weeping as I departed.

I visited Gloria at suppertime.  She was sitting in a chair picking at the food on her tray.  Her wastebasket was overflowing with soggy Kleenex.  “I don’t have a choice, do I, Dave?”

“How can I possibly advise you when it would devistate Marcia and me if you and Phil split up?  With that off my chest, yes, you do have a choice.  In either direction I will remain your doctor though I can’t tell you how many times, like Philip, I’ve wanted to threaten to abandon patients who would not give up smoking.  Maybe I should have but none loved me as much as you love Phil.”

I paused.  “But I promise you I’ll involve whatever physician and lay experts who can help you overcome your nicotine addiction.”  Gloria’s sobbing was now audible.  Again she dismissed me.

She met Phil at the door the following morning.  She hugged him and with her head buried into his chest, she wailed, “Don’t leave me, Phil.  I’ll try.  Honestly I will.  But stay with me while I try.  You’ll be proud of me.  Please don’t leave me.”  All the nurses in the unit heard every word.  There were few dry eyes, mine included.

“Okay, Babe.  You’ve got a deal.  We’re a couple and I do believe we’ll remain a couple.  I know you can do it.”

The two lovebirds left the hospital smiling, handing out trinkets to all the personnel.  I visited Gloria at home two days later.  To everyone’s amazement she had no craving for a smoke and her breathing was appreciably improved.  I wish I could say that it was smooth sailing thereafter.  Hardly.

That night I was called to the hospital Emergency Room.  Gloria had arrived by ambulance.  Philip was in hysterics.  Gloria had awakened complaining of severe chest pain.  She gasped for breath.  Phil called 911.  After six or seven minutes the ambulance attendants arrived and administered oxygen.  Gloria’s breathing eased minimally.  In the hospital emergency room an electrocardiogram showed no evidence of a heart attack but suggested blood clots in the lungs.  An emergency radioisotope lung scan confirmed the diagnosis.  Anticoagulant treatment was started.  

Philip confronted me.  “What could have happened?  She was doing so well.  She was great.”

“All I can say, Phil, is that pulmonary emboli is one of the dreaded complications of any major operation.  The longer the surgery and the longer the period of inactivity, the greater the risk of developing blood clots in the legs which break lose and end up in the lungs.”  I didn’t add that it also occurs more often among smokers; Phil already had enough reasons for hating the weed.

Gloria’s course was stormy.  After a second episode of new clots in her lungs, she underwent an operation on the large vein in her abdomen to block further clots from traveling to her lungs.  It took another three weeks until she could be discharged and a further two months until her breathing and stamina were normal.  If Philip’s threat wasn’t enough reason to continue off cigarettes, certainly the assault on her life was.

Gloria lived another twenty-six years filling her life with good deeds for many community organizations as well as caring for her numerous grandchildren, including at age seventy-eight, taking a teenaged grandson on the Space Mountain roller coaster at Disney World; the trip was her reward for his giving up cigarettes.  A year before her own demise she buried Phil, the love of her life and the giver of her own extended stay on this earth.