- My dog ate my homework
- I forgot
- This isn't what it looks like
- I thought you were coming home tomorrow!
- I didn't know
I was called recently by the intensive care unit about a very unfortunate 51-year old woman who was critically sick and actively dying. She had bounced from hospital to hospital for the past year without a diagnosis for her various vague complaints, finally landing at our hospital two weeks ago and being diagnosed with metastatic small-cell lung cancer. If that sounds bad, it should. Because it's bad. Very VERY bad, as in less than 5% of people who have it are still alive five years after they are diagnosed, and median survival is only 2-4 months. Nearly everyone who gets it is a smoker, just like this patient. As the intensive care doctor was describing her 2-week hospital course, I looked through her bloodwork on the computer, and nearly every number I saw - electolytes, kidney function, liver function, heart function, lung function - was grossly abnormal. Every organ system was shutting down, and her blood chemistry was more out of whack than seeing Bill Nye the Science Guy on Dancing With The Stars. Obviously something was drastically wrong, and they wanted my help fixing it.
I did a complete (though rapid) assessment (since she was dying in front of my eyes), and it looked like her entire small intestine had lost its blood supply and died. I told the intensivist that there was bad news and worse news. The bad news: if I didn't operate on her that very minute, she would surely die that night, probably within a few hours. The worse news - if I somehow managed to get her to the operating theatre, she would die even quicker, likely on the operating table. She was too sick to bring back, and there was nothing I could do.
Her entire family gathered in the worst room in the hospital - the ICU family conference room (aka The "Your Family Member Is Dying" Room), and I broke the bad news as gently as I could. Considering they had spent nearly a year searching for a diagnosis and had just started chemotherapy two days prior, they took it as well as I could have expected.
But that was where it went from sad to "I want to choke the shit out of you" frustrating.
Her husband asked, "Well should my children get checked for lung cancer?"
I didn't immediately understand his question, so I asked, "Why do you ask?" though as I was saying it I figured he thought lung cancer was hereditary like breast or colon cancer, and he wanted to make sure his children weren't at risk. As I was about to address that, he hit me with this shocker:
"Because they both smoke."
ARE YOU ACTUALLY TELLING ME THAT YOUR MOTHER IS DYING OF CIGARETTE-INDUCED LUNG CANCER, AND YOU BOTH STILL SMOKE? ARE YOU FUCKING KIDDING ME??!
Fortunately those were not the words that came out of my mouth. "No," I said as calmly as I could, trying my hardest to resist the temptation to grab the two kids by the ears and ask what the ACTUAL FUCK they were thinking. I looked them both right in the eye and said, "But you both need to QUIT. RIGHT. NOW. You have no excuse any more to put even one more cigarette in your mouth. None."
Her son started to protest, but I very firmly and finitely said, "NONE." He stopped dead in his tracks.
Did he listen to me and quit smoking? I don't know. But what I do know is that he has no excuse to continue.