Tuesday 2 December 2014

Sign from above

Based on the title you may be worried this post will be some theistic diatribe.  Nay, never fear, intrepid readers.  I would never subject you to such nonsense which I would never want to read and which, I'm fairly certain, violates several portions of the Geneva Conventions.  However, Mrs. Bastard has often told me that everything happens for a reason and that things may be signs from above, so while I don't have any idea what those reasons may be, I sometimes wonder if she's right.

What happened recently with Claudette (not her real name©) made me rethink things and wonder if Mrs. Bastard could be right.

Claudette was the passenger in a car accident early one morning.  Incidentally, why is it always 1 AM?  Doesn't anyone want to get into an accident and let me take care of them at 2 o'clock in the afternoon?  I'm fully awake, I'm done with lunch, I have nothing better to do, so get into your accidents then!  Come on!  Wait, where was I?  Oh right, 1 AM.  Apparently her boyfriend (who was driving) fell asleep at the wheel and went off the road, hitting a tree.  The tree, which was not moving at the time of the accident, didn't give one flying fuck that a car just hit it at 120 kph and remained exactly where it had been before the car hit it.  Trees are kind of funny that way.  Anyway, I have no idea what happened to her boyfriend, but Claudette was brought to me in a bit of a daze.  She didn't have a scratch on her, but she clearly had a concussion.  A CT of her brain showed a small subarachnoid haemorrhage.  Fortunately she had no other injuries, and three days later she went home, sore as hell, but otherwise ok.

She followed up with me in my office about a week later.  When I walked into the examination room, the first thing I noticed was the sheaf of papers from the hospital sitting on the exam table, along with her mobile phone and a cigarette lighter.

Bad move, Claudette.

If you know anything about me, you know that I look for any reason to get on people's cases for smoking, but I knew my "WHY THE FUCK DO YOU SMOKE?!" tirade would have to wait until I finished my exam and explanation about what she should expect as she recovers from her brain injury.

Wait wait wait, aren't you going way off topic here, Doc?  Quitting smoking is great and all, but since when is this post about that?

Oh pipe down, you.  I'm getting to it.  Stop being so damned impatient.

As I was saying, after a thorough physical examination, I explained how her symptoms may last for several more weeks, but that I expected a full recovery.  She told me how she couldn't bring herself to drive yet, and that she still freaked out whenever she tried to get in a car or saw headlights.  She went through her long list of questions for me, and when she was finally done, I took a deep breath and gave her my best "STOP SMOKING, DUMMY!" speech.  She looked rather embarrassed the entire time, but she nodded along compliantly.  When I was done, she looked up with a sad little smile and said,

"You know, it's funny . . . when we got in the accident, we were on our way to the store to buy cigarettes."

. . . Aaaaaaaaaaaaaaand there it is.  If that isn't a clear sign that she is supposed to stop smoking, I don't know what is.


  1. if only people would be so dedicated to their health as they are to those $%^$ cigarettes. my wife asks me why I'm not more supportive when she quits smoking.

    It's because I know she's not really quitting, she's just changing brands to Nicorette for a few days.

  2. Here's what gets me, she's worried about the possibility that she may get into another accident that is more than a fender bender. I get that she's feeling a bit of post traumatic stress, but she isn't worried about the overwhelming likelihood that she is going to experience heart disease and COPD if she continues to smoke. Denial never ceases to amaze me.

  3. What's puzzling is her fear of driving, getting in a car or even seeing headlights yet she blithely continues to smoke when one might argue that had she not been a smoker the accident wouldn't have happened. I guess it's the same reasoning, or lack thereof, that allows people who must speak through a hole in their throat due to cancer continue to smoke through that very same hole.

  4. My story is similar. 12 years old and started stealing cigarettes from my parents. One night friend and I stole a pack and off we went on our bikes (night, no lights . . .). Next I remember I was being lifted into the back of a station wagon, foreign country waiting for ambulance out of the question. Compound fracture tibia and fibia, busted off tooth, and lots of embedded gravel. Two weeks in hospital, nine months in casts. Never tried another cigarette after that.

  5. The devotion to the "cancer/COPD stick" (as one of the Cardiologists I work with likes to call them), always astounds me. I sit there counseling a patient on how we are referring him to have an evaluation for Heart Transplant because his heart is not pumping anywhere near how it should be. All he can tell me is that 1) he doesn't want to die, and 2) he doesn't want to give up his ciggies. The Doc has been Counseling him on this for years, I have been for the last year, and finally took the firm stance of telling him "I know you don't want to die, that is why you are *finally* willing to be evaluated for a heart transplant. That being said, if you are a candidate, and if you are fortunate enough to receive a new heart, you need to be prepared and give up your ciggies. Also I will forewarn you, the transplant team will push you very hard about the smoking, it's not good for you period." About 2 weeks later, the Doc came up to me and asked how I got the guy to finally quit. For this gentleman, Tough Love worked, though it often doesn't.
    Anon RN

    1. I can understand why people have a difficult time quitting - what baffles me is that children keep starting.

    2. He doesn't want to die but he doesn't wan to give up his ciggies? I don't see the reasoning in performing a heart transplant on someone who smokes. Chances are the smoking led to his need for a transplant. Smoking cessation should be a prerequisite for transplant consideration. There are too few donors and too many waiting in line.

  6. similar story here. my mother was driving and she dropped her pack of cigarettes. took her eyes and one hand off the wheel as she went searching for them. we ran off the road, hit an embankment and became airborne. the driver of the car behind us said that our car flipped at least 3 times. we were both wearing seatbelts thankfully. mother had no injuries; I had a bump on the head, a sore neck and bruising. I also got to have a ride in an ambulance and I got to wear a c-collar for six hours while I waited for cervical x-rays. smoking kills in a variety of ways!

  7. Hey Doc, while we're on the subject, what is your impression of e-cigarettes? I know that they haven't really been studied long enough to have a conclusive "these will kill you painfully" verdict, but have you had the chance to poke around in the lungs of a user? They seem like a better alternative to the tar of regular cigarettes, but several non-smokers I know who are interested in the "medical benefits" of nicotine have started to use them too. The logic goes that obesity will kill them, nicotine and the oral fixation satisfaction will keep them from binge eating, and therefore e-cigarettes will actually extend their life because they eliminate the cancer, heart disease, and COPD complications.

    Obviously a "better safe than sorry" attitude is best, but I'm curious to hear your thoughts. I've done my own research, but I've yet to find any studies with good results and much of the other information out there appears to be propaganda from the manufacturers or users trying to justify their habit. Thanks for your help!

    1. don't know Doc's opinion, but it is definitely a cleaner way to dose yourself with toxic stimulants than by inhaling combustion by-products.

    2. Good question, Caitlyn. They sure seem like they should be a good idea (better than cigarettes, anyway).

      I may just have to do a post on e-cigarettes in the future.

    3. Although these are pretty obviously better than real smoking, eating more tuna has to be a better way to get your Vit B3!

    4. There was an article not so long ago in Scientific American about e-cigarettes. It stated pretty much that there hasn't been much research on them, and the few studies that have been conducted, report only positive effects (these were made by the producing companies, basically ruled as inadequate proof because bias bias bias). It did say that e-cigs contain little of the regular cigarette crap (tobacco, tar etc.) but other potentially as harmful additives.

    5. my summary would be that they are not as bad for you as cigarettes, but worse for you than no cigarettes.

  8. Don't even get me stated about dealing with family members who smoke!

    My 80-year old mother had a quad bypass nearly 4 years ago (she did not have a heart attack; her blockage was found on cardiac ultrasound, and the doctor credits her not having a heart attack on the ACE inhibitors she's been on for years). She's being treated for osteoporosis, fibromyalgia, atrial fib and COPD and has hospitalizations for exacerbations of the latter two problems.

    She "demands" answers from her internal medicine doctor as to WHY all of this has happened to her and why he can't stop it or predict when she will "get sick."

    She's smoked for 60 years. There's your answer, and only by the grace of God has she not been diagnosed with lung cancer, which is what her mother died from at the age of 88 after ... 60-plus years of smoking. Will she quit? Of course not! "But I've cut down!" she says. Clearly cutting down is not enough!

    Let's just say I don't have a lot of empathy for those people who persist and then demand their health care providers "do something!" as their health declines as a consequence of tobacco use in whatever form.


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