Smoking

I once worked at a large rehab center in Cincinnati, and there had a conversation with a nurse who confided she had recently had a heart attack and had died nine times on the table. She was trying to quit smoking because of it. (No, she said, she had never 'seen the light').
“I guess you never had to worry about quitting,” she said to me, alluding to the fact that I am a respiratory therapist.
“On the contrary,” I said. “I love to smoke.”
She raised her eyebrows.
“I had to quit,” I said. I looked down at the newly waxed floor. It wasn’t a great memory.
“Well, how did you do it?,” she asked, pulling at the neck of her scrubs a little and exposing her nicotine patch. “I got this and it works some, but I still smoke a little.”
“With the patch on?” I asked. “No, no, no, not a good idea. Very, very bad, triples your chance of another heart attack.”
Up went the eyebrows again. Hadn’t they bothered to tell her?
“Well, I still get the cravings,” she said. “I don’t know what to do with them.” She paused. “How long have you been quit?”
“You know, I don’t really know,” I replied. “It’s been a while. It wasn’t like all the other times. I didn’t mark the date or anything. I just quit cold turkey.” I gave her a sad smile and added, "I still get the cravings, and still don't know what to do with them."
We chatted a few minutes more. I gave her some tips for quitting, warned her again about the danger of smoking with a patch on, and went on with my busy job – a large part of which was taking care of end stage COPD (Chronic Obstructive Pulmonary Disease) patients. I could tell she wasn’t impressed by my story, and I had not given her some magical trick that would make all of her angst and cravings go away.
But the conversation stayed with me, and there were several things it brought to mind. I remembered when a fellow RT kept emailing me about upcoming and pending legislation to ban tobacco, and I finally wrote him and told him to please stop, that I wasn’t going to join him in his fight to get tobacco banned. Yes, me, the respiratory therapist. I don’t want the government involved in my personal rights, and I don’t think it’s an issue that should be settled in the courts or through legislation.
I think legislation to ban any moral issue, with the exception of mountain top removal and child exploitation, which I believe to be criminal acts, is a waste of time. As with Prohibition, the black market will undoubtedly step in and take up the slack. In the case of tobacco, they will market cigarettes not made in the United States where the production of tobacco and the chemicals used on it are under extremely strict control, where all farmers handling those chemicals must pass certification to be able to buy and use them. There is no control of any kind over the growing practices used on tobacco that is imported. Herbicides and pesticides like DDT and Paraquat, that are no longer allowed in the US, are routinely used in other countries. It is why, as a respiratory therapist, I tell my patients, friends and family, quit if you can, but if you’re going to smoke, smoke American (or Native American).
Which brings up an interesting side point. According to traditional Native American lore, tobacco is a spirit, and probably, like most spirits, doesn’t appreciate being taken for granted and used without ceremony. Tobacco should never be mindlessly chain smoked, hanging out of somebody’s lips like drying spittle. It is strong medicine. As a native born Kentuckian I will tell you burley should be “sipped,” like fine whiskey or fine wine. If you can't enjoy it that way, then you shouldn't be smoking it. Period. But big tobacco makes sure there will be no "sipping" on cigarettes.
Why? Big tobacco is in the business of making money for big tobacco. They want to sell lots of cigarettes. They don't want you to sip it, they want you to chain smoke it, so they lace it with extra nicotine. Nicotine is about 200 times more addictive than cocaine, and it makes your brain feel so, so good. They learned a long time ago that smoking non-filter cigarettes was killing off their 40 to 50 year old customers, so they filtered their cigarettes so people would live into their 60’s and 70’s – an extra 20 years worth of cigarettes! A lot of our tried and true businesses are in the same category, e.g., most of your fast food places. News flash, they don’t care about your nutrition.
I have been a respiratory therapist (among other things), for about 14 years now, and this is my take home message. You get COPD from smoking the way most people smoke. It is an insidious condition that is comprised of three different pulmonary conditions: chronic bronchitis, emphysema and asthma. It is incurable.
Dying from COPD, from one who works with COPD patients, and has had to watch, is one of the most horrible and brutal deaths you can possibly imagine. By the end, you’ve gone into renal failure and you’re on dialysis. Medications you’ve been given to try to stop the onslaught have made you diabetic. The financial cost is staggering, especially if you don't have insurance. You and your family can lose everything you’ve ever worked for. The suffering you go through, and the suffering you cause your family and friends is horrible. It is an unimaginably slow and torturous drowning in your own secretions, trying to breathe through airways that have collapsed and to get air to places where it can’t go anymore, never being able to fully exhale. You mouth to us to let you die, because you have a breathing tube stuck down your vocal cords. You lie there in bed, unable to do anything for yourself, with tubes in all your orifices, yes, all of them. Your muscle and fat and tissue waste away so that you get horrible decubitus ulcers on your back and butt and hips that you can literally fit a fist into comfortably. Your hospital room reeks like a rotting, living corpse. You can lie this way for months, even years. Your body colonizes the foulest of bacterial infections.
Try this. Take a great, big, deep breath and hold it. Hold it until you cannot possibly hold it anymore and relish that unbelievable rush you get when you are able to exhale and empty your lungs. You can't do that with emphysema. You can't effectively exhale because carbon dioxide filled air stays trapped in the air sacs of your lungs, leaving you to feel like crap most of the time.
I have been a smoker, off and on for a very long time. I still break over. I relish the ceremony of smoking, the act of smoking. I enjoy it immensely. But I hardly ever do it anymore. Why? Because I placed my stethoscope over my own heart one day and just listened to it. Constant and steady, it was doing its job. And then I felt bad. And then I began to feel sorry for it and angry at myself. All the stupid stuff I did to myself and through it all my poor heart kept working so hard, so strong, so steady. I have a heart, a poor, hard-working, fist-sized beating heart! And if nobody else in the whole world cares, I do.
Smoking is an issue that has a little to do with genetics – there is a gene that codes for addictive behaviors – but it is largely an issue that has to do with your own sense of self, your self esteem, or lack of it, how you were raised, and how you are raising yourself. The tobacco is incredibly addictive, with all the crap they put in it, but the smoking is incredibly personal, and all about what it means to you. I can't tell you how to quit because I don't know what your smoking is about. That's something you're going to have to figure out yourself.

My smoking was about several things. It was about anger. It was about my space. I discovered I was extremely pissed off because I could never seem to find a quiet place for myself to be -- a place where I was truly me, and not someone's something. It was about carving out a tiny little fraction of space and time for myself, and when people wouldn't let me, instead of confronting them, I started to hide behind a smoke screen. That tiny little space became so very important. It was the ultimate game, my whole life, my little make believe world. I was trying so hard to be someone that I wasn’t, to please other people. Why was I doing that? Could it be that I didn't have the guts to do what I really wanted to do, that I was afraid of failing at it, and that rather than face that unpleasant thought, I just did what everybody else wanted, and then if I failed I could blame them? Well, it was an unpleasant thought, and I tried to ignore and forget it. I smoked, because when I smoked I bathed my brain in feel good endorphans and I put up an effective little smoke screen that I could hide behind.
I quit because I gave up on that. I quit because that lonely little organ that sits in my chest continues to beat faithfully, regardless of what I do to it. It beats regardless of who I am being. It beats because that is its job. It is my true friend, and I’m giving it a break. Whoever or whatever I am, how ever long it takes me to deal with this problem, I'm not going to screw my heart over. Bottom line. Don't look a gift horse in the mouth.

It's been a hard road, but I choose to look you in the face and be myself with you now rather than to try to be who or what you may expect me to be. I come with issues. Everybody does. It might have been someone else’s fault while I was young. But I grew up; it became my responsibility, and my fault because I didn’t take responsibility for my own actions.
With that comes a huge lesson, and that lesson is, I am no good to anybody if I am not good to myself. If I don’t eat good foods, exercise, sleep well, surround myself with good, positive people with the capacity to love, if I don’t express myself with my music and writing, cherish my boyfriend and my excellent friends and animals and my surroundings, I do a lousy job when I go to work. I’m not able to put my patients before me. I don’t do anyone any good. I come home sore, exhausted and depressed, instead of sore, exhausted and feeling like I did something. It’s a huge difference.
It is about smoking, the nicotine addiction, the habit, big tobacco and it’s not. If it isn’t tobacco, it will be something else. If you’re struggling with tobacco, be aware of the disease process and own that you’re going to pay a huge price for a little momentary pleasure. It's important to remember Big Tobacco does not give a holy rat's ass about you. They are not your friends. Be aware that it might be more about something else than simple smoking. Show some courage and just look and see. You don't have to change it if you don't want. You're the one in control. And you're not going to be anybody in the world but exactly who you are whether or not you smoke. But just once you might try to reach out and take your space. Keep going outside to take a smoke break -- just don’t smoke. For Pete’s sake, don’t tell anyone that you’ve quit. Don't tell a living soul. Make everybody think you've got to go out and smoke. Just don't smoke when you get there. Breathe instead. Breathe. Big deep breaths. If you need a screen to hide behind, go find one. But breathe. Breathe and feel the beat of your own heart.
We are all smokers, with our own weird little cigarettes. Legislation is not going to change tobacco use or any other kind of neurotic behavior. It’s like trying to legislate the sun because it causes skin cancer. If you’re truly concerned about someone else’s smoking, just be a friend. Talk about the uncomfortable things. And use that money we’d spend on legislation for our children and our teachers. They need all the help they can get.