‘And Princess Margaret always had one in her fingers as well, all the time.’ Said my patient huffing as she made her way out of the building’s main door wheeling herself. Once she had parked her chair out in the open which seemed to be her usual spot, she started lighting a cigarette. I could really see how much she enjoyed puffing it. Igniting the lighter, curving her hand next to it so the wind won’t blow off the flame and taking a deep inhale; she was natural at it. Why wouldn’t she be? She had been smoking every day for past 50 years, had managed to knacker her lungs completely with it and now had a condition called COPD. Chronic Obstructive pulmonary disease which is an irreversible lung condition at her stage. She took a really long breath to suck the nicotine in. I didn’t think she still had it on her. I mean, the physical reserve to inflate her lung that much. She was in a state, where she needed oxygen permanently at home, for at least 18hours a day. She couldn’t move from room to room if she exerted herself because of breathlessness. And her face, mainly her lips and ends of her fingers were sort of discoloured blue, an unhealthy-looking tinge of colour one develops when their body has been deprived of oxygen for so long.
‘This is one of the very few things I can still enjoy in my life now’, she said.
‘If she hadn’t been smoking that long and was addicted to it, may be there would have been so many other things she could have still enjoyed.’ I thought to myself. Knowing ‘Love of her addiction’ is killing her and despite that, choosing to continue on it; it is hard for me to not wonder what is going in her mind.
She tells me, she started smoking very early at beginning of her teens. Now she is in her late sixties and in a nursing home almost wheel chair dependent in majority of her activities; the cocktail of nicotine, tar and the chemicals has managed to destroy her life. ‘At least I always had my cigarettes’, she remarked, taking a puff and blowing out the smoke very slowly in the air, amusing herself with the cloud of smoke it created. ‘It was a thing you know at that time. All of my friends use to smoke. Everyone had a pack with them, everyone was offered one wherever they went’.
I don’t like the cigarette smell. That doesn’t mean I haven’t tried myself either. Like most children whose parents smoked, I was introduced to it quite young as well. My mom used to be an avid smoker. I guess she developed her habit by following a trend of accepting gifts and complimentary stashes distributed to soldiers very commonly at those times. Naturally the troops wives had access to what their husbands had. ‘Marlboro’ used to be her favourite. As children, when as we saw a cigarette box with bright red on a white colour, we knew it was ‘good stuff, had been imported and either dad or one of her family members who was in the army had sent it’.
There might have been many reasons why smoking became a trend and still is. ‘Advertisement’ comes in mind first. We all know how intrusive and invasive they can be in our everyday lives. An add everywhere in newspapers and billboards, add celebrities into the pictures with their fancy gowns and chic smiles; there you go a generation of brain washed teenagers and young adults who look up to their role models and are desperate to be a part of the rage. ‘To calm the nerves’ as was told to the soldiers, it was mainly sold as an anxiolytic. Papers and the studies preached its wonderful effects too, leading general public to believe ‘it was safe’. Following these slow movements into individual people’s hand, in the world wars the popularity peaked, in few weeks it became sensation. Then a social tradition. ‘To offer a cigarette to a guest or friend as a part of social courtesy’.
I came across a cigarette advertisement made in 1950’s in YouTube. It plays “Doctors in all branches of medicine, doctors in all parts of the country were asked ‘what cigarette do you smoke Doctor?’. Once again, the brand name most used was Camel. Yes. According to this repeated nationwide survey, more doctors smoke Camels than any other Cigarette.”
Imagine the confidence of the company in using ‘Doctors’ as part of their lure to the public. It alone proves how accommodating we were as a profession of cigarettes in our lives then that it used to be acceptable for hospitals to allow smoking in bays and while on consultation with doctors.
It was only much later the long-term effects of smoking was discovered. Lung conditions like emphysema, bronchitis; cancers of various origins like lung cancers, oral cavities/nasal airways, bladder cancer and disease of blood vessels, heart etc. Anti-smoking campaigns started more vigorously world-wide as result. Strict rules were then imposed and enforced on tobacco companies with heavy taxes, prohibition of smoking was announced on general public areas and now, even what used to be my Mom’s favourite at the time; Marlboro cigarette on its pack mentions ‘smoking seriously harms you and other around you’.
When she learnt passive smoking can be more dangerous than active smoking, my mom left her habit for good. She caught on time about its adverse effects from few minutes of government broadcasts that would often pop on news channel. We were then no longer asked to go and light the cigarette for her. Kind of missed not having to, for some reason it felt exciting thing to do at that age. Initially, it was hard for her to say ‘No’ when they continued to arrive in gift packs and in fancy boxes. But she pushed on her determination and helped some of her friends to quit smoking too. She hasn’t smoked for many years now.
In Nepal, people mainly used to use firewood to cook. It still is the case in many places. Cities mostly use gas while the villages are still dependent on it. ‘Food tastes better even rice on it’ my mom used to say when she prepared it while blowing air on the stove through a long metal pipe, coughing constantly with irritation. When Joey uses the firewood stove at his place now, to keep the house warm, I remember myself constantly asking her to use gas or the petrol fuelled stove. Most people in the village suffer from COPD lungs in remote parts of Nepal. I am glad, my mom gave up both, smoking and cooking on smoke before damaging her lungs irreversibly. Cities aren’t exception now either with pollution from the vehicles. If you haven’t been in the autopsy room studying lungs of a diseased Kathmandu resident, you would find it very hard to believe how much of smoke/pollution can affects lungs. Even the visible physical evidence is dramatic.
My patient can’t have oxygen at home because of the hazard risk with fire. Staffs are careful that she doesn’t sneak in any inside and would rather have her move about often as needed when she requests to. At this stage, our intervention is to only support her with oxygen. Cutting out on smoke now will not change her outcome. So, if she finds relief on smoking and feels this is one of the very few things she can now enjoy in life, she should be allowed to. And she is welcome to.
NHS offers ‘quit smoking programmes’ which we suggest to all of our smoking patients. Occasionally patients will spot doctors sneak out for ‘nebulisation’, a term we use to refer ‘smoking’. But knowing the adverse effects and impacts alone doesn’t always determine one’s choice. People choose what they choose for various reasons as long as it is an informed choice.
My friend once suggested ‘try smoking. I smoke now at least 3 times a day to lose weight’. I remember, the hype there was among the teen age girls then.
World Health Organisation (WHO) on its website mentioned ‘The COVID-19 pandemic has led to millions of tobacco users saying they want to quit’, with World No Tobacoo Day 2021 pledge.
This is a good thing. All the best.