"Cutting short his rides with Albert"
Seattle is a beautiful city and was a great place to do my residency. I spent 3 years at the Seattle Indian Health Board and Providence Hospital and have many stories from there.
This is one of them.
Harold lived alone with his dog, Albert. Albert was a big, happy, slobbery dog who loved riding in the car with Harold. Albert stuck his head out the window at every opportunity. It was clear that in his eyes, Harold could do no wrong.
Harold hardly ever came to the clinic. I usually saw him when he was in the hospital for pneumonia. I had repeatedly tried to get him to quit smoking, but he never wanted to go to the classes or take the medicines. In the three years I’d been at the clinic, I had admitted Harold five or six times to the hospital for pneumonia (a bacterial infection in the lungs).
Two of those times Harold ended up on a ventilator. His pneumonia was complicated by his smoking and resultant emphysema. Emphysema is a breakdown of the air sacs in the lungs, making it hard to get oxygen. It’s a chronic condition with no cure. It’s almost always caused by smoking, and preventing it is the only real solution.
In addition to this, ten years earlier Harold had lymphoma, which is a cancer of his lymph nodes (part of the immune system). The lymphoma had been treated with chemotherapy, but Harold never went back to make sure it was cured. Every time he got pneumonia, he became worried that his lymphoma would return. I ended up doing multiple CT scans on Harold during his pneumonias. Except for his worsening emphysema, these always came out OK. According to the pulmonologist (lung specialist) I referred Harold to, smoking put Harold at an extremely high risk of getting lung cancer.
About six months before I finished residency, Harold was in the hospital again for pneumonia. This time his chest x-ray showed a worrisome area in his left lung. A CT scan showed this to be likely cancerous. He was sent to the pulmonologist and had a bronchoscopy – a camera on a thin tube is passed into the lungs through the mouth. A biopsy (tissue sample) was taken, which showed evidence of lung cancer. Harold refused surgery and wished to try other options.
He started chemotherapy, but became very sick from it and was unable to finish. There are many types of chemotherapy, usually combinations of medicines based on exactly which type of cancer is diagnosed. Chemotherapy works by going after rapidly dividing cells. This means it can attack the cancer, but other cells in our bodies are rapidly dividing, including gut, bone marrow and hair. This is why chemotherapy patients can get nausea, weakened immune systems and hair loss. Harold was given morphine for his pain and quickly started to abuse it. He ended up in the hospital twice with overdoses of morphine. By this time he was getting thinner and had lost almost 85 pounds. Even the skin on his face hung down in leathery folds.
Subsequently, he was started on radiation treatment. Multiple treatments of radiation are targeted to the area of cancer. This caused scarring of his esophagus (swallowing tube) and he had a very hard time swallowing. He kept losing weight, but he continued to smoke.
I didn’t see Harold for several months as he refused to come in for clinic visits, although he did occasionally see the cancer specialists. He was admitted to the hospital for back pain. X-rays showed that the cancer had spread to his spine, and a bone scan showed a cancer spread to scattered areas of his spine and pelvis. His cancer was widely metastatic (spreading) and he went home with hospice care to spend his last days with Albert as there were no treatment options left.
I left Seattle for Minnesota before I learned what happened to him, but Harold’s condition was terminal. I hoped one of the hospice nurses found someone to adopt Albert, but he was an old dog and totally dedicated exclusively to Harold. If Albert did have to be put down, I took comfort in believing they were together again and driving with the windows down.
Lung cancer is the leading cause of cancer death in both men and women in the USA. There are 175,000 new cases each year in the USA, consisting of two major types, small cell and non-small cell lung cancer. About 80 percent of new cases are non-small cell and 50 percent are metastatic (spreading) by the time of diagnosis. This is the most common cancer world-wide, and usually occurs between the ages of 50 to 70. Tobacco use is involved in 87 percent of lung cancer cases.
According to the American Indian Community Tobacco Project (www.AICTP.umn.edu) three out of every five American Indian adults smoke, and nearly two out of every five American Indian deaths are due to cigarette smoking and breathing secondhand smoke. Teens whose family members smoke are three times more likely to smoke themselves.
Question:So what do we do about this?
Does anyone see a pattern here? We need to keep our kids from smoking, and we need to continue to get current smokers to quit. This is a very difficult problem as nicotine changes receptors in the brain so they only work when nicotine is present. This is why smokers need to have their “fix” and why people can get so crabby when they try to quit.
Using patches and gum help by giving a decreasing dose of nicotine over time. There are medicines to help with cravings, there is a new medicine out that blocks the nicotine receptors in the brain. Hypnosis and acupuncture are also helpful (with no side effects).
All of these should be considered in combination with counseling. Quitting with a partner also helps.
Smokers can ask for help to quit. Ask for help at your clinic or by calling 1-888-354-PLAN.
Again, from AICTP: We’ve survived too much as a people to allow ourselves to be conquered by cigarettes.
Look around. Our kids tend to do what we do. Don’t let smoking be one of them.