HOW NOT TO GET A PATIENT TO QUIT SMOKING
I don't know how many times I've taken cigarette packs from a patient's bed stand (always with their permission) or used my funeral home plea to get the message across ("Do you have funeral plot picked out? You're going to need one soon if you don't quit smoking.") Surely dozens of times over the years. If the gambits worked only once they were worth the effort.
For Amanda Wiggins though, none of my usual messages registered. She had chronic lung disease and always complained of being "short winded." That was her constant complaintduring one hospitalization on the medical ward. Neither fear of funeral homes nor emergency rooms nor ventilators nor lung cancer nor skin wrinkles made any dent in Mrs. Wiggins'smoking addiction. She was incorrigible. She continued to smoke in her hospital room and in the ward lounge even as we treated her for smoking-related chronic lung disease. (The episode recounted herein occurred before our hospital banned cigarette smoking.)
Psychiatrically Mrs. Wiggins was a "borderline" personality disorder -- not psychotic, but with a tendency in that direction. Her anchor in life seemed to be the bible and fundamentalist religion. I saw this belief as a wedge to change her smoking behavior.
One day on the ward, as she complained about her shortness of breath, I auditioned my new message. I made sure her nurse was there; no one would probably believe my method if Mrs.Wiggins really did quit smoking.
"Mrs. Wiggins, we can't get you better if you continue to smoke."
"I'll quit," she said, in a manner which conveyed just the opposite intention.
"You've got to quit."
"I'll quit. I want to get better."
"You're gonna die!"
"Don't say that, Dr. Martin. If I quit will I get better?"
"How are you going to quit? You've promised me a hundred times and you always go back to smoking."
"Well, I'll quit now."
"Can I have your cigarettes?" I knew her supply was endless; taking them would be like trying to cut off the flow of cocaine with a single arrest. Still, it would be a step in the right direction.
"Take 'em Dr. Martin," she said confidently. I opened her drawer and took out two unopened packs of cigarettes.
"Can I have the others?"
"I don't have any more. That's all I have," she said.
I knew this woman. She was not about to quit smoking so easily.
"Now Mrs. Wiggins, swear you'll quit smoking."
"I'll swear," she said, with nothing to suggest any conviction whatsoever.
"I swear." The words were limp. I reached over and picked up her bible. "Swear on this," I commanded.
"Why do I have to swear on the bible?" Now her voice was rising. "I said I wouldn't smoke, Dr. Martin. Don't you believe me?"
I knew it. She had no intention of quitting. Unless I could get her to swear on the bible she would never take her promise seriously.
"Mrs. Wiggins you've got to swear on the bible. Otherwise God won't believe you're sincere."
She hesitated and her body began to shake. She looked at me, then the bible, then at me again.
"Dr. Martin," she said indignantly, her voice now trembling a little, "that's the word of the Lord! You want me to swear on the Bible?" Her eyes were now wide open and I could see facial muscles tense.
"Swear!" I was rapidly transforming my demeanor into that of a medical evangelist. "SWEAR!"
"I can't do that!"
"Then you don't intend to quit. You lied to me."
"But I will quit, Dr. Martin. I promise!"
"Then SWEAR ON THE BIBLE!" I was acting, and enjoying every moment. I'll do whatever it takes, whatever works, I reasoned.
Slowly, hesitatingly, she placed her right hand on the bible. I could sense the adrenalin flow from her hand to the book. I was about to make my first convert.
"Repeat after me. I, Amanda Wiggins . . ."
She hesitated and looked at the nurse. Sensing a magic moment, and not wanting to break the spell, the nurse merely nodded her head, affirming my command. Then Mrs. Wiggins looked back at me. My eyes were fixed on her stare. There was no way out. Slowly, she repeated my preamble.
"I, Amanda Wiggins . . ."
"Do swear before God in Heaven . . ."
"Do swear before God in Heaven . . ."
"That I will never touch or smoke cigarettes again."
"Oh, Dr. Martin!!"
I repeated the command with raised voice. "THAT I WILL NEVER TOUCH OR SMOKE CIGARETTES AGAIN. SWEAR, MRS. WIGGINS! SWEAR!"
"That I will never touch or smoke cigarettes again," she echoed.
"SO HELP ME GOD!" I bellowed.
"So help me God," she responded. With the last word her whole body shook and she began to cry. I checked her pulse and listened to her lungs. No acute problem. She was not having an asthma attack, just a religious experience. Had I reached her? I left Ms. Wiggins sobbing quietly on the bed. The nurse watching the scene promised to check her every half hour.
Feeling quite smug about my effort, I went to see other patients. I remember thinking: to get a patient to quit smoking you must learn to communicate on their level, to search out that part of their psyche that will listen to the doctor. It requires something more than just warning them about this or that disease, this or that consequence. Why aren't all physicians similarly creative with their advice to patients?
Not 45 minutes later the nurse paged me. Could I come up the ward lounge? "You won't believe this, Dr. Martin," she said. The tone in her voice punctured my balloon. 'Oh yes I will,' I thought, and went to see for myself. There in the lounge sat Ms. Wiggins, calmly smoking a cigarette. Relaxed, her face washed and tear-free, she looked up at me without the least hint of anxiety.
"What happened?" I asked, feigning a hurt incredulity. "You PROMISED me you would quit, Mrs. Wiggins. You promised GOD! You swore on the Bible! What happened?"
"I just had to have a cigarette," she replied with a wicked smile, and blew a puff in my direction.
That was the first and last time I tried religion to break a patient's habit.
FRONT PAGE TABLOID HEADLINES OF MEDICAL INTEREST AND THE STORY AS REPORTED
DOCS STARVE MOM TO DEATH!
The Inside Story:
Mrs. Verona Jones, of New Paltz, New York, said the hospital food served after her
surgery was so bad, "those doctors almost starved me to death!" In our continuing
expose on hospital food. . .
76-YEAR-OLD OHIO GREAT GRAND-MOTHER DELIVERS TWINS!
The Inside Story: Molly Esposito,
grandmother of three and great grandmother of four, assisted a Cincinnati midwife
in the delivery of her 5th and 6th great grandchildren! Mrs. Esposito stood
proudly by the bedside and held her granddaughter's hand during labor, as the
midwife successfully delivered two new baby girls. . .
DOCTORS CONCEAL CURE FOR CANCER!
The Inside Story:
Dr. John Quack-Quack, a noted nutri-biologist, affirmed in a speech yesterday
that doctors in California have found a cure for cancer but are hiding it from
the public. "The cure will put them out of business so they won't let the
public have it," Dr. Quack-Quack charged. He also said. . .
TWO-HEADED BABY BORN IN TEXAS!
The Inside Story. A two-headed baby calf was born last
week on the Y-I-Itch Ranch, located just north of Dallas. A rare
genetic occurrence, the animal did not live more than a day. "This
happens maybe once in a million," said veterinarian John Smith.
ALIENS BRING EARTHLING A CURE FOR ARTHRITIS!!
The Inside Story: "The doctors gave up on my arthritis,"
says Melba Boredom, a housewife from Wichita. But now she is pain-free.
"The Aliens came and gave me some medicine," she said. Mrs. Boredom is
not sure where the aliens came from, but knows "they were not from Mars;
they didn't look like Martians." She added: "They were real friendly
like, not at all mean or nasty like the ones that abducted me last year."
Unfortunately Mrs. Boredom did not get a picture ofthe aliens, but she will
describe them in considerable detail in our next issue, plus reveal
more about her miraculous arthritis cure.
ELVIS SIGHTED IN HOSPITAL ER!
The Inside Story: ELVIS PRESLEY was sighted in the St. Elmo Hospital Emergency Room last week by two women, according to their testimony. The women, who did not know each other, each affirmed in sworn statements that they saw Elvis while being treated in the ER. Nancy T., a 25-year-old brunette who was being treated in the ER "because I took some pills," says she spotted Elvis leaving through a back entrance "surrounded by two other men, probably his bodyguards." Mary S., in the ER for treatment for an arm fracture resulting from falling off a bar stool, spied Elvis in the same setting, also surrounded by two bodyguards. Both women, who were treated and released from the St. Elmo ER, vow they will continue to search for Elvis because (to quote Mary), "he's out there somewhere."
SLOGANS FOR CLINICAL SERVICES
SLOGANS FOR CLINICAL SERVICES
Gastroenterology - "The job's not complete until the two scopes meet."
General Surgery - "When in doubt cut it out."
"All bleeding stops."
Dermatology - "If it's dry wet it, if it's wet dry it."
Intensive Care - "The buck stops here."
Radiology - "CT scan begets MRI which begets ultrasound which begets . . ."
Infectious Disease - "Let's change the antibiotic."
Nurse's chart note from 11 p.m. - 7 a.m. shift.
Mrs. A had a fitful night. She called out several times, requesting
her pain medication. Said she couldn't sleep and was quite tearful at times.
I sat with her, explained that we were doing everything possible to help
relieve her symptoms. She is quite anxious and fearful of dying.
Family members in and out all night. BP 110/68, p-88 and regular, resp.
30. At 5 a.m. she screamed out for another injection; 2 mg morphine
sulfate given per prn orders. She took her regular 7 a.m. po meds
reluctantly, fearful she might choke on them. I reassured her.
She finally fell asleep shortly afterwards.
Doctor's complete chart note, 7:30 a.m.
Pt. afeb., stable.
NEWSPAPER OBITUARY: "John Smith died yesterday atSt.
Elsewhere Hospital after a brief illness. He was 74 yearsold.
Mr. Smith is survived by his wife Marsha Benton Smith, three
children and one sister."
RESIDENT'S HOSPITAL SUMMARY: JohnSmith was a 74-year-old man
admitted to the ICU Jan 20 after suffering a stroke which left
his right arm and leg paralyzed. He developed aspiration
pneumonia and sub-sequently was intubated and placed on
mechanical ventilation. Multiple attempts to wean him from
the ventilator were unsuccessful. On Jan 25 he developed a
massive pulmonary embolism, confirmed by lung scan, and heparin
was begun. On Jan27 he developed hemoptysis, so the heparin was
stopped and an inferior vena cava filter was placed by vascular
surgery. Subsequently Mr. Smith developed intra-cerebral bleeding
and lapsed into a coma. Several discussions were held with hisfamily,
including his wife, all three children, and a sister. On Feb 1 the
decision was made by the entire family tohave us forgo any further
heroic measures and to just "keep him comfortable." Mr.Smith went
into irreversible shock on Feb 3 and was pronounced dead at 4:10 pm.
The family was at the bedside. Permission for autopsy was denied.
FROM THE HOSPITAL BILL:
For medical intensive care, Jan 20 - Feb 3: $62,456.
Medical Journals (poem)
Journals lie unread
In stacks on the floor
And flat on shelves.
A years' worth, maybe more
Annals this and Archives that
And "Journal of" you name it.
Inside, key articles
In those piles
A thousand human-years' effort
To tell what I need to know
And (unlike years past) so
With METHODS and CONCLUSIONS.
But all unread
And just growing.
END OF SECTION B