Shying away, temporarily, from the political rant (I've got plenty of 'em lined up), here's this week's Sunday newspaper column, on smoking:
My dad was a four-pack-a-day smoker for forty years, until he up and quit one day, cold turkey. He didn’t get lung cancer like my uncle, who smoked about as much; but he spent his last few year driving around with an oxygen generator on his scooter. My fabulous aunt’s heart gave out slowly, but she never gave up her Tareytons. She was found sitting upright at her kitchen table with an ashtray full of spent smokes sucked down to the filter; her last one burned out along with her, somehow without burning down the house.
Well, of course I smoked. Began stealing from may dad’s coat pocket when I was in grade school, hanging with friends in the swamps behind Reed College, doing the French inhale, learning to light up in a high wind, cupping my hands like a movie cowboy, cool as an under-perfused leg.
Playing sports, I didn’t smoke in high school, but did in college, a little. (Rugby!) I’m embarrassed to say I smoked in med school, too, and through my surgical internship. On the day I got married, I stopped, but started again when I took off for Vietnam three months later. Over there, cigarettes were so cheap a person really couldn’t afford not to. My last one ever I extinguished on command of the pilot who brought me home safe from the war a year later and forty-some years ago. Now, I hate being anywhere near the smell.
When you’re born, your lungs are bubble-gum pink, sensuously soft, puffy and fluffy like whipped cream clouds. Possibly the most beautiful internal body part, lungs are visual and tactile joy, the color and texture of a fairy tale, a pillow of warm strawberry comfy cotton candy. If I had the skills, I’d tell you what it feels like to handle a nicely-kept lung; how gently but firmly it resists the hand, giving way like rising dough under the hand in finger-shaped furrows which purple down, then pink up on the next inhalation. There’s joy in seeing it.
It doesn’t last long, not even in non-smokers: the sooty air we breathe darkens the lungs even of the most bodily pure. But smokers? Well, the devastation is shocking, and gruesome. How can something so pink and welcoming, something you’d like to curl up with and dream on, become another thing entirely, relentlessly, inexorably ugly, grey and black, pocked and pitted? Easily. Cigarettes. They destroy like an evil spell.
When I operated on smokers, no matter the procedure, I expected trouble, and it was evident on first meeting: the sandpaper voice, insubstantial skin looking years older than its owner. The brown-stained fingers, the breath. Smokers thrash and buck against an inserted breathing tube, and produce green-black lung crud that the anesthesia person has to keep suctioning out. They wake up coughing, sometimes hard enough that, worried about my sutures holding, I’d press down hard on the incision, counter-forcing. When I was in training, before I’d learned that trick, and, maybe, when my suturing left a little to be desired, one patient came open, pop-pop-pop, like a busted zipper, coughing hard as a person could cough without bringing up a lung.
Smokers heal more slowly, with more risk of infection than others. I’ve seen patients hold cigarettes to the hole in their neck where their cancerous larynx used to be, or in stubs that once were fingers, choked off by nicotinized arterioles. It’s a hard addiction to kick.
It’s almost a given that patients who need arterial reconstruction are or have been smokers. Often it’s pretty desperate surgery: trying to bypass or clear the clogs that have built up, to stave off eventual amputation, sewing to smaller and smaller vessels, against the laws of physics and plumbing; or stretching them open with balloons and stents, temporizing.
They say smoking is increasing among the young. Why? What makes them willing to grow old and sick and wrinkled and rank before their time? I guess at that age you can’t see it coming. I didn’t, not then.
I know my writing is unlikely to change a political mind; and based on some of the emails I get, I should probably stop trying. But maybe if one person reads this and quits smoking, or never starts, I could, even if I’ll never know, legitimately claim usefulness. Don’t smoke. It’s one of the worst things you can do to yourself. A surgeon knows that much, if nothing else.