Behind the Puff of Smoke

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Marion was sitting in the examining table. He looked cachectic and debilitated. He was stooping forward, leaning on his arms like a tripod. His lips were pursed as he breath, and was using his neck muscles to assist his respiration. A small tank of oxygen was at the foot of the table and it was connected to a long tube and into a nasal cannula that was hooked to his nostrils. He was obviously struggling, but he managed to flash a smile when I entered the room.

I have known Marion for more than 5 years, and he went through a lot over the years. I have treated him for severe COPD (Chronic Obstructive Pulmonary Disease) and repeated exacerbation, lung mass, bouts of pneumonia, respiratory failure requiring mechanical ventilation, lung collapse requiring chest tubes, and multiple hospitalizations. He had gone weaker and weaker, and is wasting away with every labored breath. It is painful just to see him breathe. He was a heavy smoker, but had quit a few years ago, albeit a little too late. He is paying for all the years he had puffed away with those damning cigarettes.

I hate cigarettes! No, I have no personal vendetta against the tobacco companies. In fact, if there is a career that cigarettes made to flourish, it is mine. I partly owe my profession to cigarettes. Because of so many people who smoke, I have a lot of pulmonary patients, and that I can send my kids to college. And even if smoking will be banned starting today, we will still see the effects of smoking for many more years to come, that my practice will be secure until I retire. But I am witness to the tragic effects of smoking every single day, that it is plainly heartbreaking. I just wish people will stop smoking. Besides, there will be other lung patients aside from smokers, that I can survive with.

It is amazing that even with the known cold hard facts regarding the ill effects of tobacco, people still continue to smoke. And more astounding is the fact, that young people who are well-informed, still start and pick up the habit of smoking. I know it is hard to quit once you have formed the habit, but still it is difficult for me to fully understand why people would continue to smoke even if they are literally dying from it.

Many years ago,during my training in Memorial Sloan-Kettering Cancer Center, I have seen patients who have lost their voice box due to throat cancer, still smoking thru their tracheostomy tube, in front of the hospital, while they lean on their IV poles. I have even seen patients who had caught ablaze and suffered facial burns, as they tried to smoke with their oxygen on. I guess they wanted to go out blazing into the night.

Nowadays most of the hospitals have adopted a smoke-free campus. Nobody can smoke in the hospital grounds, so smokers have to get out of campus to lit-up. Here in Iowa, there is a state-wide ban in smoking in all public places, like restaurants and malls. The only public place that smoking is still allowed here, are in the casinos, but that may change soon too. For some reason smoking and gambling goes together. If you think about it, smoking is really gambling, with your own life at stake.

I strongly advise all my patients to quit smoking. We even provide support, counseling and prescription to help them quit. But still quite a number of them still do smoke and this get me really frustrated. Are they just a bunch of non-compliant morons?

Before I pass that judgement, I should distinguish my aversion between smoking and smokers. I should definitely abhor smoking, but not necessarily smokers. For it is ironic, that many of the good and kind people I come to know, are smokers. Behind that annoying puffs of cigarette smoke, is a person like you and me. A person who may be suffering, a person who needs help, and a person who needs love and understanding in spite of who they are.

After I examined Marion, he told me that I need to keep him going until June. I asked him what’s going on in June. “It will be my 50th wedding anniversary”, as he answered with a smile, “and I would not like to miss it for all the world.” I felt a lump in my throat. I know he is on borrowed time. But I prayed that his wish would be granted.


Post Note (4/14/12): Marion made it through his 50th wedding anniversary. He passed away a year after this article was posted.


  1. Do you think that the new packaging that the FDA is pushing cigarette manufactures to print on their packaging will have any effect on the public?
    In Thailand cigarette packaging comes with gruesome images of the effects of smoking however I never once thought it impacted any ones impulse to smoke. like you said well informed young people still pick up the habit. How will this regulation change anything?

    1. No patient of mine had mention to me about this campaign yet, nor did I brought it up. Maybe when the time of implemenatation comes, that is on Sept 2012, this will bring more discussion.

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