Wednesday, March 07, 2007


Before I forget, the deadline for this month's Carnival of Hope is tomorrow, Thursday, at 5 PM PST. I'm more or less begging for submissions; I've gotten a lot of bland, impersonal personal-development posts this month, rather than the personal narratives I specifically ask for in the guidelines. So if you have a personal story about hope, gratitude, or good deeds, please send it to SusanPal (at) aol (dot) com, with the permalink of the post and a 2-3 line description.

Here's my own hopeful (or semi-hopeful) anecdote of the week:

Back in January, One of My Favorite Nurses at the hospital (hereafter abbreviated as OOMFN), decided to quit smoking. I learned about this because I'd seen OOMFN, clearly in a rush, buying a meal for an ED patient at the hospital coffeeshop; as I was buying my own chocolate-chip cookie, I said something like, "Wow, now there's an energetic person," and the cashier said, "Yeah, and giving up smoking didn't help."

So when I went back to the ED after my cookie break, I found OOMFN and said, "Hey! I hear you've quit smoking! Good for you! That's a really big deal! Congratulations!" OOMFN seemed startled, but thanked me. Since then, I've asked several times how the non-smoking campaign's going, and been told that it's going well, although "it's hard." (Giving up nicotine is supposedly more difficult than giving up heroin; I wouldn't know, since I've never indulged in either. But I can't even give up coffee, so it's a good thing I haven't used anything more dangerous!)

Last week, during my standard end-of-shift sweep of the waiting room, I met a young woman who said, "I'm pregnant, and I want to stop smoking. Do you have any information about that?"

I immediately thought of OOMFN. Could I get the two of them together to talk? But no: there might be HIPAA issues, and anyway, OOMFN (like all the medical staff that night) was running around like the proverbial headless chicken. And I didn't know how OOMFN had managed to stop; if the patch had been involved, that would be no help to the woman in the waiting room, who couldn't use the patch because that could hurt her baby, too.

Did we have how-to-quit-smoking info in the ED? I was constantly hearing doctors telling patients to stop smoking, so we had to have some printed material, right? But when I scanned the racks of wall pamphlets -- on heart disease, diabetes, stroke, alcoholism -- I didn't see anything about smoking.

I asked a tech, who suggested that I ask a doctor. I asked a doctor, who scratched his head, said, "I dunno. Tell her to go cold turkey?" and then suggested that I talk to the case manager. "I thnk maybe the hospital has a smoking cessation program." I talked to the case manager, who found a handout for me on the benefits of stopping smoking, with some do-it-yourself advice, but wasn't sure about the cessation program.

"Telemetry has standing orders to tell all their patients to quit smoking. They may have info we don't. Let me call up there." So she called telemetry, and sure enough, they had some pamphlets, and I went upstairs to get them. It turns out that there's a Nevada state hotline for people who want to stop smoking, paid for by Big Tobacco money. I gave one to the woman in the waiting room and gave the rest to the case manager, who said I should give them to the charge nurse, who said they should go in one of the wall racks. So I photocopied a bunch, but there were no empty wall racks, so they went into an obscure folder instead. At least the ED has them now.

During this long, involved process, I kept thinking, "It would have been so much simpler if I just could have gotten OOMFN together with that patient." I still wonder if I should have tried, if only to give the young woman a role model, although I think all of us know people who've stopped smoking.

My mother smoked a lot during her pregnancy with me; I managed to emerge without major birth defects, but I wasn't going to tell the young woman that story, because I was 150% in favor of her quitting. (My sister and I nagged my mother into quitting when I was about nine.) I see so many people in the ED who are addicted to all kinds of things, and so many of them really seem to want to quit, and so often, they face obstacles, especially the lack of rehab programs for patients without insurance. AA and NA are great, because they're free, but some folks -- especially the ones who've relapsed after some time in 12-step programs -- need closer supervision, at least for a while. OOMFN is already one of the more empathetic nurses at the hospital, but I hope that the experience of quitting smoking has created new and deeper empathy for addicted patients.

It's ironic, though, that in a part of the hospital where patients are constantly told to stop smoking, finding information about local resources took a good twenty minutes of my time. Maybe the logic there is that info on how to stop smoking is readily available on the Internet and other places, but it still can't hurt to be able to give patients printed information. And it can't hurt to remember that giving up smoking is really difficult: even for healthcare providers who know the risks of smoking all too well, even for parents motivated to stop by love for their children. We need to praise people who've given up nicotine as much as we praise people who've given up heroin or meth.

I think, and hope, that OOMFN has appreciated my interest and encouragement. I'm pretty sure the young mother appreciated my getting that information for her. Knowing that they're both trying to quit makes me very happy, and I hope their efforts succeed.


  1. Hi Susan,

    As you may recall, I am a former pack-and-a-half-to-two-packs-a-day smoker of ten years' standing who quit cold turkey. Here is the advice I give everyone who tells me they're trying to quit:

    -Very strong, spicy flavors give the best approximation of the physical effect of inhaling cigarette smoke. My favorite substitute was candied ginger. The second best was cinnamon gum.
    -Next best satisfier is a snack that can fill the mouth for a long time, the most effective example being Swedish Fish.
    -Don't even think of trying to lose weight.
    -Don't even think of taking on ANY other source of stress for several months.
    -Exercise can help too.
    -The best way to get through a craving is to pretend you're smoking without actually doing it. If you don't have candied ginger, gum or a swedish fish, do not hesitate to mime smoking a pencil or pen. For some reason, I found it comforting to pretend to inhale a candy cigarette and did so unashamedly in front of friends more than once. If there is no substitute handy, just pretend the air you're breathing contains cigarette smoke. Focusing your concentration on inhaling and exhaling will also pass the time until the craving dissipates while maintaining your status as a living being until the crisis is over.

  2. First of all, good for in going to the lengths you did for the person! Second, the ER doc might not have known that there may have been smoking cessation information in the computerized ED discharge instructions (assuming those are used in your facility).

    And even though OOMFN was really busy, she may have known of some info location off the top of her head or a good website to go to or even been able to talk to the person herself. I don't think that would have been a HIPPA issue if the RN had been willing to discuss the issue. After all, the patient/ family member initiated the conversation.

    Good job either way!!!!! : )

  3. I don't smoke, but I can't count the number of doctors who've told me I should "work on losing weight" without offering any advise on how to do it. Probably shouldn't waste thier breath with the phrase. So think of a smoker and some doctor (and probably every doctor) has said "you should quit smoking, at least cut down." and not offered them any advise or help on how to do that. Now think if it was a junkie who was sitting there admitting to shooting up 40 times a day. Would that same doctor be saying "you should think about quitting or at least cutting down?" I'm willing to bet that wouldn't happen. People who quit smoking cold turkey get really physically ill and there is no medical support for them, nor is there anything like a 12 step program to help them. My sister won't even go to a doctor because she says "all they are going to say is 'quit smoking and lose weight'", and she's probably right. So how do we get the medical industry to stop preaching and take this addiction seriously? People are dying because they can't quit.


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