Wednesday, November 10, 2004.

Best Movie Out: The Incredibles!
(Saw it twice.)

An interesting teacher/blogger in
Japan.

      

“OR MAYBE I’M THE SHEPHERD….”

 

They say about 1% of smoking cessation discussions actually result in a person trying to stop smoking. But considering how many millions of people smoke, that 1% adds up.

 

I’m not the kind of doctor who hammers on people to quit Quit QUIT every time I see them (in the hospital). I pretty much tell them once, near the end of their hospital stay, especially if it’s related to why they are in the hospital to begin with (which is almost always the case with medicine patients).

 

I tell them quietly but clearly like it is the Word Of God Almighty, or a nicer Samuel L. Jackson at the end of Pulp Fiction. There’s only two kinds of people who can really tell you with better than average odds that you are going to die soon:

 

1. someone who is going to kill you, and
2. your doctor.

And even then, it’s a toss-up as to who is right more often.

 

I’ve given the same death threat speeches so many times that they almost feel rehearsed. Like lines in a Broadway play.  A play that I’m going to perform over and over long after they’re gone, and that you’re probably only going to see once. Like CATS.

 

 

“There aren’t too many things you can say with certainty in medicine, but I can assure you of this, Mrs.______. If you keep smoking, with your diabetes and your heart disease and the stroke you just had, you WILL have another stroke. Maybe you'll lose your ability to swallow, or the ability to move half your body, but that’s what happens. And chances are, you won’t be so lucky next time. I just saw someone like that. It’s up to you.”

 

Or

 

“Mr. _____, normal people do not VOMIT PINTS OF BLOOD, right? That should tell you something. If you keep drinking, those blood vessels in your throat are going to bust open again, and maybe next time it won’t stop. You’ll be dumping blood out of both ends. It’s a horrible HORRIBLE bloody death. Had a guy like that in the Unit last month. It’s pretty bad.”

 

I’ve made both of those threats in the past week. Actually there was a third threat where I used a “might as well shoot yourself in the head if you don’t stop” analogy for one stubborn old codger who just didn’t get it. You can kind of size people up and figure out who to be gentle with and who needs graphic depictions of violence for their analogies.

 

I always remind them that it’s their choice. They just have to walk where they talk. I remind them that they’ve already been on the right road for the few days of their hospital stay. Unless of course, they snuck out and had a cigarette outside. And oh yeah, I can smell it, as sure as I can feel their pulse racing when I do.

 

The family thanks me for making the point because no one listens to family members. The patient usually appreciates my candor, because they’ve realized that I am otherwise a gentle straight-shooting kind of guy.

 

And they pray they never have to see me again in such circumstances.

 

But if they do, it’s all the same to me. It’s actually an easier admit since I already know them and have their recent history in the computer as well as in my memory. I’m still pleasant and nonjudgmental. In their new sorry and potentially avoidable state, I might tilt my head with a slight half frown knowing they've just stumbled closer to The End, but that’s it.

 

I’ll just use them as an example for the next one that comes along.

 

 

 

 

 

ADDENDUM:

 

And then this week I get this young woman who tries to kill herself by swallowing thirty-two anti-reflux pills (it was PR0T0NlX - it appears to be fairly benign). It's kind of funny. That stuff’s safer than aspirin or Tylenol, either of which can really fuck you up big time (kidneys or liver, respectively) if you overdose on them. Today she’s complaining that the inpatient pharmacy doesn’t have her brand of birth control pills.

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