Surgeon General's Warning: Beware of the irony . . .

Good Morning All:

I'll do better than an update today. My apologies in advance to the smokers who read my blog--this one isn't intended to sway your decision to smoke but perhaps I might be happy if it did . . .

The parking garage for the cancer center at Hopkins is located under the building itself. Its exit empties into an alleyway of sorts and leads to a traffic circle and the city streets of Baltimore. As you drive up the hill to this alley and stop to look for car or pedestrian traffic it is very hard, as a cancer patient, not to take notice of the activity across the street: more on that in a bit.

In the passenger seat in the car leaving the garage I am always wearing a mask. I have been instructed to wear that same mask in the hospital because people with viral and bacterial infections roam the hospital--a danger for me. Leaving the hospital, whether in a car or on foot, I must wear the same mask. There is construction all around the hospital and this stirs up dust, dirt and ostensibly microbes of some sort that I am to be wary of. As we drive through and out of the city I keep the mask on because city buses belch out plenty of potentially harmful fumes and the construction exposure continues until I'm about a mile or so out of the city.

. . . And so there I am in the passenger seat of the car emerging from the parking garage located under Johns Hopkins cancer center wearing my mask to prevent just about anything harmful from entering my depressed system. Across the street is always a handful of people smoking. Typically there's a person or two wearing hospital scrubs or even a doctor's white coat, others are wearing the street clothes of hospital visitors. There's a bench there and an awning for them to stand under and one of those tall tubular receptacles for cigarette butts. Its become a common quip for me to make as we wait to turn left: "Smoking outside the cancer center."

Its really only half a joke. I can't help but feel a bit down as I ponder the unfortunate irony of the same people who routinely see the worst of the worst cases of cancer being dragged by the scruff of their neck by an addiction to inflict the same damage on themselves that they struggle to treat day in and day out. I often catch the eye of someone as we drive by and I can only imagine what they think as they watch the cancer patient wearing the tell-tale mask drive by following an outpatient treatment. Is it learned indifference that keeps them lighting up? Do they doubt the research that links smoking to cancer? I just can't help but wonder.

After probably 50-100 visits to Hopkins now I decided to write this as we came home last night because I saw something there at the smokers bench that I had never seen before. There is at least one patient that I cross paths with frequently in the outpatient clinic who smokes. I've heard nurses talking about his smoking habits and how all have tried to counsel him to give up the habit. Sometimes they'll be looking for him and he'll have disappeared and they naturally wonder/worry that he's outside smoking. I believe that I've seen him there among the smokers on at least one occasion dressed in his street clothes.

Last night, however, as we turned left into the alley there he was crossing the street in front of us. He was an inpatient this time--betrayed by his hospital gown, wheeled IV Pole with tubes leading from bag to body, slippers, and the ever present mask. He had a coat on over his gown and a stocking cap on his bald head but he still looked cold. This time as I watched him lift the IV Pole over the curb I had to wonder what the other smokers were thinking. If I envisioned myself with my mask as a stark reminder of what was possible. What was this guy's presence going to be for the rest of the smokers? How could it be possible to ignore such a sight?

And for the patient, other questions arose. Why wear the mask at all? It can't be because he wants to follow doctor's instructions in an effort to keep matters from getting worse. How must he feel as he makes that trek? I have to assume that it feels much like he's being led to the gallows as he wanders through the hospital to do more of the same damage that probably led to his hospital admission in the first place. Does he ever question just how much effort his care team is willing to give his case if he seems unable to change this habit and simply undoes the work done by his doctors and nurses? I know I questioned that very thing last night.

In the past I have viewed the smoking habits of others as largely none of my business unless they were blowing smoke in my face. Even then I was probably more tolerant than most. While I still am not a likely person to launch a crusade against smoking or to counsel smokers at length about the damage they are doing to themselves something has changed for me. I now know what the treatment of cancer entails. I've seen patients in very rough shape, skin-and-bones terminal cases, and very young adults and children who don't have the strength to walk out of the hospital. I know what it feels like, first hand, to put just about everything in life on hold to receive treatment and to have the constant worry about whether the treatment is working. These are sights and experiences that I would not wish on anyone and would be likely to crusade against.

The sight of the cancer patient crossing the street last night brought into stark reality for me the intersection of smoking and cancer and the confounding, ironic grip that addiction has on those who smoke outside the cancer center.