Talking with my doctor about smoking

Talking with my doctor about smoking

I just got back from a trip to Anchorage, Alaska, where I lived for 14 years. Though Alaska is full of places to see, opportunities for hiking and driving and camping, I concentrated my time and attention on people. Most every meal was spent with friends. I spent a weekend with my book group, had lunches and dinners with work friends, drove my daughter to sleepovers with school friends, hugged neighbors while wandering downtown. Every moment of the visit reminded me how privileged I have been to know such a breadth of people. As I saw each face, relished hugs and laughter, soaked up gossip and caught up on everyone's stories, I was awash in gratitude. I'm still awash in gratitude.

When we compiled our list of people we hoped to see, my daughter and I both included our doctor. Our family saw the same practitioner, Jeff Russell, for the whole time we lived in Anchorage. My husband and I chose his practice when we were expecting our daughter. Over this past year we often wished we could make an appointment with him. I've been dealing with cancer and my daughter has been diagnosed and treated surgically for scoliosis. We have sorely missed Jeff, our touchstone for all things medical.

His nurse was able to find a time for a visit one afternoon, and as we were waiting to see him I realized that the anxiety I felt was excitement rather than fear. When we went into one of the exam rooms, Jeff pulled out chairs, but my daughter hopped up on the examination table. It's got to be a statement of faith to see a kid gravitate to an exam table with a grin on her face, totally at ease.

We told him our stories. My daughter showed off her foot-long scar and recounted her saga. Just four weeks past surgery, she is still very close to the pain and fear, still processing. Jeff's questions and kindness seemed to be a turning point for her. The experience is now in the past, done, over, officially a war story.

My story is a little bit different, not quite over. I've been in remission since January and I'm trying to learn how to find some closure. Many of us with cancer in remission feel like we're in suspended animation. There's a feeling that the movie has stopped but could buzz back to life at any moment. It will be four years before my doc will use the word "cured." By then, I hope I have gained the confidence to use it, too.

4502_Jeff_120As I was telling Jeff about my original diagnosis, the surgeries and treatment, I realized that an awkward moment was approaching, one that I hadn't really anticipated before then. Though most of my friends and acquaintances don't ask what may have caused the cancer, I knew that Jeff would. Medical types care about this. I suspect, like patients, they wonder if they should have seen warning signs.

My brain was scrambling and I was trying to figure out how I would tell him what I'd never told him before, that I've been a smoker. After 13 years, he knows me medically better than any one. It's a huge thing for me to say that I trust Jeff completely. Totally. With my life. And I lied to him for 13 years about smoking.

He did ask, and I resolved to tell him. His response was emblematic of why he was such a marvelous caregiver. He was totally unfazed and nonjudgmental. He asked me how he could create an atmosphere where someone like me could be honest about smoking. "What can I do differently?"

When was the last time a doctor asked you that question?

I've thought a lot about it. What can doctors do to create an atmosphere where patients can be honest?

They can take the time to get to know their patients. If they give us a space where we are more than data, we're more likely to talk to them. Knowing us as people with quirks and talents can give us confidence to talk about our weaknesses and failures.

They can dial down the judgment. My blood pressure and weight are not empirical expressions of my character.

They can laugh with us and listen to what we're saying. People tell you more than you might think if you listen carefully.

They can educate and provide resources instead of heaping on shame. There's more to the matter of smoking than do you or don't you. Like any addiction, the situation is complex. And not all who smoke are addicted.

But Jeff did and does all of these things. I know a bad health practitioner when I see one, but describing a good one is harder. Jeff taught me and showed me what a good doctor looks like.

In the end, the only thing that prompted me to tell a doctor that I had smoked was abject fear and being battered with questions. Lying in a hospital bed, clearly very sick, being asked hourly if I smoked tipped me into honesty. And my urologists's first response was, "Why did you do that?" My answer, "So that people like you would have something to judge."

The concern that lingers for me is whether I could have prevented myself from getting bladder cancer if I'd been honest with Jeff about smoking. If I'd told him, I'm sure that he would have helped me stop smoking sooner, which would have undoubtedly improved my health. Who knows if it would have prevented cancer?

I'm certain that he wonders the same thing because he's that kind of doctor.

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Filed under: Smoking, Uncategorized

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