Recently, I had a very moving encounter with a patient with acute respiratory distress secondary to COPD exacerbation. My intern (let’s call her Patricia), had just told me James’ history (not his real name), physical exams, labs, imaging, and assessment and plan. James was an otherwise healthy man in his sixties who was on 2 liters of home oxygen and still smoked over a pack a day. Patricia was surprised that James had no other past medical history except for COPD.
“If only he didn’t smoke”, she thought out loud, “he might not be on home oxygen and might not need to be in the hospital now.”
As Patricia spoke, I reflected on the countless patients like James that I have seen addicted to something that was literally sucking the life out of them. In my early years learning to love and care for patients, I was very naive. I used to look at patients and tell them to just stop smoking or stop drinking alcohol. I used to speak–often condescendingly–as if quitting a destructive habit was as easy as snapping one’s fingers. I used to think that patients continued to do those destructive behaviors because they wanted to; because they hadn’t made a decision to stop hurting themselves.
As I grew, I realized that no one, not even me, desired more than these patients did to quit their bad habits. Many of these people wanted nothing more in life than to quit their addictions. They realized that their bad habits were shortening their lives and taking them away from their loved ones and the beautiful things in life, yet, they just didn’t know how to quit. They felt powerless and almost enslaved to their addition.
James, obviously, was another example of a person enslaved to their bad habit. He was on home oxygen and was advised not to smoke because it could cause an explosion that might injure or even kill him, yet he risked his life to smoke.
As Patricia and I walked toward his room, my heart was full of empathy and love for him. I knew that James must have wrestled with quitting smoking thousands of times and failed. I knew that he felt terrible and guilty about his addiction to tobacco. Instead of giving him the usual spill that doctors give by citing the surgeon general, telling him to stop smoking, and explaining to him how smoking was killing him, I lay my hand on his shoulder and with a heart heavy with love, I told him, “James, I know you can quit smoking.” He looked at me intently, in disbelieve, as if to say, “I can’t”. I repeated myself, “I know it’s difficult, but you can do it.” I proceeded to tell him that I know that many people have probably made him feel that quitting is very easy, but I know it’s not. It’s very difficult. The only thing, though, is that I believe he can do it. It’s tough, but he is tougher on the inside. I could see in his eyes that he was getting emotional. He told me the numerous things and times he has tried and failed to quit smoking. I listened to him with empathy. Then explained to him many other medications and resources that are available for him to quit smoking that he hasn’t explored and encouraged him to talk to his primary care doctor after discharge. You are a very young man with a future in front of you. You’ll probably see significant improvement in your COPD if you stopped smoking and will probably live a longer and healthier live. I painted a vision of a brighter tomorrow for him. All the while, I would interject my communication with, “It’s difficult but, you can do it”
By the time I was done, James was starting and finishing my refrain. It went from a single voice saying, “It’s difficult, but you can do it” to two voices saying, “It’s difficult, but I can do it” because James took over and finished the sentence as I nodded in affirmation.
As I shook James’ hand, said my goodbyes to leave the room, I could see that faith had risen inside James. His belief in his ability to win this hard fight with tobacco had grown and I could see a giant.
It was a very spiritual moment, a moment where two souls connected and there was no feeling of judgment, condemnation, or skirting the lion in the room out of the fear of offending him. As Patricia and I left the room, there was a moment of silence, no one said a word to each other. I could tell she was taking in the moment.
This situation isn’t unique to medicine at all. We all live with family members, friends, classmates, and coworkers who are struggling with something. Most of the time, these people know their weakness and the consequences on themselves. They just don’t know how to fix it. Telling them to simply quit or reciting the consequences to them as though they didn’t know about them isn’t very helpful. Empathizing with them, believing in them, inspiring, empowering and supporting them to take steps towards transformation is the only way to help them.
