I started smoking cigarettes in earnest at age twenty-four when I was an intern in a busy city/county hospital emergency room working twelve hours on and twelve off. That would have been in the spring of 1959. I loved to smoke. It relaxed me when I was tense and under stress. Working twelve straight hours in a busy emergency room will make you tense. And I continued to smoke while a resident in the specialty of otolaryngology (ENT). And I particularly enjoyed a smoke after a long surgical procedure. I'd sit and dictate the operative note and light up.

Then I did a rotation on the thoracic ward of a large veterans administration hospital. That would have been in January of 1964. The surgeon general's report on smoking had not been published at that time. All physicians knew that inhaling smoke into one's lungs could not be a good idea, but most of us did anyway. If you went to a medical meeting in those days, the auditorium would be full of doctors smoking and there would be a brown haze pushed tight against the ceiling tiles. 

My first day on the job I was assigned the task of giving an intravenous injection of an anti-cancer drug to a thirty-six year old bush pilot from Alaska. I'd just removed the rubber tourniquet from his right arm so I could empty the syringe of toxic material into his vein. He looked me in the eye and said, "Doc, I want you to make me a promise."

"Okay. What?"

"I started smoking when I was twelve years old. I lived in a small town in Alabama and most of my contemporaries, the boys anyway, all started smoking by the time they were fifteen or sixteen. I just got a jump on them. And I've smoked two or three packs a day for all these years. Now I'm dying and I feel cheated."

"Cheated?"

"I feel cheated because not one doctor in all these years ever told me that smoking was going to kill me. In fairness, because I know I'm a stubborn fellow, I doubt I'd paid much attention to them. But looking back, why didn't a single one of them level with me?"

I shrugged and said, "They could have been smokers themselves. I smoke even though I know it can't be good for me. But to be honest, I don't know the answer."

"So here's what I want from you. The promise. I want you to promise me that you will tell people smoking will kill them. Then if they're dumb enough to keep it up, the monkey's on their back, not yours. Will you promise me this?"

I nodded and in a hoarse whisper said, "Sure."

Two weeks later the pilot died in his sleep and I went to the morgue to watch his autopsy. The pathologist made the "Y" incision on the man's chest and lifted out his lungs. When he cut them open they looked black. Then the pathologist showed me the primary lesion in the inferior lobe of the man's right lung. It was a friable, grayish mass of about three centimeters in diameter.

I watched the pathologist remove each organ and take samples of cancer from along the man's spine. The man's liver was full of metastasis as were most of his other abdominal organs. When the skull cap was removed there were multiple metastatic sites throughout the pilot's brain and in his brainstem. I figured it was the brainstem lesion that killed him, made him stop breathing.

I left the autopsy room shaken, nervous, and wanting a cigarette. I resisted the urge until that evening after dinner when I usually enjoyed a smoke. For the remainder of the month I made myself go see every autopsy on each patient who died of lung cancer. And they were dying like flies, sometimes two or three a day. I continued to smoke but I'd cut down considerably. Probably to half a pack instead of a full pack a day.

Three weeks into my rotation, I was walking down the hall one day and glanced into a patient's room. He was a fellow about six foot three who weighed no more than eighty-five pounds. His skin and eyeballs were the yellow color of garden fresh squash. His liver had obviously been invaded by his cancer. He was lying on his side propped up by his right elbow. He clutched a cigarette between the index and middle finger of his right hand. It was down to a short butt and I was concerned that it was going to burn his fingers if he didn't drop it immediately. I had just started into the room when he rolled over on his back and stopped breathing, the cigarette still grasped in his dead hand. His lifeless eyes stared blankly at the ceiling and gave me a cold chill. I removed the cigarette and noticed the tell-tale tar and nicotine stain on his fingers. When the butt hit the floor, I squished it into the hardwood floor with the heel of my shoe. Then I closed his eyes and pulled the sheet over his face.

There was a waste basket in the corner of the room and I walked over to it and pulled my pack of Winston cigarettes from my shirt pocket. I held them in my right hand for a second before crumpling them between both hands. They dropped unceremoniously into the bottom of the trash and I turned and strode from the room to notify the floor nurse of the man's death. I did not watch his autopsy.

Since that day some forty-six years ago, a cigarette has not touched my lips. After a smokeless month, my morning cough was gone and in six months I could walk up a flight of stairs without becoming short of breath.

I had no idea how addicted I'd become until I actually quit smoking. If someone lit a cigarette next to me, I'd break out in a cold sweat and my hands would start to shake, a fine tremor. And I craved cigarettes with a passion. There were no "quit-smoking aids" like nicotine gum in those days so if you wanted to quit, you had to do it cold turkey. I did devise a method to help me. Without it, I'm not sure I could have quit. I would smoke one small, wood tipped cigar a day, half in the morning and half in the afternoon. I did that for about five or six months and then I just stopped.

Over the years I've fulfilled my promise to the bush pilot from Alaska. Whenever I interacted with a patient who smoked, I'd try to persuade them to quit. Some did and others didn't. I'd accost my friends and get momentary, sometimes several years of cessation just to have them back slide and start up again. I've buried several close friends who never took my warnings seriously. Years later I watched my father drown in his own fluids when he was on the cusp of reaching the fine old age of eighty-one. And with all the efforts of the anti-smoking crusades, twenty-five percent of our population still smokes. It is, after all, an addiction.

When I talk to someone about this deadly addiction, they inevitably say, "We all have t die of something."

Well, yes, that's true. But I've never known an individual who developed lung cancer who didn't say they wish they'd stopped before it was too late. Years ago the actor, Yul Brynner, made a passionate television spot begging young people to stop smoking as he himself was in the terminal stages of his own disease.

So the tobacco companies have shifted their efforts to third world countries in order to keep their stock price up. How their CEOs sleep at night I'll never understand. Yet, as a libertarian, my basic belief is that all adult individuals have a right to make their own decisions even if they are self destructive. Like the bush pilot, they deserve to know the truth. I just wish common sense prevailed and denial wasn't such a strong emotional aspect of our collective psyche.  

Mike Glasscock

June 3, 2010

Austin, Texas