The best laid plans of mice and men often go awry.
-Robert Burns
Her eyes were lowered, and she would not meet my gaze. I was certain I knew why.
I skimmed her chart and reviewed my notes. “How have you been doing since your last clinic visit?” I asked. She finished her cancer treatment about a year ago and was doing fairly well. Her recovery was slow but steady. Her swallowing was gradually improving. Her weight was stable. She reported no new problems at the last few check-up visits. Everything was going fine except for one issue. Even after being treated for cancer, she had never been able to quit smoking.
Last time, she declared she was finally ready to quit. She decided she didn’t want to try any of the medications to help with smoking cessation. She didn’t need the Quit Line phone number (by the way, it is 1-800-QUITNOW). She knew smoking caused her cancer and was bad for her — no need for another lecture. She would just quit. She had a timetable all mapped out and made a solemn promise to quit later that month.
Now, about four months later, she was back for her next visit. I could smell the tobacco smoke on her clothes as I examined her.
“Still smoking?” I asked. “Ready to talk again about quitting?”
I was expecting the usual litany of excuses. Sometimes, people blame their families for leaving cigarettes around the house even when they are trying to quit. Sometimes, they say they were doing just fine until they went out with a friend for a drink or two. Most times, though, they never quite got around to quitting in the first place.
“I’m sorry, Doctor. I really am. I did quit for a few weeks but then started again.”
She paused and then continued.
“Remember the big guy with the Green Bay Packers jacket that always came to my appointments? My husband? Remember him? Well, he dropped dead of a heart attack about a month after I quit smoking. It has been a hard time; real hard. I went out and bought a pack of smokes the day of the funeral. Maybe I will quit again. I don’t know.”
We sat quietly for a while. My prepared speech was on hold. I had assumed she was not meeting my eyes because of her continued smoking. I had been wrong.
We talked about her husband and her family. I reassured her there was no sign of cancer. Encouraging her to quit smoking will have to wait for another day.
