One morning, I received a phone call from a person with special needs, interested in quitting. Her nervousness was evident as she struggled through explaining how important it was to her to quit. She tried to fight the messages her brain sent her, screaming at her to smoke, but she felt it was a losing battle – she always gave in.
We decided to set up individual counseling sessions. Since she lives in a group home and is not able to drive or take the bus, she had to set up transportation through the group home. It took numerous phone calls back and forth to get a ride scheduled. She would unfortunately have to wait at the location for over two hours, even though our meeting would only take about an hour. Thankfully, she was willing to do that; she felt she had no other choice.
At our first meeting, I realized that the normal material we teach would have to be greatly modified to meet her needs. She had a lot of questions about the patch… she had tried them before but would end up smoking while using them. Given this history, the nurse of the house was forcing her to sign a contract saying that if she wants to smoke, she has to take the patch off, and wait 3 hours before smoking. It seemed simple enough to me; she was experiencing breakthrough cravings, leading her to smoke with the patch on. The guidelines suggest using combination NRT in this situation, so we discussed using lozenges along with the patches to address this issue. She hadn’t tried this approach before, and was so relieved and excited to hear that there was hope. She wanted so desperately to quit, but felt so desperately hopeless to do so. She felt that the nurse might give her a hard time about this, and asked me to write a letter indicating that this was a safe and practical way to quit. I told her I would be glad too, that I would even speak to her nurse on the phone to explain all of it.
She went home and spoke to the nurse about our meeting. The nurse told her that she needed a prescription to use any NRT. I offered to speak to the nurse to try and explain the approach. From the moment the nurse answered, I could hear the agitation in her voice as she discussed this individual and quitting. The nurse explained that she was concerned the patient might smoke with the patch on anyway. I was flabbergasted when she went on to say that she had a license to protect, and could not allow the patient to use the patches without a signed contract that stated the individual would wait to smoke after removing the patch.
It was hard to understand how a nurse could paradoxically feel threatened by helping my patient to quit, but secure in putting up impractical obstacles without offering any constructive solutions.
Within an hour, my patient called me back, incredibly frustrated and agitated. She told me that her doctor had spoken with the nurse of the house, and that he would not write a prescription for her to use both the patch and lozenge at the same time. He had recommended using the lozenge during the day and the patch at night. I was so saddened to hear this.
I am still terribly frustrated and troubled that this individual will likely go on smoking, knowing full well that if the blockades presented weren’t there, she could have quit. I have never experienced health professionals putting up so many obstacles to someone quitting. It makes me feel helpless and at a loss for how to change it. Mostly though, it makes me sad to see the person suffer; she has lost hope and determination. If she were not mentally challenged, and did not have to live in a house that governs her every move, she could go to the store and buy these products on her own. She could easily be well on her way to quitting.
I hope that one day, nurses and doctors will feel like they could lose their license for dissuading someone from quitting, and not the other way around.
– Philadelphia, PA. August 2012