Frank T. Leone, MD, MS, associate professor of medicine, is director of the Comprehensive Smoking Treatment Program at Penn Medicine.
The Penn Lung Center’s Smoking Cessation Program team is responsible for going out into the community around Penn and counseling people on ways to quit smoking. A few years ago, on a night like so many before, I was getting ready to start a community class by getting my thoughts together and reviewing my approach to the evening’s topic. However, I didn’t expect to be the one who would be learning the most that evening.
A patient's perspective
We were doing the typical introductions: going around the room and getting to know a little about each other. It was a generally light and easy atmosphere; people were excited to be doing something positive for themselves. But I noticed one gentleman, “Bill,” remained more reserved than the rest. He was a little too quiet, even a little evasive. As the evening went on, I did my best to help him feel comfortable, assuming his ambivalence was just a natural part of facing a quit attempt. I was wrong.
Bill got extra quiet when I asked the group to describe an interaction they may have had with their doctor in the past, and to discuss how they felt when their doctor brought up smoking. People were telling stories and enjoying sharing their experiences with each other.
When Bill finally spoke up, the room got quiet. Bill had undergone a lung transplant two years earlier, but had started smoking again when life’s daily stresses had become too much to handle. He felt incredibly sorry that he was hiding something so profound from his doctors, and sorry that he was treating this incredible gift with such apparent disrespect.
I’ve often wondered what it would be like to feel compelled to do something that I knew was no good for me. What if I knew it was harmful, but just knew in my bones that I really didn’t want to stop? And what if no one, including me and my family, really understood why I kept doing it? What if someone I loved begged me to stop, but just thinking about stopping made me want to do it more? How would I feel?
Taking control one step at a time
At the Penn Lung Center, the sole purpose of the smoking cessation program is to help people stop using tobacco. My patients often try to explain how it feels to face their personal dilemmas. They describe feeling sad, angry, and hopeless. They tell me it’s frustrating and confusing; embarrassing and shameful. They feel trapped between desperately wanting to stop and desperately wanting not to stop. And they cry. They cry because their lives are literally on the line, and they have no idea how to get “un-stuck” from this trap. They cry because they are afraid, ashamed, and confused. In Bill’s case, being a lung transplant patient meant that he had an extra heavy burden to carry.
At Penn Medicine’s Comprehensive Smoking Treatment Program, the team works hard to help smokers and their families understand how nicotine addiction works to make them feel trapped and powerless to change. All of us try to understand every patient’s specific needs, whether it relates to health, family, work, or other aspects of their lives. I believe that smokers deserve to quit comfortably, so the strategy tends to be aggressive with medications in a way that helps keep that “devil inside” quiet. Most of all, every member of the team respects the problem for what it is, and respects those people struggling to find a way out from under it. The program has been fortunate to help thousands of our patients overcome this horrible addiction over the years, and it’s amazingly rewarding.
No one should suffer like Bill. Patients with chronic lung illness should understand why they feel compelled to continue smoking. Family members should feel more empowered to help in more productive ways. After transplant, patients know they have the support they need to stay off cigarettes forever. And if there is a slip, transplant patients should never be made to feel like a failure, but instead be helped to honor their gift by getting the immediate help they need to get right back on the wagon.
The real shame of this story is not that Bill slipped back to smoking, but that Bill felt like he had nowhere to turn for answers.
Call us if we can help you or someone you know, even if you don’t feel ready to quit. We’re happy to answer questions and discuss options with you and your loved ones. No hassle. No pressure. Just help.
1-888-PENN-STOP
In next week’s post, Dr. Leone discusses strategies that have been proven to make it easier to control nicotine addiction.