One Last Smoke

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One Last Smoke Empty One Last Smoke

Post  Abbas on Thu Nov 25, 2010 7:27 pm

A very nice and worth reading account of initial experiences of a young doctor. To maintain originality of writing I am giving the link below of the pdf page. However the story is also copied below. One_last_smoke.pdf.html

Code Blue Stories
One Last Smoke

From a Hospital Lobby to a Patient’s Room

Sunday mornings can be a fairly quiet time in hospital wards, as many physicians prefer to start their rounds later than usual on this day of rest. This leaves the interns, who work around the clock, to provide most of the patient care during these early hours. I was just such an intern once, fresh out of medical school, doing my first rotation at a major Chicago hospital.
I had been working since the previous morning and was looking forward to heading home after morning rounds for some well -deserved sleep. Shortly before rounds were to start, I heard a “code blue” call come over the public address system. My heart leapt into my throat. Although I had taken cardiac training classes and assisted with other codes, I had yet to manage a full code alone. My pulse quickened and the sweat began to break, as I mentally rehearsed the correct medical protocols for cardiac arrest while running to the room. Squeezing between a crowd of nurses and stepping to the bedside, I suddenly remembered the man lying there from earlier in my shift.
About 6 hours earlier, I had been sitting in the lobby going over charts when a thin, gray-haired man shuffled in. He had the gaunt frame of a chronically ill cancer patient, and the gown he wore over his frail body gave him a ghostlike appearance as he passed. He mumbled a friendly greeting and sat down wearily in a chair. Then, I saw him reach into his gown and produce a crumpled pack of cigarettes. His thin fingers removed one, placed it to his lips, and lit it. I was astonished! As a physician and a runner, I am not a big fan of smoke, secondhand or otherwise. I was sure that others nearby would have shared my feelings since, in addition to the health risks, there was also the concern about combustible oxygen. I considered this and soon began to feel the indignation of one who has had his rights violated. My immediate reaction was to demand that the effrontery be removed. As I watched this pale figure smoking in silence, however, I couldn’t help but wonder if, at this particular moment, his contentment was more important than the hospital’s rules and my right to breathe clean air. I realized that perhaps it wouldn’t be so difficult for me to put my own desires aside and let him be. The smoke didn’t drift back to any other rooms and was safely away from any source of oxygen. I specifically recall thinking for one brief moment that this could be the last smoke of his life. The man finished his cigarette, lifted himself with great effort, and shuffled back to his room. I considered the irony as I walked through the smoke-filled lobby to the elevator. As a physician, should I not have stood for good health and enforced the hospital’s sensible no smoking policies? As a bystander, should I have had to endure that smoke? Rather than ponder those questions at that late hour, I decided to forget the whole thing. No harm had been done, and I assumed that I would never see him again. But here he was staring up at me, his eyes only slightly more vacant than they were the night before. The ghostlike figure that I had deigned to let smoke only a few hours before was now dying in front of me. My hands trembled as I pounded his chest with my fist, his vomit splashing onto my face as I desperately tried to bring some rhythm to his fading heart, some life to his stiffening body. Intravenous lines were started and medications were given, as I tried everything I could to stop this man from dying.
After struggling for more than an hour, I slowly realized that I could not save him. I stopped the code and somberly signed my name on the chart, formalizing the first time I lost a patient. At home, I sat on the side of my bed, and tears filled my eyes. I had done my best and failed. Despite all of my efforts, my first coded patient had died.
I am sure that it was not that last cigarette, but the countless ones that came before that ultimately took this man’s life. That one was simply his final pleasure, a pleasure that I could have taken from him by exercising my rights, or enforcing the rules. I will never forget that look on his face, the sweat in my palms, and the fact that I could not save his life. However, with those painful memories comes the comforting thought that at least I let him enjoy his last cigarette in peace and did not force him to go to his death with the bitter ranting of a self-righteous intern fresh in his memory.

Marc Deshaies, MD
Chicago, IL

Copyright 2001 by Turner White Communications Inc., Wayne, PA. All rights reserved.
Hospital Physician March 2001


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