Tuesday, January 09, 2007

Smoking: Ruby and Glen Say No to an Incredibly Powerful Addiction

My sister Ruby and her son Glen, both heavy smokers, have decided to quit. This is big news in our family and happy news.

They know that if they don't, this graphic picture of smoker's lungs could easily be a preview of their future. They are determined that it will not be.

There is no longer any doubt about the direct link between smoking and lung cancer, a horrific disease whose symptoms often do not show up until it is too late.

Lung cancer is the leading cause of cancer mortality in the United States. In 2007, it is expected to kill some 160,000 people with most of the deaths directly linked to smoking. It is not the nicotine that causes the cancer but residue carcinogens -- such as tar -- that accumulate in the lungs. Thus the picture above.

Ruby and Glen both know all this and have known it for a long time while continuing to smoke. Why? Make no mistake, smoking is an addiction that can obliterate reason and even the instinct for self-preservation. It's grip is so powerful that it is not unusual for people with blackened lungs and hooked up to oxygen to continue lighting up.

So what Ruby and Glen have decided to do -- break a powerful addiction-- is tremendously difficult. Many people try to stop smoking and repeatedly fail. But knowing these two, knowing their strong wills, knowing how much they have to live for, ... well, my money is on them pulling this off.

Ruby and I are two of five siblings and I am the only one who has never smoked. I'm not pumping myself up here. My lifelong non-smoking came about only because of a lucky childhood incident. I and a few friends stole some money from a drunk (we saw him hide money in an alley) and, through an enabling adult, spent it all on cigarettes.

I had never smoked a cigarette before but it seemed such a cool, grown-up thing to do. Humphrey Bogart always had a butt hanging from his mouth. Want to be grown-up, popular with the girls, Bogart-tough, smart in the ways of the world? In those days, in the early 1950's, you smoked.

We took our packs of cigarettes and went to the movies. In the dark, we lit up cigarette after cigarette and smoked every one. Smoking was allowed in the movies then. It was allowed everywhere, in fact. America loved cigarettes.

For my youthful reach for Bogartdom, I got the mother of all headaches. I thought my head was going to split open. My throat burned. My stomach felt like it was going to explode. I ran out of the theatre and puked in the street. And puked. And puked. Even when there was nothing more to come out, I rolled in the street in agony with the dry heaves.

I never smoked another cigarette. The best I could do was to fake being a smoker, as in this photo with my sister Ruby. I was also faking drinking, having gotten so sick at my first drinking experience in high school that I stopped drinking the same time I started. To this day, I never take a drink.

Unlike me, all four of my siblings took up smoking. My sister Marion, an RN and a longtime nursing executive at a large Massachusetts hospital, smoked for more than 20 years before she managed to quit more than ten years ago.

Same with my brother Victor, who quit three years ago when he met Marianne. She is a nurse with a dim view of smoking. With her in his life, he basically had to choose between her and smoking. He chose her and we're all glad he did.

My brother Reggie, the baby, is still a smoker. Like every smoker, he knows he shouldn't and he knows exactly why. The photo above of a smoker's lungs would not be news to him. He's a smart guy who reads and knows the score.

He doesn't need me or anybody else to tell him to give up smoking or even to bring up the subject. If I said anything to him, he'd tell me to mind my own business. That would be the best response I could hope for.

So I have not said anything to him and do not intend to do so. The silence does not mean that I don't care about my baby brother. I do. But he has a right to smoke and I have to respect that. And only he can decide when the time comes, if ever, to quit.

However, if I thought I could get Reggie to quit, I would speak up in a second. I would gladly take a punch in the mouth if that was the price of getting him to quit. Ah ... hold on. A punch in the mouth? Smashed lips? Spitting out teeth? Facial reconstruction? Don't get me wrong. I love Reggie, but could I sort of think on this a bit?

Just as I never said a word to Marion or Victor or Reggie, I have also been silent in the face of my sister Ruby's heavy smoking. I sat with her in her smoking room-- I called it her "workout room"-- while she puffed away. At family gatherings, I went outside with her when she went for a cigarette. Always I was silent. And always I was sick inside with the thought of losing her.

Ruby has been smoking for a half a century. One time Marion said something to her about her smoking and was told in no uncertain terms to mind her own business. And so Ruby, who has a master's degree in social work and is a licensed social worker, went on smoking, year after year. The same was true with her son -- and my nephew -- Glen.

They became smoking buddies. At family gatherings, they disappear outside together for a cigarette. I often join them. I love Glen. We have a lot of fun together, laughing and joking. He's quick to laugh. My comic routines often bomb, but they never do with Glen.

He's young, hard-working -- operating his own machine shop--, ambitious, has a great wife and two beautiful young children. Yet often when we're together and I'd be making him laugh and he'd be ribbing me about something, he'd take out a cigarette and take a long, deep drag.

I would do my best to ignore the cigarette and even step up the tempo of the banter to overwhelm any sign of judgmentalism on my part. Yet I could not turn off my brain which told me that I was in the presence of slow suicide by someone I loved. I feel about Glen the way I feel about his mother: I don't want to lose him.

All of this changed a couple of weeks ago when my niece Linda, Glen's sister, told me that she had some good news for me. Now she and I are also very close and we often talk about how worried we are about her mother's and Glen's smoking. We feel completely helpless. If we say something, we know we'd get our heads handed to us.

"Mom and Glen are going to quit," Linda said.

"What?" I asked, disbelievingly.

"January 2. They're going to do it."

"They're serious?"

"Yes, dead serious."

"Oh my God! This is fabulous! This is the best news I've heard in years."

"Isn't it great? I'm so happy."

"Does this mean we can talk about it?"

"Yes. In fact, they need support, especially mine and yours."

I immediately called them both. "Is it true?" I asked them. Both said it was true and that they were determined to quit.

Glen said he was already taking a prescription medicine, Chantix, that is supposed to curb the cravings. But he said it was expensive, $232 for a month's supply, and he was going to take the pills for three months. His insurance company refused to cover it.

He complained to the company. "What do you mean you don't cover it," he said. "This is preventative. I'm saving you a lot of money down the road." After he made several phone calls and filled out two sets of forms, the insurance company finally agreed to cover the cost of the medicine.

Chantix, a six-month-old drug from Pfizer and the first new quit-smoking treatment in a decade, is helping. The drug works by partially stimulating certain nicotine receptors in the brain. It mimics the pleasurable effects of the addictive agent while blocking nicotine from binding to the receptors, delivering a buzz to the would-be quitter but a less than satisfying one.

Ruby had decided to go with the patch, which seeks to ease smokers out of the addiction by delivering small, steady doses of nicotine. She was already wearing the patch when I saw her a few days later. I hugged her and told her how happy I was that she was going to quit.

"This means that I can talk about it?" I asked warily.


"What a relief," I said. But I still wasn't sure. When the going gets rough, I was afraid she still might bite my head off. But I told Ruby and Glen that they had my 100% support.

I told them both that if they needed help, to call me any time day or night and I'll be there. "We'll do what it takes," I said.

However, Marion is the key supporter. Not only has she stopped smoking herself but she also teaches smoking cessation. She knows more about the process than any of us. After years of rebuffing her help, even telling her firmly to mind her own business, Ruby has finally accepted Marion's help.

In the days before January 2, both Ruby and Glen went on smoking binges. They smoked one cigarette after another, inhaling deeply and pleasurably. Deep-breathing itself is relaxing. But the main reason smoking is so pleasurable is that nicotine is a fast-acting drug; it goes straight to a part of the brain.

When receptacles there receive the nicotine, they signal another part of the brain to release a chemical, dopamine, that gives the smoker an almost immediate high. When you are used to this high, look forward to it, and in fact are dependent on it, it's hell to give up -- as countless people who have tried and failed to do so will tell you.

As if this physical addiction were not enough, smoking also insinuates itself into both pleasurable moments-- a work break, after a meal-- and times of stress. In crisis, many smokers reflexively fumble for a cigarette. During 9/11, ABC newsman Peter Jennings said that "he was weak" and began smoking again after having given it up several years before. He died of lung cancer caused by smoking.

On January 2, Ruby and Glen began what they were determined would be new non-smoking lives. As this is being written, it has now been a full week and neither one has had a cigarette. At work, Ruby even went outside with a colleague that she regularly smoked with and did not have a cigarette. The past weekend she distracted herself by working nonstop on her income taxes.

Ruby and Glen are talking every day and Linda is talking to them both. I have stopped by and called. This Friday night Ruby will be coming over for dinner and my wife Barbara and I plan to keep her entertained and occupied.

Marion says that the more open a smoker trying to quit is and the more people she tells, the better. "Telling people is affirmative," Marion said. She says it is a way to gather strength from others and increases the chance of success.

Marion is calling Ruby every day. Besides showing her love and support, Marion is passing on what she has learned from successfully quitting herself and as a teacher of smoking cessation. When Ruby feels that she has to have a cigarette, Marion suggests that she give herself a half hour to reconsider. The delay offers a chance to take a different direction, Marion says.

The photo shows Ruby and her son Glen having one of their last smokes together, in the garage of Linda's house. I went out there with them to share the moment and to capture the momentous occasion for the family history book.

Glen is more worried about his mom than himself. He's sure he is going to make it, though he's eating tons of food and chewing gum nonstop. But he points out that his mom has been smoking all her adult life and her habit is deep and pervasive. She's been eating bags of popcorn, he said.

I showed Glen this post and he embraced it as real and human. It even made him laugh in places. But he suggested that because his mom was "still on edge," we not show it to her until a little more time passes. "Later, when she knows that she is going to make it, I think she will really appreciate it," Glen said. "But not now."

According to an article by George Stephos based on research by the drug giant Pfizer, one of the main reasons it’s so hard to quit smoking is because all the benefits of quitting and all the dangers of continuing seem very far away. Here, from studies by Pfizer researchers, are some of the immediate, physical benefits of quitting smoking that Ruby and Glen have already received and others they will gain as time goes by:

In 20 minutes after the last cigarette, blood pressure drops back.

In 8 hours, the carbon monoxide (a toxic gas) levels in the blood stream drops drop by half, and oxygen levels return to normal.

In 48 hours, chances of having a heart attack have decreased. All nicotine will have left the body. Sense of taste and smell return to a normal level.

In 72 hours, bronchial tubes relax and energy levels increase.

Ruby and Glen have already gained the above benefits.

In 2 weeks, circulation improves and it will continue to do so for the next 10 weeks.

In three to nine months, coughs, wheezing and breathing problems will dissipate as lung capacity improves by 10%.

In one year, risk of having a heart attack drops by half.

In 5 years, risk of having a stroke returns to that of a non-smoker.

In 10 years, risk of lung cancer returns to that of a non-smoker.

In 15 years, risk of heart attack returns to that of a non-smoker.

So, Ruby and Glen, when you find yourself freaking out for a cigarette, do what Marion says and give yourself a 30-minute delay. If you give yourself a chance to say no to a cigarette, you will. It worked for Marion. Victor stopped smoking. Both of you will, too. Hey, you've already been cigarette-free for a week!

You're going to do it! You are doing it!

With love and my 100% support,


P.S. Free stop-smoking services of the Massachusetts Department of Public Healthcare are available online at: trytostop.org/ and quitworks.org/. Services include free counseling at 1-800-879-8678 and lots of free information. Finally, only 5% of smokers who try to quit on their own succeed. This poem understands why. It looks like Ruby and Glen are going to be in this elite 5%. Hip, hip, hooray!

So long and keep moving.

Update: Ruby and Glen both went back to smoking. Glen stopped in 2009, went nearly three years without a cigarette, then began smoking again in early 2012.  He's smoking furiously today. Ruby also went back smoking. But after a trip to the emergency room in 2011 for trouble breathing, she stopped smoking -- and remains smoke-free today.  She doesn't say a word to Glen about his smoking. "I know it won't help," she said. "He'll just get mad at me. That's how I was. If you said something to me, I would have told you to mind your own business." I'm glad I kept my mouth shut.

                                                  E-Books by George Pollock

 "State Kid: Hero of Literacy" is fiction based on his  real-life experiences  growing up in foster homes; "Last Laughs," is the true story of how five foster kids (he and four younger siblings) found their way in life and each other. "Killers: Surprises in a Maximum Security Prison," is the story of his being locked up for 23 hours with killers in a maximum security prison;  "I, Cadaver" is about his postmortem adventures and mischief in the anatomy lab at UMass Medical School. “A Beautiful Story” demonstrates the art and process of creative writing as a 16-year-old boy goes all out to write a story that literally saves his life;  "A Long, Happy, Healthy Life," which is about how to live the title every day; and "Unlove Story," Writing anonymously as "Elvis," a husband, dumped after 38 years of marriage, lets it all out on love, marriage, life, everything. A guy doing this? It's unheard of.

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