We wonder where the time went
And thinks of the hours we spent
I always guess wrong
About just how long.
Nothing’s a hundred percent.
I tell my smoking patients not to try to quit by cutting down, first because it doesn’t work and second because it constitutes a slow torture. Physiologically, a gradual nicotine dose reduction prolongs the agony of withdrawal while it makes the smoking habit stronger. And people who want to ‘cut down’ haven’t made an emotional commitment to quit.
Observation confirms theory; in the 30 years since I finished residency I have met 3 people who quit smoking and stayed quit by cutting down, but I’ve met tens of thousands who failed.
Thus I can’t say categorically that cutting down doesn’t work, I can say that other methods offer a much higher chance of success.
Recovering alcoholics and addicts will speak derisively of the geographic cure. Active substance abusers will, sooner or later, try to blame their addictive behaviors on their surroundings and companions. Thinking that the problem resides externally, they try moving to another place to make a fresh start. On arrival at the new destination they find new connections and bars, and their abstinence collapses less than three months later. No more than a year passes and they return, generally with their dependency having moving forward a notch or two.
Those people in recovery say the first person you need to fix is yourself.
Yesterday for the first time I met a person for whom the geographic cure had worked. For reasons of confidentiality I can’t give details, but later that evening I mentioned the case to a nurse, declaring that every day I see patients I find at least one thing I’ve never seen before. The nurse blinked and, deadpan, told about caring for a patient who survived a fall after a parachute failed to open.
Every known malignancy has at least one miraculous survivor; people who go decades with metastatic lung cancer are common compared to those who exit airplanes without a parachute and live. Yet we now have dozens if not hundreds of cases of people who survived falls of hundreds or thousands of feet.
Over the weekend a family member asked how much time a patient had; I refused to give a number because I guess so poorly. I recall one patient I looked at and thought, “Just hours now”’; yet another patient I firmly believed had months died in less than two days.
We never know how much time we have in this world, and in the last 8 days (including 5 twenty-four hour shifts) I have repeatedly run into the fallout of people with terminal diagnoses deciding to tell or not to tell their families. I advise the patients that if their loved ones would spend more time with them, knowing that the end was near, that they should by all means spread the knowledge.