Sometimes You Get to Think That You Have Accomplished Something!



I entered the PA world somewhat late in life. I had spent nearly 30 years toiling as a RN, in ER, as nursing supervisor and in ICU, when I decided that a change was in order.

For most of my nursing practice, I had counseled my patients that stopping smoking was in their best interests. Those that seemed receptive, got the entire “treatment”, recounting how my (now) ex wife, mother of my children, and an RN herself, smoked. I observed that, aside from marrying me (and subsequently divorcing me), she was pretty smart. In addition, she displayed a backbone formulated not from calcium salts, but rather from ordnance steel. As Mom, I am entirely in favor. (As the Plaintiff, I’m not such a fan) In either case, even in light of her own ICU experience, she persists in smoking. I shared that this illustrated that the difficulty of ceasing smoking was often understated. Worthwhile, but underestimated.

I regaled patients with this tale time after time, as each seemed receptive. I never received any feedback for these efforts. Yet, following the role of nurse as teacher, and later of Physician Assistant as teacher, as well as clinician, I persisted.

My first PA job out of school capitalized upon my years as paramedic, ER RN as well as ICU RN, and placed me in a rural hospital ER. I continued to insert smoking cessation teaching into my discharge instructions, even if I did not see it elicit any change in behavior. My nursing colleagues even observed that my time was not effectively employed, because, in their appraisal, folks would not stop smoking due to my efforts. I persisted.

One attraction of a rural community is that everybody is, indeed, your neighbor. You get the opportunity to practice community medicine, even as an ER clinician. The child whose sprain you treated last weekend, likely will be playing on the local school team alongside your own child the next. You are not anonymous, and neither are your patients.

That was brought home to me one evening, as I took my family out for dinner in our small town. It was some surprise to me, in spite of the foregoing, that our waitress approached us with the greeting, “I bet you don’t remember me, do you?” I admitted the truth, and asked how she was.

“My ankle is all better,” she prompted, and continued. “I bet you don’t remember telling me I had to quit smoking, do you?”

Again, the truth was told. She again prompted me, “You told about how smart your wife is, and how she is a nurse, but still smokes.” (THAT earned me a glare from the Loyal Opposition!) I allowed that I frequently offered such counsel, while attempting to non-verbally make nice with the mother of my children.

“Well”, she continued, “I really thought about what you told me, about emphysema, and leather skin, and throat cancers and all that stuff I was risking. I decided that I did not want to drag an oxygen tank around like my mother did. I quit smoking last week, and it is all because of you taking the time to tell me how bad it was for me!”

I responded with something encouraging, and in recognition of her own investment of energy, decisiveness, and determination, and she thanked me again and walked away to serve other customers.

I think about that woman from time to time. I realized that people will stop smoking, when they are ready to do so, for the reasons that matter to them. The only thing I can do is encourage the decision, and attempt to nudge it along.

Occasionally, I can nudge a decision. Then I must wait for the patient to make that decision, on their timetable, and for reasons that matter to them.