Better Living Through Denial?

Smokers, one fifth of American adults,  often tell me they’re not worried about the future.  Why?  Because, as my webmaster and other smokers tell me, they don’t foresee a long term future.  Retirement?  Long term care insurance? Pointless.  As many explain, “Smoking is my retirement plan.”

Sorry, guys.  It doesn’t work that way.

Do Smokers Die Earlier Than Others?

Certainly.  But early death does not mean fewer years of illness prior to death.

Smokers disproportionately develop many acute and chronic illnesses.  These diseases (often multiple) ruin jobs, careers, love affairs, marriages and bank accounts – not to mention  physical, mental and social health. And the problems often occur long before smokers die.

The TV Version of Death

When I asked a former girlfriend about her smoking she claimed she had a ready plan for grave illness:  “Look, if I get lung cancer, I’ll get a gun and shoot myself in the head.”

Guns may be plentiful but she doesn’t like them. I very much doubt she’ll buy that gun.

Many people have imbibed a media image of death – here today – gone today. Media violence provides  for especially quick, “untroubled” deaths.  People imagine heart disease  caused by smoking will lead to painless, sudden ends.  Cancers also will quickly snuff out your life.

Unfortunately these are sad, exaggerated fantasies. America does not handle death and dying well.  Yet even physicians who know better traffic in this  “romantically quick” life denouement.  Oncologist David Agus starts his best selling “End of Illness” with a vision of the future: thanks to the yet unfulfilled promise of genomics and proteinomics, you dance away your last night, then at age 101 peacefully die in your sleep.

Interestingly, physicians refuse cancer chemotherapy far more often than other patients.  Perhaps they know too much about the American way of death.

Indeed, smokers face not sudden demise but a much less happy, long and turbulent health future.

Smoking and the Sordid Lifestyle

The Heart

It’s a myth that smoking usually causes rapid, sudden death.  Ongoing smokers are far more likely to experience survivable series of heart attacks – frequently followed by congestive heart failure.

I discovered this result early in life, working the CCU at the University of California, San Diego.  I admitted a young man of 34 with sudden chest pain.   He was a charming fellow, a handsome admiral’s aide.  The nurses, all of whom were women, many former Navy personnel, fawned on him terribly. His flag officer superior received a yet more royal welcome.

My young patient had experienced a “mild” heart attack.  His risk factors – slightly high cholesterol levels and smoking – two packs per day.

He claimed his job was satisfying yet stressful, requiring round the clock work for his determined, ambitious boss.

As he left we told him to stop smoking.  He told me he thought that highly unlikely – it was “the crutch I have to have.”

Thanks to statins and better anti-hypertensives, many smokers now outlive multiple heart attacks.  They carry on too frequently with weaker bodies, awful fatigue, depression and declining energy thanks to their failing hearts and the many medications.  Often they become physically disabled from doing almost any kind of work.

Smokers should get to know people with congestive heart failure.  Getting short of breath walking to the bathroom is not the romantic Hollywood version of stoic suffering; it’s even  worse when you don’t make it there in time.

Lung Disease

About ten percent of smokers die of lung cancer.  Far more will come to live with chronic obstructive lung disease.

When horror writers imagine ghastly deaths for teenagers, media stars and corporate villains they often trot out asphyxiation. Even thinking about lack of air can provoke people to panic, and panic attack victims often decry their inability to breath.  Real life asphyxiation provokes thoroughgoing terror.

Now consider spending years where you’re unable to fully breathe – and still have to work.

As with often accompanying cardiac disease, chronic lung disease can destroy the flavor of life – and that’s prior to accessing the American health care system.

Life and Death on the Installment Plan

Smoking will kill you in about as many ways as there are illnesses in a medical textbook – and that’s before you spiritually die.  The great French singer-songwriter Serge Gainsbourg might have imagined smoking as his last, great romantic tryst, rebelliously lighting up on cardiac wards as the press gathered round.  But by then he had long ago wrecked his family and shed much of his brainpower.

For many smoking creates what the French call “mort a credit” – death on the installment plan.

Medical care is expensive.  And even if you have “great” health insurance, the ravages of smoking will quickly demonstrate the many holes of even the finest “Cadillac Plans.”

And you’ll still need to buy food – and pay for the rest of your life.

Options

It’s never been a better time to quit.

States facing bankruptcy see big dollars through increased tobacco taxes.  Insurance companies charge more and more to smokers.

And then there are the endless continuing indignities – pressganged into zoo like glass cages in airport “smoker lounges”; tobacco “forbidden” signs in every parking lot and side door of hospitals and public institutions; furious glares of passersby incensed by proximity to carcinogenic fumes.

Plus there are the many personal indignities – thinning, browning skin; yellow stains on dresses; ash filled closets that remind family members of crematoria.

And there are more stop smoking treatments than ever – cognitive techniques, behavioral techniques, visualization, hypnosis, rest-relaxation, chantix, bupropion, electronic cigarettes, atropine shots and plenty others.

As reggae master Jimmy Cliff, who smoked many varied  substances sang, “you must try…try and try…you’ll succeed at last.”

Most smokers quit multiple times before quitting for good. The effects are quick – heart attack risk dissipates by half on quitting smoking – in just one week.

Bottom Line

Smoking is no retirement plan. Instead, it’s a death on the installment plan – with higher and higher payments.  You’ll pay fiscally, mentally, socially – and physically.  And most times the payments will go on for as long as you’re alive.

And though government social security programs might go bust if everybody stopped smoking simultaneously (or so the British once conjectured), it’s time to confound government pundits.  Quitting is liberating.

With all the money and living cells you’ll save, it might even become the beginning – of your real retirement plan.

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