In the 1960s, the habit of smoking cigarettes was at its zenith in America. According to the CDC, 42% of adults were regular smokers. There is no tabulation of the adults who were irregular smokers. Two or three decades or more into the future, a miniscule percentage of those smokers would become my patients. For those patients who were habitual smokers and who required surgery, impaired wound healing was a cause of worry though not enough to keep me awake at night. It was too commonplace for that. Nevertheless, when preoperatively weighing a patient’s surgical risk, a significant history of smoking unquestionably tipped the balance scale in the wrong direction. In flagrant cases, I was obliged to share this with the patient. Not rarely, a pulmonologist was engaged. The frequent smoker gets little credit for strength of character, but I found them stoical when faced with discouraging news that was the consequence of their habit. The attitude I most often encountered was in concordance with the proverb about putting spilt milk back in the bottle. If there was remorse, it was saved for another time and place. I respected that (insert hard hearted surgeon stereotype).
Throughout my childhood, smoking cigarettes was ubiquitous. And glamorous too. Movie stars did not limit their smoking to private trailers and dressing rooms as they do today. They smoked on and off camera. Today, viewers might see a professional football player, needlessly perhaps, inhale oxygen from a sideline canister before rushing back onto the field. Incredibly, in my youth, it was possible to see a professional athlete on the sideline puffing away on a cigarette before entering the big game. A future Hall of Fame quarterback did that during the Super Bowl. In some quarters, the hazards of cigarette smoking were known but concealed. At the same time, most of the public were ignorant of the risks. People were inundated with advertisements featuring for example a rugged hypermasculine cowboy on horseback, a leering smoking camel, or a liberated woman (you’ve come a long way baby) and these advertisements were the slickest of productions. Even a popular cartoon, The Flintstones, was used as a prop for product placement.
At age six, I heard the Siren Song of a cigarette. I happened upon this cigarette as it perched on a gun metal silver ashtray. The filter of the cigarette protruded beyond the flattened edge of the ashtray, and the tip of the cigarette lay in the bowl of the ashtray. Though smoking was prevalent virtually everywhere, it was uncommon in the household of my upbringing. My mother, the smoker in the family, was the quintessential irregular smoker before she quit smoking entirely and almost never smoked in the house. Ashtrays were exclusively for visitors to use. Even so, the cigarette I stumbled upon belonged to my mother. This particular cigarette was king size or 84 millimeters in length. Only a few millimeters of the cigarette had been consumed. With the exception of a trivial amount of residue, the ashtray was clean. The cigarette was basically intact. This was a rare discovery akin to finding a clovis point arrowhead in the backyard. Presumably, my mother had been interrupted in some way and had gently extinguished the cigarette she was smoking with the intent of returning to it later. A cigarette lighter barely larger than an adult's thumb lay flat on the nearby coffee table. Crucially, there were no adults in my immediate vicinity. Perhaps an adult was in the yard or since it was late afternoon, in the kitchen preparing supper. I was alone. It seemed natural to entertain myself with the cigarette. I plucked it out of the ashtray with my dominant left hand. Miming adult behavior, I held the cigarette pinched lightly between my thumb and the tips of my index and long fingers. I brought the filter end of the cigarette toward my mouth and tapped the distal end of the cigarette with my ring and little fingers. Next, I shifted the cigarette so that it was held between the facing sides of my index and long fingers; the filter projected toward me. Secured this way, I did not use my thumb to brace the cigarette. I flattened the palm of my hand and brought the cigarette to my mouth with what I thought was sophisticated nonchalance. My fingers were too small to allow me to twirl the cigarette around and over my fingers like a magician, but had my hand been larger I would have tried that.
As my play continued, the lighter on the coffee table beckoned. I returned the cigarette to the ashtray and grasped the lighter. After struggling to snap the spark wheel while simultaneously depressing the fork that released the fuel, I succeeded in producing a flame from the lighter. I brought the flame to the cigarette, still in the ashtray, and clumsily lit the charred tip. In the process, I burnt up a good portion of the remaining rod of tobacco. With the cigarette lit, I pulled my hand back and because I ceased to depress the fork on the lighter, the flame went out. I let the lighter drop from my hand to the floor. Picking up the glowing cigarette, I placed the filter tip between my lips, and lightly inhaled. To my disappointment, nothing happened. After watching all those fabulous television commercials with magisterial narration and seductive background music, I expected more. Rapture maybe! I decided achieving the full effect from the cigarette required a stronger effort. I inhaled deeply on the filtered end of the cigarette. Twice. The effluvium tasted like hot, dry dirt. I was familiar with the taste. At an even younger age I had scooped up a handful of dirt and tried to eat it. Even though I spat out the dirt, by virtue of being cool and moist, the dirt was more palatable than the cigarette. And dirt did not make me lightheaded or set me coughing. The cigarette did. The fun was over. Flustered, I mangled the cigarette in the bowl of the ashtray.
The memory of this experience discouraged me from smoking. Somewhere along the educational pathway endured by physicians, I learned it was not taste but the dopaminergic rush from the nicotine in the tobacco that got smokers hooked.
Unrelatedly, I learned my mother smoked a brand of cigarette with the slogan “Tastes Good Like a Cigarette Should”. The brand name of this still popular product, Winston, is a toponym of a city within easy driving distance from where I practiced surgery for many years. Reversing etymology, the nickname of that same city, Camel City, is derived from an even more successful brand of cigarettes.
Bruce Harris MD FACS is a retired General Surgeon who practiced in North Carolina. Dr. Harris earned a BS in Physics at Harvey Mudd College in 1977, and is a graduate of the University of Missouri-Columbia School of Medicine in 1981. He enjoys running, reading, writing, snowboarding, and rafting.
