Dr. Blacklung, I Presume?, Part 4

Dr. Blacklung, I Presume
By:  slimv

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Chapter 4: The Doctor's Visit
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"My mother smoked Pall Malls.  Did I ever tell you that?" asked Dr.
Blacklung.  "She was a beautiful and saintly woman and I loved her dearly.
She contracted lung cancer when I was 14.  It was the most amazing thing I
ever witnessed.  My father was too poor to afford medical care, but he could
buy her cigarettes.  She smoked them until the end you know.  She knew they
were killing her but she couldn't quit.  I don't think she wanted too.  You
understand, don't you?  She's the reason I became a doctor."
- Ben Avery aka Dr. Blacklung



Margie O'Hare flipped the tattered pages of the Lady's Home Journal.  The
date on the cover proclaimed its seniority.  But it was the most recent and
up to date magazine in the waiting room.  She looked at her watch.  Katie had
been called back almost 40 minutes ago and she was beginning to worry about
what could be taking so long.

Dr. Wilson allowed the stethoscope to drop to his waist.  He hadn't liked
what he heard in her chest and he hadn't like what his young patient had to
say.

"I'm not going to lie to you Katie.  Your lungs sound horrible, but so do the
things you're telling me.  I can't imagine what you're going through.  Most
of my COPD patients are much younger than you.  They've lived full lives.  I
sympathize with your pain but you need to stop thinking of emphysema as a
death sentence."

"Then what is it?" asked Katie.  "If its not a death sentence then tell me
what it is.  I can hardly breathe and walk at the same time!  My lungs feel
like rocks, like they're going to break in half if I cough to hard.  Isn't
there any thing you can do for the pain, something you can give me to keep
from coughing out chunks?"

Dr. Wilson picked up her chart and thumbed through it while he spoke.  "Tell
me again.  How many packs a day are you smoking?"

"I don't know", said Katie.  "Maybe 2 packs a day on school days and three
packs on the weekend .  I've tried to cut back.  I can't.  It just feels
worse when I'm not smoking.  I know that doesn't make any sense."

"Yes it does", said Dr. Wilson as he hung her chart on the wall.  "It makes
more sense than you realize."  He took a seat in the stool beside her and
looked up at his young patient.  "Think about your days.  When do you feel at
your worst and when do you feel at your best?"

"What do you mean?" asked Katie.  "I feel like shit all the time.  Like right
now.  I feel like shit."

"I bet you do," said Dr. Wilson as he looked at his watch.  "Its almost
11:45.  How long has it been since your last cigarette?"

Katie shrugged.  "An hour?  An hour and 15 minutes I guess.  Why?"

Dr. Wilson put a finger on his chin as if he was considering on whether or
not to divulge some great secret.  "How do you feel when you wake up in the
morning?  Do you feel better at night or in the morning?"

"Night," said Katie.  She said it without having to think.  "Mornings suck.
I wak e up and feel like I'm drowning.  It's awful.  I got all this gunk in
my chest that I can't get up and I cough and it hurts."

"How long do you wait before smoking your first cigarette of the day?"

"Ten minutes.  Maybe fifteen.  I don't know.  I just know I want one but it
hurts to smoke the first one.  The first five or six are bad.  I don't even
feel half way OK until its time to go to bed."

"You're not smoking in school are you?"

"Of course not.  I'm not a freak.  I'd get suspended if I got caught."

"Yes, I'm sure you would get suspended if you were caught smoking in school.
Listen Katie, what I'm about to tell you might seem a little odd but hear me
out.  I don't think you're smoking enough."

"What the hell are you talking about?"

"Please Katie.  I asked you to hear me out.  The reason you feel so bad in
the mornings is because you're not smoking at night.  Now believe it or not
there is something we can do to remedy that problem.  And depriving your self
of cigare ttes while you're at school is doing your lungs more harm than
good.  You have a very advanced state of emphysema Katie.  We both know that.
It's not going to get better.  Even if you were to quit smoking today and
never pick up another cigarette, your lungs will not repair them selves.  You
started too young.  Your lungs were so under developed when you started
smoking Katie.  That's why this happened to you so soon."

"So what are you saying?  If I smoke more I'll feel better?"

"That's exactly what I'm saying Katie."

She laughed, but when she did, a coughing fit erupted and phlegm spewed from
her mouth.  Surprisingly she wasn't embarrassed.  She was becoming used to
bathing people and things with her lung snot. 

"Sorry about that.  I think I got it on your diploma."

Dr. Wilson got up and wiped the phlegm from the glass that protected a copy
of his credentials.  "That's OK," he said.  "It happens a lot around here.
I'll have the nurse come in and Windex it."  He turne d back around and faced
his patient.

"I can't do much to stop things like that from happening, but I can help with
the pain.  I'm sorry Katie, but you're going to have to start smoking more if
you want to start feeling better.  It won't cure you.  We both know that, but
it will help you live with it."

"Dr. Wilson.  Hellooo Dr. Wilson.  Are you there?  Katie to Dr. Wilson.  My
lungs are killing me or haven't you been listening.  The only reason I smoke
as much as I do is to keep from going through withdrawal symptoms.  My head
hurts like crap and my skin crawls when I don't smoke enough, but I can't
smoke more than I already am.  My lungs won't take it."

"I think they can," said Dr. Wilson.  "You just need someone to train them to
smoke more and you're going to need all the support you can get from your
family and friends."


Katie fought the urge to laugh.  One good lung spewing per customer she
thought.  "And who is going to train my lungs to smoke more?" she asked.

"He 's a colleague of mine.  He used to be pulmonary surgeon like me but he
gave it up because he thought he could help girls like you more with
counseling than with medication and surgery.  His name is Dr. Ben Avery and
we can bring your mom in and talk about making an appointment with him if
you're ready to start feeling better."

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