Dr. Blacklung, I Presume?, Part 6 | |
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Dr. Blacklung, I Presume By: slimv -------------------------------------------- Chapter 6: Dr. Blacklung's Exam -------------------------------------------- Katie didn't know what to make of the small man who entered the room with his hand extended. He introduced him self as Dr. Ben Avery and he went down the line shaking everyone's hand. It was the first time she'd ever shaken hands with a man wearing latex gloves. His eyes were barely visible behind the pair of thick lens perched on his crooked nose. She could barley distinguish his pupils as they darted this way and that. His thin lips moved as he read her chart to him self. "Started smoking when you were eight I see." It was a statement and not a question, so Katie didn't answer him. He was almost amusing; much like a cartoon character and Katie tried not to stare. The comb over on his head was not doing him justice, not that a shaved head would have helped, but she wondered why he even bothered. "And you've been referred by Dr. Wilson I see. He's a fine doctor. I hope you enjoyed his care." He looked up from his chart and peered at her through his glasses. "Yes. He's very nice," said Katie. Dr. Avery nodded his agreement, lifted his stethoscope and tabled her chart. "OK, lets take a listen, shall we? Unbutton the top two buttons of your blouse and light a cigarette please." "Really" asked Katie? "You want me to smoke in here?" "You smoked in my waiting room, didn't you? "Well yeah, but every one was smoking?" "I'm glad to hear that. But yes Katie, I need for you to smoke while I examine you. I can't make a diagnosis until I see hear your l ungs in action. Did you bring your own cigarettes or should I get some from a nurse?" "No. That's OK. I have my own," she said as she pulled the gold pack of Benson & Hedges from her purse. Dr. Avery put the scope to her chest as Katie lit a cigarette. The scope was cold against her skin and the initial puff was harsh. It always was. She struggled to hold back her cough. "Don't hold it back Katie. Let it go. Let me hear you cough." Katie did as she was told and the tickle in her throat became a full fledge cough. Avery listened as the fluid in her lungs rolled like water in a vase. "Very good Katie. Now I want you to take a real big puff from your cigarette and inhale as deep as you can. I want to hear the sound of smoke sinking down to your toes and then I want you to hold it in. Don't exhale until I tell you its OK. Do you understand?" Katie readied her self with air from the room before putting he cigarette to her lips. Her cheeks drew together. The tip of her cigarette burned hot. Smoke entered her mouth and she pulled on the cigarette until she could pull no more. "Inhale it now Katie. Inhale it deep", said Avery. Katie opened her mouth and allowed the thick smoke to slide down her lungs. It had been awhile since she had taken such a deep puff and if felt surprisingly good as her lungs began to fill. She couldn't help but smile. It actually felt nice. "Keep the smoke in your lungs. That's right. That's a good girl," said Avery as he pressed the scope hard against Katie's chest. "Now exhale." Kenny and Katie's parents stared in amazement as a seemingly endless cloud of smoke billowed from Katie's mouth. "Very good," said Dr. Avery. "Now Katie, I would like for you to smoke rapidly for me. Puff and inhale. Puff and inhale. And remember to inhale as deep as you can." Katie returned the cigarette to her lips time and time again. Her lips played the filter like a flute and the smoke from her exhales f illed the room with her music. And her music devoured the air in the room as Dr. Avery listened carefully as Katie's lungs performed their score. Her lungs were a symphony and Avery was their audience. He imagined them like a worn out accordion with pinholes that rose and fell. How many more times could they rise and fall before finally collapsing? Avery knew the answer to that. Her lungs were in miserable condition but Katie was young. They could perform for years to come and it was his job to fine-tune them. When he saw her cigarette was nearing the filter, he commanded her to light another and continue smoking while he listened. She was to continue until he told her to quit. He warned the evaluation of her lungs could take some time. "What about a Chest CT" asked Margie? "Wouldn't that give you a better idea of her condition? Dr. Avery waved her off with an angry stroke of his hand. He looked like a conductor waving off an offending member of his orchestra. His long white coat concealed the embarrassment that grew between his legs. If only she had come to him sooner. All these wasted years of minimal smoking. It was a shame. He felt his member rise and inflate every time she exhaled the dirty noxious contents of her lungs. Ben Avery was a devoted practitioner. He had invested his life toward studying the pulmonary system of female smokers. But now he realized it wasn't enough for a woman to smoke. Society was making life difficult on his patients, filling their heads with guilt and shame. His job as a Female Pulmonary Counselor had as much to do with building his patient's self esteem as it did with increasing their lung capacity and flexibility. The anti-smoking community had attacked his theories with a vengeance, but there were some, like Katie's Dr. Wilson, who listened to reason, dealt with the facts and appreciated the results he was achieving with his patients. The sad truth or the happy truth, depending on p ersonal preference is this. People for the most part, especially women, cannot quit smoking. Yes they can abstain for a period of time, some longer than others. And it wasn't always this way. Before 1960, the quit rate among all smokers attempting to break the addiction was 55%. But that changed when the tobacco companies began tweaking their recipes of death. And when they were done, the quit rate dropped to an astonishing 5%. It would be easier for Katie and her mother to give up eating than it would be for them to give up smoking. It was biologically impossible, a fact most smokers don't realize. This thought brought a smile to Avery's thin lips. Such beautiful thoughts played out to the tune of Katie's lungs. It was a scam and everyone was involved. Even the most rudimentary physician can say with certainty that a smoker will smoke more when stress is increased. The Anti's were supplying all the stress necessary for increasing smoker's habits. They are th e unwitting partners of the tobacco industry thought Avery. God bless them. He looked at his patient sitting before him. Katie O'Hare was so young and beautiful. Cigarettes only added to her essence. The world would be a prettier place with more Katie O'Hares. If only she could smoke more. But she could with his help. That's why she was here. But she needed her family's support. She had to know and they had to know that extreme smoking was beneficial to her. Dr. Avery stood straight and let the stethoscope drop from his fingers. He sighed loudly and looked concerned. He lowered his eyes and met Katie's and her families. They had to believe in their hearts that Katie's situation was grave and only he could help her. Dr. Blacklung was her salvation. The look on Katie's face assured him that she was absolutely horrified. And her horror was contagious. He addressed her parents. "You knew Katie's situation was serious before you arrived so I won't sugarcoat i t. Your daughter suffers from multiple problems. Obviously she's addicted to nicotine. Unfortunately, despite what some people say, it is virtually impossible for a person to give up smoking once the addiction takes root. I say this for your sake as well as for your daughter's, Mrs. O'Hare." He turned his attention to Bill and Kenny. "The two of you are non-smokers. By just being here, I know you love and support Katie. Your support is invaluable, but keep in mind, you have no idea what these two women are going through. They need your love, understanding and support more than ever. If you have any doubts as to the severity of their addiction, then I suggest you get them out now. When you leave here, I want you to be fully supportive. I'm not talking about tolerance. I'm sure you're tolerant now. But these women, especially Katie, need support and encouragement." "Katie is experiencing chest pain because her lungs are brittle." Avery moved his hands in front of him as if he were massaging a pair of invisible breasts. "With therapy we can soften her lung tissue and make it more pliable. Her pain is directly correlated to the stiffness in her lungs. The reason I had Katie smoke so deeply during my exam was so I could listen for signs of softening. The good news is that I heard it. The more Katie smokes. The deeper she inhales. The better she will feel." Dr. Avery's words were bizarre, but he said them with such urgency and conviction that all who heard them felt relief. There was hope and Dr. Avery was that hope. "So that's it," asked Bill O'Hare? "All Katie has to do is smoke more and she'll feel better?" "I wish it were that simple Mr. O'Hare. Actually it is simple, but it would be impossible for Katie to obtain the level of smoking her lungs require on her own. She is physically and mentally unable to smoke the amount she needs. It's been my experience that females feel guilty about their smoking. She will requi re massive in-patient therapy to get over her guilt and shame. And of course she needs physical therapy as well, if she's going to be able to smoke five packs a day." All four of them gasped. "Did you say Katie needs to smoke 5 packs a day," asked Bill? "At minimum" said Avery. "The majority of my patients complete the program by smoking seven or eight packs a day. Some of my best patients reach 10 packs, but that's very rare and you shouldn't expect that kind of achievement from Katie. I always advise my patients and their families to lower their expectations while hoping for the best." "But after she completes the program she can go back to smoking like normal, right?" asked Margie. Dr. Avery shook his head. "How much do you smoke Mrs. O'Hare? Be honest please." "Three packs a day I guess." Her husband turned a disgusted eye at her and she bent her head in shame. "Mr. O'Hare, the response you gave your wife is exactly why I asked you here today. You have to get over the idea of your wife and daughter's smoking being a bad thing. I agree that it would have been best for all if neither of these beautiful women had ever taken up the habit, but we can't turn back the clock. They can only deal with the hand they've been dealt!" Dr. Avery's voice became gentler as he readdressed Katie's mom. "Mrs. O'Hare, you will never see two packs a day for as long as you live. Three packs a day is your normal level. A smoker can increase her level but she can never decrease her level and she must learn to maintain that level." "I'm not saying therapy will be easy. Katie will tell you that she firmly believes she already smokes as much as possible. With hard work and perseverance, she and I can change that. Together we can improve the quality of her life." "The in-patient program takes four weeks to complete. Once she graduates and comes home, it will be up to you three to offer her the emotional support she'll need to feel comfortable in her new life." He looked at Kenny and said, "I assume the two of you are sexually active. Correct?" "No! That's not right. Katie and I have never had sex!" The look in Bill O'Hare's eyes flashed from anger, to relief to suspicion in the time it took for Dr. Avery and Kenny to complete their sentences. "Well you're going to have to start then, and you Mom and Dad are going to have to get over your Puritan beliefs for the sake of your daughter. Once Katie completes the program, the most rigorous exercise her body will tolerate will be sex. I'm not saying this will be easy for you Kenny. I know you're a non-smoker and by the looks of you, I can see you're an athlete. I don't know what your connection is to Katie but she must think a lot of you or else she wouldn't have asked you to be here." "I don't know what to tell you Mr. and Mrs. O'Hare. As parents I'm sure its probably easier for you to accept the idea of your teenage daughter smoking than it is to accept her being sexually active. But this is a life or death situation. I can't in good faith allow Katie to participate in our program if you can't provide her with the level of after-care support she will require upon graduation." "If Kenny is unwilling to become Katie's sex partner then there are other options. Our office can provide sexual surrogate partners. Unfortunately your insurance carrier probably won't cover the expense and it does get expensive. Our surrogates charge $125 per hour/session. And Katie will require sexercise therapy once a day for the rest of her life. That's why we strongly suggest our patients provide their own partners. Perhaps you have an understanding neighbor that can assist?" Bill's tune suddenly changed. He was no longer concerned with his daughter having sex. He understood it was necessary for her health. It was Kenny's reluctance to be her partner that provoked him now. "What's wrong with you Kenny" asked Bill? I thought you were Katie's boyfriend- her friend at the very least. You've known each other since you were old enough to walk. And now my daughter isn't good enough for you just because she smokes?" Kenny was stunned. "No. It's not like that at all," he stammered. "It's OK Kenny, I know how you feel. You're not the first sexercise partner to experience reluctance and fear. It will seem awkward at first making love to a woman while she smokes." "What? You want Katie to smoke while she makes love," asked Margie. "Obviously," said Dr. Avery. "No disrespect, but haven't you been listening Mrs. O'Hare? It is imperative that Katie keep her lungs as flexible as possible by smoking and exercising and sex is the perfect exercise for her." Dr. Avery scratched his head. He knew he wasn't making a mental connection with the family and he needed an analogy that they could understand. "Think about it this way" he said. "The best case scenario would be for Katie to run several miles a day w hile smoking simultaneously. This would allow the smoke to travel freely while flexing her lung tissue at the same time. Obviously Katie's running days are behind her. The next best thing is smoking during sex." It was as if a light bulb had gone on in the room. Suddenly it made sense to everyone. Dr. Avery produced four tri-folded pamphlets from his lab coat and handed them out. "I need to check on a patient," he said. "I apologize for having to leave and I'll return in a moment. While I'm gone, I want you to look through this pamphlet. It describes the program and the treatment center that Katie will need to attend." "Thank you Doctor," said Margie as she accepted the pamphlet. Dr. Avery smiled reassuringly and then shut the door behind him on his way out. The pamphlet was entitled "Smoking For Life". The front cover depicted the face of a beautiful young woman smiling as she accepted a light from a disembodied hand. The caption on the bottom read, "Her habi t was her master. Now she's mastered her habit." |
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