Tuesday, August 19, 2008

Guest Post: One Victim in the 100 Years War

Special thanks to Roger for this guest post!

Each of us involved on the various fronts of the 100 Years War on Tobacco probably has an emotional connection to someone who lost their lives because of tobacco use. I suspect that loss in some way fuels the blow torch of change that each of us feels is necessary. I am no different than you.

Before I tell my story, the phrase "100 Years War on Tobacco" may have slowed your reading pace. The director of UW-CTRI, Michael Fiore, has recently begun using that phrase to describe the protracted and sometimes frustrating struggle in which we are engaged. Dr. Fiore identifies the start of the 100 Years War on Tobacco with the first Surgeon General's warning on tobacco use in 1964. We are close to being halfway through the 100 Years War and our victories in drastically reducing adult tobacco-use rates and rapidly increasing the number of states with tobacco-free worksite laws is remarkable.

A small part of our common success is encouraging clinicians who treat tobacco users to use the best evidentiary tobacco cessation treatments at every patient visit. The clipped shorthand reminder is to have the tobacco talk with "every patient at every visit." The every patient at every visit intervention is a consistent and necessary attack to help patients permanently remove the cigarette, cigar, pipe or wad of tobacco from their lives. Ten years ago, a clinical model to treat every patient at every visit was introduced and we know it as the Five A's: Ask, Assess, Advise, Assist and Arrange.

While we are thankful that the Five A's model is here, my family could have used that model in the first decade of the 100 Years War instead of in the fourth.

I'd like to introduce you to my dad, Richard (Dick) Dier. Born in Fort Frances, Ontario in 1935, like a lot of Canadian kids he took up the national sport-ice hockey-and Dick Dier was good at it. When he was 13, his parents moved their family across the Rainy River to the International Falls, Minnesota. Sometime in the late 1940s, he put his first cigarette in his mouth.

As my dad grew into a young adult, he continued to smoke and continued to play hockey. Being an athlete who strove to be in top condition despite smoking a pack or two a day were diametrically opposite behaviors, but tobacco addiction, like many addictions, trashes the rational order of things. In 1958, investors launched a professional hockey team called the Green Bay Bobcats. My dad hopped on a DC-3 and flew south from Northern Minnesota to Green Bay to try out for the Bobcats and he made the team at age 23.

He never stopped smoking as the years in his 30s and 40s sped by. In 1991, he was having problems with one of his knees (most likely some clutter was floating around from his hockey-playing days), so he went to an orthopedist who prescribed minor surgery to clean up his knee. During that visit, when my dad was 56 years old, someone noticed that he had early signs of COPD, or chronic obstructive pulmonary disease. That nurse or doctor advised him to quit smoking. My dad said he would think about it.

A week later my dad called that doctor's office and said he wanted to try to quit. He got a prescription for the patch, and a month later was smoke-free for the first time in 40 years.

The date he quit smoking was something of which he was proud: Each year, he took my mother out for dinner on the anniversary of his quit date. I had quit smoking and using spit tobacco when I was in my late 20s, but my two brothers, their families and my family were very relieved when he quit. By quitting, I thought he and we had caught a break. My dad and my mom were in their mid-50s and healthy; their children were on their own, their work careers were winding down and the warren of grandchildren to spoil was growing.

In the spring of 1995 my dad dropped a little weight. I saw him on his 60th birthday (June 24, 1995) and noticed his weight was down. I didn't say anything and remember feeling happy because he had gotten pudgy since quitting. In late July and early August of that year, his face would sometimes be puffy when he woke up in the morning. One Saturday morning in mid-August I biked over to my parents' house and rapped on the back door. My dad had just gotten up and I was stunned: His face was so swollen that it looked as if it were beaten with two-by-fours.

The following Monday I called his doctor and they told my dad to come in. When he did, they took an X-ray and saw a shadow. That led to a CT scan, which revealed a significant mass that was impeding the flow of blood back to his heart when he was lying down.

He went in for a biopsy on Oct. 17, and I'll always remember him talking to the surgeon before they wheeled his gurney into the operating room. He grabbed the surgeon's hand with both of his and asked the surgeon to please fix his face.

They found a cancer, and it was virulent. As his oldest son, I gathered his entire medical history, from International Falls to Green Bay, and took all of it and him to Mayo Clinic for a second opinion and we hoped, a second chance. Before we left, I noticed that in all of his examinations before 1991 not one clinician talked to him about his smoking. The first time a clinician told him he needed to quit smoking occurred in that pre-surgery consult in 1991.

The journey from life to death for someone suffering from lung cancer is too visually horrible and emotionally painful to recall here. I will share this, however: On our way back from Mayo Clinic, he rued the day he ever started smoking and said, "Those goddamn cigarettes, they just don't let you go."

I often share my dad's story with clinicians, and their crowded lives being what they are, I suspect that it's one of the few things they take away from my presentations. My dad died on Feb. 12, 1996, about 100 days after he was first diagnosed. He was only 60 years old and he wasn't ready to leave his wife, his children, his grandchildren, his friends or his life.

I tell my dad's story to help clinicians understand how much power and responsibility they have when they talk to their patients who use tobacco. I am haunted to know that if a clinician had talked to him about quitting smoking in 1961, 1971 or 1981 instead of waiting until 1991, Dick Dier might be 73 years old today and wondering why the Green Bay Packers ever parted ways with Brett Favre.

This guest post was written by Roger Dier, a UW-CTRI outreach specialist in the Northeast Region of Wisconsin.

Please feel free to share your story below in the comments section or at www.mysmokefreestory.com


Anonymous said...

This is excellent. - Thanks. Laurie Van Tuinen, Waukesha, WI

Jennifer Gombar, Stoughton, WI said...

Very touching and compelling. Thank you so much for sharing. Sadly you are right, most of us have a similar story in our families which continues to drive us on our quest.

Maggie Moo said...

My dad quit a pack-a-day habit, at age 49. However, five years later he developed lung cancer, which took him from us when I was 21 and my younger brother was just 16.

Sadly, I fear smoking will rob me of my sister early, too. She has asthma and a bad cough which is obviously the first signs of emphysema, but she is in denial. "It's allergies, sinus, etc." Such is the addictive nature of tobacco. :-(