There is a tendency to think about tobacco-associated diseases as comprising mainly heart disease, emphysema, cancers and other illnesses brought about by smoking.
But we need perhaps to be reminded that tobacco products are associated with many other problems, including risks among tobacco farmers and other workers involved in the tobacco product industry. For example, there’s Green Tobacco Sickness (which I described in a previous post), risk of physical injury, problems associated with child labour, and grief and other psychiatric and social problems associated with suffering and loss of a loved one who has died prematurely from the devastating effects of tobacco use.
Then there are environmental issues, including the trillions of cigarette butts that are discarded worldwide every year, and pesticide pollution from poorly regulated tobacco farms.
And, please, let’s not forget the fires and burns caused by cigarettes. Indeed, as a child I remember well the incredibly painful burns I received on numerous occasions, inflicted accidentally on the backs of my hands by smokers, carelessly holding out their lit cigarettes between puffs. That happened numerous times when I was among crowds of people, for example when I went to watch a local soccer match. It did double damage, because not only did I suffer the sores from the burns for well over a week as they slowly healed, but also I had to breathe in the foul, irritating smoke that they blew thoughtlessly into the air around me.
I remember well, also, the occasion, when I was at college, when an angry man in a pub attacked me by pushing the glowing end of his cigarette into my face. I had excruciating pain for days and it took over three weeks for the oozing sore just below my right eye to heal properly.
Fires cause the deaths of up to 900 smokers and non-smokers in the USA every year, and that doesn’t include the many more who survive with serious burns from cigarettes. And what about the damage to property caused by the 25,000 US fires yearly that are caused by smoking? And the children who are injured by these? Cigarettes are, in fact, a significant cause of home fire deaths.
Did we forget, also, about the hundreds of children who are deliberately burned by an abusive parent or other adult using lit cigarettes? I remember well, as a medical student in the USA, during my mere eight-week paediatrics clinical rotation, encountering several babies and young children with sickening cigarette burns characteristic of incomprehensible child abuse.
Yes, cigarettes and their ugly effects are all around us, and today it’s just as bad in many parts of the world as it was when I was a child in my small English village.
Well, now I come to one of my favourite patients, John, who, in his mid-forties, was a very successful businessman, and a happy, kind, good natured man, as I was told by several of his friends of relatives. That was, until he burned his house down while smoking in bed and suffered severe burns over his whole body, from the crown of his head to the tips of his toes. He spend months and months in the intensive care burn unit of a US hospital, requiring multiple skin grafts and other surgeries. He almost died several times, but he pulled through somehow.
That was the end of John’s happiness and his successful business. He became my patient several months after leaving hospital, but the fire was only the beginning of his problems, which were, ultimately, caused by a single burning cigarette. John suffered excruciating pain, and needed many extra surgeries. His face, indeed his whole body, was scarred and disfigured. He became depressed and anxious at the same time. He felt ashamed to go out in public because, he said, “People find me repulsive and scary.” As his finances dwindled, from medical and other costs, he ended up living in a poor apartment and hiding away there day and night. He ate uncontrollably, gained a tremendous amount of weight, and he continued to smoke heavily. Smoking cessation treatment and pyschiatric help didn’t solve his problems. Sending him to a support group for burn victims was a failure- he felt too depressed, even embarrassed and ashamed to go to their meetings.
He saw me once a month and told me I that I was one of the few friends he now had- me, his doctor! I gave him more time for his visits so I could chat with him and try and make him feel better, but any advice or help offered for smoking cessation was useless. He was addicted to cigarettes, moreso because the devastating damage done to his body and mind from that single burning cigarette made him smoke even more: “It’s one of the few pleasures I have left in life,” he said. That is the power of the grip that tobacco has on its victims!
It really was, tragically, just a matter of time, and he died suddenly in his early fifties of a massive heart attack, undoubtedly precipitated in large part by smoking. Cigarettes had found two victims in one man, and I will never forget my dear patient and friend, John.