My Grandmother’s Cigarettes

From the Bureau of Alcohol and Tobacco but not Firearms

Sometimes the job fits your personality, and sometimes it doesn’t.

The other day I saw a patient for a physical who told me he drank probably too much, meaning a drink a day, maybe two, alright sometimes three, more on weekends. I wasn’t judgmental, just made a note, and when the exam was over, as I always try to do, I distilled my impressions into at most three recommendations, in order of importance, of things he should focus on over the following year if he wanted to improve his health and well-being.

In reverse order, he could lose a little weight by exercising more and going low-glycemic; improve his mental health with meditation, maybe therapy; but number one was the thing he did not want to hear: reduce his alcohol intake. I consider a moderate amount of alcohol to be the 7/2 rule – no more than seven a week and two in a day.

You’re not going to want to hear this, I said, but that’s what you should do, and not only that, but some people are all or nothing, and if you are one of those, then you should stop drinking altogether rather than engage in a frustrating and losing battle of trying to cut back.

I was right, he didn’t want to hear it. But he knew it was coming, and he responded graciously, and appreciatively. And who knows? Maybe next year I’d see him again, and he’d tell me that he followed my recommendation, and not only felt better, but believe it or not, without the alcohol, he’d lost all that weight without even having to cut back on carbs. It’s happened before.

Nevertheless, I always feel a little bad in those situations because, even though I know I’m right, and even though I’m acting in the best interest of the patient, and even though that’s the whole point – the reason they are there in the first place – I don’t particularly like telling people what they don’t want to hear. It’s just my personality, an aspect I have to resist to do a good job, a current in the river of my profession that I have to swim against in order to be a good doctor.

When I was young and my grandmother was still alive, my two brothers and I would visit her in Florida at least once a year. Usually it would be in the dead of winter. A cold wind nipped our noses as we entered into La Guardia airport, bundled in hats and gloves, only to surrender to a balmy breeze that caressed our cheeks as we exited the airport in Fort Lauderdale. As we shed our layers, the gentle air made even the exhaust from the buses and taxis lining the curb smell good.

My grandmother’s apartment was the opposite of the light, spare, sun-drenched interior design that people favor today. It was full of textiles – rugs on top of carpets, layers of drapes on the windows, piles of sheets and blankets on the beds. The one exception to the plushness of it all was the sofa, whose cushions were encased in clear, protective, plastic, zippered covers.

We used to make fun of those plastic covers – what were they protecting the cushions from, exactly? Our butts? But we also felt weirdly attached to them, as did the skin of our bare legs, moist from the heat and humidity, which audibly resisted being peeled off the sticky plastic as we stood up.

I liked to stand outside on my grandmother’s small, rectangular terrace, Atlantic Ocean to the left, Collins Avenue to the right, breathing in the clean salty air. Inside, her apartment had a slightly musty smell – the smell of a closet full of clothes of different eras, mixed with a kitchen smell of food of various vintage, mixed with the smell of cigarette smoke that permeated everything.

My grandmother was an inveterate smoker, an old-school chain smoker, a >100 pack-year smoker, to put it in clinical terms. I almost never saw her without a cigarette between her fingers or lips, smoke curling up around her prominent cheekbones and keen, skeptical blue eyes.

One day, we came up from the beach, or maybe from around the pool, where we played shuffleboard hockey, a sport we invented that transformed a benign retirement activity into a dangerous competitive event involving ceramic discs flying through the air. My grandmother was sitting in front of the T.V., smoking a cigarette as usual. She was watching a documentary about the tobacco industry.

We gathered around her old television, with its bulbous glass, intermittent static and antennas. On the screen was footage of a senate hearing from the 1950’s on the dangers of smoking, with a panel of tobacco company executives being grilled by politicians, just like tech CEOs, airline executives, or college presidents are today. Except for the style of the suits and the leave-it-to-beaver haircuts, nothing much has changed.

The executives were lined up at a long table with microphones, papers, and obstinate facial expressions. This was before the data on tobacco became incontrovertible, when it was still possible to get away with defending smoking as all-American, and dismissing the other side as health nuts and commies come to take away our inborn freedoms.

You’d think the fact that the footage was black-and-white would have tipped her off, but somehow my grandmother missed the part about this being a documentary about the past. She thought it was happening in real time.

At one point, a tobacco executive grandstanded, defiantly proclaiming that smoking was an ancient tradition, practiced by cultures around the world, and furthermore, the scientific studies didn’t actually prove anything, and you know what? There is, in fact, nothing whatsoever bad or dangerous about tobacco in any way.

I knew it!, crowed my grandmother, jabbing her cigarette at the screen in triumph. My brothers and I stared at her, and then at each other, dumbfounded. Should we tell her? Didn’t she deserve to know the truth?

My grandmother was either pushing or already past ninety at the time. In just a few short years she would be dead – of something other than lung cancer or any tobacco-related illness, as it happens. It was patently obvious that she would never quit smoking, which would anyway have accomplished nothing by then, except to deprive her of yet another earthly pleasure as life’s road relentlessly narrowed.

So did we tell her? Of course not. Wow, Grandma, that’s amazing – you were right all along!, we said, giving her a kiss and retiring to the terrace for a breath of fresh air.

Sometimes people need to be told what they don’t want to hear, and sometimes they surely do not.

Dr. Bertie Bregman
Dr. Bertie Bregman
Full Stack Family Medicine is a newsletter about what it’s really like to practice medicine and run a medical practice in New York City.
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