How to Get Rid of a Pernicious Desire

Draft 6/25/2014

How to Get Rid of a Pernicious Desire

By Dr. Samuel De la Pava

As told to Karen Chadwick, May 2014

Two packs a day. Forty cigarettes every day for 20 years.  Add five years to the front, when Samuel, now free of life in a locked leper colony, would join the other medical students in the café in Bogotá, Columbia at night, where they had their own designated table. The café owner was happy to have the respectable young customers and allowed them to leave their valuable textbooks on the table as they came and went. Keep in mind that Bogotá citizens were not noted for their respect of private property, either.  The medical students were grateful for the owner’s sympathetic assistance and gave him business each evening as they either ordered coffee or beer while they studied. At this table, Samuel took a step into manhood and started smoking, first with a pipe as the older students showed him the technique, and then he smoked a pipe and cigarettes. Soon he found the hassle of the pipe accouterments bothersome, so now cigarettes exclusively, and a pack would last a week. Samuel was born in 1926 and now in 1945, by the dint of his brother’s love and encouragement (“Samuel, you are not going to be a priest! Don’t be an idiot! You are going to be a doctor!”), was on his way to becoming a doctor.

His father smoked, but only in the evening when he would join the other men confined to the leper prison, as they would meet for coffee and company at the small café within the barbed wire. His parents had very limited means due to mother’s leprosy diagnosis and subsequent forced family removal to the locked village, Leprocomio de Agua de Dios, in 1930. They did not want their children to develop a “bad habit,” perhaps a vice, addiction, or foolish expense was what they had in mind. How well Samuel remembered his mother having to stand in a long line with the other lepers each week, to receive a government hand out of $1.60. This pittance was stretched for their young family of seven. Father found a job within the leper prison and in spite of very little income and great deprivations, they kept their family together.

But Samuel was not a child now, and a sure sign of manhood included smoking in the 1940s. His older brother, also free of the leper village upon adulthood and working a tough laborer job, would give Samuel a little money as he could. He was willing to have this bad habit if it helped launch his mature status with the others at the table. But to think cigarettes a health danger? Ridiculous. The professors at the medical school had no clue whatsoever that cigarettes kill. So it started.

Samuel had student obligation with the Bogata Cancer Institute, but of course at this time, 1945-50, they made no connection between lung cancer and cigarettes. He found cancer research interesting, it was new and important, just right for his active mind that liked to solve problems. Smoke, smoke, smoke those cigarettes.

One thing leads to another.  If you were a graduate of medical school in Columbia, and if you wanted to add to your professional stature, the USA and medical advancement was a “must do” for a few years at least. A location in New York seemed interesting, but first a year of pathology study in Washington, D.C. would be necessary. Then, maybe then he could join the prestigious and cutting edge medical research facility, Roswell Park Cancer Institute (RPCI) in Buffalo. The next year his application to join RPCI was approved. By now, two packs a day.

Within a few years he met and married his Dominican Republic doctor in training, Irma, and they started their family. His wife was so kind that every morning she would bring him coffee in bed to help him start his day. That first cup of good coffee must include a good cigarette.  

RPCI was not only a research and teaching facility, but noted for taking only cancer and rare disease patients and only those who had been referred by an MD in it’s mission to research these health conditions. Another intriguing aspect of RPCI was that any patient admitted must sign a consent that in the event of their death, they gave permission to in-house autopsy. Samuel’s specialty in pathology meant that he saw a lot of end game cancers.

What he also saw was something that bothered him more than the flesh in the morgue. Along the halls of RPCI were large framed photos of notable citizens, celebrities, and distinguished professionals, all who had been patients at RPCI and died of lung cancer. Samuel walked the halls every day, and would take time to read one more tag with a photo as he hurried from lab to morgue. The photo information would include how many years the person had smoked cigarettes. This was his first clue that there was a connection between these two.

Within a few years at his new job, RPCI shocked the medical world with irrefutable research – their rabbits died of lung cancer when forced to inhale cigarette smoke. It was a huge new concept that Samuel had to fully understand to accept. Could this really be true? He smoked, smoked, smoked, yet he was the picture of good health. In fact, it would likely be unhealthy to stop smoking. How can he have a cup of coffee without a cigarette? Impossible. So he smoked. A lot.

One day at lunch at RPCI cafeteria with a cordial group of colleagues, the Chief Pathologist posed a question to Samuel, “We see you love your cigarettes so much, Samuel. I wonder, if you had to make a choice, would you give up sex or cigarettes?”

Everyone stopping chewing. Their eyes got wide as they looked at Samuel’s handsome face and their ears perked up. Samuel’s quick response, “Sex!” got the whole table laughing. This little story got legs of it’s own and Samuel got a bit of teasing on this over the next few months.

It also got under his skin. I mean, after all, he was a virile man, manly, yes, manly. Could cigarettes be that important, really? And could cigarettes really, really be killing him? The photos in the halls started to haunt him. Maybe quit? How?

Someone suggested will power. Sure. Just stop. Sure. Samuel was nothing if not strong, nothing if not disciplined, nothing if not intelligent, nothing if not capable of doing anything he set his mind to. After all, growing up in a leper colony teaches one a bit about hard life. He wanted only the best for himself, he’d worked too hard, his brother had worked too hard, his wife had worked too hard, his children were too beautiful. He was not ready to give up sex or life. Will power, ok, no problem.

Problem.

What about the ritual of smoking? He had honed a dramatic and elaborate procedure for starting the cigarette. With a flourish, the right hand to the left shirt pocket, out comes the pack. Transfer the pack to the left hand, and with two fingers of the right hand, thump thump thump the top of the open pack. One cig would rise above the others, offering itself for sacrifice. Into the mouth, lips holding the cargo, while the hands dance for the matches, the sudden flame, the sweet sweet moment of the first drag, the euphoria, the calm swept over him. All is right with the world. The grand pleasure of puckering the lips and seeing the first exhaled smoke float up and away, ahhhhhhhhh. It was one thing to stop smoking, but giving up the ritual was another matter. He hadn’t fully realized what these unspoken chains of cig ritual meant to his deeper psyche.

Sure he could stop for a day, or two, sometimes three. Then a little voice, that nasty little wicked bad boy voice would whisper, “Oh, one. Have one. Just one.” There was always an accompanying reason – it’s Friday; it’s just while I drive home; it’s been a crappy day with that gruesome autopsy; it’s been a good morning watching my son play football (“Dad, they call it soccer here!”); it’s cold; it goes so perfectly with coffee, one, just one. An hour later, the seductive, evil voice in his head again, “Another, just one more.” Within a few hours he was buying his next pack. This went on for many months. Will power was a fart in a windstorm. But cigarettes had taken on a new persona—the enemy.

One busy day, a typical busy day in the life of a doctor who studies death, he lit his next cig, working at his desk that afternoon, and when he went to put the cig down momentarily, to his shock the ashtray already had a lit and burning cig in it. His. Only his. No one else’s cig. He was alone in the office, that first cig could only be his. And now this second one? What evil is this cig business? That second cig put him over the top. He had so mechanically lit the first and second cigs, he was becoming a robot to them. And he knew, knew to the depths of his soul, that he was a manly man, not a mechanical man. Something had to change. What was beyond will power?

Samuel liked solving puzzles. Why else be a pathologist? Why else take up a hobby of floor loom weaving in the evenings? Why else take up French cooking? Why else play chess?

God works in mysterious ways. Who put that magazine article where Samuel would see it? An interesting light read here, a psychology article about how to defeat the enemy. The advice: observe the enemy, find his weaknesses, study those weaknesses, and then you will be able to defeat him. This pierced Samuel, it bored it’s way into his soul. He realized he could use this strategy to defeat his desire for cigarettes.

He took on a new layer of obligation and observed his mechanical smoking habit in detail. The two lit cigs still deeply bothered him but now suddenly an epiphany. Yes, of course, he had the proof of two lit cigs that unconsciousness was the power of the habit. He put his full intellectual focus on this and vowed that he would be totally conscious of every physical motion of having a cig, every cig. No more automatic anything with cigs. He also promised himself, “As long as I want to smoke, I will.” But with each and every cig from then on, he forced himself to be conscious of every detail of the physical process. His habit had a life of its own and Samuel faced a fact: these many years he’d created a lie within himself that cigarettes were a harmless companion, when in fact the opposite was true, they were little death sticks controlling him on an unconscious level. Time to face it. Time to observe the enemy.

I am raising my right hand. I am reaching into my left shirt pocket. I am taking out the pack. I am thumping the pack. I am reaching for one cig. I am raising it to my lips. My lips are holding the cig. I am putting the pack back in my shirt pocket. I am digging for the matches. I am pulling one match off the pack. I am striking the match against the little track of sandpaper. I am raising the lit match to the cig. I am inhaling. I am shaking the match to extinguish it. I am exhaling. I am putting the spent match in the ashtray. I am flicking the ash into the ashtray. I am setting the lit cig down, now I am picking it up, I am inhaling, I am exhaling, I am smoking number 33 right now. I am now crushing the burning cig butt. I am now leaving it with its kin in the ashtray. Be here now. Yes.

He smoked, kept cigs handy in his shirt pocket and on the bed stand, and this new awareness went on for weeks, two packs a day. Then a miracle happened.

One morning when his wife came in the bedroom with his morning coffee, something very odd happened. He had no desire to light a cig. None. Nadda. Zip. Zero. Zilch. A half hour later at the breakfast table downstairs, the second cup of coffee and alarming as it was, unthinkable as it was, yet truly, no urge whatsoever to reach in his shirt pocket for a cig. Yes, the pack was there, in fact, he kept a pack in his shirt pocket for a week. Not one came out, not one was lit, not one was desired. The next week it gave Samuel great pleasure to take the pack out of his pocket and throw it in the trash. What an appropriate funeral for cigarettes! His mechanical habit was defeated, now he was a free man. He had challenged desire and won. Checkmate!