Dr Tom Mulholland: No one on their death bed ever says 'you have to die of something'
"You have to die of something," grinned a forestry worker out the back of Lake Rotorua.
You could smell the tobacco on his breath as he tried to blow in to a device for six seconds. His bravado soon faded as he saw he had lost 30 per cent of his lung function due to smoking.
Sure you have to die of something, but it doesn't have to be emphysema, cancer or a heart attack. In my 25 years of being an emergency department doctor not one person suffering these fatal conditions has ever said "you have to die of something". Mostly they're short of breath, pale, sweaty, frightened and often want their mum.
"Not the anti-smoking lecture," moaned one woman as she rolled her eyes in Tolaga bay.
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It's not a lecture. Imagine you're out getting paua and your foot got stuck between the rocks, the tide comes in and you're drowning. You see me walking along the beach with my surfboard, would you yell out and want me to come and rescue you? Of course, you would. Consider this the same - you're slowly drowning now and I'm trying to save you.
"No-one has ever put it that way before." We came up with an action plan.
The ambos unloaded a 68-year-old man at Auckland City Hospital - his eyes bulging.
He was what we call a blue bloater, rather than a pink puffer - someone who has got so used to high carbon dioxide levels in his blood, only the lack of oxygen keeps him breathing. Unable to speak due to shortness of breath, he looks at me, wanting to be rescued. I might get him a few more hours, days or months but a year would be unlikely. The damage has been done. We can't do miracles.
Back out to the waiting room midnight on a busy Friday at Auckland City Hospital where I have now worked for ten years. A 28-year-old asthmatic has run out of inhalers and is short of breath. He is a smoker.
"You have to die of something," he says. What can I say to change his mind? Am I wasting my breath? I feel like taking him into resus and saying this is where you will be. This is your future, but I can't, it's not ethical.
So I try another angle. How does your smoking affect you? "It doesn't," he says. "I can still run up a hill."
Think of your lungs as balloons. When you are 28 you may have 6 litres in your balloons. If you don't smoke you lose 30mls per year. If you do smoke you lose 100mls per year which you can't get back. So in 10 years you will lose a litre of lung volume. In 30 years (and no one who starts smoking thinks that will do it for 30 years) you have lost 3 litres. You can walk with what you have left but not up a hill, your inhalers won't work as well. Soon you can't play with your kids or grandkids, then walk to the shop, its insidious.
Sometimes this talk of the future works sometimes it doesn't. It's not a blame thing, it's just the facts and these are your numbers, they don't lie and they aren't my numbers, they are yours.
It's your future and we are just trying to help.
Dr Tom Mulholland is an Emergency Department Doctor and GP with over 25 years experience in New Zealand. He's currently a man on a mission, tackling health missions around the world.