DOES SMOKING cause lung cancer?
First the Tobacco Institute: "Certainly, that link has yet to be determined, because if it had been conclusively determined, we would not see all the ongoing research to try to prove it."
Now the American Cancer Society: "We attribute 85 percent of all lung cancer deaths unequivocally to cigarette smoking. I'm not sure the Tobacco Institute has much credibility any longer."
The cool, rational observer will notice that 136,000 people, most all of them smokers, will die of lung cancer this year, that cigarettes have also been proven to increase the risk of heart disease, and -- to be blunt -- that smokers cough a lot. But rational argument has never been the reason people start smoking; nor is it much help to 54.5 million American smokers who might prefer not to be.
An estimated 7 million people will quit for 24 hours on Thursday, the 11th "Great American Smoke-Out," but it is the rare smoker who quits for good on that day. Still, there are 40 million former smokers in the U.S., and surveys shows that most of them quit on their own.
What follows are stories by people who smoke, who used to smoke, who have watched someone die. Most are by Washington Post reporters and editors -- who work in a professional culture that long included a smoldering cigarette by the typewriter. There are no numbers or arguments here, just true accounts of very personal relationships -- individuals and their tobacco. Paul Berg
THE FIRST TIME
ACT I, SCENE I
We're talking serious peer pressure here.
In my high school, an all-boys Jesuit school in Manhattan, there was a lounge reserved for seniors. In that lounge were three pool tables and many ashtrays. Unless you were on the cross-country team, there was no excuse: You had to know how to handle the cigarette and how to handle the cue, preferably at the same time.
So we sophomores spent our afternoons at Pete's, a pool hall on Third Avenue right out of "The Hustler." The elevated trains still ran on Third Avenue then, so the real estate was cheap, and joints like Pete's could survive. So I learned to shoot pool, but I still had to learn how to smoke.
I took the plunge, so to speak, at an inauspicious moment. I was about to go on stage for my small part in the school production of "Macbeth," and I was nervous about it. So one of the other guys in the cast, John Cuff I think it was, said that what I needed was a cigarette to help me calm down. Here, try one of these: a king-size Chesterfield, unfiltered.
My head swam, my eyes watered, my stomach turned over, my hands were sweaty. I could barely stand up. Then came my cue.
If I had been playing a death scene, I would have been perfect. Why do people do this to themselves? Somehow, I lurched through my scene without embarrassing myself, and by the end of the show, the discomfort forgotten, I was ready to try again. By the time I was a senior, I knew all the important stuff -- how to cup my hands to light up in the wind, how to talk with a cigarette in my mouth, when to change the flint in my Zippo. It was 13 years before I stopped smoking, and I enjoyed every puff. -- Tom Lippman SUNDAY IN THE CAR WITH DAD
Back in the days before the first surgeon general's report on smoking, my father, a shirt-sleeve Chicago newspaper editor of the old school, smoked the real things -- unfiltered Camels.
On one Sunday drive, Dad's cigarette was smoldering in the ashtray. I asked to take a puff, though I couldn't have been more than 10 or 11 years old.
Sure, he said. Go ahead. I did.
Odd, what sticks in the mind. I remember coughing and gagging on the passenger side of the front seat as smoke swirled around my head.
He taught a powerful lesson. That's my only memory of a cigarette.
Never touched another. -- John F. Cullicott AT SAWYER'S POND
When I had scraped together enough money, saved from uneaten junior high school lunches, I bought my first pack. I bought them at the Village Store, for about 35 cents. Pall Malls. I took my treasure to the big rock beside Sawyer's Pond, and I sat there and smoked one. I remember it seemed to take a long time. When I was finished, I tucked the pack under the rock, to one side, invisible to the quick eye.
Then the rains came. I went back to the rock the next day and retrieved the soaked pack of Pall Malls. Very carefully, because the pack was tight with swollen cigarettes, I took them out one by one. Only the first couple of cigarettes disintegrated beyond use. Those I took down to the water, where I watched the tobacco and paper float away.
The others I laid on the flat surface of the big rock, where the sun dried them. If you think a fresh unfiltered Pall Mall is strong for the 12-year-old lung, there is something about a rain-soaked, sun-dried unfiltered Pall Mall that can't be beat for sheer dizziness and nausea.
There have been many, too many, packs since then: black-tobacco Rex cigarettes smoked in Madrid, Gauloises in France, Dunhills offered around after dinner in Rome. None was as hard-won, none as exhilarating, as the pack of Pall Malls that got me hooked. I suppose I should have quit right then. -- Karen Craft
THOSE WHO DIED
It was late September when I got the call. My uncle was at the Mayo Clinic, and after months of fatigue and misguided treatments from his doctors at home, the diagnosis was in: lung cancer, a lump the size of an orange.
Two days later my aunt and I settled into the clinic's family waiting room, prepared to spend three or more hours pacing, and reading, and pacing some more, while the doctors removed the lung. But in just an hour and a half we were summoned: The cancer had metastasized to the bone; there was no point in taking out the lung.
We spent a week on the pulmonary ward of the Mayo Clinic, eyewitnesses to the ravages that smoke brings, watching the pain of the patients, the pain of their families.
Until that week, I had been gentle with smokers, although never one myself. I had refrained from nagging, from speaking out.
No more. -- Linda Halsey LIES PEOPLE TELL
They didn't detect my father's lung cancer until that final summer. He had broken a rib swinging a golf club and the X-rays showed what had been growing inside him for some time. Within a few months, he was dead. We grieved and reminisced about the loss of a wonderful and interesting man, a 69-year-old retired New York City private eye. After the funeral, I remarked to his brother, my Uncle Lester, that it was ironic that George Perl succumbed to lung cancer after having given up smoking several years earlier.
"Given up? He never gave up. He told you he gave up?" Lester said.
"Of course," I replied, stunned and irritated at my uncle's misinformation.
But then the tale unraveled: George had been a pack-a-day man of Chesterfields for more than a decade, then moderating to filter-tipped Kents. My mother and our family were proud of him because we believed he had quit smoking more than a year earlier, and we rejoiced at his turnaround.
But Uncle Lester, one of George's golf partners, knew better. George kept his cigarettes in his golf bag. He never smoked at home, but he virtually chain-smoked on the golf course. Mouthwash and Binaca covered the odor. When my mother occasionally questioned the smell of smoke on his clothes, he blamed somebody else at the golf course or said he had been in a smoky restaurant.
My parents had been married for 36 years and were deeply close in an old-fashioned way. When I learned the truth from Lester, I debated whether to tell my mother about the fraud he had perpetrated for the last couple of years of his life. I decided to tell her.
My mother misses my father deeply and has never gotten over the loneliness. And now she is angry at him also, angry because he robbed them of a little more time together. -- Peter Perl
A DAUGHTERS'S EYE
The burning occurred when my daughter Mai was 3 years old. What happened was this: I accidentally burned her eyelid with a cigarette. There was no permanent damage, but it was painful for her and terrifying for me. But I was such an addict that I didn't stop smoking right away. I didn't stop feeling badly about hurting Mai, either.
I had tried to quit smoking in the past and was successful only for short periods. But Mai was a powerful persuader, and I stopped again. That was nearly 12 years ago, and I haven't had a cigarette since.
But just in case I should weaken, Mai still brings up the burning of her eye from time to time. As though I could ever forget. -- Ann Mariano 'A LITTLE PROBLEM'
"There's a little problem with your chest film" is how my doctor put it on the phone on Oct. 4, 1987.
The "problem" was a growth in my lung. He told me the growth was not necessarily a cancer, but he was "concerned." So concerned that he had already met with a radiolgoist, a thoracic surgeon and at least three other specialists. So concerned that a date for surgery had been set.
I was panic-stricken. I had never heard of anyone with a benign growth in a lung. I knew I had cancer. The thought of my 13- and 10-year-old sons watching my suffering and death was unbearable. I knew the statistics. Nine out of 10 people with lung cancer are dead within five years. I did not want to be a dead 40-year-old.
The worst part was that I had done it to myself. Now my boys would not only grieve for me, they would also hate me for what I had done. I was so terrified, I did the unthinkable. I Quit.
The first few days, I felt psychotic. My brain was bursting, and all my nerves screamed. I needed nicotine. I kept saying, "Go one more hour, then you can smoke." After a day I said, "It can't get worse." It did. I said, "Millions have Quit, so can you."
Within a few days the acute pain subsided, to be replaced with unremitting misery. I was truly addicted. All I could think about was how much I wanted a cigarette. To take my mind off nicotine craving, I made myself think of other things. I thought about my upcoming operations, my cancer, my poor little orphans.
The day before my lung operation, my surgeon smacked chewing gum while we spoke, having recently Quit himself. He had me sign permission for him to remove all or part of my left lung. I fully expected to be awakened with a cheerful voice telling me I still had part of the lung, and they think they "got it all."
Instead, I heard this: "Mrs. Runkle, it's definitely benign."
And despite my new lease on life, it still took a year of torture -- I do not exaggerate -- before the craving went away.
All Quitters love to give advice. Here's mine: If you're quitting and you're a believer, pray for strength. If you're quitting and you're not a believer, pray anyway -- it will take your mind off cigarettes. -- Deborah Runkle THE DEATH OF IVAN ILYICH
I started having dreams that I was the central figure in Tolstoy's famous story, "The Death of Ivan Ilyich." The theme is that you die alone. Ivan suddenly gets a pain in his side. Gets worse. Usual doctor back and forth. Finally dies. As he is lying in state, his "friends" at the funeral and even his close relatives are surreptitiously looking at their watches to see if they can leave the lying-in ceremony for the dead man in time to make a bridge game, concert, party, etc.
One morning, my daughter's first birthday, I dreamed this Ivan Ilyich dream, in which I was lying dying of cancer of the lungs a few years in the future at age 34, woke up, threw all my cigarettes away (I had them on the night-table) and have never smoked since -- over 25 years. Have never missed it, except for Uppman cigars, which I liked a lot. -- Spencer Rich DOCTOR'S ADVICE
The surgeon pulled the tube from my chest and closed the tiny incision with a butterfly patch. My right lung had collapsed a few weeks earlier in this spring of 1962, but I was unaware of it and to this day don't know the cause. Not until I complained of shortness of breath and had an X-ray taken did my doctor diagnose the blowout and order me hospitalized. I was terrified, but the surgery was simple and commonplace: insertion of a tube into the chest cavity to allow the air to escape and the lung to re-inflate over the next week.
Now, as the chest surgeon closed the butterfly patch, he advised me to take it easy for a month but otherwise to return to a normal life. "When can I start smoking again?" I asked half in jest. "Whenever you like," said the surgeon, a smoker himself. "There shouldn't be any problem." I hadn't had a cigarette in more than a week and no longer really craved one, but I lit up as soon as I hit the steps of the hospital. It was dizzying and delicious, and within weeks I was back to two packs a day.
A year later, the surgeon general of the United States issued his famous report warning of the dangers of smoking. I quit for good that very night, cold turkey, suffering all the agony and anquish that I could have avoided with a little encouragement a year ago. I wondered if the chest surgeon was going through the same hell. -- Robert A. Webb
There is a photo of me at around age 2 with a cigarette in my mouth. My parents kept a glass container of them on the coffee table, which was low enough to the ground that I could hold myself up on the table and reach for one. I suppose my parents found the incident funny and there happened to be a camera lying around.
Now, at 22, I have been smoking a pack a day for about six years. In all other ways, I am a very typical yuppie-to-be. I am about to graduate from the University of Virginia, I eat tofu, work out, wear only 100 percent cotton and take the stairs instead of the elevator. So how do I justify my habit? I can't.
And so I am an outcast at social events, a destroyer of friends' meals, and the recipient of much lecturing. I want to stop, but I don't know how. I am telling myself that I will try hypnosis when I have the money. But I've heard it doesn't work. -- Lynn Prowitt NO REGRETS
Yeah, yeah, I smoke. So sue me. And I've about had it up to here with these anti-smoking Nazis. I don't mean the people who are genuinely irritated by it, like a friend who has some sort of nose condition, or the people whose house is never smoked in and don't want the smell. I mean these yahoos who take it upon themselves to police public restaurants, bars, shopping malls and sidewalks. These people also own diesel cars for "good mileage." Go figure.
These people don't even bother with a polite, "Excuse me, but that's really irritating my (eyes, nose, kneecaps, you name it)," they come up with an arrogant "Some of us are trying to breathe" sort of thing. Oh. Pardon moi.
I can understand how people find it offensive. Then again, I find a lot of peoples' faces offensive. "Excuse me, but could I recommend a good plastic surgeon?" "Oh, by the way, they have something new out. It's called a diet." "Gee, this is the 'No Children' section of the restaurant. Would you mind taking your brood of mouth-breathing brats to the parking lot?"
Yes, there are lots of good arguments against smoking. I'm sure that if I quit, I could run faster and jump higher. Or I could buy a pair of P.F. Flyers and get the same result. If I quit, I could avoid all the snide remarks at work. But someone has to maintain, for the youth of America, the image of a newspaper person. And I've heard smoking cuts five years off your life. Like I'm really going to miss those wonderful years between 85 and 90. People can't stand me now -- I'd be doing them a favor knocking off a few years earlier.
Just be thankful I don't smoke cigars. -- Scott Patton IF YOU SMOKE . . .
My 7-year-old saw a billboard which read: If you smoke, please try Carlton.
Finally, he thought, someone other than himself is interested in helping folks to stop smoking and invented some new method called "Carlton." When I explained to him it was just another brand of cigarettes, he was devastated. Every time I smoked in his presence, he fell to the floor crying. I've now stopped smoking at home, and whenever I smoke at my desk, I turn his picture to the wall. -- Debbie Fleming
WAYS OF QUITTING
I knew I needed help.
In the far reaches of my mind, I remembered hearing of a fellow Corcoran student who had learned to stop smoking through a workshop at the Seventh-Day Adventist Hospital in Takoma Park. The next day at work, I looked up the number and called. A class had begun the night before and I could still join.
That evening I found myself at the stop smoking clinic -- one of a nervous group of about 20 or more new nonsmokers.
The doctor who spoke had me in the palm of his hand. He appealed to my artistic sensitivities, telling us how these beautiful cells that made up the alveoli would after years of smoking gradually lose their shape and become collapsed cells, no longer beautiful, no longer capable of doing their job.
Knowing I was destroying these beauteous life forms gave me pause -- as did the realization that I was an addict. Researchers, he said, knew a lot more about the addiction process because of studies done with returning Vietnam veterans. He assured us that in two weeks all physical addiction would be gone. After that, we would be fighting habit, and it was a powerful foe. If, however, we had even one cigarette, all the receptors for nictoine would be reactivated.
A final image remains with me from our session: The doctor perched on the edge of an imaginary bed, imitating what it would be like to die from emphysema, gasping for that last breath of air. I found I could not choose to die like this. I chose to be a nonsmoker, as the card I signed verifies: I, Ann Corbett, choose to be a nonsmoker, April 8, 1974. -- Ann Corbett THE COUGH
By the time I was 26 my head was so stuffed from smoking that I was coughing through the night. I had to sit up in a chair to try to sleep.
I tried a pipe. I burned out the bowls. I tried puffing on two cigars a day, after lunch and dinner. I was soon inhaling and chain-smoking cigars, which made the situation worse than ever.
So then I really quit. I resorted to Dentyne gum, and chewed so much of it that my mouth got sore. So I quit that.
I missed cigarettes for four years. Then, my head having cleared, I thought I'd try them again. I bought a carton. Within a week I was coughing. That finally cured me, several years before the cancer-and-smoking scare. I haven't missed smoking since that week. -- Victor Cohn THE REVELATION
I smoked for 34 years, starting with Lucky Strikes in the green package and ending with Pall Malls in the red. I never got the hang of filtertips, preferring, as I joked during those years of self-abuse, lung cancer over a hernia. I enjoyed every puff except during bouts of the worst bronchitis, and I based my life's schedule on whether smoking was allowed where I would or wouldn't go.
When I quit I was smoking about a pack of Pall Malls a day, down from the three a day I'd burned up at my peak, the middle 25 years or so.
So I was not a beginner the day I didn't decide to quit. It was on Jan. 26, 1984, and I knew all about fear, including the fear of dying with my Marlboro Country exposed to the jeers of the chest surgeons (and worse, their nurses), and fear had done nothing. Fear had been my running partner for a good many years in another part of my health, and I had left most of it behind four years earlier when I stopped drinking alcohol.
On this morning I'd made a routine doctor's appointment, this time for some more sophisticated tests. The results were apparent, with some clouds: My blood pressure was okay, with medication taken daily; prostate was clean and normal; blood good; heart minus the inverted T wave that had concerned my doctor for years. No shadow on the chest X-rays. But my lungs blew about 67 percent of what they should have on the respiration test, and that was that. I was about to turn 51.
As I left the doctor's office that morning I was reminded of a line from Flannery O'Connor, who had her own catholicism with which she could wrestle, and it came to me as I looked across the tree line and toward the blue skies above Silver Spring that there had never been such a day, and I had never felt so good. The line was one the nuns (who were absent from my own childhood) had taught O'Connor: I am the temple of the Holy Ghost. I never understood that line before, and am not sure I do now, but I have not had a cigarette since, and I have not wanted one. -- Robert H. Williams THE FEAR
One morning four years ago, when I wasn't looking, my psyche quit smoking while my body and I stood idly by.
It was the morning after a staff party at which I had as usual drunk too much and smoked a couple of packs of, er of . . . I can't remember what brand I used to smoke five packs a day of.
I stuck a cigarette in my mouth on the way to the bathroom, as usual, but never lit it. While I was drinking my second cup of coffee without lighting my first cigarette I began to realize that there was a mutiny afoot, centered in my boiler room. My bronchioles or cilia or something had decided they weren't going to take it any more, and every time I reached for a cigarette, which was about every 15 seconds, they slammed shut some psychological hatch.
By mid-morning I knew I had quit smoking for good. The desire was as sharp and persistent and unmanning as ever, but I was afraid to light up. I still am. -- Hank Burchard
1. DON'T TRUST SALESMEN
I was watching the CBS "Evening News" when I had an experience that helped me over the top. They were discussing the amount of smoking in the black community. The numbers were startling to me as a black -- a disproportionately large number of blacks are killed by smoking-related illnesses -- and more depressing for me was that the spokesman who appeared for the tobacco industry was a black woman, obviously well-to-do, and well-spoken. Smooth. She delivered the standard tobacco industry line -- with just the right amount of deceit and arrogance that, for me, typifies any tobacco industry spokesman. I swear there was something about that black tobacco lobbyist, smooth and cool as she was, that made me mad and ashamed. It seemed to me she was selling out her race in the worst way. What difference is there, I thought, between her and the drug pusher on the street?
I figured if I ever got a leg up on this addiction, I would use the memory of this smooth saleswoman to keep myself going. It was a great help to me when I quit -- the one thing I've done this year that I'm most proud of, because I never thought I could do it. -- James McBride
2. PREPARE FOR THE POUNDS
My obsession with cigarettes today has nothing to do with a desire to smoke. Rather, today my major concern is losing the weight that has hounded me since I quit.
As many an ex-smoker has experienced, your metabolism, no longer under the accelerating influence of nicotine, slows down when you quit. While, I am told, your system eventually does right itself, it's the waiting for this adjustment that is so difficult.
When I had been smoke-free for about six months, my doctor quizzed me about where the extra weight -- all 30 pounds of it -- had crept in. As I explained to her the cause, she quickly was drawing up an itemized diet plan. It was somehwere about that time that my friends became concerned about the expansion of the new me, particularly my mother, who to this day has made my weight loss her major crusade. My explanation about the metabolism factor fell on deaf ears, sounding I guessed from their reactions remarkably similar to a fatty's alibi. So I learned to suffer, to exercise and diet in silence. The most frustrating reality I found was that no matter what I did, no matter how I tried, my weight continued to escalate.
Someone told me many smokes ago that it would take as long as five years for my lungs to clear once I gave the cigarettes up. That's believable. What I'm wondering now is whether total weight reversal or control -- or whatever is next in my post-smoking weight cycle -- will also take that long to right. -- Curtia James 3. FIGHT FOR YOUR RIGHTS
Woe betide the antismoker who tells the middle-aged, rhinestone-braceleted woman in the airport crowd that her cigarette came within a millimeter of your 6-year-old grandson's eye. "He shouldn't have been standing that close to me," she huffed as she puffed.
Never mind. Her rights, and those of other smokers, end where mine begin: in that part of the air that I have to breathe, and I will continue staking my claim to it so long as there is breath left in me. Surgeon General Koop is my nominee for the Nobel prize, and I expect to live long enough to see smoking banned on all aircraft, all restaurants and other public indoor accommodations, and maybe, just maybe, the newsroom of The Washington Post. -- John Means 4. FIGHT SOME MORE
As a lifelong smoker, I sometimes wonder what my life would have been like without cigarettes.
No Sunday sightseeing rides in the family car, with windows rolled down even in bad weather so that Dad's cigarette smoke would blow through.
No newsroom memories of intense deadline pressures, the staccato rattle of typewriter keys covered with the brown-tinged film from cigar, pipe and cigarette smoke that haloed around the rim of the copy desk.
No hospital room where, at age 26, I agonizingly inhaled on a respirator for eight days, willing my fragile lungs to expand and contract. The X-rays showed double pneumonia. The doctors shook their heads and said, "You've got to give up smoking."
The fact that I personally had never had a cigarette didn't protect me. I had been a lifelong sidestream smoker, inhaling what smokers left behind.
So I gave up work and spent four years in the mountains of North Carolina, where my carbon-filled lungs gradually healed. No newspapers, no television reception, no radio stations without static -- and no smokers.
We used to be part of the silent majority, we sidestream smokers. But lately we've learned how to be vocal. Today, when someone lighting up in a restaurant arches an eyebrow and asks, "Are you one of those people who hate smokers?" I can answer: "No. In fact, I've even loved a few. That's why I hope they stop." -- Julie Dear 5. BLOW OUT THE CANDLES
I actually wanted a cigarette the other day. I walked through a cloud of somebody else's smoke and for a fleeting second, I really wanted to light up, suck in a deep breath and feel the rush of that drug from my toes to my head.
Then I remembered I don't smoke any more. Haven't for a dozen years. Then I took another deep breath and inhaled (relatively) clean air and exhaled slowly, savoring the depth of breath my lungs can accommodate, remembering the round little burn holes that characterized any wood furniture I ever had. Actually, short of marble there wasn't anything that a cigarette left burning wouldn't at least stain.
I popped M&Ms and amphetamines when I stopped smoking. I did it cold turkey. In my case, that meant I got a cold on Thanksgiving Day. It settled in my chest. All my colds always did when I smoked -- two packs a day for about 25 years, from (pre-filter, I'd-walk-a-mile-for-a) Camels and Gauloise (Bleu) in my roaring twenties to Carltons approaching mid-century.
I figured that by the time I could breathe normally again, I'd be over the worst of it. I wasn't, but by that time I'd invested so much angst into stopping that I stayed stopped. The amphetamines didn't help. The M&Ms did, but of course I never lost the weight I gained. Still, my colds usually can be smothered in a day or so. I'll be able to blow out all the candles on my birthday cake next year. There'll be a bunch of them. -- Sandy Rovner