When I think of smoking: A nurse’s perspective

As nurses, we learn very early in our careers that smoking is one of many modifiable lifestyle risk factors that should be eliminated. Smoking, like poor diet choices, lack of exercise and alcohol consumption are those things in your life you should either eliminate or whittle down to an “almost never” lifestyle activity.
Smoking was and continues to be a very prominent activity in my immediate family. I can remember thinking that everyone smoked, since it was everywhere I went. Looking back at old pictures (yes, Polaroids!), there was always someone with a cigarette in  hand or an ashtray on the table. It wasn’t until I moved out and went to college that I realized smoking was not that commonplace.

Fast forward 15 years or so. I’ve learned exactly what smoking does to the human body. It’s a multi-leveled carcinogen that wreaks havoc on many parts of our homeostatic environment–everything from micro vascular constriction to alveolar damage and permanent burning of the cilia from your inner airways.

As a nurse, I have a crystal clear memory of my first COPD patient. Now, keep in mind that many patients who suffer from COPD never smoked a single cigarette, but the majority of the population who suffers from COPD are long-time smokers. We nurses know all too well the “pink puffers” and “blue bloaters.” Most of us in healthcare have lumped together restrictive lung disease, obstructive lung disease and asthma into the COPD category, even though all three illnesses have very unique etiology and pathophysiology. I’ll continue to conform to the umbrella term of COPD here.

I was a green-behind-the-ears nurse. I think I had just come off my ICU orientation and was working an NOC shift. My patient was an elderly woman in her 60s or 70s. She was a long-time smoker with end-stage COPD. She had a loving family by her side most of the evening. Days prior, she and her family had decided to make her a DNR (Do Not Resuscitate) status–they did not want any heroic measures taken the next time her respiratory status declined. I had just come on shift for the first of my three consecutive NOC shifts.

Over the course of those three nights, I watched her struggle for every breath she desired. She was on high-flow oxygen at times and nasal cannula at times, but always needed supplemental oxygen.

She was restless. She would lean forward in bed, sipping and gasping for every shallow breath she could muster. Every activity was like running a marathon for her. Transferring from the bed to a bedside chair taxed her so violently that she would desaturate and her color would become grey.

I can remember how helpless I felt. I would give her medication when she needed it for comfort. I would help her use the restroom to relieve her of any additional physical stress. I would help feed her if she was hungry. I would help dress and undress her. It’s a hard concept to understand since its so automatic for us, but when every breath you take feels as if you’re breathing through a straw and a 500 pound human being is standing on your chest, EVERYTHING becomes tiresome.

By my third shift I had developed quite a rapport with her and her family. The patient and the family knew it was only a matter of time now. During the early hours of the morning, the patient was all alone in her room–the family had decided to go home and get some rest. She hadn’t rung the call bell in hours. I’d been poking my head in occasionally to see how she was doing.

This time when I checked in on her, I could see she had reached a new level of exhaustion. No amount of medication could comfort her at this point. Her respirations were getting further and further apart now. I must have stood there long enough for her to look up and see me. She winked at me. I took it as a cue to sit down next to her.

I scooted my chair up close to her and held her hand. She leaned in towards me with as much effort as she could muster and in a very raspy shallow whisper said she was “tired of being tired.”

I cannot tell you how long I sat there, holding her hand. I watched as her breathing got more shallow. Eventually, this kind and loved woman just stopped breathing.

Whenever I think of smoking, I think about this woman. I think about how she died because she just couldn’t make the effort to breathe anymore. She got so tired of being tired that she got tired of breathing. While she passed away peacefully, I can only hope that I made her transition as comfortable as possible.