Up in Smoke

In the last months of her life, my mother-in-law simply denied that she started smoking cigarettes when she was 15 years old. And that – some 65 years later – she still was.

She hid the carton in her dresser under the thin disguise of a layer of t-shirts. She slipped them out when no one was looking, opening the sliding doors of the bedroom, huddling into the shrubbery along the wall, hiding in a haze of smoke and greenery. She trailed the scent of burnt tobacco with her anyway.

“She told the doctor she didn’t smoke,” my husband confided over the phone. He was calling from a California emergency room in the deep summer of last year, shortly after his mother was diagnosed with lung cancer. His voice sounded soft with grief and worry and guilt. He’d found the hidden carton and hadn’t thrown it away yet.

“Did you tell him the truth?” I ask.

“Did you want me to call my mother a liar?” he snaps.

“Yes,” I flash back. “He needs to know.” Anger and worry hiss  across the connection.  Both of us right, both of us wrong, catching for that balance between honesty and dignity that’s so hard to find in a terminal illness.

But he sighs. She’d finally made herself say she used to smoke, maybe a few cigarettes, you know, now and then. The doctor’s voice had been soft also. Gentle even.

He could tell, he said, just by looking at her. I can imagine how she looked there in over-hyped clinic lights: a slight woman with blond hair fading to silver, Norwegian blue eyes, a smile that blazed with friendliness.

Usually, you couldn’t miss the smile. But the doctor, I realize, was reading her differently. He saw instead, the etching of lines, the roadmap face of a long-time smoker.

The Mayo Clinic offers this rather ruthless description of the way smoking erodes the skin:  “The nicotine in cigarettes causes narrowing of the blood vessels in the outermost layers of your skin. This impairs blood flow to your skin. With less blood flow, your skin doesn’t get as much oxygen and important nutrients, such as vitamin A. Many of the over 4,000 chemicals in tobacco smoke also damage collagen and elastin, which are fibers that give your skin its strength and elasticity. As a result, skin begins to sag and wrinkle prematurely because of smoking.”

It tells you maybe more than you want to know about the corrosive nature of cigarette smoke. Or maybe not enough; it just hints at the havoc those compounds can create internally – the weakening of the heart and lungs, the sly spread of cancerous tissue.  But it doesn’t really tell you about the woman, smiling nervously at the doctor while he studies the chemical etching of her face.

Her name was Helen.  She laughed like a loon at bad jokes and could dance like a wild woman. She surrounded her home with flowers and fruit trees – peaches and apricots, pomegranates and oranges.  When we moved from California to Wisconsin, she bombarded us with boxes of walnuts,  oranges, raisins,  jars of home-made pomegranate jelly. She took in unwanted cats, wandering dogs, and just about anyone who she thought needed care and feeding. She wanted to make people happy and found it almost impossible to tell them no, a blessing and a curse.

She’d been trying to quit smoking ever since I knew her, an endless struggle with a habit that dated back to 1945. “Don’t tell Peter,” she would say to me when she came to visit. “Don’t do it,” I’d say.  “I’m down to just a couple a day,” she’d insist. “I’m almost done with them.”

She’d go sneaking out into the backyard, sometimes shivering in the icy drift of a Wisconsin winter, sometimes leaning against the mulberry tree on a summer evening with the air so soft you could barely see the thin ribbon of smoke.

When my husband threw those hidden cigarettes away last summer, she never said a word.

In November, the U.S. Food and Drug Administration announced plans to require new, more graphic warning labels on cigarette packs: images of a corpse with black stitches tracking up the chest, a mother blowing a gray cloud on a child, toe tags on a body and some cautionary words. WARNING: Smoking can kill you.

Cigarette companies are already going to court to fight the new labels, which are scheduled to take effect this summer. My favorite quote on the subject comes from a New York Times story in which a tobacco company executive complains that the graphic warnings could “denormalize” smoking.

The truth is, there’s no warning that comes close to describing a smoker’s death. Smoking can kill you, the label says. It doesn’t say that death can come like a benediction. That the pain from the spreading cancer can be so intense that you will be gasping with it even while unconscious. That when your son flies to California to say goodbye, you won’t know him. You’ll look look at him, eyes glazed with narcotics, and you’ll call for your mother, dead these 30 years.

After the funeral on Sunday, one of my nephews wonders about the way she chanted her mother’s name at the end. We’re back at her home, leaving behind the chapel with its welter of flowers and history of grief. I had not realized how empty a house can seem, even when full of people.  “Maybe she saw her,” he says. “Maybe she knew they’d be together again.”

“I hope so,” I answer.

But mostly I hope she felt safe in those last moments.  That she wasn’t in some dark place, calling for a protector who didn’t come.  I wish for her to be tucked away, happy and warm, in the home of her childhood. Or in a garden awash with orange trees and the starry tangle of jasmine.  And I wish for what I cannot have. I wish she had never tried that first cigarette, answered its beckoning glow, taken the path that brought us to this January day as gray and cloudy as smoke itself.

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32 Responses to Up in Smoke

  1. Such a beautiful tribute, beautifully written. And so sad.

  2. Deborah Blum says:

    Thanks so much, Maryn. I wanted to do something for her here, light a candle really. And to let her make a difference here, remind us that all those smoking death statistics are about people who matter.

  3. Laura Newman says:

    Deborah, thanks for this nice piece about your mother-in-law. She sounds like a sweet woman. I think a heck of a lot of lying goes on between patients and medical professionals about smoking and alcohol. I was recently with someone at a cancer hospital here, newly diagnosed with lung cancer. No, he doesn’t smoke now, but he did for years, and he does drink. Both smoking and drinking are viewed so badly that I just don’t think many people can admit to it openly. You come in, so vulnerable. Sorry for your family’s loss.

  4. Deborah Blum says:

    Thanks so much, Laura, for writing and for making this absolutely right and completely generous point.

  5. Steve Silberman says:

    Oh, Deborah. So sad and beautiful.

    I smoked for ten years myself, but was finally able to quit. What a complicated hell this drug is.

    Thank you for such a deeply humane, sober, and clear-eyed piece.

  6. Avice Meehan says:

    A piece as graceful as the mother-in-law brought back to life by your words, that also evoked my own mother, alive but dealing daily with the complex consequences of decades of smoking. Thank you.

  7. Deborah Blum says:

    Well, I always wish that I wrote as well as you do. But I really worked to get this right, to do justice, I guess, to the death of someone I loved and to the bigger, darker story behind that death. Complicated hell is such a good description.

  8. Jody Schoger says:

    Deborah,

    I grew up with two parents who smoked. And I lost two parents to lung cancer; the first at 52, the other at 59. My father died in three weeks from the time of his diagnosis; my mother lived a much longer time following her diagnosis, a little more than three years.

    What I love about your post is its great truth. You are honest about cancer and the vibrant, funny woman who you eulogized so beautifully today. You have done your family a great honor. Thank you so much,
    Jody

  9. John Rennie says:

    Deborah, what separates you as a writer from most of the tribe is that, in a time of fresh grief, you succeed in finding spare, honest phrases that are no less beautiful for the anger and loss they embody. Bravery and talent, both.

    Forget the scary graphics for cigarette labels. Smokers should just have to read pieces like this aloud before they can buy a pack. Your 4th-to-last paragraph should send them weeping into the night.

  10. Jean Carlson says:

    Deborah,wonderful as always,, I like peters mother was a closet smoker for 32 years until, the day we know so well, I had a massive stroke at 46 years old smoking stole my life, smoking obviously a contributing factor to my event, we are good people who just can’t help ourselves, even when we nknow howvwrong it is, why else are we so secretive,god knows I tried many many times to quit, I so empathize with peters mother, I’m so sincerely sorry for your families loss. I was lucky, I haven’t had a smoke in nearly 5 years, but it took a stroke for me to quit permanently

  11. Mary Knudson says:

    Deborah,

    What a perfect balance you struck in this moving essay. You share the horrible truth of death by smoking and you show what a beautiful, caring, and human person your mother-in-law was.

    Cigarette addiction can rule anyone who smokes that first pack, maybe that first cigarette. A former head of Johns Hopkins Hospital smoked heavily and told me it wasn’t in his genes to get lung cancer. But it was. He was one of the smartest, toughest, most clear-thinking people I ever met. But not about dying. I don’t mind trying the harsher ads to see if they work. And if they don’t, try something else. But we have to keep trying to put cigarette makers out of business.

    xoxo,
    Mary

  12. A beautiful piece and tribute. I smoked from age 15 until I was 32, when I finally really did quit cold turkey because I became pregnant with our first child. It took me three years to stop dreaming about smoking. And every time I develop a new chronic health problem–which is often, lately–I have to turn and face myself and ask, “Is this because of the smoking?”

    It’s a blight, and a pox on the tobacco purveyors who entrap people in that horrible, deadly addiction. This piece should be required reading for them, as well.

  13. Paul Rigby says:

    Thank-you for this moving account-
    I’m going to have to say a similar goodbye to my father one day, sooner rather than later. He’s been a smoker since he was 12 or 13, and last month he turned 80. Like your mother-in-law, he’s tried a number of times to quit, but nicotine is such a powerful drug..
    I used to want him to quit, especially through his 50′s, 60′s and 70′s. But now, I’m happy for him to smoke as much as he wants, and I’ll tell you why:
    He loves, loves, having a smoke. Always has.
    He knows that it’s bad for him, and if he lung cancer, well the prognosis won’t be great. But at his age, driving the car to the supermarket is fraught with danger.
    When he was growing up in the 30′s and 40′s, he was told that God gave you 3 score years and 10 (70 years). So every day past 70 is a bonus, and he’s had over 10 bonus years.
    And yes, dying from cancer is a horrible death. I’ve been a medical imaging technologist for 30 years, and in my experience, most elderly deaths are horrible: not many get to stroke out or cardiac arrest in their sleep.
    Should he get a terminal diagnosis, he’s had 80 years or more, 80 really good years. And I’ll happily ask doctors to dope him up with morphine if he’s in pain- I will not see my dad in distress.
    So for dad to be 80 and still smoking, well, good luck to him, and your mother-in-law, for living so long, and enjoying having a smoke

  14. Thank you for this piece. I lost my father 4 years ago, two months after his diagnosis of lung cancer. He had been a heavy smoker for years, but had quit 15 years before the diagnosis. He was in all other respects a healthy and active man, initially thinking golf was the culprit behind the pain in his back and shoulder, when instead it was numerous invasive, bone-destroying tumors in his humerus and 10 of his vertebrae. He was only 60 when he died, he and my mom just starting to plan their retirement years. Instead, we spent the last few weeks of his life helplessly watching him waste away physically and mentally until he didn’t see us or hear us anymore. It was a brutal way to die, and a brutal way to watch someone die. Is that what the tobacco companies are fearful of denormalizing?

  15. Steve Silberman says:

    Amen.

  16. Lisa says:

    Beautiful, achingly sad essay. Thank you for having the strength to write it. My mother died of lung cancer four years ago. She smoked since she was 12 to the age 52 when she was diagnosed and died.
    I just found out my father HAS to quit smoking (he’s had three heart attacks and now has an ulcer, an enlarged heart, and polyps) or else really bad things could happen (like what you wrote about). The saddest thing is that I don’t think he will do it. What do you tell our parents who smoke, know it will kill them, but still won’t quit? I say, Dad, do it for ME. Still, he does not.
    Blessings to you. Thank you again.

  17. Kim Arcand says:

    My father in law is struggling (and quickly loosing the fight) with COPD and emphysema. It is horrible to watch, never mind have. He smoked heavily and was also a firefighter – back before they had the protective gear that is now required – a double death for his lungs. When I see people smoking now, my eyes just flash forward to rumpled hospital beds and desperate, painful gasps for breath.

  18. Hello Deborah— very nice post, thank you. And condolences on your loss. My own mother passed on several years in similar circumstances— thoug she was finally able to stop smoking at age 77. May I use your essay in my work– I’m a stop smoking coach for our local Health District, and also write books and articles and essays about the craziness of this habit. Again, thank you for your deeply human and understanding response. The Big Wheel turning. In peace—

    Bear Jack Gebhardt
    Smoking Cessation Counselor
    Health District of Northern Larimer County
    Author, How to Help Your Smoker Quit, The Enlightened Smoker’s Guide to Qutting, Practicing the Presence of Peace.

  19. Deborah, what a haunting piece. I got goosebumps. Thanks for sharing.

  20. Deborah Blum says:

    You are so welcome to use this essay in anyway that would help in your stop smoking work. I’d like to think that it could make a difference in that way..

  21. Deborah Blum says:

    I’ve always admired your courage, Jean, in telling this story and in our daily life. I think it’s important for people to hear exactly this kind of effect. Thanks so much for writing.

  22. Laura Dodd says:

    Deborah, I am so sorry for your loss of such a lovely mother-in-law. I lost my own wonderful father to lung cancer, and curse the day he ever started. Thank you for this eloquent tribute to her and condemnation of that terrible habit.

  23. Deborah Blum says:

    Thanks so much, Jody. I really appreciate it, especially coming from you and all the amazing work you do to raise awareness.

  24. Tom Levenson says:

    This is the piece I couldn’t write for my mother, dead of lung cancer 10 days before my scheduled wedding day.

    Thank you for this.

  25. Deborah Blum says:

    Oh, Tom. I’m so sorry. But, yes, I was running on grief – and I think rage – with this one. I’m glad it worked for you.

  26. Such a touching post. Thank you for sharing.

  27. Aurora says:

    Couldn’t agree more.

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