Wednesday, February 9, 2011

Real talk.

"Do you smoke cigarettes?"

"Yeah. . . .I do smoke every now and then. . ."

Before I could hide it, my eyebrows raised and I was giving my patient the hairy eyeball. I didn't mean to do it. . . .it just sort of happened. I hoped he hadn't caught it.

"What was that for?" he asked with a chuckle. He had obviously caught it. "That look on your face. What was that about?"

"Oh. . . I'm sorry."  I laughed nervously, feeling busted.

"Real talk, doc. Why you make that face?"

Real talk.  I love that expression. It embodies everything I love about slang terms. Sometimes slang words have a meaning that can't be covered as quickly or as effectively with non-slang.  Case in point: "real talk." Two simple words that explain so much.

"Real talk?" I confirmed before proceeding further.

"Real talk."

"Alright. Real talk. . . . .the minute I walked into the room, I knew you smoked. At least a half a pack per day, but my real guess is somewhere around a whole pack. My suspicion is that maybe you smoke other things, too. Like marijuana." I immediately wanted to take the second part back. How could I assume somebody smoked marijuana, too?  (Oh yeah, because I could smell it.)

"Damn, doc. Why you say that? I don't smoke that much. . . ."

"Real talk? I don't usually smell cigarettes on people who smoke under a half a pack. I smell it.  And. . " I paused, wondering if I should just stop talking.

"And what?" he pressed.

"And your lips . . . . .your lips have turned darker from smoking, which tells me that you smoke quite a bit. . . .maybe something more than cigarettes, even. Okay, and as for the weed. . .real talk. . .I smell that, too."


"Have you ever thought of quitting? I mean, you're in your forties. . . you could benefit a lot from quitting."

"You can smell it on my skin and see it in my lips?"

"I'm afraid so."

"Cigarettes is bad news, huh?"

"You got that right. They wreak havoc all through your body. They even make you have trouble with your nature. . . .you know. . .like how you perform."

"Damn." He shuddered at the thought of being unable to gain erections. "Come on, doc."

"I'm saying. . . .you said 'real talk,'" I replied with an eyebrow raise.

"I know. . . . I hear you, doc."

"So. . . .what are your thoughts on quitting? I mean. . .have you thought of it?"

"Man. . . .I'm not really there yet. I just love smoking too much to quit."

"You love it?"

"Love it. Love the relaxation of it. The social part. The breaks with my buddies. A good smoke on the commode or after dinner. I just love it. I wish I didn't, but I do. I love smoking."


He sighed. "I know, right?"

"It'll just hurt you, that's all." I looked at him carefully. His youngish face was chiseled like that of a model, and his job in construction afforded him a physique to match. I could tell that he didn't see this as a real problem, at least not yet. He was what we call "precontemplative" or, that is,  not even close to ready to change.

"Aiight then, Miss Manning. I mean. . .I hear what you saying. . . .but let's talk about it again next time, okay?"

"That's cool. I'll get you some information on quitting, and when you're ready let us know."

"Miss Manning?"

"Yes sir?"

"A pack and a half. Some days, two. And one to two joints per day."

"Wow. Real talk?"

"Real talk, Miss Manning."


Today I'm reflecting on a question that one of my students, Joshua Z., got me thinking of the other day:

Why do we do things that aren't good for us even when we know the consequence? 

Eating the wrong foods, drinking the wrong drinks, calling the wrong person in the middle of the night. Why do we do it. . .over and over and over again?

I don't know that answer.

But real talk? We're all precontemplative about something.


  1. Real talk doc? I quit smoking 35 years ago because the man I wanted to marry didn't like it. I gave up sex ten years ago because I got a divorce from that man and I don't believe in sex outside of committed relationships. I gave up drinking 4 years ago, only to find out that I am not an alcoholic. I can go easily between binge drinking, moderate drinking and not drinking at all and it means little to me. But as a health habit for the medications I take, I don't drink. I began exercising everyday two years ago and rarely miss a work-out. Same health reasons. Recently I was diagnosed with type 2 diabetes and have been working with an obesity doctor. She took away carbohydrates; no more bread and chocolates. I have no vices left and instead of filling empowered and healthy, I feel resentful and deprived. It is the vices that keep us in touch; remind us that it is good to be human. Life just isn't good without them.

  2. 'Why do we do things that aren't good for us even when we know the consequence?'

    I don't have a medical background, I'm only 16, but from a human nature perspective, I'd say it's probably because it makes us feel good for a while, even though we know that it won't make us feel good/be good for us in the long run. In many ways, we, as humans, live for today's satisfaction and not tomorrow's contentment (even though so many aspects of our health would be improved immeasurably if we did, making the jobs of people that work in the medical field much easier). Why do I buy myself a pie once a week even though it's not exactly the healthiest food? Because it tastes good, and I make sure that I do enough exercise and maintain a healthy weight and lifestyle.

    Reading this post, if I had to guess, I'd say that your patient enjoyed smoking, not only because of the stress release and addiction side of things, but also because of the social side of it - being around his mates and talking to them etc. Even though he knows the health concerns associated with smoking, to him at that point in time, the social benefit of smoking was more valued in his eyes than the health that he would gain from quitting smoking.

    Lucy :)

  3. Thank you! :) I love reading your blog, Kim! I sometimes find doctors quite cold and 'removed' from the patients' situation, and I love that you allow yourself to feel for your patients and are immensely affected by their stories. I found you from Oprah's website and I'm considering applying for entry into Health Sciences (I live in NZ, so I assume training is quite different from in the US) when I finish school so that I might have a chance of getting into medicine.

    I check for new posts at least twice a day, I'll try to comment more often!


"Tell me something good. . . tell me that you like it, yeah." ~ Chaka Khan

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