“I can’t breathe, doc,” the man said. Dave is 56 years old and a lifelong smoker.
Vitals were pretty decent. No fever. I could smell it when I walked through the door. He is nicely dressed but smells like a stale campfire mixed with feet. He looks 25 years older than he is.
“Hey, bro, what can I do for you today?” I already knew the answer. This was not the first time we’ve had this conversation.
“I got the crud again. Happens to me this time every year. Coughing’s driving me crazy. Can’t sleep. That’s driving my wife crazy. She’s driving me crazy. Can’t get any work done. Nobody wants to buy a car from somebody who sounds like he has TB. I want a shot.”
He stares at me quietly now. The look in his eyes communicates that the fact that he is sick is somehow my fault.
“Coughing anything up?”
“Green crap. Looks like rotten peanut butter. Tastes like hell.”
“You don’t have any sugar problems, do you?”
“You never told me I did.”
“Any drug allergies?”
“I’m allergic to clams and ugly women. They both make me swell up like a toad.”
He smiles. He’s told me that before. I smile back just to keep him happy.
I put my stethoscope on his chest and ask him to hold his breath. His heartbeat is sinus, and I don’t hear any murmurs. I press my scope against his back in half a dozen places. His lungs sound like a harmonica factory — soft musical wheezes but no crackles. In the absence of fevers or more troublesome lung sounds, he likely doesn’t have pneumonia. I put my stethoscope around my neck and take a glance in his mouth. His tongue is brown. I study his hands. His fingertips are yellow.
“You know it’s coming, don’t you?” He slumps his shoulders and looks deflated but doesn’t say anything.
“When you gonna to put ’em down, buddy? They’re killing you right before my eyes. I don’t think you have pneumonia today. Four months ago, you did. Remember that? Nearly killed you then. You spent what, four days in the hospital? Let me help you with this, brother. I got all sorts of tools that can help get you off those things.”
“C’mon, doc. Just give me my damn shot. I got a stressful job. If I don’t sell cars, I don’t eat. If I didn’t smoke, my wife would strangle me. That time two years ago, you talked me into quitting, she went out and bought me a pack three days into it just so I wouldn’t be so bad to be around. I just caught something.”
“Listen, stud, I tell people they are going to die from lung cancer about once every six weeks, and I deal with the stress of my job without cigarettes. You can, too. That’s an excuse. Be a man.”
He didn’t say anything, but he was clearly ready to move on.
“Help is a phone call away anytime, and you know it. Leave me a message, and I’ll call you in some medicine to help you put them down. For now, I’ll send you some antibiotics for 10 days and some of that nighttime cough medicine that helps you sleep to the pharmacy. I’ll get you a prescription for a puffer that will help open your chest up as well. My nurse will be here in a minute with a shot of steroids. You know how that’ll make you feel. Come back if you’re not better in four or five days, and we’ll do a chest X-ray. Go to the ER if it gets worse. You got any questions?”
He spunked up when he realized his sermon was over. Now, he was a salesman again.
“Nope. Thanks, doc. Tell your wife hi for me. You ever want to trade in that antique jeep you drive for a proper set of wheels, you come see me. I’ll make you a good deal.”
He meant that. Despite my best efforts to the contrary, I genuinely like this man.
“You tell your bride hi for me, too, Dave. Holler at me if you don’t get better.”
I was in and out in seven minutes. It took me longer than that to write about what we had discussed, order his shot and send his prescriptions to the pharmacy electronically. Smokers are great for business. We ought to put a big bowl of Camels in the waiting room with a sign that says, “Free, Take One.”