Smoking was banned in all hospitals last year. On the surface, this is a positive move, will discourage patients and staff from smoking at work, increasing the chance they will quit. Some die-hards huddle just outside the front entrance to the hospital, patients wrapped in white gowns, still attached to intravenous lines and leg bags. People enter through a fug of smoke and hospital smells. Nobody seems quite game to approach the smokers to butt out.
We put pressure on people to quit, because that’s want we want, right?
I was walking to my clinic today, just near the palliative care ward. I saw a courtyard. A sign on the door read “smokers courtyard, palliative care patients only”.
I saw the blokes out there smoking. One in a large reclining chair, with his wisps of hair blowing in the breeze. He needed physical help with the act of smoking, so weak was he. Another fellow, tinged bright yellow from some doubtless horrible biliary tumour, wasted but with bright black eyes. He looked at me.
We say, “let ’em smoke, it’s all they have left”. It might be true. Perhaps with the pain and the nausea and mouth ulcers that is the only thing that is semi-pleasurable. I really hope they have other things to hold on to – precious memories of a life well lived, valuable time with family, loving words. I hope they enjoy their food – all the food they can eat, plus a wine chaser, if they tolerate it. We do not begrudge Pall care patients pleasures, for their time on this earth will be short.
I realised something – there are plenty of other hospital patients – a few I have looked after spring to mind – for whom their sole enjoyment is smoking. Something that may shuffle them into the pall care ward (hopefully after a good innings) where their pleasure is legitimised.
Their lack of joy is palpable – the fear, the loneliness, the vulnerability. They have a small child aura about them. Small acts of kindness or understanding, without any sense of “you bought it all on yourself”, that’s what they need.