The Quitting

Each cigarette is my last. I had my last last cigarette about 1 week ago.

For me smoking has always been associated with certain activities. Reading, writing and watching television, or simply being at home for prolonged periods of time, are my major associations with smoking. Stress, in general, has also been an important trigger for me. So each time I have tried to quit in the past, I have tried to avoid those activities and situations. As a result, I would usually try to quit during a quiet period of my life, when things aren't too stressful, when I don't have any papers to write or books to read, when the weather is nice and I don't feel so homebound. Inevitably though, within a relatively short period of time I would have to write a paper, give a presentation, study for an exam, or simply stay at home because the weather is crappy.

This time I am going to try something different. I am going to try to quit at the worst time possible (the holidays), during one of the most stressful times (in transition at work), during one of the coldest periods of the year (below freezing for the past 2 weeks), and I am going to do it with the aid of one of the activities which I have most strongly associated with smoking (writing). I've pretty much tried everything else, so I may as well give this a shot.

7 days and counting.

The Smoking

There's no denying it now. I am absolutely, unequivocally addicted to smoking. I find myself smoking even though: It makes me nauseous. It browns my teeth. It wrinkles my skin. It irritates my eyes and warps my cornea. It makes my breath rancid. It causes my respiratory glands to go into overdrive and secrete copious amounts of mucus. It paralyzes my respiratory cilia, preventing the mucus from being cleared, allowing it to collect in my throat where bacteria fester. The mucus becomes thick, turns white, yellow, sometimes green, is unceremoniously coughed up in the morning in heaving, embarrasingly loud whooping conniptions which my next door neighbor can hear. Out plops a gigantic wet, half-solid snot from my mouth onto the plastic bowl of my bathroom sink where it sticks. It refuses to be washed away by the running water. Only with a vigorous swipe of toilet tissue which is then wadded into the trash can the ghastly mucus be removed from my sight.

But even these obscene events are not enough to scare me away from inhaling another nefarious whiff of that seemingly innocuous white smoke filled with black tar toxins. What scares me more are the events that I can't see but that I know, through my medical training, are occurring. The toxins are slowly accumulating in my cells, binding my DNA at random sites, rudely inserting themselves between my nucleotides where they don't belong, throwing a wrench into the carefully orchestrated processes which aeons of evolution have almost perfected, causing bizarre mutations, shutting off good genes, turning on bad genes, transforming my respiratory epithelial cells into microscopic monstrosities, multinucleated, hyperchromatic, pleomorphic squamous and glandular cells with unchecked mitotic potential. These rebel cells are many times worse than bacteria, because they are one of us, they are traitors, trained by us, equipped by us, aware of our defenses and weaknesses. They use our own enzymes to dissolve our structural matrix, infiltrating ever deeper into unsuspecting tissues where they enter the bloodstream, hitch a ride to vital organs and cause havoc that will inevitably lead to death.

The Beginning

My 12 year long smoking story begins sometime at the end of my first year of college. During my first-year of college, I lived on the ground floor of a dorm where smokers outnumbered non-smokers. But throughout that year I remained a non-smoker. I was never one to follow the crowd and succumb to peer pressure. Both my parents had smoked so living around people who smoked was nothing new to me. I also had more than enough diversions during that first year of college and didn't need to add smoking to the list. But after that year ended, I spent the summer on campus taking a light-load of summer classes. I found a small sublet near campus and moved into my first apartment. The normally frenetic campus slid into a deep hibernation, and my mind became restless. I needed something to do with the seemingly endless hours that passed each day between waking and sleeping. The oppressive Midwest summer humidity drove me into the air-conditioned library where I read Dostoevsky's Brothers Karamazov in 3 days.

By the middle of my summer semester I was half-crazy with boredom and isolation. Then somehow, a thought crept into my mind - I wondered what it would be like to be a smoker. I wondered what it would be like to hold a cigarette to my mouth and inhale the white smoke deep into my lungs. But moreso, I wondered what it would feel like to be addicted to something. What would it be like to feel that I have to have something? I thought that I had never had that feeling before. I thought that it would be a character-building experiment to consciously develop an addiction and then beat it. Looking back it seems like such a silly and naive reason to start smoking. If only I could have told myself what I now know - that the feeling of addiction is nothing more than the feeling of want. There is nothing exotic, romantic, or tragic about addiction. The feeling of wanting a cigarette is no more than the feeling of wanting a drink when you are thirsty, of wanting a Big Mac when you drive by a McDonalds, or wanting an IPod when you walk by the Apple Store in the Mall.

And so with that ridiculous romantic notion of addiction in my mind, I bought my first pack of cigarettes and smoked my first cigarette in the seclusion of my summer sublet apartment. I think I had one cigarette and threw the rest of the pack away. But still, I had crossed that threshold between smoker and non-smoker - I had touched my barefoot in the water and convinced myself that the water wasn't all that uninviting, and it wouldn't be long before I would be swimming laps in the tar-stained cesspool of nicotine addiciton.

It would be several months before I picked up another cigarette. I believe it was winter semester finals. This time there was no need for over-rationalization because I had already crossed the threshold the previous summer. I had already punctured the membrane and my will-power to remain a non-smoker had been slowly leaking out ever since. This time, the stress of finals was the ostensible reason for picking up a pack of cigarettes. I'm pretty sure I smoked the entire pack this second time. At first, I would smoke a cigarette as a counterpoint between intense studying or writing sessions. Soon, I found myself smoking while studying and then I was smoking while getting myself into the mood to study. Pretty soon I was smoking after meals, while watching television, while surfing the internet (or "gophernet", or "ftpnet", or whatever it was called back then). During my heaviest smoking periods, I was smoking about a pack every 2 days. Curiously, I rarely ever smoked in public. For me, smoking was associated mostly with studying, not socializing as I know it is for many others. So I smoked and studied my way through 3 more years of college, 4 years of medical school, and 4 years of residency.

During medical school and residency, the irony of being a smoker did not sway me from my habit though I often made failed attempts to quit. I have tried and failed the gum, the patch, the cold-turkey, and the self-help books. I have not gone so far as to try medications or hypnosis, though lately, I think my smoking is much more closely intertwined with my psychosocial state than I had previously imagined, and that if I am ever to truly quit I will have to completely change my mindset about everything - a total reboot. The longest period I have been smoke-free in the past 12 years has been about 8 weeks. Throughout my smoking history, my habit has pretty much been a secret. None of my co-workers have known that I smoked. Only my closest friends know that I smoke.