DO YOU SMOKE?
They give you that little clipboard when you check in. A thing you can hold on your lap and work on in the waiting room, a few pages to fill out, a cheap ball point pen. You don’t want to spend a lot of time on it: the chairs are uncomfortable. If the doctor has never seen you before, or if it’s time for your regular old doc’s office to update their records, you get the long version of the patient’s questionnaire.
Lots of simple binaries:
“Have you ever been treated for anxiety or depression?” Yes or no?
“Are you concerned about your current weight?” Yes or no?
“Do you experience side effects from any medications you take?” Yes or no?
“Are your teeth or gums causing you any problems?” Yes or no?
Those kinds of questions can vary a bit in the way they are phrased, but there seems to be one question which never varies:
“Do you smoke?”
A simple yes or no: either you smoke or you don’t. It’s a terribly loaded question.
The thing implies an identity: If you smoke, then you are a smoker. You either are or you are not a smoker. If you are, then you enter into a category, and it’s a very important one in the eyes of modern medicine. Smoking is the first item on the list of things associated with the risks of heart disease, the nation’s greatest killer, as well as any number of cancers, especially lung cancer. If you are a smoker, then you exhibit a high-risk lifestyle; high blood pressure, heart attack, stroke, mayhem will follow. Chances are, your life expectancy will be short. Your health insurance company will surely want to know. Somewhere on an actuarial table in a very tall building, there is also a box to check, corresponding with the box you checked when you admitted to your doctor, “Yes, I smoke; yes I am a smoker.” The company now places you in the high-risk category; you’re in the red.
But the matter of identity does not end there.
If you are a smoker, then a series of instantaneous assumptions go with it. Everyone will make these assumptions. First and foremost: You smoke cigarettes. That means you habitually inhale tobacco smoke into your lungs. There is hardly any point in smoking cigarettes if you don’t inhale, as any middle-school miscreant can tell you. You teach yourself how to inhale; well, someone shows you, but then you have to condition yourself to fight the urge of a coughing fit every time you do it. It doesn’t take long. Soon you’re inhaling like a pro – you could be in a glamorous film in the 1940s – dragging that narrow stream of particulates and complex chemicals (more than 6,000 compounds in cigarette smoke!) into your lungs and blowing out long spears of fatally sexy white-gray exhaust. Make some rings too – they’re not that hard; all you need is still air around you, the air indoors is best for rings, and then the smoke collects in the room and you get to have your cigarette twice.
Cigarette tobacco has long been engineered for mildness of a kind that not only permits but demands inhalation of the smoke. That mildness is the key feature of the “delivery” when cigarettes are referred to as “a nicotine delivery system.” Because cigarettes are designed to be inhalable, not just any tobacco can go into them; most of the varieties of tobacco that compose cigars and pipe blends are not used in cigarettes. The things that came to be known, rightly, as “coffin nails” were designed, beginning late in the 19th century, to be a convenience – a quick and ready means of delivering nicotine in the short burst of a cigarette’s life. The fastest way to deliver the nicotine punch is through the lungs, those evolutionary wonders that drive oxygen into the blood. Smokers speak of the “taste” of a cigarette, but it’s not a matter of literal flavor in the way that food, or wine, or a glass of lemonade carries flavor, the gustatory sensation which begins in the nose and mouth. Cigarette smoke is nearly tasteless in that sense. “Flavor” in a cigarette is a feeling mostly in the lungs that satisfies the smoker’s desire for the comforting hit of nicotine. That’s the key, and so it was in the interest of cigarette manufacturers to develop strains of natural tobacco that produced an inhalable smoke. It had to be mild – far milder than the leaf used in cigars or most pipe tobaccos.
A variety known as brightleaf Virginia was what they came up with, and it has long dominated the blended contents of nearly all cigarettes, which, depending on the brand and the flavor effects being sought, might also include burley or oriental tobaccos. Then come the additives – 599 cigarette additives approved by the FDA. No such number goes into a single brand of cigarette, but nearly all of them contain substances to enhance flavor, aroma, combustibility, or other aspects of the smoking experience. Some additives are known to enhance the addictive properties. It’s quite insidious: the nicotine level of tobacco grown for cigarettes has dropped substantially over the years, something the manufacturers can trumpet while not mentioning that smokers compensate by puffing more often and more heavily on their fags while substances have been added to re-create the craving which higher levels of nicotine used to create.
A second assumption lurks behind the question, “Do you smoke?” If you are a smoker, then you must be an addict. Everyone knows, after all, that nicotine is among the most addictive substances in the world. Addicts need help quitting, everyone knows that too, so now you enter the needs-help-quitting category. One can only assume that you want to quit – no one in her right mind, after all, wants to continue smoking, knowing what we know today. It used to just be a “filthy habit,” meaning it made a mess of the furniture, and the dashboard, and your clothes, and the smell of your hair, and your fingertips – those disgusting yellow stains. Now it’s nothing as benign as being merely “filthy” – no one even says that anymore. Now it’s fatally dangerous, to yourself and others. You’re putting everyone around you at risk. Even if you don’t smoke in the presence of other people, subjecting them to secondhand toxins, you risk dropping dead, and so you are gambling with the well-being of your spouse, your children, your employees, your parishioners, everyone who depends on you. We don’t blame you anymore for not quitting; we pity you. Smokers are the new lepers. We’ll do anything to help.
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For those reasons and more, “Do you smoke?” is a question that gives me pause. I have had a lifelong relationship with tobacco, but I don’t know whether I am “a smoker” or not. As a kid who grew up in a non-smoking family, I somehow developed an inexplicable fascination with tobacco (see my essay, “The Tobacco Hunters,” posted on the “Writings” page in this website). As early as age 7 or 8, I was pilfering cigarettes from unguarded end tables in the homes of friends whose parents smoked. In grade school, I would look for uncrushed butts on streets and sidewalks, and either re-light them or pinch the remaining dregs of tobacco into a little cloth bag for later rolling. In college, I smoked regularly for a time, mostly hand-rolled cigarettes with a rich Virginia tobacco blended in England. (Three Castles was the brand; the Elizabethan-era script on the label made the first “s” look like an “f”: Three Caftles.)
For one summer and several Christmas breaks, I worked in a pipe and cigar shop in the mall nearest our home in Denver. I learned how to blend tobaccos, how to select a good cigar, how to break-in and care for fine briar-wood pipes. And yet . . . . I never became addicted to tobacco. I could stop smoking for years (25 years at one point), and never miss it; I could pick it up later, and smoke again for a time, and stop. That pattern persists today. I still enjoy an occasional cigar – I consume maybe three a year (the things have become so expensive, I could not possibly afford more); I kept some of my pipes from the mall-store days and maintain a small stash of fine, tinned tobacco, which ages much like wine. When the weather grows hot (around three months of the year), or cold (another three), I stop smoking entirely, as I will only light my pipe out on the porch. Smoking, to me, is a comfort, and both hot and cold weather create discomfort. In fact, hot weather can somehow ruin the taste of even the best pipe tobacco. Cold weather makes your teeth chatter on the pipestem. In seasons when I do smoke – the shoulder-seasons – I average around one bowlful of tobacco a week. Do the math: around two dozen pipes a year. I never inhale pipe- or cigar-smoke – it’s way too strong. I have not smoked a cigarette in more than 30 years.
Do you smoke?
Do I?