An Off-Site Consultation

An invitation to consult off-site is a pretty heady, ego-boosting experience, especially for a young physician early in his career. So, it was with optimism and eagerness that I pulled into the Southampton Hospital parking area, having driven out early one morning from Manhattan. Checking in with the supervising nurse on the patient’s floor — this was before high-tech intensive care units, coronary care units, critical care units — I was directed to a regular hospital room near the nurses’ station. The patient’s chart revealed a straightforward case of an uncomplicated heart attack (one can argue now whether there really is such a thing) in a middle-aged, orthodox Jewish man, whom everybody referred to simply as “Rabbi.” I reviewed the history of classic chest pain, the treatments he had been receiving, and the orders that had been written by his physician. A woman of indeterminate age, wrapped in an oversized shawl and with a sheitel on her head, sat outside the room, eyes down, disconsolate. Assuming she was Rabbi’s wife, and thinking I would speak with her after examining him, I entered his room — and stopped abruptly. Rabbi was enclosed in an old-fashioned oxygen tent, the kind that surrounds you like a plastic rain-cover on a baby stroller. He wore a skull-cap on his head, and had an extremely bushy black beard in the center of which a small, pinkish mouth held a brightly glowing cigarette. It only took an instant for the reality of the situation to sink in — an oxygen tent, pure oxygen flowing, a bearded man puffing avidly on a lighted cigarette. I turned heel and hurried back to the nurse. “Done so soon?” she asked. “Fastest consultation I’ve ever seen.” “The man is smoking in an oxygen tent,” I said. “I’m leaving and I advise you to run out with me because the whole place could blow up.” She sighed, clearly having seen it before, and chose the more responsible option of going into the room. “Rabbi,” I heard her say, “you know you’re not allowed to smoke. You’ll cause a fire, you’ll burn yourself, and it’s bad for your heart.” She came out of the room, shaking her head resignedly. “He keeps smoking,” she said. “We can’t stop him.” “Who gives him cigarettes?” The nurse pointed to the woman outside his room, who hadn’t moved at all. I went over to her, and as calmly but forcefully as I could, I said, “You can’t give him cigarettes. They will hurt him. He just had a heart attack. Smoking is terrible and it’s dangerous. And in an oxygen tent he can get burned and the whole hospital can blow up.” She nodded, she understood. “Why do you give him cigarettes?” I asked. “He tells me to,” she said. “But why do you listen to him when you know it’s so bad?” “He’s my husband,” she said quietly. “I cannot refuse anything he wants.” “Even if it kills him,” I said. She shrugged. “He’s my husband. I cannot refuse.” I turned to the nurse, shaking my head. I wrote a note in the chart, confirming the validity of the care Rabbi had been receiving, and added an underlined, capital-letter line, that said, “NO SMOKING!” like nobody else had tried and that would finally end it. Before I left, I ducked my head back into the room to wave good-bye to Rabbi. Leaning over him, and from the folds of her shawl, his wife was just extracting a cigarette. I now have a house in the Hamptons, and every time I drive by the wonderful Southampton Hospital I think of Rabbi and the day the old hospital was almost destroyed.