Thread by @TheRealDoctorT

TW: pet animal death.

My last patient of the day sits across from me in the exam room.

A hulking tree trunk of a man, his arms are folded across his massive chest and he has his usual irritated look.

He leans back in his chair.

We begin the rituals of the office visit. 1/

I follow him for chronic kidney disease, but the story of our interactions could be encapsulated in one issue; smoking.

He lost weight, like I requested. He gave up his heavy soda intake and now drinks water, like I requested.

But the smoking is a bridge too far. 2/

Some patients get angry when I talk about smoking cessation. They tell me that no matter what I say, they won’t quit it. And they want me to QUIT talking about it.

But I’m not going to quit if they won’t.

I think that’s only fair.

Yet you always have to dig a little... 3/

The man sitting before me is physically imposing, rippling with muscle. But he’s a gentle giant.

He’s a biker, so he can ride with a group against child abuse.

I discover that he didn’t start smoking until his pet dog died. He lives alone now.

Our stories define us. 4/

Taking away his smoking is probably taking away something more than just cigarettes.

A coping mechanism.

I ask him for the first time about his dog, and the floodgates open. The usually impassive face softens and he becomes almost childlike in his enthusiasm to show photos. 5/

He shows me the photo taken of him cradling her the day she was taken to be euthanized. I look up at him and see his eyes filled with tears.

And suddenly I understand, clearly. The quiet anger, the folded arms, the smoking, all of it.

We grieve in so many different ways. 6/

I don’t talk to him about smoking anymore after that.

Instead, every time I see him in clinic, I let him talk, and I look at old photos of him and his dog, Lucy. The only friend he’s ever had who never judged him.

What intensely lonely lives some of us live.

So many of us. 7/

One day, during another follow-up visit, I make the suggestion of perhaps getting another dog.

Not to replace Lucy, no one could ever replace her, but just to have another furry friend to provide non-judgmental love.

At first his silence makes me think I’ve overstepped. 8/

But then he exhales in a long shuddering breath, and admits that he has thought about it...

At his next office visit six months later, I notice something immediately.

He doesn’t reek of cigarette smoke anymore. 9/

He shows me photos of his new buddy, named Tesla, because he can’t afford the car but now he can still say he owns a Tesla and impress the ladies.

I groan, but can’t help but laugh at his newfound (cheesy) sense of humor.

I make a mental note to name my future dog “Castle.” 10/

As I listen to his heart, I notice that the bulge in his shirt pocket isn’t a pack of cigarettes, it’s a box of Tic-Tacs.

We go over his kidney function, blood pressure, anemia, vitamin D, and make plans for his next follow-up.

As he gets up to leave, he asks me a question. 11/

“Doc, why did you stop asking about the smoking?”

“Because I know you quit.”

He grins. “Maybe I just washed my clothes real good.”

Considering this, I sigh.

He laughs, “Just messin’. Crap was getting too expensive anyways, I just bought a Tesla...”

I can’t help but laugh.

Thank you so much to everyone for the feedback and shared stories and kindness! I made a promise once that I would respond to every single comment. I intend to keep that promise but unfortunately my lunch break is over so it’s back to work for me. I’ll be back.

Thank you 🙏🏻❤️

The response is getting overwhelming. I am humbled. I just can’t respond to everyone, I’m sorry. I’ll keep trying.

Donate to a charity that matters to you. Be kind to each other, and definitely your pets. And save the planet, in ways small and large.

Thanks. You amaze me.