The Patient

It’s in the morning, a sunny good morning, it has been raining for a quite a few days. A young man entered the pharmacy and asked if we had electronic cigarettes, we didn’t have them and they were nowhere to be found in Kigali. He then asked what I can advise for smoking cessation.

It was my third day in the pharmacy doing my first ever internship. I have been, for those days, struggling to memorize all medicines, quickly locate them in shelves and being able to offer proper medicine information and patient counselling, the latter is a practice we rarely do or learn in class.

All other workers in the pharmacy were women. Being the only male, the gentleman felt more comfortable to discuss with me about ways to stop smoking. He must never had taken a look at my badge to see that I’m just an intern, it was so much confidence for me to deal with.

The young man said to have been smoking for more than six years and said to have tried several times to stop but always suffered with respiratory problems and addiction which made him fail. He was now decided by all means to end it up and he confidently told me it was crucial for his relationship. I didn’t have by then enough information on electronic cigarettes, smoking cessation processes and how long it would take. It was better to do it in a peer-to-peer approach instead of patient to health professional. His office was next door, in the same building with the pharmacy, so he had to come over quite often.

I went on taking some kind of his smoking history and asked him questions like when he feels the need to smoke, if it’s a very bad addiction (more than a pack a day), if it’s stress induced, so on and so forth. I discovered that he was more of a social smoker, depressive and stressed. I took time to talk with him and listen to what burdens he has. These discussions went on for several days, even out of the pharmacy when he used to come at the end of my shift and we had to take the bus together. We always had around a forty five minutes ride before he reached his bus stop while I had to go for few more.

The young man looked like the kind of guy you can define as a walking hangover. I missed the part of patient counselling on our first encounter where I had to go like: “Hello, I’m Israel, the pharmacist and you are?” And I never had a chance to hear anyone call him and later saved his phone number under ‘smoking guy’. His eyes were always red. The lines around his mouth were deepening that you could stick in mini matchsticks and they would hold. He looked like he had never slept since he turned twenty one. He looked 28 but you can tell he is much younger than that. He looked smashed and wasted. Except his smoking addiction, one can tell he cannot also control his drinking addiction.

With only two weeks of internship, it was practically impossible for me to follow up my patient’s, now friend, evolution. However, I did some research on how to quit smoking and I had to set up the best plan for him which involved to set a quit date, to tell his friends his plan to quit, to anticipate and plan for the challenges and then remove cigarettes and other tobacco products from his home and office. And to that, I found it really necessary for him to change friends and his environment. He was easily influenceable and I feared that his company would get him back into smoking. This was to be hard because there are no anonymous clubs for smokers and alcoholics in town or any youth group to help fellow youth out of such addictions.

I suggested him to use for a short time Nicotine patch or nicotine gum to manage his smoking and while decreasing doses over time, his cigarettes cravings would disappear. But it can be hard for a craving to disappear while taking nicotine products. I thought of a random idea which was that every time he is craving for cigarettes to play a game, temple run 2 was popular then. It personally helped me overcome some of my cravings. Because he was now my friend I had to find and suggest replacement for the time spent with his friends. I gave him four books of the Robert Langdon series by Daniel Brown, assuming they can be addictive. I advised him to read them in the evening after work and just ignore phone calls from his friends while reading, then get a library card if he can. I also suggested him to attend bi-weekly talks hosted by an institute in town to nourish his professional spirit and may be get inspiration on how to invest his money spent on alcohol and cigarettes. And finally interested him to just go to the nearby internet free center to spend his time surfing after work if he doesn’t want to be home early. I occupied his evenings hoping for him to get used to the new routine. My internship was over and I had to go back to school for exams.

Few weeks later, he sent me a message that he missed his quit date and was unable to follow the plan. I couldn’t do much for him on chat. I just told him to stick to the plan and accept the fact that he could miss three or four quit dates but he would eventually succeed. He must have been going through a lot of challenges and an increasing stress.

When I was back in town from a trip and had to check-in to the pharmacy and greet people there, I met my patient, or friend, in the corridor. He looked strong and healthy. He said to have quit smoking and now handle well his bottles. It didn’t take him much time to adjust everything in his life. In a funny way he told me that in all advises I gave, I didn’t say this sentence that a co-worker, a prolific ex-smoker, gave him: “it’s simple – just don’t smoke.”

There lie my passion for pharmacy, to be able to make a direct and personal caring commitment to the individual patient and acts in the patient’s best interest.

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