Tongue Depressors and Depressing Tongues

Over the recent month of Family Medicine, quite a bit has been made of the need for us to have conversations with our patients concerning their diet and tobacco smoking habits. As a Minnesotan, I was shall-we-say less exposed to the ailments of smokers than most. If I am not mistaken, they have banned the activity in public indoor spaces and pushed most cigarette sales into the tiny, poorly-lit part of gas stations. Down here in the south however – It’s pretty pervasive, as are its effects.

They teach us not to react to the amount patients smoke, not to speak condescendingly, or remain overly fixated on the effect it has on their children. A conversation with a state representative revealed that libertarianism runs so deep in the south that they believe no law should exist that bans families from smoking in the car with confined kids. As you can imagine, I was crushed to examine the mouths of a couple kids in this rural clinic to see that they’d had some pretty extensive dental decay, multiple extractions, and visible tar on their tongues.

It’s rough out here in rural America. Even rougher if your parents decide that your lungs aren’t worth the pain of breaking away from an addiction.

The flipside. I had a mother tell me that she quit smoking (Like a G.) As soon as she received a positive pregnancy test.
Boom – Just like that. A doctor told her that smoking increased the chances of a premature pregnancy…and she tossed the habit like a dirty vacuum bag.

Her kid looks like it. Happy, energized, and maybe just a little too curious about my examination of his ears. We discussed the teenage mutant ninja turtles (donatello is our shared favorite), and as I examined his oral cavity with the tongue depressor the poor guy burped, gurgled a bit, and threw up…

I’ve never laughed harder. Hearing that his mom quit smoking before his birth made everything that followed look, sound, and smell wonderful. He was a great sport about it too…and seemed awfully concerned about my white coat. There was no need, I dodged that flying fluid like Neo in the Matrix.

Medical education is crazy. In one day you can see a best and worst case scenario and experience helplessness while realizing your power all in an hour.

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