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ralph robert moore
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i get a colonoscopy
july 1, 2012
Every once in a while, Mary and I come up with a To Do list.
Each one lists the tasks we want to accomplish in the next few months.
Like most To Do lists, ours isn't for simple tasks. "Clean the house" never makes the list. That's part of day-to-day life.
Our list is for those chores that are usually one of a kind, or at least infrequent.
For example, here's the list we created this past March:
The items with an asterisk we've completed, and have had great satisfaction crossing off the list.
The original To Do list was printed. Like most such lists, additional items were added at the bottom, in blue ink:
In this edition of Lately, I want to focus on one of those penned-in items: Get colonoscopy.
Dentists take your blood pressure now when you go in for a visit, a practice that seems to have started about five years ago. The first time I had my blood pressure measured by a dentist, it was 120/80. A perfect reading. But since then, it's steadily crept up. Just a few months ago, in April, it was at 164/103. That's kind of high.
I don't have a doctor. In the forty years I've been an adult I've never been sick, other than the occasional cold or flu, so I never needed one. I thought about going to one of those doc-in-a-box places you find on street corners to get a prescription for my high blood pressure, but then Mary suggested, Why not just go to her doctor?
After so many years of accompanying Mary on her visits, it was weird for me to be the patient. I explained ahead of time I didn't want a full physical-Just a check of my blood pressure, heart, etc.
My pressure was high. The doctor prescribed Lisinopril-HCTZ 10-12.5 mg (which I've been taking over a month now, and which immediately got my heart pressure down to the 120/80 range again.) Because high blood pressure can damage the body's organs, she also did a urinalysis. My kidneys were fine. No damage. I was given an EKG, to check my heart, and that also came back showing no problems. She listened to my lungs. Music to her ears.
Finally, she asked if I would be willing, because of my age, to get a colonoscopy.
Now, I don't know about you (though I suspect in this instance I do), but the last thing in the world I wanted was a colonoscopy. I haven't been naked in front of anyone but Mary since the late nineteen-seventies, but now I'm going to get naked for a bunch of strangers, while one of them runs a garden hose up my ass? It sounded like the horrors of a dentist visit, times one thousand.
The doctor and I compromised. I'd take an occult blood test. The nurse gave me a kit to bring home with me. Once I had my sample, I'd drop it off at their office, they'd send the sample out for testing, and we'd know if there was a problem. (Incidentally, although this column is about a colonoscopy, I'm going to be careful to not get too graphic. Let's face it, it's an unpleasant subject. I promise you I won't go into too much specific detail.)
The original plan was for me to obtain the sample and drop it off at their office in a month, during my follow-up visit to see how the blood pressure medicine was working. But the Friday after my initial visit, I woke up with a really uneasy feeling about the occult blood test. A fear that the test would find I had intestinal cancer, or something worse (assuming there is something worse.) I don't know why I suddenly got so worried, but I did. So I decided to do the sampling the following Monday, and drop it off then. Which I did. I figured, if it's bad news, I want to know as soon as possible, to take steps to fix things.
The next day, the nurse called me with the results (usually, they just email you.) There was in fact occult blood present (occult blood, by the way, in this context means blood in the stool that can't be seen with the naked eye.)
I needed to get a colonoscopy to determine what was causing the presence of blood.
As long time readers of these Latelys know, I'm Mary's caregiver. Mary suffered a severe stroke ten years ago. Although she's much better now than she was immediately after the stroke, she still suffers from pronounced aphasia (her speech center was damaged, to where it's very difficult for her to understand speech, or to communicate.) As her caregiver, I have a responsibility to make sure I stay in good health, to take care of her. So I agreed to set up an appointment for a colonoscopy.
The nurse called back in about a week with the name of the gastroenterologist, and the appointment time. I of course immediately went on the Internet, to find out more about him. One site had a picture. A bit sloppy-looking, blonde hair flopped across his forehead. Not too reassuring. I searched some more. He had a minimal number of credentials. His patients (those that had bothered to post their scores) rated him only one or two stars. One patient rated him half a star, and another, zero stars. The patients reported that his diagnosis had been wrong fifty percent of the time.
So I started searching for other gastroenterologists in our area. Found one that looked perfect. Grew up in India, moved to America at an early age. Dreamy credentials. Sat on a lot of boards. Citations showed he had advanced in his profession over the decades.
I called the doctor's office back. They were gracious about switching me to the new gastroenterologist.
So, what is it like to get a colonoscopy?
My appointment was for a Wednesday. The procedure was scheduled to be performed at one o'clock, but I needed to get there by noon to complete some paperwork, show my driver's license and insurance card, etc.
The week prior to the procedure, I dropped off the forms I had been sent at the gastroenterologist's office (he has an office for consultations, follow-up visits, etc. and then a separate clinic located a few miles away where the colonoscopies are performed.) After I dropped off the forms, the receptionist asked me what pharmacy I used, and called in the medications I would need to pick up prior to my procedure.
Since we were this close to the clinic, we decided to drive over, to check it out. It was located in a shopping mall that was virtually deserted. Lots of cars outside the clinic's entrance, but the rest of the parking lot, big as a lake, was carless, store after store of blank windows; in this huge blank expanse one shopping cart lying on its side a hundred yards away like it had been shot and left for dead.
Because I'd be receiving general anesthesia, Mary would have to drive me home after the procedure. She's maintained her driver's license but hasn't driven in years, so in that empty parking lot I turned over the car to her, to drive us back home. She did fine.
We picked up the medicines I'd need.
The first prescription was for two tiny pills I'd take in the early afternoon the day before my colonoscopy. Each was just a little larger than a pin head. I was pleasantly surprised. I thought they'd be as big as horse pills. For the second prescription, the woman at the pharmacy lifted a huge, fucking jug up onto the counter. This is the laxative you have to drink the night before you have your procedure. It's called, GoLightly. Someone has a sense of humor about this. The jug holds four liters.
While we were at the supermarket (where the pharmacy is located), we bought some supplies. From Monday on prior to the procedure, I wouldn't be able to eat solid food, so I loaded up on chicken broth and beef broth. And some lime popsicles. You can have clear fluids, and black coffee. No sugar, no milk. You can't have anything that's red or purple (because it might be mistaken, during the procedure, for blood.) So no grape juice, red wine, tomato juice. You can have orange juice, but it has to be without any pulp.
Sunday, we ate like we always did. We wound up having leftover pizza and subs from Sam's, a local restaurant.
I love to eat. Even while we were in the store buying the broths, and even though I had had a substantial breakfast just prior, and would still be eating regularly for the next few days, the fact I would be on a no solid food fast beginning that Monday made my stomach rumble.
Monday morning, I went upstairs to my study, dinked around on the Internet for a while, smoking (you can still smoke prior to the procedure.) I came down, made coffee. Fed the cats.
When Mary woke, we had some black coffee (Mary was so sweet-she wanted to go on the fast with me. I had to convince her she had to eat something, to keep her strength up, to drive us home after the colonoscopy.)
Usually for lunch on Monday we'd have a sandwich, maybe a pastrami on rye, or chicken salad, or a BLT. I ended up with a can of chicken broth. Mary had canned soup, with some Saltines. My broth was actually pretty good. Late morning, we both had a lime popsicle. In the early evening we went upstairs to work on our projects as we normally do. I didn't really feel that hungry. I had a few vodkas as I normally do. Around seven, we went back downstairs. More chicken broth for me; another soup for Mary.
Tuesday morning, the day before the procedure, black coffee. We watched some recorded TV shows. At two o'clock, I took my two tiny pills. Washed it down with ice water. Mary reminded me to keep drinking water (you have to stop drinking water-or anything else, other than the laxative-after five o'clock. You can't drink water again (or anything else, other than the laxative) until after the colonoscopy the next day.)
I was thinking of having a vodka before the five o'clock cut-off, but decided not to, since alcohol is a blood thinner (I take an 81 mg dose of aspirin each day, like a lot of people do, to keep my blood thin, but I had to stop that, per the pre-op instructions, after Monday.)
At seven o'clock in the evening, you start drinking the GoLightly laxative. There's a packet inside the huge plastic jug. The packet contains the actual laxative. Early that morning, you open the packet and dump it in the bottom of the jug. There's a second packet, which contains an artificial lemon flavor. It's up to you whether or not you want to add that to the jug. I decided to. What the hell. Once both powders are in the bottom of the jug, you fill the jug with tap water, up to its fill line, cap the jug and shake it to get everything mixed together, then put it in the fridge. I had to move all these foods I would really like to eat in order to fit it on the top shelf. You put the filled jug in the fridge early in the morning so it has time to chill. The instructions say it tastes better when it's cold.
So it's seven o'clock at night, I have to start drinking 4 liters of this laxative, and keep on drinking it, until all the contents are gone. That's over one gallon of liquid. The instructions say to drink 8 ounces every 15 minutes and don't stop until you're finished.
Outside of the obvious nervousness you feel about getting a colonoscopy, drinking that much liquid within such a short time frame was the hardest thing about the whole experience. To be honest, early in that process, after about the first hour or so, when the level in the jug didn't appear to have gone down much at all, despite me gulping it almost non-stop, I really started to wonder if I'd be able to drink such a large quantity of water in one evening. But I did. After a while, because I would get discouraged each time I opened the fridge to refill my glass, and saw how much was left, I asked Mary if she would refill the glass herself while I stayed in bed. That way I could at least imagine the level was lowering rapidly.
While I kept drinking all this liquid, we watched old episodes of the American version of The Office on DVD. Mostly seasons 2 and 3. It was the perfect distraction. Really funny, with the added poignancy of the Jim and Pam relationship.
Around eleven o'clock or so I finished my last glass.
It would be remiss of me to not at least touch on how the laxative affected me, so this paragraph is going to be slightly graphic. If you prefer, simply skip down to the next paragraph. I'm including details here because I assume some people are going to be reading this who have never had a colonoscopy before, and want a blow-by-blow description of the whole process. Anyway, if you're still here, the two tiny pills didn't really seem to affect me. I felt a slight rumbling down below, but nothing major. But after I had the second or third glass of Go Lightly, I did have to use the toilet. And visiting the toilet every ten or fifteen minutes continued the rest of the evening. After the first or second visit, everything was liquid. Water. The more I returned to the toilet, the lighter in color the water became. You are, essentially, purging yourself. That's the whole point to the fasting and laxatives.
I take a pill for high blood pressure, so the morning of the procedure I swallowed my blood pressure pill, small sip of water.
We had to be there at noon, the drive would take less than a half hour, so at ten o'clock I showered. My hair is long now, past my shoulders. Although I usually wear it straight down, I asked Mary to put it up into a ponytail for me, since I figured that would be the easiest way to keep it out of my eyes.
We left for the clinic at eleven-thirty. I drove. I was scared. But putting on a good face.
My greatest fear of course was that the beginning of my death was about to start, couldn't be braked, and the world would go on without me, people crossing streets, watching food rotate in their microwaves. And very few would care I was no longer there.
One thing about a good gastroenterologist clinic is that all the staff are extremely cheerful. They know you're frightened and feeling alone. With their smiles, the inflections in their voice, the sideways tilt of their heads, they try to mitigate that fear. To persuade you that what you're doing is pretty close to routine.
Once we went through the outside glass doors into the clinic, we were in a wide room with a lot of chairs, most of them unoccupied, a counter at the front, a bathroom to the left, the door you disappear through to the right. A sign on the back wall read, Out of Respect for our Patients Who are Fasting, Please Do Not Bring Any Food or Beverages into the Waiting Room.
I went to the front counter, identified myself. I had to sign some forms, mostly about my insurance. I have Blue Cross/Blue Shield of Texas. The procedure with biopsy cost $3,202.00. Because I have Blue Cross, and was therefore eligible for the PPO discount, which I had inquired about, the total cost of the procedure was reduced to $749.40. I saved nearly $2,500 by having insurance. (I'm retired but not yet eligible for Medicare, so I have to pay for my own insurance, which costs about $2,600 a year. My yearly deductible is $10,000, so Blue Cross didn't pay a dime in benefits, but by me having Blue Cross my own cost for the colonoscopy was reduced by an amount about equal to a year's worth of premiums. A lot of times it pays to have medical insurance, even if you have a high deductible, because of the PPO savings. Essentially, this year I got a year's worth of medical coverage for free.)
I wrote a check for the $749.40.
Which took all of five minutes. So they really shouldn't say, Be sure to get to the clinic an hour before your appointment time. They should say, get to the clinic five minutes before your appointment time.
Mary and I sat in one of the rows of chairs. We were both nervous. Mary and I held hands off and on. She flipped through her supermarket tabloids; I tried to focus on a Sudoku puzzle.
Time passed, slowly.
A little before one o'clock, the door on the right opened. The female nurse called out, "Ralph Moore?"
I stood up, kissed Mary. At the door, I turned around to wave at her wave.
Once inside the back of the clinic, the nurse and I turned to the left. Sat in a small room. She went through my paperwork. "We're running really late today, so your colonoscopy probably won't be for another two or so hours. There are three people ahead of you."
Wow. Here I was thinking I was five minutes away from starting to get this thing over with, but in fact I'd have to wait at least another couple of hours.
"Was there an emergency?"
She shook her head. "Some of the earlier colonoscopies just required more time."
Since I'd be back here far longer than Mary and I expected, I asked if I could go back out to the waiting room to let her know the wait would be an extra two or so hours, so she wouldn't worry. We kissed and hugged again, then I returned to the back, to the small interview room.
After the nurse verified when I last ate, if I had any allergies, etc., we walked to the deep end of the area. I could see that three of the curtained cubicles we passed had people in bed. At the end of that wide corridor, I was led to the right into what would be my cubicle. A bed on wheels took up most of the small space.
"Okay Ralph, remove all your clothes except your socks, put all your clothes, including your shoes, into this plastic bag. Do you have any removable teeth?" I shook my head. "Any jewelry?" I shook my head. She pointed to my left hand. "But you can keep your wedding ring on. After you've removed all your clothes, put this gown on, so the open side is in back, get in bed and pull this blanket up over you to your shoulders."
She drew the white curtain across the front of the cubicle.
In that semi-privacy (I could hear another nurse talking to the patient in the cubicle directly across from me), I took off my shoes and all my clothes, put them in the bag. Put my arms through the thin cotton gown, the back of the gown open. Little bit like voluntarily putting on a straitjacket. Pulled the blanket up round me, to my shoulders.
A couple of minutes passed.
"Okay to come in?"
She had a second blanket with her, one that had been warmed. Laid it across the first blanket. The warmth actually felt really good. Took my blood pressure. Checked the oxygen level in my blood. Had me sit up, take a few deep breaths, cough a few times, then checked my oxygen level again.
While we talked about cats, the nurse in the cubicle directly across cheerfully joining in, the bee sting of a syringe head getting pushed into the top of my right hand. Taped in place.
"Okay!" She handed me some magazines to read while I waited. A National Geographic, two issues of Texas Monthly. "I'm sorry your procedure has been delayed."
"Oh, that's fine." After she drew the curtain across the front closed again, I flipped through the three magazines, verifying there was absolutely nothing whatsoever in them I wanted to read. I started to read them anyway.
A couple of hours passed. Slowly.
Every once in a long while I'd hear a curtain get pulled open somewhere, a man asking the patient inside a few quiet questions. I took it this was the doctor.
Finally it was my turn.
The gastroenterologist was a short, slight, dark-skinned man about sixty. Gray in his black hair. He smiled at me as he quickly read my forms. Asked about my personal history, family history.
"Okay then, Mr. Moore. I'll see you inside."
He meant the procedure room, of course, but I had to smile at the unintended humor.
The nurse standing beside him asked if I wanted her to let Mary know I was about to start the procedure. I told her yes. "Tell her, I love her." She tilted her head. "Would you like to see her before you go in?" Absolutely. The nurse vanished, reappeared with Mary. We kissed, clutched each other's hands.
After Mary went back to the waiting room, waving, the nurse grabbed the base of my bed, rolled me out into the bright aisle. Came around to the back of my bed, so I could see where we were headed, wheeling me down the aisle, the way I came in two hours before.
Up ahead, to the right of the door to the waiting room, and I hadn't noticed it when I first entered, turning left with the nurse, two hours prior, was a large, dimly-lit room. I could just make out a few figures standing inside in the semi-darkness.
I was actually calm at this point. I was finally getting the procedure, which meant the time when Mary and I could leave, and go back to our home, was drawing near.
Once inside the darkness, a young black man smiled at me. "How's it going, man?"
It turned out he was my anesthesiologist. He seemed like he knew what he was doing. I relaxed some more.
He placed some sticky sensors connected to wires on my chest and just below my ribcage.
A nurse asked me to turn onto my left side, and move towards the left side rail of the bed.
There was a monitor set up a bit away from the right side of the bed. Looking at it, I realized it was showing a bare ass. I shifted slightly. The ass in the monitor shifted.
The anesthesiologist screwed the end of a tube into the rear of the syringe head stuck into the back of my hand.
I tried to think of something to say. "Are those my vital signs?"
He looked at the smaller monitor near my face, the different bright-colored numbers and flowing lines. "It sure is. This is your blood pressure, and your heart rate. This one here…" I don't remember what the rest were.
"Okay, I'm going to start the anesthesia." He looked down at me. Smiled. "Have a nice trip."
I could smell something at that point, which I guess was the anesthesia entering my body. It wasn't an unpleasant smell.
A few seconds passed.
I was still wide awake.
A worry that the anesthesia wouldn't take.
I glanced back at the vital signs monitor. (There was nothing else to look at.) My blood pressure was remarkably normal.
I felt, like, inky fingers flowing in from either side of my head.
Absolute blackness in front of me. Just long enough for me to be aware of it.
A nurse, a nurse I hadn't seen before, had her face in mine, asking how I was.
I got up on one elbow. I was in a different room, much larger. Brightly lit.
"Is it over?"
"Yeah! You're all done. I'm going to bring your wife in here, we'll let you rest a bit, then you're good to go."
"Did they find anything?"
"Doctor found a few polyps, which he removed."
"Is there any cancer?"
"We have to send the polyps out to the lab for biopsy, but he said they're not cancerous. He's done so many colonoscopies, he can tell. He'll be out here in a few minutes, once your wife is here, to talk to you. You can ask him any questions you want." She handed me a sheet of paper that had the results of my procedure, the number of polyps found, a drawing that detailed with blue dots where they had been located in my intestines, and small color pictures of each polyp.
(Later I told Mary, "I'm going to keep the pictures of the polyps in my wallet. Next time someone asks us, Wanna see pictures of my kids? I'm gonna go, Sure! Whip out my wallet. Wanna see pictures of my polyps?")
Mary came in, happy and nervous and beautiful, clutching the black satchel filed with the tabloids we bought. We kissed, talked. She handed me our plastic jug of water, first water I had had in almost a day.
The doctor showed up, smiling. "How are you feeling?"
He said basically what the nurse had said. It was his professional opinion the polyps he removed were not cancerous. Once they had the biopsy results, in about a week, his office would call me.
The nurse drew a curtain around my bed so I could dress, pulling my clothes and shoes out the plastic bag in which I had put them, a few hours before. Mary helped my clumsiness as I got out of my hospital gown, into my clothes.
After I was dressed, Mary and the nurse got me to my feet.
The three of us walked slowly to the front door, out into the bright day. Mary had moved the car to right in front of the exit. They both assisted me as I got in on the passenger side. Mary stretched my seatbelt across my chest, buckled it below my left hip. Shut the door. Went around to the driver's side.
It was over. My colonoscopy was no longer looming in the future. It was receding in the past.
As Mary started the engine, I found my pack of cigarettes, lit one.
Everything from that moment forward should have been happy, but unfortunately, it wasn't.
I felt fine most of the way home. Once we were about a mile from our home, I lit a second cigarette.
I started seeing bright clusters around me. Could barely make out the dashboard, because of all the pretty lights. The combination of not eating for three days, the after effect of the anesthesia, the sudden infusion of so much tobacco, was making me light-headed, although I was too dizzy at that point to realize what was happening. I just felt confused.
We pulled up into our driveway. Mary got out, rattled up the garage door. Drove our car into the garage. Braked. Turned off the engine. Happy look on her face.
I opened my passenger side door. Stood up too quickly out of the car.
Next thing I was lying on my side on the hard garage floor. I had passed out on my feet.
As Mary was racing around the nose of the car towards me, I stood up again, confused.
This time when I passed out I didn't land on my side. I landed on my face.
Recreating what had happened afterwards based on my injuries, this second time I passed out on my feet I evidently fell onto my right knee, then pitched forward, the front of my face smacking down on the concrete floor.
Mary had her hands under my arms, lifting my face from the floor.
I reached my fingers up to my face. Lowered them. Lots of bright red blood.
My forehead, my nose, my mouth, the back of my neck hurt like hell.
I got into a kneeling position on the garage floor. Felt the sides of my nose with my two forefingers. Incredibly, my nose was not broken, even though blood was pouring out. Felt my upper lip. Really hurt. Ran my tongue under my front teeth. All still there. Reached inside, with dread, trying to waggle. They seemed secure.
Spit into my palm. Clear, no blood.
Mary holding onto me, I crawled on my hands and knees like a large dog from the garage through the utility room to the kitchen, then from the kitchen to our bedroom. Lay down in bed.
The cats barely lifted their whiskered faces from their naps to witness this extraordinary sight. Thanks, guys.
After a few minutes, I decided to go into our master bathroom, to the mirror over the double sinks, to survey the damage. Mary held onto me the whole way.
My nose was drenched in bright blood, swollen on both sides. My upper lip had split open. A red ding on my forehead. Still, my teeth seemed fine. I started getting a horrible pain in the back of my neck, I guess from the whiplash of my head hitting the floor, being pushed back. Did I break my neck? But after the pain rose to a crescendo, forcing me to bend forward, back teeth gritted, it subsided. After another minute, the pain winged away.
Mary helped me back to bed. Picking up the remote, I turned on the TV. Whatever else you want to say about it, TV does help make things seem normal again.
I realized I was hungry.
Before my colonoscopy, I kept thinking about what my first food would be afterwards. A way of projecting myself past the event I dreaded. I didn't want to eat too big a meal after nearly three days of fasting, so I thought small. A few weeks prior, before I knew I'd need a colonoscopy, while we were doing our regular monthly food shopping, I had, on a whim, picked up two white-wrapped cans of Underwood devilled ham spread, added them to our cart. I used to love devilled ham sandwiches as a kid, but probably hadn't eaten one in over a decade.
The twin cans were still in our pantry. I asked Mary if she'd please make me a sandwich. White bread, a dense-grained brand called Grandma's Bread, both slices slathered with Grey Poupon mustard, an entire can's contents of devilled ham for filling.
I lay in bed, scab forming on my nose, split upper lip hurting, while she went out into the kitchen. A minute or so later, me watching one of the many daytime small claims court shows on TV, I don't remember which, like all of them, it either had a white judge with a black bailiff, or a black judge with a white bailiff, Mary came back in with a small white plate, my sandwich sliced in half on the diagonal, a wet green pickle spear on the plate's rim.
I ate it gingerly.
After three days of no solid food, after having the colonoscopy behind me, finding out I had no cancer, after surviving a fall that should have meant calling 911 to have an ambulance's revolving red noise take me to the emergency room of a hospital, but instead here I was, warm and safe in our home, our bed, surrounded by our indifferent cats, can you begin to imagine how good that sandwich tasted?
It is amazing to me that I sustained such a severe blunt force trauma as falling face-first onto hard concrete, the equivalent of being smacked in the face with a baseball bat, without suffering any permanent damage. God was watching over me (although apparently hinting I should stop smoking.)
The scab on my nose grew, glossy and dark, until I looked like Rudolph, but then one morning, a week or so later, fell off. My spilt lip healed on its own. My teeth are as strong and unwaggable as ever. My neck is fine.
The Monday after my procedure, Mary and I were in bed, clowning around about this and that, watching TV, I think it was one of the Bravo reality shows we had recorded, when the phone rang. It was the gastroenterologist's office.
The results of the biopsy had come in. It was official. All the polyps were benign. No cancer. The office suggested I get a follow-up colonoscopy in three years, which is standard (polyps grow at a slow rate.)
For those of you on this page who are contemplating or about to undergo a colonoscopy, here's some reassuring information: The procedure, in most cases, only takes half an hour. Which is not bad at all. Less than a dentist appointment. The scope is about the circumference of a finger. The length is between six and seven feet. You don't experience any of the procedure, because you're under IV sedation. One minute, you're talking to the anesthesiologist, the next minute, you're waking up to a nurse in the recovery room. Zero pain. Because they blow air into your intestines before they start the probe, to make the procedure easier to perform, you'll feel some gas pains in your abdomen on your way home. You get rid of the gas the same way mankind has gotten rid of gas for over a million years. But please, please, please, please, please, if you smoke, don't light up that first cigarette until you're home again, safe in bed.