A Smoke-Free Story

Bar workers in Scotland reported a 33% reduction in respiratory symptoms just 2 short months after smoke-free legislation was enacted in that country, according to a study reported this week in the Journal of the American Medical Association. Objective measures of respiratory tract inflammation and pulmonary function were also significantly improved. (JAMA.2006;296:1742-1748.)

Here in New York City, we passed similar smoke-free legislation in 2003, making ours one of the toughest anti-smoking laws in the United States.

I like to think I had something to do with that…

She was 32 years old, married and head waiter in a swanky hotel bar where smoking was prevalent. So much so that it had become known among the workers there as “The Cigar Bar”. She wanted to get pregnant, but was afraid of exposing her fetus to such large amounts of second hand smoke.

“I need a letter from you to my boss saying that too much second hand smoke is bad for my baby, and that I should be transferred to a different restaurant in the hotel. He doesn’t believe me when I tell him this.”

Of course I wrote the letter. I also gave her a presciption for prenatal vitamins.

“Call me when you’re pregnant”, I said, smiling.

But when I saw her a year later, she still had not left the bar or started her family.

Her boss had agreed to transfer her from the hotel bar to the breakfast cafe. But with the transfer, her income would be cut almost in half ; breakfast cafes just don’t generate the kind of tips that bars do. Without the income, she could not save for the down payment for an apartment big enough to raise a family. So she stayed at the cigar bar, saving as much of her income as she could.

“I figure I need to tough it out there another year, then I can quit and get pregnant,” she explained.

“But you’ll be that much older,” I gently advised. Almost 35.”

“I know’” she said, her eyes filling with tears. “But what else can I do? I really need that income. And if you think I have it bad, it’s even worse for some of the others there.”

Then she told me about her friend, a bus boy in the bar whose asthma had worsened severely since he had begun working there. His co-workers had taken him to the emergency room more than once that spring, gasping for breath, his inhaler useless. He continued to work in the bar because the tips there were too good to turn down, almost every penny of them sent back home to his wife and family in Peru.

She brushed her tears aside, angrily. “What good will he be to his family is he dies?” she said.

“There’s something you can do”, I told her.

I gave her the name and number of a woman I knew who worked with the anti-smoking coalition in New York City. They were actively lobbying for a bill that would ban smoking in restaurants, and seeking individuals to testify at the public hearings scheduled the following month at City Hall.

But my patient refused to take the number. “I don’t want to lose my job. If the management finds out I’m working against them…”

“Look, I can’t tell you what to do. But your story, and your friend’s story, needs to be heard. Just make the call. I’m sure there’s a way to protect your privacy if you really want that.”

I pushed the number gently across the desk.

“Call her.”

As it turns out, she did call that woman. And later that fall, both my patient and that bus boy willingly and openly testified at the City Council Hearings in support of the bill that would ban smoking in NYC restaurants. I heard they were among the most compelling witnesses of the day.

Shortly after that hearing, the New York City Council passed the Smoke Free Air Act of 2002, 47 votes in favor, with 2 abstentions. Mayor Bloomberg signed it into law in March 2003.

And my patient? Well, both she and the bus boy kept their jobs. I hope his asthma is better. Unfortunately she ended up needing in-vitro fertilization, and last I heard, was still trying to get pregnant…

For information about second-hand smoke in the workplace, and to find out how you can get anti-smoking laws passed in your area, visit The Americans for Non-Smokers’ Rights Website.

For information about tobacco control laws nationwide, see the website of the American Lung Association.

Category: Second Opinions

2 Responses to A Smoke-Free Story

  1. You should be very proud of your work on this! Our hospital became “smoke free” a few months ago. Smokers among us had a year to prepare for the official ban, yet still I see people traipsing across the street to the Taco John’s parking lot to smoke. I asked a smoking nurse friend how they all found out about Taco John’s being smoker friendly. She said they were handing out flyers in the smoking zones outside our hospital for a few days before the ban went into effect. “Smoke in our parking lot! On your way back to work, buy a taco!” (I exaggerate, but the message was bizarre).

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