As a Health Educator, you are expected to give people the truth about their health and support them in whatever way possible, even when the desired outcome might seem impossible to you both. This was definitely the case when I met Elizabeth (name has been changed to protect client identity). Elizabeth rushed through the doors of the Baker County Health Department frantically one Friday afternoon, in search of someone who could help her quit tobacco. She had just been discharged from the ICU days before from a severe case of pneumonia. She explained to me, with tears in her eyes, that she did not want to die, and was more dedicated than ever to quit smoking and finally take charge of her health. My mentor had recently spoken to me about coaching clients through Tobacco Free Florida’s Quit Your Way website, helping them understand all the options available to them, so this seemed like a perfect chance to try out my new role as “Tobacco Cessation Coach”.
One week later: Elizabeth is sitting across from me filling my office with the stench of cigarette smoke. We talked for a while about her tobacco use, her triggers and patterns, and past quit attempts. As a 75-year-old who had spent most of the past 50 years smoking, with very few attempts to stop, it seemed very unlikely to me that she would be successful in this attempt. But the more that we talked, the more confident and optimistic she became. Soon, the woman sitting across from me was filled with a new hope and determination that I, and maybe even she, didn’t recognize.
Two weeks later: We are back in my office with the same smell of cigarette smoke. In the week that had passed, she had continued smoking despite not being able to afford it; she claimed that her Phone Coach was not available at times when she needed him; and her Nicotine Replacement Therapy (NRT) had not yet arrived. At this point I saw a much different person sitting across from me: someone filled with anger and frustration, as well as sadness. I didn’t want to say or do the wrong thing, but I also felt that I was giving her absolutely all the information, resources, and help that I had available. Wasn’t that enough?
6 weeks later: While setting up for our July Tobacco Cessation class, I was met by a familiar face and warm greeting. Elizabeth beamed at me with a smile I’d never seen from her before, looked like she’d put weight on her frail body, and best of all, did not smell of cigarette smoke. “Elizabeth!” I exclaimed, “How are you doing? It’s so good to see you here. I’m happy that you made it.” She smiled again and said “I’m the best I’ve ever been. 41 days without a cigarette!” Although the tone and happiness in her voice was contagious, I couldn’t help but to be filled with surprise and doubt. I desperately wanted this to be true, but had such a hard time believing that this woman who yelled and complained and placed blame during our meetings could have been THIS successful on such a major life change. “Wow” I said cautiously, “let’s see it then!” We test each client’s Carbon Monoxide (one of the main chemicals in cigarettes) levels at the start of every class, using a machine that they blow into. The monitor shows us a number, giving us a better idea of their smoking habits since many clients tend to understate or even lie (as I suspected she was doing now). 0-6 is the range for non-smokers, 7-12 for light smokers, 12-18 for moderate, and 18 + for heavy. I passed her the CO monitor, she blew for a few seconds, and I expected a high number to appear. To my surprise and disbelief, her number was 0. She really had quit 41 days ago.
My few weeks with Elizabeth, and experience leading her through the beginning of her first successful quit attempt, taught me so much about my service term and how I should interact with others. As someone who is almost always optimistic, I had a hard time when Elizabeth seemed not to mirror my optimism and was instead filled with anger and sadness during the first weeks of her attempt. I was doing everything “right,” wasn’t I? It was not until later that it hit me - all of what she was doing was really hard. Quitting tobacco is really hard. Listening to a young stranger tell you how to live a healthier life is really hard. Changing a lifelong habit and addiction is really hard. Doing all of this at 75 years old with limited access to the internet, a car and cell phone, resources and people to support you is really hard. Her emotions, feelings, and experiences during the entire process are real and valid and deserve to be acknowledged, and in seeing her as a “project” that I could “succeed at,” I wasn’t doing a good job of treating her like a person who was desperately seeking help. My role wasn’t what I had expected it to be, and I learned the importance of servant leadership first hand. Elizabeth needed someone to give her the necessary information, which I did. But she also needed someone to believe in and support her as a person regardless of the expected outcome.
I can’t begin to imagine what quitting a life-long addiction would be like, so I have to leave that to her. In serving others, we can only make so much of an impact by just giving people information. It’s the personal relationships and interactions- the understanding, the compassion, and the empathy- that will make all the difference. No one is ever “too far gone,” “too emotional” or “too hard to handle” to help themselves or to be helped by you. In this case, my service ultimately led to a success, but that will not always be the case. And when it isn’t, your service to the community should be so much more about building relationships than it is about “succeeding at your goal”. Most importantly, I was reminded of my hope to be a compassionate, loving, and supportive individual in my roles both within Baker County and in my own life- which is what I hope for the rest of you too.
This blog post was written by NHC FL member, Catherine Kradel.
Catherien serves at the FDOH in Baker County as a Health Educator.