University HealthCare Alliance

February 22, 2020

Scope | A Difficult Conversation: When Your Patient has an Addiction

Ironically, his fingers looked like cigarette butts. They were black and chalky at the tips, and then tan through his knuckles to his hands. A couple were capped by long yellow fingernails, shooting out like stalks of hay, bending in different directions.

A few other fingertips had already fallen off, leaving behind stumps he could barely flex or wave.

I sat down and asked what he knew about his disease.

“I’ve googled it,” he said. “It’s rare. Caused by smoking.”

Mr. X has a disease I never thought I’d see outside of a test question — a disorder in which the small vessels of the hands and feet become inflamed and blocked by blood clots. When a clot forms in the vasculature, the blood stream halts. Everything beyond the obstruction, muscles and tissues, begins to die without their blood supply.

Mr. X’s fingers were dying, and several were already long dead.

He asked me for something to drink, and I handed him the styrofoam cup from his bedside table. He clasped it between his two open palms, and took big gulps of room-temperature water.

He told me that when it first started, years ago, it was only on one hand. “So I started smoking with the other,” he said.

Later, he learned that the problem wasn’t actually from touching cigarettes, but from inhaling their smoke into his bloodstream. That explained why his toes began to turn black too, sparking an electric pain through his heels.

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