I TOLD YOU SO

When is it ok to say, “I told you so”? Most of us suppress the urge to say, “I told you so” while trying not to make a friend or relative feel worse than they already do. After all, saying “I told you so” really doesn’t accomplish anything. Or does it? 

Does being right feel good? Most of the time, it feels great to be right. An “I told you so” loudly declares, “I was right!” I guess the polite thing to do is to feel good inside but, outwardly, be sympathetic. 

In my profession, I would rather be wrong about a great deal of things than be right and have to suppress my “I told you so.” Confusing, isn’t it? Let me explain. 

Mrs. “S” has smoked 2 packs per day for the 28 years I’ve known her. For many of those years, I’ve warned her that the price she would pay for smoking would be a life of misery. She ignored me. She felt fine. Her usual refrain was “I have a friend who is 95 and smokes three packs of Camels a day and he is fine. You, docs, just hate cigarettes.” 

Mrs. “S’s” was in the office the other day. She is recovering from pneumonia and can’t understand why she can’t breathe. She is using maximum doses of her albuterol, Spireva, and Advair and just can’t catch her breath. She wants me to do something. Her docs aren’t helping her and she wants me to speak to them. She feels horrible. Brushing her teeth is a chore. 

While Mrs. “S” lungs were marginal before she got pneumonia, she still had enough lung capacity to function. The pneumonia finished the destruction of her lungs she began 50 years ago. Mrs. “S” is out of lung and is going to be oxygen dependent for the rest of her life. Her lifestyle is changing rapidly. She is angry and demands “fix me!” Unfortunately, no one can. 

Sure, I will send Mrs. “S” to another pulmonologist. He will do a full battery of pulmonary function tests and diagnose her with end stage lung disease. He will start oxygen, maybe add pulmonary physical therapy, and switch her meds around. That’s what specialists do. Unfortunately, he has little to offer. Verifying the diagnosis will only serve to reinforce how bad her situation is. 

Mrs. “S” will become sedentary. She still insists she is cutting down on cigarettes and is only smoking 3 a day. I explained that “only three a day” is like saying “I only plunge the knife in my chest three times a day”. Why hassle her now, after all, her lungs are shot! The answer is easy. Oxygen is flammable. 

Mrs. “S’s” heart is strong. Her brain is sharp. She will probably have a long time to regret smoking. She may well end up in a hospital bed and then a nursing home before her life ends. Her treatments will be expensive. Medicare will pick up much of the bill. Eventually, her treatments will exhaust the nest egg she and her husband accumulated. Mr. “S” will become her caregiver. They will apply for Medicaid. 

Even a self-righteous “I told you so” couldn’t make me feel better. I would rather that I had been wrong about her smoking. I would have rather her be able to say, “See, doc, I’m 100 years old, still smoking and still breathing on my own.” That would have been great. Instead, I get to watch a 70-year-old struggle to find her next breath. 

Are you still smoking?

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One Reply to “I TOLD YOU SO”

  1. another wonderful and beautifully written story of sound advice . I am a specialist and everyone on of Stewart’s patients tell me they miss him dearly . that is the mark of a great doctor !!!!!!

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