Essays | Themes | Research
One Last Class
— She spent a lifetime in the classroom, but saved her most powerful lesson for the very end.
by Russ Hostetler
Photo: AngTheDesigner, Unsplash 2021
Tobacco—what a conundrum. In middle Georgia in the mid-1980s, it paid the bills. Farmers could make more on five acres of tobacco than 20 acres of peaches. Chronic obstructive pulmonary disease (COPD) accounted for a large portion of the usual diagnoses circled on the superbills of the patients who visited my clinic (The Mercer Center for Health Care in Jones County, Georgia). The pulmonologists ran the intensive care unit because the majority of the patients there were their patients. And yet, tobacco killed and did so relentlessly, despite the efforts of primary care physicians, pulmonologists, allergists, cardiologists, thoracic surgeons, vascular surgeons, and oncologists to encourage people to stop smoking, or better yet, not to start.
But generations of people grew up thinking smoking was OK, even cool. Smoking was something adults did (a big drawing card for adolescents)—something to be emulated. So it was no surprise that pulmonology was a large part of my practice. It was usual, ordinary. But the people who come to mind when I think about tobacco were not the ordinary, but the extraordinary.
Marian Jones was an extraordinary person. She had been an elementary school teacher and actually graduated with one of her sixth-grade classes into a more specialized arena, teaching English in the middle school in Jones County. During her career, she taught thousands of students, 32-34 at a time. She was an African-American woman of slender build and angled front teeth that gave her an Ali McGraw smile. She was soft-spoken, and by the time I got to know her, she had a husky voice. At her funeral, I spoke with people who knew her when her voice was soft, sweet and clear. More than one person commented on her superb diction and extensive vocabulary. She could exercise her vocabulary in a way that did not make the listener feel he or she was stupid and did not cause them to go running for a dictionary. The meaning was clear from the excellently crafted context.
Ms. Jones had end-stage idiopathic pulmonary fibrosis, a disease in which chronic irritation and the inflammation caused by it creates less flexible scar tissue where pliable lung tissue should be. Another extraordinary bit about her was that she never purposefully inhaled tobacco smoke during her entire life. Unfortunately, however, she had lived with a husband, now long dead, who exposed her to tobacco smoke in their home and in the confines of their car. Although it was called idiopathic, to me, the cause of her pulmonary disease was clear, and it was all too clear to Ms. Jones as well.
Ms. Jones experienced failed attempts to improve her symptoms with oral and inhaled medications, a visit to a pulmonologist, biopsies and pulmonary function tests. Ms. Jones was then confronted with having to accept the risks and side effects of long-term steroid treatment to keep her pulmonary function at the brink of failure and supported by supplemental oxygen via a tank and tubing to get the oxygen to her nose. The idea of a lung transplant was brought up, but summarily dismissed. It was too much: too expensive, too weirdly unnatural for her. After months of reduced return on the investment and increasing side effects from the steroids—weight gain, diabetes, fungal infections, gastropathy (problems with her stomach), kidney dysfunction—Ms. Jones decided to let nature take its course. She didn’t tell me she had stopped her prednisone. She just stopped. And she didn’t show up in my clinic for a couple of months.
Then one day, Mary, my receptionist/office person/bookkeeper, got a call from her saying she wanted to come in to the clinic. She was scheduled for the next day and arrived gasping for breath after the short walk from our backyard parking lot to the front door. Able to speak only one or two words per breath, Ms. Jones asked me to put her back on the steroids because she had to live long enough to accomplish one more teaching effort before she died. She explained that she wanted to live long enough to speak to an assembly of the junior and senior high school students to tell her story and plead with them not to smoke. We talked about extending her effort to speak also to the faculty who fogged the teachers’ lounge with smoke, a cloud of which was disgorged with every opening of the teachers’ lounge door for all of the students in that hallway to see. We talked about asking the students to carry her message home to their smoking parents, aunts, and uncles—to say to them, “Please do what you can not to end up gasping for breath like Ms. Jones.”
Her face was illuminated, but the light seemed to come from within. She spoke with her soft but raspy voice, one or two words per breath. She captured their attention.
She did it. A set of risers were placed on the basketball court in front of a stage, which had been filled with risers and chairs. The rest of the basketball court was covered with a heavy tarp so folding chairs could be placed there to accommodate the junior high students. The senior high students were in the bleachers on either side.
Ms. Jones was introduced by Ed Cole, the senior high principal. He stepped up onto a dais in front of the risers in front of the stage and facing the rest of the crowd in front of him and along the sides. “Students, Faculty, Staff—Ah think many of y’all know Ms. Jones. She has requested this opportunity to speak to y’all, and given her many years of fine service as a teacher in our Jones County School System, Ah agreed. Ah didn’t ask the School Board. Ah just said, ‘Yes,’ so here she is.”
The lights dimmed and a spotlight hit the spot where Mr. Cole had been. Four football players lifted Ms. Jones in her wheelchair with her oxygen tank up onto the dais and pushed her into the spotlight. Mr. Cole handed her the microphone. In the darkness, two boys carried a large garbage can into the gymnasium and placed it on the floor in front of the dais. Ms. Jones took the microphone, bowed her head for a moment, and then lifted her head to look directly into the spotlight. Her face was illuminated, but the light seemed to come from within. She spoke with her soft but raspy voice, one or two words per breath. She captured their attention.
“Thank you… boys. Thank you… Mr. Cole. I am Marian Jones. Some of you…may remember me…from when I taught…in the junior high building,…and since I’m going to die soon… I hope… after today… that none of you… will forget me.” In the next 20 minutes, the only person who spoke was Ms. Jones. The chatter between inattentive girls and boys stopped, no one had to get up and go to the bathroom, and no one tried to make a joke out of what Ms. Jones was telling them.
She told them smoking was not OK. She told them not to smoke. She asked them to tell the people they loved not to smoke. She advised them to stay away from people who smoked, or at least stay away from them when they smoked. She explained what had happened to her scarred, restricted lungs. And she told them smokeless tobacco would kill them just as surely as the tobacco that had already killed her.
She told them she had given up. The increasing side effects and reduced effectiveness of the steroids were too much for her to continue. It was too difficult to go on struggling for each breath. One night, however, when she had decided she would likely die before the next day, she got the idea of speaking to these very important people, the students to whom she had dedicated so much of her life. So she started back on the steroids to flog that last bit of function out of her kidneys, her GI tract and her lungs.
She told them smoking was not OK. She told them not to smoke. She asked them to tell the people they loved not to smoke.
She asked the smokers in the assembly, as a favor to her as a dying teacher, to please get up, to stand in the space on the floor in front of her, and to toss into the garbage can whatever tobacco they had on them. She asked that they spare their bodies at least that amount of damage. After a minute and a half of deathly silence, a senior girl named Ann got up, pulled a pack of Winstons from her purse and tearfully walked up to Ms. Jones and the garbage can. The sound of that pack of cigarettes hitting the bottom of that can resounded in the hushed gymnasium. Dan Worther, the high school assistant football coach, led the faculty response. In the next 10 minutes, the can was full, and the crowd in front of the risers stretched down the aisles. Ms. Jones smiled her Ali McGraw smile at each respondent and mouthed the words, “Thank you,” to each one. As the flow of respondents slacked off, and the tobacco packs spilled out of the garbage can and onto the floor, Ms. Jones took a deep breath, said “Thank you,” out loud, and bowed her head. She was carried off the stage by the football boys while the crowd applauded. They continued to applaud for two whole minutes after she disappeared from the gymnasium. I think, after that, she died a happy woman.
I have no idea how many of the people who answered Ms. Jones’ call to give up one pack of cigarettes were able to quit smoking. Research would suggest that, faced with the addictive properties of nicotine, few would be able to heed the message and act in a reasonable way. But the important thing is that Ms. Jones did not shy away from a chance to make a difference, and neither should anybody.
(Originally published: One Last Class. Florida Family Physician. Fall 2010, 56(4):16
While Russ’ essay captures the emotional weight of a teacher’s final lesson, the public health reality remains sobering. According to the American Cancer Society Cancer Action Network, secondhand smoke is responsible for more than 42,000 deaths among nonsmoking adults in the U.S. each year, including over 3,000 from lung cancer. The U.S. Surgeon General confirms there is no risk-free level of exposure. Click on the image current research. — Editor
Russ Hostetler found his calling as a physician while working in Conflict Management and Crisis Intervention as a Special Police Officer in Dayton, Ohio after graduating from Ball State University with a degree in psychology. His medical career included faculty positions at two medical schools, directorships in three managed care settings and a consultative clinical practice in geriatrics. After retirement, he volunteered as a Senior Medical Officer in Marine Corp endurance events operations, is an active member of the Florida Department of Health Medical Reserve Corps, and is a Healthy Community Clinical Director for the Special Olympics. He enjoys building furniture, tennis, writing, cooking and baking, nursing his understanding of the German language, and being grandpa to several delightful children.
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