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Samantha Land was in her 20s when area hospitals allowed smoking in patient beds -- so imagine the 46-year-old's surprise when she discovered a doctor wouldn't operate because of her habit.
The Ormond Beach resident was in for a facelift consultation when the doctor told her that she needed to quit smoking cigarettes for at least six months before he would smooth out her lines. That's quite a far cry from when doctors smoked on rounds and when nurses would bring ashtrays to patients' bedsides -- all in the 1980s.
Dr. Herbert Kerman -- whose name graces the headquarters of Halifax Health's Regional Oncology Center -- looks rueful when he remembers smoking either a pipe or a cigarette, sometimes even as he treated his cancer patients.
"During World War II, I was a two-pack-a-day-er and smoked a pipe," Kerman, 92, said.
When he finally quit 30 years ago, 100 of his pipes went into the trash.
"It started to look like it was not too good for your health," he said.
The definitive link between smoking and cancer was first published in a medical journal in 1950, according to the National Cancer Institute. But health care institutions were slower to catch on. Dr. Edward Favis recalls being warned he'd have no patients when he opened an office in 1957 where smoking was banned. Cigarette lighters were part of the fixtures in the psychiatric unit of what is now Halifax Health at the time today's youngest doctors were being born in the maternity unit. Eventually, the area's largest health care provider became the first to ban smoking from its property altogether in 2007. But Chinese hospitals just banned it from inside hospital hallways starting only this year.
A growing body of evidence is suggesting, however, that doctors might do better -- and face less liability -- if they banned smoking patients altogether.
Peer-reviewed journals contain studies showing better outcomes for patients who either don't smoke at all or gave up smoking for a fixed time before and after everything from wound care to rotator cuff repair. And a 2004 article in the Medical Journal of Australia entertains the question of whether it's acceptable to give smokers lower priority on wait lists for elective surgery.
Dr. Carl Lentz, a Daytona Beach plastic surgeon, has his patients fill out forms when they come to his office attesting to whether they smoke or not. For anyone who admits to smoking, he won't do breast lifts, tummy tucks or facelifts until they sign an affidavit promising they won't smoke.
It's because of the way that smoking constricts the blood vessels that carry healing oxygen to the peripheral blood supply.
"You can look at someone who has been smoking who has an incision and tell," Lentz said. "The skin has a different color. The wound edges look different. You can see it in the skin -- it cuts the blood supply off."
But the former smoker will admit to a habit that had him smoking up to three packs of cigarettes a day, particularly when he needed that lift at about 2:30 or 3 p.m. after being up all night, doing surgery.
"I would tell patients, 'I'm going to cut your leg off if you don't quit smoking,' while I was smoking," he said, laughing.
Dr. Stephen Levine, a general surgeon, said he wouldn't want to do any kind of elective surgery on anyone who smokes -- particularly something like a knee replacement.
"One cigarette decreases the blood flow to the legs by 30 percent for one hour," he said. "If you smoke a pack of cigarettes, you will have chronic low blood flow. Under those circumstances, nothing's going to heal."
And since that translates into a higher rate of complication -- and thus legal liability for doctors -- doctors don't want to take the risk.
"Once you realize how serious this is, you just can't accept it," Lentz said.
Dr. Rebecca Peck, an Ormond Beach primary care physician, said that she wouldn't want to see a patient's treatment limited because of a habit, no matter its destructive potential.
"A true physician tries to see behind the flaw and what they need to improve their health," she said. "Are you going to take the next high-risk complication and say the same thing? About fat people?"
Land walked out of her facelift appointment offended, she said.
"I don't think it's right," she said of a doctor withholding the operation because of her smoking. "It's my choice."
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When the workers arrived again, the hole had doubled in size. And it took another 45 minutes of work to get the track fixed again. During that time, hundreds of fans deserted their grandstand seats and traffic outside the track became bumper-to-bumper heading toward the interstate.
"They need to get some maintenance people from Cleveland, they can fix a pothole in 30 seconds,'' joked fan Mark Dorenkott, who waited out the two delays from his seat in the front grandstands.
It was almost that easy.
Ultimately, the hole was repaired with good ol' race "Bondo" -- a putty-like filler used to help shape race car bodies and for quick race day repairs on cars. By all accounts it held up just long enough for the race to conclude -- a thrilling stand-on-your-feet exhibition of why NASCAR is the most popular form of racing in America.
Unfortunately, that exhibition came six and a half hours after the race started and at the expense of many fans in the once-capacity crowd and likely thousands of television viewers who simply ran out of patience.
Asked after the race if he worried about the repercussions, Daytona International Speedway President Robin Braig conceded, "Well, sure.''
"We're the 'World Center of Racing','' Braig said. "This is the Daytona 500. This is not supposed to happen. And I take full responsibility.''
"But we can come back from this. We know how to fix it.''
Braig said his staff inspected the track Sunday morning -- as it does before every race -- and found no problems with the surface. The track was last paved in 1978 and Braig is considering repaving it next year.
But you should see the new Bistro in the Fan Zone.
Ironically, the recurring theme of this year's NASCAR Speedweeks and its crown jewel, the Daytona 500, was about a new and improved NASCAR that that bent over backwards -- and forwards and sideways -- for its fans with a "let em' race" attitude, faster speeds, and extra overtime chances.
For its part, NASCAR insists it was satisfied with the way the track handled the situation.
"With regard to what happened today, obviously it's not good for the fans, it's not what you would rather have,'' said NASCAR spokesman Ramsey Poston, who along with Braig addressed the media after the race.
"But anyone who's been a fan of racing very long has sat through rain delays and sat through other things like that. What we do know is those fans who did continue to watch throughout the day saw great racing and a great finish."
Almost to a man, the drivers refused to place the blame solely on the track. They didn't think it ultimately played a role in the race outcome -- despite the fact the race was supposed to end in the afternoon and finished under the lights.
"Track surfaces are going to have problems from time to time,'' Earnhardt said. "This wasn't a fault of NASCAR, it wasn't a fault of Daytona's or nobody's. It was probably more or less everybody's cars beating on the racetrack with trailing arm mounts and tail pipes.
"That's going to knock a hole in some asphalt, I don't care where you're at.''
So should Daytona completely repave?
"It's due, I would say,'' Earnhardt said with smirk.
