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The horrors of smoking
  1. Center for Health Promotion and Disease Prevention
  2. Henry Ford Health System
  3. One Ford Place, 5C
  4. Detroit, Michigan 48202-3450, USA
  5. rdavis1{at}

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    Blood and smoke. Stephen King. New York: Simon & Schuster Audio, 1999, $23.50 (audiocassette), $27.50 (CD), 3.5 hours. ISBN 0671046160 (cassette)/0671046179 (CD)

    I have never read a book by Stephen King. But I couldn't resist buying Blood and smoke, available only as an audiobook and read engagingly by King himself. It comes in a flip top box resembling a pack of Marlboros, and contains a CD or three audiocassette tapes, depending on the version you buy. The “book” is actually a series of three short stories, which, according to the packaging, take the listener “inside the world of yearning and paranoia, isolation and addiction . . . the world of the smoker”. “The now politically incorrect habit plays a key role in the fates of three different men in three unabridged stories of unfiltered suspense.”

    In Lunch at the Gotham Café, Steve Davis is distraught after his wife leaves him. Two days later he quits smoking, after a 20 year history of smoking 20–40 cigarettes a day. For the next two weeks he suffers intense withdrawal from nicotine and his wife, until he meets her and her divorce lawyer for lunch at a Manhattan restaurant. While arguing at the table, they are attacked suddenly by a psychotic, knife-wielding maïtre d'. Davis fights him off bravely, saving his own life and that of his ungrateful wife. Afterwards he buys a pack of Marlboros and lights one up, but then tosses the cigarette in the gutter and stamps the pack with his foot. “I hadn't gone through this day just to start killing myself with tobacco again,” he explains.

    1408 is about Mike Enslin, a bestselling author of “true” ghost stories. While researching his book about haunted hotels, he stays in New York City's most haunted hotel room. Enslin quit smoking nine years ago after his brother died of lung cancer— “another fallen soldier in the tobacco wars”. But the writer always carries a cigarette behind his ear, replacing it each day with a fresh one, explained as “part affectation, part superstition”. In his 70 minutes in room 1408, Enslin experiences horrifying distortions of reality, and finds himself vanquished by “the room”. He ignites his shirt with a hotel matchbook, and the room—perhaps because of its distaste for “cooked meat”—allows him to flee into the corridor. The matches and the fire, ironically, save him from an “unspeakable end”. Another hotel guest, returning from the ice machine, puts out Enslin's flames. However, Enslin is left with severe emotional and physical scars, and can no longer write—another in the long list of victims of room 1408.

    In the Deathroom features Mr Fletcher, aNew York Times reporter being interrogated in a Central American stronghold. Authorities are using electric shock to extract information from him about an upcoming Communist coup against the country's fascist dictatorship. Escobar, his chief interrogator, offers Fletcher a Marlboro—“the preferred cigarette of third world peoples everywhere”. At first Fletcher, having quit smoking three years previously, declines. But at the moment of greatest peril, he accepts Escobar's offer. In launching his dramatic escape, he thrusts his lit Marlboro into the eye of one of his captors, grabs his gun, shoots three of his captors, and kills the fourth with his own electric shock machine. One month later, back home in New York City, Fletcher lives out a vision he had during his captivity. He buys a pack of Marlboro from a newsstand kiosk, smokes a cigarette, and then discards the rest of the pack. In a brief exchange, Fletcher and the vendor agree that smoking is a “very bad habit” and that “We're lucky to be alive”.

    Each of these stories is creative, suspenseful, and well narrated. Character development is quite strong. As one reviewer on amazon.comcommented, “this is bloody good stuff”. My main interest in the stories, though, was in their portrayal of smoking. And King's treatment of the subject is unmistakably pro-health. Listeners are left with the clear message that smoking is harmful and addictive. A particularly compelling example is this excerpt fromLunch at the Gotham Café:

    “There are two phases of withdrawal from tobacco, and I'm convinced that it's the second that causes most cases of recidivism. The physical withdrawal lasts 10 days to two weeks, and then most of the symptoms—sweats, headaches, muscle twitches, pounding eyes, insomnia, irritability—disappear.

    “What follows is a much longer period of mental withdrawal. These symptoms might include mild to moderate depression, mourning, some degree of anhedonia (emotional flatness, in other words), forgetfulness, even a species of transient dyslexia. . . . The most common symptom of phase two withdrawal is a feeling of mild unreality. Nicotine improves synaptic transferral and improves concentration—widens the brain's information highway, in other words. It's not a big boost and not really necessary to successful thinking, although most confirmed cigarette junkies believe differently. But when you take it away, you're left with a feeling—a pervasive feeling in my case—that the world has taken on a decidedly dreamy cast.”

    Why has King focused on the evils of tobacco inBlood and smoke? The most likely reason is the trauma he suffered when he was hit by a Dodge van in June 1999, while walking alongside a country road in his hometown of Bangor, Maine. He was hospitalised for three weeks, underwent at least six operations to repair broken bones in his right leg and hip, and suffered broken ribs, a punctured lung, and a laceration of the scalp. He told the Bangor Daily News in August that he hadn't had a cigarette since the night before the crash. “I took the Dodge van cure,” he quipped (

    Two months later King told the Associated Press: “to be able to walk and talk and occasionally crawl on my belly like a reptile has made me intensely grateful to be alive.” No doubt he recognises that smoking is incompatible with the joy of being alive. Now, with his message about tobacco in Blood and smoke, King aims to preach that gift of life to millions of others.


    A shorter version of this book review was published in the August 5th issue of the BMJ.