Tomorrow Never Comes

Why men with heart problems keep on smoking

a beautiful heart

Its doctor’s orders: heart patients must exercise regularly and eat the right foods if they want to get healthy.

But some men resist.

An unhealthy lifestyle – sedentary behavior (sitting too much), eating foods high in salt and fat (cheeseburgers), and smoking (tobacco) – often leads to a “cardiovascular incident” such as a heart attack or a stroke.

Compared to their wealthy compatriots, Canadian men on the lowest rungs of the socioeconomic ladder are more likely to choose an unhealthy lifestyle.

And these men are less likely to survive one year after heart surgery.

Social scientist Mathieu Savage and colleagues wondered: Why do these men in precarious health ignore doctor’s orders?

No Longer Young

To answer their question, Savage and colleagues sought men to talk to in the Quebec province. The researchers advertised their study, among other means, through posters in food banks, homeless shelters, pubs, and corner stores.

They found 20 men aged 40 to 65. All 20 recently had a cardiovascular incident for which they were hospitalized, but at the time of the interview, they could get around on their own.

The men they talked to were not wealthy. Only one had a college education. Over half are divorced or single. Half have a history of drug addiction or have been to jail, and a little over half have a job. When they have a job, they work in construction or they drive a truck or a bus, and the like. All of them receive social welfare benefits of some kind. They’ve lived like this since they were young.

Most of these men live what the authors call “lifestyles incompatible with the recommendations of cardiac health promotion experts,” meaning that they do not do what the doctor ordered. Most smoke.  Almost none say that they are physically active. About half don’t take the prescribed drugs to help them recover. They ignore the free seminars in heart health.  

Tomorrow Never Comes

The authors concluded that these men don’t listen to the doctor’s orders because of short-term and fatalist mindsets.  

Short-term thinking, AKA present-time orientation, is when you only think about the now and rarely do anything to benefit your future self. Every day is one day at a time.

Short-termers are often fatalists. Fatalism is when you think that whatever happens in life is beyond your control. And since you are not in control, there is little reason to try to change your lifestyle.  

These men, who feel stressed out and weaker after the cardiovascular incident, blame their lot on the vicissitudes of life.

Short-term fatalist thinking manifests in various ways. Some, like Eddy (age 47), who lives on social assistance, think heart problems are genetic.  

“I think it’s genetic,” said Eddy. “It can’t help when both your parents have had a heart problem … my brother also has heart problems. My sister has heart spasms, she tells me about them every time she calls … I probably have some sort of ticker misalignment … I know I have to be careful. Sometimes, I ask myself if it’s really important or not … I didn’t go to the rehab programme. So, when I have heart problems, I let it pass.”  

“Most of the time it passes,” Eddy added.

Some chalk it up to the Lord’s will:

“I believe in God,” said Max, a 44-year-old former tow truck driver. “Like I told you, he has his Big Book. Your expiration date is written in there somewhere. When that day comes, that’s it … when the product is past its due date, it’s not good anymore.”

Max laughed at that.

They know that they have bad habits, but their bad habits make them happy.

“What am I going to do if I don’t smoke?” asked Lionel who, at 55, is a soup kitchen clerk. “My doctor tells me to stop … he says: ‘prevention’ … I’m sure it helps. I’m aware of that … but I just turn around and light up another cigarette … I wouldn’t know what else to do with my time … it’s a habit … it’s the same thing with food, I really like fatty foods … if I’m going to make myself a hamburger, I flip them around on both sides, soak them in grease, add some bacon, and that does the trick!”

One trouble leads to another, and these men have troubles galore. Consider their work lives. They have a heart problem and they have to work, but they don’t have a CV to get a good job. So, they take the jobs that they can get: low paid hard labor. They stress out because they can’t get a better job. The stress and the work conditions are bad for the heart. And so turns the wheel of misfortune.

Meet Pierre-Luc. He’s 57 and drives a truck for a living.

“Everyone told me that after the operation, if you follow the doctor’s orders, you’d be in perfect shape,” Pierre-Luc explained. “I tried getting better, but it’s really hard when you drive a truck for a living … The only thing you can eat in a truck-cab is fast food. That’s it! You don’t even have a family restaurant food or a MacDonald’s. No restaurant can accept you with a truck the size of mine. You need space for that.”

In the end, some men learned to embrace the short-term fatalist life.

Meet Gary. He is 48 and used to be a mover.

“I live more day-to-day now,” he said. “It’s just that, you know, I go with how I feel when I wake up in the morning.”

Because in that world beyond the hospital gates, tomorrow never comes.


This was written by Josh Dubrow based on Mathieu Savage, Alex Dumas, and Stephen A. Stuart. “Fatalism and short‐termism as cultural barriers to cardiac rehabilitation among underprivileged men.” Sociology of health & illness 35, no. 8 (2013): 1211-1226.

In Canada, the richest men live, on average, five years more than the poorest men. (p. 1212)

Quebec province has an usually high mortality gap between rich and poor. (p. 1214)

“lifestyles incompatible with …” p. 1215

“I think it’s genetic…” pp. 1217 – 1218

“I believe in God…” p. 1218

“What am I going to do if I don’t smoke…” p. 1219

“Everyone told me that after the operation….” p. 1219

“I live more day-to-day now…” p. 1222

Copyright Occam’s Press 2021: Attribution-NonCommercial-NoDerivs CC BY-NC-ND



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