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According to a flashback, his ex-wife smoked from an octodecuple (that's eighteen ) cigarette holder

A very similar piece is in the Collection of the Museo del Palazzo di Venezia in Rome

Liver or Pancreatic Diseases : Liver or pancreatic diseases, such as viral hepatitis (hepatitis B and C), cirrhosis, fatty liver, chronic pancreatitis, or pancreatic cancer, often necessitate the knowledge and skills of a gastroenterologist

Or just stressful situations

Philippine specimens were collected in accordance with terms and conditions of the gratuitous permit and under the supervision of BFAE Fisheries Regulatory and Quarantine Division and NFRDI