Sunday, April 3, 2011

Weekly Whine: Cigarettes

When I rotated at the VA, it seemed like 9 out of 10 patients reeked of cigarette smoke. Now I'm not a primary care doctor and the last thing I want to do is to lecture a patient on the dangers of smoking. So I don't. They can smoke all the cigarettes they want and eat a dozen Big Macs for all I care.

But if you're going to be shut in a room with a patient who just was outside smoking, you may as well go hang out in a smoky bar because it's just as bad. I'm not allergic to cigarette smoke or anything, but it still makes my throat scratchy and my eyes burn. And I come out of the room smelling like I was smoking. And the room stinks for the next hour.

I'm not a smoker (obviously) so I really don't know: do people who smoke think about the fact that the person they're going to be trapped in a room for the next half hour with someone who likely isn't going to appreciate the smell of smoke? I think it's obnoxious. I mean, when I eat something garlicky for lunch, I always eat a mint after for the benefit of others.

I'm not a militant anti-smoker by any means. In college, I used to occasionally have a cigarette when I was out drinking. In fact, I remember once when I was about twenty, I was sharing a cigarette with a friend on a street corner at like 11PM between bars (ahh, crazy youth) and some woman came all the way down the block to yell at us that the smoke was bothering her. So I feel a little bit of sympathy for the plight of smokers. But at the same time, I really don't like smoke, especially when I'm already sick (which is always, these days) and my eyes are already irritated from lack of sleep (which is also always).

In fact, I know that even many smokers don't like smoke. When I was a kid, I got stuck in the smoking section during an international flight (due to poor planning) and people kept coming back from the non-smoking section to smoke. When my dad challenged some guy about it, he said he didn't like sitting in smoke.

I remember in med school, there was a rotation where my attending used to always go out and have a smoke right before our team meetings. She was often like 5-10 minutes late to the meeting and would breeze in stinking very strongly of smoke. We were in this tiny room, so it was unpleasant anywhere you sat, but especially unpleasant if I ended up sitting right next to her. So I'd actually scheme to figure out where she was going to sit so I could sit somewhere else.

I never entirely understood how a doctor who routinely treated patients with serious complications that were at least in part from smoking could still smoke. I felt sort of bad for her too, because that's surely what everyone else was thinking too. I guess nicotine is pretty addictive.


  1. I was always thankful of one of my medic partners - when she would smoke, she'd put on a sweatshirt and go outside, then take the sweatshirt off and leave it outside. She never smelled of smoke when we were in close quarters (like the cab of an ambulance).

    Maybe it's just that I notice it more because of the irony, but I swear most pulmonologists/pulmonology techs smoke.

  2. Smoking is a very powerful addiction. It has been my personal experience that individuals in the grips of any addiction rarely if ever think about those in close proximity to them. Be it smoking, alcohol or narcotics.

    What confuses me is if it was really about the nicotine more patients would readily agree to a nic' patch while in the hospital. Sadly most don't.

  3. Nicotine addiction is a bitch. I can't imagine the cravings that addicts to hard drugs have. I chewed cope/skoal (yeah, ew... i know) for about 5 years at an average of 3-5 can years. That was over 5 years ago that I quit. I still can't go into a convenience store without having to make myself not buy a can. I don't know how long this will last, but pay at the pump has probably saved my teeth.

  4. Studentdoc: Yeah, that's what I'm talking about... just do something to be considerate to others. I don't care if people want to smoke, but I don't want to be coated in it and smelling it for the next hour. It actually makes it hard to concentrate when I'm with a patient and they smell so strongly of smoke that it's affecting my breathing.

    Jeremiah: True, I've noticed that a lot of smokers don't want the patch even when hospitalized and deprived of cigarettes.

    SuFu: I gave up drinking cokes a few years ago and I still get cravings for *that* so I can imagine how hard it is to give up cigarettes. I was only really able to give it up completely when my husband stopped drinking it.

  5. "I never entirely understood how a doctor who routinely treated patients with serious complications that were at least in part from smoking could still smoke."

    It's because we have a sickness, we are addicted. I've read reports that nicotine is probably the most addictive substance on the planet, it just doesn't get the heat like heroin or cocaine or meth because it takes 40 years to kill you and doesn't cause immediate problems.

    I mean look at the numbers, it's still the #1 drug people abuse their bodies with.

    I'm an on/off smoker myself, I'm a stress smoker.. I have gone about 7 months without a cigarette. Even when I'm on those periods of not smoking, the smell of smoke from others doesn't really bother me. I mean I smell it, but its like any other annoying odor. It's kind of like driving through New Jersey, its stinky, its a nuisance, but it'll pass.

    And @Jeremiah, it's not about just the nicotine. It's the nature of the smoke itself, with cigarettes in particular. You feel as though something is missing, a certain fullness in your lungs. You also mix the hypoxia, which you wouldn't get with a patch

    It's like addictive and pleasure inducing substance+asphyxia (asphyxia can feel good if you know what I mean).

  6. I really don't think most smokers realize how strongly they reek of smoke right after they come inside from having a cigarette.

  7. good post. This term of school I have a math class. I hate math... I bought a used text from the bookstore, and after having it for several days, noticed that it's former owner must have been a heavy smoker. It became difficult to do homework for an hour at a time with the smell wafting out of the books - it was making me sick. I am sensitive to smells and prone to migraines. I finally broke down, returned it to the bookstore and paid the extra money for a new book... so much better.

    I can only imagine that smoking is a difficult addiction to break and takes several attempts to be successful at quitting.

  8. Smokers who've been smoking for much longer than what they'd call "a little while," often have reduced ability to smell and taste. It's not odd that they wouldn't smell the stink and that's over and above the acclimatizing that the nose does when exposed to a lot of any one smell in a small space.

    That said, I'm sure that most have been told that they reek, eye-wateringly, of smoke just after a cigarette. I had a BF who refused to think I wasn't being precious or joking when I said I wouldn't kiss him for a while after he smoked. He thought this even after many explanations that it was still emanating from him, clothing, skin, and lungs, for a while afterward. (He thought drinking a glass of wine would make the breath thing fade quicker but instead it just made for an even nastier stench. Even today the smell of wine in a smoke-filled room bring memories of that right back. Blech.)

  9. J: A similar thing happened to me recently. I got a book out of the library and it smelled so strongly of smoke, that I couldn't read it. I considered leaving it outside to air it out but I was afraid it would get lost or stolen, so I just returned it, unread.

    S.b.: I've seen some smokers end up in mortifyingly embarrassing situations because of smoking. I remember at a restaurant, this random nut job started screaming at a woman smoking as she was eating her dinner with friends (in the smoking section), then actually left a card on her tablet that she threw on the floor, so I saw that it read something about how she was making everyone around her miserable and going to die of lung cancer. I'm guessing stuff like this happens often enough, in addition to the health risks, aesthetic risks, etc, that it must be a pretty strong addiction.

  10. Its crazy the number of nurses and doctors I still see smoking. Now that most hospitals have banned smoking on-grounds they hit the public sidewalk nearest the hospital doors, looks horrible to those driving by. Then again hospital cafeterias are the worst places for healthy food too.

  11. What you're talking about is third-hand smoke, something that is just recently becoming understood, and getting attention:

    From a NY Times article in 2009:
    "Parents who smoke often open a window or turn on a fan to clear the air for their children, but experts now have identified a related threat to children’s health that isn’t as easy to get rid of: third-hand smoke.

    That’s the term being used to describe the invisible yet toxic brew of gases and particles clinging to smokers’ hair and clothing, not to mention cushions and carpeting, that lingers long after second-hand smoke has cleared from a room. The residue includes heavy metals, carcinogens and even radioactive materials"

    Full article:

  12. both my parents smoked and it adversely affected their health. I hated everything about it and to me it is really the smell of death. I destest the smell and I resent being subjected to it by others and I am really disgusted at the way people toss butts everywhere as if we want to live in their detritus- most people do not throw gum wads, used tissues, or other items that have been in their mouths all over the streets and sidewalks, but somehow they think tossing butts everywhere is A-OK. :(

  13. Heavy metals, and radioactive materials in what amounts?

    We can detect nanograms of substances today.

    I completely agree that smoking is an extremely hazardous habit. However, I also think people make a big deal out of everything these days.

    As a smoker myself, I don't think we should be allowed to smoke in restaurants, because lets face it..The "smoking section" is a joke, its usually all open anyways, with maybe a token barrier such as...a railing or something.

    And how toxic is this 3rd hand smoke? I read about this a while back as well. In the end, parents that give a damn, will cease smoking, and parents that dont, wont.

    Secondly I'm willing to bet my basement and garage are more "toxic" than those rooms people have been smoking out of the windows of.

    All this reminds me to check the radon levels *yeesh* in the basement and replace the CO detector batteries.

    And yes, when I am smoking cigarettes, I do not notice the smell at all.. and it is strong. But if a smell like cigarettes is making you that ill, then I think the problem is you.

    Personally,I find the smell of alcohol particular bad, but its not something that would make me go around telling people not to drink. I also think most smokers would stop, but sometimes.. you just need one even if it is -20 outside. As far as the war on malodorous smells go, I think BO is a bigger problem.

    -just my 2 cents.

  14. N.P. Odyssey: In my med school, there was a fair number of students that would smoke, and I remember even then, a lot of people would comment how odd it was.

    Tess: Wow, I never heard of that. It doesn't really say what the health risks are of 3rd hand smoke though. Probably not much for people who just have to see some patients who are smokers but maybe more for children of smokers.

    S.b.: I don't love the smell of alcohol either and smoking is certainly not the worst smell I've detected on a patient, however it's the most common destestible smell. It's way way more common for people to walk into a room smelling like smoke..... mostly people aren't drinking enough alcohol midday for that ever to be an issue. And I don't know if it's fair to blame the person who doesn't like the smell.... I personally really don't like it, but I don't get violently ill from it. But there are others with asthma or breathing conditions that I can see getting somewhat sick from it. And unlike other bad smells, it's harder to breathe through your mouth and just ignore it when the smell is smoke.... because it's not the smell so much as the air that's bad.

    Smoking should definitely be banned in restaurants for the reason you said. I was in a bar/restaurant once where the couple at the next table was smoking directly on my food. I was so pissed off, I was tempted to go get some cigarettes and start blowing smoke right on their food when it came, because I had a feeling they wouldn't like it any better.

  15. N.P. Odyssey: if you're a smoker and apply to work at the Cleveland Clinic you're screened for smoking metabolites: "The presence of Cotinine will be confirmed during the post-offer required physical exam. Applicants who test positive for tobacco products will not be considered for employment and will be referred to tobacco cessation resources paid for by Cleveland Clinic. After 90 days, applicants successful in quitting will be encouraged to reapply."

    They also got rid of a McDonalds on the Clinic campus.

    SB, Fizzy - "Having a no smoking section in a restaurant is like having a no peeing section in a pool." [not original with me]

  16. 1. The smokers that smell that way absolutely don't believe it can be as bad as it is, because they can't smell it at ALL. I am a former smoker, and since quitting two years ago am *amazed* at how bad smokers smell to me now. I could not smell it when I smoked and am horrified that I smelled that way to people.

    2. Even if they do know how bad they theoretically smell, smoking (as any other addiction) hijacks the reasoning centers of your brain in order to perpetuate the drug use. I smoked a cigarette right before my first interview for medical school, which was a HORRIBLE idea (knowing theoretically that my interviewer would smell the smoke on me), but I could not stop myself. It's an amazing addiction.

  17. I have a lot of sympathy for people who are smoking because I know it's really an addiction.

    But I much less sympathy for smokers who say it's my problem if I can't stand the smoke.

    It's not me. It's my lungs and I don't get a choice. Just the smell of smoke on someone's clothes has triggered an asthma attack.

    Also, I hate the smoking gauntlet at the hospitals. When I was going to follow-up appts after being hospitalized, the second-hand smoke on the sidewalks was a real problem. I was still doing nebulizer treatments 24/7 just walking to the appt was bad enough, the smoke on top of that presented a real risk of another ER visit for me.

    I don't understand why hospitals think a policy that has all the smokers congregating in public walkways is doing anyone a favor. COPD asthma etc... are common enough, I'm surprised no one thought about how those patients are affected.

    You want to smoke? Fine. But find a way to do it that doesn't put people with respiratory diseases in the hospital.


  18. POP: Yeah, I was on board with S.B. until that comment about how if cigarette smoke makes you ill, that's your problem. A lot of people have serious respiratory issues, and cigarettes are a huge trigger. It's not like people who get sick from cigarettes do so because of some mental hang-up.

    I just find it extremely unpleasant, along the lines of the time I was going into the subway station and I saw a homeless guy masturbating. I'd say smoking and seeing THAT were equally unpleasant.

  19. The big thing about smoke, for me, is the way the stench can transfer from the smoker to me, my clothes, my hair, everything. I once gave a ride to someone who smokes (who did not once light up in the car), and my car smelled smoky for months afterwards. For the first week, the smell would even cling to me after I got out. Yuck.

    And I totally resent when people say it's my problem that it bothers me, too. I have a *very* sensitive sense of smell (and very acute hearing and touch, as well) -- even minor odors like the smell of garlic that lingers on my husband and comes out his pores for 24 hours after he eats Italian food make me feel queasy, but I don't expect other people to change to accommodate my unusual sensitivity. Heavy perfume and smoke, though, linger and cling to me long after the offender has left, which is another thing entirely. I shouldn't be able to identify -- by smell -- that my husband talked to certain perfume-happy and smoking co-workers on a given day!

  20. Hi there, awesome site. I thought the topics you posted on were very interesting

    cheap nolvadex