I’ll be one of the first to admit that I tend to have absolutely no sympathy with smokers, judge them very harshly, and I’m just all around very rude and not understanding to them. I realized this was going to be a problem when I was shadowing in cardiothoracic surgery a few years ago because, well, there’s just a ton of patients I’ll get who will be smokers, and as their doctor, I can’t be nasty with them. So I always knew this would be difficult. Our first week in the pulm unit, we had a class on smoking cessation beginning with a patient presentation. I remember thinking that when they told us they’d bring in a smoker, I was very disgruntled, wondering what a smoker had to offer to a presentation when it’s really easy to find a smoker. What new information would this person provide?
Well, she was a quitter. And I guess that didn’t do much for me at first, but the more I listened to her talk, the more I realized how wrong I am/was about smokers. Granted, smoking is still terrible for your health. And you still should not start it. But I guess I always just approached the quitting part in a way that wasn’t conducive to anyone quitting at all, which makes me think back to a bunch of people I “defriended” because of their smoking habits. One of my classmates asked our patient what it feels like to try to quit, what a nicotine craving really is like, and she couldn’t really tell us except that she just wanted to smoke whenever she needed to cope with something stressful. I’m sure I’ve heard something like that before but this time my perspective changed. Maybe it’s because I’ve started to realize more of my own unhealthy coping mechanisms, but in that moment I suddenly felt a big burst of empathy for smokers (I know, I can’t believe I’m saying that too). It’s really hard when you’re in that moment to try to convince yourself out of your unhealthy habit — you know it’s irrational, you know it’s unhealthy, you know that in any other normal state of mind you wouldn’t want to do this, and yet you still do. I’ve struggled with my own demons for years, and it’s HARD. Even now, after seeing a psychiatrist and therapist, I still have my relapse days. And as we learned in psych, mine is based on neural circuits that I’ve ingrained since I was a child. So how different is that really from the smoker whose own neural pathway is also messed up, telling him/her to just get that burst of relief and calmness and happiness from the cigarette?
So I’m glad I actually had that interview in the end. Next week we’re supposed to practice motivational interviewing, something I was initially dreading because I didn’t think I could pull off acting sympathy. Well now I know I won’t have to because I really do get it, I think. And I’m glad that I’m learning more about what it feels like to be the patient (hah, as if I don’t have enough experience with that).