Of all the changes from a Youth Inpatient Unit to an Adult Unit, the one change that is most distressing to me is patients’ addictions to nicotine. Many patients who are transferred to this new unit from other community hospitals are most concerned about whether they will be able to smoke.

As a Youth Psychiatrist, it is customary for me to ask patients at the onset of care whether they smoke. While youth do use nicotine, many more who say they are smoking are primarily using marijuana. It is not usual to have to discuss with youth patients daily why it is not possible for them to smoke, and I have never heard them characterize smoking cigarettes as a right. With the adult patients that I see who are addicted to nicotine, asking to smoke and insisting that it’s a right happens at least daily.

While I know that nicotine causes a strong addiction theoretically, it’s good to be reminded so forcefully of that fact. All these adults desperate to smoke has been a real eye-opener for me – especially since they sound so much like adolescents in their persistence and their assertion of their “rights”.

I also learned quickly that, if I try to have a “health discussion” about the risks of smoking and nicotine addiction, I am shut down, told by my patient that they’ve “heard it all before” or that they’re “not dead yet”. What is most disconcerting is that it seems as though no one has even the smallest concerns about the health risks of smoking.

There is so much evidence that smoking is harmful for health and we have handouts that are very understandable to provide to people. No one is interested.

I just cannot understand it.

(This statue stands in Khabarovsk, Russia. It is a monument to help people stop smoking. This explains a bit more and has the photo credit.)


2 thoughts on “My COVID-19 Journal – Day 56

  1. drgailbeck says:

    Thank you for this reminder, Katherine.

  2. Katherine says:

    At the hospice where I volunteered, we used to be able to push patients out for a smoke just outside the door on a patio. I remember being very surprised that that was one of my tasks. But I worked hard to move beyond my judgement as I did around alcoholic abuse. Granted, these people were dying and a few cigarettes would make no difference to that. But more to the point, to be fully present with each patient, I had to let go of judgement and be with them. As they were.

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