One night, during my rotation through the Emergency Room, a woman in great pain arrived. She had a chronic condition in an acute flare. She was transported in by ambulance and while she appeared to be in pain, she was able to convey to the attending Physician what was wrong. While witnessing her intake I was keenly aware of a distinct odor. When the patient’s husband and mother rushed into the room to be by her side, the smell became overwhelming. The Physician quickly wrapped up the intake, we stepped out of the room and as if on cue, we both took in a deep sterile breath.
He said to me “you’d think that at this point people would realize how detrimental smoking cigarettes are to their health.” We quickly moved on to the next triage room.
His statement tugged at me. I agreed. You would think…
Later that evening the patient, still in acute pain, had another request: Two nicotine patches to hold her over. The doctor obliged.
If you entered a hospital in the 1960’s, 1970’s or even the 1980’s you would find cigarettes sold in gift shops and you would likely see plumes of smoke coming from waiting rooms. Hospital staff and Hospital directors smoked. It was a common practice until the early 1990’s when regulations changed. While the number of health care professionals who smoke has dropped, you will still find patients smoking in parking areas or near doorways. According to Dr. Steven A. Schroeder’s recent editorial in the Archives of Internal Medicine, one in five smokers admitted to the hospital continue to smoke during their stay.
While some patients are more motivated to stay away from the sticks while in the hospital, mainly cardiac patients, others are not. Patients with long term hospital stays are more likely to continue smoking and those who are in hospital with strict policy regarding where they can smoke, will leave the premise if necessary.
Dr. Schroeder also pointed out that the intensity of one’s craving was a better predictor of whether or not a patient would smoke during hospitalization, not the number of cigarettes they typically smoked. Hospital cessation programs and counseling is key to helping these patients through their hospital stays and towards the patient of quitting.
Although a nicotine patch in the ER might not seem like the most important priority, it serves a purpose, and plays a role in providing appropriate care. As I walked to my car at 5 am that morning, I caught a hint of something in the air. I started my car and my eyes caught someone tucked away in a cold corner on the side of the building. I saw our patient’s husband lighting up.
New York Times, When Hospital Patients Continue to Smoke