every cigarette is doing you damage...

... or so they say. now as a medical student, i am supposed to know the evils of tobacco smoking like the back of my hands. and in a way, i do. i know bits and pieces about the pathophysiology of atherosclerosis, emphysema, and cancer; i've heard the condemning epidemiology to death; and i've met and known patients suffering and dying because of their smoking. but even though i know all this, somehow i am still in the precontemplation stage of change.

i think there are three main reasons why this had been so. firstly, i've always thought doctors should not preach to their patients. nor should they lead by example. for after all, they are human beings just like their patients, not some perfect example of a healthy human being. as we all know, this is so far from the truth it's not funny. if you want an example, get to know some physios *grins... ahh, what a good time rapp was* patients should know the facts, and make up their own mind. i think some people call it informed consent. i call it taking responsibility for your own life. secondly, i don't think i really have full insight into what is going on. psychiatrists talk about several levels of insight. the highest level is emotional insight, when you not only understand what is going on, but you feel it and actively pursue a particular course of action. the next level is intellectual insight, when you understand what is going on, and you follow a particular course of action, because of secondary gains. i think my insight into this smoking business is the same. while i understand that smoking causes bad things, somehow i don't really believe it. i suppose it's because i'm not really a logical person, like galaxy or mike - but more of an emotional blob. maybe all that i need to become a believer is the first patient i take care of as an intern who has COAD. thirdly, i enjoy smoking. i don't want to quit. i don't think i'm addicted - but of course i don't know for sure. the last time i stopped smoking for an extended period of time was for ten weeks at the beginning of the year, when i was doing my electives in taiwan. i felt like a smoke a few times, but it didn't really bother me that much. when i got back to australia i started again, for no other reason but because i enjoy it.

yesterday i was having a smoke with dunno outside in our smoking chairs. he was talking about getting some nicotine patches, gum and flavoured tooth picks. he was talking about quitting and doing more exercise and sorting out his job and saving money and getting a chick. dunno talks about a lot of things - mostly crap. he's being doing it for years (sorry dunno but you know it's true). but yesterday he seemed more ernest than ever. he was even applying the fundamental concepts of behaviour therapy without knowing it (when you feel like a smoke, you come out here, sit in the chair, chew gum. but only out here. not anywhere else). so i said fine i'll quit as well, just to make things easier for you. i'm always making impulsive decisions like this (like that time i said i'd jump into the pool in the middle of winter if thommo did it - oh boy was i sorry). so all of a sudden i've shifted gears from precontemplation to action, skipping through contemplation and planning (doesn't this mean i'm bound to fail?), and chewing gum with a hell-bent intensity of withdrawal. i guess i was addicted after all. maybe i should stop smoking and clean up my system, at least for a while. but the real test will come when i am worrying about my ballarat interview on monday morning, and when brumbles or anyone else asks me to have a smoke with them. only time will tell if i have truly quit for good, or just around dunno.