Smoke on the water

I am a smoker. I started smoking at school and developed a 30-a-day habit at medical school. I gave up in May 2000 and didn't touch a cigarette for six and a half years, but then at the end of 2006 I suddenly started smoking when I was drunk and out with friends who smoked. A bad day in November made me think it was a good idea to buy a pack of twenty and I've been smoking ten a day ever since. I did try to give up around New Year but soon started again. The trouble is, I enjoy it. I like the solitude and space that going out for a 'fag break' brings. It also confers a kind of weird solidarity between fellow smoking pariahs - for example, I went on a PACES course recently and found myself chatting to a man with Eisenmenger's syndrome and an acromegalic while we stood outside having a quick fag.

I don't like the smell, which sticks to my clothes and hair and makes my breath like an ashtray. My boyfriend hates it. And there is, of course, the whole lung cancer thing. I don't know whether the large warnings on cigarette packets actually deter anyone from smoking - I can't imagine anyone asking for twenty Marlboro lights and then saying to the sales clerk, 'Oh my God, it says 'SMOKING KILLS' on the packet. I had no idea. I won't buy them after all.'.

I am giving up, for real this time, on the day of my PACES exam. After the exam, of course. There will be a lot of drinking and celebrating the week after, which may throw a spanner in the works as it did in January. But we shall see. I can't be arsed with patches or gum or anything. When you haven't smoked for very long the physical withdrawal symptoms aren't really too bad, and are over within 48-72 hours. I think nicotine replacement just prolongs the withdrawal period. It's the psychological side of things that's the real bugger - you want to want one. Especially after a few glasses of wine.

I can't carry on like this though. It really does get to my boyfriend, who is vehemently anti-smoking. He's also a doctor and therefore knows as much as I do about the health risks and has probably treated more lung cancer patients than I have.

I'm not sure what I make of the upcoming anti-smoking legislation. It will be nice to come back from the pub and not stink of smoke. I'm not sure if it extends to smoking in the street - I think that would be a little Draconian to say the least. Our hospital Trust is now 'smoke-free', so we have to either be discreet or walk off hospital grounds to smoke. I do agree with it in a way - it probably helps patients who've come in with a heart attack to stop if they don't see a gaggle of nurses standing outside puffing away. I do think it's cruel, however, to force terminally ill patients to stop. What is the point? We are very bad at providing nicotine replacement to these patients, many of whom have smoked for years and therefore have nasty withdrawal symptoms. We are rather good at treating alcoholics with withdrawal from booze, so why not smokers? It is nigh on impossible to get nicotine replacement from the hospital Pharmacy - we tend to ask patients' relatives to bring it in. I think that's disgraceful.

Anyway, seven days til I give up. I don't want to end up as a pink puffer or a blue bloater. I don't want to exsanguinate horribly from an eroding bronchial carcinoma (I've seen that happen - it is not nice). If I give up now and don't start again, I have a good chance of not getting any of the above. Of course, I may already have contributed to my ischaemic heart disease (particularly in view of my family history), but that should reverse itself in time. I will be able to tell patients they should give up smoking without being a hypocrite.

Oh, did I mention I want to be an oncologist when I grow up? Smoking is most definitely not part of the plan.