As a surgeon, I have witnessed firsthand the devastating effects of tobacco use, and today, I want to share some deeper insights and reflections that might encourage some to make different choices. Let me briefly mention that I once smoked myself, primarily during my time in the Navy in nuclear power school and aboard an aircraft carrier. Fortunately, I successfully quit almost twenty years ago, but this personal experience deepened my perspective on the ethical concept of patient autonomy.
Patient autonomy is fundamentally about informed decision-making concerning one’s health. Early in my healthcare journey, while volunteering in an emergency department, I encountered a patient being discharged following severe respiratory distress related to smoking. As I wheeled him outside, connected to his oxygen cylinder, he promptly lit a cigarette. I passionately urged him to quit smoking, believing it was my duty to guide him towards better health. His respectful yet firm reply, that he fully understood the risks but chose to continue smoking, struck me profoundly. To him, the joy he received from smoking outweighed the massive benefits of quitting. Autonomy hinges on informed consent, requiring complete transparency about the risks, benefits, and alternatives involved.
The body’s remarkable capacity to recover means it’s never too late. In fact, healing begins almost immediately
It wasn’t until medical school that I began to appreciate the plethora of risks, far beyond my pre-medicine understanding, that smoking creates. Further, it wasn’t until I had performed dozens of amputations and cancer operations, as well as denied patients elective surgeries because of their smoking-related deficiency in functional capacity, that I truly understood the risks of smoking. First, tobacco is a potent carcinogen linked to multiple cancers everywhere that the smoke and swallowed smoke particles touch, including those of the lung, throat, mouth, esophagus, pancreas, kidney, bladder, and cervix. Second, smoking leads to profound vasoconstriction (blood vessel narrowing) and triggers chronic inflammation, accelerating the progression of atherosclerosis, a process that dangerously hardens and thickens all arteries throughout your body.
The atherosclerotic plaques dramatically raise the risk of stroke, potentially causing severe and irreversible consequences, including loss of control of bodily functions, cognitive decline, immobility, and heartbreaking inability to recognize close family members. Cardiac outcomes include sudden and debilitating heart attacks, often striking individuals far younger than one might expect. Lung-related impacts of smoking are particularly grim: persistent fear of lung cancer, continuous reliance on oxygen tanks, severe limitations on physical activities, and episodes of spontaneous pneumothorax, which can lead to invasive interventions like chest tube insertion and, of course, cancer.
Your other organ systems are also vulnerable. Beyond the elevated risk of cancer throughout the entire gastrointestinal tract, smoking significantly increases the risk of mesenteric ischemia, a painful and life-threatening condition marked by death of intestinal tissue, causing excruciating abdominal pain and demanding immediate surgical intervention. The risk of peptic ulcers is dramatically increased due to the altered blood flow to the stomach’s protective lining. The relaxation of the lower esophageal sphincter exacerbates esophageal reflux. Erectile dysfunction is common, resulting from compromised blood flow; again, a direct consequence of vascular damage. Poor circulation to the lower extremities leads to chronic wounds, difficult-to-treat infections, and sometimes necessary amputations. The risk is so pronounced in smokers with diabetes that severe vascular complications become almost inevitable. Indeed, vascular surgeons, despite their advanced skills, frequently manage catastrophic complications directly tied to tobacco-induced arterial damage. These arteries become brittle and so calcified that they visibly look like bone on X-rays, feel crunchy, and are very fragile during surgery.
Responsible surgeons will insist that patients cease smoking before elective procedures. Tobacco use dramatically impairs healing due to reduced oxygen supply and impaired immune response, risking surgical wounds that fail to heal properly. Intestinal surgeries pose an elevated risk; critical connections (anastomoses) are prone to breakdown, increasing the chance of life-threatening complications such as abdominal sepsis. Choosing to perform elective surgeries without addressing smoking as a modifiable risk is, therefore, medically negligent.
At UIHS, your health and well-being genuinely matter to us. Although quitting tobacco is undeniably challenging and requires significant personal commitment, the rewards are immense. The body’s remarkable capacity to recover means it’s never too late. In fact, healing begins almost immediately: within 20 minutes, your heart rate and blood pressure drop toward normal; within a day, oxygen delivery improves as carbon monoxide clears; within weeks, your circulation and lung capacity strengthen; and within months, coughing and breathlessness ease. At one year, your risk of heart attack is cut in half. By five years, your stroke risk can return to that of a non-smoker, and at ten years, your chance of dying from lung cancer is reduced by about half. At fifteen years, your risk of heart disease is nearly identical to that of someone who never smoked. With the proper support, many of smoking’s harms can be substantially reversed. Take charge of your health today, and embrace the fulfilling, healthy life you deserve.