A pregnant woman waddles across the parking lot, balancing her soon-to-be-born child while causally puffing on an extra long cigarette. In an off moment my eyes wander outside. Two senior citizens are making their way to their car. Each is supported by a crutch or two. Their movements are labored yet both are able to balance while lighting a cigarette. Handicapped sit in wheel chairs bound by the unresponsiveness of their extremities but unbridled by their passion to smoke. Parents put their young children in car seats while exhaling a silver gray cloud over them. Adolescents congregate outside of the local theater chatting and branding their tobacco weapons. Our patients report chest pain, difficulty breathing, wounds that fail to heal, sorrowful complexions, lines about their faces, breath that is stagnant with teeth to match and yet are still passionate about their tobacco brands.

We know intuitively that cigarette smoking inappropriate irreparable damage. Toxins that spew out of the lit end promot death not health. Oxygen no longer bathes the nascent human cell and, worse yet, is replaced by carbon monoxide, the very antithesis of well-being. Forget about the cigarettes: save money! Just pucker up to your exhaust pipe. Each cigarette causes vasoconstriction for up to 12 hours, diminishing blood flow, life sustaining oxygen and nutrients, the very essence of what we need to mend our wounds. These vital substations are replaced by over 40 known carcinogens and toxins that most assuredly will be the ruin of skillful surgery; yet we question the responsibility of asking our patients to totally suspend cigarette smoking.

The goal is to promote a salubrious lifestyle through counseling and surgery. Why allow our patients to continue smoking? Endeavor to assist your patients in discontinuing cigarette smoking in the perioperative period. This window of opportunity for a breeze of clean air to fill their lungs is 2-4 weeks before and after surgery. Rather than downsize an operation by offering less than optimal maneuvers, surgery may be deferred or postponed for up to six months, especially when dealing with a facelift or similar procedure that would be potentially jeopardized. The damage that cigarette smoking has reaped is permanent; however, we can minimize the extra risks of combining surgery and smoking by unabashedly insisting on restraint.

There can be no financial incentive high enough to risk an undesired surgical exit and the accompanying disguntled patient that must live with this untoward conclusion. Not to mention the albatross that will swing from your neck until the crisis is resolved to everyone's satisfaction.

Difficult as it may appear to dissuade your patients from smoking, it is the easiest and safest path to follow. Of course, this does require additional time to inform your patients of the harm that smoking will cause and carries the attendant risk of losing these individuals to another physician who has complied standards of care. The misguided impression that even 1 cigarette is acceptable will transfigure the most adept sleight of hand magic into a ghastly headstone memorial.

Our power to motivate these individuals should not be dismissed lightly. We can offer them the initial impetus through our guidance, concern and knowledge. This not only informs them of the dangers of smoking but also allows them to partake in the decision-making and healing process. Some of your patients may bridle at the thought of restricting their choice but most understand that optimal results require a healthy individual.

If our first obligation is to practice exemplary medicine then purveying this message is of the highest priority. I look foreward to the day that signals the end of this scourge and the beginning of a brighter and most assuredly healthy time.