Tuesday, June 12, 2012

Cigarette Culture of the Middle East Through the Eyes of the Hospital.

Walking around Tel Aviv, you begin to realize that there's basically two things that define Israeli culture. Simply put, you're not Israeli unless you have a daily coffee, and a half pack of cigs. I'd compare Israelis to America in the 80's as far as cigarette habits. While laws were recently passed here to stop smoking in public venues such as bars etc., there really has been no effect, and if anything Israelis have dealt with the law in a distinctly "Israeli" way. For example, there's a bar on Dizengoff Street has a police light that can be triggered by the bar which alerts everyone to toss their cigs when the police come to make their rounds and hand out fines.

This is just the tip of the iceberg however. I'll never forget my first day of physical diagnosis. I was nervous because this was supposed to be the first time I was exposed to patients. I had a good experience that day the first lesson in physical diagnosis was pretty memorable. However for some reason I felt the need to cough every couple of minutes and I couldn't understand why. I thought I smelled cigarette smoke but that just seemed too unlikely, so I ignored it. After several more visits to this ward, I realized this was something that was reoccurring. We were finally introduced to the professor of the ward, who came out of his smokey office to talk to us. I couldn't believe it, the head of our internal ward was habitually smoking cigarettes in his office which was adjacent to several patients. Patients who were on respiratory support, had COPD, and a host of other respiratory conditions that don't do so well when aggravated around smoke. No one cared, this .. apparently is normal in Israel, that's just how things are. (On a side note, there's an extra story worth mentioned about this professor. The ward I was in was known for having a lot of gay doctors. In the 80's my professor was facing the outbreak of HIV in Israel. One of his patients needed to be worked up, he required a list of the patient's sexual partners in order to inform them of their potential exposure. When he looked at the list, sure enough one of the patient's sexual partners was also a sexual partner of my professor. Needless to say the professor checked out clean).

The ubiquitous nature of smoking in the hospital really began to hit me the more time I spent there. When I would come down from the ward I would see a host of patients walking around with their IV-on-wheels in one hand while the other hand they were smoking cigarettes. Sometimes I would notice that the IV was filled with chemotherapy. A cancer patient smoking a cigarette? I couldn't believe it.

In my latest rotation, OBGYN, another shocker, I couldn't believe how many pregnant women were smoking. While there is no documented evidence that smoking causes deformities, it does raise the risk of several life threatening conditions for both the mother and fetus. For example, preterm labor, premature rupture of the membranes (premature water-break), and placental abruption are just a few. I walk out of the OBGYN building everyday to see at least one woman, sometimes several, gathered around smoking cigarettes.

Along the lines of smoking in the hospital, I know of some students who have smoked weed while they are at the hospital. I don't condone this, at all and nor have I ever done this myself, but it does happen, and its a lot more common than you might think. For those of you who are medical students, I can tell you that a former medical student attending a top 3 school, would smoke with several other students before rounding the wards in the hospital. He may or may not have been a co-author of the USMLE First Aid. Pretty crazy to think about. Whether you believe it or not I don't care, I don't have much to lie about or to gain from doing so, but it's definitely true.

I am doing my psych rotation now, and having been there for 2 days, I can tell you that the entire ward stinks of smoke, and most of the schizophrenic patients do as well. In fact, there's a whole reality gating theory that says that nicotine might help psychosis in schizophrenics, and this may be one of the reasons why they smoke more than most other groups of people. Anyways until next post, off to the wards ..


  1. Pretty shocking and hilarious at the same time. Nice to see you posting again. Would love to hear more of these stories. Very interesting.

  2. Thanks for sharing this very interesting post. It is too bad for pregnant wowen to smoke.