"No one ever asked me if I smoked. Not my patients, not my colleagues, not my head nurse. I think everyone preferred not to know." Élise is 29, a nurse in a pulmonology ward for eight years. For eight of those years, she also smoked, secretly, in building C's fire escape stairwell, between patients hospitalized for complications directly linked to tobacco.
The paradox no one ever says out loud
"I spent my days explaining to patients why they needed to quit, with the right words, the right patience, knowing exactly what awaited them if they kept going. And twenty minutes later I'd go downstairs to smoke, hands shaking a little, hoping not to run into anyone." Élise never found that gap that strange at the time, until she actually started thinking about it. "It's a subject nobody talks about in this job, even though we're supposedly the ones best placed to understand it."
I'd counsel patients all day long knowing exactly what awaited them. And twenty minutes later I'd sneak downstairs to smoke, hoping not to run into anyone.
The ward where you treat the very thing you're doing yourself
Working in pulmonology meant seeing, almost daily, patients with COPD (chronic obstructive pulmonary disease, a progressive lung condition often linked to smoking) or lung cancer, often after decades of smoking. "There was a constant gap between what I saw on the scans and what I did myself in that stairwell an hour later. I knew it perfectly well, intellectually. It didn't change the craving at all." That sense of contradiction, far from helping her quit, instead fed a kind of shame that pushed her even further into hiding the cigarette rather than talking about it.
Shift work didn't help. Nights, twelve-hour shifts, sleep schedules shifting week to week: the cigarette had become the one fixed point in days with no regularity at all, the anchor to hold onto when fatigue and the ward's emotional load rose faster than she could handle any other way.
Why hide it, specifically
"It wasn't fear of some internal rule, the hospital never really disciplined anyone over it. It was the look. From patients, who wouldn't have trusted my advice the same way anymore. From colleagues, who I knew wouldn't say anything but would inevitably form a silent judgment." That weight of other people's perception, more than the addiction itself, is why Élise believes so many smoking healthcare workers never bring it up, not even with each other, not even with their own doctor.
The turning point didn't come from a prevention campaign
"What flipped it for me wasn't a poster or a campaign. It was a 41-year-old patient, in palliative care, who caught the smell of stale cigarette smoke on my scrubs one morning while I was helping her sit back up. And yet I was so careful about it: I'd take off my scrubs before going out to smoke, wash my hands two or three times when I came back, always keep gum on me. She told me, very calmly, between two coughing fits: 'You know, you should quit while you still can.' She wasn't lecturing me. She just knew, better than anyone, what it cost not to have quit in time." That sentence, said without a hint of reproach, did more than a year of prevention posters hung in the hospital's hallways.
Today, eighteen months without a cigarette
Élise hasn't changed her job or her hours: she still works nights, in the same ward. What changed is what she does during her break, and the fact that she now talks about it openly with a few colleagues, two of whom have since started their own attempts to quit. "I don't feel like I have to lie about what I'm doing in that stairwell anymore. That might actually be the real relief." She also finally got support, later than she'd have liked, from a smoking cessation specialist at her own hospital, a resource she'd been recommending to her patients for years without ever considering it for herself.
