"I'm not sorry I have COPD," she said

"You don't know what it's like to sleep in these beds," Mrs. Patient said, and smiled. It was the first time I had seen her smile in the two days I had taken care of her.

"You might be surprised," I said, preparing my syringe to draw my a.m. ABG.

"How could you possibly know what it's like to sleep on these uncomfortable mattresses?" She was admitted with exacerbation of COPD, and had been requiring a bronchodilator at least every two hours until today. She was looking pretty comfortable all slouched down there on the bed.

"You might be surprised. "I grabbed her hand, knelt alongside her and held her hand, feeling for her pulse.

"Usually they get it on the other hand. They keep missing on that one."

" I feel a great pulse here." I uncapped the syringe.

"Okay, I'm ready." I'm not poking you yet. I'll warn you when I'm ready."

She relaxed and smiled again. "So what did you mean I might be surprised."

"Because I slept in this very bed in December. I know how uncomfortable it is first hand." The needle pierced the skin. She did not flinch.

"You did, really?"

As she pondered that, I watched as the blood flowed quickly and smoothly into the syringe. I pulled out the needle and held her wrist with a pad of white gauze. "Yeah. I know exactly what these beds are like."

"What was wrong with you."

"A bleeding ulcer."

"How bad was it that you had to be admitted?"

"I lost four units."

"Oh, I guess that's bad. How does a young man like you get an ulcer?"

"It was probably secondary to asthma medications, I guess. Or a bacteria. No one really knows for sure."

"Oh, you have asthma."

"Yeah, I've spent my fair share of time in hospitals for it, but not in the last ten years." I removed the gauze. She was still bleeding a little. I held pressure again.

"Oh, I'm sorry."

"I'm not. I wouldn't have this job, and I wouldn't have my wife, and I certainly wouldn't enjoy writing if I didn't have asthma."

"That's a good attitude. You know what, I'm not either. I mean, about my COPD. I'm not sorry I have COPD." She smiled. "There's people who have it a lot worse than I do."

I didn't say anything to that for a few minutes. I thought of the irony of that statement. Here she was knowing she may never breath normal again, and probably will spend the rest of her life thinking about every breath, and she says she doesn't feel sorry for herself, that there are people far worse than her.

Finally I broke the silence. "I love that attitude in a patient."

She smiled. "You didn't get bad lungs because you smoked, right?"

"That's correct." I plastered a bandage over the gauze and stuck it on tight. "All done."

"That didn't even hurt at all," she said, looking down at her wrist.

"Thanks."

I grabbed the capped syringe and got up to go. She said, "I made myself this way. I destroyed my own lungs."

"When did you start?"

"When I was 17. I quit for five years believe it or not, then I started up again and smoked for 40 years. How stupid was that?"

"To your defense, though, back when you started you probably didn't hear all the time how bad cigarettes were for you."

"On the contrary. You had doctors on commercials talking about how cool it was to smoke."

I chuckled. "On the other hand, kids today know of the dangers, and they still smoke. Most kids just think they'll live forever."

"True."

"You probably would have smoked regardless too, hey?"

She smiled. "You know what, you're probably right there."

I've have this type of discussion with a patient from time to time, almost to the point I know exactly what to say; what they want to hear; how far I can push them. Especially when I'm tired at five in the morning I'm not shy about sharing my experiences with my patients, and getting them to share their experiences.

Perhaps we both get some solace out of it.

"Is there anything I can get for you before I leave?"

"No," she said. "But you could take a picture of me as I lie here in this bed and send it to someone who's thinking about smoking. Maybe they'd think twice."

"I doubt they'd think twice,"I said, jokingly

"I doubt it too."