I've had many but the one that comes to mind is a woman in her early sixties with end stage ca of the lungs.She had a trach previously-now just an opening in her throat. On rounds, I found her sitting up in bed smoking a cigarette through the opening in her throat. I was too shocked to speak. She said to me "I might as well smoke it doesn't matter now"

I would have been speechless too. I like when patients go outside to smoke wiith their IV's etc. Especially when they say they are in the hospital for something like COPD.