I can sympathize even though all my working time was spent in a hospital. I will never get the image of a trach patient sitting in the smoking area holding a cigarette to his trach smoking away. Another patient had been ventilator dependant for over four years. Ater working with him for six plus months to wean him from the vent, he was sent to a regular room. He still had his trach. Within a week he was found dead in a bathroom with Camels all around him. After not smoking for at least five years, one of the first things he did was to get one of his buddies to go buy him a carton. Go figure.