In reply to Iainhw: Right, lets get something straight. I think that smoking is one of the greatest curses that we have inflicted on ourselves; it's particularly tragic that 60 - 70 years on from the clearest evidence of harm, that it is increasingly restricted to the less well off, who have enough to deal with is as it is.
A constant theme - which I picked up from the OP and your posts - is 'We can't understand it, we don't do something that might kill us so why do they?' This bafflement, which often has a definite tinge of superiority, is reflected in the NHS anti-smoking schemes, which on the whole seem pretty ineffective at stopping the key demographic - young working class kids - from taking it up.
Your original post used the word 'disbelief' - which to me means you couldn't believe that ... what exactly? Your patient knew why he had had to have surgery; he almost certainly knew the risks he had been running for years. (We certainly knew them when I was a smoker in university in the 70s; that was part of the appeal. Adverts that tell teenagers about the risks they are running completely miss the point - teenagers LIKE running risks.) There would be all sorts of rational calculi he could make for continuing, and a couple of huge incentives: it is an addiction, and it IS massively pleasurable. He'd be wrong, but to me, it's not a hard thing to understand.