"So who will be the surgeon fixing her heart valve?" -- family of 104 year-old patient found to have a murmur on exam. The conversation about how she would not be considered an operative candidate even if I found something on an ultrasound of the heart did not sit well with them.
Me: "Sir, if you don't mind me asking, how is it possible that you are still smoking? Your lungs are terrible. I can't believe that you could even inhale the smoke."
Patient: "I go outside to smoke and put my inhaler in one hand and the cigarette in the other. Sometimes I stick the cigarette in through the hole in the mask of my nebulizer and smoke while it's running."