Last summer, I worked in Los Angeles as an emergency medical technician, where textbook health risks became immediate and individual. 

Throughout the experience, my paramedic supervisors and I treated unhoused war veterans, individuals struggling with drug addiction and drivers under the influence. Yet, the patient who most deeply resonated with me was a simple, quiet grandmother. She lived, immobile, in an apartment with her children and granddaughters. As we transported her from the third floor to the ambulance, she coughed and heaved, each breath fighting to escape. 

Her daughter held the woman’s blue-gray, scabby hands and rubbed her swollen legs in comfort while I readjusted her oxygen cylinder. Chronic obstructive pulmonary disease is a progressive, incurable lung disease that makes breathing labored rather than reflexive. Without the metal cylinders habitually supplying her with 100% compressed oxygen, the oxygen circulating in her bloodstream could decrease dangerously, potentially fatally.

The woman, perhaps embarrassed by the commotion of a dozen burly paramedics and burlier firefighters, turned to me and wheezed, “God bless you, sweetheart. May you never smoke.” 

Reading through her medical history — a pack a day since her 20s — I was reminded of the prettiest girls I know, all the way back in my middle school cafeteria: 14-year-olds playing around with their last bites of lunch, chairs scraping against colorful linoleum and their lungs filling with nicotine rather than their stomachs filling with food. 

Nicotine abuse can start casually with ignorant children recreating the habits of self-conscious adults, vaping or smoking to keep from gaining puberty weight, and transforming vice into virtue while smoking’s long-term costs remain deferred. 

Research conducted by epidemiologist Jing Tian at Menzies Institute for Medical Research consistently shows that smokers tend to weigh less than non-smokers because it dulls hunger and allows the body to run on less. Nicotine suppresses appetite and increases energy expenditure, a metabolic sleight of hand that seemingly makes bodies thinner before it then makes them sick. 

According to her article, when nicotine disappears, appetite returns, weight follows and the illusion collapses. Unfortunately, if not fought against, nicotine abuse often ends in dependency and chronic illness. 

Doctors call it being “nic sick” when too much nicotine makes you nauseous — immediate, short-lived and socially understood as “oops, too much.” What we don’t name as sickness is what happens when the nausea never comes — when the damage takes decades to interrupt a life: reduced lung capacity, cardiovascular strain, chronic inflammation and eventually diseases like COPD that turn breathing into a task. 

Los Angeles is one of the most image-obsessed cities in the country, and as an EMT, I see the overdoses and lung disease that coexist with — and often result from — such a focus on beauty. 

For teenagers watching their bodies change in real time, vaping becomes less a drug than a strategy. The girls from my middle school cafeteria are now in college: still thin, model-esque and picture-ready, quick to deny and defend their addiction, each insisting the vape just “helps them digest” or “keeps their appetite in check.” 

According to neuroscientists at UCLA, the continuous feedback loop of likes, compliments and peer validation trains these girls’ behavior: Every inhale seems justified, every calorie avoided is rewarded. Yet the body accumulates what the eye cannot see — decades of strain on the lungs and heart, a slow surrender that begins in adolescence but only becomes visible in later life. 

The constant desire for a “summer body” to match the weather nurtures an appearance-based culture that justifies vaping as a “life hack” and treats the future of chronic illness as an afterthought. 

In that ambulance, I observed the grandmother. She could not breathe without machinery. Her illness was severe but not sudden or dramatic; it was the subtle accumulation of years of nicotine. In her, I saw my friends. 

The bodies that look like the consequences of discipline are actually built on dependency. And such dependency will be rehearsed long before consequences become clear and feel like a disease. After all, regardless of money, status or beauty, physical deterioration is inescapable. 

When your breasts sag, your eyes blur, and your greatest value is in your health and experience rather than your physical appeal, you will come to see clearly what sickness has arrived too late to warn you against. A body built for others’ gazes is not worth the private, permanent struggle to climb a flight of stairs. A body remembers every inhale and every choice, until breath itself becomes the measure of life. 

Soefae Chen is a sophomore writing about health and fitness culture in her column, “Vital Signs,” which runs every other Friday.