There's a strange, discordant pathology to the state of being stuck. Nobody who starts smoking plans to be hooked for life. Nobody who's obese secretly wants to stay that way. When a doctor or family member pleads with us to make lifesaving changes, we mean it when we say, 'I know, I know, I should, I will'. What's left unsaid is the killer caveat: 'Just not today'. Over the years, I have had more conversations like this with patients than I can count, so many that the phrase 'I know I should' has become a red flag - a sad predictor that I will probably one day crack open those patients' sternums in the operating room, trying to undo the damage that poor choices and unhealthy lifestyles have done to their hearts.