Quite a predicament you're in, @uma1. It does sound like you're facing some difficult choices. My mother had also been a smoker and had to undergo a bronch many years ago so I can relate on some level. This actually occurred after she had voluntarily stopped smoking a few months earlier.

Perhaps the first place to consider is some kind of smoking cessation program because you are correct that smoking will only exacerbate severe COPD in the long run; although it may soothe your nerves in the short term, you've probably found the results aren't lasting. Perhaps that combined with other techniques to help curb your anxiety? Harvard runs an excellent program in mindfulness meditation which might be worthy of exploring.

There are heart attacks called "silent MI's" or myocardial infarctions. These can occur without any traditional symptoms and only show up on subsequent medical tests. You can ask your doctor if this is the kind you may have had.

As far as I know, a biopsy is the traditional "gold standard" for most accurate diagnosis of a lung nodule. Other imaging tests, such as a PET scan, can determine the metabolic activity of a lesion to see if it "might" be a metastasis but it's far less accurate, And having a clear diagnosis is very important in how one goes about determining how to treat the underlying condition.

So it does seem like you do have some difficult choices to make. You are at an center of excellence and appear to be in capable medical hands. You are armed with good knowledge to make informed decisions. It's tough right now but with support and guidance you'll find the direction you need to take the steps to forge the right path going forward for you.