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It seems the cigarette smoking is catching up with him. He seems pretty knackered now.
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Yup, apparantly he has regualr coughing fits and the likes
EDIT: Saying that it looks like something is helping him get over it, an injection of some sort.
It's also strange to see Snake using a knife, he specifically says in MGS2 that he's not a fan of blades. It all seems very... Big Boss.