Smoking bothers me. Bigots bother me. Liars bother me. Pop music bothers me (yes, pretty much all of it). Trolls bother me. But what bothers me more than most anything else is hypocrisy.
\ (noun): the behaviour of people who do things that they tell other people not to doI will not claim to be completely innocent of hypocrisy, since I eat doughnuts and drink coffee despite knowing it isn't the best breakfast/lunch/dinner/snack for me, and despite telling my patients not to do exactly what I just did 20 minutes prior. And 60 minutes prior. And 4 hours prior. And seven times the previous day.
However, there are some flavours of hypocrisy which I find just completely intolerable:
- A member of Indonesian parliament who was an anti-porn crusader but was caught watching porn in parliament
- A guy who worked at the International Monetary Fund and was later the Secretary of the Treasury of the United States who didn't pay all his taxes
- A judge who ran a successful anti-drunk driving campaign who then drove drunk into a city bus
Meet Dr. Carter (not his real name™).
There were several-dozen surgeons ultimately responsible for my training, Dr. Carter prominently included (for reasons which will become obvious shortly). These men and women were tasked with teaching me how to diagnose surgical diseases, how to operate, when to operate, and when not to operate. In addition to the surgical aspects of medicine, they also taught me the more abstract points of actually being a physician - how to talk to patients, how to break bad news, and (possibly most importantly) how to behave in general. This portion of my education was not done in a classroom, it was only learned by carefully observing their behaviour and emulating the conduct I considered best and most appropriate.
More important than anything else Dr. Carter ever taught me was one very valuable lesson - how not to act.
As a cardiothoracic and vascular surgeon, Dr. Carter was responsible for curing some of the worst diseases in some of the sickest patients - he performed coronary artery bypass grafts, lung resections and pneumonectomies for lung cancer, and lower extremity bypasses for peripheral arterial disease. Some of his patients were actively dying, while most of the rest were passively dying.
My first procedure with Dr. Carter was a short one, an arterio-venous fistula procedure for a patient with kidney failure who needed to start on dialysis. For the entire hour-long procedure I kept smelling the rancid reek of cigarette smoke wafting off the patient, and I distinctly remember thinking that this patient wasn't doing himself any favours by smoking, despite his already-failed kidneys. That may be a slight under-representation of my actual thought, which was much closer to "This fucking moron is actively killing himself! Why bother going through dialysis if he's trying to commit suicide by tobacco?"
That experience shook me and affected me deeply. I worked with Dr. Carter twice more over the next month, and because smoking is a major risk factor for heart disease, and peripheral arterial disease, I was completely unsurprised that both patients had that same familiar odour of cigarette smoke. Of course I had previously seen numerous other smokers in my then-brief medical career, but for some reason these particular events stuck with me and began to colour my future interaction with smokers. Over the ensuing days and weeks I began to ask patients not only if they smoked and how much, but why. Why had they started? Why had they continued? Why hadn't they quit? Weren't they aware of the damage they were doing to literally every single cell in their bodies? I confess I never really got any answers that satisfied my morbid curiosity, so eventually I capitulated and stopped.
About a month later as I was about to rotate off Dr. Carter's service, I was assigned to assist him on a coronary artery bypass graft (in other words I was going to watch carefully and try to stay the hell out of his way). This was an operation I had been looking forward to for the entire rotation, one of the most fascinating operations in existence, and I was giddy at the opportunity. I eagerly scrubbed in and waited for Dr. Carter to arrive. I was somewhat surprised when his patient did not smell of tobacco.
If you can already see the punch line coming, then you're several steps ahead of where I was at that point. M. Night Shyamalan ("Sixth Sense" MNS, not "The Village" MNS) I am not.
When Dr. Carter finally entered, that familiar scent of cigarette smoke entered with him and smacked me across the face. It dawned on me (as it no doubt did on all of you several paragraphs ago) that it hadn't been the patients who had smelled of tobacco smoke, it was Dr. Carter. My mind started racing. How was this possible? This man was responsible for treating lung cancer, coronary artery disease, and peripheral arterial disease - the very diseases directly caused by cigarettes. How could he possibly be a smoker himself? How could he look a patient in the face and tell him he had lung cancer, and yet still smoke?
As if he hadn't surprised me enough at that point, Dr. Carter floored about an hour later. In the middle of the procedure, Dr. Carter paused, looked up, and said (I swear I am not making this up), "I'm going to go get a breath of fresh air". He then broke scrub and walked out of the room.
I looked in bewilderment at the scrub tech, who obviously worked frequently with Dr. Carter, because she simply sighed and rolled her eyes. She clearly saw the look of utter confusion in my eyes, so she explained to me quite simply, "He's going outside for a cigarette". Under my mask she couldn't see my jaw open wide in disbelief. I stood there completely baffled, wondering if that could possibly be true. And about eight minutes later he strolled back in (reeking even worse of cigarette smoke, of course) and completed the operation without mentioning his little break any further.
This event took place very early in my training, so I did not have the guts to confront him about his smoking. By the time I finished my surgical training several years later, he was still smoking, and still taking his "fresh air" breaks.
I happened to run into Dr. Carter at a surgical meeting a few years after this, and I was hopeful that he had broken his habit. As I shook his hand, however, those same acrid fumes greeted me. I saw him get up to leave in the middle of a presentation and return a few minutes later, his air no doubt somewhat fresher.
Maybe I'm wrong. Maybe I'm making a mountain out of a molehill here. Maybe I'm being overly judgmental and a big asshole. Maybe he simply started smoking long ago and has been unable to quit despite numerous attempts.
But maybe not. Maybe he needs to quit no matter what it takes and set a better goddamned example for his patients. Which means I probably shouldn't have a doughnut or three tomorrow for breakfast.