"Not too well, actually," said my friend Colin when I asked him how he was doing.
That surprised me, coming from him. Colin's an oncologist with a pretty successful practice, and he learned long ago to steer conversations away from any path that might work its way around to the comparing of symptoms and dispensing free medical advice. He was having a Greek salad while I enjoyed a steak. I'd started to suspect something was on his mind when he failed to make any cholesterol jokes.
"This guy came in for tests a couple weeks ago," Colin said, "and I gave him the whole battery. Turned out he's got lung cancer. Pretty far advanced. Not a death sentence necessarily, but serious.
"But it was how he reacted to the news that threw me for a loop."
"Well, denial's the first stage, isn't it?" I asked.
"Yeah, I see that all the time. But this one took me by surprise. The guy says, 'No. I refuse to accept this diagnosis.'
"So I went into my speech. 'You need to take some time,' I told him. 'Talk to your family. I expect you'll want a second opinion, and I can recommend some names if you'd like me to. But the tests don't lie. You've got a fighting chance, thanks to new therapies, but you're in for a rough time. First thing you'll have to do is stop smoking.'
"And he says, 'I knew you'd say that, and that's the main thing I won't accept. I tried to stop smoking for years, felt guilty about it, beat myself up over it. But recently I've come to accept the fact that I was born to be a smoker. I read that geneticists have identified a DNA marker for people who can't stop smoking. I'm confident I'm one of those people. I'm a smoker, that's what I was meant to be, and I take pride in it. I demand respect for my lifestyle.
"'I'm a Christian. If God created me to be a smoker, I don't believe there's any point trying to hide in a closet and pretend to be what I'm not. And since God is love, I can't believe He'd punish me with a deadly disease just for a little thing like a cigarette. My God wouldn't do that. So maybe I have cancer, but I refuse to accept your judgmentalism about my smoking.'"
"Wow," I said to Colin. "That's a new one."
"That's just the beginning. The other day I got a letter from his lawyer. They're suing me for violating his civil rights. They said I caused him profound mental suffering through imposing my personal beliefs on him and trying to make him change his essential lifestyle. They're accusing me of 'fumophobia.'"
"They're arguing it's a hate crime."
I said something about finding this hard to believe.
"I don't know," Colin said. "When you think about it, what right do I have to force my beliefs down his throat?"
"Well, you're a licensed physician who's spent years studying cancer and trying to save lives. It's kind of your job."
"Yeah, but what if somebody doesn't actually want to live a long time? I've worked all my life on the assumption that helping people live healthy lives, as long as possible, is a good thing. But who am I to say? If this patient wants to enjoy his nicotine and check out early, isn't that his call? Frankly, I'm rethinking my whole career. Maybe I need to find another specialty. Something more in tune with the times."
"Like what?" I asked.
"I dunno. Elective amputation, maybe. Or assisted suicide. They say those are coming fields."
(Author's note: For reasons of privacy, I have changed "Colin's" name. As well as the facts.)
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