A doctor, newly minted from medical school and nervous as could be, stepped into the examination room to talk to his first patient. The wizened old man smiled at him from the exam table.

“Awful nice to have a new doctor,” he said. “Maybe you can fix me up!”

“What seems to be the problem?” the doctor asked.

“Well, my fingernails are just so yellow lately. I’ve tried lots of things to fix it, but nothing seems to help.”

“Let me take a look.” The doctor examines the man’s hands. His nails were certainly discolored, and after some thought, he prescribed a special soap. “It’s probably something you’re touching. You should pay attention to the things you handle from now on, and I’ll help you figure out the source of the stain.”

At his next checkup, the patient was a little frustrated.

“My nails are still yellow!” he said. The doctor questioned his patient about what he touched every day and asked if he was using the soap.

“Oh, I use it sometimes. It just makes the yellow look worse to me. I don’t think you’ve given me the right medicine.”

The young physician nodded and wrote him a new script for a stronger soap. He was puzzled as to what the patient might be doing to cause the stains but hoped the new soap would do the trick.

It didn’t. A short while later the patient was back in his clinic.

“Well, my nails aren’t getting any better,” the patient huffed. “And you know, I noticed yesterday that my teeth are yellow too!”

“Let me see,” the doctor said. His teeth were discolored, and the man’s gums looked red and inflamed. After some thought, he prescribed an antibiotic to address what seemed to be an angry infection. “Have you used your soap consistently?”

“The soap is useless. It doesn’t work at all. You need to find me something else.”

The doctor tried several other soaps, creams, and prescriptions. Worrying that he could not help his patient began to keep him up at night. He got out all his medical books to look for clues to a diagnosis, but without fail the patient returned with the same symptoms and growing more frustrated and sick with every visit.

“Are you even trying to fix my problems?” the patient grumbled. He coughed into a handkerchief and glared at the doctor. “Now I’m coughing every day. I think you’re making me worse!”

“Coughing? That’s a new symptom.” The doctor listened to the patient’s chest and heard rattles and wheezes. “Take a deep breath for me.”

The patient fell into a coughing spell, and a familiar smell engulfed the doctor. Suddenly, the puzzle pieces fell together in the doctor’s head. Yellow fingernails, yellow teeth, sore gums, a deep hacking cough, and that smell, covered before by cologne and peppermints, but now unmistakable.

“Sir…” he said, feeling a little sheepish, “do you smoke?”

“Of course I smoke!” the patient coughed. “For as long as I can remember! Now are you going to fix all these problems or what?”

The doctor sat down on the stool in the front of his patient and spoke as gently as he could.

“Sir, your cigarettes are the problem. Every symptom we’ve been fighting comes out of a lifetime of smoking. I’m sorry I didn’t think to ask before if you smoked, but if you want to get well, you have to stop.”

The man turned purple with rage.

“How dare you! I’ve been smoking since before you were born, son, and I have never had a problem. At least until you came along!”

“But sir, your cough, the stains, your teeth. It all comes from the cigarettes!”

“Listen, you. All my problems started when you became my doctor! I can’t believe you’d dare try to blame me for all these things that are wrong,” In a fury, the man pulled a cigarette out of a box in his pocket and lit it. He blew a puff of smoke in the young doctor’s face. “I think it’s obvious I need a new doctor.”

The young doctor stared at his patient in shock.

“Sir, what you need is to stop smoking. It is rotting you from the inside out and may give you cancer if it hasn’t already. I’m trying to save your life!”

“You’re trying to cover up your incompetence. You don’t know what is wrong with me or how to fix it, so you’re blaming it on me. I’ve had enough. I want a new doctor. One who knows what he is doing and treats me with more respect. Get out!”

The doctor left the exam room and walked slowly down the hall of the clinic to his office. He sat down behind his desk still stinging from the man’s words. Was he really incompetent? He had worked so hard in medical school, but now he felt completely clueless and unprepared. The signs were obvious now, and he felt foolish that he hadn’t noticed what the problem was sooner. But more than his own mistakes, his patient’s words rang in his ears: I can’t believe you’d dare try to blame me for all these things that are wrong. I want a new doctor. One who knows what he is doing and treats me with more respect.

He leaned back in his chair and stared at the ceiling, the smell of cigarette smoke still lingering on his coat. He wondered how he could have missed such an obvious cause of illness. Had the patient hid it that well, or was he incompetent? Doubt wormed down deep into his heart, and he rubbed his face with his hands.

“Well,” he whispered. “Maybe I need to do to something else.”