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Late Friday evening, the White House made a mysterious decision to ask for Surgeon General Vivek H. Murthy’s resignation. He was quickly replaced by Rear Adm. Sylvia Trent-Adams and all social media accounts were scrubbed of Dr. Murthy’s presence. It’s unclear what prompted Murthy’s sudden dismissal but one clue could be that he’s not about that vape life.

Surgeon General Trent-Adams is believed to be the first to hold the position without being a medical doctor. She is a nurse who holds a doctorate in philosophy from the University of Maryland. Murthy, a holdover from the Obama administration will continue to serve as a member of the Commissioned Corps. An emailed statement from the U.S. Department of Health and Human Services offered little explanation. It reads:

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Today, Dr. Murthy, the leader of the U.S. Public Health Service Commissioned Corps, was asked to resign from his duties as Surgeon General after assisting in a smooth transition into the new Trump Administration.

It’s not unusual for holdovers from previous administrations to be asked to resign but the Trump administration has famously been slow to nominate replacements so far. It has also drawn controversy over several high-profile dismissals that are still shrouded in scandal. U.S. Attorney Preet Bharara famously refused to resign after he was told that he’d be staying in his position. It later came to light that Bharara was investigating Health and Human Services Secretary Tom Price for potentially illegal stock trading. Acting Attorney General Sally Q. Yates was also controversially fired for refusing to order Justice Department lawyers to defend Trump’s illegal immigration ban.

With no nominee for the surgeon general position, the decision to replace Dr. Murthy certainly raises questions about why he needed to resign so suddenly, late on a Friday when news is often dropped to avoid raising attention.

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Dr. Murthy first generated conservative pushback during his confirmation proceedings when the NRA pushed lawmakers to oppose his nomination because of his willingness to label gun violence as a public health issue. Surgeons general don’t really have much official power and they generally act as a public voice for the medical community. When they stand up against a powerful lobby as a concern for the public’s health, they simply create a bad PR issue and in some cases their opinion might effect lawmaker’s decision making.

Another notable issue that Murthy might have butted heads with the Trump administration on is vaccination. Trump has wavered between saying he was unsure about the safety vaccinations and outright alluding to a link between early vaccinations and autism. Being a man of science, Dr. Murthy has slapped down that notion which is generally understood to be complete nonsense. Murthy even started a campaign with Sesame Street’s Elmo to encourage kids to get vaccinated.

But one bizarre issue that could have alienated Murthy from members of the administration is vaping. Late last year, the surgeon general ruffled some feathers when he released his office’s official report on e-cigarettes. Murthy recommended an effort to reduce the usage of vapes among young people out of fear that the nicotine delivery devices could lead to a relaxed attitude towards smoking and could serve as a gateway to smoking standard cigarettes.

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That might seem like a minor issue but it’s a big frickin’ deal to the influential conservative activist Grover Norquist. When Murthy’s report was issued, Norquist’s powerful foundation Americans for Tax Reform called on Trump to fire the surgeon general. Norquist made headlines back in February when he said, “I think that the next election, at the presidential level, and a lot of other levels, is going to be determined by the vaping community.” The Atlantic spoke with the controversial anti-tax crusader in Washington this week and he continued to hammer on how important an issue e-cigs are. In Norquist’s eyes, vapes are good for public health and eliminating the smoking of “acoustic cigarettes.” He also sees the issue as another example of government intrusion into freedom. “It’s none of the government’s goddamned business if it makes your nose fall off!” he told The Atlantic.

So, maybe the vape life killed Murthy, maybe Health Secretary Tom Price just decided it was time for a change. But if these past few months have taught us anything, decisions like these are rarely innocuous in this administration.

[New York Times, USA Today]