Former surgeon general Jerome Adams and his wife, Lacey, often find themselves talking about what they have named the "Trump Effect."

It followed them from Washington to their home in the Indianapolis suburbs. They felt it when he was exploring jobs in academia, where he would receive polite rejections from university officials who worried that someone who served in the administration of the former president would be badly received by their left-leaning student bodies. They felt it when corporations decided he was too tainted to employ.

Now, two years after Adams left office as only the 20th surgeon general in U.S. history, the couple feel it as acutely as ever. As Donald Trump announced this month that he will run for president again, they had hoped it all would have faded away by now.

They would rather talk about public health, in a very personal way. This summer, Lacey Adams was diagnosed with a third recurrence of melanoma. Both Adamses have been sharing her experiences on social media and in public appearances, hoping to spread a message about skin-cancer prevention. But the stigma of his association with Trump, even though neither of them is a supporter of his political campaign, remains.

Trump is "a force that really does take the air out of the room," Adams, 48, said. "The Trump hangover is still impacting me in significant ways." He said the 2024 Trump campaign "will make things more difficult for me."

The former surgeon general's predicament underscores one of the givens of today's political environment: Association with Trump becomes a permanent tarnish, a kind of reverse Midas touch. Whether indicted or shunned or marginalized, a cavalcade of former Trump World figures have foundered in the aftermath of one of the more chaotic presidencies in modern American history.

Lacey saw it coming. She said she "hated Trump" and did not want her husband to leave his comfortable life in Indiana, where he practiced anesthesiology and served as state health commissioner under then-Indiana governor Mike Pence, who was Trump's vice president when Jerome became surgeon general. Lacey, 46, worried about a lasting "stigma" but her husband talked her into supporting their move by saying he thought he could make a bigger difference inside the administration than outside it, especially when it came to his efforts to combat opioid addiction.

Now Jerome bristles at his forever label as "Trump's surgeon general," an image sealed by his highly public role during the much-criticized early White House response to the coronavirus pandemic. Other surgeons general, he feels, have been less intensely identified with the president who appointed them, permitting them to glide into a life of prestigious and sometimes lucrative opportunities, unencumbered by partisan politics.

Not him. "It was a lot harder than he thought to find a landing spot because of the Trump Effect," Lacey said. For eight months after leaving office, Jerome could not find a job. The couple started to worry about how they would support their three children, especially since Lacey does not work outside the home.

"People still are afraid to touch anything that is associated with Trump," Jerome said. Though he was quick to add in the interview that he is "not complaining." He added, "It is context."

Finally, in September 2021, Purdue University President Mitch Daniels, a former Indiana governor and Republican stalwart, hired Adams as the first executive director of health equity initiatives at the school.

Even as Adams was seeking to define the next chapter of his life, he was engaged in an almost constant battle on social media. His frequent tweets about everything from his personal life to public health issues have invariably drawn attacks from both the right and the left. Rather than ignore his critics, he has often punched back, engaging in Twitter spats that stretch for days.

He has battled on social media over his recommendation that people continue to wear masks in crowded indoor settings, his criticism of President Biden's declaration of an end to the pandemic and about his advocacy for coronavirus vaccinations for children and for adults to get booster shots. He takes heat from the left for a pro-life stance on abortion and from the right for his opposition to laws that dictate what a doctor can say to a patient about abortion.

"I get mad at him for being addicted to Twitter," Lacey said. "People hated him because he was part of Trump's administration. Now the Trump people hate him."

Carrie Benton, an Ohio medical lab scientist who has tangled with Jerome Adams on social media, is critical of what she considers "blanket statements" he is now making about topics such as masking. But she also feels he should still be held accountable for errors committed by the Trump administration early in the pandemic.

The pushback has done little to dissuade Adams. He invites debate. He wants to argue, genially. He tries to search for ways to use his platform as a former surgeon general that do not turn into politically charged spats.

"It is hard to find an issue," he said.

In August, an issue found him, and it was precisely the topic that he had hoped would not feel so personal anymore. During a routine follow-up check, doctors discovered tumors on the outside of Lacey's right thigh.

"Here we go again," Lacey said to herself.

She had first been diagnosed with melanoma 12 years ago, in 2010, when she spotted a "weird mole." She had it removed. She thought she was in the clear.

"No big deal," she said.

As an adolescent growing up in the Midwest, she had been a frequent visitor to tanning beds. She did not worry much about the sun, even though she is very light-skinned. After having the mole removed, she changed her ways. Sunscreen. Long sleeves. She joked that her mother would chase her around with floppy hats. She started getting regular dermatology checks. It was all good. Until it was not.

In early 2018, just as her anesthesiologist husband was starting as surgeon general under Trump, she noticed lumps on her groin while shaving her bikini line. The doctor in her house, newly minted as America's doctor, was constantly on the go as he sought to get a grasp on his job, serving as a public health advocate and overseeing thousands of members of the U.S. Public Health Service Commissioned Corps. "The doctor in my house is my absent-minded professor, always running in 100 directions," she said.

So Lacey called the doctor next door: her neighbor in Indiana and dear friend, Amy Hoffman, an emergency room physician. When Hoffman realized why her friend was calling, she put her on the speakerphone, so that her husband, an oncologist, could listen in.

He just had one question: Was it on the same side as the melanoma from years earlier? Yes, she said. She could hear the worry in their voices.

"Stop unpacking," she said they told her. "Stop going to fancy events with your husband. You need to make this a priority."

She was soon ushered into a special area of Walter Reed National Military Medical Center reserved for high-ranking officials and their families. She was given a fuzzy robe with an embroidered White House logo.

"All of a sudden it is like you are in the Ritz-Carlton," she recalled, and asked herself, "Why am I deserving of this special attention?"

A scan showed a tumor somewhere between the size of a pea and a grape. She needed to have surgery. Doctors eventually removed 12 lymph nodes, some of which were cancerous. While she was recovering from surgery, still groggy from the anesthesia, her husband came into the room with a request that was hard for her to comprehend through the fog of the drugs: He wanted her Facebook password.

She had taken a selfie at the medical center and posted it to her Facebook page, and she also took a little dig at the administration. The White House was not happy, he told her. They wanted it taken down.

In the months to come, she would again think she had beaten cancer. She underwent a year of immunotherapy treatments. She rang the bell, a tradition among cancer patients completing treatments, at Walter Reed after scans showed she was cancer free.

"Cancer, schmancer," she thought.

There were other things to worry about. Her husband had come to Washington hoping to focus on opioid addiction, a plague that had hit members of his family. Instead, he was thrust into a much more public role with the arrival of the coronavirus. As the Trump administration struggled with effective responses, the new surgeon general kept setting off firestorms.

He shared a Valentine's Day poem on social media that said the regular flu was a greater risk than covid and urged people to get flu shots. He told African Americans, who were contracting the coronavirus in disproportionate numbers, to take precautions to protect their "Big Mama."

In each instance, he fumbled the messaging, making incomplete or poorly explained statements. He asked people not to buy masks because there was a shortage. He said people were at a greater risk of catching the regular flu than covid because projections by the Trump administration, later shown to be inaccurate, suggested more people would get the regular flu.

He used the words "Big Mama," which led to accusations that he was using Trump-style racist dog whistles, because it was a term of affection in his own family that he thought would help him connect with African Americans.

Those missteps, which Adams has blamed on a partisan atmosphere, drew heavy criticism, which might be expected. What he had not anticipated was how people would come for his loved ones. On social media, trolls called his family ugly. They criticized Adams, who is Black, for marrying a White woman.

While her husband was trying to fend off critics and nasty commenters by sharpening his messaging, Lacey, like many Americans, was putting off medical appointments while limiting her movements because of the risk of contracting the coronavirus. She had a clear scan in January 2020. It was not until July that year that she returned for another scan. It revealed a tumor on her back.

The cancer had returned for a second round: This time it was Stage 4. She started immunotherapy. And again she beat it. For two years she passed routine scans, with good results. Then, this past summer, came the tests that revealed the cancer had returned. His wife cries herself to sleep some nights. He marvels at her resilience.

She has been speaking and writing about the disease that lurks inside her and threatens to deprive her of so many things she looks forward to, like the days her children, now 18, 16 and 12, graduate or get married.

Some days she is too ill from side effects of her treatments to do much. But other times she is full of energy and ready to go. People might look at her and not know she is sick, and that is one of her points: Melanoma is a stealthy disease, the doctors keep telling her. It can hide inside people without any outward signs. She had once had a mole, but other times nothing showed up on her skin. The disease was hiding from her.

She understands that she has been given a platform few have. No one would be listening to a mom from Indiana if she were not the wife of the former surgeon general.

The other day, her husband asked if he could post a photo of her on Twitter. She said for him to go ahead. It showed her in profile, lying in bed with the covers partly obscuring her face, on a day when she was not feeling great. He asked for prayers, but he also gave some advice: "See a dermatologist right away if a mole changes/looks different from your others!"

What happened next was nothing short of amazing to them. People wished the best for Lacey even though they were not fans of Jerome: "I don't agree with your politics. God bless your sweet wife." "I'm sorry your wife has cancer, even though I completely disagree with some of your decisions."

Some people even wanted advice. "Should we worry about a single mole or look for odd shapes and changes in several?" That person did not mention Trump at all. That might be a person they could help. That might be, they dared to imagine, the end of the Trump Effect, and the beginning of a Lacey Effect.