Behind the Mask
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J Gen Intern Med DOI: 10.1007/s11606-020-06095-4 © Society of General Internal Medicine 2020
up,” I ask, because something is always up “W hat’s when a radiation oncologist calls on Thursday
afternoon. “I saw this woman today . . .” he begins. “Saw” being a somewhat dynamic term now—formerly referring to an inperson, face-to-face consultation and assessment, but now encompassing seeing a patient on laptop via a Zoom call. He reviews the case and his impression—all succinct, professional, and caring. “I can see her tomorrow,” I respond. I have been taking care of head and neck cancer patients since 1990 when I began my residency in San Francisco—in the midst of another pandemic. As young trainees, we daily observed the pernicious lethality of that virus as we cared for countless people who entered our hospital and never left. A virus which put health care workers at risk while we negotiated the path of safe care and created terms such as “universal precautions.” Here, we are three decades later treading a similar path into the unknown. Head and neck cancer can be particularly cruel. Its manifestations rob patients of so many aspects of our humanity: speech, swallowing, breathing, and smiling. It can damage or scar the face, a part of the body not easily hidden. Patients with head and neck cancer will adopt elaborate means of covering the disease with hair or clothing to hide its progress and stigma. I come in early the next morning. Travelling to work now is easy as the deserted city is simple to traverse. I wear scrubs for clinic now—no more trademark starched white shirts and treasured ties. I walk into the exam room. She sits uncomfortably in the chair with her husband seated opposite. We all stare at each other for a moment, taking in what we can. We all wear masks—such a different time this is. Their masks match, given to them at the hospital door. Mine is thicker, with strong rubber bands binding the balding crown of my head. We form an equilateral triangle, just less than six feet apart. I know they are scared; everyone who sees me on “short Received June 22, 2020 Accepted July 30, 2020
notice” is terrified. Her husband inches his chair toward hers—shortening the base of our isosceles. I motion him to be closer to her. She tells me how she noticed—six weeks ago—that her tongue looked different, but she has no pain. Her speech is fine, as it emanates from behind her mask—sound only, no visual accompaniment. Her husband nods in agreement, his mask tilting up and down, concerned eyes fixed. We talk further—query, answer, explanation, repeat. I wheel my chair closer and the exam begins. My gloved fingers feel her neck, probing along the muscles and great vessels for signs of concern. I press under the chin on each side, feeling nothing worrisome and leaving her mask undisturbed. We are at the “why she is here” part of the exam. I need to look at her mouth and throat. I need to examine behind the mask. What is going to be hidden there? She lowers her mask tentatively, as I leave mine in place, allowing it to filt
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