For two months in the spring of 2021, I was part of the care team involved in the treatment of a sixty-seven year old woman with a newly diagnosed squamous carcinoma of the anal canal. This woman’s cancer had not spread beyond her pelvis at the time of diagnosis. This was a good thing. My job was to give this woman a few doses of chemotherapy at the same time as she was receiving six weeks of daily radiation treatment. The goal of this treatment was to try to cure her cancer.
She could have alternatively chosen to undergo a large surgery that would have left her with a colostomy and the uncoveted need to poop into a bag attached to her tummy for the rest of her life; this would have the same chance of cure as doing radiation and chemotherapy. She didn’t want a bag. She chose the radiation and chemotherapy option.
It is important to note that the short but very meaningful-to-me relationship I had with this patient took place during the beginning of the second full year of the Covid-19 pandemic. This fact is very relevant to how our story unfolds.
I saw this woman less than a handful of times pre-vaccine availability. Each time I saw this woman, we were both masked as per the required personal protective equipment protocol which was implemented at my hospital at the start of the pandemic’s first wave; staff also had to use eye protection with goggles or a face shield. Additionally, staff were advised to try to keep socially distanced in the examination rooms; an abundance of caution was required while doing physical examinations. In fact, at that time, it was rare for me to even extend my hand, for a proper shake, to a patient or family member as a sign of introduction and welcome. Suddenly touching people had become dangerous and taboo, even in your doctor’s office.
At the first visit with this woman I knew she was going to have a difficult road ahead. When I walked into the room to introduce myself, she was laying on the examination table. This was unusual. Most patients I encounter at initial consultations are much more comfortable sitting in a chair opposite to me for most of the interview portion of the appointment, only moving to the examination table for a few minutes to allow me to do a physical exam; most will then move back to their chair so I can start explaining their cancer and the recommended treatment to them. I was told she was lying there because she was in physical pain from her cancer.
I noted immediately that she did not want to keep eye contact with me. She barely glanced at me when I introduced myself. For the rest of the next hour, while I asked her questions about her symptoms and explained the chemotherapy that was being recommended along with potential side effects, she mostly kept her eyes closed. I wasn’t sure she was listening to me despite asking her multiple times if she understood what I was saying or if she had any questions. It was as if when she closed her eyes she was also closing her ears off to the words I was speaking to her, and to the realization that she had cancer. When her eyes were not squeezed closed, they were darting around the room as if in search of something. I remember wondering if this woman was in more emotional pain than physical pain.
She came with her sister to this first visit. Interestingly, when I asked this woman about whether she had any other important medical issues that I needed to know about, the patient said no. Her sister qualified this stating she in fact had a significant history of anxiety and depression. She had been seeing a psychiatrist and had been medicated for these diagnoses since at least 2006. This was not a surprise to me as I had noted these diagnoses in our electronic health record when I was reviewing her chart a few days before. Even if I didn’t know this ahead of time, I could have easily cut through the anxiety she was powerfully emanating from every single one of her pores with the dullest of scalpel blades. The anxiety in the room was palpable.
Our second in-person meeting was shortly before she was to start her curative chemotherapy and radiation treatments. I ran through her chemotherapy and the possible side effects one more time and then asked her if she had any questions. She had only one:
“Can I see your face?”
Her question shocked me. I recall that it momentarily paralyzed me.
It was a question that had never been asked of me before. Not a single person in over a year of seeing patients during the pandemic had asked anything close to this. I don’t know exactly how many patient encounters I had in that time frame. I would guess it would be over one thousand. Most of these people would have seen my face before masking was mandatory. But I had almost certainly met upwards of one hundred and fifty new patients during that pandemic year. These people only saw the whites and greens of my eyes. None of them had asked to see my face.
As the initial shock of her question subsided, my brain did a very quick assessment of the pros and cons of what I was just asked. In only a few split seconds I ran through everything I knew and didn’t know about the coronavirus through the lens of my job: appropriate work place protocols, personal safety and the concern of being exposed to a virus that we still didn’t know much about, the inexplicable heavy worry that I know most health care providers have had during the pandemic of inadvertently bring home the virus to my family, unknown outcomes of the illness which was known to kill, and, most importantly, the safety of the patient in front of me who was anxious and scared. What was I to do?
I repeated her question back to her. “You want to see my face?”, I asked in surprise.
“Yes. Can I see your face?”, she replied.
My brain had decided what I should do. I proceeded to roll my little, black-seated stool as far away from her as possible in our examination room. I took off my mask. I said in a loud and happy voice, “This is me!”, while I flashed her a smile. I let her acknowledge my face. And then, I put my mask back on.
To this day, I think about my decision in that situation. There probably wasn’t a “right” or a “wrong”. I recognize I could have gotten this patient sick if I was unknowingly harboring the virus. I know there was a small risk I could have exposed myself to a virus which could have gotten me sick. There could have been downstream effects that might have been detrimental as a result of my decision in that room. These things were highly unlikely, and as it turned out, nothing “bad” happened, but something could have. I knew not what the outcomes would be after those moments in that room.
I did know for sure, however, that my actions made a difference for the patient in front of me. I know this because she said, “Thank you”, and began to cry. She said nothing else at that meeting with me after that – just a simple and heartfelt thank you which her tears spoke as well. That’s how I also know for sure, that in that moment, I did the “right” thing for her and for me. This woman wanted to see more than my shielded eyeballs. She needed to see my face to ease her anxiety and make me more human to her. She wanted to see that I wasn’t just a masked stranger – that I had a nose and a chin and a smile.
I have started shaking hands again in my clinic rooms. It feels right to me. Touch is a powerful connector. I ask if my patients and families are comfortable with this before I extend my hand. Most people say yes. I have not removed my mask again in a clinic room since that day. I haven’t been asked to. But I know for sure I would do it again if I thought it would help someone else.
Author notes:
I do not think this woman realized the impact her small question had on me.
“Can I see your face?” is a question with so much vulnerability, meaning, and hope behind it. With this question, she was telling me what she needed. She needed to see my face in order to feel just a little bit safer with me in her scary cancer journey. Her question showed me she was living with her anxieties and depression. She was a fighter. She had hope.
Her question helped me solidify a learning I will forever carry with me from working in a hospital during this global crisis: connection is a powerful human need which both requires and allows for courage, love, and growth. Connection is necessary.
I think connection has been missing in a lot of our everyday lives through this pandemic. This woman asked for connection in an unpredictable situation. What a remarkably brave thing to do. It was a privilege to connect with her by doing a small thing in showing her my smile, which turned into a big thing of connection for both of us.
Covid has helped us practice our isolation. For me, isolation is dangerous. The Covid Connection I experienced with this patient in clinic has highlighted my desire for honest, raw, powerful connection with a handful of my important people. To know I want and need to be seen for everything I am, and everything I am not, even if by just one special person who I trust infinitesimally, has been a gift of this pandemic.
I would like to thank this patient for wanting to see my face and for reminding me that real connection is essential and that we must have courage to ask for what we need to help us feel safe.
I am curious to know about a time when you, reader, felt truly connection with another person. Whether this was with a patient or doctor or spouse or good friend or a child – when did you feel seen and heard? When have you felt like you mattered most? What is your connection story?
