Behind The Doctors? Mask, A Little Room To Maneuver

During medical school in my native Oklahoma, I once saw a breast enhancement surgery performed under local anesthetic. We, the country surgeon and I, worked that Saturday morning in the converted garage he used as his operating room. The walls had been wood-paneled, but he had done nothing about the floor — we stood on cold concrete.

The patient was a young woman eager, she said, for sufficient cleavage to display her new gold necklace. She chattered away about her big plan to surprise everyone at work Monday morning. I listened but was uncertain where to rest my eyes as the surgeon struggled to insert the saline bags through the small incisions.

Finally we were done. The surgeon snapped off his gloves and walked away. I prepared to follow him when the patient turned to me. This is a great idea, right, doctor? she asked.

I grimaced. No, I was thinking, I cant believe youre doing this. I was new at doctoring and didnt much know the rules, especially those governing the seemingly casual Saturday-morning variety of cosmetic rearrangement I had witnessed.

Despite my grimace, she kept a sunny smile. I couldnt understand why, until I remembered: I was wearing a mask. Before the procedure, the doctor and I had washed our hands and slipped on the uniform of gloves and a mask. She couldnt see my expression.

This isolation garb, as I soon came to learn, is a mixed blessing. It is time-consuming to put on, and I am usually in a hurry; the gowns are a garish yellow, and I am vain; the disposable garments leave a trail of litter, and I like trees. Moreover, the mask imposes a literal barrier between the patient and me: it makes me feel like a hygienic bank robber.

But recently I rediscovered what I had learned that morning. The get-up isnt so bad after all. In addition to the small uplift one receives from wearing a uniform, it introduces a comfortable and useful place to hide.

A doctors face is very closely watched terrain. Patients look for the slightest sign to support a hope or confirm a fear. A twitch at the wrong moment might be interpreted as bad news, a shadow of a smile as some sort of imminent jackpot. Doctors minor tics are analyzed with the care of an anthropologist combing through bits of shattered ceramic. Maintaining composure, including a neutral, eternally bland expression, is crucial in the entire high-stakes enterprise.

Slipping on the mask gives us a little more room to maneuver, a chance to gather our thoughts and proceed at our own pace. We can grimace and frown, perhaps bite our lip, all without the risk of provoking an unwarranted reaction. Dont underestimate the value of that extra moment. After all, events can happen fast: a patient may suddenly reveal a crucial and surprising fact; troubling results from the days tests may need explanation; a patient or family may have a moment of swooping panic as trouble unfolds.

We want to be as tranquil and as accurate as possible — not, like political spokesmen, because we are looking to dodge the truth, but because, when discussing a persons health, the facts often need to be coaxed along slowly and with care.

The mask — and the entire costume — can have a strangely calming effect. Everyone who visits now has the same inscrutable nonexpression. We become an army of serene interchangeable soldiers in the long, soundless march to health and healthcare delivery, there to assure a patient that his situation will be handled with utmost delicacy. Not bad for a five-cent device.

On that distant Oklahoma Saturday morning, though, I decided I should remove my mask in the name of honesty. Nothing would come between me and my patient. Well, maam, I began.

But she had already moved past seeking my opinion and was busy rifling through her purse. I had become disposable — doctors are very useful in short, intense bursts and then, within a blink, worthless and cumbersome. Which leads to the masks final contribution to the doctor-patient interaction: when the time comes for a furtive departure — just as we are about to overstay our welcome — it allows us to backpedal out of a room as if invisible.

Dr. Kent Sepkowitz is the director of infection control at Memorial Sloan-Kettering Cancer Center.

Tag Cloud

External Information

Additional Information

Where Am I?