Not much to smile about lately? It has been a rough patch. Everyone is anticipating a return to normalcy…. Then Dr. Fauci informs us there may not be an effective vaccine, treatments are not proven, even if you have had Covid-19, immunity may not be sustained. It’s a hot mess. We can hide behind the masks so that no one sees our scowl. Unfortunately, we can also miss the real brain change that occurs when we smile- it is all neurons and stimulus so consider smiling- right now as you read on.

Interactions are so weird right now. I am used to smiling and putting patients at ease when we meet, but a starched white coat and N95 mask hides the gentle, caring assurance they need from me.  In the cancer center, I have come to break our mask rule for those first moments. I stand at the door and greet the patient with a smile so they can see my face, then mask up for the discussion and exam. It helps a little I hope.

For Arthur, we have an added issue. He is deaf and lip-reads. I considered a plastic see-through mask just for these occasions but plastic over nose and mouth doesn’t seem like a good idea- No one wants their doc passing out in front of them.  Standing 6 feet away, I present him with the information and resume the mask as he takes his off for the exam. Then I see his smile too. It is comforting for us both. We are missing so much in giving up that simple interaction. People love engagement, crave it and many need it more now than ever. Another long time patient Marlene arrives. She has had a partial facelift, blepharoplasty, lots of injectables, and if I hold her initial picture up from 8 years ago, she looks like a different person entirely. It was her way of dealing with the changes cancer brought. “Doc I am going to get botox next week.” I am reminded of a video a few months ago from south Florida with a doc poking his head into the car windows of patients and injecting women in masks with botox. Doing anything to keep the office open. “Marlene, don’t be ridiculous. People can only see your eyes- with injections you will have no expression at all. Wait until masks are not mandatory and people can see your beautiful smile again.”

At a time when personal interaction and proximity are limited, a smile could go a long way. My recommendation for us all is to find ways to express our concern, kindness and joy behind the mask. Wear your heart on your sleeve- say it with words or a nod of the head or wave of the hand to others. Everyone is eager to engage- you just might (if it’s not Marlene) see their eyes crinkle a bit in response. When you smile behind your own mask, your brain will respond and your open heart will cheer you, which is just what you need now too.