Reflections in a Head Mirror

“The most effective form of birth control I know is spending the day with my kids.”
-Jill Bensley    


Cancer of the roof of the mouth rarely occurs in children. Several years ago, I took care of a young teenager whose orthodontist had noticed a slowly growing, painless mass on the hard palate. After determining that everything else was fine, we took her to the operating room and removed the tumor. Once she had healed up, she never had any more problems with her mouth. I saw her regularly for a while and then she stopped returning.  

Several years later, her mother brought her back to the office for a check up. The patient sat glumly in the chair occasionally glaring at her mother. As I updated her medical history, she was having some trouble with forming words.  

“I feel fine,” she said. “I’m only here ‘cause she made me come.”  

“Okay, open up,” I said.  

This was no longer the cute little kid I had cared for a few years before. As she leaned forward to let me examine her, I smelled tobacco smoke. When she opened her mouth, she clicked an enormous tongue stud against her teeth.  

Her mother rose from her seat. “There! Doctor! Tell her that that thing is bad for her!” The girl rolled her eyes.  

“When did you start smoking?” I asked. She shrugged and immediately delivered the same withering glance at me that she had just leveled at her mother.  

We reviewed what I knew about tongue studs: they are interesting, they don’t help during job interviews, but they are not dangerous.

We also talked about smoking. As a survivor of cancer, she might be at an increased risk of additional malignancies, especially if she engages in high-risk behaviors like smoking. For the first time during the visit, she was engaged and was clearly listening, although she did not give me the satisfaction of saying she wanted help with quitting.  

Mother and daughter left the office, both frustrated yet both vindicated, in a way. I'm pretty certain that the battle continued when they got home.  

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The following is feedback received for this blog: Thought of you as we recently enjoyed a weekend in SMOKE-FREE CHICAGO. Not only is it safer inside - it's safer outside too. The streets are now monitored by smokers. C'mon Milwaukee. - Lucia

Bloggers often issue challenges to each other. This week I was "tagged" by Suture for a Living. The challenge was to create a six-word memoir. The other challenge is to tag other unsuspecting bloggers to do the same.

The challenge brings to mind a “Six Word Story” contest. To me, the best example of that genre is Hemmingway’s “For sale. Baby shoes. Never used.”   Another favorite (I can't find the author right now) is: ""I'm sorry.' 'For what?' 'Never mind.'"

So, my six word memoir reflects a continuing tongue-in-cheek battle that often surfaces in my office conversations with patients. I say it so often that it is a theme in my practice. When confronted with a cancer survivor who continues to smoke, I sometimes grin and say:  

“No problem. Smoking’s good for business.”  

Hmmm. Now that I have written that, is "smoking's" one word or two?

Anyone else want to try? Submit your Six-Word Memoir by hitting the "Feedback" button below.

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The following is feedback received for this blog: Sing. Ease burdens. Pass it on.   learned these things from my parents, Richard and Virginia and I am so grateful. Sing in happiness and sadness, proclaim the Word of God, lift spirits (including my own) of those wearied by what happens on the journey of life.   Ease burdens of the dying, brokenhearted, those who have lost hope. Pass it on - things, poems, food, skills, peace, anything that makes the world a better place. - Deborah Ruck

“We make a living by what we get, but we make a life by what we give.”
- Winston Churchill    


“Weren’t you scared?” my colleague asked a couple of days after we had returned from Tanzania. “Weren’t you scared? My God, there’s so much danger! It must be a very scary place!”  

I was as startled by the unnamed questions as I was by the one she had asked. Maybe she was wondering if we were in danger because of the disparity between their poverty and our wealth. Maybe she was convinced that white people would be automatic victims of stereotyping and hatred. Maybe she thought the violence that has plagued so many nations on that continent over the past decades was present everywhere.  

I pondered her question. “Yes, I was scared at first.” I went on to explain, “You see, everything was so unfamiliar. I am not accustomed to being in the minority. I did not know instinctively what situations to avoid. I was suddenly dependent on people I had not yet learned to trust. And, foolishly, I had read a disturbing book on the plane.”  

“What book?” she asked.  

On the flight to Tanzania, I had finished Left to Tell: Discovering God Amidst the Rwandan Holocaust by Immaculee Ilibagiza, a first-person account by a Tutsi who had survived three months during the 1994 genocide by hiding in a tiny bathroom with six other women. "It is a frightening description of the unbelievable atrocities that took place in a country that borders Tanzania. The book culminates in redemption, but the images of violent gangs wielding machetes and of the unspeakable, unthinking hatred haunted me. I could have picked a better book to read.”  

She nodded, believing that she understood.  

“As soon as we landed, though, I had the opportunity to interact with the Tanzanian people. They are soft-spoken, loving, and gentle. Most have very few material possessions. (Tanzania ranks in the bottom 10 percent of countries with a median income of $340 per year – less than one dollar per day.) They seemed oblivious to the deeply rutted roads and the near-complete lack of infrastructure. They didn’t seem to mind walking for miles in driving downpours. The few with access to electricity didn’t notice when the power went out yet again. I can’t recall any of them ever complaining.  

“You see, their schedules and priorities seemed so different than ours. After a couple of days, I began to notice things. We saw almost no begging in the city of Arusha. We noticed how the people took pride in their small homes, carefully sweeping the dirt in front of their doorways. We heard stories of how they take care of each other and their extended families. We learned from their farmers, their pastors, their teachers, and their healthcare workers. We marveled at how they creatively carry on despite a near-complete lack of resources. I found myself envying their peace, serenity, and generosity in the face of seemingly insurmountable challenges, even though I barely understood their culture.”  

She furrowed her brow. “But weren’t you ever scared?”  

I laughed. “Yes. Without a doubt, the scariest night was the first time we heard lions roaring a few hundred meters from our tent camp in the Serengeti. That was a little unnerving.”  

She shuddered and went back to work.  

Later, that same day I was still thinking about my colleague’s question. Suddenly, my pager went off and I responded to the Trauma Operating Room. A young woman had been slashed with a knife by someone she knew. The trauma surgeons had saved her life and had asked us to repair some of the damage. The multiple wounds were deep and long. It had been a serious attempt to kill her.  

As she lay asleep on the operating table, I explored the injuries. Here was a wound that could just as easily have occurred as a result of a machete attack during the time of the Rwandan genocide, from a brutal assault in Darfur, as a result of the recent unrest in Kenya, during ethnic cleansing in the Balkans, as a reprisal for a killing in Iraq, or in any of a hundred troubled lands in the world. Our patient was different only in that she would survive.  

Silently, I thought to myself, “Weren’t you scared? My God, there’s so much danger!” I am scared that we will never learn the lessons that are just as evident in our own towns and cities as they are half a world away. I am repentant that our position of privilege has yet to teach us how to discern ways that make everyone safer and more secure. Mostly, though, I am grateful to our new friends in Tanzania for helping me realize that each of us, me included, is called to make a real difference whenever and wherever we are able.  

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The following is feedback received for this blog: Wonderful story. Blessed are the poor... Seems counter intuitive but when all of life's material distractions are removed, character and kindness are the most valuable currency. - Val Jones www.revolutionhealth.com/blogs/valjonesmd

“The person I miss most is the one I could have been.”
–G. B. Shaw    

The little boy ran circles around his mother as she stood outside of the restaurant smoking a cigarette. The young woman and a friend were engaged in an animated discussion and the smoke rolled from their mouths and drifted past their faces. Suddenly, the toddler stopped running and squeezed his mother’s hand. Once her gaze had focused on him, he smiled broadly. She grinned back at him and he resumed running laps. She took a drag on her cigarette and resumed her conversation.  I remember being charmed and disturbed by the interaction.  

A few days later, I stood at the bedside with the family of a delightful woman in her mid-fifties. Her smoking-related cancer had required removal of her voice box and a course of radiation therapy. Months later, her cancer had recurred and all of her treatment options had now been exhausted. She was at peace, slipping in and out of wakefulness, very near to death.  

The whole family had tried to prepare for this day and her adult children gathered in a semicircle around the bed. One of her boys sat dejectedly in a chair gripping her hand. As I watched, she slowly opened her eyes. He brightened visibly and wordlessly returned her gaze. She closed her eyes, but they both continued to smile. This, too, was a powerful yet disturbing moment.   

I was struck that the two scenes were essentially from the same drama, with the second following inexorably from the first. Within a few days, I had witnessed two points along the same arc. 

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A previous version of this essay appeared in the MCW Cancer Center News. 

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The following is feedback received for this blog: Once again you have captured the moment (or two in this case) so very clearly. - rl bates http://rlbatesmd.blogspot.com/ Great post, Bruce! I wish all the parents I used to see in the ER, smoking as they brought in their wheezing children, would read it.... and see themselves. Before it's too late. - David Loeb http://doctordavidsblog.blogspot.com/