Appearances

Never underestimate the pain of a person, because in all honesty, everyone is struggling. Some people are better at hiding it than others.
— Will Smith (actor)

My patient went through seven weeks of radiation and chemotherapy for a large tonsil cancer, followed by a long, difficult climb back to health. Right after treatment wrapped up, he told me that the experience was "brutal." "My mouth is so sore!" he said at the time. "Everything tastes like cardboard. I had hoped to work through the treatments but gave up after about three weeks. I am exhausted."

The physical transformation from then to now is striking. Six months later, if I didn't know he had been through cancer treatment, I might not have guessed. "You look amazing!" I tell him. He really does.

At this point most people are really starting to feel like themselves again and, indeed, he appears to have bounced back. He is again able to eat what he wants, about 80% of his sense of taste has returned, and he is sleeping better. "We can finally enjoy going out to dinner," he says. "My clothes actually fit. I'm not back to where I started but this is probably a good weight for me."

I run through the exam and confirm that everything has healed. "No sign of cancer," I tell him.

Same for the scans. "Your recent PET scan was perfect." I pull up the pre- and post-treatment images on the computer and compare them side-by-side. "See?" I ask. "The cancer has completely disappeared. Couldn't be better."

He smiles but not with the full, enthusiastic smile I expect.

"It's good news, right?" I ask. "You look great!"

"Yeah, that's what everyone tells me."

I wait.

"You see, whenever someone says, 'You look great!' and I don't feel great, I don't know how to respond."

He shifts in his chair and looks at the floor.

"I mean, I am grateful I'm cured, of course. Thanks to you and the other doctors. It's just that it was so hard. I still can't taste everything. My mouth is so dry. I'm dealing with the guilt that my health problems disrupted my family's lives. I'm in sales, so my income disappeared when I couldn't work and it's taking a while to get back up to speed. The out-of-pocket costs will keep us in debt for a long time. Today, I feel good but there are occasional days when I don't want to get out of bed. I dunno…"

He looks up at me.

"I mean, whenever I start telling someone about how I feel and they say, 'But you look great,' it shuts down the conversation. It's like I'm not allowed to be sick or worried any more. What am I supposed to say? But, I don't feel great? That seems ungrateful or pessimistic or something. So, I don't say anything."

We sit for a bit, letting his words penetrate the silence.

"That must be hard," I say. "Like we aren't really listening to you."

He nods. "Weird, isn't it?"

"So, what should we say?"

"That's part of it, too. I'm not sure what is better. But letting me talk really helps."

For the rest of the visit, I make an effort to really listen. I ask him to go through his list of questions. I don't interrupt.

After a few minutes, it gets quiet again. "Anything else?" I ask.

"Nah. That's it. Thanks for letting me ramble. I appreciate it."

"You're welcome," I say. He stands and reaches for his coat on the hook behind the exam room door. "Call if you have any questions. Otherwise, I will see you again in three months and…"

I pause until he looks at me.

"…and, when I see you, I will tell you, 'you look terrible.'"

He snorts. "Nice," he says. "Well, you don't look all that great, either." He grins and shakes my hand. "Thanks, Doc. Looking forward to it."