Comfort

We are in community each time we find a place where we belong.

- Peter F. Block

His clothes hang too loosely from his thin frame but his hair is neatly combed. He dabs the corner of his lip, mopping the accumulating saliva. He has difficulty forming words as though there is something large taking space inside of his mouth.

I asked about his life. He was a shoe salesman at a big-name Milwaukee department store that has since gone out of business. He found another job selling shoes for a while but is now retired. By his own admission, he rarely strays far from the familiar streets of the neighborhood around his apartment, located several miles from our campus.

His oral cavity pain sent him to a dentist down the street from his building. I imagine that the dentist was shocked when she looked in his mouth. She told him that he needed to make an appointment in the Head and Neck clinic. Now he is here.

He speaks deliberately. “I believe that there is a problem with one of my teeth,” he says. “The dentist said I should come here for help.”

He does, indeed, have a problem but it is more than just his teeth. He cannot open his mouth fully because a huge, destructive cancer has invaded his tongue and lower jaw. It has been growing for a long time.

“When did this start?”

“The tooth began to bother me at least a year ago. It has made it hard to eat.”

“How much do you think you weighed before it started to hurt?” I ask.

He shrugs. “160, I think.”

I look at the chart. “You weigh 115 today.”

His eyes widen with surprise. His medical history is very brief because he has never been to a doctor as an adult. I grab a headlight and look in his mouth, describing what I can see. I tell him about the neck mass that is likely a lymph node full of cancer. I steer the conversation from his dental issues to the more pressing problem. As I talk about the cancer, his eyes become glazed.

This would be a lot easier if he had someone here with him, I think. We will need help with his care. “Do you live with anyone?” I ask. “Do you have family nearby?”

He stares at his hands. “No one in town. I have a brother who lives in Out West. I haven’t talked to him for a while.”

As far as I can tell, he is alone in the world. The touchstones of his life – his neighborhood, any friends, his brother, his former life as a shoe salesman, any familiar thing on which he might depend – are far, far away. He came to us with what he thought was a problem tooth; now, we have plunged him into a frightening and incomprehensible world, giving him a fearsome diagnosis and unknowable challenges.

Even as I promise that we will help him, he shrivels into the examination chair. I cut the discussion short, planning to go into more of the specifics at the next visit.

We will cover the details, I think to myself, if he returns.

Over the years, I have seen people so stunned by a diagnosis that they decided against receiving any care. I watch as my new patient appears to retreat into his shell, clasping his hands and staring at the floor. The appointment is nearing an end and I still have no idea of how to open the door the tiniest bit. I pause.

“Rockports,” he says.

“Huh?”

“Your shoes, Doctor. They’re Rockports.”

I look down and smile. Sure enough, I am wearing my black Rockport dress shoes. “You’re right,” I reply. “I love ‘em. Really comfortable.”

“Great shoes.” He nods and looks at me. “They practically sell themselves. Good choice.”

“How about this?” I offer. “We’ll complete the work-up here but let’s see if we can arrange treatment at a hospital closer to your apartment. Would that help?”

He brightens. “That would be great. I am completely lost whenever I come to this part of town. It’s too hard.”

A few phone calls later and his treatment is arranged. I am not surprised when he returns as planned later in the week and completes all of his testing. And when he returns for follow-up, I make certain I am wearing the shoes that provided us with our initial opportunity to connect.