This week I visited the National Cancer Institute, the best oncology hospital in all of Mexico, to shadow in the dental and oral surgery service. I walked into the maxillofacial prosthetics operatory and the first thing I saw was a patient with a strangely hairy cheek.
I asked whether the skin on his cheek, darker and shinier and hairier, was a graft…I’m not sure if I directed the question at the patient, a young man just a little younger than me, or toward the dentist I was shadowing; I was a little astonished. I was stripped by said astonishment of my normal social skills, that whole eye contact business, that whole conversing business.
I don’t know what I was expecting at a cancer hospital, but not something so striking, so straight from the pages of the New England Journal of Medicine, so soon.
But yes, replied the dentist on behalf of his patient, who could not speak. The skin was from his stomach. The young man was asked to open his mouth so I could see the hole left in his palate despite the surgeon’s efforts to excise as little maxilla as possible around where the patient’s tumor had been.
And he closed his mouth, still wordless because, as the doctor explained, they were currently in the process of making him a prosthesis to allow him to speak again.
I was quiet for a bit, kind of drowningly pensive.
Geeking out, first–the hole, the prosthesis, the linguistics, the pathology, the Spanish, the Mexico, the surprise and the power of medicine to restore function–
But also, second, an unwelcome tourist itch of a thought: I wish I could photograph this. I wish I could show my social networks, my blog readers, how cool my life is. The thought of our Instagram age: is this even real if I don’t have proof in pixels?
This is, I suppose, what it means to be a doctor in the year 2013 and further; when the rest of our life is LOMO’d and HIFI’d and shared and re-shared, blogged and tweeted and Pinned and plus-one’d around and around until it’s ragged, our patients’ lives remain in the safety of those four clinic walls.
I was so happy, a minute past that tourist-y thought, to realize the sacredness of the space I was in. Even miles and a Rio Grande from my Boston hospital stomping grounds, I was welcome: as Don Berwick calls it, a guest in my patient’s life.
No matter how strange, how rare, how unusual the presentation–I’m reminded that they are not first sensational or peculiar, but parts of the body which is my patient’s home. The white coat, then is just a visitor’s badge, not a media pass, ensuring and promising that the moments spent between the two of us will remain just that–between the two of us.