Bald Is Beautiful

She was sitting up and resting comfortably in her hospital cot, her home-made mauve and black afghan tucked comfortably under her arms. A pale yellow handkerchief was lumped on the bedside table beside the phone. She looked up at me as I walked into the room, greeting me with her big smile and sparkling hazel eyes. Except for a few patches of sparse, fuzzy auburn hair, she was bald.

"Hi, Mom," I said, walking up to her and pulling my mask down to gently kiss her cheek, "how are you today?" Despite the heart-breaking circumstances which lead to her being a patient lying in a hospital bed, I had never seen Mom look so beautifully breath-taking. And under normal, healthy circumstances, she was already quite a beautiful person, inside and out.

Mom ran her hands over her scalp, weakly smiling. "Well, honey," she said, "I guess we can cancel the rest of my hair-dressing appointments for the year." Over the past few days, the ravaging effects of Mom's chemotherapy regiment had taken ahold, which included her hair falling out in clumps.

"Mom," I said, reassuringly, "I don't think I have ever seen you look more beautiful." I walked over to the yellow handkerchief and picked it up, examining it. Strands of her thick, wavy hair clung to it. "What do you say we just throw this out?"

"Oh, Jimmy," she said, exhaling a deep breath, "I just don't think I am ready for that yet."

I understood completely. Mom had been raised in an era where curlers and perms and colorings played an important part of a woman's presentation. And although Mom was far from vain (how could she be when she was busy raising seven kids), she thoroughly enjoyed indulging in her hair. Hair that was now gone.

Despite a custom-made wig and multiple handkerchiefs, I don't think Mom's beauty was ever more evident than when she went bald during her chemotherapy days. Her baldness only seemed to enhance her indomitable spirit. Her eyes danced more openly. Her raw facial expressions confirmed her appreciation of life. Her prominent cheekbones exuded her infinite strength And the curve of her smiling lips were only that much more welcoming, appropriately framing the beauty of her words.

Accompanying her baldness, the truth of Mom's bravery in fighting her illness could not have been any more evident.

As I go along in my typical days of being an ER physician and the father of a child who has survived his own life-threatening illness, I can only tell you, without hesitation, that this baldness that accompanies one's fight for their life is as pure and as defining of one's character as any physical attribute can be. Without any words spoken, a patient's baldness from chemotherapy reveals a fighting spirit and a commitment to continue living. It reveals a strength drawn from reservoirs most people don't recognize they have until faced with crisis.

It commands my respect. And I rightfully give it.

Recently, at my gym, I couldn't help but notice one of the trainers, Barb, working-out with a woman who wore a handkerchief over her scalp. It was obvious that this client was intimately familiar with chemotherapy. It was very inspiring, to say the least, to watch this woman physically push herself through a workout despite her recent setback.

A few weeks later, surprisingly, I saw this same woman working-out without her handkerchief. Evidently, she chose not to cover up her baldness. And she looked stunning. As Barb and she worked out beside me in the cable room, I decided I had to speak up.

"Excuse me," I said to the woman. keeping it simple, as Barb looked on, "but I just have to tell you how stunning you look. I have no idea what you are going through, but I've seen you working out and pushing yourself these past few weeks and am thoroughly impressed. I wish you the best."

Well, Barb's client blushed a little as she thanked me. And later on, Barb came up to me and said that my words were exactly what her client had needed to hear since she was having a bad day. I hadn't been sure I should have said something, but Barb reassured me that my words were quite welcomed by this brave woman.

Especially in our ER, because of our regional cancer institute, we are privileged to treat many people who are wearing their baldness proudly as they undergo chemotherapy treatments. Both male and female. From the very young to the very old. And every time I have a patient who is bald for this reason, I make sure they know that they have my utmost respect. And if it is a child, that respect is also accompanied by a pile of stickers, a coloring book, and a Popsicle, if allowed.

A few weeks back, a brave little seven year-old girl greeted me as I walked into her ER room. She had been battling acute lymphocytic leukemia and, despite some mouth sores, still managed to greet me with her fading smile. On her head, nothing but baldness. At most, just a few patches of fine blond hair clinging desperately to their homeland. I smiled back at her as I approached, hoping my eyes conveyed my happiness to meet her. I must have looked like a big giant Smurf--I had donned a blue paper gown, a blue mask, blue foot covers, and cream-colored gloves. Until we figured out her immune status, we had to protect her from us.

"Hello, May," I said, extending my hand. "It sure is nice to meet you." We talked a few minutes about school, her best friend, and who her favorite doctors at the regional Children's Hospital were. Her mother sat at May's bedside, contributing to May's memories. "May," I continued, when there was a pause in conversation, "when did you lose your hair?"

She got quiet, hesitant almost. Her mom spoke up. "About three weeks ago, doctor." "Well, May" I said, my eyes hopefully conveying my sincerity, "I've seen many patients who have lost their hair because of their medicines, but I must say that you are by far the most beautiful." May looked up at me, serious now, and locked her eyes onto mine. I didn't flinch nor did I look away.

"Seriously?" she asked. "Seriously," I replied. In her child's voice, she softly said "But I don't like it. Everybody stares at me."

"You know why, May?" I asked, grabbing her hand with my gloved one. "They aren't staring because you lost your hair. They are staring because they are amazed to see such a brave and courageous seven year-old. And that's you. Showing all these people that you can be beautiful and brave no matter what medicines you are on or no matter what disease you are fighting." She nodded at my words. "The next time someone stares at you, May, just give them your biggest smile ever!"

"Like this?" she asked before donning one of the most perfect smiles I have ever seen.

"Just like that." I told her, admiring her gaps from losing her baby teeth.

I'm not saying that if you are undergoing chemotherapy and have lost your hair, that you need to express your baldness. Hardly. Wear a wig or a bandana if you feel more comfortable. During your fight, you do what you need to do and don't worry about what the rest of us think. But if you are in my ER or if you pass a middle-aged guy who happens to take a second glance at you, don't be alarmed.

It's just me, sending you good energy and well-wishes. And recognizing your courage.

Yes, indeed. Bald is beautiful.

As always, big thanks for reading. I appreciate your time. Emma update--day 15 of 17. Swimming at the Great Barrier Reef today before beginning the long trip home tomorrow. If she comes home, that is! Australia, you have a new, wildly-excited admirer in my daughter. Thank you. See you in a few days...

The Complacent Eyes

I walked into Room 35 to find a three year-old lying on the hospital cot. Her father sat alongside her bed, whispering softly to her. The patient appeared quite tired, wiped-out even, and if it weren't for her complacent eyes tracking my every move, I would have thought she might be sleeping.

She was visiting our ER because, after a few days of cough and congestion, she had developed a fever. 102.2. Not such a big deal, usually, for a healthy child. Unfortunately, this child was not healthy.

She had leukemia. Acute lymphocytic leukemia (ALL), to be exact. And because she was currently receiving chemotherapy, a fever with an immunocompromised system could signify tremendous trouble for her.

Because of my experiences with my middle child, Cole, who sadly spent two of the first six years of his life battling his own life-threatening illness with multiple chemotherapies, I was well-aware of the concerns of this family. Besides the concerns, I was also well-aware of the lessons of bravery and love, of sadness and heartache, that came with this child's illness. Immeasurable. Five years after our own journey, I can easily see that I am a better man and a better physician from our experience. A better human being, actually.

I knew how to help this family through this crisis.

This beautiful little girl, with her brown, wavy, returning hair, had been diagnosed with ALL last summer, following symptoms of significant fatigue. She had been transferred to Children's Hospital, where she had a mediport placed and began an aggressive regiment of chemotherapy, high-dose steroid therapy, and prophylactic antibiotics. And, happily, she responded well. Her chemotherapy, just eight months after her diagnosis, had just been reduced to the maintenance phase. Instead of receiving IV chemotherapy every week, she now only needed to receive it once a month. The steroids, the antibiotics, and the oral chemotherapies were continued on their regular schedule.

So, her fever--where did come from? The typical cough and cold symptoms had passed through their house. Mom first, then Dad, and then this patient's younger sibling. Against offered prayers, she was the last to get the runny nose, the congestion, and the coughing. Ten hours before arriving at our ER, she had developed a concurrent low-grade fever that steadily climbed until her presentation for treatment.

Dad brought his precious daughter to us, entrusting us to do right, while Mom stayed home with the younger sibling. He walked through our ER entrance, explained to our triage receptionist and nurse what brought him and his daughter to our ER, and was immediately escorted from our busy waiting room, where his daughter might be exposed to other illnesses, to an isolation room. The door was shut and reverse isolation warnings were placed. Until we learned the status of her immune system, we would take no chances of this little girl getting exposed to any further illnesses.

Anyone who wanted to enter Room 35, while this little girl was being treated, would need to don a mask and gloves and a sterile gown. That included myself, the nurses, the IV team who would access her port, the radiology techs who would take her portable chest x-ray, and our phlebotomists.

So, this is how I met my brave little patient and her father, wrapped in a sterile, disposable, pale-yellow gown, with a blue mask clinging over my mouth and rubber gloves snugly fitting my hands. Hardly a welcoming outfit, but necessary.

"Good morning, Meghan," I said, speaking through my mask, watching the little girl's eyes slowly follow my movements, "I'm Dr. Jim. And I am going to help you feel better today, okay?" I looked for a little spark in those complacent eyes, but, sadly, there was none. Between her fever, not feeling well, and probably expecting to be poked and prodded, she looked miserable.

After talking with Dad, he with the heartfelt smile and calming voice, I performed my exam on Meghan, who appeared so fragile and tiny lying within the cot's hospital blankets. She had an obvious cough, somewhat wet. Looking in her ears, I found a whopping left ear infection. Crusty nares. A patent, non-reddened throat. Her heart and lung exam was perfect. No abdominal pain. Her extremities were unremarkable. Most importantly, she had no rash.

Interestingly, her mediport was not near her collarbones, or clavicles, where I usually find them. Instead, it was on her right lateral mid-abdominal section. "They had a hard time placing one up by her neck," Dad said, "so they put it there instead." The mediport is basically a little pin cushion, placed under the skin, with tubing that is inserted and anchored to a larger vein. When accessed with a needle, it can be used to administer fluids or medications and withdraw blood. Basically, it functions as a permanent IV. After a successful outcome, the mediport is removed, leaving a battle scar about 1-2 inches long.

My son has two, one near each collarbone. Two battles. We won that war.

With Meghan, we accessed her mediport and obtained blood to check her white counts and for cultures. We obtained a urine specimen to check for infection. We performed a chest x-ray. After all of that, we administered a dose of IV antibiotics and a dose of Tylenol.

Happily, her test results returned in her favor. Her chest-ray was negative, absent of any infectious findings. Her urine results were clean--no infection. And her blood counts? They were low, as we expected from her chemotherapy, but not dangerously low. She had a sufficient immune system to fight off this infection.

I called her hematology/oncology team and shared our workup and findings with them. Meghan had the same team as my son, and I was familiar with the person on the other end. They were appreciative of our efforts and we arranged Meghan to be seen by them in two days.

I walked back into her room, smiling, ready to deliver some good news for a change. I no longer needed my gown, my gloves, or my mask. Hopefully, Meghan would be able to see my happiness for her, plastered all along my face's edges. I had a bounce in my step.

If I thought I was happy with her results, seeing Meghan after we gave her fluids, antibiotics, and Tylenol simply made me ecstatic. She was a different child. A beautiful, smiling, interactive toddler was sitting upright in her cot, playing with stickers, eating a blue Italian ice, and watching a funny cartoon on the room's TV. Her fever had obviously broken. And looking at Dad, ten years had been erased from his face.

For a split moment there, I forgot about Meghan's fight for her life.

And in this moment, a spark had returned to her complacent eyes.

After spending some enjoyable time with both Meghan and her father, I walked back to my hallway desk, lost in my own thoughts, suddenly thinking about the five years that have passed since my son's complacent eyes regained their permanent spark. And I said a few silent prayers. One for my son. One for Meghan. And one last one, for every child who's eyes have lost their spark.

May they someday get it back.

As always, big thanks for reading. May your weekend be a great one. See you Monday...