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 Lonely Walker

They made a regal couple, the elderly man and woman sitting in Room 19. She was the patient, he the supportive husband. She sat in the treatment cot while he sat in a chair pulled near her bedside. Together, they greeted me with their warm smiles as I walked into their room.

They both had full heads of healthy, silvery hair that shimmered from the overhead fluorescent bulbs. Their eyes were intense and watchful, and their crescent lips, framing big, teethy welcoming smiles, stretched like thick, pink rubberbands across their lower faces. He was impeccably dressed in conservative, mid-season wear, including a green layering-sweater. She was in a threadbare hospital gown, clearly confident and stylish despite her outfit.

After introductions and the shake of our hands, I learned that they were both in their early eighties and had been married all of sixty years. Sixty years! Can you believe that? How amazing. I congratulated both of them on achieving such a milestone.

"I know where I'm going," she laughed, looking heavenward, "for putting up with him all of these years." He laughed harder at her words than she did.

This, ultimately, explained the matching walkers that were parked against the counter in Room 19. Who needed matching rings for a 60th anniversary present, anyway? I would think that I, too, would be more practical on my 60th anniversary. I noticed these walkers immediately upon entering the room. His and hers. Identical. Front wheels, back posts with thick rubber stoppers, and a right-sided hand brake on each. Greenish-blue in color. Her's had feminine clothing casually strewn over the front bar.

She was 82, to be exact. "He's a few years older than me," she jokingly added, dismissively nodding toward her husband, "I'll always be his spring chicken." By triage notes, she had presented with a two-week history of worsening abdominal pain "that came in waves," mainly to the right upper quadrant. "But right now," she told me, "it isn't so bad." It seemed to be associated with any intake of food.

She still had her gallbladder and my first three thoughts of the cause of her pain were gallbladder, gallbladder, and gallbladder. Of course, elderly women thoroughly enjoy stumping us in the medical field, so I also entertained other suspected reasons for her pain--an ileus (where the bowels are less efficient in moving air or material forward), a bowel obstruction (where the bowels kink on themselves and prevent any forward passage), referred pain from the heart or lungs, an atypical urine infection, or some form of peptic ulcer disease.

I questioned her further. She had no fever. No change in bowel movements. Some occasional nausea and bloating. Then, I asked her one last question, whose answer raised my suspicions beyond the normal concerns.

"Do you have a cancer history, Mrs. Brown?"

"Actually," she answered reflectively, "I do. I had breast cancer about a year ago." She looked over at her husband and smiled. "Remember those days, dear?" She explained that she had undergone chemotherapy following a right mastectomy.

Oh no, I thought to myself. Add metastatic cancer to that list. Unfortunately, I have seen several cases of elderly patients with a remote history of cancer who had presented with a recurrence of their cancer, abdominal pain being their only complaint. I could only hope Mrs. Brown wouldn't be in that category.

I did my exam on Mrs. Brown. Sure enough, she had significant abdominal pain to her right upper quadrant, but only if I was palpating deep in that area.

I explained my suspicions to her. We would need to test her urine, her blood, perform a chest x-ray, and finally, the most important of all the tests, perform a CT scan of her abdomen. That would effectively rule-out or rule-in my biggest concerns. Because we had just had a stroke patient and a trauma patient before her, I explained her workup may take a few hours time.

"Honey," she said to her husband, "go ahead out to the car and take a nap. I'll be all right in here. Dr. Jim," she added, winking at me, "will take good care of me."

Any other night, I would have worked hard to find an extra cot for Mr. Brown, but this night in the ER was crazy. I knew there were no available beds. "Go on, Mr. Brown," I said, "you have a few hours nap time ahead of you. I'll take good care of your wife."

I left the room and let Mr. and Mrs. Brown have a private moment. Minutes later, I saw Mr. Brown shuffling down our hallway toward the exit sign, guiding his lonely walker along the way.

Slowly, Mrs. Brown's results started to return. Her urine was clean. Her chest x-ray was unremarkable. Her blood work, however, returned with two concerns-a mild drop in her red blood cell and platelet counts and an elevation in three of her liver enzymes.

I entered her room to explain her results to her. And also to share that she was now second in line to go over for her CT scan. She was, however, napping. I softly strolled up to her lone walker to check it out more closely. It was spiffy. I've only seen aluminum and black walkers before, and was wondering if this was a custom paint job.

"I never wanted that thing," Mrs. Brown said, my back to her, startling me. I turned around. She had awakened. "Edgar needed one. I was afraid he was going to fall. But you know men...he insisted that he didn't need one. The only way I got him to finally accept using one was if I got one, too."

I nodded. "They sure look nice," I said. "Thank you," she said, "they are identical. We call them "the twins." If I had to use a walker I didn't really need, then at least I was going to pick out a color that suited me."

I smiled before remembering the business at hand. Slowly, I explained to Mrs. Brown what I had meant to explain when I first revisited her room. After finishing, I assured her that I would be back the minute her CT results returned.

An hour later, I walked, heavy-hearted, back into Mrs. Brown's room, accompanied by her nurse. Mr. Brown had returned, his silvery hair now somewhat mussed up from his successful nap. The greenish-blue walkers, side by side again, seemed to present a fortified protective wall. I held her CT report in my hand.

"Good news or bad news?" she asked, as Mr. Brown leaned forward from his seat and grabbed her hand. I looked them both in their eyes.

"Not good," I said. I went on to explain that Mrs. Brown's liver, via CT, appeared abnormal. Not only did she have multiple liver lesions suspicious for metastatic disease, but she also had a solid liver mass that was partially obstructing her small bowels. As I spoke, I appreciated the tightening grip Mr. Brown's hand took to Mrs. Brown's.

We all took a deep exhalation when I finished my explanation. "Well," Mrs. Brown said, "I guess that how she goes, then." She looked over at the two walkers, side-by-side. "I guess I won't be needing that thing much longer, Edgar." Her eyes grew glassy, and I was surprised that she had focused her attention, after such devastating news, on the walker. After spending a few more minutes with them, I stepped out to arrange for Mrs. Brown's admission.

Rare or not, I still strongly believe in the power of prayer, sometimes if even to make me feel a little better about things. I'll admit, though, that there are times when my prayers take on a very different, even bizarre, angle. The night I treated Mrs. Brown, I'm sure, my prayers were along that path. Although, to me, they were quite simple and clear.

I prayed that those walkers would sit side-by-side for another 60 years.

As always, big thanks for reading. To the amazing commenters from my Wednesday post, thank you, thank you. Too kind. Next post will be Monday, May 24. See you then...