Keep Smiling

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The importance of a smile has become somewhat cliché in our culture; yet, a patient reminded me just how significant a smile can be. I was on the pulmonary service assisting with consultations at one of our hospitals and had the pleasure to consult on an 85-year-old gentleman admitted with acute heart failure with a known history of COPD. He was a veteran and, as I do with all of our veterans, I extended a firm handshake and thanked him kindly for his service upon our meeting. He expressed his appreciation.

We talked about why I was called to see him, his diagnosis and current treatment, and dwelled in conversation for a moment on how he was feeling. He noted he was doing better since they gave him the “medication to help him pee a lot” and that his legs, which were on initial presentation very edematous, had gone down now that he was several hours into the hospitalization.

As I left the room, he said, “Doctor, keep smiling.” I thought for a moment: KEEP SMILING. I already know I have a tendency to smile a lot — everybody tells me that — and I remember reading somewhere several years ago that laughter has the potential “to clear arteries.” As a physician, my initial assessment of the claim was that it lacks the evidence or even physiologic basis to be true. Yet, expressing some degree of happiness has obviously been shown to be positive and has been accepted to potentiate some degree of a health benefit. I realized by this very assertion, this elderly gentleman had realized something very important about the outward expression of happiness — how very crucial such an action can be not only to others’ perception of you but also one’s perception of oneself. It’s amazing how such an effortless expression can brighten someone’s day and make someone else smile.

As a young physician, I learned that going through the rigors of training can be quite burdensome at times. Sure, medicine is an extremely rewarding profession in more ways than one, but there are days that are “heavier” than others. It’s in those times that we as doctors may forget and even find it utterly impossible to smile. Yet, we must.

In studying the Nicomachean Ethics as an undergraduate student, I remember fondly that “happiness is an action of the soul according to virtue.” What a wonderful, Aristotelian statement. Happiness — this intangible, even cryptic entity that we as mammals have the ability to express with our senses is in fact a true expression — is an action. It requires movement. What a fascinating opportunity we get daily, as physicians, to interact with the ill, the sick, and the “least of these” in some respect. Although society places upon us the task of teaching them, we are taught, actually, by them.

This elderly gentleman, although hospitalized with a potentially fatal condition, taught me to express my happiness continually. As my patient for the moment, he found something delightful in my demeanor and wanted me to never cease to use it. To me, it’s so necessary that I must. This has been a great reminder that although we as healthcare providers employ many physical tools to treat and attempt to cure, our emotions, body language, and overall disposition can be potent tools to help us take the best possible care of our patients.

I charge everyone on the front lines of healthcare to do yourself and your patients a favor and always remember, no matter how dismal the days may get, to express yourself with goodness and a sprinkling of mercy.

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