Earl Stewart, Jr.
The importance of a smile has become somewhat cliché in our culture, yet a patient recently 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 eighty-five year old gentleman admitted with acute heart failure with 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. 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 with such a claim, 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 statement, this very assertion, this elderly gentleman had realized something very important about the outward expression of happiness and deemed it necessary to remind me how very important it is—how very crucial such an action can be not only to others’ perception of you but also one’s perception of one’s self. It’s amazing how such an effortless use of the muscles of facial expression can combine in action to foster a gesture than can brightened someone’s day and make someone else smile.
As a young physician, for me, 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 they are “heavier” than others. I wrote a poem recently recanting just how this can happen and titled it, “Heavy.” It is at those times when we as doctors may forget and even find it utterly impossible to smile. Yet, we must. Smile in the good times. Smile in the bad. Smile when you’re happy. Smile when you’re sad.
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, Aristotlean 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—it is an action. It requires movement. It takes verbs to make true the noun that it is. What a fascinating opportunity we get daily, as physicians, to interact with the ill, the sick, the “least of these” in some respect, and, although society places upon us the task of teaching them, be taught, actually, by them. This elderly gentleman, although hospitalized with a potentially fatal condition if not promptly treated, took the time to teach me to express my happiness continually with a simple spoken reminder after our encounter. As my patient for the moment, he found something delightful in my demeanor and wanted me to never cease to use it, and, to me, it is so necessary that I must. This has been a great reminder that although we as health care providers employ many physical tools to treat and attempt to bring cure, our emotions, body language, and overall disposition can be potent tools to help us take the best care of our patients that we can. I charge all of us on the frontlines of health care, therefore, to do yourself and your patients a favor and always remember, no matter how dismal the days may get, to express yourself. Just smile.