Reading Around the Mask

Beatrice Preti is a PGY-4 in medical oncology at Western University.

I never anticipated the challenge of not being able to see others’ faces.

A.N. All names have been removed and replaced with sequentially-assigned Greek letters to preserve anonymity.

One of the most bizarre experiences I’ve faced will forever be starting fellowship in a strange city in the midst of a global viral pandemic.

There were many complications with the transition that I anticipated. Difficulty finding movers. Inability to tour homes before signing a lease. Delays in online orders. Restricted access to rest stops.

However, I never anticipated the challenge formed by starting work in a new centre without being able to see others’ faces. Such a simple thing is easily taken for granted. As physicians, we have been trained to recognise and respond to facial expressions and subtle changes in tone; yet, with masks obscuring familiar faces and muffling voices, the daily practice of medicine is already intimidating.

Introduce a complete set of faceless strangers: new attendings, new nurses, new allied staff, a new programme director…

It was with even more trepidation than usual that I started my subspeciality training. And, one by one, the usual tricks I’d learnt for starting at a new centre failed. First went the time-revered tradition of Googling an attending’s name (and, consequently, face) prior to meeting them for the first time. Every trainee knows that the ability to recognise an attending makes them look more prepared, more confident, and more trustworthy.

Enter a crowded clinic space with over a dozen physicians, nurses, and staff milling around (plus medical students, residents, and fellows), all wearing the same masks and face shields, and that Googled photo suddenly dims in significance.

As was my habit, I’d researched Dr α, one of my first preceptors, online the night before clinic. I didn’t realise how useless that manouevre would be until I stood in the centre of Clinic 1, trying (and failing) to differentiate facial features behind masks.

Hoping luck was on my side, I picked the one that looked most similar to the Google photograph I’d found. “Good morning. Are you Dr α?”

Luck was not on my side. The lady, although very nice, was not Dr α. She did tell me, however, that she’d very much like to be Dr α. Both of us then spent several minutes searching several different clinic spaces trying to locate the elusive Dr α.

We did succeed. Eventually. It appeared I was (thankfully) not the only one who was struggling with masked identities.

There is a degree of forgiveness which might accompany a new trainee mistaking the identity of a preceptor they’ve never met. The more difficult (and far less forgiving) part, I find, is recognising individuals already met. At one point, I thought I had developed a system using hair colour and height (two of the most-easily identifiable features of a healthcare worker in full personal protective equipment).

But I was wrong.

“Good morning, Dr β,” I said to a gentleman in the hallway, as I scuttled between patient rooms.

When the gentleman looked baffled, I worried that I’d gotten his name wrong. Maybe this was that other physician with the blond hair. Doctor…Doctor γ, was it?

But the gentleman, it turned out, was not a hospital worker. “Huh? I’m not Dr β. My name is Adam. And my wife is taking too long in the bathroom. She doesn’t need all that lipstick if she’s wearing a mask. No one can see it.”

In the moment, my mouth opened and closed uselessly, cheeks burning at the blunder. At least, beneath my mask, my facial expressions were invisible. Adam looked at me intently, as if waiting for a reply, or perhaps hoping that I could offer some solution to his wife’s lengthy bathroom break.

I could provide neither, and, instead, scuttled away in search of the next patient room.

There is, of course, also the reciprocal situation.

“Who’s that?” I whispered to my co-resident, after a kind gentleman came into the resident room bearing a basket full of garlic and tomatoes to share.

“That’s Doctor δ. Don’t you remember him from the orientation?”

Orientation? Doctor δ? I strained my memory. Who was that? Did he like garlic?

Ack. Maybe I would remember if I could see more of him than tufts of hair poking out over his face shield.

Over recent months, I’ve tried to learn to read eyes instead of expressions – a science which perhaps merits subspeciality designation in its own right. Every subtle eye movement is easily overread. Is this disappointment? Horror? Scepticism? Or maybe just a muscle spasm?

It’s a challenge to operate in a domain as public as medicine when you can’t see whether those around you are laughing or smiling or smirking or frowning. Fortunately, as I’ve found, it’s a situation which works both ways. When my preceptor asks me a question that stumps me, he can’t see me twisting my mouth and grimacing as I struggle to concoct a plausible answer. A mask helps me hide the way my lips curl upwards when my staff tries to negotiate with, then threaten, a frozen computer to please print the last prescription, PLEASE. (It never works, no matter how much he begs.) A mask helps me hide my jaw as it drops to the floor when my brilliant, compassionate (look, Boss, I used compassionate, not empathetic!) programme director uses her powerful advocacy techniques to provide the highest quality care for those placed in her charge.

Gradually, as was bound to happen, the absence of facial expressions has taught me to rely on other senses, and I’ve begun to notice things I didn’t notice before. Like the way Dr ε moves her arms when she talks about something she’s passionate about (or the way she uses “hellery” in lieu of stronger language). Or the way Dr ζ’s eyes crinkle when he pushes us to think outside the box. The way Dr η uncrosses her legs to place both heels on the ground when she means business. Or when she’s talking about the SPA trials in prostate cancer.

Perhaps I should be grateful to the pandemic situation for exposing me to this side of medicine, recognising the unique beauty of body language that I had heretofore failed to recognise.However, I never anticipated the challenge formed by starting work in a new centre without being able to see others’ faces.