Boulevard, August 2009
Dr. Suzanne Steinbaum
When I was in training, I loved teaching. When I began my first year of residency, I was in charge of younger doctors-to-be and was an integral part of their education and their perception of their patients, as well as their views on careers and other facets of their own lives. I loved not only explaining medicine, but also teaching the nuances of being a good clinician. We took blood pressures and heart rates, checked oxygen levels, did blood counts and liver tests, read EKGs, and did a “lipstick check.” This check was less clear in its diagnostic specificity, but was a very telling predictor of how well a woman patient was feeling.
Some think of putting on makeup, getting dressed and styling hair as elements of vanity, but for most women it is part of their instinct. My older women patients often tell me that they don’t even recognize their own bodies and that they mourn the loss of their younger selves. Yet many, if not most of them, come in wearing lipstick.
One of my most precious patients was named Lily. I often think of her in her large sunglasses, fur hat, leopard print scarf, fur coat, jewelry and bright red lipstick, sitting in her wheelchair. Her blue eyes projected her inner diva. She was filled with the spirit of theater and music and a sense for the dramatic; her innate sense of beauty radiated from the makeup she carefully applied every day. The first time I saw her without makeup she was in the hospital in congestive heart failure and struggling to get oxygen. She had no makeup on, no lipstick and no desire to look better. I knew that this was a bad sign. Several days later I saw her sitting up, makeup done and lipstick on, waiting for her discharge from the hospital. Before even checking, I knew her blood pressure and heart rate were going to be normal and that she would be ready to go home. It was then that I understood the degree of her illness was based on how well she applied her foundation, eye shadow and lipstick.
I remember my grandmother’s two rules: Never leave the house without clean underwear and never leave the house without lipstick. These two tenets seem to be part of many women’s consciousness. And therein lies the “lipstick check.” When too debilitated to take care of oneself, the first thing that goes is one’s vanity. The survival mechanism clicks in and all a person can focus on is summoning energy to get better, to be well. Often when a person starts to feel better, survival is less exhausting and the vanity mechanism clicks in. The first thing to come out of their purse is lipstick.
Entering a woman patient’s room during morning rounds, I check blood pressure, heart rate and temperature. Then I explain to my students the most important sign that the patient is improving – a dab of red or pink paint on the mouth. The desire to feel beautiful, and an innate and healthy sense of vanity, has returned. It is a no-brainer. Red stains on the sheets don’t always mean blood. Sometimes it means that the patient is almost ready to go home.
