I feel the structures: normal-except the back left. The tongue has the lack of bulk and redundant folds associated with paralysis. With light reflected from the odd round mirror perched on my forehead and covering my left eye, I review the illuminated anatomy. She lowers her mask tentatively, as I leave mine in place, allowing it to filter 95% of the small particles in the air.

We are at the “why she is here” part of the exam.

I press under the chin on each side, feeling nothing worrisome and leaving her mask undisturbed. My gloved fingers feel her neck, probing along the muscles and great vessels for signs of concern. I wheel my chair closer and the exam begins. We talk further-query, answer, explanation, repeat. Her husband nods in agreement, his mask tilting up and down, concerned eyes fixed. Her speech is fine, as it emanates from behind her mask-sound only, no visual accompaniment. She tells me how she noticed-six weeks ago-that her tongue looked different, but she has no pain. Her husband inches his chair toward hers-shortening the base of our isosceles. I know they are scared everyone who sees me on “short notice” is terrified. We form an equilateral triangle, just less than six feet apart. Mine is thicker, with strong rubber bands binding the balding crown of my head. Their masks match, given to them at the hospital door. We all wear masks-such a different time this is.

We all stare at each other for a moment, taking in what we can. She sits uncomfortably in the chair with her husband seated opposite. I wear scrubs for clinic now-no more trademark starched white shirts and treasured ties. Travelling to work now is easy as the deserted city is simple to traverse. Patients with head and neck cancer will adopt elaborate means of covering the disease with hair or clothing to hide its progress and stigma. It can damage or scar the face, a part of the body not easily hidden. Its manifestations rob patients of so many aspects of our humanity: speech, swallowing, breathing, and smiling. Head and neck cancer can be particularly cruel. A virus which put health care workers at risk while we negotiated the path of safe care and created terms such as “universal precautions.” Here, we are three decades later treading a similar path into the unknown. As young trainees, we daily observed the pernicious lethality of that virus as we cared for countless people who entered our hospital and never left. I have been taking care of head and neck cancer patients since 1990 when I began my residency in San Francisco-in the midst of another pandemic. He reviews the case and his impression-all succinct, professional, and caring. “ Saw” being a somewhat dynamic term now-formerly referring to an in-person, face-to-face consultation and assessment, but now encompassing seeing a patient on laptop via a Zoom call. “What’s up,” I ask, because something is always up when a radiation oncologist calls on Thursday afternoon.

Another word for hiding behind a mkas