As a med student in the OR, often your role is to just sit/stand quietly and observe without contaminating yourself or the sterile field. However, it is often nice to be able to smile and communicate non-verbally with people like the circulating nurse and the scrub tech. However, your mouth is covered with a mask, and you don’t want to be waving, as you need to keep your hands between your waist and your shoulders. I have noticed that people tend to communicate much more with their eyes, and that includes smiling with the eyes crinkled up on the corners. So I’ve taken to sort of acknowledging/greeting people in the OR by smiling with my eyes, giving a sort of double eye blink and minuscule nod/bow; I’ve been doing it so much over the past few weeks, that I noticed that I was doing out in the grocery store.
It’s amazing how important the eyes are to the smile. Most people have some intuition as to a fake smile, often involving just the mouth but not the eyes. However, this is an area which has actually been very well researched. The French neurologist Guillaume Duchenne was one of the first people to really do extensive research into the muscles of the face and expressions of feeling and emotion in the 1800’s. His name has been attached to another area of his research, Duchenne’s muscular dystrophy, but he is also known for his work on facial expression. This is an iconic picture of him applying electrodes to the face of a older man to elicit different expressions and examine the physiology of the muscles of the face (it’s well off copyright, so I can reproduce it here):
Although it looks pretty horrific, apparently the man who was used as a subject had no sensation in his face, so the electrical stimulation did not bother him at all.
Relevant to smiling, it was Duchenne who described two types of smiles. Typically a consciously initiated smile involves only the zygomatic major muscles around the mouth (this is what you can think of a fake smile). However, what is called a Duchenne smile, or authentic smile, involves contraction of the orbicularis occuli muscles around the eyes, which shows really happiness. This is often why people with crow’s feet around the eyes give people a happy and playful expression. This is also why Botox injections which temporarily paralyze the muscles of the forehead and around the eyes make people appear less engaged and their smiles sometimes seem less authentic.
This representation of smiles has something of a cultural component as well. In the “Western” world, representation of the smile is often focused on the mouth. The iconic yellow smiley face has an upturned semi-circle mouth and round eyes. The emoticons that people use to convey smiles in text, SMS, email, etc., are typically round eyes with a smiling mouth, for example 🙂 or perhaps a wink 😉 or even with a nose :o).
However, in many parts of eastern Asia, a different set of smiling emoticons is often used, and the emoticons are such that you don’t have to turn your head to the side. ^_^ is used to represent a smile, here the mouth is kept relatively level, but the eyes are crinkled up into two little rainbow arcs to show happiness.
So in the OR, I smile a bit like the Asian emoticon, with my eyes crinkled up, but my mouth a mystery under my mask.
I hope whatever you’re doing your having fun and your days are full of Duchenne smiles of authentic happiness.
