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Vital Signs: Those Who Know Us Best

A faint whiff of bad breath tells 
a worried wife something is seriously 
wrong with her husband.

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Jerry was in fine form as he stood at center stage, his hand resting on the microphone stand, waiting for the laughter to subside. He had invited me to watch him perform stand-up at this West Los Angeles comedy club, and he didn’t disappoint. But his wife, Sandy, wasn’t laughing. She leaned across the small cabaret table we were sharing and said, “I need to talk to you about Jerry.” They had both been patients of mine for many years. Both were late middle-aged, and neither had ever had a serious medical problem. I looked at her quizzically and she said, “His breath.”

I leaned closer and asked, “What about his breath?”

“It’s different. Not bad, but it’s changed. Something’s not right.”

“How long?”

“Maybe three months.”

I asked if anyone else had mentioned anything, and she shook her head.

“How does he feel?”

“He says he feels fine. But ...

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