The conversation was not one I was unfamiliar with. Discussing a serious diagnosis, a worrying test result, or a life limiting prognosis is something I have been doing on probably a weekly basis for years. This conversation was no different; the recipe that guides me through imprinted on my mind, the right words on hand, time for silence, opportunities for questions, acknowledgement of fears, a shared sense of fear and often of loss.
Now though it’s different. Now an enforced barrier separates me from my patient; a mask that disguises my expressions and muffles my voice, an apron that reminds us both of the need for space to halt the spread of the invisible danger that has been at the forefront of our minds for months, a pair of gloves that removes the ability to delineate warmth from cold, life from death.
We made it through the detail; my patient lying in a hospital bed, me sitting on a hard plastic chair beside him. I held his hand through my plastic shield as we talked about the cancer that was invading his frail form. He was alone, family visiting now restricted to certain circumstances. I wondered if he would make it out of this hospital ward and back to his home and his wife of sixty years. I took my time. We talked about his family, the grandchildren he was so proud of, the village he had lived in all his life. I tried to answer his questions in the best and clearest way I could, with kindness and honesty. We laughed at times, despite the seriousness of my message.
When there were no further questions, and I’d promised to go away and contact his family with the same news I had just imparted to him, I gave his hand one final squeeze before standing and turning away. Pulling off my apron and removing my gloves, my foot went automatically for the foot pedal to open the bin, the lid of which I knew would come crashing down intrusively moments later. Turning back towards him to smile, forgetting that my mouth was hidden from view, our eyes met; his now full of tears which had suddenly appeared from nowhere, rolling down and soaking the mask that covered his mouth and nose. Instinctively I moved back towards him, reaching out to put one arm around his shoulder and to grasp his hand in mine.
And then Covid stopped me in my tracks. My plastic protection discarded in the bin, a voice telling me not to approach but my head and heart urging me forward. What should I do? Stop and put back on the flimsy plastic apron that did little more than flap in the wind, and struggle back into another pair of plastic gloves? Or just carry on as I would have done without hesitation this time last year, to comfort my patient in that moment?
Touch: a hand held; a hug; a gentle resting on a shoulder; an embrace. Something we just do at the beginning of life and at the end, and at all times in between. An act that happens in times of joy, and in times of sorrow. Comforting, celebrating, congratulating, consoling. Instinctive in the main; at times passionate, at others the final embrace as the breath of the one we hold fades away. Touch can be healing. It can fill the void when words don’t seem enough or simply don’t come. Touch can convey meaning when there are simply no words, or when the fear of a choked voice and tear-filled eyes means we dare not speak. Touch can at times be violent and destructive, but in the main it is not so. Mostly, touch is kind and thoughtful; an expression of humanity, of care and of love.
The spontaneity of touch is the thing I think I’ve missed most over the last nine months. The Covid pandemic has snatched away this instinct from one of the most human of acts. I didn’t realise how much I relished and relied on it in both my personal life and my clinical practice until it ceased being natural, becoming instead something to be resisted, reserved for necessity, a potential danger to be avoided, a threat to both health and life.
My concern is how the absence of touch is in itself a threat; a threat to kindness and compassion, a threat to humanity.
2020 will soon come to an end, and although I’m under no illusion that the beginning of 2021 is going to be significantly different, I’m cautiously optimistic that maybe this time next year the world may be beginning to adapt to a newer normal that widespread vaccination will hopefully offer. I’m curious how human behaviour will change over time. Will we ever go back to the spontaneity of human emotion exhibited through touch, where it was once normal to hold a hand or offer a caring embrace? Will instead there continue to be a sense of reservation, both by the giver and receiver of human touch? How can the human race recover from the fear that Covid has brought to our lives?
In fact, I’m excited. I wonder if this unnatural year may be a catalyst for increased human instinct: the profound instinct to care; show emotion; express empathy; actively listen – with or without the added dimension of touch. Have some of our other senses become more attuned during this time due to touch being off limits in such a fundamental way? Have we become better at listening and speaking? Are we more aware of the power of eye contact and how even with our mouths hidden behind a mask our eyes can convey a smile, or a frown, shock and fear? Are our eyes more astute in noticing the flicker of fear, or joy, in the eyes of others? I really like to think that if anything positive is to emerge from the depths of the pandemic it will be a world where human connection is cherished, actively sought and valued as the fundamental building block to human existence that it is.
Since that day when Covid stopped me in my tracks, blocking the instinctive behaviour that would normally be so natural to me, I’ve thought a lot about touch. I’m very aware that in many situations touch is neither welcome nor appropriate; it’s important to be mindful of that and to have the ability to read the situation dynamically. But thinking back to some particularly memorable clinical situations from my career and personal life, I’m in no way surprised that touch, in some way featured prominently. Comforting an injured toddler, celebrating the news of a clear scan, imparting news of a child’s death, holding the hand of a dying octogenarian, being comforted when my own child was critically unwell as the resuscitation trolley was wheeled to her cot side. Touch in these situations was not a conscious act. It was instinctive. It was fundamentally human.
You may be wondering what I did as the lid of the bin into which I had just deposited my plastic protection came crashing down. Yes, I stopped in my tracks as my head told me I couldn’t approach without re-donning my PPE, but only momentarily. Was that the correct thing to do?
Yes, undoubtedly so.