Touch-up

In the last 3 years, I've noticed myself momentarily hesitating before I touch someone. Rest assured, this isn't the result of me becoming a born-again germaphobe, although medical school has afforded me a new found respect for protective barriers. Certainly I now ask myself, "are your hands washed," before I touch I touch anything (a patient, a door handle, my book, my food, a friend), but there is something else contained in my hesitation. It's more a pause to clarify the reason behind my touch, what I want to gain or communicate. Of course touch is significant - this is why we find comfort in it, why it makes us cry, why we are so stingy with it, and why we recall moments of touch (especially the first ones) with visceral clarity. It used to be that my reasons for touching were buried somewhere beneath my awareness - not repressed, but not considered either - like food, touch was simply a thing to receive or give, want (even need) or reject.

In the last few years, the significance of touch has risen into my consciousness. Now I am almost hyperaware of it's existence and completely dependent on it's power. Practically speaking, in the doctorly profession, it is through touch that we learn about the decay of the skin or the disease of the heart. A patient's response to our hands on their abdomen allows tells us to move appendicitis higher or lower on our differential (the running list in our head of reasons for symptoms). Pressing behind the ankle and on top of the foot, we learn about circulation problems. A toe dulled to sensation makes us concerned for diabetic neuropathy. We ask, "Does it hurt here? Can you feel this?" We say, "Your knee feels swollen. Your abdomen tight. The two sides of your lungs sound different to percussion (essentially tapping on the body)." Before we order the (very important and useful) blood draws and the CT scans and and the stress tests, we gather information by touching.

And then there is the other side of touch. Its less practical, but more human (and almost more useful) significance. It is through touch that we are concerned and passionate. Standing side by side, a hand on the back emphasizes that we, the patient and the doctor, are allies in the process of health. Running a hand up and down an arm a few times conveys sympathy. Two hands on the shoulder, looking a patient in the eye tells them we are heartfelt, serious, and speaking the truth. A long hug tells a patient it's O.K. to cry.

For the record, I am not celebrating the days when touch was our primary diagnostic tool. I do not believe that we can heal through touch alone, but I do think that without touch we cannot heal.

Touch is different for me now. I am aware of its significance, and so I try and choose with consciousness. And this new-found awareness does not stop with patients. Now before I shake hands with a patient or hug my dad, before I lay my head on my mom or test a patient's reflexes, before I feel a patient's heart or hold hands with a friend, I delay momentarily. And in that delay my mind runs through these questions: Who is this person? What is my relationship to them? What does this touch mean? And, of course: Do I need to wash my hands before this or after this?