WHERE’S MY HUG? | Meg Sniderman
Carl always asks for a hug. At first, I was flattered, but now when I see his name on my schedule, I want to call in sick.
“Where’s my hug?” Carl asks when I walk into the exam room. My insides shrivel like a raisin. I resent that in addition to managing his medical care I have to let him touch me. Am I being uncaring? Can I say no even though I previously said yes?
This is not a lesson they covered in nursing school.
***
Carl has endured great tragedy in this recent season of life. When I first began seeing him, he had a full-time job and went boating on weekends. He moved with swagger. Now he has a neurodegenerative disorder, no income and memory loss. The misaligned wheel on his walker squeaks as he crosses the lobby floor.
In his visits now, he cries at the shape of his new, difficult life, and I sit with him and try to hold space for his grief. In one instance when his shoulders shook with weeping, I let him lean on me. And now it’s become a thing. He wants a hug when I greet him and a hug when he leaves. I seem to have reached my limit.
Still, I hesitate to deny him. Touch is therapeutic; its absence leads to illness. And anyway, is a hug so much to ask for? Carl’s family hasn’t exactly stepped up to the plate since he fell ill; he probably needs someone to hold onto, someone who sees what he has lost and will embrace what is left. But is that someone me?
***
Physical contact was never discussed much during my training. Nursing school lectures spanned broad and disparate topics, but an implicit precept always ran underneath, pulsing like a metronome from one side to the other: nurses are faithful servants; nurses are disruptive leaders. Nurses exist to change the bedpan; we exist to change the world.
We learned that nursing demands physical intimacy: lean in to hear the lungs, hold a wrist to count the pulse. And we learned that nurses, above other healthcare professionals, connect with their patients. Through thorough assessment and a dash of self-sacrifice, we take the time to understand them. We are educated angels. Or so I was told.
But I think now that certain mechanics were left out. And that sometimes, in the shadow of connection, there is repression, a disengagement from our own emotions that we undertake in order to care for others. We don’t talk much about that part.
I remember my very first day in the hospital, standing with five other student nurses around the bed of an elderly woman. Our bodies in scrubs made a navy-blue curtain around her. She was not awake, would not wake up as I recall, though I no longer remember why. Her mouth hung slack as her chest rose and fell. We surrounded her with our youth and our good health, and in our midst, she was completely alone. Tears fogged the plastic of my glasses lenses before we even moved to help her.
We did help her, though. With our instructor’s advice, we overrode our own distress and repositioned her body. The effort of her breathing seemed to lessen then, and some of the tension left her face. Our own discomfort eased as well. Suffering begets suffering, but so does relief.
***
Another day later in my career, I was preparing to place a Nexplanon, a long-acting contraceptive device, in a patient’s arm. Before I started, she told me, “I know I’m going to start yelling, and I want you to keep going.”
I did what she asked, advancing the large bore needle under her skin while the nurses looked on wide-eyed, and the patient’s screams, so close to my ear, drowned out all other sound in the room. The procedure wasn’t complicated; the trick was simply to continue. Perhaps, beyond all else and like anyone who takes care of other people, nurses learn to endure.
When I’d finished, triumphant and a little shaken, the patient went silent. Then she turned to me, smiling. “That wasn’t as bad as I’d thought.”
***
When things got tough with Carl, I’d been working in primary care for a decade. Many of my patients lacked insurance so I researched their conditions and tried to provide some of the specialty-level care they couldn’t access. I was not a good substitute for someone with actual expertise; I was just all they had.
Carl’s situation was no different. His neurology referral landed him on an 18-month waiting list. In the meantime, I’ve looked for other resources and consulted other providers. But mostly, I’ve come up empty. Maybe there really is nothing to do beyond what I have already done. Maybe endurance is all I can offer him.
If that is true, is enduring his hugs a requisite to caring for him? Or is the real requirement that I set a boundary between us and endure his disappointment and potential withdrawal from care? I tried that option years before with another patient, Twain, a man who looked like a cross between Crocodile Dundee and Santa Claus, and who expected an embrace as routinely as a blood pressure check. Younger then, and new to my job, I allowed his hugs until the day he passed me in the clinic hallway while I was looking down at my computer, furiously typing up another patient’s note. Without a word, he reached out and ran his finger along the curve of my ear, a gesture so intimate and unexpected, I jumped in my chair, then called my boss to report it. At our next visit, I explained to him that I would no longer hug him because his action had made me so uncomfortable. His wife sat with us, as usual, though that day she stared straight ahead, silent and stone-faced. We never recovered the ease of our initial visits.
The loss of rapport was not devastating, but Twain’s care was not as complex as Carl’s. I didn’t think about Twain in my free time and wondered which diagnoses I had overlooked. So, is it caring, cowardice or guilt that prevents me from drawing the same lines now? And what clinical clues am I missing because of this preoccupation with my own dilemma?
***
When I was in nurse practitioner school, I was told that my job would focus on preventive health care. Rather than a physician’s expertise in disease, I would become an expert in keeping people healthy. Perhaps well-intentioned, this distinction was a lie, a betrayal I have felt every day of my career. The truth is my patients are not disease-free. They have as many chronic problems as patients anywhere, and their treatments demand the same competence.
Unfortunately, despite my professors’ assertions, I have not definitively kept anyone healthy. I have made suggestions and written prescriptions but have never figured out once and for all the trick of evading disease. Nor have I mastered the management of loss. For me, this is the most difficult aspect of life in medicine: in cases of greatest need, it often feels like there’s little we can do.
A hug is a gesture, a potent resource always within reach. It signifies compassion and traverses the solitude that is our human inheritance. In Carl’s case, it also represents powerlessness, both his and mine. He can no longer take care of himself, but I can’t really take care of him either. I want to run from this feeling and the action that symbolizes it, but I have sworn to do no harm. So where does that leave us?
***
I saw Carl again yesterday. I had been dreading his visit and the feelings that seeing him brings up—that I haven’t done enough to help him, yet don’t have anything more to offer. Hiding my frustration under cheeriness, I walked into the exam room smiling and sat down.
“That’s it? I don’t get a hug or nothing?” he asked.
I tried to make a joke and move on, but we never really found our footing. As often happens, he struggled telling me a story, and the effort made him cry. I understood that his son had gotten arrested again, and his air conditioning was broken at the height of a Tennessee summer. They were not insignificant troubles.
At the end of the visit, he heaved himself off the exam table and pulled his walker with its bad wheel over to him. The effort of his movement was painful to watch. I patted his arm, and he pulled me into a hug.
Meg Sniderman lives in East Tennessee and works as a nurse practitioner for people living with HIV. Her work has been published in the American Journal of Nursing and the Journal for Nurse Practitioners. Sniderman spends her free time hiking, cooking and tending her chickens and pigs.