COMMENTARY: COVID-19 Diary Day 8: I'm a 'Hugger.' Now I'm Socially Distant.

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APRIL 15, 2020 -- "I have to keep my hands in my pockets," my nurse navigator, Carolyn, exclaimed as she entered the room.

I was just getting settled in at Newport Hospital, preparing to change out of my street clothes and into my scrubs. I had arrived a little bit early and had the luxury of taking my time before my first patient arrived.

"Why is that?" I asked.

She looked at me, slightly exasperated. "I'm a hugger," she said. "I feel like I'm fighting to keep my hands to myself!"

Alas, I've struggled with this too. I will typically greet a patient with a hug when I first enter, sit close to them as we talk, and at the end of that visit give a hug to the patient and a firm handshake to whomever had come with him or her. There is something powerful in the human touch; it is both comforting and intimate. For me, it has always been the physical manifestation of hope, and of caring.

Now it was off limits.

I've since tried to come up with another way to connect in this era of physical distancing. I've tried the fist bump, the elbow bump, and even the toe tap. I've tried a bunch of sayings as well: "Stay safe," "Be well," "Take care," and even "Stay home."

Yet nothing seems as satisfying as a hug. It's as if we've all resorted to life in a bubble and no one is allowed in for fear of contamination.

It's not that I don't understand. Of course I do; we're part of mitigating the risk of spreading COVID-19 by following the World Health Organization's guidance: physical distancing, frequent handwashing, not touching your face, and staying home. I am also aware of the data to support it, like the flattening curves seen following social quarantine orders in China, Italy, Greece, and New Zealand, to name only a few. The guidance is also probably now showing results in California and New York.

But I worry about the toll. I had imagined how hard it would be on patients at first. Cancer is already so isolating in and of itself. I have always encouraged my patients to reach out often, to talk about how they are doing, and to let people in. In our own clinic we have even instituted a frequent visit program—the High-Touch Clinic. We offer additional calls and/or scheduled visits to patients on toxic regimens, those who have been hospitalized after treatment, and those who we are just generally worried about.

Continued

I realize now that social distancing is also taking a toll on clinicians, and specifically on me. To avoid physical contact during the practice of medicine feels deeply abnormal, even wrong. Each day I don't touch my patients ends with the feeling that I am being "less than" I was trained to be. Every instance where I talk to a patient about their end-of-life treatment on video, or sit 6 feet apart from them as they cry, or am unable to hug them after giving good news robs me of an essential piece of what doctoring is all about.

And the only thing that rescues me from my self-pity?

My patients. Their expressions of gratitude at being able to receive care, whether in person or by video, sustain me now. Without exception, each person has reached out to me with kindness, offering their words of hope that this will pass, concern that I need to be safe, and forgiveness for not being able to hug or touch them. In a weird way, they are the ones providing me comfort.

And yes, I need that at the moment.

Don S. Dizon, MD, is an oncologist who specializes in women's cancers. He is the director of women's cancers at Lifespan Cancer Institute and director of medical oncology at Rhode Island Hospital.

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