Over the past 18 years, I have travelled far and wide, lecturing to oncology care providers as well as survivors and their caregivers. I love the travel, despite the hassles of airports and flight delays. I really do love sitting in my seat on the plane, feeling that momentary lurch as the plane loses contact with the ground, and then there are the clouds that delight me with their changing shapes and colors. I love seeing cities and towns that I would otherwise have no reason to visit. Even the brief 24 hours or less in any place can give me a flavor of that city or town, from the greeting by the taxi driver to the check-in at the faceless hotels where I sleep for a few hours before heading out to a clinic or hospital.
Due to COVID-19, my travels are now a memory of the past, but my love for teaching is not. What used to be an experience of being able to see the faces in the audience has now been replaced by my image on the computer monitor. Webinars and Zoom meetings are now the norm and I am begrudgingly getting used to them. This past month I have been working on presentations for two conferences for young adults with cancer. For one, I asked those attending to send in questions that I will answer during my presentation. Forty-five registered attendees responded with questions that reflect the most common issues for young adults with cancer. There were questions about relationships, changes in body image and sexual functioning, fertility preservation and infertility, loss of desire and altered sexual responses, pain and the side effects of treatments that impact on sexuality.
The questions also echoed issues with anxiety about the COVID-19 pandemic that so many are experiencing now. These struck me in their reflection of the loneliness that single individuals face. One person wanted to know how they can date during the pandemic and, if they have sex with someone, do they have to quarantine for 14 days afterward. Another wondered how they could meet someone considering the need for physical distancing. And yet another asked how they can date safely during these times. This speaks clearly to the lack of communication about sexual relationships in this challenging time.
This is not unique to young adults who are single. A couple that I am counseling by video told me that they have not kissed for almost 3 months, never mind doing anything more than that. This couple is in their 60s; the man was treated for colorectal cancer 5 years ago and his wife is concerned that physical contact is a high-risk activity, despite the fact they have been isolating themselves since the start of the pandemic. They sat shoulder to shoulder during the appointment and I wondered to myself if this was the closest physical contact they had had since mid-March. I asked them about that, and they glanced at each other before she answered: “I guess so…. Is that bad?” I told them that there is no right or wrong in this instance, just the physical loneliness that comes from lack of touch.
Oxytocin, the hormone of attachment, is released in response to touch. This is perhaps most evident during the early months of parenting when the parent-child bond is cemented. Both parents experience a rise in oxytocin levels and it is probably this that gets them through the sleepless nights and anxieties of caring for a baby who can’t tell them what he or she wants! An elderly person told me that what she missed most while being cared for in hospital was the touch of an ungloved hand. The professional touch she experienced did not comfort her in any way; it felt perfunctory and task oriented.
There has been a lot written recently about the virtual care that health care providers are performing during the pandemic. Patients seem to like it (no need to drive, find parking, and wait for a delayed appointment) and health care providers do too. But I miss seeing patients face to face. Video appointments are certainly better than those done on the phone absent of faces and the ability to observe non-verbal communication. I miss the firm handshake on greeting and departure. I miss being able to gently touch the elbow of someone brought to tears by their suffering. I miss the occasional hug, especially if the patient asks if I would welcome it instead of getting up close and personal and surprising me. I miss the smell of tobacco or cannabis on a patient’s clothes that prompts me to have a discussion about smoking cessation.
Perhaps, like some of my patients, I’m in oxytocin withdrawal and I don’t like it one bit. And I really don’t want to get used to it.