I have been seeing a couple regularly for 3 months. The man was diagnosed with lung cancer when the cancer was at a very early stage; today, he is well with no evidence of disease. He has been having some sexual problems that are causing conflict in his relationship of 20 years and he asked for a referral to me to help them sort out their issues. I have seen them together four times and, as is my usual practice, I have an individual session with each of them to discuss family-of-origin issues and also to hear their uncensored perspectives on the problems they are having. I had an appointment with his partner a month ago and this past week was his turn.
But COVID-19 got in the way. As with most patient contact, being face to face with a patient is something that I took for granted in the pre-COVID-19 days. Now that all non-essential appointments at our institution are happening by phone or video, I do not have the privilege of being able to see my patients face to face. I cannot use video with many of my patients, as not all of them have access to wifi or a computer with a camera and microphone, so these patients are “seen” by phone. Such was the case with this patient. I called him at the appointed time and he answered quickly. He needed to move to a room where he had some privacy and he started talking in a quiet voice; his spouse was in the kitchen and he didn’t want her to overhear our conversation.
As we talked, I struggled to find a comfortable place for myself. How could I indicate to him that I was listening? How could I communicate my empathy and understanding of his story? My work as a sexuality counselor is one of listening to the stories of my patients and helping them to make the connections between their history, their beliefs and attitudes, and their present challenges. Many of us lack insight into how our past experiences inform our relationships and it is part of my practice to support patients as they connect the dots from the past to the present. I of course provide evidence-based suggestions to help patients with sexual problems as a result of their cancer treatment, but information without reflection and understanding is usually not enough.
The patient told me about his past, his previous relationships, and his image of himself as a man. I found myself nodding—but instead of him seeing me, all that happened was me seeing my reflection on my computer monitor. I hesitated to interject into his story with words; normally I would use a hand gesture or a facial expression to indicate my encouragement for him to continue. But not this time. Once or twice I heard the emotion in his voice as he described a difficult time in his life or previous relationship. I would normally reach out a hand in support and empathy. But this time there was no one to touch. At one point I thought that he was about to cry, and I found myself angry with the 19th century technology that did not allow me to see his face and the emotion in his eyes. I could not point to the box of tissues on the table in my office or show him through my facial expression that I had heard him and that I understood his pain.
I sensed that he wished to prolong our conversation, but I did not have the ability to gesture to him that our time was over as I usually would. I had to interrupt him to tell him that we needed to stop; it felt impersonal and even a little cruel. There was no handshake as he voiced his thanks to me and I missed that feeling of having helped him in real time.
We said goodbye and I sat alone in my office, reflecting on his story and my feelings about what had transpired. I felt empty and unsatisfied, thinking that I had not been able to help him the way I could have had he been sitting in my office. I missed the face to face, the non-verbal signs that I was reaching him and he was understanding me. I raged inwardly against the changes that have happened and the place we all find ourselves in now as oncology care providers and as human beings.
My reflections were interrupted by a “ding” from my computer; it was an email from him. He had enjoyed our talk and was grateful for my listening to him. I reread his email and cried.
Anthony Frank Provenzano, MD
Apr, 25 2020 7:49 AM
Having participated as a panelist for one of the COVID-19 and Cancer weekly webinars I made a comment at the end of my presentation about telehealth vs telephonic medicine. I am putting together some thoughts that I will try to get published on line. You might find it helpful.
Anthony F Provenzano MD
Chairman Cancer Committee
New York Presbyterian MG