Louise Dubras is a GP in Derry-Londonderry, and Professor of Medical Education.

“What are you giving me doctor?” is a question asked by many: our elderly patients have been watching the news and reading the papers and talking to their families. They have eagerly awaited the much-publicised roll out of the Covd-19 vaccines. They have watched the enormity of the pandemic unfold around them over the last 12 months. Their worlds have shrunk, many have not been out of their homes for 11 months, starved of contact with friends and family, unable to do the simplest things that enabled social contact, like a trip to the local shop to buy the newspaper. There’s been no reason to “smarten up”, and no-one to share stories with. Maybe some have been lucky and been able to join a “bubble” with their family, but many haven’t.

Their worlds have shrunk, many have not been out of their homes for 11 months, starved of contact.

And us- the doctors, nurses, pharmacists, receptionists. We haven’t had the experience of patients coming through the door, enjoying a bit of chat, and the general “buzz” of the place. The baby clinics have been “one at a time” and so much has been undertaken on the phone.

De Zulueta observes the nature of skin as a ‘social organ’1, and how starved of physical, social contact we have all been. How we have missed the casual holding of a hand to offer comfort or solace in times of extreme stress.

How we have missed the casual holding of a hand to offer comfort.

So when that patient comes in for their vaccination, I talk to them, I go through the screening questions, I notice their excitement, maybe their anxiety. I look into their eyes as I explain what I’m doing. They, for their part, ready, some more than others. Some with upper arms bared, others still with layers to remove as its cold outside, all with face masks on (though some have to be reminded to keep it on as we proceed).

I go through the process of drawing up the dose of vaccine, making sure it’s “just right”. Then I touch their arm. I get close to the patient, and touch them. What they feel isn’t the needle, its my touch, and they are surprised. “Is that all?” they ask, and in that question, I think there is more than the surprise that the needle is so small. Sometimes I detect some wistfulness that my hands are on their arm for such a short time.

This encounter is about so much more than enabling their T cells to learn about COVID-19.

Some are pleased, relieved and ready to return home, but some want to prolong that moment, the opportunity for physical contact, and want to hold my hand for a moment as they say goodbye and leave the room. I am working to a tight schedule, we have scores of patients to work through, but I take their hand in mine, and I let that touch linger. This encounter is about so much more than enabling their T cells to learn about COVID-19. This opportunity, this moment represents the healing of getting out of isolation, of social interaction, of rekindling the trusting relationship between doctor and patient.

“What are you giving me doctor?” I can’t quantify what I am giving that patient, but I’m very sure it is so much more than “the Oxford Astra Zeneca vaccine”. Of course it is hope, but I think that the transaction we enter as I touch that arm and administer that vaccine is to enable a sense of “being in the world”1 which has been so distant for so many months, perhaps for me as much as for my patient.

Reference

1. de Zulueta P. Touch matters: COVID-19, physical examination and 21st Century Genral Practice. British Journal of General Practice 2020;70(701):594-595.

Featured photo by Claudia Soraya on Unsplash