When the bear hugs are better medicine than the bair hugger

There is a concept in medicine called third spacing. This describes an abnormal shift of fluid from the intravascular space into the interstitial space. A very medical way of saying ‘fluid going where it shouldn’t.’ Pancreatitis, burns, an effusion or an obstruction. This concept largely describes fluid loss, or fluid shift which leads to an imbalance. Now medical people get very uptight when things are in an imbalance. Fluids, electrolytes, biochemical markers – we get very distressed over minutiae that may represent a state of being unwell. So we correct the imbalance. Or we try. We titrate and give, and then we give some more. And then we give ourselves a pat on the back because the numbers staring back at us are more representative of a physiological system back in balance. But is this really what makes the long hours, the disrupted sleep and the sheer exhaustion worth it?

I recently worked over a long weekend. Which, unsurprisingly, is not an uncommon occurrence in the medical world. A long weekend in a hospital often feels like a Sunday that has been stretched out over too many hours, where the rest of the world exists in a lazy Sunday haze that has seemingly forgotten to include the confines of the hospital in all its bliss. The thing about hospitals though, is that even on a lonely stretched out Sunday, you are actually rarely alone. I was walking down the stairs to get to another ward to try and make semblance of a dent in my ever-growing list of jobs to do that day. I passed one of our lovely ICU nursing staff on my way down the stairs and she stopped me. She had to abruptly stop me and ask “are you okay?” (with a slight amount of alarm in her voice). I must have a terrible poker face. Wearing all the troubles of the stretched out Sunday all over my face. I paused in my haste in making my way down the stairs and had one of the loveliest corridor conversations with her about how beautiful it was outside, and how we should both make a point of getting out there to see the sunshine before it all sets on yet another evening in a hospital. Pausing for a few minutes helped me realise that my haste didn’t really need to be haste at all. Thankfully, no-one was acutely unwell, and all those jobs became just jobs again. Achievable ones, within the hours that I left on the clock.

I think these hallway conversations that catch us by surprise can be some of the most important ones.

They occur in a third space where you certainly don’t expect to have these moments. ‘Third spaces’ in society describe a concept where the in between spaces in our lives (such as gyms, bars, churches, libraries) represent places where we can have familiar social interactions and engage with our communities. There’s a certain intimacy to this. It’s the people you always see in your F45 class because they’re the 6AM-ers just like you are. It’s the person at work who always buys their coffee at the corner café at the same time as you, so you know exactly how they smile at the barista. The hospital microenvironment has certain moments like this too – I think we just forget all about it in all our haste and obsession with correcting a state of physiological imbalance in our patients.

But what if we try to break away from our tried and true, but ultimately sheltered, ways for a little bit? Doctoring can bring about a special type of loneliness and a certain type of tiredness. Sometimes the disconnect between the doctor and the patient can feel much, much further than that blue curtain. So I started trying to ask, when I could, an unexpected question. Yes, some days it has to be about just characterising the chest pain and the medications. But some days the stories are a little bit more than that. It’s the 70-year-old lady who just sounds so chuffed when she tells me that she’s the only one who looks after her husband’s medications (as well as her own), because they’ve been married for over 40 years and it honestly sounds like there’s nothing else in the world she would rather do. It’s the 42-year-old single mother of 3 who calls bullshit on the advice of ‘no heavy lifting for 4-6 weeks after your surgery’ because she’ll be damned if she can’t cuddle her kids. It’s the 82-year-old who’s just a bit more on the wrinkly and hunched over side of life, but who can still tell me the story of how he met his wife. Because of course he’s going to still remember how he met her. Of course you’d remember the important moments when you’ve had the privilege of loving someone for that long. It’s those very moments that show you just how much love there is.

Maybe I’m just a very sentimental writer who happens to also be in this whole doctoring business.

But ask the unexpected question. Learn something more about the person in front of you than what medications they take, or how they would characterise their fifth presentation of chest pain. Maybe that ECG will still be cause for exasperation, but maybe, just maybe it’ll be the shift that helps bring your own balance back.