The Needs of Strangers
My eyes are wonky. When I was born they were completely crossed. The first person I think I clearly loved was my eye doctor for he looked at me deeply in the eyes. He was warm and called me George. Decades later, I cried when he died because he took care of me in a way that included but went beyond my body.
I am on the West Coast 3000 miles away from home, and my body is here, where I am. With these words, I feel myself lying on my side, my space pen in my left hand, my breath coming into my belly at the waistband of my pajamas. I am not uncomfortable. I am breathing and sensing the in and out below. I’m a feeling writing breathing body and I’m not uncomfortable! Normally, I fail to notice this. Because once noticed, there is often fear and judgment, as though to have a body in a relaxed state is a dangerous act. A body can be a weapon in aggression, and can be intruded upon, broken into. Is vulnerable. We are all Bambi, I said to a friend.
The day before my trip west, I had flashes of light in my left eye and was seen by a resident in emergency ophthalmology. She was deadpan as she did the scleral depression exam. “Protocol,” she said and inserted a tool like a Bic pen into each of my eyes and pressed each quadrant so she could get a 360° view. It went on and on. As she pressed, she said nothing. I braced. I am used to intrusion, but my body doesn’t like it. Nobody’s body does.
I asked if she was learning trauma-informed therapy in ophthalmology. “No,” she said she’d not heard of it. I said I could tell her a bit when we were done, and she could look it up. “Okay,” she said and pressed the next quadrant. We were still only on the first eye.
It reminds me now of the scene from the Luis Bunuel film Un Chien Andalou where a razor slashes an eye as a cloud moves horizontally across the moon.
I mean, this was my eye! My good eye and she seemed to have a little awareness about how a person in this position might feel. To be fair, she was a resident and perhaps nervous. And the waiting room had been full. To her credit she’d said, “it’s good that you came,” which gave some comfort. But I felt very alone in that chair.
Towards the end, I asked if she’d ever had this exam herself. “No,” she said. And then suddenly, “it must be horrible!”
She woke up, she saw me. She had entered the room.
Empathy can be lost in a waiting room of thirty patients, in an ER of 100 patients, after eighty hours a week, but it can’t be overrated. I relied on her. I trusted her because I had to. Nothing bad happened and it was over. For now. But there will be another time. Another person. The needs of strangers are endless and we risk everything if we go out without tenderness.
I breathed.
I hope I remember this.
I was invited to write this piece exploring the trust people have in medicine or don’t. Writing as a woman, a former psychotherapist, a poet who has worked in health care, a roving observer, how do I even start? It’s easy to get lost down the rabbit hole of trust studies, so I write to friends, teachers, health care providers asking about their experiences. (It’s a biased survey. Everyone is white and educated and knows me.)
My friend, a nurse, tells me it freaks her out how people hand themselves over, trusting those who haven’t earned it. “When someone tells me about a health issue, I say: Have you asked this, this, this?. When they say no, I cringe.”
“What would you have had me ask the resident?” I say.
“Well, for starters: how many times have you done this exam?” And I see that, essentially, I’m one of those blind trusters.
I’ve been lucky, treated mostly with respect and competence. And my response to authorities was always deferential. Was I really a person to them or an obedient patient? Perhaps because I was such a good product of patriarchy, I didn’t see my obedience as obedience, I saw it as normal. The water in which the fish swims is the world. If a doctor actually had asked me about the circumstances of my situation I’d have been surprised. The fact that I usually felt better and they were mostly benign meant it was okay to trust. What if they had actually dug deeper? What if instead of a thousand tests when I had hives at seventeen, they asked if anything had happened? I’d have said yes, my friend has killed himself. I’d have been surprised at their face and at my own voice.
My nurse friend and her colleague who teach in Thunder Bay give their Masters’ students reflection papers. These are students who’ve come back to school as a last resort after nearly burning out on the floor. “Why do we have to write these?” one asks. “I have nothing to say.” Later one is surprised when they hear themselves speak: “I do have a voice.” There’s a difference between compliance and trust. Maybe it’s the difference between being a patient and a person. And maybe trusting oneself is part of it. Hearing oneself and being heard.
During the pandemic when no one saw a doctor for at least a year unless they were so ill they couldn’t breathe, people looked online for support. Zoom cocktails, (what show are you watching?) but also advice on nutrition, exercise, mental health. What began before the pandemic—long wait times for health care and fewer doctors—merged with the through lane of social isolation. We were living alone on the unpatrolled internet highway. Where does trust even enter there? Mostly with the weighted blanket or the parasocial relationship. With the mystery of how Covid started, the uncertainty of long-term effects of vaccines, the absence of real human contact, and the real dangers of illness and death, it is easy to see how trust could be shaken, or manipulated.
My sense is that the pandemic provoked everyone’s early trauma, wherever it lay. Mine lay in fear of the world and in deference, so I was glad to stay home. For those who experienced poor treatment prior, or systems that delivered hurt not help, it’s easy to understand their anger. My default has been to ask for support. For others, it’s to go it alone.
Many new doctors who were residents during the pandemic didn’t see patients in person. They didn’t learn on physical people. They didn’t touch anybody, smell anything. This was a profound loss for them and those who needed the care.
Told to distance, I became distant. In April 2020, I wrote to a friend living nearby: “I’ve thought of you so often—not far away, yet far away. I find myself taking a long time to respond to emails as though we all live in a computer and then I remember ‘they’re real people!’ Virtual alters reality.” In 2024, a psychiatrist at a Toronto hospital asked for advice on a patient from colleagues via group email. It took days for anyone to respond to the need. Were they busy or had she stopped being real to them too? Before Covid, it would have been easy just to track someone down in the hall and ask.
So far, I see that empathy matters, having a voice matters, physical presence matters. Being in a room with another person and seeing them. Has all this been eroded? “We don’t nurse patients now, we nurse institutions,” the nurse from Thunder Bay said. “There is no space for you to gain trust, no time, not even a chair in the waiting room.”
Another friend says, “My doctor used to take time with me. Now he looks at the screen, not my face. He looks at my body part, not my face. He doesn’t touch me. The neurologist gave us five minutes with my husband’s diagnosis and we were left alone. There’s no time. I don’t know how we go back?”
At dinner one night a third friend speaks into her food. “My doctor is good at referring me to specialists. She’ll send me wherever I ask. But I don’t feel anyone sees the whole picture. It’s a lonely feeling.”
And I begin to feel a need for poetry. Though it won’t fix anything, that never stopped me. Under the heading “Health and Illness” at The Poetry Foundation website:
the sign read
Harmacy
after Frank shot
the P out
CA Conrad
And I feel better. Not because it’s redemptive but because it tells the truth. And because I think poetry is a better driver than statistics or at least it takes me where I want to go, I read poems for a while instead of trust studies. CD Wright, in the last book she wrote before she died, paraphrases poet Alan Grossman: The true function of poetry is to keep the image of persons as precious in the world.
This is as good a reason as any for writing poems anywhere but especially in a hospital which I did from 2012-2019. I sat in the hallway or cafeteria as people worried past me and occasionally one would sit down and I’d ask what they needed a poem for, then write it, and hand it over. For those ten minutes, they told me something raw and true, trusted me, because the stakes were low. If the poem worked it was like the sun came into their face, or they broke with tears, and relief moved through. They walked away with the poem like it was a bottle of something good and private.
In 2013, while I was at that hospital, I was invited to a “high level” meeting on trust. Asked to sit in, listen, then write a poem and share it at the end. The conversation focused on trust between staff and senior management. The CEO was there. All the big wigs. Why was I? Apparently based on interviews “trust scores” were high, but the hospital was merging with a new institution. Hard times were coming they couldn’t even countenance. An ethicist led the meeting. He greeted me warmly and said, “We don’t need more economists, we need more poets, because they’ll tell us the truth.” Astonished by the depth of that welcome, I sat down.
Among the things that stay with me from that meeting is the idea that both parties have to be seen as “trustworthy.” For staff to see managers as trustworthy and vice versa. When I was first a psychotherapist, I flailed around like an anxious fish until my boss said the other staff needed to see me as competent. He said, “I hired you. I trust you. Now do it.” It woke me up. Helped me realize my own capacity and power. Trust is relational. Doctors too want to see their patients as trustworthy, that they will take their medication, check their insulin.
But what of the person who comes in repeatedly from substance use who cannot sustain relationships because so little of their life is sustainable? Or the person whose own traumatic history, personal and cultural, affects how much they’ll stay the course, how much they can trust the one holding the pen or the instrument? Or the one assumed to be an addict because of their appearance or who will be treated differently because of their colour or language? I cannot get Joyce Echaquon, the young Indigenous woman, out of my mind and the racism and maltreatment she suffered as she lay dying in the hospital with no help.
Where is the baseline for trust? Is it empathy? Competence? Compassion? Integrity? A woman who survived a flesh-eating disease spoke at the funeral of Dr. Low, the doctor who carried the city of Toronto through the SARS crisis. She described how sick she was, how close to dying, how scared she was and how he was with her in emergency. “He simply said to me, see you later. And I believed him.” How do you quantify that?
A friend of mine who is not a healthcare practitioner was walking down her street. She heard a feeble, “help.” She did not want to turn around. The word came again. When she looked, she saw a neighbour she knew vaguely, bleeding from the face, disheveled, clothes half off, parts she didn’t want to see. She wanted to keep walking, pretend she didn’t see. But she turned around and stood at a distance and asked them if she could call 911. Many in her neighbourhood heard and ignored him. I too might have. Some texted each other and decided to do nothing. Some closed their windows when they heard him. She was shaken for weeks, both by what she saw and by the closed ears of those she felt were her community. When she called the hospital a day later they said he’d most certainly have died if she hadn’t done something. What is the baseline for trust whoever you are? Is it not simply about the fact that a person before you is vulnerable, and you might be in a position to help, that they stand there with their insides showing because they have no choice?
In October 2024, I listened to the radio show The Current about an initiative in Toronto to build a fifty-two unit supportive housing and healthcare complex for people chronically ignored, often homeless, living with multiple complex conditions. Matt Galloway asked at least three times: “how do you build trust with people who have lost it?”
“Humility,” said one of the doctors. He told the story of a homeless man who came for his Covid shot and said “I don’t need you to convince me to get the shot. I’ve done my research. But where will you be when this is all over?” That doctor expressed his shame having stepped up in the care of the unhoused during the pandemic to prevent transmission, and then abandoning them when it was “over.” What kind of action might humility lead to? What kind of presence?
We never know the risk of treatment. Once I was given a medication for a stomach ailment that caused a severe rash. When I returned, the doctor gasped: “the cure is worse than the ailment!” I didn’t lose trust in her. She was humble. When I was a therapist my supervisor said, all the therapy is done in the mistakes. It’s not about being perfect; it’s about repair.
This was the poem I wrote and read at the end of that meeting on trust in 2013:
Civility Among the Metrics
When we institute the necessary leanness.
When the tough standard comes in
on its dark road. How do we respond?
How do we generate a light that’s inviting?
That makes it possible to see amid the curves
and cut-offs? How to travel the road in a way
that’s clear, and gives back more?
We need civility, and not by protocol
by heart. Remembering that the journey
is not without passengers. Asking how to carry
ourselves with courage and gently.
It did what the ethicist had said. Metaphor has no hierarchy. The managers in the meeting were moved that one could bring the heart’s language into the institution. It brought them back too. The true function of poetry is to keep the image of persons as precious in the world.
I ask my meditation teacher for direction. She says, “What is trust? So much of what people mean by trust is that if I trust you, I can go to sleep. I can stop being aware.”
Unless I am completely unconscious, I want to be awake. I don’t want to hand myself to another saying here hold this. But healthcare is the closest we get to handing ourselves over. Since childhood. At times, we’re literally giving the other permission to drug us and take our body parts. Other times there is no choice but to go with what’s offered. Balanced on the knife’s edge of surrender, all I can trust is my awareness to keep bringing me back to seeing what I need to do in this moment. If I can get up to do it, I am lucky. If I can find a person who will meet me there when I need them, I am luckier.
Photo graciously provided by McKenna Phillips from Unsplash.
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