The Antidote to the Epidemic of Loneliness

“I’ve never told anyone this… not even my wife.”

As I started to give W a reassuring smile to gently encourage him to continue, I quickly realized he wouldn’t be able to see it past the yellow mask obscuring half my face.

Not that it mattered anyway.  Tears dammed up over the last 12 years started to fall into the therapeutic silence carved out for him as his gaze settled beyond me.  The internal struggle was written all over his face – there was so much he needed to say but the right words escaped him now that the opportunity to be heard had finally come along.

Waiting, my mind drifted to the conversation I had with his nurse last night just as I was about to leave for the evening.

“Dr. M, just wanted to let you know when I was asking W our admission screening questions, he admitted to having some depressive mood symptoms.”

“Ok… I mean, he was just here 3 weeks ago.  He’s allowed to be sad about it.”

“Yes, but then he made an off hand comment about asking his wife for a gun this Christmas.  Maybe a psych consult would be appropriate…?”

Sighing, I glanced at my watch.

6:30 pm.

The likelihood of psych dropping everything and coming to evaluate this patient – 0%.

My ability to have this sensitive conversation at the end of my work day and do it well – also 0%, if I was being completely honest with myself. Sure, I could do it now but that would be doing him a disservice.

“Is he actively suicidal right now?”

“… No.  It’s more passive suicidal ideations.  I don’t think he’ll harm himself overnight.”

“Ok.  Well, I just admitted him an hour ago so he’s understandably upset that he’s back in the hospital, plus he’s feeling horrible from his infection.  Let’s let him settle in, get pastoral care to see him tonight and I’ll have this conversation with him tomorrow.  And of course, please keep an eye on him overnight and get a sitter if we need to.”

As my attention returned to W’s room, the irony of the word conversation was not lost on me.  The silence continued to stretch on while his internal monologue went round and round in circles, not sure where to begin.

Should he start when he was first noticed that every cold seemed to turn into a sinus infection or pneumonia?  When each subsequent illness became more severe than the time before, to the point that he would now run to the hospital if he developed even the slightest low grade fever?  Or how about when he was diagnosed with liver failure that seemed to come out of the blue?  The fear that the fluid building up in his abdomen would get infected and his expected lifespan would reduce to a matter of months, not years?

Of course, I knew all this.  Yesterday, we reviewed his medical history of severe combined immunodeficiency which only became apparent in adulthood, talked about all his medications in detail, discussed how weak he had become after losing 70 lbs from all of his illnesses over the last year.  He expertly distilled his story to the events and facts, a true hallmark of someone who’s had to tell his story too many times.

But he hadn’t said everything.

I’ve never told anyone this… not even my wife.

Together, but apart

Standing in my yellow isolation gown, gloves and mask, I saw the chasm widening between us as his struggle to find his words continued.

What a perfect representation of the isolation his disease brought upon him for the last decade of his life.

To be surrounded by people who were here for the sole purpose of helping him feel better, yet separated by a physical divide.

To be able to talk for hours about the chronology of his medical illnesses, and yet unable to connect regarding the havoc these illnesses have wreaked on his psyche.

With every hospital stay, we were attending to his illnesses with labs, fluids and antibiotics but we weren’t adequately addressing his suffering.

Longing to be seen beyond his extensive medical problem list, as more than an object hidden away in a hospital room waiting for its turn to be repaired.  To have his hand held for a brief moment beyond the sterile touch of a cursory heart and lung exam.  To be able to speak from his heart freely in a way it could be understood and reconnect with the people he loved most.

He was unable to come up with an adequate way to explain his tears, but I could sum it up in just one word:

Loneliness.

Pulling his glasses off his face, he gestured as if to wipe the fog clear but caught the trembling in his hands and clasped them tightly instead.  He was so close.  So close to making the connection he needed so badly, but too terrified to forge ahead.

Last night, I might have let him retreat back into himself.  I might’ve even been grateful for the opportunity to leave for home a little earlier.  But this morning, I came ready to meet W halfway.

“I can’t imagine how hard this has been for you, to always be afraid of getting sick the moment you step foot outside of your house.  I see where that would get really lonely at times…”

W’s dull brown eyes shot up to mine as he mulled over the word I had given him.

Would he take this gift or spit it out?

No one wants to admit they’re alone.

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Stepping into the stairwell, I closed my eyes for a brief second and let out a deep sigh to wipe the slate clean for my next patient.

For the most part, these conversations always followed the same pattern.

Tears.  Establishment of trust.  Gently probing if they had active thoughts of hurting themselves and if they did, getting them to divulge their plan.  Asking what reasons they had to not act on these impulses.  Brainstorming what things they could do to bring them a moment of joy, something to look forward to.  Pulling in the resources at my disposal to help support them.  Promising to check in with them at a future time and leaving them with a safety plan.

A recurring theme always emerges → feeling utterly disconnected from the people they should feel connected to.

And me, holding out the hand that would anchor them to this place and time, if just for a moment.  Asking for their permission to allow them to feel felt for the first time in a long time.  That in itself is often more powerful than any of the drugs I order.

But this is what they don’t see → me, shaking the emotional resonance off and moving on to the next thing.

“Medicine and burnout can be very isolating and lonely.”

All of us understand this statement intimately – in fact, this was from an email someone sent me today and it’s not the first time I’ve heard it.

But why?

Why is medicine so isolating?

How could we possibly feel alone when we interact with so many people over the course of our work day?  Patients, nurses, social workers, PA’s and NP’s, specialists – the number of conversations we have should be more than enough to fill our social meters.  How do we explain the emptiness after spending our days doing fulfilling work?

We expertly navigate the intimate spaces of other people’s lives.  They freely give us details of things they would never dare tell their families and if we’re trusted enough, they also give us their hopes and fears.  Tears and vulnerabilities.

This should be enough.

But it’s not.

Because while we know everything about everyone else, they don’t know us beyond our guarded sharing of the superficial details of our lives.

We work to maintain an invisible barrier of separation while we ask people to share everything with us and for good cause – how else do we maintain our professional decorum and still provide compassionate care?

However, no one warned me about the cumulative effect from years of standing together, yet apart.

Being in someone’s pain, tending to it but still maintaining enough emotional distance to get out and do it again for the next person down the hall.  How the invisible walls we build don’t just come down once we walk out of the clinic or hospital, keeping us in isolation while we continue to recite our well-worn scripts to our inner circle.

We’ve become too comfortable with together, yet apart.

Until those moments when you’re surrounded by your loved ones and realize they don’t know a single thing about you.

The real you.

Not the persona you’ve created – the one who’s calm and measured.  Who knows how and when to make people laugh and smile.  Who walks around dropping words of encouragement and 10 second snippets of “wisdom” with an ever present smile on her face.

When your default setting is to side step people’s questions, refocusing your collective attention on someone else, it makes it impossible for you to be seen.  You’ve mastered the art of drip feeding out enough information to make people think they know you, but keeping enough in reserve just in case you need to pull back.  After years of perfecting your navigation of the small talk and other social scripts we play out with strangers every day, the realization that all of your interactions are devoid of authentic, knowing connection slowly creeps into your periphery.

But by this point, it’s almost too late to do anything about it, isn’t it?

You’ve already become too comfortable hiding your personal victories because they’re too stupid or trivial for someone else to share that joy with you.  And when we stop sharing the things that make us happy, the struggles, moments of doubt that keep you up at night, nightmares that shock you out of sleep – these will never see the light of day.

So we sit next to each other at Friendsgiving/Thanksgiving/Hanukkah/Christmas dinner – together, yet apart.  Unsure how to discard the revered stoicism that we weren’t explicitly told we were supposed to have, but saw it modeled to us during our training.

We all know those doctors – the ones who were brilliant, compassionate doctors at work – but at home, their private lives were silently falling apart.  Docs who were on their 3rd or 4th marriages, chasing that deep connection but unable to maintain it over time.  Pictures of their children lining their walls, but only capable of relaying the second hand information about their lives as told to them by their significant others or even worse, Facebook.

Hand curled around a bottle of beer and the other cradling their phone, scrolling down a never-ending list of names but unable to identify that one person they know would drop everything at seeing their name and pick up.  Rather than exposing themselves to that vulnerability, out went the text message blast organizing some activity where they could pretend to be together with their “friends”, yet come away still feeling worlds apart.

Is it any wonder that they would return to the safe haven of work, to once again be regarded as amazing, generous, benevolent superheroes?  We would all marvel at their genius handling of short, intense bursts of one way connection, their ability to play in other people’s secret spaces and yet seemingly emerge unscathed.

However, as stories leak out over time of admired, warmhearted physicians who suddenly end their own lives, our level of shock is underwhelming compared to the general public’s.

Because if we’re willing to face the cruel truth, we’re all a little too familiar with the long con of “community”.  To be upheld as important pillars of society, but knowing they’re only interested in what we’re able to offer them, never thinking to see us as something human.  For all the accolades and high praise, we understand how easily we’re discarded and replaced, whether it be driven by a change of a patient’s insurance or the medical system finding more “cost-effective” care. Yet we still show up every day and do the best we can – this is all we know how to do.

It is our gift and privilege to hold space for people’s suffering, but who holds space for us?

The opposite of loneliness

Some people are better at living in a one-sided relationship with medicine, but for many of us, we don’t know how to not imprint that on our other relationships.  We don’t know how to not hold our secret pieces back when it’s time for us to reciprocate.  In today’s technological world, it’s too easy to bury our lack of genuine connection by merely increasing the number of connections we make in a given day.

But two sentence snippets and a flurry of likes on social media are poor replacements for the soul to soul conversations we all crave.  To have someone sit across from us and hear what we want to say in our silence.  For someone to read between the lines of what we say and pick up on our secret truths, then mirror them back to us. To know the thoughts behind that single glance, shrugged shoulder or arched brow.

The opposite of loneliness is to feel felt.

It’s reciprocity – to know there’s someone else out there who wants to know you as deeply as you want to know them.  Constancy and reliability – to always have an anchor to return to.  It’s being and becoming about things together.

Maybe that’s why you’re still here reading this – perhaps in my moment(s) of loneliness of the last two years, I inadvertently created this space for us.  As I’ve written less and less over the last several months, I’m continuously astounded by the people who check in and reach out – I never expected people to become as invested in this journey as it’s unfolded.  I didn’t anticipate that this, too, is becoming about things together.

While I recognize this has been really important for many people as it has been for me, it’s not enough.

These conversations need to happen offline.

You need to look someone in the eye, hear the concerned timber in their voice, fall into that therapeutic silence yourself and allow yourself to be held deeply.

You need to sit heart to heart at gatherings with family and friends and meaningfully engage beyond the small talk and social rituals, rather than being content to drift into the role of bystander to your life.

It will feel like the ultimate act of self-betrayal.

You’ll throw out so many reasons to not do it – you don’t have the right people in your life, they won’t understand, they won’t reciprocate.

The reality is, it’s not them you don’t trust, it’s you.

Asking someone to see and embrace the pieces you’ve hidden because they were too awful for you to accept is one of the hardest things you’ll ever do.

Do it anyway.

How do you know if the connection and love is true unless what you bring to the table is your truth?

This, my friend, is the antidote to the epidemic of loneliness.

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Thank you for your continued attention, all the messages of commiseration and for sharing these sporadic posts over the last year.  

Seeing that this is going to be the last post of 2019, I just wanted to wish you a happy holiday to you and yours.  And if you’re like me and are a total grinch around this time of year, I want you take advantage of these awful shoved-down-your-throat consumerism driven holidays and recognize these opportunities for connection. 

It’s why we’re here.

So suck it up and try to ignore the fact that you’ve heard Mariah Carey’s “All I want for Christmas is you” way too many times in your lifetime and you’re only almost 34, meaning you’ve got at least double your lifetime to hear that nauseating song on repeat🤣

Anyway, if you have a moment, please read The Art of Intimacy by John Gorman.  Reading this broke my writer’s block and inspired today’s post – in fact, I pulled quite heavily from it.  When you find something that puts into words the things you’ve always wanted to say, it’s a beautiful thing.

Happy 2020!

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Drone photo taken by J of myself and our two pups at the Oregon coast.  Follow me HERE on Instagram for pics of our upcoming trip to Kauai as I round out the last days of the decade!