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The hand from behind the curtain

It has been almost two decades since I worked at this hospital. This is where I grew up as a physician. After my home, I have spent most of my life within these walls and walking these hallways. The hospital used to have two main buildings, but a few years ago, the administration decided to erect a third building, which is a state-of-the-art facility. The hospital is situated at the northernmost part of the country along the coastline of Lake Ontario. On a sunny clear day, you can imagine the breathtaking view of Toronto’s skyline from the top floor of the building.

When the construction of the building was near completion, we were given a tour of the facility. We were amazed by how large and well-equipped the patient rooms were. Walking through the yet unfinished rooms, I made a comment that my colleagues thought was in bad taste. “Take a good look. Whoever amongst us ends up living in Rochester long enough, it is a good possibility that we will die in one of these rooms.”

It was a Monday, the beginning of the workweek. I looked at the list of cancer patients that I had to round on. Although most of the patients were on the oncology floor, others were distributed all over the hospital, including the Old Building and the now fully operational New Building. I started rounds along with the residents and medical students in the New Building first. I took some of the new residents to the break area to have a look at the views of the lake and downtown through the large window panes. The patient rooms were exorbitantly spacious and outfitted with comfortable furniture for family members. Each room had a beautiful view surpassing any that local hotels offered.

After seeing a few patients, we headed to the Old Building. Among others on my list was Mark, my patient suffering from stage IV lung cancer but doing exceptionally well on immune therapy. Unfortunately, he was now admitted with shortness of breath, and we were debating whether it was from pneumonia or medication-induced pneumonitis, or both. Mark has an auto repair shop on Dewey Avenue and trades in luxury cars and often jokes that if I cure his cancer, he will get me the best car deal possible. I told him that I am perfectly happy with the car that I am currently driving, to which he quipped, “Doc, is that your way of saying that you don’t want to cure my cancer?”

We walked into Mark’s room. This was a tiny room (compared to the rooms in the New Building), and his two sisters were by his bedside. I had three students with me, totaling seven people in the room, including Mark and me. We were clearly having problems fitting in the room.

“How are you feeling, Mark?” I inquired.

“My breathing is so much better but still not yet back to normal. I would have liked to stay another couple of days in the hospital but I really want to get the hell out of here,” Mark replied.

“But why don’t you stay in the hospital until your full recovery, Mark? Why the impatience?” I asked.

“Well, have you looked at this room? This is smaller than the bathroom at my house. Last time I was admitted to the hospital, I was in a room in the New Building, and that was like a room from the Ritz Carlton. This one is as if I’m in a Motel 6!” He complained.

“I understand what you’re saying, Mark, but the size of the room is not reflective of the quality of care you are receiving. The nurses are doing an excellent job, and your treatment is working just fine,” I pointed out.

“I understand that, Doc. I know this is not the priority, but if either I could go home as soon as I can or if you can pull some strings and move me to the New Building, I would appreciate it,” He persisted.

“OK, well, I will see what I can do,” I falsely promised.

Next up on the list was a patient that I was going to see for the first time. The resident had presented her history to me. She was newly diagnosed with metastatic bladder cancer, and while she was informed of the diagnosis, this was the first time she was going to meet an oncologist. I had to inform her about the incurability of the disease and that she had no more than another few months to live. This would be one of, if not the most, important conversations of her life for which I wanted to create as comfortable of an environment as possible. However, as I walked into the room, I realized that it was one of the few rooms in the Old Building that was a shared room, meaning there was another patient in the same room. In administrative meetings, I had heard that they were trying to convert all the rooms into private rooms, but they did not yet have the capacity to do that. Many hospitals in the country now have private rooms, and a shared room is now considered a thing of the past.

It was a room about half the size of the rooms in the New Building. There were two beds, which were separated from each other by a flimsy curtain. Sue, our patient, was in the bed closer to the entryway. The nurses were administering medications to the other patient, also a woman. There was hardly any room for additional people. I pulled up a chair and set it up as close to Sue’s bed as possible. The residents had to stand in the corners of the room. I pulled the curtain a little bit more to give Sue as much privacy as possible. I asked her if she had any close family members or friends whom she wanted to be part of the conversation. It turned out that she was close to only one of her daughters, who because of her own medical issues could not be there. Sue had to partake in this conversation all on her own. I started telling her about scan findings, pathology reports, and explained her diagnosis in detail.

She appeared impatient and eventually asked, “How long do I have to live, doc?”

I wished there was someone with her before I gave her the answer. “If we don’t do any treatments, you may have another few months to live, but with treatments, if they are successful, I’m hoping we could be looking at a year or two as a best-case scenario.”

Sue’s hands started trembling, her mouth appeared to be dry, and her palpitations could be felt by everyone in the room. She broke down into tears that started rolling down her eyes.

As I looked around the room to find a tissue box, trying desperately to do something to comfort her, I saw the curtain move. I saw a hand emerge from behind the curtain that was trying to reach for something. I got puzzled. There was the IV stand carrying the infusion bags, and for a moment, I thought that it might be one of the nurses trying to reach it to stop the infusion. The hand kept exploring and finally reached for Sue’s hand and held it firmly. Then the other hand removed the curtain fully, and I saw the other patient, not moving from her bed but having reached out to Sue to ease her pain and sorrow. At that moment, no number of sympathetic words could replace the loving touch of a fellow human being, and I saw a hint of comfort in Sue’s eye.

Here I was, worried about the lack of privacy afforded to Sue at the time of having such a difficult conversation. Part of me worried about the HIPAA laws that have been ingrained into our minds over the years. I came to find out that Sue and Jenna had been in the same room for a few days now, had become good friends, and were sharing each other’s worries through their illnesses. Sue was discharged from the hospital soon afterward and now follows with me in the clinic. Her cancer is responding to chemotherapy, and she has a decent quality of life. She tells me that she is still in touch with Jenna. They don’t live too far away from each other and now meet on a regular basis.

Loneliness amongst the elderly and the ill is an epidemic that the US Surgeon General declared to be a central issue in his advisory statement in 2023. What leads to loneliness? There could be multiple possible explanations. But to me, society’s emphasis on individualism is one reason behind rising rates of loneliness. The individual is at the top of the agenda. In the world of family law, as children and the elderly are being helped in the form of preventing abuse, they are separated from their families and put into foster and nursing homes respectively. In the world of rising women’s rights, they are being burdened with two jobs of employment as well as rearing a household, often alone as single mothers, driving them to the brink at times. The nuclear family living together happily is being destroyed by having the children leave the house upon adulthood in search of their own livelihood. The grandparents are being left alone in the guise of autonomy and independence. Next-door neighbors are estranged in pursuit of privacy and seclusion. Work-from-home jobs are more convenient but the bonds with work-colleagues are becoming increasingly scarce.

Having a private room in the hospital should not be considered a luxury in today’s world. Don’t get me wrong. If I’m admitted to the hospital, I want a private room too. But the days when there used to be a ward with multiple patients in one large room together, although inconvenient, built a sense of community. Now you have more privacy and comfort, but it comes with another unwanted, uninvited, ominous visitor – loneliness.

Farhan S. Imran is a hematology-oncology physician who blogs at Did I Ask?

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