Skin Out of the Game

Skin Out of the Game

A couple years ago a veteran dermatologist gave me advice that seems almost scandalous today.

“When you’re seeing someone who is embarassed about their skin condition, spend time really sitting with them. They may feel like they’re contaminated, stigmatized, ostracized or worse by the fact of how their skin appears. Don’t add to that. Examine them – closely. Without gloves if you can.”

Without gloves?!? I can’t even buy beer without gloves these days! I do telehealth visits with people who are wearing masks and gloves in their own homes! I feel like I’m contaminated, and I’m completely asymptomatic (except for constant anxiety)!

But once upon a time, that was good advice. While a person with tzara’at (the biblical word that gets translated as leprosy, but clearly isn’t – maybe it’s psoriasis, since there’s a lot of talk about scale, and the words kind of sound similar), the skin condition that renders them unclean, was isolated from the community for a time, the kohen that has to examine them would actually get in quite close, and do a detailed examination, to make this determination.

The dermatologist’s advice was clear – stay and spend time, help the person recognize that they may be sick, in a very visible way, but that they are not repulsive. The really compassionate, courageous healers go to the people with stigmatized skin disease, not away from them. There are stories of the Messiah changing lepers’ bandages while he waits for the text from Elijah that it’s time to reveal himself. Mother Teresa got her start treating lepers.

This is tricky, though. That time spent needs to be time spent with a person, not time gawking at a curiosity. Arthur Kleinman’s Illness Narratives includes a detailed, revealing portrait of a young man with severe, chronic eczema who feels a deep sense of shame about his condition. That sense of shame only deepens when teams of healthy, attractive medical students and residents are paraded in to marvel at how diseased his skin is.

And it’s true that sometimes our faces give us away. We don’t train our reactions ahead of time, and expressions, or words, slip out – or burst out, sometimes. We hear the word “scabies” and instantly become itchy, squirming our way through the rest of the visit. When my friend’s oldest son was born, he developed the harmless rash known, mystifyingly, as “erythema toxicum,” very quickly and all over his body. It was impressive enough that when the family doctor who was caring for him, who knew my friend quite well, came into the room, he blurted out, “Oh my God!” Recovering, he stammered, “I mean, uh, hi, congratulations, what a, ah, beautiful baby!”

Sometimes our reactions to things that are deeper, are, unfortunately, just as shallow. Last night I was reading a social media post from a woman with a chronic disability who described the immediate change in her doctor’s demeanor as he read the medical history and medication list in her chart. I like to think, “Well, I’d never do that,” but I know I have. I know I’ve been “warned” by partners and office staff about people I’m about to see, and gone in to a room already looking for a way to get back out.

If those individuals are neurodiverse, whether because of an autism spectrum disorder, attention issues, severe mood disorders, or psychosis, it can be even harder to maintain our focus. If you have one of these conditions, you’ve seen it – friends, colleagues, healers, people helping you at the store who don’t know how to handle your uniqueness, and choose to handle it by trying to get the hell out of there. It’s not flattering, and it’s not fair.

It may be months, maybe even years, before we consider touching someone else’s abnormal skin without gloves, but we can take off our emotional gloves right now. I’ve been saying for years that listening to people and talking to people are critical skills that deserve as much practice as tying knots in sutures or reading EKGs. The first skill of this kind that most people ever see us use is how we react when we first encounter someone. It broadcasts what they will perceive as our true feelings, and creates a first impression that is hard (though not impossible to alter).

So practice. Like Harry Potter and the hippogriff, practice meeting someone’s eyes first thing, instead of staring into their chart. Or practice your warmest smile and a tone of voice that says you are happy to meet someone. Train yourself in patience that when someone speaks in a way that makes you uncomfortable, what you will hear is that they are uncomfortable and you need to help them feel more at ease. Practice meeting people with a demeanor that says, “I am not scared of you, or repelled by you. I am open to you and curious about you. I am here with you (at a physical distance appropriate to the latest “new normal”) and we can talk.”

This doesn’t even need to be advice only for healers. And it doesn’t need to wait for social distancing to end. In fact, this may be the perfect time to start. People for whom interactions come easily are already putting themselves out there on social media and Zoom meetings. If a person feels they have something to hide, or that others want you to keep hidden, the lack of chance, in-person encounters is far more isolating. Think of the person with whom your body language sends them a message of discomfort; they are the person that needs your call.

The truth is that for the next few months or even couple of years, our body language even around our best friends and most beloved relatives is going to radiate discomfort and even fear. How do I know that my friend’s adorable baby isn’t going to kill me with COVID 19? We are all going to need to develop, and practice, genuine ways of conveying caring and concern, but without so much closeness. We may not be able to get in there without gloves, but we can get in there with genuineness if we work at it.

It is a whole new way of interacting. So to everyone for whom our old way of interacting sucked, and not just because it spread germs but because it dehumanized you, I am sorry. We – I – could have been better. I’m committing to making sure the new normal includes a new way of seeing all of who you are – even if we’re not allowed to come near each other until 2023.

Dr. Jonathan Weinkle

Dr. Jonathan Weinkle is an experienced primary care physician seeking to fix our broken healthcare system by returning the focus to the relationship between human beings. His new book, Healing People, Not Patients, gathers together ancient wisdom, medical science, and the experiences of one doctor to draw a portrait of a partnership—a medical covenant—not just between doctor and patient, but also including receptionist, nurse, transporter, and radiology technician.

Healers Who Listen would love to listen to what you have to say, too.

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