Drs. Jean and David Case practice internal medicine in the New York Physician’s Group. Dr. David Case is a trustee on the board of HealthCare Chaplaincy.

HEALING TOUCH  
By David B. Case, M.D.

The Meaning in Touch
What does it mean for one person to touch another? Touching, even by shaking hands, is a complex form of human connection that derives its meaning from the context in which it happens. The context could be social introduction, expression of affection, medical examination, and of course many others. Touching is a gesture of intimacy that is accompanied by some sort of feeling: warmth, comfort, trust, or even an expression of love.

Dr. Lewis Thomas, the legendary teacher at Memorial Sloan-Kettering Cancer Center wrote:

“Some people don’t like being handled by others, but not, or almost never, sick people. They need being touched, and part of the dismay in being very sick is the lack of close human contact. Ordinary people, even close friends, even family members, tend to stay away from the very sick, touching them infrequently as possible for fear of interfering, or catching the illness, or just for fear of bad luck. The doctor’s oldest skill in trade was to place his hands on the patient.”

Patients in a hospital are out of their familiar surroundings, separated from their families and friends, needled, scanned, irradiated, operated on, hooked up to monitors and iv’s, and often restricted to bed. They are forced to give up their independence and are often frightened by the procedures, pain of the treatments or the disease, or the thought of the impact of their illness on their lives. Legions of nurses, doctors, and the many other hospital staff including chaplains pass by each day, some friendly and encouraging, others getting their work done without much human interaction. Sometimes “medical touching” leaves the patient feeling like a “piece of meat.”

“You are not Alone”-Spiritual/Emotional Healing
So what is needed to make the patient feel better? At first glance, there are some obvious choices: relief of pain, learning good news about the illness, seeing the bandages come off and the catheters removed, and being able to get out of bed. Sometimes these events don’t happen. And, feeling better physically does not always equate with feeling better spiritually or emotionally. This part of the healing process often becomes critically dependent on those special human interactions that happen with staff of the hospital. How can we, as healthcare providers, make people feel better? Aside from our expertise, we can do much to comfort patients by forming a bond of trust and compassion. We must reflect a genuine interest in the person, not just the patient, in the bed-the person who is frightened, lonely, and in pain. A hand that reaches out to this person and gently touches the shoulder or the wrist says to the person, “I am with you and for you, you are not alone.” That seemingly simple gesture penetrates a barrier of professional remoteness and brings the relationship to a more personal level. The person often responds by smiling or by placing his or her hand over ours as a validation of the comfort that our hand is providing.

Historical and Modern Views on Therapeutic Touch
Is it professionally appropriate to touch patients? In medical school, we are told that it is not professional to sit on patients’ beds. In addition, professional ethics advise that we should not touch patients other than to examine them, so that the boundaries are clear. Perhaps it is because medical educators have set arbitrary boundaries that doctors have this historical obstacle to comforting our patients. Coupled with these sanctions about touching patients, paradoxically, is the widely acknowledged power of the “laying on of hands,” as described by Dr. Thomas. Interestingly, nurses, chaplains and most other healthcare givers are not, in their training and education, discouraged from touching their patients. “Laying on of hands” is an action which we most likely learned as children from our parents and adult caregivers. Touching provides comfort, allays fears, establishes trust, and provides another level of assurance that one is not alone. Recent studies have shown that human beings or even animals raised with minimal touching are commonly disturbed and unable to form intimate relationships. So, physical touching renews this meaningful primal connection. Touching in various ways has developed as a separate or freestanding healing art as well. Some forms of touch therapy go back to early Eastern medicine and all the way forward to Reiki and IET (integrated energy transfer). There is a belief that the toucher (with a learned technique) can transfer healing energy to someone else. Given the enormous growth of touch therapy along with the more conventional personal massage therapy, it becomes clear that the act of touching has great adjunct value to traditional medical care.

“Please Don’t Let Go”
Without even thinking about it, when I go to the bedside, I invariably touch the person’s wrist or shoulder during part of the time when we are talking. I recall one woman’s comment, “please don’t let go, the only time someone touches me here is to do something to me.” If the occasion arises to inform the person of difficult information, the touching hand buffers the harshness of the news.

Those of us who visit the hospitalized have a great opportunity to add another layer of healing to our care by the gentle laying on of hands. The symbol of our transferring some sort of healing power by that touch is appealing to us as caregivers-we are soothing and comforting and relieving fear and aloneness.