Section 2 > Exercise 7 > Quotation on middle distance
In the following passage a doctor reflects on maintaining physical and personal boundaries between the clinician and the patient. The author calls the balance between proximity and respect 'middle distance.’ Middle distance comes into play when there is intimate bodily contact, handling response to unpleasant bodily findings, and dismissal of sexual feelings. Understanding how a clinician distances him or herself from aspects of the body is a first step in handling the privilege of intimacy. However, this distancing is not merely dissociative, because the physician must also find a way of acknowledging and addressing her patient’s bodily and sexual issues. Only then is a trusting conversation possible.
The physical intimacy we physicians experience with our patients requires a careful gaze into middle distance. Unclothed, covered with a thin sheet, our patients trust our searching eyes and hands—trust that we desire only to help, not overpower, hurt or humiliate. We are not to lift the pannus of their abdomen and say: "Your belly is a giant flabby mammalian mass." We are not to say: "Your skin is encrusted with barnacle-like scabby excrescences." We are not to laugh suddenly and without explanation, or gasp in horror (Oh, what's this ?) at some revelation.
I should add that the same goes for the body's seductions, if there are any. In the examining room, the temptations of the naked body are in fact few. Even on those rare occasions when I have admired the muscles of an able young man, the curve of a waist, I seal these thoughts in a leak-proof container. They do not torment me. Mysteries are erotically delectable precisely because they are mysteries. A philosopher once said: the skirt's hem traces the exact line where seduction takes place, perfectly balanced between what is revealed and concealed. But this interpretation does not seem to be fully correct. There is nothing tantalizing about lifting the corner of a paper gown, however slowly, to reveal an underarm or a wart.
Middle distance also means, no fondling. No kisses on the lips. Every now and then I read an article in a medical journal: Should we hug our patients? We agonize over boundaries, about being too close. We are not to press into the imaginary space, which snaps open like a tent when the body lies naked. It envelops the patient, creating an inviolability, a saintly lining that redeems the flesh.
Of course, we make it happen this way—incorporating this respectful distance into our routines. We have a sequence of rituals to draw the line, carve out our place at the examining table. We step out while the patient undresses. We bring in a chaperone. We lift only one piece of curtain at a time. We sheathe ourselves in gowns and gloves. They say these measures protect the patient. I say: amen. |
