Showing my (digital) age

“The quality of silence is organically linked to the quality of language. You and I are sitting here, in this house surrounded by a garden, where there is no other noise other than the sound of our conversation. Here I can work. Here I can dream and try to think. Silence has become a huge luxury. People are living in a constant din….What will become of serious and difficult reading? Is it possible to read Plato while wearing a Walkman?” —George Steiner

My first patient of the morning—a 15-month-old boy—is sitting on his father’s lap when I enter the exam room. His father has a cell phone glued to his ear. He continues his digital chat while I attempt to engage the toddler by making faces. Finally, he ends the call with a short “Gotta go now, doctor’s here,” snapping the flip phone shut.

My next patient—a 2-year-old girl—clings to her mother’s pant leg, tears in her eyes. “Don’t worry, honey; no shot today, I promise,” the mother says. To me she continues: “She’s been sticking her fingers in her ears. I think she might have an infection.”

“Let’s have a look,” I say, directing the mother to restrain the child in her lap. As I attempt to peer into the little girl’s ear with an otoscope, the mother produces a smart phone and swipes the screen with her thumb, skimming messages in her e-mail account.

Midway through the interview with my third patient—a 16-year-old adolescent with shoulder pain—his mother’s cell phone sounds off. “Sorry,” she says, as she turns toward the corner of the room to take the call.

Sometime ago our office staff posted colorful signs in prominent places: “Please turn off all cell phones in this office.” After this morning’s fiasco, I’m beginning to think that the majority of parents suffer from literacy regression.

The Irish have a saying: Every man a king in his own home. Here in America, every patient (or in pediatric practice, at least the parent) exercises totalitarian rule. Rude is not a word in their vocabulary. They think nothing of inconveniencing me; God forbid I should inconvenience them.

I see my own primary care physician once a year for my annual physical exam. He used to sit and talk to me. Now he sits behind a flat screen monitor and records my answers to his questions with the click of a mouse. All of my salient medical data is duly digitalized, readily available for immediate electronic access. This, I’m told, is progress.

(Of course, the traditional prostate exam remains digital as well. And in that position, face to face communication is likewise impossible.)

The other week at Sunday services I noticed a teenager standing beside her mother, one arm raised in worship, the other by her side, cupping an iPhone, on which she stroked the small screen with her thumb, surfing digital data on the web.

I mull these scenarios over in my mind as I drive home down the interstate. An SUV merges into traffic from the entrance ramp, nearly cutting me off. I hit the brake pedal with my foot, flip the signal stem down, check my side view mirror and scoot into the left lane. The SUV holds a steady speed. As I pass by I shoot a glance at the driver. He’s busily chatting away on a cell phone, oblivious to how close he had just come to a collision.

These are the sorts of attention deficit disorders than no amount of stimulant medication will fix. This is our modern-day pandemic, ADDD: attention deficit digital disorder, a clinical entity as real as any DSM-V diagnosis, for which no treatment exists.

Talking to a wall

I pad down the back hallway and exit the office through the door marked “Private.”  As I insert my key into the lock to throw the dead bolt, I hear a man speaking in a loud voice.

Not quite twenty yards away, he teeters on the sidewalk in front of the business that abuts our office in this strip mall, head shaven, dressed in a colorful T-shirt, short pants that fall below the knee, white cotton socks and high-top tennis shoes.  Back and forth he ambles, shouting phrases and epithets, gesticulating with his arms as though he were a priest invoking the gods before this makeshift altar of brick and mortar.

The community mental health services agency is housed at the rear of the parking lot.  Many times clients opt for a midday stroll down to the Dunkin’ Donuts for lunch or a coffee.  Mostly they just shuffle by, some seemingly lost in thought; others saunter in pairs or groups of three, quietly murmuring among themselves.  This is the first fellow I’ve seen in a state of heightened agitation.

I step into the parking lot and walk to my car.  He’s still spewing epithets as I fiddle with the key in the lock.  I open the car door and pause momentarily to assure myself that he hasn’t got a gun.

This scenario brings to mind Oliver Sacks’ description of a mentally ill person he encountered one afternoon on the streets of New York.

“My eye was caught by a grey-haired woman in her sixties, who was apparently the centre of a most amazing disturbance, though what was happening, what was so disturbing, was not at first clear to me.  Was she having a fit? . . . [A] slow smile, monstrously accelerated, would become a violent, milliseconds-long grimace; an ample gesture, accelerated, would become a farcical convulsive movement.”  (“The Possessed” in The Man Who Mistook His Wife for a Hat.)

Was this in fact what I was witnessing here in this man acting out before my eyes?

I start the car and drop the power windows.  The man’s shouts become louder, echoing across the expanse of macadam.  Perhaps I should notify someone.  Perhaps I should return to the office and call the police.

As I ponder my civic duty, the man turns and strides up the sidewalk.  Suddenly I see it:  the appendage protruding from his left ear.  He continues to spew venom into the air, but now I know that most likely he’s not mentally ill.

He’s merely carrying on a semi-private conversation through his cell phone with Bluetooth technology.