Surreal Reality: in our time

“Good pilgrim, you do wrong your hand too much,
Which mannerly devotion shows in this;
For saints have hands that pilgrims’ hands do touch,
And palm to palm is holy palmers’ kiss.” —Romeo and Juliet 1.5.102-05

“How are you doing in this time of surreal reality?” a colleague asks. In this time of the global coronaviral pandemic that two-word phrase nails it: surreal reality.

Hemingway lifted the title for his first collection of stories from the Book of Common Prayer: “Grant us peace in our time.” Instead of peace in our time, we’ve been granted surreal reality.

I just finished plowing my way through Atul Gawande’s latest New Yorker piece, “Amid the Coronavirus Crisis, A Regimen for Reentry.” He advocates using lessons learned in healthcare delivery as a template for reengaging on a societal level: hygiene measures, screening, distancing, and masks.

Those are precisely the measures we implemented at my workplace, a private pediatric practice in southern New England. Patients are screened with a series of questions over the phone and subsequent temperature measurements before being admitted to the office. Only one parent is permitted to accompany the child; both must wear masks. They are immediately escorted to a sanitized exam room for the well child visit. Providers practice good handwashing between patients before donning N-95 masks and gloves. For the first time since my house officer days, I habitually wear scrubs to work. Distancing is maintained within reason. (Even in a modified physical exam, it’s hard to keep a toddler at arm’s length.)

In primary pediatric care, this has become conventional surreal reality in our time.

It’s reminiscent of healthcare delivery, delivery room style.

Telehealth has also become standard care. We’ve had the technology to enable virtual visits for a long time. Lately, in our current surreal reality, telehealth has become an economic necessity for medical practice survival. Traditional screening tools have given way to the virtual screen: no touch, of course. Instead of a hands-on encounter, healthcare has become a conversation, albeit a virtual one.

Patients seem to be appreciative of our efforts. Most greet us with a smile; we make every effort to smile back. When asked, most say that they are holding up okay. Families are sheltering in place, parents are working from home, kids are engaged in online learning. Everyone is getting on everyone else’s nerves, but most everyone seems to be doing okay.

“We can’t complain,” a young mother tells me. “We’ve got a place to live, the kids can go outside, my husband can still work.”

“What does he do?” I ask.

“He delivers newspapers,” she says.

I ask if they’ve got enough money for food.

“We’re okay,” she says. “We can’t complain. Other folks got it a lot worse.”

The other week at the grocery store the woman standing in line behind my elderly parents told them she was paying their bill. “In honor of my grandson,” she said. “He passed away.”

Another man handed my mother a $20 gift card before he walked out the door of a local Subway shop. “For your sandwiches,” he said.

The last time my father went to the supermarket, there were only two loaves of bread left. He bought one and left the other on the shelf. “I figured somebody else might need it,” he told me.

Random acts of kindness have always been done; but lately, they seem to be more poignant.

After work I take my 3-year-old grandson out for a walk along the river. I point out the spring wildflowers, the warblers. We stop and talk to folks standing in the doorways of their houses along the street. The neighbor lady tells us to take some compost from the huge mound in her yard for our garden. Another neighbor invites us in to see the robin’s nest in the cherry tree in her back yard. She and her husband wear masks. My grandson and I practice physical distancing.

In our time of surreal reality, hugs and kisses are reserved for home.