When the Illusion of Distance is Too Heavy to Bear
Jiameng Xu, MD, CM, PhD
1. He startles upright clutching a heavy blanket to his chin: its fabric rough, nothing like
the satiny sheets sold in the department store upstairs. Behind me the dim light from the
garage is enough to illuminate the gleam of his eyes, his knuckles taut with fear. He was
lying prone when I stumbled into his abode; this alcove bordered by furnace fans I
mistook for the mall elevator. Before I intruded he might have been resting or sleeping.
Now he stares; with the concrete wall at his back he has no room to retreat so I tread
backwards until my feet step over the yellow lines of empty parking spaces. Out here
metal grilles hide him from view. The fans start spinning as though to shield him from
discovery, their noise becomes the walls of his cloister sheltering him in momentary
safety.
2. A red container of Tide liquid detergent sits next to a carton of orange juice on the
sidewalk damp with rain. They must belong to the people sleeping in tents nearby, the
flaps zipped shut for keeping dry and quiet in the early morning. The roof of red brick
and a single white cross mark St. Paul’s Hospital at the end of the street. On this simple
walk to work I am transported to a memory of my childhood home: there was not yet
enough money for shelves nor bins; shoes, toys, heaps of clothes, household items no
matter which category were spread across the floor ready for use. I used to feel
ashamed of my family’s messiness but now I understand it was actually evidence of a
life overflowing. Tomorrow, next to the silent tents other objects will appear. Along this
corridor of slumbering strangers I plant my feet as softly as I once had upon the tiles
outside my parents’ room, sliding down the hall in the morning to get a glass of orange
juice.
3. One of the first things you learn as a psychiatry resident is how to conduct an
interview from the door. The physical distance keeps us safe, we are taught when we
are meeting a patient for the first time and do not know what they might do. I have
learned to ask for security guards to accompany me when I go into the Acute
Behavioural Stabilization Unit. My patient this morning was once a resident, had
struggled with substance misuse, now living homeless. I meet him in a small room
containing only a mattress and metal toilet anchored to the floor. The security guards
enter first and come to flank the young man on both sides. He lifts his head upon
hearing my voice and I see he is barely older than I am. In the gap between us he tells
me what he remembers before police officers brought him to hospital: he had been
walking on the street in the Downtown East Side, trying to find a place to call his
mother. I have read the police report: passersby described his behaviour as bizarre,
disorderly, called the police who believed he required evaluation and care. When I turn
to leave at the end of the interview I hear him say quietly, “Thank you, Doctor,” his gaze
fixed upon the floor. It is only when I am in the stairwell I wonder how long it has been
since he has heard his own title spoken out loud; what would have happened if I had
called him “Doctor” in return?
4. I worry about the crossing of lines. I fret over the maintenance of appropriate
distance: not too close so that I might get hurt not too far so that I might lose sight of
someone’s humanity. Yet I spend much of my life forgetful of the humanity I share with
others. I am forgetful of the reality of suffering: that when the rain falls the pattering is
heard by us all whether on a tent canvas or glass window; but some get wet while
others stay dry. Though I remain at the doorway with my title and health, the humanity
of others is ever closer than I would comfortably believe. And even as I stand an arms’
length away, or pass a few paces in front of where strangers live and sleep, the invisible
distance between us is already so vast, from the very beginning, that I fear more the
distance itself. Whatever lessens it, whatever makes the necessary distance less
empty, is a precious thing.
Dr. Jiameng Xu is a psychiatry resident at the University of British Columbia, with an MD-PhD from McGill University. Her PhD dissertation focused on experiences of family members and others whose loved ones have mental illness. She has a background in neuroscience and is passionate about incorporating arts and humanities into healthcare via Journeys Through Health, a hospital-based exhibition of artworks by persons with lived and living experience of illness. She also helped to found the McGill Humanities and Arts in Medicine interest group. In her current role as a resident, sharing her experiences of loneliness and displacement while moving to different locations, and using poetry, observation, and reflection have helped her through difficult times. Her encounters with strangers, as addressed in her prose, have inspired her to cultivate greater empathy and compassion towards patients and their families.
