Hug or Ugh

When I stepped into Fawn's examination room, she was bouncing on the edge of her chair, feet drumming against the scuffed tiles, more like an impatient schoolgirl than a woman in her late fifties. I had been forewarned. She had hurled insults at the EMTs when they first rolled her into the emergency department and informed the triage nurse of her well-known heroin and cocaine habit. Found nodding off outside the police station, she had woken up only after receiving Narcan, an opioid antagonist. Now, her sun-roughened face reflected an unsettling mosaic of emotions. I extended my hand and introduced myself. "Yes, doctor." She popped upright, grabbed my hand, and without letting go--before I could even say another word--asked me for a hug. "A hug?" I said. "Yes, sir," she said, boldly locking my gaze with her bloodshot eyes. She ranted on about living in shelters, and how, sure, she'd made mistakes in her life, but don't believe that EMT bullshit about her using heroin; maybe a little crack, but she's no addict, and she had nobody in the world to prove them wrong. "Just a hug," she begged. My emergency medicine training and over fifteen years of practice had primed my mind and body to respond swiftly to a wide variety of urgent situations. But now my muscles tensed with a new critical challenge. The weight of each second counted against me as I took in her dirty nails, ill-fitting clothes, and dark jigsaw teeth; as I inhaled her strange aroma of old sweat, recent cigarettes, and greasy food. I registered the loneliness trembling in her face. I opened my arms. We hugged. To be completely honest, she hugged me. She pressed her head against my chest. My heavy white cotton coat felt flimsy and porous between us. "OK," I said, gently coaxing her away. But she wouldn't release me. Only with forceful encouragement did she return to her seat. "What's going on?" I asked. Words exploded from her tiny mouth, a landmine of thoughts: bogus arrests, undeserved jail time, bad marriages, field hockey and soccer stardom back in high school, ungrateful children, hospitalizations for "bipolar," no sleep for five days straight--no, six. I disengaged from the scene as she spoke, watched myself listening to her. I still felt the force of her body against mine. Later, I informed the senior emergency medicine resident who had first evaluated Fawn about her request for a hug. The resident chuckled. "She asked me for a hug, too." "Oh," I said, my pride leaking by the second. "What did you do?" She scoffed, as if the answer was obvious. "I told her there were professional boundaries." "Sure," I said. That was a nice way of wording it. I kicked myself for not thinking of that myself. But Fawn made an explicit request. I realize I'm not obligated to comply with patients' wishes if they aren't medically indicated. A hug, however, isn't unwarranted gallbladder surgery or needless antibiotics. A hug isn't medical treatment. But from inside that moment, refusing a hug seemed inconceivable, even dangerous. I confessed to a few residents what I'd done, certain there was something admirable in the act. They squirmed as if I'd just eaten food off the hospital floor. "Don't touch your wife when you get home," said one nurse listening in. "Shower and boil your clothes very first thing," said someone else. These young doctors and seasoned nurses were superb clinicians, kind and sensitive individuals, yet my hug was greeted with disbelief, even horror. I wear regular street clothes when working in the emergency department, not scrubs. This commingling of my personal and professional life might have intensified the implications of my possible transgression. …