I realize that to comment on odour is to confront a two edged sword –none of us journeys without a scented trail- but apart from those occasional inadvertent and indelicate smells, the time has probably arrived when we should be wary of artifice. Well, at least in those areas where there is no escape; where the air is as imprisoned as the nose; where the vulnerable may be subject to harm: the hospital.
Now, to be clear, I am not advocating the abandonment of deodorants, nor am I exculpating the voluntarily unwashed. I am merely suggesting that artificial scents may have unintended consequences, as an editorial in the Canadian Medical Association Journal points out: http://www.cmaj.ca/content/187/16/1187.full And it would seem that, ‘According to large surveys of the general public, about 30% of people report having some sensitivity to scents worn by others. Twenty-seven percent of people with asthma say their disease is made worse by such exposures. There is emerging evidence that asthma in some cases is primarily aggravated by artificial scents. This is particularly concerning in hospitals, where vulnerable patients with asthma or other upper airway or skin sensitivities are concentrated. These patients may be involuntarily exposed to artificial scents from staff, other patients and visitors, resulting in worsening of their clinical condition.’ One has only to take the long journey to a distant floor on an elevator to know how uncomfortable odour can be.
And this danger is particularly applicable to health care facilities because: ‘Federal and provincial human rights acts require accommodation for employees who are sensitive to scents in the workplace, but not for patients in hospitals or clinics.’ As the editorialist points out: ‘Many public places promote a scent-free environment. Some hospitals also do so. But it is not policy in all Canadian hospitals, and it is not required in hospital accreditation standards. [italics mine]’ In this respect at least, the truly vulnerable are not being adequately protected.
But we all need protection; odour is one of those modalities that we have been taught to sublimate –or at least not bring to the owner’s attention lest it be misconstrued. In fact, the perpetrator may have long since been habituated and therefore be blissfully unaware of the effects of the smell on others. Or worse perhaps, wants to inflict it on the rest of us in the naive belief that it enhances their identity –or enforces it. There is a fine line between self and not-self, I think; the boundaries are subtle. How far do we extend? At what range is another person an intruder? Given that personal zones –comfort zones- are often culturally established it would seem to be a labyrinthine problem only soluble by sensitivity and, probably, trial and error.
It certainly works like that in my office.
I don’t like to characterize people –especially patients- as difficult, but sometimes I can’t help it; it is forced on me. One vicious peck from their eyes on my attire, or a facial attack on my beard and I can feel my cervical hair standing at attention… On guard, really. I’m not sure what it is about non-verbal criticism that is so difficult to take, but perhaps it is its unexpectedness, its lack of specificity that doesn’t allow for rebuttal. Whatever it is, it makes subsequent rapport more difficult to achieve.
Sometimes the office is a brutal affair with patients and complaints lined up like laundry hanging from a clothesline on a cloudy day. Even patches of sun are welcome diversions, and I had just seen a young woman who had biked across the city for her appointment. Sweating profusely but obviously proud of her achievement, her humour was a needed distraction from the long line still hanging in damp anticipation in the waiting room and I smiled fondly when she left. A flash of colour for my day.
But Elspeth, one of the last patients of the morning, was a mature lady who seemed to eschew colours, however. A large black bag sat beside her chair and she had a dark grey coat resting on her lap like a sleeping child. Her long black skirt topped with a pure white blouse complete with frilly cuffs would not have stood out in the waiting room ordinarily, but the way she wore her hair would. It was pulled so tightly off her forehead into a little raggedy tail at the back of her neck that it looked painful -her skin screaming in silent agony. Her expression mouthed the same feelings; she was not a happy person.
She stood to follow me into my office –reluctantly, I sensed- and I could feel her eyes burrowing into my back as we walked. Even in the office, her guard was up and her eyes tense and menacing.
I smiled to reassure her that I meant her no harm, but she ignored me and began to inspect the room suspiciously. She started with the walls, progressed to the various statues and plants in the corners, and finished with my desk and its contents. I wasn’t sure whether she was appraising their worth or my taste, but when she finally examined me like she was itemizing my clothing, I realized it was neither.
“There is a disturbing smell in here, doctor,” she said through her teeth.
How does one respond to that? “I… Uhmm…”
“And it’s not just in here,” she continued, “I first noticed it when I entered the waiting room.” Her eyes were angry. Mistrustful. “I thought perhaps it was somebody’s failed deodorant or a cover-up perfume so I tried sitting in several places, but it was the same everywhere.”
“I’m sorry Elspeth…”
“Mrs. Trudle please, doctor. I don’t call you by your first name.”
“Sorry.” It was all I could think of replying.
“You of all people should know about the safety hazard of injurious odours and their effects on susceptible clients.”
“Patients, Mrs. Trudle; I do not have clients! I am not a lawyer, nor a beautician.” I shouldn’t have said that –I don’t like the power implications inherent in the word ‘patient’- but I couldn’t resist. I felt attacked.
The effect, however, was almost immediate. The skin on her forehead rose briefly –perhaps to relieve the pressure- and then the ghost of a smile trickled across her face. “Touché, doctor,” she said and then chuckled. “I’m sorry if I was rude, but I’m terribly sensitive to smells nowadays. I find they give me headaches.”
I’m a gynaecologist, not an otolaryngologist, but her insistence that there was a disturbing odour in the office was worrisome –not least because nobody had commented on it before.
“Is it as bad in here as in the waiting room?” I asked, hoping it wasn’t my deodorant.
She thought about it for a moment before answering. “No… No I don’t think it is, although I can still detect it.”
“Any idea what it might be?” I wondered if it might be somebody’s perfume, or perhaps a chemical residue from the cleaning staff. We no longer had any carpets, so it couldn’t be unvacuumed dust or mold in the fabric.
“Well, many things seem to set me off… But here it was feet,” she said simply. I must have looked surprised, because the smile on her face grew larger and she sheathed her eyes.
She nodded her head to interrupt me. “But there were only three other women in the waiting room -I know that. They must have thought I was demented to keep moving to different seats, but my headache was getting so bad I was afraid I was going to gag.” She slumped in her chair and closed her eyes for a moment. She looked uncomfortable. “Maybe it’s not the smell of feet so much as shoes…”
I just stared at her. I couldn’t make people take their shoes off at the door.
She shrugged and shifted uneasily in her chair. “I haven’t had a period for over two years, so I’m wondering if all of this is related to the menopause.” Her eyes scanned my face for some reassurance. “I’ve got an appointment to see a neurologist this afternoon, but I was hoping it was something simpler… more easily fixed.”
I smiled but I’m not sure my silence comforted her.
She sighed, and looked at me as if she felt she was wasting my time. Then she gathered up her coat and purse. “Hope is sometimes naïve, isn’t it?” She stood, started to walk towards the door and then stopped, but didn’t turn around. “Even ‘Lilies that fester smell far worse than weeds’, I guess…”
I recognized it as the ending of one of the more enigmatic of Shakespeare’s sonnets and I had the uncomfortable suspicion that she’d rehearsed it for just such an occasion.
Just as she left, she turned her head and smiled a sad smile. “I’m sorry,” she managed to whisper, and then disappeared through the door.
I was sorry as well… And all I could think of to respond was what Shakespeare’s King Lear says to Gloucester: Thou know’st the first time that we smell the air we wawl and cry… But I said nothing. Air was a continual surprise for Elspeth; and she was certainly not mad…