Screening in the Digital Age

I never thought it would happen to me, but all the same: ‘I grow old … I grow old … I shall wear the bottoms of my trousers rolled’. Or at least some days in the office feel like that. Perhaps it’s the clientel who’ve worn the years with me –people whose children I delivered who are now patients of mine, with their babies, in turn, waiting for liberation: Samsara… the eternal round of birth and death.

Or maybe its just the mood that Ellen drags along with her on her annual visits. Lennie, as she insists on being called, seems to straddle that razor edge between then and now. Like someone dressed in layers to cope with changing climate, she seems to wear Time like a jacket that she can don or shed as the mood strikes. And just when I think she has lost all contact with the here and now -that dementia has finally arrived- like a bodhisattva she doffs her jacket and enters my world again. Or is that giving both of us too much credit? We are each of an age when the past is retrospectively falsifiable to endorse the visions we have created for ourselves –our personal myths. The trick, of course, is finding a buyer. I think this is why Lennie insists on returning to me year after year for a pap smear despite my insistence that in her case, with her pristine and otherwise untouched cervix, the interval is too short. And in my region, if the pap smears have always been normal, we stop doing them at 69, so I don’t know what she’s going to do next year…

“Can’t you make and exception in my case, doctor?” she said, anticipating my usual advisory monologue. Then she moved her chair so close to the desk it hit the edge, rattling the little wooden statue I’d hidden behind a plant for some reason. She always did that. And she was always dressed the same: a black, knee-length skirt with a white frilly blouse that hugged her neck like a noose. Her hair was short and died dark brown. She managed to wear it like a bathing cap that was so impeccably arranged, it could have been painted in place. She was tall and slender –too slender perhaps, but the hair style suited her.

“You’re 69 now Lennie and your pap smears have always been normal. You won’t need them after this.”

A coy look that I’d never seen her use before, gradually crept onto her face. “You told me the reason you stop doing paps at my age is because most of us don’t get exposed to new sexual partners and the sex virus…”

“HPV you mean?” I thought I’d add that for clarity.

She brushed off my attempt at information with a dramatic flick of her wrist. “Whatever.” She stared at me sternly in silence for a moment to heighten the suspense. Then her face relaxed and the wrinkles reappeared around a broad smile. “My girlfriend, Shirley, has been helping me to learn the computer,” she said proudly. “She’s showed me how to enroll in a dating site… And she lent me her tablet… It was a gift from her daughter, but she can’t figure it out. Touching the screen makes her nervous, for some reason.” She studied my expression for a moment, then apparently satisfied that she hadn’t shocked me with her technological savvy, continued sotto voce. “Problem is, I can’t figure out what to do some of the time either.” She shook her head slowly. “Kinda gets away on me sometimes. And then when I touch the screen to try to enlarge one of the…”-she searched her memory banks for the word- “…one of the apps to see what it says, the stupid thing thinks I’ve chosen it and I get rerouted onto something I don’t want.” She shrugged, as if to admit that it’s an adventure that all techies have to endure. “Ever happen to you?” she asked -to be polite, I suppose.

I sat back in my chair, remembering my visit that morning to the cash machine. They’d installed a newer, faster model over the weekend. But, whereas on the old one –the one I was used to- you actually had to touch the screen to make a selection, the new one seemed to sense my finger when it was a few millimeters away while I was on my way to another choice. It took me a few seconds and several more attempts to figure out what I was doing wrong. I suddenly felt old.

And what was I doing discussing dating sites in the consulting room anyway? I was running an office, not a coffee shop. But she was looking at me as a child might for validation that it wasn’t just her that was struggling with technology. So I nodded.

There was a recent article I’d noticed on the IPhone BBC app I routinely read at breakfast that had addressed that very same issue: ‘The response time for icons on an Apple screen is 0.7 seconds, but the over-65s have a response time of about one second’ Or perhaps more worrisome –I’m a surgeon after all: ‘And tests suggest that if an older person has a slight tremor, it can be registered on a device as a swipe rather than a touch.’  Wow! Was age so apparently disabling that they realized they’d have design stuff differently for us? New apps? New screens? New innovations to deal with tremors? Were we being offered technological walkers? Worse, was Lennie trying to include me in that group?

“So,” I began, trying to change the subject -trying, in fact, to change the mood in the room, “how did we get on to this subject anyway?”

“My dating site,” she said, but seemed a bit uncertain herself. I sighed a little too obviously I’m afraid, and she noticed it. Her eyes narrowed for a second. “But I don’t trust it, you know.” She chuckled softly and looked at me. “Shirley tried it, too, she said. The guy was in a nursing home and didn’t tell her –it wasn’t in his profile… But she had trouble with the apps as well; she probably hit the wrong one.” She blinked -a cautionary flicker of her eyelids. “Scary, eh? I mean it’s not worth it to go through that just to get another pap smear.”

She stared at the wall behind me for a second. “Maybe next year I could see you for my osteoporosis…”


The Loneliness of Social Media

There comes a time when solitude is not enough. When weekends are deserts that must be crossed to get to people on the other side. Where there are eyes that welcome, ears that hear, voices that desire a response. When your own voice is not rusty with disuse and your mind not imprisoned inside a page you’ve just read twice.

That, almost word for word, is what a patient told me recently after a routine gynaecologic examination at my office. She’d had no need to visit me other than getting a pap smear that wasn’t due for another year. She’d asked her family doctor for a referral but I’m not sure what she told him –there was no letter. I suspect she simply took up too much time. Was too vague to slot into one diagnostic category or another.

Doctors are busy; we deal in diagnoses, descriptions we can place in algorithms that lead to conclusions and thence to prescriptions… We are computers, but not as fast. And without recognizeable data to input, goal-oriented analyses, interpretation and even investigations are difficult to devise. Especially in the fifteen or so minutes usually alloted for their resolution.

I don’t mean to disparage my colleagues with this quick dissection –I, too, am prey to its siren song. But sometimes, the scramble for parsable phrases, or attributable words, leads nowhere but to confusion. Sometimes the only thing necessary is listening. Patience. Time.

Strange isn’t it? The answers usually surface, bubble to the top, when you least expect them. When you haven’t even asked. When you yourself are often at risk of capsizing in the turbulent sea of emotive misdirection. No, not misdirection exactly –the patient truly wants help- but more like multidirection. Stochastic: random observations from the maelstrom in which they are living.

And the diagnosis for my patient? Well, I am certainly no psychiatrist and pretend no background in psychology, but from what I could gather, she wasn’t clinically depressed (a selective differentiation I’ve never really understood)–or any more so than anyone else in her situation at any rate. If I were listening as her friend and not her doctor, I would be fairly convinced I knew what the problem was: loneliness. I certainly wouldn’t honor it with a DSM-5 categorization –even if I knew how to use the manual. Some things are just obvious. Or become obvious if you simply listen. Hear.

Her problem troubled me and I suppose one of the reasons was that although she had tried the usual methods of meeting people at work and at clubs, she had been singularly unsuccessful. A friend had suggested an online dating site and that’s where her real problems had begun. It was not that there hadn’t been an over-abundance of interesting profiles –apparently a buzz-word in that community for acceptable suitors- but that the ones she had agreed to meet were lies. Is that the right word? People who had misrepresented themselves in the categories that had most interested her. She had become disillusioned with the whole process. Exasperated. And other websites seemed no better.

While I’m sure that some dating sites are better than others –more reliable, more responsible and trustworthy- she seemed to think they all attracted the same clientel –or at least the same type of person. She had even done a reverse look-up of some of the pictures submitted (I have no idea how you do this) and discovered the same pictures on different sites –some with different names.

I had no solution for her, obviously, but it got me thinking about the issue of loneliness. It has always been with us, of course, but the prevalence in this age of ubiquitous, omnipresent social media surprised me. I had assumed –naively- that our almost universal and continuous interconnectedness would have banished loneliness to a locked, unroutered closet somewhere off the grid. But I was wrong.

If anything, social media as a solution to loneliness is an illusion, a bedtime story meant to lull us into complacency. There is an existential reality it simply does not confront: although it allows –indeed fosters- communication, it does so once-removed. You need eyes to communicate. Faces with expressions to analyse and judge. You need to be able to touch and maybe to hug in order to communicate meaningfully. That is really what socialization implies.

You can say or declare anything online, but there is still a gap. It’s the very same space where loneliness lives. And where people –real people- don’t. I wish my patient well, and all the others who come to me with masks. It is my job to look behind them, coax them off. But even after all these years, I still may not recognize what they hope I’ll see; sometimes I can only look for clues, or wait with patience painted on my face, and trust they’ll understand. We can communicate in the old way…

I can’t help but remember what Iago said in Shakespeare’s Othello: “How poor are they that have not patience! What wound did ever heal but by degrees?” Isn’t loneliness a wound?