Carly has a cousin whose children always tease Carly that her stock phrase is “Just give it a rub”. This is in response to whatever ailment anyone suffers, however serious or debilitating. It has become their mantra every time they see her. Even if they are entirely healthy or unwell and in hospital. This has made Carly ponder. Not a lot, as Carly is not prone to the longevity of pondering. She is always in a rush hither and thither. But she does wonder if it is true. Does she truly believe that rubbing something will make it better? Is rubbing an area better than dishing out paracetamol and ibuprofen? Rubbing, at least, is a physical act and less emotionally distant. Certainly, returning to hugging, which is a large-scale version of rubbing, as the pandemic relinquishes its tight grip, has been great for everyone.
And as Carly is a doctor, a paediatrician to be exact, she sees a lot of patients with ailments. Many of which would be helped with a rub and probably wouldn’t need to see her in the clinic. She spends at least half of her clinic appointments explaining to children who have functional (also known as psychosomatic) headaches and tummy aches, about laughing and crying. She asks the children “Why do people laugh?” They nearly always think this is a trick question. But she reassures them that it isn’t. Then she asks them, “Why do people cry?” Carly explains that laughing and crying are the physical manifestations of feelings and emotions. And she feels this helps to explain to them why they might have a pain or feel dizzy or a multitude of other ailments.
She wistfully remembers one such patient. Let’s call her Mandy. That wasn’t her real name. Mandy is not a common name at all for a girl these days. Carly has seen lists of names that parents give their children nowadays. Olivia is very popular. As are Milly and Molly. Just not Mandy. Carly had been seeing Mandy for quite a while. She seemed overly sensitive to life’s knocks and bruises. One day she came to the clinic to see Carly. She refused to get on the scales for her weight to be documented. She said she had a very sore toe from stubbing it in a door. Carly looked at her records, as Mandy had come to the Emergency Department howling the night before. So much noise for a stubbed toe. She had an X-ray of her foot, which was, of course, normal. Everyone knows when you stub your toe, you are given carte blanche to swear your head off, you give the injured toe a rub and all will be well.
But Mandy had form on this. She had hit her elbow a year ago and still wasn’t fully using her arm. Chronic regional pain syndrome had been diagnosed, and she was in a bit of a pickle. Carly really didn’t want her patient to have the same problem with her toe. So, she took off Mandy’s shoe and rubbed it gently. The level of hysteria in the clinic room was really overwhelming. Mandy was screaming, her father was crying, and her mother was looking vengefully at Carly. Then Carly tried to explain to them about allodynia. This is the reason you rub something that you have injured. The body senses the ‘touch’ and this lessens the pain. But if you don’t do that then the pain becomes intense. The nerve fibres that were originally for touch, become associated with pain and every time you touch the injured area the skin is hypersensitive and all you feel is pain. This is called allodynia and Carly knew all about this as she had done her PhD on these nerve fibres and how they could change Aδ to C fibres. She knew Mandy had allodynia in her elbow and she wanted to show the family that if she rubbed the toe then she could avoid that problem recurring in another part of her body.
However, the emotion in the room was too intense for anyone to listen to Carly giving her scientific explanation about these nerve fibres. Now really wasn’t the time. Maybe Carly could explain it in a letter to the family afterwards. Fortuitously, after a few minutes, Mandy calmed down, her father stopped crying, and her mother looked at Carly with slightly less fury. And the toe hurt less. Within a couple of days, Mandy had no pain in her toes at all and they weren’t sensitive. So, in this instance “Just give it a rub” had been the right course of action. The elbow took longer but the family now understood how to better manage these painful joints. Interestingly, if she hadn’t stubbed her toe, ended up with an X-ray and a clinic appointment soon afterwards, Carly mused she might still have an elbow she couldn’t move and socks she could neither put on or take off? Stinky feet. The worst…
But advising parents to always “Just give it a rub” isn’t the right response sometimes. Recently, Carly had a lovely patient, Nina, who was born with a very scrambled heart. She was eight and again this wasn’t her real name. Some very clever surgeons had cobbled her heart back together with bits and bobs and flipping things around. Nina was pretty well and doing pretty much what other eight-year-old girls do. Her parents waited a very long time for her to be stable before deciding on having another child. One of Carly’s genetics teachers told her that parents often do this, so they don’t overburden themselves with many children with severe hereditary conditions. It is called reproductive choice. Nina’s mother was an inpatient on an antenatal ward because of some medical obstetric complication while her baby was still cooking – well gestating is probably a better term, decided Carly.
Nina had come to Carly’s clinic with episodes of her heart beating too fast. Carly has decided she is a bit of an expert in these functional symptoms. Whenever anyone gets stressed, especially teenagers, they can get palpitations and experience a fast-beating heart. Carly sees loads of these patients and the trick is to say it is anxiety and not do a whole load of unnecessary investigations. These just uncover minor variants which are in the normal range and then everyone is stressed, and yet more investigations are ordered. Such a waste of time and money, not to mention unnecessary anxiety. It is like a vicious cycle of more investigations to prove the first ones were normal, when they should never have been undertaken in the first place.
In this instance, Carly very nearly didn’t organise a heart tracing test for Nina. But she had been told by the specialist heart doctors down the road she must. Grrrrrrrrr thought Carly. Really this is just anxiety about her mother being in hospital and a sibling about to be born. Often Carly doesn’t do what she is told but Nina is pretty young for adolescent stress to cause palpitations. And she did have a previously scrambled heart, and this means she possibly could have real palpitations. So reluctantly and confident that she would be proved right, she organised a 24-hour heart tracing test. “Well blow me down with a feather” thought Carly when one of her cardiology colleagues phoned her to say she really did have some very serious palpitations that would need treatment. “Phew”, thought Carly who had begrudgingly organised the test, and “Thanks”, to having good colleagues who called her up to say it was abnormal. So, in this instance, “Just give it a rub” would have been wholly the wrong thing to do.
Carly wonders if giving things a rub and hugging are actually the same thing. Rubbing is a repetitive movement over a particular area that is sore. Hugging is helpful when you are feeling mentally sore, or just lonely. Carly thinks back to these last few years. She has always liked hugging. Her sons are good at it. Her daughter is more unpredictable. But the pandemic put paid to hugging. Well, it did if you followed the rules. Which Carly doesn’t. So, she hugged lots of people. These were all people in her ‘bubble’. Carly had a rather loose definition of her bubble. It was really more of an ephemeral construct which would expand and contract according to Carly’s needs. Mostly she wanted cuddles and hugs. But Carly also realised there were times when she didn’t.
Carly cries a lot. And this can be overwhelming for others. But she doesn’t actually mind crying in front of others. But they don’t always like it. So, they will engineer an end to Carly’s sobs by hugging her. And if Carly didn’t want this, she could put up her hand as if to say, “No hugs, it is the pandemic after all”. And then she tries to explain in this particular instance that hugging isn’t helpful. Crying is fine. She even cried in an Uber recently when she and the driver were each trying to make sense of their recent divorces. The driver didn’t try to hug Carly. He gave her his copy of the Quran instead. Maybe that is a spiritual or religious hug. Words to surround and comfort you. Yes, thinks Carly. That is a hug. Good.
