Bert was a single man in his 80s who wore a lot of tweed. He had watery eyes, a white moustache and, if it weren’t for the stark walls and fluorescent lights of the health centre waiting room, one might imagine he had stepped straight from the pages of a beloved children’s book.
Every move Bert made was thoughtful and precise. With time, this deliberateness extended to our consultations. Before long we had developed our own unique and unofficial etiquette. He would place the current novel he was reading – somewhat ceremoniously – on the edge of my desk and I would ask if it was any good. The conversation would then progress to arthouse films and the best inner-city cafes in which to read and nurse a cup of coffee. Eventually, reluctantly, we would get down to business.
On one particular day, Bert had presented to discuss the results of recent blood tests. My eyes scanned the numbers, hovering over the ones highlighted in bold.
“It may be nothing,” I reassured him, “but it’s probably best to make sure.”
I recommended further investigations. First, endoscopies. He nodded and smiled, ever obliging. He didn’t even flinch at my rather candid description of the bowel prep.
It came as some surprise then to see his face harden when I mentioned he would need someone – a family member, a friend – to pick him up following the procedure.
“Can’t I take a taxi?” he asked, his gentle voice suddenly tight.
“I’d have to check with the endoscopy centre but they usually like patients to have someone stay with them overnight.”
Bert’s body grew stiff in the plastic chair.
“Is there someone you could ask?” I said, ashamed of the desperation in my voice. “A neighbour? Anyone?”
“No.” He reached for his hat, scooped up his book. “I’m afraid there’s nobody.”
The words sat between us, stubborn and irrefutable. I ran through alternatives but I could tell Bert was only half listening. The delicate rapport we had built over the years had crumbled to reveal a disappointing but unavoidable truth: we were not friends, we never were. And what Bert needed now, more than anything, was a friend.
In her collection of essays, Intimations, penned during the early months of the coronavirus lockdowns, the British author Zadie Smith writes, “The single human, in the city apartment, thinks: I have never known such loneliness.” And while this may be true, many people, like Bert, were experiencing loneliness long before the pandemic.
In my case, peak loneliness occurred during my medical elective in Charlottesville, Virginia. I knew nobody. I had answered an advertisement for a granny flat within walking distance of the university. The elderly couple who owned the place made it clear they liked to keep to themselves. They recommended I do the same. Like fearful grandparents from a Brothers Grimm fairytale, they told me to be home before dark. It was January in the middle of winter – the sun set at 5pm.
It wasn’t the aloneness that bothered me – I’m an introvert, I’m energised by solitude – it was the vulnerability I felt, knowing there was nobody I could call should I suddenly need something. It was the same vulnerability Bert must have felt during our difficult conversation about the endoscopies.
As it was, I came to rely on the kindness of strangers. The taxi driver who stopped the meter and kept me company the night I arrived home to a locked and empty house. The medical student – the only one – who talked to me during ward rounds and later invited me to parties, dinners, the medical revue. The professor of paediatrics who turned up at impossibly short notice – his unrinsed hair still slick with shampoo – to drive me to the airport when my prebooked taxi failed to show.
Reflecting on these events now, I can’t help but think that if there is an antidote to loneliness, then surely it is kindness. Even Sylvia Plath – the American poet well known for her own profound loneliness – once wrote: “So many people are shut up tight inside themselves like boxes, yet they would open up, unfolding quite wonderfully, if only you were interested in them.”
The pandemic has forced us to confront how connected we are to one another. How reliant. We now accept that one person coughing in an elevator can result in the death of another person’s grandmother. And we’ve observed how the severing of ties during lockdown can prompt a collective human wilting – as if, rather than separate entities, we are all leaves fed by the same tree. This revelation – that everything we do has unforeseen and unintended consequences – is an enormous cognitive burden. But what if such connections were not only conduits for bad things like viruses to wreak havoc, but channels for good things, too?
In her book, A Paradise Built in Hell: The Extraordinary Communities that Arise in Disaster, Rebecca Solnit shows us that historically disasters – including infectious disease pandemics – have prompted unprecedented acts of kindness. Amid all the trolling on social media and brawls over toilet paper, it has been easy to lose sight of this during our current health crisis. A recent article published in Nature Medicine, titled “How kindness can be contagious in healthcare”, documents several pay-it-forward programs that have been implemented – both before and during the Covid-19 pandemic – with excellent results.
Whether it be testing for sexually transmitted infections or uptake of influenza vaccines, pay-it-forward campaigns that harness the generosity of participants have resulted in increased engagement when compared with standard fee-based care. And the benefits are not just for the recipients. Multiple systematic reviews have demonstrated that the act of being kind is itself associated with improvements in subjective wellbeing and psychological function in the givers.
The other day, during a telehealth consultation, a patient who was emerging from her depression stopped in the middle of recounting all the good things that had happened to her since our last appointment to look at the webcam with a disbelieving face and say, “Ripples, you know?” It was enough to jolt me out of my bad mood.
Ripples. The word got my attention because it was the same term the authors of the Nature Medicine article had used. But how do we measure these “ripples” outside the manufactured conditions of a scientific study? Unlike the coronavirus, there is no easy way to test for the contagiousness of kindness. We can’t represent it in fancy graphs or calculate its reproduction number. We can only listen to the stories. For me, that story involves a lonely student in a foreign country who was saved by the generosity of strangers, and who, as a result, was more inclined to impart kindness when faced with a similar situation in the future.
In a society so often powered by outrage and hate, not much surprises people anymore. But kindness does. I keep reminding myself to practise it – if only to behold, for an instant, the look of happy astonishment on a stranger’s face in this world where kindness is still a radical and unexpected deed.
This article was first published in the print edition of The Saturday Paper on November 27, 2021 as "Ripple effect".
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