The highlight of my lunch break these days is not the taco bar or burgers, but the checkout line. After I pay for my food, Alba sticks out her elbow from behind the register and says, “Elbow Love, Dr. Leif.” I bend down and look away, and we gently touch elbows.

Immediately, I get this warm, expansive, uplifting sensation in my body. “Thank you and see you tomorrow,” I say. Feeling light on my feet, I walk to sit down, thinking, “Life is good. What a lovely person. These are my people, and this is my place.”

I’m a doctor at Alta Bates Summit Medical Center in Oakland, California. While the number of infections is unfortunately picking up here and across the country, it has been months since those at the hospital were gripped with the fear that every surface we touched could give us COVID-19. And we now know that good masks—especially when worn by everyone at work—keep us pretty darn safe. While I keep distance from my masked colleagues, it is done with a sense that I am supporting a successful team effort rather than out of mortal fear. With this greater security, there is a slight movement from being back on our heels to leaning in toward those we care about.

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Now, I feel a voiceless mental calculus telling me that moving in close just for a second to bump elbows needs to start happening. With a scary, exhausting eight months behind us and many more months of uncertainty ahead, these quick, safe interactions put gas in our emotional tanks and allow us to bring the commitment and compassion we need to do our job going forward. Indeed, everyone who has been battling the virus with masks, physical distancing, and dramatic life changes need all the help they can get to just keep going.

In a desert of touch, just a square inch of clothed skin touching the elbow of a cashier triggers a sensation that can be felt head to toe! It is a simple fact: People need to touch people. This is one of the fundamental lessons of 2020. 

Why do we touch?

Why does touch feel so fundamental and how come the sensations associated with it are so profound? That’s the question that had me puzzled last week as I ate my taco bowl.

From a purely tactile standpoint, touch is superficial; evolutionarily and physiologically, it is deep. Touch was an important mode of communication in our primate ancestors, who had limited verbal communication. Even now, it’s perhaps the most important mode of communication in infants. 

What does touch do? According to years of research, touch quiets the “fight or flight” part of the nervous system, and it turns up the calming “tend and befriend” response, which for infants encourages growth. The role of touch persists into adulthood. We have all felt the healing power of soothing touch from a parent, friend, or lover. Research suggests that touch can also signal cooperation. This has its roots in primate grooming, and it is evident now in the greeting handshakes of many cultures.

Touch (and other nonverbal communication) can also be seen as an amplifier of emotion. This makes sense to me when I think about my checkout lane Elbow Love. Today, we need our feelings of belonging and connection amplified in a big way. We are an inherently tribal species, and that means at an unconscious level we are always assessing who is in our clan and who isn’t.

Months of anxiety and conflicting nonverbal cues can leave us feeling unsettled even while we are surrounded by people we know well. You can get that alone-in-a-crowd feeling, even among friends! Elbow Love is literally reaching out again to reaffirm the important bonds between members of “our tribe.” When we are met with reciprocity, our commitment is confirmed—and the touch acts to amplify our affection and cooperation that have been waiting for months to be more fully expressed. For me, this provokes a head-to-toe flush of pleasurable bodily sensations, including a soaring, expansive heart. My positive thoughts are amplified, too: Place, purpose, and community feel profound when tied to such positive bodily sensations.

As cerebral, verbal creatures, we can have trouble grasping the extent to which our thoughts and actions are influenced by nonverbal stimuli. In milliseconds, we unconsciously process stimuli like touch, which can activate neural pathways that lead to a secondary physical sensation—the “feeling” part of feeling—and a cognitive tone that together make up an emotional response. Caught up in our thoughts, we can neglect to notice the bodily sensations and cognitive tones that arise during these challenging times. This is especially true for those of us in stressful caregiving settings.

When we pay attention to our body and our thoughts, we can better appreciate the good, like my experience of Elbow Love with Alba. At the same time, we can create positive mental scaffolding for difficult situations, such as another frustrating Zoom meeting or, for me, when a patient’s health deteriorates. Emotions have been called the wisdom of our ancestors. When we look for this wisdom by paying attention to our bodily sensations, we can amplify the good and temper the challenging.

Rebuilding community through touch

I take COVID-19 seriously. At work, I am always masked except when I am eating, which I try to do outside. I take the stairs instead of the elevator, and I look for isolated corners to work on my patients’ charts. Wearing masks and looking away, holding the breath, then leaning for just a moment to touch elbows is an extremely low-risk encounter—and the benefits are real: It can transform an interaction and the whole feel of a place. Our collective mental health has suffered during the pandemic, and for those of us who have remained vigilant these months, the time is right for this small amount of contact.

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We have been through incredibly tough times. Our friends and colleagues were turned into potential infectious vectors overnight. The pandemic upended our communities. While we may have a stronger intellectual appreciation of community, at an emotional level I think we are all suffering in part because without the normal nonverbal inputs, our experience in community remains disrupted. But with just the slightest touch, we can make manifest the connection that community implies. Through the visceral way that touch amplifies emotions, a little physical connection can reaffirm our connection and powerfully bring back more of the good feeling we get from being around those we care about. 

One day in the hospital ward, I see my nursing colleague Tirhas, who is perhaps the most affectionate person I know. At about 10 feet apart, our eyes meet over our masks. I can see her cheeks widen and eyes narrow, suggesting a big smile under her mask. She raises her arms in a big welcoming gesture as if expecting a hug. “Dr. Hass!” she practically yells. We approach each other, then look to the side, hold our breath, and gently touch elbows.

Stepping back, I feel like I am lifting off in a hot air balloon, a joyful warmth and expansiveness practically lifts me off the ground.

“Dr. Hass, we are back! I have been waiting for a hug from you for months, but that was sooo nice. I love this place and I love this work!”

“You are the best, Tirhas!” I reply. “Let’s keep spreading the Elbow Love and let’s hope that same feeling will flow to our patients!”

With news of effective vaccines on the way, many of us can sense light at the end of the tunnel, but we have a long way to go. Thankfully, I believe, we are wiser from the challenges we have faced. We have a deeper understanding of the importance of relationships and community. With an understanding of the role of touch in human interactions, I hope we can safely use just a little Elbow Love to reaffirm and amplify the sense of connection and community we need to make it through the coming months.

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