I’m usually a hugger. When I see people I haven’t seen for a while or want to acknowledge someone in an open-hearted way, I often will automatically reach for a hug. Physical acknowledgment is usually perceived as a sign of warmth. But not always. In the last few years, I have noticed that this automatic hug can actually cause harm or insult even though my intent is not to.

I learned an important lesson about touch through my work as a hospital chaplain because I often ask permission for the many ways that we interact: “May I visit for a while?” “May I sit down?” “May I turn your TV down while we talk?” Asking permission is a way of respecting the person’s autonomy. This is especially important in a hospital where throughout the day nurses, doctors, physical therapists, dietitians, custodians or repair people walk into a patient’s room often without explicit permission, disturbing or poking the person in the process of delivering their care.

It’s important people know they can say no to me when they can’t say no to so many other providers. I learned to ask someone if they are hand holders in prayer or whether I can touch them. I rarely offer a hug to patients or family members because they may feel pressured to say yes, but occasionally I sense that a sincere hug from a caring stranger at that moment would be appropriate and helpful. In those rare situations, I will ask permission, listen to their words, and watch their body language for the answer.

When my partner was diagnosed with cancer, I learned that unwelcomed touch could be a matter of life and death. She is immune compromised due to her ongoing chemo treatment even when she looks healthy. What may be a simple illness like a bad cold could, for her, become life-threatening pneumonia. She avoids crowds where sick people and those who are about to get sick can be found. We vet people for their state of health before they are invited over. We insist on people washing their hands before coming into the home. She prefers matinees where there is alternate seating if someone sits next to her who sounds sick. Handshakes are even harder to avoid without feeling rude. In response to an outstretched hand, my partner often offers a bow. Humans feel like walking germ carriers. That is a hard way to think about people, but it is her unfortunate reality.

The matter of touch became very real for me when I broke my elbow. Without a sling signaling to people to be careful, I was scared of being bumped. I tried to keep a safe distance for fear of being jostled. As people approached, I would pull away. I noticed that some people were very loving and respectful, others puzzled, and many others pushed the boundaries. “What about a hug like this?” “What about a virtual hug?” “I’m not sick.” “Why can’t you hug?”

It was so restful and caring when someone gave a kind look, put their hand on their heart, or bowed without asking any questions. They assumed there was a good reason I pulled away.

There are other reasons uninvited touch can be harmful to someone: they may have a hidden injury or chronic pain, or they may be an abuse survivor where touch initiated by someone without their permission can be triggering. Recent revelations of widespread sexual harassment and the #MeToo movement have also made many people wary of unwelcome touch. In addition, there are culturally specific norms about touch we may not all be aware of. In order to be respectful, we need to listen to people’s body language and accept all responses to an offer of physical touch without questioning it. Everyone gets to control their body. For any reason. We don’t need to understand or challenge them.

Sometimes we need a hug. I remember walking home from work one day. I was so sad from the state of the world and had just spent the day serving a large family with a tragic trauma at the hospital. I walked by where my hairdresser works. I knocked. When she came to the door, I just said, “I need a hug.” She said, “Me too.” We embraced without words, and then I went home. A moment of mutual understanding, shared permission and deep healing.

Each of us is on a continuum of touch-needs at any moment. I invite us all to find multiple ways to express our warmth to one another. Through our eyes, gestures, words. When invited, through loving hugs, handshakes, or hand-holding. This awareness of each person’s touch-needs requires us to deeply listen to body language as well as their words.

When I say I am not hugging today or during flu season, please know that my heart still joins with yours.

Chaya Gusfield is a palliative care and acute care chaplain.

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