Open Windows


It was a three-car accident, with three distraught drivers walking between their disabled vehicles and the flashing blue lights of police cruisers drawing attention to the scene. Traffic was slow, with hundreds of bypassing drivers craning their necks to see what had happened. Though I have long disparaged such “looky loos”, I found myself drawn into the action. I gazed for a second too long, turned forward, found a car stopped just a few feet ahead, hit the brakes, and swerved into the shoulder to avoid a crash. I barely made it; with no harm except to my pride.

After thanking God for saving me from this close call, I considered why it happened. The morning temperatures were in the high forties but road conditions were good and visibility clear. On leaving home I had opened my driver’s window, and had noticed that of the thousands of cars on the road, only two had their windows even partly open. It was easy to see why – it was cold, and the wind chill made it worse. Still, opening the window made me much more aware of my surroundings. Instead of just seeing the activities on the road, I could hear them, and to some degree even feel them. I had gotten cold and closed the window just before my near crash. The traffic opened up, but several minutes and several miles later I saw another emergency vehicle about ¼ mile behind me. He moved closer and I pulled over, seeing rather than hearing him from a distance. Others didn’t pull over at all.

A morning commute can be supremely isolating. Thousands of people drive alone in almost hermetically sealed cars with careful climate control. They hear little road noise, because skilled engineers have engineered much of it out. A driver’s only contact with the outside world is through the windows, the radio, or the phone. The isolation, especially in the early morning, can lull drivers into a near-stupor. Accidents happen, in part, because there are few open windows.

Later that week I was visiting offices and noticed the same pattern; isolation from the outside world and from each other. Aside from meetings, which workers almost universally deride, people are glued to computer screens, like I am as I write this article. Offices are climate controlled, sound-deadened, and seem almost hermetically sealed. Surprisingly, perhaps, cubicles can be just as segregating. Maybe workplace rules and cultural norms discourage individual office workers from opening emotional and social windows with their colleagues.

Non-auto commutes can similarly separate people from nature and from other people. Few people ever conversed during the years that I took the Metro and the Virginia Rail Express to work at Health and Human Services (HHS). Most people looked straight ahead, looked down at a magazine or cell phone, or slept. Trains and buses have few open windows.

Windows are not merely physical; they are emotional, social, intellectual, and even physical. One thought provoking memory was of six people, four women and two men, walking along the sidewalk on 4th street near an HHS building in D.C. Each had head forward, neck bent, and shoulders hunched. They were wearing ear buds and looking at their phones. Though being within a few feet of the others they showed no acknowledgement of those around them. One woman stepped on to the street and almost got hit by a passing car.  An accident nearly happened because her attention had no open windows.

Homes can also isolate us from nature, from others, and even from God. Television, game consoles, and smartphone apps take the place of work computers in consuming our time. Kids don’t play outside together; they sit inside playing alone on their electronic device. Whether office or home, doors open only long enough to go in or out. Windows let sunlight into our houses. Perhaps the media fixation with conflict, sex, and violence teaches people to close the windows of their homes, and the windows of their hearts.

Health care, by its very nature, requires interacting with patients, and therefore it is less isolating. However, today doctors spend more time with Electronic Health Records (EHRs) than with patients.[1]  Past physicians performed comprehensive history and physical exams, largely because they did not have the technology that we enjoy today. However, physicians today often take short histories, perform minimal exams (just enough to get paid), and order an avalanche of tests.  A little girl drew a picture of her doctor’s visit:[2]

ehr-separating-doctor-from-patients-picture-small

The doctor is off to the side typing on the computer, while the patient and her family are far away on the other side of the room. The doctor is not even looking towards them, and the back of a large chair separates him from them. We have to wonder if this doctor had many open windows. Was he open emotionally to the needs of this patient? Was he open intellectually to the diagnostic and treatment possibilities? Was he open socially to meaningful interactions with her and the others pictured: her mother and her grandmother? Was he open physically to touching his patient in a good physical exam? Did he want to be open, but was unable too because of the situation? Perhaps the government’s mandate to use electronic health records and hospital’s requirement for high patient volumes forces health care professionals to close windows that they wish to leave open.

One of the most common psychological complaints that I hear in my medical practice is that people feel isolated. People may have “friends”, but no one that they can open up to, or count on. Men and women have sex, but don’t talk. Even husbands and wives guard themselves from each other in a dance of dashed hopes and disappearing dreams. Friends split and couples divorce. Accidents happen because hearts have few open windows.

Windows are open or closed to the natural world. Do we see, hear, touch, and smell the trees, the sky, the grass, the mountains, the sea, and the rest of the world or do we not?

Windows are open or closed to new experiences. Do we seek variety in the moments of our lives, or do we not?

Windows are open or closed to other people. Do we yearn to grow closer to others, or do we not?

Windows are open or closed to God. Do we desire to relate to Him, or do we not?

In my car, in my home, in my medical practice, in my life, and before God, I will try to have more open windows. In our society, I will try to encourage open windows. What will you do?

[1] In the wake of the 2003 and 2011 duty hours regulations, how do internal medicine interns spend their time? https://www.ncbi.nlm.nih.gov/pubmed/23595927

[2] http://www.gordiandynamics.com/wp-content/uploads/2015/11/iPatient-drawing.png

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