Editor’s note: This article is in response to “From the Editorial Board: Empathy Decline in Medical Education.”
I walk around the hospital now, a fourth year months from being a doctor. On my medicine sub-internship, I walk around in scrubs with my stethoscope attached to my waist next to my pager and cellphone. Some of the third-year med students who know me pull me aside to run a patient by me before they present to a resident. I’m as evolved as they come on the medical student ladder. I don’t quite reach the bottom rung of the doctor ladder — but still, I’m at the top of one ladder!
I’m going to be an emergency medicine physician, and my medical school career has spanned delivering babies and telling a family their loved one was dying. I’ve acquired a veneer of cynicism for my colleagues, and a layer of emotional armor. It’s that emotional armor that lets me walk away after a patient I’ve been performing CPR on dies, and be able to go to the next room. I’ve experienced the suppression of empathy common to graduating medical students. I’m joining a specialty considered among the most jaded: emergency medicine. Despite that, I disagree with the editorial from the in-Training editorial board on empathy.
Last week, I had a patient with stage IV lung cancer. She and her family had no idea as to the prognosis, and she’d been admitted for a pneumonia. My attending and my team were all about getting her fixed up from the pneumonia and getting her home. Her impending death, the terrible decisions that she and her family had to make were “an outpatient problem.” I vehemently disagreed. I was overruled. Finally, when our best actions did nothing, we had a family meeting. It was there that I stood by as her oncologist told her daughter and her that she had maybe one to six months, probably less.
I walked out of that room feeling sick. I ran into a third year on my way out, who wanted to ask me a quick question. I brushed by, ignoring her as I grabbed my jacket and bag and headed out into the cold night. I walked, trying to process my angst. My patient was going to die, and my actions had if anything prolonged her life. Why then did I feel so wretched? It was empathy, the thing that clinical education beats down, rising back up to the surface. My empathy made me feel for her, and I felt a pale reflection of her and her family’s agony. Unbidden, quiet, hot tears ran down my face.
Empathy is an important characteristic, but all the more, it’s a weakness. Feeling empathetic for my patient made me feel terrible and sent me home in agony. Logic would dictate that I’d never want to feel that way.
I remembered later, a quote I’d used to write an article for in-Training:
“See, there’s two kinds of doctors…there’s the kind that gets rid of their feelings, and the kind that keeps them. If you’re gonna keep your feelings, you’re gonna get sick from time to time — that’s just how it works. People come in here and they’re sick and dying and bleeding, and they need our help. Helping them is more important than how we feel. But it’s still a pain the ass sometimes. Sometimes, I just want to quit and do somethin’ else.”
-Mark Greene, “ER”
I realized then and I realize all the more now that that’s the kind of doctor I’m going to be. I’m going to hold onto my feelings, my beliefs and I’ll fight to keep them all: the good and the bad, the sublime and the agonizing.
There are good days and bad days. Good days when I can do good for my patients, bad days when nothing I’m doing works. There are days when my empathy is worn down to a thin veneer over a hard clinical shell, when my patients are holding me from my sleep or a bite of food. Those are days when I could and should do better. But then there are days when my empathy forces me to feel some of the terrible things I see around me, and those days humble me again.
I believe that we choose to hide our empathy as medical students. The whole process, from our medicalese description of a patient to our clinical detachment is a self preservation tactic. Our patients could be us, and that scares the crap out of us. So we hide the characteristic that lets us identify with them: our empathy.
I’ve realized that my empathy is like a shutter of a camera. I sometimes have to clamp it down hard when there’s too much intensity coming my way and become the cold, emotionless machine that needs to slice open a chest or put a tube down a throat. And there are sometimes when my empathy has to almost overpower me, to reach out to my patients and their families.
One of the founders of emergency medicine said it best for me: “You need to be able to cry for your patients. The day I stop being able to cry is the day I’ll quit.”