Soon after I began medical school, I found myself hungry for stories — despite (or perhaps because) I had essentially no contact with patients. I read pages of internet forums for people who suffered the diseases I was painstakingly learning from unwieldy textbooks, trying to absorb through the screen what it felt like to have recurrent blisters all over your body, what it meant to lose sensation in your feet or control over your bowels, or how it affected you to know you were going through menopause 25 years too soon. Everyone who has ever Googled a health concern (read: everyone) knows that Internet forums on health can be alarming at best and alarmist at worst. And, while this held true, the forums were also saturated with a gentleness towards the newly diagnosed or suffering.
In these preclinical years, each practice question I did began with a patient vignette (a 56-year-old man with an extensive smoking history walks into the office complaining of increasing shortness of breath) that sent me down a path of imagining the lives these patients led. As the subtle clues in the question stem pointed me towards the diagnosis of lung cancer, I felt such sorrow — guilt, even, as the man and his doom were conjured purely for my own learning.
When I finally made it to third year — the year that deserves all the clichés thrown at it: the promised land, the whirlwind, the rollercoaster, the “most fun you never want to have again” — my patients captivated me. I wrote down their words, their curiosities, the emotions they tucked away, hidden inside fists inside pockets until the exam room door closed and they could finally uncrinkle their palms and let them drop. The privilege of catching some of them in my own outstretched hands was nothing short of remarkable.
One man walked in with the chief complaint of “palpitations.” Once he sat down, it became clear that what he really wanted to do was discuss his wife’s recent cancer diagnosis — an English teacher, he quoted Hemingway off-handedly to give color to his fears (“It is awfully easy to be hard-boiled about everything in the daytime, but at night it is another thing”). He called me at the office later that day to recommend a favorite Faulkner short story.
One 88-year-old woman, in the hospital for the sixth time in as many months, pulled out her makeup as I asked her how she was feeling that morning. She was wearing a hot pink bathrobe, New York Times crossword in her lap. “Sweetheart!” she winked at me, “Grab me my brush, will you? I can’t be seen by all of these handsome young fellows in a state like this.” Later, the doctor explained that her only real shot at a cure was a major surgery. He could guarantee a long recovery time but couldn’t guarantee success. She waved him off, eyes gleaming, and reapplied her lipstick.
A father promising never to drink again after his new diagnosis of cirrhosis with devastating earnestness. A lovely woman who, during an episode of psychosis, attacked a neighbor with a rolling pin. An eighteen-year-old, 39-weeks pregnant, who didn’t have any prenatal care because the fetus’ father was killed shortly after conception and she just couldn’t bear the ultrasound reminders. A 12-year-old girl steadily interpreting her father’s stories of torture. A man realizing minutes before his operation that the surgeons were planning to remove his entire tongue; the way he looked at his wife after this dawned on him. A group of friends giggling at a friend who split his lip during a skateboarding accident.
I accumulated these moments, holding them as sacred — or at least near it. But as the year progressed, I got tired. I wrote less; my journal took on a new identity as a coaster on my night table. I read less. I asked less. I noticed less. This happened slowly, and then seemingly all at once. I practiced the skill of directing the conversation with patients to efficiently get the information I thought I needed and, in the process, became less tolerant of meandering stories — the stories they needed to tell. Late in the year, I performed my first chest compressions on a 14-year-old girl, her softness startling to the heels of my hands. After the doctor pronounced her dead, I went to the bathroom in anticipation of tears, but none came.
This spring, I reported for duty in the emergency department. I was tired, coffee in hand in preparation for the night shift. A man rolled into the CPR room, obtunded, with no obvious source of his altered mental status. As is customary, he was surrounded by a flurry of people in motion: hooking him up to the monitors, performing a physical exam, administering supplemental oxygen, undressing him. I slipped off his right shoe, which, to my chagrin, housed six small cockroaches — “water bugs,” as I’ve learned to call them in the south. As one skittered towards my leg, I smashed it, reflexively, with the Timberland in my hand. The commotion in the room screeched to a halt. There was another shoe to remove, and a pair of pants too, but no one was moving.
The emergency resident beside me murmured, with a tenderness that almost broke me, “This poor man.”
She was right. Of course — this poor man. That should have been the first thought in my head too. Empathy. Understanding. Hell, moral outrage: How can our society tolerate the fact that one of our fellow humans is in such dire straits that he is living with a roach infestation on his actual person? But not once during the commotion did any of these thoughts cross my mind — instead I felt dismay, disgust, exhaustion. What was wrong with me?
These kinds of failures sting the worst. I’d always taken comfort in the fact that — even if I had struggled with a concept, botched a dissection, done poorly on an exam — at least I had my humanity. At least I gave a shit about people. And now, maybe I didn’t even have that.
I had a moment of clarity during the witching hour of that night shift. Empathy is a muscle you have to exercise just like any other. It is a choice. It’s something you have to study and practice and sometimes fail at and always try again. Putting on my little white coat doesn’t automatically transfer to me all the traits the best doctors have: empathy, compassion, warmth, kindness. I have to actively commit to working at these, every day with every patient. This is hard — so much harder than I expected when reading online health forums as a first year. It’s much easier to follow the path of least resistance, let the idea that emotional distance is required — to best serve the patient, to protect your own sanity, to get your freaking work done — edge out the reason I went into medicine in the first place.
I fail. All the time. But I’m trying, and I’m going to work to keep it that way.