Methodically, we placed on our yellow gowns. Precautionary measures were just as important as the patient’s well-being. The gloves came next. Any airborne pathogens could prove deadly to a patient with an already weakened immune system. As I peered into the faces of the medical professionals, I witnessed an almost defenseless demeanor in each one. The previous patient had received a good prognosis, but their faces had shifted drastically in a matter short seconds, vacant and expressionless now. The attending pushed open the door, and we followed solemnly, as if trying not to invade the patient’s privacy. After all, she had already been invaded. The surgical procedures, the questions. They had probed into her body. They had probed into her mind. She had had enough. As we entered, I noticed the attending’s second change in demeanor. She had somehow assumed a cheery disposition, and began to question the patient. I watched in the shadows, unnoticed, but still there.
“Can we listen to your heart?” she asked. The patient complied. She and the medical students retrieved their stethoscopes and began listening to the patient’s heartbeat. I still, to this day, wonder what they heard. Probably something very slow. I’m sure her heart had grown weary over the years, and was struggling to keep her alive. At this point, though, I wasn’t sure if she still wanted it to. I wondered if her internal pain could somehow manifest itself into her organs, consuming her, just like her disease had. I wondered if she had given up, surrendered to the power of her cancer, or if she had been relentless in her battle. Either way, it didn’t matter. All that mattered was that a woman was suffering, and there was nothing I could really do to help her. She was an elderly woman. In her mid- to late-70s. Life was supposed to be enjoyed during those years. They were meant to be years of nostalgia. Of happiness, and relaxation. But here she was, dying. With only the faint grooves of her outline, etched into a hospital bed, to acknowledge her existence.
The students examined her a bit more. There were a few quick nods, and then more questions. “Do you need help eating breakfast?” A quick shake of the head was the patient’s response. I watched in pain, as they tried, unsuccessfully, to probe into her mind. I wondered what they were looking for. And if they would ever find it. Her decision to avoid interacting with the doctors and students was conscious, I believe. Her choice to not fully engage in the conversation, whether conscious or subconscious, was a gesture. An attempt to seize her pain. An attempt to show us who it really belonged to. It was hers. She wouldn’t let us share it. She didn’t want us to. The doctors and students, aware of her discomfort, ceased their questioning. But not without one last inquiry. “Do you want us to leave us alone?” “Yes.” It had been the only word that had escaped from the patient’s mouth during the entire encounter. Hearing that word, and seeing the desperation and hopelessness painted on her face crushed us. It was a realization that no matter how hard we tried, we would never truly understand her pain, her suffering. And no amount of schooling, intense training, or experience in the medical field, could teach us how.
We disposed of our yellow gowns, and gloves, said our goodbyes, and left. But we weren’t just leaving behind a patient. We were leaving behind an entire world. Of sorrow, of fear, of miscommunication, and uncertainty. We were leaving her behind.
But as Leslie Jamison mentions, “Empathy isn’t just measured by checklist item 31 – voiced empathy for my situation/problem – but by every item that gauges how thoroughly my experience has been imagined. Empathy isn’t just remembering to say that must be really hard – it’s figuring out how to bring difficulty into the light so it can be seen at all…requires inquiry as much as imagination… requires knowing you know nothing… means acknowledged a horizon of context that extends perpetually beyond what you can see (Jamison 5).” That day, we hadn’t just failed to understand the patient’s pain, it is my belief that we hadn’t tried hard enough to. The doctor and students had received almost a decade of extensive training. They knew all the symptoms the patient had. They knew how the cancer and stroke had affected her sensory nerves, how it had decreased her white blood cell count, and forced her on several medications. They knew how it had stolen away her hair. They knew that she was in pain, whether physical or emotional, or a combination of both. But they hadn’t truly understood that pain. And neither had I. To understand her pain was to imagine it. To imagine what it would be like to be in her position, slowly dying on a hospital bed, during what were supposed to be the greatest years of her life. But maybe the doctor and students had had more patients to see, maybe they had been busy that day. Or maybe they just didn’t want to imagine her pain. They had just accepted their perceived hopelessness of the situation, and had wanted to move on, normally. But after reading “The Empathy Exams,” and having now a better understanding of what empathy really means, I think that they should have stayed. And tried to understand, rather than accept.