Here I sit, in our closet of an ICU workroom, my left leg is locked straight in a rather cumbersome brace. ACL surgery was 3 weeks ago and I’m struggling to work the 12 hour days while fully participating in the rehab process. My husband still has to help me put my compression socks on and tie my shoes at 5:00 in the morning, a much less rejuvenating routine than our usual morning runs around Sugar House Park. The mad click of keyboards and screech of pagers fill the silence and a full day stretches out ahead of us. Today, my problems need to be set aside so that I can focus on the 16 patients who are having a much worse day in comparison. While an ACL tear is a minor setback in the scheme of all of the things that can go wrong with a body, I am learning how it feels to be dependent on others, physically restricted, and constantly uncomfortable. These tangible lessons allow me to realize the moments that I may have lacked empathy with patients in their weakest hours.
As we near the end of our intern year, I have been thinking a lot about how I have changed in my first year as a resident. For example, I no longer look frantically around the room when someone asks if there is a doctor in the vicinity. However, the hundreds of hospital hours that have built up my medical knowledge may have also contributed to the slow erosion of my empathy. Maybe the erosion started even a bit before residency. In medical school, we devoted a total of 4 hours in learning how to sound empathetic. They taught us an acronym that we were expected to use verbatim in a fake clinic scenario where we were graded on our interpersonal skills. The technique is called “BATHE” (Background – Affect – Troubling – Handling – Empathetic statement). I still find this laughable, particularly the “Empathetic statement” part of the algorithm. The idea that I, as a human talking to another human, would be using a memorized formula in order to connect with a patient. Despite the absurdity of this scripted empathy, I understand what my medical school was (however misguidedly) trying to cement in our brains. As I’ve come to experience, doctoring is basically a crash course in empathy. Each patient room is filled with a different end of the emotional spectrum and the physician is the emotional sponge. It is my job to sit with complete strangers and share their experience with them for a minute.
How do we, as healthcare workers, plunge into the depths of human suffering hundreds of times per week and not lose our empathy on the way? We see problems like fibromyalgia, and unable to come up with a physiologic explanation or a good solution, we discount it. A homeless man, high and agitated, throws his shoes at us in the emergency room demanding narcotic pain medication for his back pain, and in our frustrated state, we tell ourselves that he’s not in pain, he’s just using us. An anxious 20-year-old comes in with hundreds of symptoms and are convinced they need a full-body CT scan because they read online that they might have cancer. All of these people are suffering, but we have a hard time even acknowledging that suffering because we know that we neither have the answers nor the solution to their problems. Leslie Jamison puts it perfectly in her essay “The Devil’s Bait” (an essay about Morgellons disease that I highly recommend). “What kinds of reality are considered prerequisites for compassion? It’s about this strange sympathetic limbo: Is it wrong to speak of empathy when you trust the fact of suffering but not the source?” I love the message of this essay – that empathy is not about deciding whether someone deserves to feel a certain way about something, it’s about acknowledging how they are feeling and sharing that feeling with them for a minute.
As I lurch down the hallway with my swollen knee throbbing in a forced pirate-like gait, I think about my ridiculous ski injury and how grateful I am to have my co-workers and family sharing the pain with me regardless of how minor my injury may seem to them. My husband dutifully setting up the ice machine for me, my colleagues getting my breakfast from the cafeteria so that I don’t have to make the trip, the brief words of consolation from strangers on the sidewalk. The empathy is just as important as the ibuprofen and physical therapy. These painstaking experiences are paradoxically the moments that slow my empathy erosion and remind me that time spent listening is never wasted time.
Jessica Petrovich, MD, is a first-year resident in the Division of Family Medicine at the University of Utah. Her medical areas of interest include women’s health, OB, pediatrics, teaching, community outreach, and underserved populations.