This week and last, students around the nation started medical school. Medical school is an incredible, overwhelming and challenging experience. Those who survive will have to fulfill a remarkable task for the rest of their professional lives if they are going to be one of the truly great physicians who care for us. We want our doctors to not only care for us but also care about us and be empathetic to our pain and our fears.
Retired Major League Baseball pitcher Vernon Law once said, “Experience is a hard teacher because she gives the test first, the lesson afterward.” I have learned (again) that our experiences allow us to be genuinely empathetic, and that without such experiences we are left with the less powerful tool of sympathy. In medical school, great emphasis is placed upon learning to be empathetic. But, it is a skill that cannot be taught. It can only be learned.
A good doctor may feel and express sympathy if they understand a patient’s illness or challenge but they cannot truly feel that patient’s pain. Not convinced? Consider that same patient who visits, for example, a cancer support group composed of people who truly understand – empathize, that is – with the horrors of radiation or the symptoms that result from poisons doctors call (chemo-) therapy. There is a difference. The failure of the physician to grasp the true impact of illness or suffering or pain is not a failure of the system, medical training or personal character. Rather, it is a simple reality of life. It is only after experiencing a challenge can we truly relate. Sure caregivers can strive to understand and to project authentic caring, but if one has not walked in the proverbial shoes of another, it is impossible to perfectly empathize. And even that lesson is one that is learned the hard way….
After a easy time getting pregnant with our now-three-year-old-daughter, a medically uneventful (but, otherwise very eventful!) pregnancy, and a long but trouble-free labor and delivery, my wife and I – without verbalizing it – believed that the blue strip on the pregnancy “pee stick” at the beginning of 2009-2010 academic year would mean an identical ride. It was, after all, all that we knew. Consequently, we started to talk about names for our newest addition. We imagined room changes and paint colors. We started to envision Ysabel being a big sister, even recognizing that she may be the type of kid who asks, “Ok, when is that crying machine going back into mommy’s tummy?” We started to plan. We got excited. We allowed ourselves the gift of all the magic that we knew was forthcoming.
Though the details may be clinically important, they still feel totally irrelevant. My wife miscarried. No, she suffered a miscarriage. In truth, we both suffered. We lost a part of us. We cried a lot. We tried to get on with our life but I could not concentrate in school and my wife struggled to make sense of how our plans and our joy had been erased by pink urine. We had suffered a loss and we were devastated.
Though we had adhered to the strange American custom of keeping one’s pregnancy a relative secret until the 12th week, we did share our loss with some family and close friends. With few exceptions (notably our friend, Dr. J.R.), we received consolation packaged in words like: “This is your body’s way of saying something was not right;” “It happened for a reason;” “You’ll try again soon;” and “It just wasn’t meant to be.” The words left me numb. Worse, though, was the realization that I have offered the same well-meaning but hollow phrases to at least a score of friends who over the years have had trusted me with the news of what medicine euphemistically calls a “spontaneous abortion.” This realization made me want to vomit like the sickest of first-trimester-pregnant women (or so, I would and can only guess).
How could I know what my friends who had experienced miscarriages would be feeling until we struggled through ours? I couldn’t. Life is filled with lessons, and if we’re paying attention, we actually learn some of them. It seems patently clear to me that try as it may, medical school cannot teach empathy. It can, however, ask the future physicians to grow from their experiences and to pivot the lessons that they learn from such experiences in a direction that eases pain… or at least lets their patients know that they are trying to understand their pain. I will never forget how the loss of our pregnancy made me feel. And, the next time a friend or patient shares the same, I will realize that they suffered true loss. I will offer support while they mourn, and encouragement only when they are ready for that part of the process. Empathy really means that I have suffered and I now have the tools to help me understand that you are suffering. Empathy cannot be taught and it hurts to learn it.
Special thanks to my wife, Patti, for letting me share this story.