We Can Barely Dream In The Place That Empathy Dies

It was a vulnerable time.

The man sitting next to me in the car shifted gently.  His arthritic hands curled into a bow and rested on his lap.  He melted into the seat as if all those years working on automobiles had somehow strangely made him part of one.  I self conscioussly placed the key in the ignition and glided out of the parking spot.  I could feel his gaze upon my shoulder as we both strained to listen.

After the accident, almost the whole body needed to be repaired.  I marveled at the clean finish and drove home overjoyed to forget all that had just happened in the last few weeks.  The shell, however, often betrays that which dwells within.  It only took a few miles before I noticed the knocking coming from somewhere behind the left rear wheel well.

So I drove a few miles with the elderly man from the body repair shop in my passengers seat to see if we could tease out the problem.  I marveled at how uncomfortable I was with this stranger in my personal space.  I was aware of my every movement, my every breath.  For him, this was routine.  How many times had he ridden in the car with a complete stranger trying to diagnose a bump or squeak?  But for me, secretly shattered and struggling with my confidence after an unexpected car accident, my skin bristled with every displacement of the intervening air.

I couldn't help but think of my patients.  Their presence, the exchanging of secrets, the caress of skin, all so familiar.  So familiar for me, the doctor.  The apprenticeship of medicine teaches not only the ad nauseum details of disease but also the physical and emotional closeness.  One learns how to face tragedy not as the event changing moment in another's life, but as a part of ones daily routine.

Yet it occurred to me that sitting in that car, what I most needed at the moment, was to be told that it would all be okay.  The big it (not the knock in the wheel well).   I was so vulnerable.  I needed to be reassured that my confidence would come back, that my heart would stop racing every time I merged onto the highway.  But why would this kindly gentleman know that?  He was just an auto body repair man coming to work, taking a ride to diagnose a problem.  You know, routine.

And I struggle with how to professionally not become the body repair man.  Because indeed cancer, and infections, and heart disease, and death and dying are the fare served up on my daily menu.  My repeated exposure to such things, the nightmares of the general populous, changes how I experience.  Changes how I feel and perceive. The exact qualities that make us master diagnosticians, i.e. repeated exposure, make us lousy human beings.

Those of us steeped in the difficult, have lost the ability to break out of our practiced shell.  We have lost the ability to experience as the novice.  Yet as physicians, it is exactly the novice who we have dedicated our lives and careers to.

It is no wonder there is a disconnect.  Our patients come to us desperately needing our skills and knowledge.  Yet in the process of obtaining these skills, we lose the ability to see the ensuing landscape through the same unaware lens.  We can no longer experience what our patients experience.  Nay, we can barely dream in the place that empathy dies.

The patient is thankful for the help but sometimes just wants to be told that everything will be okay.  The doctor is confused about why physically treating the problem doesn't bring about full resolution.

It turns out we were never able to reproduce the troublesome noise the car made that day.  As I thanked the gentleman for his help, I hung my head sheepishly feeling the weight of yet another humiliation.  He looked me square in the eye, and I could feel the warmth in his grip as he grasped for my hand.

Any time.

His shoulders stooped and his back bent as he walked away.

Any time.