Acquisition of Compassion Among Physicians: Why Is This Rite Different From All Other Rites?
+ Author Affiliations
- Corresponding author: Benjamin W. Corn, MD, Tel Aviv Medical Center, Institute of Radiotherapy, 6 Weizman St, Tel Aviv, Israel; e-mail: bencorn@tasmc.health.gov.il.
In the process of forming professional identities, physicians undergo several important rites of passage.1,2
In addition to memorable milestones such as scrubbing into surgery for
the first time or cutting into a cadaver, apprentices
in medicine must acquire a broad fund of knowledge,
develop diagnostic acumen, hone procedural dexterity and communication
skills, and learn the “culture” of medicine, such as
how to interact with consultants, colleagues, and allied health care
workers. But novice physicians also have a core need
to retain an essential trait that they often have in abundance at the
outset of training: empathy.3
In the midst of reminiscing at the last
Seder, I realized that my most formative experience with physician
communication had
been accidental. For me, one physician's apparent lack
of compassion profoundly affected the course of my life—as did an
empathetic
intervention by someone dear to me.
I remember April 2, 1972—the fifth day of
Passover—as the day when I was told, “Daddy is very sick.” On that day,
along with
my mother, older brother, and younger sister, I
boarded a subway train en route to one of the finest cancer centers in
Manhattan,
if not the world. We didn't realize it then, but as we
were ushered into a gloomy room to witness the skeletal shadow of a
man who had loyally served in the US Air Force before
excelling in track for the City College of New York, we were saying
good-bye for the last time.
My childhood recollection is that my father
was buff, and that the most prominent attribute of his physique was his
lower-extremity
strength. His muscular legs had the diameter of tree
trunks—oaks. A few months before that difficult April day, business
trips
(spelled “hospital admissions”) began to preoccupy
him, or so we were told. I'm still not certain how my parents managed to
pull off the ruse (with our subconscious compliance,
no doubt), but before that most memorable of all Passovers, my siblings
and I had not understood Dad's absences. In the
hospital, seeing only thin wooden sticks remaining to support the man
who
had once anchored the 4 × 100 meter relay team for
City College, we began to get the picture. Looking back, I realize also
that, during our visit, my father was overmedicated
with pain-relieving drugs. He was, as cancer specialists say, “gorked
out.”
As we approached his bed, he could barely
lift a laminated card from the nearby tray and thrust it into my palm.
It was a
menu, covered with fingerprints and smelling of
institutional food. I had no idea why my father gave it to me. I was
uncomfortable
and immature, and I began to giggle.
Suddenly, I felt a sharp elbow in my ribcage.
Some of those pain medicines would have helped right about then, but
instead
of pharmacologic assistance, I got a quick lesson in
life from my older brother. Without words, Joe was explaining that Daddy
was inviting us to lunch—that the gesture was our
father's sickbed attempt to continue to be our provider. I hardly spoke
to my brother then, and I don't speak to him enough
today, but I always know when he's right. Joe pointed to the tuna salad,
and I recovered quickly enough to gesture straight
toward the dessert section. I think I remember Dad cracking a smile. At
least, that's what I want to remember.
On the way home to Brooklyn after the visit,
our family did not process what had happened. Two days later, an hour
after my
mother lit the holiday candles, our phone rang.
Somehow, each of us recognized this ring as foreboding. Although the act
was
an overt violation of the Orthodox laws of Judaism
that were observed in our household, we picked up the telephone
receiver.
On the other end of the line, a physician communicated
the news, “Mrs Corn, your husband expired 30 minutes ago. May we
perform
an autopsy?”
Silence.
Mom had the look of someone who was shocked
but not surprised. I am sure she had known that a call like this was
imminent;
still, her stunned reaction was exacerbated, no doubt,
by the abrupt way in which the bad news was transmitted. Holding the
Princess phone, her hand quivered. We helped her hang
up the receiver.
I have no ill feelings toward the doctor. He
was probably an overworked intern or resident still learning his craft,
asked
by his superiors to perform a duty for which he had no
training. Rather, I distinctly remember being overcome by two other
emotions.
First, I was genuinely glad that we had
broken the laws of the Passover holiday by answering the phone. God, it
seemed, deserved
some sort of a beat-down for the devastation that He
had inflicted on our family. Even now, as a religious adult, I continue
to construe that childhood response as occupying the
sophisticated as opposed to the primitive terminus of the theological
spectrum.
Second, I envisioned myself as malnourished
and enduring torment in some dank workhouse as a Dickensian orphan. I
feared for
my survival. I did not know then that Dad (ever the
provider) had set aside enough tangible assets to get us started, or
that
Mom would emerge as a heroic single parent. I found
myself, instead, wallowing in worry. “What are we gonna do?” I cried out
to anyone within earshot. Immediately, I felt my
brother's arm—the same arm that had wounded me just 48 hours
earlier—drawing
me in toward the undeveloped, concave bosom of his
young chest. “It'll be OK, Benjie. It'll be OK.”
I realize, in retrospect, that I have never felt more comforted in my life than I did at that moment, shepherded by my brother.
And as for that doctor—well, he could not possibly envision how poignantly his shortcomings were elucidating the complexities
of bedside manner, or how enduring would be the lesson he taught me.
Intricate strategies have been proposed for inculcating empathy. For instance, recent empiric work has suggested that formal
instruction in compassion can alter neural responses to suffering.4,5
Yet it remains unclear just how a person who lacks compassion (or is in
danger of losing it as a result of overwork and cynicism)
can acquire and cultivate this mysterious and critical
quality. Will these new approaches yield compassion that is organic
as well as generous, like my brother's, rather than
merely mechanical? And can even the most motivated physicians invest the
time to develop such a skill? I don't think anyone yet
knows for sure.
I suggest, instead, that a reasonable first
step for physicians who are engaged in the pursuit of empathy might be
to recall
actively their initial exposure to kindheartedness—or
possibly, their first collision with callousness—and then begin to do
the emotional work that is required to determine how
those encounters left their mark.6 For many of us, thoughts and behaviors are shaped, to a great degree, by experiences and memories.
AUTHOR'S DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST
The author(s) indicated no potential conflicts of interest.
Footnotes
-
Author's disclosures of potential conflicts of interest are found at the end of this article.
No comments:
Post a Comment