Neither Said Nor Done: How Does One Express Empathy?

Is it what we say? Is it what we do? I believe each of us wakes up in the morning with a sense of compassion, but what does it really mean to share it?

How does one express empathy? As a medical student-healer, it is a question I often ponder.

I have seen many doctors say and do all the right things. "Oh, I'm so sorry to hear that", they put their arm all the way around the shoulder. They smile, they nod fifteen times in their interview. They ask, "How is your home situation? Do you feel safe at home? How are your kids? How is your dog?" They conduct the comprehensive, textbook, patient-centered interview. And yet, from personal experience as a chronic illness patient, and from the hundreds of interviews I've now observed, I can tell when these are motions. Out of room, out of mind, onto chart. Not sure that is an empathetic relationship. In fact, I'm almost certain it's not.

On the contrary, there are the men and women, who seem to oddly be wearing white coats. They say all the wrong things, at least according to our textbooks. "If you don't stop smoking you will certainly die," or even "You are getting fat, and you need to lose weight." Yet, somehow in their intonation, in the nuance of the phrases they choose; in the subtle, last second candid intercalation of "You can do this," the tough love becomes tangible. The sense they care is unquestionable. There's a doctor like this in Chapel Hill, North Carolina. You can't see her -- she's booked solid for the next year.

Godmother of healing and the patient-doctor relationship, Dr. Rachel Remen, author of the New York Times Bestseller, Kitchen Table Wisdom, regularly compares empathy to love. It's said to be raw, tangible, not predictable, and most certainly a million miles from something you can say from a rehearsal or script.

Then there's the big sister part. One of the best professors of medicine at Duke, is a Physician Assistant in the emergency department. Brandy Frazao's patients love her a lot. Maybe it's because she says very little. She listens, listens some more, and then often solely responds by echoing the person's own sense of hopefulness. "What I'm hearing is that you are not an alcoholic." [Pause] "What I'm hearing is that you are strong." Empowering and responsive. She gives the person a chance to take responsibility. Human relationship textbooks encourage summary, what Brandy does so well is not summarize. She actually hears them.

Then there's those for whom empathy is a synonym for tenacity. The trauma surgeons who run to the hospital at 3 a.m. Often too tired for a full interview, likely even sentences, it's the single nod, the sigh, sweat drop on the floor, the I'm going to do whatever it takes to frieking save your life tonight.

One of my very insightful classmates, highlighted today, "We can never know what our patient's are really feeling. When a woman has just lost her unborn child, how can we say anything that will make her feel better?" We can't. And it is simply not empathetic to pretend we can, and come up with something nice to say.

It seems ultimately, empathy is silent. It's neither said nor done. It's not words, phrases, movements, gestures. It's listening well, and perhaps helping the other person respond to their own feelings. Whether that requires our voice, requires a hand gesture, touch, movement, possibly. Possibly not.

But I think even that approach, alone, is not enough. We have to be present as we can. We have to try to understand. It seems we can consciously or subconsciously feel compassion for people we don't interact with, but the expression of empathy is a chosen, active process. We are choosing to become a part of someone else's life, we are choosing to use our full sense of being to make their life less painful. Thus, we do have to share a little bit of their perception of pain. Not the physical pain, but the sense something is drastically wrong. The butterfly pain, the heart racing uncertainty pain.