My first ICU rotation of intern year was filled with great darkness. It was dark outside as I walked from my car into the hospital each morning before sunrise, and it was again dark when I walked to my car at the end of the day. Less than one hour into my first day in the ICU, a patient’s weak and ineffectual heart stopped beating, and CPR was swiftly initiated. The patient, unfortunately, did not make it. Rounds had not even started, and I already saw a patient die. I thought to myself, “How much darker could this get?”
Patient after patient, I was reminded of the somber nature of this work. I felt like I was constantly saying phrases such as “respiratory failure,” “heart failure,” and “kidney failure.” Day after day, I would share on rounds that my patients and their organs were deteriorating. I could not help but feel helpless in our pursuit of fixing them. I struggled to find a glimpse of positivity until I met Charles.
Charles was transferred from the general medicine floor to the ICU toward the end of my week in the ICU. During our first interaction, I asked my usual line of questions, including ones about his past medical history. This prompted Charles to tell me about his prior primary care physician, Dr. L, and how much he admired him and his bedside manner. I asked Charles if he could describe Dr. L’s bedside manner.
When the scarring and inflammation of his lungs made it too difficult for Charles to speak in the following days, he wrote me an essay to further answer my question. Charles’ words resonated with me deeply. As I witnessed on my ICU rotation, despite our best efforts and intentions, we cannot always cure our patients or fix their failing organs. However, as Charles reminded me, we can and must always lead with empathy—especially in the darkness.
Charles asked me to disseminate his essay to a larger audience, with permission to include his name. Please find it below.
Pathos and the bedside manner
by Charles Jackson
Pathos is the root of empathy, sympathy, and, oddly, at first glance, pathetic. I’ll write a bit about Dr. L describing his bedside manner. He was the ultimate empath. You’d come in and sit in the slightly shabby small office. He’d come right over in his chair and, after next to no chit-chat, go directly to why you were there. With some seemingly innocuous question, you could feel your floodgates open and everything you knew would pour out. How could this be? Dr. L was a normal person with all the usual parts that make us a person. He excelled academically. But it wasn’t knowledge that created that space that allowed the patients’ innermost troubles to emerge ready for a curing process. It was empathy. Putting it bluntly, empathy is the polar opposite of abuse. With empathy, you experience the other person, and their troubles outweigh your own. Their life is of greater importance than your own in that moment. You lift up their needs above your own. If in even the slightest way you should lower the other person beneath yourself, you have become an abuser. An abuser does harm. Now, all living things must look out for number one.
How can you be a non-abuser but worry about yourself now and then? This is where the derived word “pathetic” comes along. When that pathetic soul arrives before you, all thoughts of self must go. No pressing appointments. No plans for the future. No remembrances. The empathetic, and thus the person with good bedside manner, enters that moment, and for the time, empathizes. For some, this will come more naturally than others. Practice.
Emily S. Hagen is an internal medicine resident.
