General Thoughts

seconds to empathy

One of the myths of modern medicine is that there isn’t enough time to really talk to our patients. The day is only so long, things are so busy, there are five new admissions and I haven’t eaten anything all day. The wheel that is acute inpatient medicine keeps spinning, and we must spin with it or find ourselves crushed underneath. I get it – I’ve been there myself. I remember feeling at times like it was all I could do to hang on and not slip off the ride.

I remember as a resident wishing that my patients would acknowledge how hard it must be to do what we do – to practice medicine, to feel overworked and at times under-appreciated, to be around death and dying all the time. But then some of my patients did acknowledge it – usually with words like “I can’t imagine doing what you do all day long” – and I found myself feeling profoundly guilty. It wasn’t about me, after all – I shouldn’t burden my patients with my emotions. I wasn’t the one lying in the hospital bed.

Looking back on these moments, what I’m struck by most is not the role reversal but how easy it is to forget that we are all human, and how easy it is to remember. Sometimes it only takes a word, or a gesture, to remember our humanity. It takes really no time at all: seconds, to show empathy.

For those who feel there isn’t enough time to talk to each other in the hospital, my thought is that it doesn’t take long – just an acknowledgment here or there that we are human, and not defined by disease or title. Saying something like “that was a really tough situation” to a colleague or “tell me about your dad” to a patient’s child takes moments at most, and can help ground our work in the most common of purposes: to be nothing more or less than human in everything we do.

a metamorphosis

It’s not uncommon to hear that a loved one has been transformed by their illness. Physical and physiological transformations aside, something happens when the expected course of life is slowly and gradually pulled away from center. Personal identity is redefined and repurposed – there is a subtle attrition of traits that renders us, in many ways, a patchwork of our former selves. In some cases we become known more by our disease than by our dreams and desires. “I am Cancer,” a young woman told me once, “and nothing more.” It was heartbreaking to hear.

I see this transformation most often now with indolent cancers, and with dementia. It’s as if a person’s life – once full bodied and intricately carved – gets whittled down to the bare essentials. We recognize that we are looking at a life, but the finer details – those unique and storied elements – have been scraped away.

Several weeks ago I helped care for an elderly woman with dementia. She had developed pneumonia, and was slowly climbing out of a devastating delirium. Her family shared that over the past three years she had been changed by her disease – she was no longer outgoing and social, she no longer loved to play cards or tell jokes. Even her face was more sallow in parts, as if what defined her personality had been drawn out of her skin. Discarded in a syringe.

I’ve seen this pattern many times before – a terrible chronic illness leads to an infection which leads to a hospitalization then a nursing home then another infection and so on, sometimes for years on end.

And life is suddenly redefined by lengths of stay.

But this family asked me something I wasn’t expecting. “How do we talk to her?” they asked. “It’s like she’s a completely different person, speaking a completely different language.”

I didn’t have a good reply. I think I said something about sharing a few of her favorite memories, speak to her in a way she would appreciate and find comfortable, bring in her favorite music, decorate the room to look more like home.

But if effective communication is about adapting our style to match how our loved ones best communicate, how do we do this when they are transformed by an illness? When the person before us is different from the person we knew? When the way they communicate is changing with time?

our time spent talking

A good deal of what we do in life is talk. The typical person speaks 16,000 words a day (1) at roughly 150 words per minute. With average life expectancy in the United States nearing 80 years (let’s say 75 spent really talking), the average person spends 3,000,000 minutes talking over the course of a lifetime. That’s 50,000 hours, or 2,083 days – almost 6 entire years spent in the act. This is only a rough estimate, of course – politicians probably speak much more, mimes much less – but still, that’s quite a bit of talking.

A lot can be said of what we say, but perhaps even more can be said of how we say things – the way we communicate, our non-verbal cues, our temperament in turbulence. Our messages may change with time and experience, but how we communicate reveals a lot about who we are as individuals. It speaks to our priorities in life, our patience, our generosity at times – at others, our insecurity. Our fear. 

If we could somehow be more aware of how we communicate, perhaps we could communicate better – and perhaps those 3,000,000 minutes could be time spent, not only sharing our thoughts and dreams with others, but bettering ourselves as well. 

My hope is that this site can be a forum to explore how we communicate with each other about the things that matter most – a place to share stories and experiences, and perhaps learn a bit about ourselves along the way.

1) Matthias R. Mehl, Simine Vazire, Nairán Ramírez-Esparza, Richard B. Slatcher, and James W. Pennebaker. Are Women Really More Talkative Than Men? Science 6 July 2007: 317 (5834), 82.