In my medical humanities and ethics class, I get the attention of my pre-medical students by starting with Anton Chekhov’s short story masterpiece Ward No. 6. Chekhov was a doctor who watched and wrote about the medical world with penetrating insight. In the story, a doctor becomes callous to the suffering of his patients in his psychiatric ward. They receive degrading treatment everyday, including insults and beatings from the ward caretaker. But the doctor does not intervene or do anything to improve his patients’ lot. This is the way things work in the hospital, he surmises, and it is not his concern.
Then, by a quirk of fate, the doctor becomes a patient in his own ward and gets the same dehumanising treatment his patients get. When he protests, the caretaker hits him hard in the face and the back. The injured doctor, terrified and in agonising pain, bites his pillow, clenches his teeth and stays quiet, lest he receives blows again. Amidst this, a thought torments him. “How could it have happened that for more than twenty years he had not known it and had refused to know it?” He wonders about the pain he felt and that had been inflicted on the inmates of this ward. But it is too late for him. He soon dies from the injuries and, in further irony, only two people attend his funeral.
The story makes students contemplate on caring for patients, and is often more effective in reaching them than weighty medical ethics textbooks.
A “Ward No. 6” moment
Once, I was in the same place as Chekhov’s protagonist and understood better what the writer meant. Empathy or the lack of it can be revealed in many ways: how doctors talk to their patients and how careful they are in choosing words. While hiking, I slipped on a downhill path, slid fast, fell of a cliff and landed on a stone slab, crushing my right ankle. I was brought to the hospital where I had worked for 35 years. My ankle had multiple fractures, my leg was massively swollen from edema and I was in excruciating pain.
“What do you think of my leg?” I asked my orthopedic colleague who was to operate on me.
“It’s not pancreatic cancer, you know,” he said, “you will get better with surgeries, in time. But any surgery will be very risky.”
He was telling the truth but I wish he used different words and was gentler in his pronouncements, at least at that agonizing time. I knew that pancreatic cancer is one of the deadliest cancers and sometimes had difficulty handling the pain of its miserable victims. Along with the pain, their surgeries were fraught with complications. In my own trauma and agony, I worried. Would I suffer the same pain that the pancreatic cancer patients suffered? And would my surgeries have similar complications?
When my pain subsided after analgesic injections and I had some semblance of peace, I pondered about the lapses in my behavior with my patients. Though I considered myself an empathetic doctor, how many times had I blurted out hasty words in answer to their frustrating questions?
Illness and a patient’s life
I believe that empathy can be nurtured. Medical students watch what their teachers do, and during their impressionable years, that can have an impact on their psyche. When I was a medical student at Dhaka Medical College decades ago, one of my teachers, Professor SM Rab, used to say, “You can’t separate your patients’ illnesses from the lives they live. So you must listen to them carefully to arrive at a diagnosis. Simply accumulating scientific facts will not make you a good doctor.”
I saw how reassuring Professor Rab was with patients. A few words of encouragement and empathy and interest went a long way. “Healing begins with your empathy and your reassuring presence at your patients’ bedside,” he said. During my training years in Dhaka and in the United States, medicine rapidly ushered in technology to improve care. But in the process, we began to misuse technology, and worse, to be less attuned to the importance of bedside manner.
Some doctors and experts contend that empathy is overrated in medicine on the basis that it is difficult for the doctors to be empathetic all the time in daily practice. I understand their point, but they are wrong. Doctors are human beings and they are likely to fail at times. But then, no human endeavor succeeds every time. Yet, one must try and do the best one can. If doctors keep patients’ suffering and trust in mind, over time empathy becomes an integral part of the medical practice. Would the naysayers themselves want to be treated by uncaring doctors?
Furthermore, unnecessary surgeries and medical tests have become common practice in both rich and developing countries. These practices harm patients. They exact a physical and mental toll besides costing extra money. Moreover, these practices drain the national resources that can be used to improve healthcare of the general population. True, sometimes these surgeries and tests are done because the doctors are unsure of a diagnosis and medicine is an inexact science. But more often they are done for remuneration. Empathetic doctors avoid these practices, because they think of their patients’ interest first, not of their own pocketbooks.
At a time when essential medicine is giving way to unnecessary aesthetic surgeries and public hospitals are turning patients away for lack of funds, the poor have no place to go to when they are fighting for their lives and the mental health system is abysmal, a little empathy for patients who do make it to hospitals can go a long way.
The writer is an oncologist, teacher and author of the memoir, The Temple Road: A Doctor’s Journey.