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Teaching and Learning Moments

I Am Sorry to Hear That

Reed, Benjamin

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doi: 10.1097/ACM.0000000000001878
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He arrived to the trauma bay as he would leave it—limp-limbed, splay-legged, tiny and fragile, nurses pumping furiously at his chest to work the tiny heart inside. Paramedics, residents, and social workers trailed after him, beepers chirping and laptops open, wires and tubes in tangled messes. Then came the surgeon, white-haired, arms crossed, plodding into the room. Finally, pulled by an intangible bond, came the mother. She was dressed with jarring pep, in a pink collared shirt and capri pants, barefoot as if attending a picnic. She settled in a corner, pushed there by the shrill bustle surrounding her son.

As a medical student, I had one task—to obtain the medical history. I stepped tentatively over to her. “Ma’am, does your son have any allergies?” She shook her head, “No.” Preexisting medical conditions? Surgeries? Complications during birth? No, she shook her head. I turned to the scribe and gave my report, then settled back beside the mother. We watched her son as he steadily accumulated catheters and monitor leads. Seconds passed with musical, electronic alarm bells. Then she turned to me and said, as if to relate the weather: “He was playing by the window, and he fell through the screen. I turned away for just a second, and when I turned back, all I could see were his feet falling out the window.”

Supposedly, I have been trained to properly respond to mothers whose toddler sons have fallen a hundred feet out a window and who wish to tell me about it. What my training tells me to do is to make an empathetic statement. For example, when a patient says, “I have been feeling unwell recently,” or something of the like, the student must respond with, “I am sorry to hear that.” After I have said, “I am sorry to hear that,” I am supposed to say, “Would you like to tell me more?” However, what I said in this instance was nothing. Instead, I stared at her. She stared back at me, then at her son. “I should have known about that screen. It’s my fault.”

Absurdly, my first reaction was to deliberate in my head about whether or not her assessment of blame was correct. On the one hand, she did live on the top floor of her building. Did she check to make sure the screen was securely fastened before letting her son play near the window? On the other hand, what kind of person regularly checks the status of their window screens? Can a mother reasonably be expected to foresee every hazard her child might encounter? Hadn’t that expectation resulted in a generation of neurotic, helicopter parents? Ultimately, it was a question that demanded particulars, and I felt that the person best positioned to make such a judgment was her. However, at this point, she undoubtedly had a negative bias toward her actions, which may well have been perfectly reasonable.

I tabled the ludicrous debate in my head, sharing none of it. Instead, I placed my hand on her shoulder and said the least stupid thing that came to mind, which was exactly what I had been trained to say: “I’m sorry.” I rubbed her back for five seconds or so. It became awkward, so I stopped. We both turned again and stared at her son. We said nothing.

If I had made the same effort with a standardized patient, I would have earned a solid Pass. “Excellent use of empathetic cues, though you could have invited her to say more about what she feels,” my preceptor would have said. Perhaps the standardized patient might have added, “I really liked that you made physical contact. It seemed very sincere.” To me, though, it seemed a hollow thing—an apology, a pat on the back. What she needed in that moment was more than empty-headed words could offer, more than I knew how to say or do. Can that kind of empathy be learned? Can it be taught?

We did not speak again. She answered questions about her address and insurance, asked by other people. As for me, I was soon out and about again in the emergency department. As I latched on to every simple task that came my way, the drama playing itself out behind me slipped out of mind. I glued an eyebrow shut, assessed a man who had been shot in the face, learned to identify blood on a CT scan. It wasn’t until the end of my shift that I passed that trauma bay to see the nurses once again pumping furiously at that tiny chest, wheeling him off to the operating room for a futile surgery. And the mother, standing like a gaily-dressed statue, motionless in the hallway.

Copyright © 2017 by the Association of American Medical Colleges