A better quality of fear

The pandemic has given me a new perspective on empathy

Doctors often grapple best with danger that is clear and present. Broken hips, lung cancers and clogged coronaries are all worthy adversaries. For many of us though, lower-back pain, depression and conversion disorders are not. We tend to be least comfortable with threats whose physical basis is vague or undefinable. And this is true of how we treat ourselves professionally too. Think of punctuality, politeness or hard work. They’re neat and easily-boxed goals for all of us and, ideally, are the engines for success in the best doctors (although we can all think of some honourable exceptions).

But what about those ethereal, straggly attributes that are less easily captured in a text message or three-monthly evaluation? What about empathy? This question clearly worried my university enough for them to develop a seminar in our final year, delivered by a health service veteran, on how to be empathetic. It took place over an afternoon, featured some moving talks, and the experience really was in a different key to our college life thus far.

But trying to teach a doctor (or any human) empathy over the course of an afternoon is a fool’s errand. Empathy is not to be taught, any more than kindness, commitment or courage are to be taught. They’re grooves in your personality, formed from years of weathering by the storms and summers of life’s experiences. They are not easily formed and not easily erased.

I mention this because I think we all may have developed a new groove in our character over the past few months. Mine started in an oncology clinic on 5 March. For doctors, a cancer clinic can be a thirsty draw on your compassion and stamina, but is rarely a place of true empathy: How many of us have suffered cancer before? For patients, while these encounters can sometimes overflow with hope, they can be fearful and achingly sad too.

The news came in significant looks and raised eyebrows initially, then mutters behind closed doors. The first case of Covid-19 diagnosed in our hospital, not an abstract threat in distant clips and threads, but leaping over our threshold with gusto. While the universal first reaction of grim acceptance was as expected, its physical companion was more of a surprise for me. Covid-19 brought a wrench to my gut, of the kind that comes when you realise you have taken a turn down the wrong street at night and danger has crept closer. While the risk to me was very low, the threat was of a kind that occupied my thoughts for days, changed my behaviour and made me think about the future in a way I rarely do.

The twist in my stomach unwound over a few days, and I settled into a weary familiarity that is the new normal for most of us. That kind of visceral dread just is not sustainable. But there has been a lasting impact too, I think, a deeper groove. For the first time in an oncology clinic, the fear I felt was not an emotional impostor that really belonged to my patients, that caused me to furrow my brow and offer the practised words and replay PowerPoints in my mind about ‘Breaking bad news’.

Instead, it was shared and haunting. This is not to equate our experiences: Our patients, often frail and on chemotherapy, had much greater reason to worry than us (and yet were so often sanguine regardless).

But my fear was real, too, and I saw the world a little through their lens.

I have heard people recently, when spirits were low, trying to pluck happiness from the ether that surrounds us. They ask, ‘what are the positives? What are the unintended benefits?’ And it’s true that climate change, neglected hobbies and banana bread are having a moment in the sun right now. But perhaps this is a moment for empathy, too. This crisis has achieved what a lifetime of seminars could not, and made a generation of doctors feel a little bit of what their patients feel every day.

And how to make it last? I read recently of the plight of Sonali Deraniyagala, who lost her husband and two sons to the Indian Ocean tsunami of 2004. She forced herself to write about it afterward because, although it brought agony, writing was a “much better quality of agony than trying to forget”.

I have taken to writing a diary since this terrible crisis began. While we may still live in fear, I think the writing may bring a much better quality of fear, in empathy, than simply drifting through and trying to forget.