Usually a chatty and boisterous bunch, my anatomy lab mates and I were huddled in silence over the body bag, the stench of formaldehyde burning in our nostrils. My gloved hands were clasped together, fingers laced. I looked up to find blank faces among a sea of body bags. I had never seen a dead body before. My mind was racing. I exchanged looks with my lab mates. Hesitant, we continued to look at each other, unsure of how to proceed. A professor nudged us forward: “Go ahead and get started. What are you waiting for?”
“I guess we’re supposed to open the bag,” I said sheepishly. Slowly, I pulled down the zipper to find a still, wrinkled woman, her body lying stiff against the steel gurney. She had milky white skin, blemished with the occasional liver spot. Her hands were crossed, tied together with a rope, and a black plastic bag covered her face. Eerily, it looked like she had been kidnapped. And here I was, her captor, hovering overhead. It was a surreal feeling. I was still processing that this was a real person, once as alive and vibrant as we are today, perhaps even more so.
Today, we were cutting open the chest. “Go ahead and make the first incision,” the professor announced. My hand trembled as I dug the scalpel through her taut skin. It curled back like an orange peel. At first, I made ginger incisions. For a second, I almost thought I was hurting her. I winced slightly as I cut—could I truly be certain that she felt no pain? Reluctantly, we took turns cutting through the chest wall, finally popping the top off like the hood of a Mustang. After a short while, however, we became trigger happy. We called dibs on the bone saw, and shotgun for the scalpel. Our hands packed inside the chest cavity to grab hold of the precious organs. Slowly, we became desensitized to the sounds of ribs cracking, the peeling of pleura, and even the smell of body juice (still having some trouble with this one).
We became detached. Medicine gave us a lens to look at our cadaver, to cope with our own mortality. We became lost in the delicate papillary muscles of the heart, the neatly arranged layers of fat and fascia, the spiraling loops of bowel, all while death was laying right in front of us. Yes, we became detached, the exact opposite of what all medical students are taught. We are taught to express empathy, understanding for pain and suffering, and even to cry with our patients. That got me wondering, if I became very sick, would I want my doctor to cry with me? Would I want the surgeon operating on me to wince with each cut, wondering what my illness feels like? Would I want them to bear the burden of my pain?
Naturally, like any medical student, I turned to PubMed to answer these questions. First off, I discovered that humans are hard-wired for empathy. In the 1990s, a group of researchers were monitoring motor neuron activity of macaque monkeys when a graduate student walked in the lab with an ice cream cone—no surprises so far. But then, the motionless monkeys watched on as he lifted the dessert toward his mouth, and suddenly their activity monitors went into a beeping frenzy. These researchers would go on to discover specific brain cells, called mirror neurons, that would fire in response to simply observing other people’s actions and experiences. That’s why we flinch when someone gets hurt, or feel second-hand embarrassment when someone makes a public gaffe. Monkey see, monkey feel.
Empathy is our gateway to understanding others, and in a limited sense, it provides an important evolutionary role for our species. In a hospital, however, a place where pain and suffering are imported daily, constant empathy can wear you down. Matthieu Ricard, a biologist turned Buddhist monk, conducted a small trial where subjects were either given extensive empathy training or memory training (control). In response to watching a film of human suffering, practically the SparkNotes of a night on call, subjects with the empathy training experienced significantly more negative emotions. Areas of the brain responsible for negative affect lit up on fMRI, and persisted long after the film in response to everyday situations. Ricard himself reported feelings of emotional fatigue after ruminating over the pain and disability of others. It’s no surprise then that physicians, hard-wired and systematically encouraged to be empathetic, experience high rates of burnout. More than 50% of the medical profession currently suffers from burnout, and it seems that bearing the burden of your patient’s pain may be a contributing factor. But that’s not to say we should become sociopaths. Lacking empathy entirely, we fail our patients. Excessive empathy, and we may fail ourselves.
Perhaps, like anatomy lab, we need a different lens. A shift from empathy to compassion. Compassion, while colloquially synonymous with empathy, is an entirely different concept: it’s the difference between a mother, internalizing the pain of her dying child as she weeps in the corner, and a caregiver, comforting a patient by holding his hand and lending warm words. So different are the two, that Ricard was able to identify mutually exclusive areas of the brain on fMRI while subjects performed either empathy or compassion based meditation. In fact, he discovered that empathy-trained subjects who were later trained to focus on compassion were able to watch another equally distressing film and experience positive emotion afterwards. The takeaway: empathy is fatigue-able, compassion is not. Compassionate care is not a disengagement, but rather a loving detachment in the face of adversity. So instead of focusing on the pain of an accident victim, dwelling on the fact that he may never walk again, we must concentrate our power to comfort, care, and heal to the highest degree. While hospitals are fertile ground for grief and sorrow, there are ways physicians, with training, can cultivate a sense of fulfillment and positive emotion. Empathy is not one of those ways.
As a medical student in anatomy lab, there is a clear choice. When I pull down the zipper of the body bag, I can either focus on the death and loss, or the big-heartedness (figurative and literal) of the donor. Now, I choose the latter. Now, when I wield the scalpel, I’m not afraid to laugh with my lab mates, or feel the joy of discovery. Now, I just cut.