I aspired to work in medicine to help heal suffering. Then I became ill, and needed healing myself. In the depths of depression, I started to believe what I was once told by a professor at the beginning of medical school. He taught that maintaining a distance from the work was a tool for self-preservation, protecting a finite amount of career empathy that would constantly be depleted until there was nothing left to give. I was told that human connection drained the empathic well, and once it was dry, apathy, resentment, and brokenness followed. He and others taught a systematic form of coping with tragedy by desensitization. Every day, I see people who approach their life and work with a survivalist mind-set, wearing protective layers of emotional chain mail in an effort to deflect emotional arrows. And yet, day by day, I see those people tire under the weight of their ironclad shields.
I tried first to distance myself from the battlefield, then to desensitize myself with alcohol, and then to don heavy armor. Those strategies left me feeling empty, isolated, and without purpose. I couldn’t run far enough away from the thoughts and feelings in my own mind, and being told to not feel them at all further invalidated me into the line of thinking that I was different from everyone else. Maybe I wasn’t strong enough to be a doctor. Maybe I don’t have what it takes. Maybe my personality conflicts with the steely, cold, detached demeanor required to be a successful medical practitioner.
In the depths of my soul, I always knew that teacher was wrong. I knew because I saw how loving my father was to his patients, such as when an eleven-year-old boy ran up to him at one of my first tee-ball practices. I saw my dad talk to that boy’s parents then in a generous way that allowed him to be present for my practice, yet gracious to his profession. I overheard his kindness and patience on early Sunday morning phone calls, and I watched as he balanced those efforts throughout my childhood. In all the years I spent chasing esteemed mentors, famed institutions, and prestigious titles all across the country, I needed to travel on my own journey into darkness to see the light of healing flicker from a small town in southern Oklahoma and from the footsteps of my father.
Following in his example, I learned that empathy is not finite. I just had to connect it with a deeper meaning and purpose. In living through my experience, I now see in my own pain, suffering, and sadness resides a beauty, and an opportunity to help others. I learned that wounds become wisdom. And in the opportunity of my disease, this wisdom taught me that recovery, for all of us, is really about community, connection, and a greater sense of belonging.
In recovery, I switched careers to work in palliative care, a growing subspecialty in medicine with a focus on maintaining quality of life in the midst of life-threatening and/or life-limiting medical conditions. In this transition, I’ve been able to explore a more meaningful professional life, and I found an employer that values me for who I am. I joined an incredible team, surrounded myself with supportive people, set new boundaries, reset expectations, and together we continue to create safe spaces that allow for people to live their authentic truth. In these spaces, I see the power and privilege of working in medicine again, and the incredible opportunities to make an impact in other people’s lives. In this environment, and with this new perspective, I learned to embrace the potential to care for other people in life and work, in order to live a much deeper and more fulfilling life.
I finally learned a way to extract the marrow of patient encounters while preserving the sanctity of my own sanity. In years of counseling and self-discovery, I learned how to balance empathy with the skills of a steady, trained hand, so that I could provide support to others in their struggles with a measured control. I could also bring that empathy with me in a way that allows me to live my own life and take care of my family.
For me, the greatest moments of reclaiming my humanity have come out of caring for individuals facing some of the most difficult times of their lives. This process has given me permission to explore the fragility of my own medical condition that was almost certainly life-limiting, as I discovered in the woods. I’ve lived through the fragility of life, stepping across lily pad islands of fractured pieces of my own mortality. My disease pressured me to confront the pointlessness of living another day. My professional duty affords me the opportunity to help other people answer their own questions about how to live each day well. As I do this work, often being invited into another person’s story, a reciprocal healing takes place. I am blessed to be able to help other people navigate their own uncertain paths forward, and in doing so, I gain a profound gratitude for each day I am alive. When we are grounded in our mortality every day, it puts the rest of life into a greater perspective.
Allow me to share with you some of the stories of my patients and their families in order to show you how their narratives and experiences have gifted me with a greater sense of purpose in my own recovery process. These stories are not medical per se; they are tales of hope, loss, love, and kindness. They are human stories told within the context of medicine, but their significance extends into everyday life outside the hospital walls.
Let me tell you about a brave Maasai mother, about Louis, about Olivia, and about Nick. All are innately human stories that show the power of human connection. All have been critical points for me as I have traveled the path of my own recovery. I share them to inspire you to reach out to those you meet in your journey—to show up, be present, listen, and learn, no matter the expected outcome. In doing those things, I have learned that there is power in the journey, not just in what happens in the end. When we look at these kinds of experiences as daily steps in a journey, the power of empathy can mold any form of personal recovery into an exploration of deeper human connections.
I vividly remember a moment early in my recovery, while on a medical mission to western Kenya, when three colleagues and I walked up a hillside, out in the rural Maasai farmlands, a few hours from the city of Eldoret. It was monsoon season. The trek there required a seventy-minute hike due to rain-carved crevices on the sole access road. The mission was to deliver a mattress to a twelve-year-old boy with cerebral palsy who had spent most of his life sleeping on the dirt floor of his widowed mother’s modest hut.
A beehive was nestled within an interior wall of their home, and I watched a mother walk out through a curtain of bees to greet us, a testament to her resilience. The boy lay on the floor due to his spastic immobility. I saw open sores on his back that must have been difficult to keep clean. Over the years his muscles had clearly wasted away, leaving a tensile battle of tendon versus bone. His skin was pulled tight like tissues of rubber bands, as the tension stretched him into unorthodox and uncomfortable positions. In what looked like a cruel discomfort, he smiled widely and his ears wiggled with his expanding grin. I saw how his short black hair was meticulously combed, and then turned around to see his mother sweeping the dirt floor with a homemade straw broom.
We had come to offer a small bit of assistance, the four of us hiking up the hillside while passing a mattress from one head to another and carrying handfuls of personal-care supplies.
Day in and day out, she carried her eighty-pound son on her back down the same roads. In the past, she had even carried him four hours each way on a fractured red clay road for a single trip to the medical clinic. Since the sudden passing of her husband, these trips had become increasingly difficult, as she had no one to help harvest their crops. Medicine was a distant luxury that her time and their mouths could barely afford.
We delivered the mattress, provided dressings, lotions, and ointments, and taught her techniques to stretch the boy’s spastic limbs. They welcomed us into their home, and we shared an experience of true human connection in an atmosphere of overwhelming gratitude. I sat on the dirt floor, listening to our interpreter speak their Swahili dialect as the buzzing African bees hovered around our heads.
“Your gifts will be repaid in this life, or ever after,” the mother said, placing her hands together in a prayerful steeple and gently nodding her head.
“Thank you for the blessing,” our interpreter told her on our behalf.
“You are the blessings, my children. Travel well on your journey.”
On the way back down the hill, I stopped. My colleagues were out of my sight. I took a deep breath, gazed over the canopy of brilliant, red-orange Nandi flame trees, and felt a great sense of inner peace. Ever since I had begun my career in medicine I had idolized the international aid work of Dr. Paul Farmer. I first read his story in Tracy Kidder’s Mountains Beyond Mountains, and sadly felt I would never have the impact he had, as depicted in that book. Now at least I felt a little bit of resolve. By navigating a remote terrain, appreciating the beauty all along the way, to bring something meaningful to a person in need, I learned how to walk a mile in someone else’s shoes, and it connected us all in a moment of profound joy.
Halfway down the hill, I looked down at the access road, and then glanced back over my shoulder at the young mother’s hut. I saw every rock, every boulder, and every twist and turn in the path behind me. For a moment, instead of focusing on how much farther I still had to go to get to the car, I took stock of how far I had already come. I realized, step by step, that I was walking forward toward my own goals of personal recovery, and I had already overcome many obstacles along the way. Each rock, each boulder, and every twist and turn marked a milestone on my journey into a new life. I took a deep breath in, thankful I was exactly where I was supposed to be at exactly the right time. In the exhalation, I became overwhelmed by the incredible places my journey had taken me.
On a Friday evening in early April, one of my patients, Louis, came into the hospital. Louis was not just a patient; he was a mentor and an inspiration. On the same Friday evening, Louis was dying in his hospital bed from a rare, recurrent form of a cancerous lymphoma. Louis had a softly welcoming face, with ample cheeks and gentle green eyes. Under the shadow of his disease, the strength in his smile continuously shined, even while the tumors had spread and all therapies had failed to halt the progression of his cancer. In his final months, Louis enrolled in hospice treatment to maximize the quality to the remainder of his life. Louis truly lived during those months, traveling the country, speaking at churches, and inspiring other cancer patients with the occasional skydive out of an airplane. Then this beautiful twenty-three-year-old man came back to the hospital because he wanted to be with his friends at the end of his life—his friends being the nurses, doctors, therapists, and café staff he grew to love during two years of his on-and-off treatments.
I walked into his hospital room, sat down at his bedside, squeezed his hand one final time, and through trembling lips whispered, “I love you, brother.”
His fingers squeezed mine in pulses that felt like Morse code for “I love you, too.”
I looked up, a tear rolling down my left cheek, and his eyes confirmed that I had translated the code correctly.
Driving home, I reflected upon the fact that I had likely said my final goodbye to Louis. I was overcome by the sentiment that a young man had called me to his room to gift me with his presence during his final hours. How many people are blessed to be called to say goodbye? When moments are priceless and minutes are fading, to be invited into a sacred space. To deeply sense a person’s light amid inaudible words, in the rhythm of unspoken air. I paused to inhale and to never let that moment go. There can be no assignment of value to that moment, nor can I ever adequately describe it with the written word. All I can tell you is that there is meaning and purpose within a genuine friendship, a love, a connection, and a bond that transcends the mortal gatekeeper’s hand.
Today’s customs and standards would say Louis’s treatment was a failure—medicine failed him, and we failed him. But to simply label the end of Louis’s life a failure diminishes his individual worth and discounts the greater meaning and purpose of his own journey, blinding us all to the impact that he had on other people’s lives up to the very end. Is it heartbreaking that this beautiful, vibrant, articulate soul only lived to experience early adulthood? Absolutely. It is devastating and unfair beyond words. However, the quality of his life and the impact he had must not be undermined by quantitative measures, because as he told me himself, he did not want it that way.
Louis chose to focus on and measure the human impact, such as the impact the medical team had on him, and the gracious wisdom he imparted to us all during his remarkable life. He moved mountains of fear and anxiety for hundreds of other people through his outreach. He inspired thousands with online videos expressing hope and resiliency, and generously lived in his commitment to comfort others to his dying breath. His impact should be measured by his gift for helping children and young adults with cancer, teaching life lessons, and selflessly bestowing his enlightened perspective. He forever changed me, my colleagues, and other friends who walked the journey with him. The impact of such a life is world-changing.
In his final days, Louis told a young resident physician, “You have only one life,” and then asked, “Now, how are you going to spend it?”
Instead of waiting for an answer, he then told the young doctor about a dream he had the night before of driving a white Mustang with black rims down the California coast—top down, sun on his face, wind in his hair. Louis didn’t need an answer, I think he knew his lessons were complete.
Louis simply said, “I’m driving home.”
Just a few nights before I wrote this page, and a few years after Louis passed away, the resident physician sent me a text message with a photo of a white Mustang with black rims, without any caption. I thought about the lessons that young man taught that young physician; how the doctor learned the meaning of living a life well.
I also thought of my own journey, and how Louis taught me to appreciate every day of my life as a gift. I simply smiled, then, imagining Louis cruising down the coast, free from tumors, IVs, and pain—driving home.
A few years ago, I was consulted about a teenager with a complex history of a neuromuscular syndrome. The mother was nearing a crossroads where she would need to make difficult decisions about her child’s medical care. A surgical intervention for her son’s chronically dislocated hips was under consideration, among other possibilities. These were not necessarily life-or-death decisions, but they would certainly affect the child’s life going forward, and she struggled to determine the right thing to do, as a lot of families do.
During that month, a medical student was rotating with our team. At this point, he had been with us for several weeks. I had been teaching him about exploring emotions, asking open-ended questions, and using empathic communication techniques. In our first meeting with the mother, we introduced ourselves as palliative care specialists and told her that we could assist her in weighing the potential risks and benefits of her impending decisions. We hoped we could help her solidify goals for her loved one’s care. We noticed she was alone, and she told us that she did not have a lot of support.
The following day, we returned to continue the conversation and help her move forward in the decision-making process. But every time we broached the surgery option, it seemed like we hit a wall. We used exploratory questions such as, “Tell me more about what worries you.”
She would say, “I just cannot see him on a breathing machine.” (A ventilator would be required for surgery and post-op care.)
We kept hitting the same wall when asking follow-up questions, and would receive the same answer without further explanation. Insightfully, our student observed that the mother always wore the same large pendant necklace, emblazoned with a Christian emblem. When she spoke about not wanting to see her son on a ventilator, she held the necklace tightly in her hand over her heart.
The student asked, “I wonder if you could tell me about the meaning of your necklace.”
The mother dropped her head and let out a deep sigh, and the tension fell out of her shoulders. She paused for a while, and we all sat in silence.
When she lifted her head, she spoke. “Three years ago, I was in a serious car accident with my brother and father in the car. My father died as a result of the accident. He spent the last three days of his life on a breathing machine in the hospital. And my brother was paralyzed. He spent seven months in the hospital because of his injuries. My mother and sister no longer speak to me—they blame me because I was driving, and I blame myself. That’s why I’m alone. The last memory I have of my father is of him on that machine, so I just can’t imagine seeing my son that way. This cross, my son, and my faith are all I have left.”
She went on to share about her dark moments of depression, culminating in feelings of wanting to end her own life after the accident, in an all-consuming guilt. She said her son was the only reason she did not take her own life, and she couldn’t imagine facing the demons she still carried if she ever lost him. Even just talking hypothetically about his death, she spiraled into moments where she felt like she was dying herself. And whenever someone wanted to talk about the surgery, she felt as though she was drowning in guilt for what had happened to her father and her brother.
Weeks of effort by other team members to obtain the mother’s consent for surgery, and to explain the technical risks and benefits of the procedure, had not even scratched the surface of her burdens of fear, suffering, and anxiety. By being patient and observant, and by empathetically embracing the moment, the student and I were allowed to connect with her in a moment safe enough for her to reveal the true story behind her hesitation. It reminded me that we all guard our hearts, protecting intimacies of our past, and these secrets can weigh us down in isolation for the rest of our lives. I lived it myself in a different form, and hearing her story made that point of view seem perfectly understandable. I still don’t pretend to know what her experience had been like, but I listened patiently so that I could try to imagine. I hope that in doing so I helped her realize she wasn’t alone, as I realized I wasn’t alone either in mine.
A few years ago, I opened up my work email at the end of a long work day. At the top of the queue was a name I recognized from my earliest days in medicine. With some apprehension, I opened the message to find a picture of a letter. Scribbled cursive on aged paper.
Her name was Olivia, and she was fifteen years old when we met. In her hospital bed, she sat in full knowledge of the gravity of the “C” word, but with teenage exuberance, she said that cancer should be scared of her. Olivia had a quick wit, a sharp tongue, and no time for pretensions. She had short, curly brown hair, thinning from the rounds of chemotherapy, and a surgical scar running down the length of her left leg. Fresh into clinical medicine as a medical student working on the oncology floor, I drew the lucky straw to have Olivia as one of my first patients. After early-morning rounds, she quizzed me about the deeper meaning of The Life of Pi—a novel about a boy and a tiger stranded together in a lifeboat—with all its symbolism and allegory. We sat together as she ate pickles from a mason jar and the scent of vinegar wafted through the air.
“I didn’t always like pickles, you know? Something about the chemotherapy and my taste buds. Suddenly, now I can’t get enough,” she said, taking another chomp.
With a wry smile, I weaved in some cursory medical questions about her nausea, vomiting, and comfort level during treatment. She tilted her head, placed her hands on her hips, and playfully said, “Just when I thought I could trust you! There you go, doctoring again.”
She remained in the hospital for a few weeks of treatment, which was merely the beginning of the long journey ahead. As the days ticked by, we played cards, we talked about the transition to high school, and she shared some of her deepest worries and concerns about whether or not the chemotherapy would work. She trusted me, I admired her, and we built an indelible bond. On one of her final days in the hospital, I stopped by her room to say a friendly goodbye, but she was sound asleep. So, early in the morning, I left her a note on a scrap of paper in scribbled cursive, with a jar of pickles to hold it down.
“I hope you have a wonderful day. Enjoy the pickles. Maybe the tiger was really never in the boat, or maybe he was. Regardless, I know your boat is destined for safer shores.”
Later that day, she was discharged from the hospital, I moved on to the next rotation, and we never saw each other again. Twelve years later, I scrolled through a pixelated email with a photographed letter and a brief note typed at the bottom of the screen.
I wanted to thank you for the kindness you showed me during the toughest times of my life. My boat made it ashore. I still have the letter, but I ate the pickles.
—Olivia
She didn’t know it, but her kindness found me exactly when I needed it most. I’ve been privileged to share countless intimate moments with people during their struggles with illness. I understand what an incredible gift that is. Heartfelt rewards often flow from the mere fact of being present, and there is great power in those small acts of kindness we extend to each other every single day—moments often overlooked that actually change the world.
I barely even remembered writing that letter, and she kept it for twelve years.
It may have taken only five minutes of my day to pick up a jar of pickles and scribble a note, but to her it was poignant memento. The small gesture she returned over a decade later filled me with gratitude that I had made an impact on another person’s life. In her act, she made me think about all of the small acts of kindness other people have extended to me, and how I need to spend more time telling those people about the positivity they brought me.
Her email changed the way I thought about medicine, and about the healing power of the smallest gestures of human kindness.
In his short time on Earth, all Nick knew of life was cancer, having been initially diagnosed at the age of three. We met when he was fourteen. The latest iteration was a progressive sarcoma invading his spine, and he had come back to the hospital for another round of chemotherapy and radiation. Early in my career, only months into medical residency training, I was fairly sure I had an interest in oncology, but certain I had an interest in Nick. He was charming, charismatic, and kind, and he always cared more about other people than about himself. A young boy with an old soul, Nick spoke poetically in words of wisdom far beyond his years. For months, he cycled back through the hospital for treatments, but the cancer progressed. And yet his spirit remained. When his chemotherapy infusions were complete, I would visit him to pick up our friendship right where we left it off; I always tried to comfort him, yet he always seemed to comfort me.
In his final weeks, the tumor left him paralyzed from the waist down and confined to a bed. I vividly remember writing the orders for his pain medication drips and thinking the Drug Enforcement Administration could arrest me on the spot for prescribing such huge doses of Dilaudid. The DEA did not come, though, and the meds helped. He still endured pain, but he continued to comfort all those around him anyway. His mother was a nurse at the hospital, part of the lifeline helicopter crew, and toward the end of his journey she and her husband made the decision to take him home so he could spend the precious little time he had left with his family.
A week later, I received a phone call. On the line was the receptionist in the oncology clinic. “Nick is here. He did not want to talk to anyone else. He came to see you.”
I paused for a moment, and said I would be right down. I grabbed a notepad and an envelope from the call room table, and I sat, took a breath, and wrote a note, crying as I signed it.
The contents are for him and his family, but the essence is that I told him how much I loved him, how proud I was of him, and how much he had changed my life. I folded up the note, fumbled it into the envelope, and headed down the stairs. As I came around the corner, his mother and father were standing there, and they began to cry. His mother said, “He told us this morning he still had one last thing he had to do.” They opened the curtain to usher me into his room, and then closed it behind us. While it was clear that Nick was physically dying, his spirit was still savoring every moment. We sat, shared, laughed, and cried. I told him how the lessons he taught me had made me a better man and a better doctor, and in that moment, in his pain, he thanked me. I hugged him and slipped him the note, and after an hour we said goodbye. I remember feeling inadequate for having learned some of the greatest lessons of my life from him. It was like I had taken away more than I was able to give.
The next day, a Saturday, Nick passed away. His mother called me to say that she was reading the note I had written for him when he passed. “I told you, he had one last thing he needed to do—he needed you to know how much he cared about you.” I still feel inadequate in telling his story, and unworthy of the gifts he gave me—yet that was Nick, selfless to the very end. His actions serve as a shining example of caring for others with every single breath and enjoying the gift of every moment. When we in medicine lift the veil of pretense, drop the walls of separation, and shed the white coats, people like Nick teach us all that we can heal each other. He cared about me, I cared about him, and that matters deeply. Nick taught me that love is the greatest reward for a job well done in caring about another person’s pain and suffering. I didn’t earn it; he gave it to me. But he taught me how to show up to receive it.
I will share one last story about empathy in palliative care, an experience that illuminates the trust required to be invited into personal places. I had the honor of working with a family of a critically ill child, a family that had been in the hospital for several months as they watched their infant son get sicker and sicker from a rare genetic condition. It became clear to the medical team that this child would not survive his stay. There were no treatments or cure options, only the choice to prolong his life by artificial means.
For weeks, the medical team worked with the family, comforting them in their processing of an evolving tragedy. I met the family weeks into their journey and started to build a relationship with them. I started simply by getting to know them and their support structure, and scratched the surface of the story of their lives. Over time our rapport grew stronger, but then I sensed them backing away. In the stages of grief, they had cycled through denial and anger and were stuck in bargaining for more time with their loved one. Sometimes, a “clinical visit” consisted of simply bringing them a soda or dropping off a note to say I was thinking about them—not forcing the issue, but respecting them and their space while continuing to let them know I cared.
A few days later, the father called me up to the room, where I was invited into their private space. His soft-spoken wife sat in a bedside chair while he somberly paced from corner to corner. I offered a casual introductory sentiment, and he turned away, put his head in his hands, and cried. I reached over, put my hand on his shoulder, and acknowledged his emotions while I explored the meaning behind the tears.
“I can see that you’re going through a hard time. Do you mind sharing what happened?”
A few moments passed, and then he turned to me and said, “I just can’t go through this again.”
I sensed a seismic shift happening, yet as I stood there, I did not know direction it was taking.
Softly, I asked, “Could you tell me more about that?”
The father explained that several years earlier, in a previous marriage, he lost a child.
“We had to make the decision to take her off life support,” he said with a deep exhale. He was holding back the urge to weep. “I just can’t go through that again.”
All this time, in the months of discussions I had with these parents, it had never been revealed that this heartbroken man was struggling with the lingering effects of bereavement and post-traumatic stress disorder (PTSD) from the death of another child who was hospitalized. It was only then, after many weeks, many acts of kindness, and hours and hours of trust building to create a supportive space, that he was ready to disclose his story.
Of course his unfathomable loss had directly impacted the way he viewed the world, the decisions he would make, and his own behavior, forever. Acknowledging this prior tragedy, and then taking time to process the newly triggered emotions, was necessary before he could move forward in dealing with the events unfolding before his eyes. At the same time, the mother was suffering from the thought of losing her firstborn child, while also not knowing how to help her husband through the difficulties he was expressing.
This family’s story was deeper than any preconceived notion could have captured, and it was not until that story was cautiously delivered and empathetically heard that they were able to move forward. I witnessed their heartache, and while I couldn’t change it, I was present in a sincere way, and stepping into that process with them brought us close together in a connection of the truest form.
I learned the deeper meaning of standing with a family during difficult times when I was a patient myself. Those months taught me a new way to practice medicine. Instead of hiding my truth, I decided to use it to help guide others, because the art of empathy is in embracing our humanity, not hiding behind it. Empathy resides in walking a long, fractured clay road in another person’s shoes, and in the wisdom gifted by a young man at the end of his life. It is about showing up, being patient, and partaking in small acts of kindness. The true art of empathy is to let yourself feel, and be moved by the compassionate love required to care for another human being.
In embracing the art of empathy, medicine has an extraordinary opportunity to heal. Because when it is all said and done, medicine heals when one person dedicates their time to earnestly listen to another person’s story.
I sincerely thank you for taking the time to listen to my story. I hope you will find a place of safety to tell yours as well. I hope we can all feel empowered to stand up for other people who feel bullied or judged due to the struggles in their lives.
For me, I know my children are watching, without any preconceptions, labels, prejudices, or discriminatory notions. In their simple view of the world, there is joy in being able to connect to other people. When they get home from school, they just want a listening ear and a safe place to tell their story.
I hope to keep it that way.