According to Bryan Stevenson, the founder of the Equal Justice Initiative and author of Just Mercy, we must get “proximate” to suffering in order to understand the nuanced experiences of those who suffer. While Stevenson speaks in the context of inequality, this concept of “proximity to suffering” has also been true in my life in medicine. “If you are willing to get closer to people who are suffering,” Stevenson says, “you will find the power to change the world.” More importantly, you will be changed.
Aren’t we always proximate to suffering in medicine? As a physician for over twenty years, my answer is “not at all.” Doctors are physically near suffering every day. We break bad news, observe pain, and pronounce death. However, we often attempt to take away our discomfort by medicalizing our response with pills or more tests, making an excuse of “not having enough time,” or stepping away knowing that we cannot “do anything more.”
I first got close to suffering when a mother in my daughter’s kindergarten class was diagnosed with a recurrence of her breast cancer with metastases. What do you say or do at a Mother’s Day celebration with a mom who might not have more of them? It was not until several subsequent fortunate years of birthday parties, class field trips, book clubs, and other gatherings that closeness developed. She had a fabulous team of doctors, loving siblings, a priest, years of friendships, an incredible husband, and two young daughters. Her life was full, and yet she opened the door to our companionship. I stepped into the privilege of talking about life, fears, pain and even our funerals. In the ultimate form of intimacy, I found myself “proximate” at her bedside when she died, and I found myself forever changed.
A beautiful part of medicine is that we share our experiences with colleagues who become friends. During one Christmas week, my best friend and I visited the home of our young parish priest to explain that the biopsy of the mass in his lung showed cancer. As all of the priest’s family was in Uganda, my friend and I found ourselves with the gift of being present for every one of his appointments, summarizing and reflecting on his life together as we prepared his eulogy. Another opportunity presented itself when a second-year resident in our internal medicine program was found to have an aggressive abdominal sarcoma. Her desire to do nothing more than return to work and care for others even while undergoing harsh chemotherapy transformed my relationship with my colleagues and our collective perspective. We did all that we could to help her (including hosting and organizing her wedding!) and shared the gift of knowing her much more deeply than if she were well. Over the last ten years, these stories have multiplied, each experience changing me and pushing me to grow closer in daily interactions with patients, peers, and loved ones.
At the same time, there have been times when I could not give even an ounce more than the minimum. Times when the physical and emotional toll of the work separated me from compassionate responses. This is a universal challenge faced in medicine, and during times such as these, the object of our proximity to suffering must be ourselves. Through introspection, we may discover that sleep, reflection, discussion, escape, time with loved ones, and other strategies will renew us. In those times, we are the ones suffering, and we must be supported.
“We must be willing to do things that are uncomfortable,” Stevenson said in describing the surprisingly restorative power of discomfort. The uncomfortable thing to do is to be present during the pain of pain of recovery, the unknown, despite not being able to cure. When we do not know what to say to bring comfort, it is because no words can take away the pain, but our presence can lighten it. By being proximate to the suffering of another or our own, we can change the world.