"How many of you have experienced crippling anxiety?"
All the women in a group of domestic abuse survivors we recently spoke with nodded.
"I have a tough time being alone," one woman said.
"I have had several panic attacks that felt like heart attacks and landed me in the emergency room," another said.
For the last six months, we have been volunteering at a local safe haven to offer health information. On this night, the topic was anxiety and coping strategies.
Thinking back on some of our anxiety-provoking experiences, such as getting through medical school and starting residency, we thought we had a good coping strategy to suggest.
"We experienced moments during our training where we felt like things were falling apart. Yet, we overcame them, and now we have faith that we will get through future challenges, too."
This only perplexed our audience.
"Should we be trying to calm our anxieties?" one skeptic asked. "There's no guarantee that we'll be OK. We don't have a safe place to return to after we leave the haven."
They were right.
Our hearts sank as we listened to their words. We were teaching them what anxiety means to people who have job security, food security, and safety. We failed to truly empathize.
In the psychiatric emergency room where I work, anyone in Philadelphia who is experiencing an acute mental health crisis or an addiction issue can show up for a psychiatric evaluation. It's during these encounters that I'm forced to confront my own limitations as a physician to "make things better" for patients struggling with trauma and poverty.
Deprivation, and the sense of isolation that it instills, can fuel the feelings of depression and hopelessness I see in my patients. I also see what homelessness, racism, and stigma do to the ability to make sound decisions that align with personal values.
Rather than taking time to sit and acknowledge this sadness, I am too quick to suggest medications, mindfulness strategies, and outpatient programs. My advice is well-meaning, yet frequently tone-deaf because it is impractical for many of my patients. My quick reaction to long-simmering need comes from my own discomfort with feeling powerless to help, rather than from thinking about how to really be helpful.
As the women at the shelter reminded me once more, humbly listening, attempting to understand, and recognizing our common humanity can exceed the value of advice and resources.
On a daily basis I encounter patients who are suffering from intractable pain. Those with end-stage heart failure, or legs without blood flow, writhe in bed, unable to find a moment of respite.
If surgery would not help them, I might apologize for that, and then advise them "that any intervention carries a risk, which in your case would outweigh the potential benefit."
These justifications are valid. A big part of my job is deciding when and for whom surgery is warranted. Yet I wonder if my kindly meant words betray my failure to understand their circumstances.
Excruciating pain wipes away every modicum of lucidity, never mind the ability to calculate surgery's benefit vs. harm. As Emily Dickinson wrote, "PAIN has an element of blank; It cannot recollect / When it began, or if there were / A day when it was not."
When you're in agonizing pain or watching a loved one suffer, there is no mental space for anything else. Knowing this, I recognize that my approach may only rationalize my powerlessness to offer relief. It doesn't consider what they really need.
As David Brooks once said on how to help someone who is suffering, "Don't come like the cavalry trying to save the day, just come like the milkman bringing milk, just show up and just be there and sit alongside and keep company."
At these moments, it is enough to say, "I'm truly sorry that you're in so much pain."
True empathy demands more than imagining what we would do if we were in someone else's shoes. Rather, we have to imagine how their circumstances would affect our own ways of thinking and feeling.
In the end, we asked the women what they wished people who don't share their circumstances understood about them.
One said she wished more people knew that anxiety and fear can be so heavy, they make you physically sick.
Another wished for real empathy. Not sympathy from people who label her as a domestic violence survivor and think they know how she feels.
"The kind that makes you feel," she said, "like they accept you without judgment."