Editors' Commentaries on "When Words are not Enough"

 , April 13, 2019

One of the most treasured aspects of the patient-physician relationship surrounds discussing difficult topics. A strong bond begets the necessary trust to explore and provide therapeutic interventions for emotionally-laden diagnoses such as a miscarriage, depression, dementia, or cancer. At times, however, the physician is called upon to be a voice of compassion in the aftermath of violent acts against patients – physical assault, sexual assault, and intimate partner violence. Trauma-based care requires, at its core, an empathetic provider willing to meet patients where they are in their trauma. When our patients acutely perceive and process our every head nod, pause, positional change, and spoken word in the midst of their suffering, our attention to our verbal and nonverbal cues makes or breaks the rapport necessary to act as a confidant and servant in our patients’ times of need. Communication can be immensely difficult in these situations.

Now, add a language barrier and, by proxy, a cultural barrier.

Alexis’ piece “When words are not enough: Does empathy translate?” explores this very challenge when a patient in her clinic disclosed, through a Spanish language interpreter, that she was a victim of assault. The narrative then abruptly ceases as Alexis appears to stop time and transport the reader into her mind. The reader gleans a detailed inside look into Alexis’ whirring thoughts about how to proceed with empathy and support. Yet we, as well as the author, are painfully aware that this pause occurs in real time, and that the resultant silence from the uncertainty of how to proceed itself has consequences for rapport.

I do not want to give away Alexis’ conclusions, but I invite readers to explore her piece and how to provide compassionate care across even linguistic barriers. Afe, thank you for your humbling reflection so very important for all young physicians and physicians-in-training to realize and examine within themselves.

Herbert Rosenbaum

With this piece by Afe Alexis, "When words are not enough: Does empathy translate?" we are introducing a new feature where we ask undergraduate students to provide an outsider's perspective on submissions accepted for publication on "The Living Hand".  What follows is a commentary by Seysha Mehta (Class fo 2021 at Dartmouth College).  

JGIM Web Editor

Reading Alexis’ piece, I felt that I was walking next to her, peering into her thoughts. I could imagine Alexis’s anticipation, her curiosity, perhaps even her anxiety as she saw a new patient at the outpatient clinic. She paints her patient’s expression vividly - how her (the patient’s) wide eyes convey her reluctance to trust Alexis. I could picture Alexis’s discomfort, her recovery, and how it must have proceeded. It was like I felt every moment with her, empathizing with every step she took.

It wasn’t until after finishing the article that I appreciated the bridge that was built between my psyche and the author’s – undoubtedly, by the language and culture we share. I was reading words on a screen, but my familiarity with the language, the words, and their meaning, made the experience three-dimensional. The experience was so vivid that I felt tears in my eyes reading Alexis’ account with her patient. I wonder if that is what the author means by how a pause or delay due to language and cultural barriers can hinder empathy. A story on a screen came alive for me. I wonder if with a barrier to limit immediate connection, a real-life interaction can be obstructed and flattened of meaning.

Alexis was trying to peer into her patient’s thoughts just as I was trying to peer into the author’s. However, since they spoke different languages, there was a translator in between them. This piece makes it painstakingly clear that having that “middle man” not only diminishes the ability for someone to empathize, but it also diminishes the opportunity for the patient to heal because she cannot feel the empathy. This piece reminds us that it’s not necessarily the words of comfort that help a person, but the face of understanding while she speaks that heals, that reminds her she’s not alone.

Seysha Mehta