Free Lemonade Stand: Giggles in the Examining Room

She was out of town, visiting a friend who was on the faculty at a well-known medical school. Her friend had carved some time out of a busy day with his new group of interns, medical students who would soon be working with patients for the first time. She was glad to see her old friend, but kept getting distracted by sounds that were coming from the examining rooms in the hallway adjacent to his office. Male and female voices seemed to be hushed, soft, intimate, he thought, and from time to time a burst of what seemed embarrassed laughter would erupt before again giving way again to the quiet, intimate voices. It seemed that this same kind of pattern was going on simultaneously in the dozen or so small rooms.

Finally, vexed by her distraction, she asked her friend what was going on in the examining rooms. “Oh, their noises,” He said, smiling. “They’re examining each other naked.” Her friend went on to explain that these medical students needed to be able to become objective about the body, to be able to suppress their learned responses to nudity and embarrassment and privacy in order to do focus on what they needed to in order to be healing practitioners. They needed to separate themselves from the other person enough to be of help to that person.

So in Howard Gray’s see-feel-help-change model, we’ve considered seeing, and not giving in to the temptation to look away, or move away. And we’ve considered feeling, and blocks to feeling. But as we stand at the synapse of feeling and what Gray proposes in the natural instinct to help….

Hmm. I called helping a natural instinct. Remember how the collective hearts of the country broke when Hurricane Katrina struck, how unprecedented levels of donations of money flowed to the Red Cross and other response agencies? I think that the collective heartbreak and unprecedented donations were evidence of our frustration when the synapse from feeling to helping can’t be connected, when we are helpless. In the case of Katrina, the faces we saw were on people there, where we could not go from here. We sent money, so we could live with ourselves. The people whose plight we saw were blameless, so we did not have the shield of judgment that yesterday’s young Polish girl had to wall off that synapse. We had to do something; our hearts ached too much.

But at some point we become overwhelmed, overpowered by the complexity and persistence of the problems that others face; the incessant demand on our feelings push us either not to look or to somehow repress our feelings. We’re under stress. If we’re afraid that we don’t have the capacity to help, we push back on feeling, trying to become unfeeling, apathetic. But it feels lousy. To escape the lousy, empty feeling, we stop looking. It’s called Compassion Fatigue. I looked online for strategies for avoiding or treating Compassion Fatigue, but found something missing. It had to do with those voices in those examination rooms.

Compassionfatigue.org gives these ways of fighting this lousy feeling:

• Be kind to yourself.

• Enhance your awareness with education.

• Accept where you are on your path at all times.

• Understand that those close to you may not be there when you need them most.

• Exchange information and feelings with people who can validate you.

• Listen to others who are suffering.

• Clarify your personal boundaries. What works for you; what doesn't.

• Express your needs verbally.

• Take positive action to change your environment.

While I find these valid, I found an article by brain scientist Jean Decety opening a door to deeper understanding. For five years, Decety, who joined Chicago’s psychology faculty this January, has studied the physiology of empathy, charting its existence using brain imaging and projected pictures of physical and emotional suffering: a stubbed toe, a child’s nosebleed, a grieving father clutching the body of his son. Consistently, he says, studies show an overlap in the neural regions that process personal pain and the pain of others. “But,” he says, “it is not a complete overlap. The person [in the fMRI] is not actually in pain.” The brain knows the difference, “and that is important.”

“The brain knows the difference.” “Accept where you are on your path at all times.” I find in myself that when I am with a person whose need calls to me, evokes compassion, there is a third person in the room, on the path where I encounter this needing person. For those who do not accept the idea of god by whatever name god is called, this will be vexing, because one of the characteristics of the one whom I call God is endless capacity.

So now imagine three people in the room: me, the person who I see and for whom I feel compassion, and this person of limitless capacity who I will call God.

If I ignore all but myself, I live in delusion and boredom, and cease to grow as a person, falling prey to egoism.
If I ignore God, I fall prey to my inadequacy, either by choosing not to help or to burnout when I have reached my capacity.
If I ignore the person in need, my relationship to God is to a god who is an extension of myself and my ago, and thus no god at all.

For me, God is "the difference", the third person in the room, the separation between me and the needing person. It is God’s capacity that flows through me to the needing person, and when it is time for me to leave the room, I have not been diminished or depleted or exhausted. I have rather been a well-used conduit between the capacity of God and the need of the other. And I have been fed by the experience of observing the flow of this grace from God. I have been not the savior in the room, but the companion with the needing person in this experience of healing of which the residue is hope. I have been fed, and not depleted.

In those examining rooms, as each of those pairs of medical students takes turn playing doctor with each other, they come to know that when they bring their humanity into that room with another human being called a patient, there is a third person in the room. It is not their embarrassed self, it is their Doctor self. As their hormones and habits become educated by the experience, their brain knows the difference.

With this caveat, I believe we are ready to trust our feeling, accept our natural instinct to help. Come back tomorrow for this.