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OPINION | The least empathetic thing to say

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A FRIEND posted on Facebook that her son’s college had closed for the rest of the year: “He and his friends are devastated.” I scrolled down to the comments. “At least he’s not a senior!” someone offered. “My daughter will never get to go back to campus.”


Later I read a tweet from a stranger about how he still had to go to work as a garbageman and was scared he’d get sick on the job. Someone replied: “At least you still have a job, man.”
With the coronavirus shaking the world and forcing us into isolation, I’ve found myself reflecting on how the things we say can bring us closer together or drive us further apart. As a physician, I’ve received training in the art of empathic communication. The job is defined by people coming to us with “complaints,” which we navigate and support them through. I’m still in training and have a lot to learn, but one lesson that’s stuck with me is that it is never helpful to start a sentence with “At least...”
We’ve all said it. The intention is almost always good. I can imagine someone reading the garbageman’s tweet thinking it could be helpful — comforting, even — to remind him how lucky he is. It doesn’t work that way.
One of my favorite speakers on this subject is Brené Brown, a professor of social work who has spent the past two decades studying empathy. In her talk “The Power of Vulnerability,” she says: “Rarely, if ever, does an empathic statement start with ‘At least.’ ... Rarely can a response make something better. What makes something better is connection.”
Ms. Brown’s words came to mind recently as I was staffing the oncology service at the hospital where I work as a resident. A patient, recently diagnosed with leukemia, was there for chemotherapy, which, as it killed her cancer, was also destroying her immune system. The patient lay in bed watching CNN report new coronavirus statistics.
“How could this be happening now?” she said. “I have no immune system. I’ll be the first to go.” She turned to us, her breathing heavy. “I’m just — I’m paralyzed with fear.” No answer could allay her concerns.
A colleague was the first to speak: “I can only imagine how scared you’re feeling right now. It’s unfair that you’re dealing with leukemia and now this. I don’t know what the future holds, but we’ll be with you every step of the way.”
Her response wasn’t perfect, but that’s the point. It’s impossible to relate to the precise circumstances that is causing someone distress. Yet we’ve all felt despair. It’s OK— and even helpful — to admit that you can’t imagine what someone is going through. But you can tell her you care and you’ll be with her through it all.
It can be hard as a doctor to keep my “empathy tank” full. I’ve had bad days when I diagnose a 25-year-old with a terminal illness, and later find I have trouble caring when a friend calls to complain about a snack-stealing roommate. I worry that the coronavirus era will strain our collective ability for empathy, but I also have hope that we will rise to the challenge.
On tough days, I find it helpful to pause, take a deep breath, and let myself be present for the person in distress. Sometimes we have to silence the small voice in our head that says, “At least you weren’t diagnosed with a horrible disease today” — or “At least you still have a job.” Whether suffering is big or small, it’s all-consuming and it isn’t relative.
Dr. Stuart is a resident in internal medicine at Brigham and Women’s Hospital in Boston.

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