When empathy strikes and the curtain falls
Philadelphia, PA, United States
One slow November afternoon, while sitting in an advisory dean’s meeting about the countless items I needed to add to my resume before applying to residency, I received a surprise in my inbox. It was an email about a fifteen-week theater course that would be held on campus (how convenient!), taught by professionals (how cool!), allow me to act (I can be dramatic!), write a play (never done that before!), and foster empathy (yeah, whatever). Because I needed to be taken out of the room in which I was sitting… physically… metaphorically… anything… I decided to respond with a “Sign me up!”
Sure, I was nervous. After all, I am still scarred from my years in middle school drama with Ms. Angst (a woman arguably worthy of her name). The only role she ever trusted me with was narrator—year, after year, after year. Sometimes she put me in the chorus. Let me tell you, I hated being in the chorus, but it did teach me one valuable lesson: to be a great performer, you must live in the world of someone else, and to do that you must ask yourself three questions: Who am I? Where am I? And what do I want?
Before coming to medical school, I obtained my master’s degree in public health and learned different theories about what motivates people—the barriers and enablers of their every day health decisions. In a class on cultural humility and competence, each student partook in an exercise to create his or her own “cultural pie”—those components that you think define you. The size of the pie slice indicated the significance of each component. For months afterwards, each time I would meet someone I would think, “What components are in their pie?”
I come from a Lebanese family, so my cultural pie is composed mainly of three slices: family, friends, and food (gossip, religion, and political instability are other notable slices that we don’t have time to get into right now). My Lebanese upbringing has really shaped my cultural pie and as a result, I always prioritized other people. Furthermore, my Lebanese parents immigrated to the United States on their own, leaving their family behind. They faced many struggles living in a culture very different from their own. As a first-generation-loyal-child-of-immigrants, I tried to carry some of that emotional burden. It is debatable whether that was healthy, but regardless I did it and now you know that other people are important to me because I am willing to take on emotional baggage that is not even mine.
After a prolonged struggle to figure out what I wanted to do with my life, I finally decided upon medicine. I like science and problem solving. I likely will not have to worry about unemployment. I am in a “noble profession”. And of course, the opportunities of what I can do with an MD are endless. But ultimately, I chose medicine because I care about people. I want to speak to them, listen to them, and understand them.
I have sought a career where I could have daily meaningful interactions with other people. Yet, when physicians-in-training come to medical school, we spend so much time holed up in library cubicles that we slowly forget how to interact with people. With each passing month more demands are placed on us and in order to take on a fresh burden, we let go of a little piece of humanity, helplessly watching it fall to the floor. When my friend tells me she broke up with her boyfriend, I glance at my watch. While I care about her and want to listen, I also need to study. When my dad asks me to drive him to the emergency room because he has kidney stones, I question whether it needs to be done right this second because I am this close to finishing a review sheet.
As I progressed through medical school, I realized I was changing in a way that I didn’t like, but I couldn’t stop. My biggest worry was that one day I wouldn’t notice that I was leaving my humanity behind. That I would just go on about my daily life, numb. That it would all feel normal. I dreaded that day. But I also thought that when that day came, it would be so much easier.
And that is exactly when that much-needed-email-in-the-middle-of-a-pending-nervous-breakdown-during-an-advisory-meeting came into the picture.
I plunged into the program: 15 weekly sessions of two hours each, with directors and dramaturges of the Lantern Theater Company of Philadelphia. We were taught improvisation and playwriting. More importantly, we were taught a different way to view the world, and in doing so, we were taught to empathize. In fact, the theater class allowed me to both perform as another person and write my own story. Each time I was cast in a role, I would have to think about what exactly was influencing this person’s actions or motivations, how I was going to express them to the outside world, and how that would lead to my next behavior. It truly allowed me to be someone else, to live inside another person. As a result, I started perceiving patients differently during my time in the hospital. I was thinking about them much like you would think about a character in a play. After a year and a half in medical school, I was finally doing what I came here for and more: understanding other people by performing in their shoes.
In addition to what I learned from acting, the class also provided me with the opportunity to write my own story. Through the character of an invisible unicorn, I was able to portray my own personal journey in medical school through various fantastical vignettes. My fellow theater colleagues embraced it, and for the first time since medical school began, I finally felt understood. This class was open to a wide range of people in different stages of their education—students, residents, and even attending physicians from medicine, as well as nursing students, physical therapists, and family counselors. Our little class grew a sense of community by writing and performing for each other, and as we expressed our experiences through a creative medium, we noticed similarities between us all. In fact, the class gave us the sense that we are all broken, and through that insight it taught us kindness.
At times empathy feels like a buzzword, meant to convince exhausted medical students that they aren’t just doing all of this for nothing. Theater showed me the other, more important, side to medicine. It introduced me to a way of thinking about other people that reflects just why I came here in the first place. It showed me a world full of colors rather than stifling black-and-whites. It showed me life.
YASMINE KOUKAZ is now in her third year of medical training at Sidney Kimmel Medical College at Thomas Jefferson University in Philadelphia, Pennsylvania. She obtained her undergraduate degree in environmental biology and sustainable development from Columbia University. Prior to starting medical school, she obtained her master’s degree in public health from the Jefferson School of Population Health. Her interests outside of medicine include running, traveling, foreign languages, and now theater.