Hospital as a river: Navigating uncertainty and empathy

The hospital is like a river. Patients float downstream into our care, stay in sight for a moment, and leave after we have done everything we can to help them. Regardless of why they arrive or how long they stay, every person in the hospital will always leave, whether for recovery, rehabilitation, transfer, or death. Meanwhile, the hospital staff guard the river banks, keeping watch over the steady flow of patients that happen to travel down their portion of the river.

It is Tuesday morning. Murmurs float from nursing stations and the building teeters on the edge of waking. As the hallway lights switch on, my attending, resident, and I leave our workroom, our footsteps softly announcing our journey to deliver terrible news. Admitted overnight with bulky metastatic cancer, Mrs. Johnson is half-asleep when we walk into the room. She moans and stares past us with unfocused eyes, seemingly unaware of our presence. Her son sits straight up.

“We’re ready to do whatever we need to,” he says, his face bright. A thick silence fills the room, interrupted only by Mrs. Johnson’s rough breathing. An eternity seems to pass in the three seconds of quiet taken to find the right words. Sensing our hesitation, his face quickly dims. “Don’t beat around the bush,” he says. “In this family, we tell each other how it is. Tell us exactly what’s going on.”

“Spontaneous tumor lysis syndrome.” “Very sick.” “Medication not helpful.” “Hospice.” My resident carefully introduces terms with brief clarifications from my attending. I sit there listening to the conversation unfold. I have nothing to add as the student; I am there to learn how to approach such a conversation. I am there as a witness.

The blare of the IV alarm momentarily steals my attention. As I glance over, my eyes stop at the bed. A wave of shock hits me. The woman’s curly grey-brown hair has gone straight black, her face and body morphed to new proportions. “That’s MY mom,” I think, dumbstruck. “Why is she here?” I blink once. Hard. Like a magic trick, my mother vanishes, replaced by Mrs. Johnson. As I look at her son by her side, I’m close enough to see that his eyes are glossy. Or maybe it’s my own eyes that are tearing up, because the figure begins to blur in my vision.

“What should we expect?” he asks, his voice quivering as his throat tightens. Mine begins to constrict in response. He’s trying to be brave for his mother and father. Perhaps now I’m projecting. It’s hard for me to tell where he ends and I begin. The same river I was learning to guard from the shore now threatens to swallow me. Every word my resident says is another wave crashing down on me, submerging me deeper in worry about my mother. The room is spinning, my view of the world tilting. Only muffled sounds from the conversation now reach my ears. Fear circles me: it nips at my heels, brushes behind me, waiting patiently to swallow me up if I dare glance at the bed again. My chest hurts. How long have I been holding my breath? I want so desperately for this to stop, but I also need to hear this. This news changes everything. My mom is –

The IV alarm shatters the illusion, grounding me back in reality. Our team expresses our condolences, we offer our support, and we excuse ourselves from the room. There are still many more patients to see. Mrs. Johnson is discharged before lunch, swept out of the room with her family accompanying her on either side. Her son and husband are smiling through tears. “We’re going home,” they tell her. When I walk by her room later, a new patient is already in the same bed, traveling through this healthcare tributary.

As the hours pass, I slowly drag myself back onto shore. The solid ground provides stability and the open air warms me up, yet my body still clings to the experience. Before meeting Mrs. Johnson and her family, it was comfortable work. I had subconsciously kept my feet dry. This encounter plunged me into the frigid water, disoriented beneath the surface, pushed around by turbulent currents, fighting alongside my patient. The decisions I make have become weightier, and I find myself shouldering my patients’ perspectives: the discomfort of pain and sickness, the anxiety surrounding an unclear diagnosis, and the frustration of waiting. I am told that empathy is what we strive for as holistic physicians, but to willingly dive into that river often defies survival instinct. Over time, will I still have the strength to swim back to shore? If I begin drowning, who will be on the shore, fulfilling what should be my role?

Every day in the hospital, as I stare out from the bank, the water foams and bubbles, betraying the chaos beneath the surface. Over time, I learn to read the river slightly better. The once threatening water looks just a bit familiar. With each subsequent dive in the months to come, I practice the swim back and grow to understand my strength. Until I master my segment, this slow growth will have to do. I spot my patients upstream, floating down my way again. I stand up and stretch, preparing for the work that will hopefully one day become second nature.

Daniel Song is an internal medicine resident.

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