The first essay in Leslie Jamison’s The Empathy Exams is titled the same as the book. It introduces Jamison’s job as a medical actor, someone who pretends to be sick in order to train medical students on recognizing and diagnosing ailments. Jamison describes the detailed scripts that actors are given to memorize, that include details like age, hometown, symptoms, and fears. The scripts tell you what to reveal and when to reveal it to the students, or perhaps tell you what you know but can’t reveal. They’re formatted with sections for the character’s (patient’s) name, case summary, medications, and medical history.
For a few pages, Jamison sticks to discussing the job and the roles she plays in it, such as a woman named Stephanie Phillips who has inexplicable seizures. After each scene, she fills out an evaluation of the students’ thoroughness. “Checklist item 31,” she writes, “is generally acknowledged as the most important category: ‘Voiced empathy for my situation/problem.’” From there, she discusses empathy as an idea.
“Empathy isn’t just remembering to say that must be really hard—it’s figuring out how to bring difficulty into the light so it can be seen at all. Empathy isn’t just listening, it’s asking the questions whose answers need to be listened to. Empathy requires inquiry as much as imagination. Empathy requires you knowing you know nothing. Empathy means acknowledging a horizon of context that extends perpetually beyond what you can see: an old woman’s gonorrhea is connected to her guilt is connected to her marriage is connected to her children is connected to the days when she was a child.”
That last bit feels especially important in a medical setting. These students don’t know their patients’ histories or backgrounds beyond what they’re told. Starting the process of helping them should be done with an acknowledgement that there are reasons behind the ailments that they don’t understand, and might not ever understand completely.
After exploring the meaning and origin of the word empathy, Jamison discusses medical struggles of her own, through the lens of another character. Using this form allows her to examine her own experience through a different perspective. She presents a character who is seeking an abortion, and has an irregular heartbeat. The character’s mother wants her to bring up the heart condition in case it is relevant, but the character doesn’t want to talk about it. Even when Jamison expands on her history with her boyfriend, and the abortion, and the empathy she wants her boyfriend to express, she doesn’t expand much on her heart, at least until later.
Empathy as an idea is present even when it’s not explicit. This is true for all of the essays in this book. This essay outwardly discusses empathy more than the others, but it still has moments for empathy to hide in. After expressing that she wished her boyfriend would be more readily empathetic towards her needing to have an abortion, she writes about an evening before the procedure.
“That night we roasted vegetables and ate them at my kitchen table. Weeks before, I’d covered that table with citrus fruits and fed our friends pills made from berries that made everything sweet: grapefruit tasted like candy, beer like chocolate, Shiraz like Manischewitz—everything, actually, tasted a little like Manischewitz. Which is to say: that kitchen held the ghosts of countless days that felt easier than the one we were living now. We drank wine, and I think—I know—I drank a lot. It sickened me to think I was doing something harmful to the fetus because that meant thinking of the fetus as harmable, which made it feel more alive, which made me feel more selfish, woozy with cheap Cabernet and spoiling for a fight.”
She’s empathizing with something that can’t feel anything yet, much less appreciate her empathy. That’s part of empathy, though—sometimes it can’t help but show up, even when it makes things harder for yourself. We suffer a little ourselves in an attempt to understand others’ sufferings and put them at ease. It’s a complicated, sometimes painful process that ultimately, hopefully, makes the world an easier place to live in.