Read The Empathy Exams Online

Authors: Leslie Jamison

The Empathy Exams (2 page)

One time a student forgets we are pretending and starts asking detailed questions about my fake hometown—which, as it happens, is his
hometown—and his questions lie beyond the purview of my script, beyond what I can answer, because in truth I don’t know much about the person I’m supposed to be or the place I’m supposed to be from. He’s forgotten our contract. I bullshit harder, more heartily. “That park in Muscatine!” I say, slapping my knee like a grandpa. “I used to sled there as a kid.”

Other students are all business. They rattle through the clinical checklist for depression like a list of things they need to get at the grocery store:
sleep disturbances, changes in appetite, decreased concentration.
Some of them get irritated when I obey my script and refuse to make eye contact. I’m supposed to stay swaddled and numb. These irritated students take my averted eyes as a challenge. They never stop seeking my gaze. Wrestling me into eye contact is the way they maintain power—forcing me to acknowledge their requisite display of care.

I grow accustomed to comments that feel aggressive in their formulaic insistence:
that must really be hard
[to have a dying baby],
that must really be hard
[to be afraid you’ll have another seizure in the middle of the grocery store],
that must really be hard
[to carry in your uterus the bacterial evidence of cheating on your husband]. Why not say,
I couldn’t even imagine?

Other students seem to understand that empathy is always perched precariously between gift and invasion. They won’t even press the stethoscope to my skin without asking if it’s okay. They need permission. They don’t want to presume. Their stuttering un-wittingly honors my privacy:
Can I … could I … would you mind if I—listened to your heart?
No, I tell them. I don’t mind. Not minding is my job. Their humility is a kind of compassion in its own right. Humility means they ask questions, and questions mean they get answers, and answers mean they get points on the checklist: a point for finding out my mother takes Wellbutrin, a point for getting me to admit I’ve spent the last two years cutting myself, a point for finding out my father died in a grain elevator when I was two—for realizing that a root system of loss stretches radial and rhyzomatic under the entire territory of my life.

In this sense, empathy isn’t just measured by checklist item 31—
voiced empathy for my situation/problem
—but by every item that gauges how thoroughly my experience has been imagined. Empathy isn’t just remembering to say
that must really be 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 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. All this is connected to her domestically stifled mother, in turn, and to her parents’ un-broken marriage; maybe everything traces its roots to her very first period, how it shamed and thrilled her.

Empathy means realizing no trauma has discrete edges. Trauma bleeds. Out of wounds and across boundaries. Sadness becomes a seizure. Empathy demands another kind of porousness in response. My Stephanie script is twelve pages long. I think mainly about what it doesn’t say.

Empathy comes from the Greek
(into) and
(feeling)—a penetration, a kind of travel. It suggests you enter another person’s pain as you’d enter another country, through immigration and customs, border crossing by way of query:
What grows where you are? What are the laws? What animals graze there?

I’ve thought about Stephanie Phillips’s seizures in terms of possession and privacy. Converting her sadness away from direct articulation is a way to keep it hers. Her refusal to make eye contact, her unwillingness to explicate her inner life, the way she becomes un-conscious during her own expressions of grief and doesn’t remember them afterward—all of these might be a way to keep her loss protected and pristine, unviolated by the sympathy of others.

“What do you call out during seizures?” one student asks.

“I don’t know,” I say, and want to add,
but I mean all of it.

I know that saying this would be against the rules. I’m playing a girl who keeps her sadness so subterranean she can’t even see it herself. I can’t give it away so easily.



SP Training Materials

You are a twenty-five-year-old female seeking termination of your pregnancy. You have never been pregnant before. You are five-and-a-half weeks but have not experienced any bloating or cramping. You have experienced some fluctuations in mood but have been unable to determine whether these are due to being pregnant or knowing you are pregnant. You are not visibly upset about your pregnancy. Invisibly, you are not sure.

You are not taking any medications. This is why you got pregnant.

You’ve had several surgeries in the past, but you don’t mention them to your doctor because they don’t seem relevant. You are about to have another surgery to correct your tachycardia, the excessive and irregular beating of your heart. Your mother has made you promise to mention this upcoming surgery in your termination consultation, even though you don’t feel like discussing it. She wants the doctor to know about your heart condition in case it affects the way he ends your pregnancy, or the way he keeps you sedated while he does it.

I could tell you I got an abortion one February or heart surgery that March—like they were separate cases, unrelated scripts—but neither one of these accounts would be complete without the other. A single month knitted them together; each one a morning I woke up on an empty stomach and slid into a paper gown. One depended on a tiny vacuum, the other on a catheter that would ablate the tissue of my heart.
I asked the doctors. They explained that meant burning.

One procedure made me bleed and the other was nearly bloodless; one was my choice and the other wasn’t; both made me feel—at once—the incredible frailty and capacity of my own body; both came in a bleak winter; both left me prostrate under the hands of men, and dependent on the care of a man I was just beginning to love.

Dave and I first kissed in a Maryland basement at three in the morning on our way to Newport News to canvass for Obama in 2008. We were with an organizing union called Unite Here.
Unite Here!
Years later, that poster hung above our bed. That first fall we walked along Connecticut beaches strewn with broken clamshells. We held hands against salt winds. We went to a hotel for the weekend and put so much bubble bath in our tub that the bubbles ran all over the floor. We took pictures of that. We took pictures of everything. We walked across Williamsburg in the rain to see a concert. We were writers in love. My boss used to imagine us curling up at night and taking inventories of each other’s hearts. “How did it make you feel to see that injured pigeon in the street today?” etc. And it’s true: we once talked about seeing two crippled bunnies trying to mate on a patchy lawn—how sad it was, and moving.

We’d been in love about two months when I got pregnant. I saw the cross on the stick and called Dave and we wandered college quads in the bitter cold and talked about what we were going to do. I thought of the little fetus bundled inside my jacket with me and wondered—honestly
—if I felt attached to it yet. I wasn’t sure. I remember not knowing what to say. I remember wanting a drink. I remember wanting Dave to be inside the choice with me but also feeling possessive of what was happening. I needed him to understand he would never live this choice like I was going to live it. This was the double blade of how I felt about anything that hurt: I wanted someone else to feel it with me, and also I wanted it entirely for myself.

We scheduled the abortion for a Friday, and I found myself facing a week of ordinary days until it happened. I realized I was supposed to keep doing ordinary things. One afternoon, I holed up in the library and read a pregnancy memoir. The author described a pulsing fist of fear and loneliness inside her—a fist she’d carried her whole life, had numbed with drinking and sex—and explained how her pregnancy had replaced this fist with the tiny bud of her fetus, a moving life.

I sent Dave a text. I wanted to tell him about the fist of fear, the baby heart, how sad it felt to read about a woman changed by her pregnancy when I knew I wouldn’t be changed by mine—or at least, not like she’d been. I didn’t hear anything back for hours. This bothered me. I felt guilt that I didn’t feel more about the abortion; I felt pissed off at Dave for being elsewhere, for choosing not to do the tiniest thing when I was going to do the rest of it.

I felt the weight of expectation on every moment—the sense that the end of this pregnancy was something I
feel sad about, the lurking fear that I never felt sad about what I was supposed to feel sad about, the knowledge that I’d gone through several funerals dry eyed, the hunch that I had a parched interior life activated only by the need for constant affirmation, nothing more. I wanted Dave to guess what I needed at precisely the same time I needed it. I wanted him to imagine how much small signals of his presence might mean.

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.

Feeling Dave’s distance that day had made me realize how much I needed to feel he was as close to this pregnancy as I was—an impossible asymptote. But I thought he could at least bridge the gap between our days and bodies with a text. I told him so. Actually I probably sulked, waited for him to ask, and then told him so.
Guessing your feelings is like charming a cobra with a stethoscope
, another boyfriend told me once. Meaning what? Meaning a few things, I think—that pain turned me venomous, that diagnosing me required a specialized kind of enchantment, that I flaunted feelings and withheld their origins at once.

Sitting with Dave, in my attic living room, my cobra hood was spread. “I felt lonely today,” I told him. “I wanted to hear from you.”

I’d be lying if I wrote that I remember exactly what he said. I don’t. Which is the sad half life of arguments—we usually remember our side better. I think he told me he’d been thinking of me all day, and couldn’t I trust that? Why did I need proof?

Voiced concern for my situation/problem.
Why did I need proof? I just did.

He said to me, “I think you’re making this up.”

meaning what? My anger? My anger at him? Memory fumbles.

I didn’t know what I felt, I told him. Couldn’t he just trust that I felt something, and that I’d wanted something from him? I needed his empathy not just to comprehend the emotions I was describing, but to help me discover which emotions were actually there.

We were under a skylight under a moon. It was February beyond the glass. It was almost Valentine’s Day. I was curled into a cheap futon with crumbs in its creases, a piece of furniture that made me feel like I was still in college. This abortion was something adult. I didn’t feel like an adult inside of it.

I heard
making this up
as an accusation that I was inventing emotions I didn’t have, but I think he was suggesting I’d mistranslated emotions that were actually there, had been there for a while—that I was attaching long-standing feelings of need and insecurity to the particular event of this abortion; exaggerating what I felt in order to manipulate him into feeling bad. This accusation hurt not because it was entirely wrong but because it was partially right, and because it was leveled with such coldness. He was speaking something truthful about me in order to defend himself, not to make me feel better.

But there was truth behind it. He understood my pain as something actual and constructed at once. He got that it was necessarily both—that my feelings were also made of the way I spoke them. When he told me I was making things up, he didn’t mean I wasn’t feeling anything. He meant that feeling something was never simply a state of submission but always, also, a process of construction. I see all this, looking back.

I also see that he could have been gentler with me. We could have been gentler with each other.

We went to Planned Parenthood on a freezing morning. We rummaged through a bin of free kids’ books while I waited for my name to get called. Who knows why these books were there? Meant for kids waiting during their mothers’ appointments, maybe. But it felt like perversity that Friday morning, during the weekly time slot for abortions. We found a book called
, about a boy who confesses all his misdeeds to his father by blaming them on an imaginary red-and-green striped horse.
Alexander was a pretty bad horse today.
Whatever we can’t hold, we hang on a hook that will hold it. The book belonged to a guy named Michael from Branford. I wondered why Michael had come to Planned Parenthood, and why he’d left that book behind.

There are things I’d like to tell the version of myself who sat in the Planned Parenthood counseling room. I would tell her she is going through something large and she shouldn’t be afraid to confess its size, shouldn’t be afraid she’s “making too big a deal of it.” She shouldn’t be afraid of not feeling enough because the feelings will keep coming—different ones—for years. I would tell her that commonality doesn’t inoculate against hurt. The fact of all those women in the waiting room, doing the same thing I was doing, didn’t make it any easier.

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