Progress Notes

‘Hardened softness’ and compassionate empathy in healthcare

On my neurology rotation, I had the privilege of taking part in the care of a patient who I personally never met, although I really wish I could have.

That morning, I walked into the ICU with an expressionless face, wondering how I should be feeling and what I would say if I encountered his family. I ran through his previous day’s brainstem reflexes in my head and rather naively hoped for a change that would improve his prognosis.


This shouldn’t have happened to Mr. T. By the data in his chart, he had been in the perfect state of health: no chronic disease, a normal blood pressure that even ran low, and excellent follow-up with his primary care physician. Yet there he lay requiring full life support after suffering from a massive intracranial bleed the previous day.

His wife was now at bedside. It was 7 a.m. My heart was beating out of my chest.

After 10 months of wards, I had assumed what I describe as “hardened softness.” This state of being had helped me persist through bad outcomes and interpersonal conflict. And, thankfully, it helped me that morning. I relayed her husband’s overnight vital signs and disposition, conducted my physical exam, and wished her well until the next time I’d see her on rounds. In those 15 minutes, I was hard.

With tears welling up behind my eyes, I made my way back to the team room. Every other worry or burden I had been carrying on my shoulders now felt petty. In those three minutes, I was soft.

Altogether in those 18 minutes, I had been present. I had been strong.

As physicians, we adhere to evidence-based guidelines for the delivery of patient care. We are taught to deeply empathize with our patients, implying that they should also reside in our brain’s emotional hemisphere uniquely occupied by our parents, siblings, and children.

We are also instructed to curb our emotions in order not to offer false hope to our patients or expend valuable resources in medications or procedures in futility. We must feel – but also get a grip – to succeed at our jobs.

What I refer to as “hardened softness” may also be thought of as a form of compassionate empathy, in between a cognitive or callous state and an over-emotional state.

Mr. T and his wife compelled me to reexamine how and to whom I express my emotions. After all, emotions reveal messages about our rawest priorities. They often inspire the execution of these priorities despite our attempts to perform diligent research and reason with logic.

Nevertheless, they truly are gifts we receive in being born human. And as such, we must balance protecting and sharing our emotions in our roles as caretakers and loved ones.

-By Jackie Olive, third-year medical student at Baylor College of Medicine

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