An Empathy Artist
During these last decades, the interest in professional empathy has markedly diminished. It used to pay well to perform as a traveling standardized patient under one’s own management, but today that is quite near impossible. We live in a different world now. At one time, medical students took such pleasure in their standardized patient encounters. The standardized patient was the pride of any respectable medical school, and the standardized encounter, its prized jewel. Weeks of tension would mount leading up to such an encounter, and the study, intrigue, and wonder involved in the whole affair would make event he most obtuse medical student shiver with excitement—just the thought of all the possible ailments; the list of differential diagnoses would whet the appetite of even the dullest pupil. The standardized encounter was the culmination of all of a medical student’s skills and knowledge—each and every tool in his or her kit would be tested individually and thoroughly. If one had not sharpened his sense of sympathy or solace acutely enough, one could be sure to fail miserably.
For this reason the empathy artist demanded the utmost respect. He commanded awe and fear in equal parts, and no medical student completed their training without a proper introduction to, and most likely more than a few embarrassing failures in front of the empathy artist.
There in the examination room, sitting up on the stiff, blue examination chair, he was perfectly aware of the slightest movements and mannerisms of his body and speech. During the interview (from which he derived a immense amount of pleasure and suppressed completely; the sensation would raise his body temperature, his heart rate, flush his cheeks) and sometimes between them as well, he was as adherent to his patient script as the paper it was written on. He knew his grim history, family, past illnesses, traumas, all to the minute, second. And he did not know these details for any student to ask, their questions could never be pointed or direct enough to access this history, no—rather it was for the refinement of his craft, a process of constant refinement for which he found the donning of another’s life—whether real or fictional—a perfect vessel for his art.
Faking (although he despised this word, as it implied something evil, sinister about the acting process) illnesses, as the mainstay of his profession, separated his art from ‘mere’ actors and thespians. This he could mimic with perfect accuracy. There was never a whooping cough so convincing or grueling from a patient in an isolation room. Appendicitis (and this was one of his least favorite diseases to mimic—too messy, crude, obvious) too, he would replicate. This process, however, would physically pain him, and so his entire body could tremble and ache with terrible accuracy. Given a few hours notice, his cheeks could be made gaunt, his abdomen scaphoid and tense as a barrel, and even his eyes could be induced to a yellowy-pink. Still, his more favorite illnesses were much more subtle. For on his best and most passionate performances (the degrees to which his performances did vary, however slightly and imperceptibly to the medical students, were noticeable to him, although he aimed to iron them out entirely in the name of consistency) he could demonstrate the most illusive and technical of all physical exam findings: hyper-reactivity of the smallest reflexes, which were easy to mimic but almost impossible to convince physicians of their genuine presence, bounding peripheral pulses, nystagmus, seizures (amateurs often pretended to have seizures, and we have resultantly named them “psychogenic” seizures, but the seizures of the empathy artist could not be called anything of the kind. Some had even claimed that his self-induced seizures could produce results on an EEG machine), palpitations, and even heart murmurs.
His preparation process of course varied, depending on the illness. Usually, however, and as a general rule he had imposed on his life, he was always preparing for his next performance. He remained in the examination room most hours of the day; he slept in the examination chair to reflect the general annoyance and impatience of people who spent hours and sometimes days waiting in the emergency department for treatment. He ate nothing but hospital food and woke himself up at odd intervals with an alarm clock to simulate the experience of having regular blood draws by nurses. Because of this rigorous and disciplined schedule, his appearance was notably shabby and ragged, but not disturbingly so, if anything, lending him the exact appearance and smell of a hospitalized invalid.
It was in this way that he had lived the entirety of his professional career, and left no element of his craft up to chance or accident. But this intense mimicry, although he was profoundly proud of his achievements in replicating illness, were nonetheless ancillary to the true aim of his act. This aim, although the artist maintained it at the forefront of his mind constantly, was sometimes lost on medical students too distracted or challenged by chasing various differential diagnoses or treatments—these he deemed the unfortunate ones. Only the finest and most well tuned medical students could appreciate his genius unfold before them. And yet he performed for everyone without discrimination, on the small chance that he could dazzle even the most obtuse medical student: he counted on the fact that a keen observer would always be able to understand the subtle magnificence of his art. It was this group that he performed for, as well as for the rigorous aim of improving and perfecting his art, for the sake of all empathy artists and practitioners everywhere.
Our artists goal was simple, but yet one that had never before been attempted in the profession of empathy artists, at least before his time—many medical schools had refused him on the basis of his strict and unusual criteria under which any other other circumstances he refused to work. For one, there were no observers to be allowed into the examination room with him and the student—under no circumstances. There were to be no cameras in the examination room, as this was considered a great insult to him and his art. Many schools had refused him on the basis of this demand alone. It had caused him much trouble in finding a position performing, and many times he was faced with very tempting offers that acquiesced to all of his demands barring this one—these positions he refused, and considered them almost the greatest insult of all. Secondly, however, and for the same reason as his prior condition, he was to write all his own patient scripts. The script writing process, like the performance process, took great skill to master, and most often, he was a believer that most doctors who wrote scripts for standardized patients were embarrassingly and surely deficient in the realm of empathy. Once again, many schools refused him on this request. In fact, all of his demands seemed either unnecessary or plainly bizarre to most people; the schools however, at which he performed (or as the schools liked to call it, ‘trained at,’ as they viewed empathy as less of an art and more of a necessary skill, like pulse taking or auscultation) invariably had the highest performing and most well-trained medical graduates, not counting the praise and glowing reviews he received from his students (whom he referred to affectionately as his audience). Because of this, he not only remained in high demand, but also was the most sought out standardized patient in the entire country, despite his particularities. The third of his demands was that no student share or spread information regarding the events that transpire over the course of the interview (once again, he deemed these “performances” rather than simple interviews. The terminology is confusing here, as it is whenever people are apt to misunderstand the work of a genius). This, he assumed, like any good performance artist would, was a natural and logical extension of his work, and just as moviegoers do not reveal the endings of masterpieces, so too did he want his performances to remain shrouded in appropriate mystery. As a testament to the greatness of his works, no student in the great majority of the years he performed found this in the least difficult.
Still, most of his students found him great for the wrong reasons, or oftentimes, found him incredibly memorable, but for a reason they couldn’t understand. Empathy is a subtle act, especially when performed properly.
These misperceptions, however, were a necessary companion to the profession of empathy. Not everyone, in fact, perhaps the minority of students, could possibly understand the true goal of the empathy artists. While some were simply more perceptive than others, sometimes even the perceptive were left wondering—empathy is often an unrequited process, like love: it can be provided amply in heaps and mounds, can be offered on a silver platter, it does not necessarily have to be accepted, nor ingested. And so even at his best, when the artist reflected the human light of empathy like a magnificent, huge mirror, it was still possible to fall on deaf ears. No one could possibly produce first-hand evidence that the empathy artist had achieved the most perfect instantiation of empathy the world had ever known, and while some lucky students came away from their encounters with an experience that they could neither explain nor hope to replicate, often an experience equivalent to pure bliss or tranquility, only the artist himself knew the true extent of the art form he had mastered, the perfect degree to which his empathy ascended, and he was therefore bound to be the sole completely satisfied spectator of his own act.
Because of this natural limit in understanding, the artist often limited his own empathy so that it could be matched by the student’s own level. This he did for teaching purposes (although he still disliked this concept, his livelihood depended on the test results of students)—he let slip an occasional misspeak or non-sequitur, a mistake both intentional and precisely placed, but nonetheless given to provide a lead point, a life raft that a drowning student could grab hold of and swim to shore with.
These mistakes he did not necessarily need as part of his art, but experience had proved that at his full and most ferocious display of empathy, the kind of which he was able to provide if given the opportunity, and which was the explicit goal of his life’s work, was not the most beneficial for teaching purposes. And so as long as medical schools employed him, his goal was, often to his dismay, instruction in the art of diagnostics, not performance. On the rare occasion he did try to remove his self-imposed handicap, and provide what he thought to be his given gift, student scores fell, graduation rates dropped, and administrative scrutiny would invariably intensify—deans and professors would take the first possible opportunity to blame the artist, whom they still viewed as an outsider regardless of the fame he had accumulated, and his strange and exclusive demands. Schools would threaten to remove these rules, his salary, and even his employment at the slightest dip in standardized test scores. His co-workers found his methods unorthodox, offensive, corrosive to their strict curricula, and they would jump at any possible opportunity to threaten him. But as long as he provided his services in a way that continually increased student test performance, however, his job was safe, as were his demands.
And so he lived and taught in this way for many years, living in acclaim and world-renown, yet limited by the most trivial and pedantic of constraints. He was all the more troubled, however, because no one could grasp the full extent of his art, nor even its possibility, and so neither could they take his trouble seriously. Still he was mostly satisfied with his work, and for the most part, he had achieved great success in the art of empathy. By most professional standards, he had achieved what most artists only dream of—he had mastered the medium in its entirety, performed for thousands, had achieved global fame, and made a living solely off of his art.
In the recent years there had been, however, occasions—with increasing frequency as well—of students mocking him and his performances. This coincided with a period of a large-scale pandemic, when students found the need for standardized patients to be gratuitous. He first heard rumors of this mockery through the whispers and hushed conversation amongst administration, but eventually the mockery reached his own door when a particularly bold and daring student got an idea in his head and challenged him during the interview. He, and several students after him, would with some slight variation, venture past the bounds of the medical interview, and, trying to probe the boundaries of the empathy artist’s scripts, inquire about irrelevant and obscure pieces of history, hoping to catch the artist in a trap, off guard, and reveal his “true” identity as an actor and therefore—in their minds—a failure. Little did they realize, however, the extent of the artist’s commitment to his scripts and dedication to roles, and so never did these episodes succeed in anything other than angering the artist immensely.
With the aforementioned change in public interest, these events began to occur with a dangerously increasing frequency—students were losing interest in empathy, and hospital administrators were losing interest equally, as metrics and efficiency became the main drivers of medicine as a discipline. Soon, the change almost appearing overnight, the empathy artist found himself deserted totally by medical schools, and without a job. Instead, they had placed multiple-choice tests in his place, trivial little pieces of paper examining nothing but a student’s capacity for guesswork and stamina. These tests were put in his place, and despite the years of work and fame he had accumulated, the artist faced himself on the streets of New York, pedestrians passing him by on the street without the slightest idea the capabilities of the man the stepped over.
In a desperate last attempt at performing, the artist left for Europe, where he had heard the services he provided were still somewhat valued by medical schools. This trip too was in vain, as he discovered the same growing distaste for all things empathy and in its place an intense hunger for metrics and ergonomics. Of course, he thought, this change could have not arisen so suddenly; there must have been signs, illusive and premonitory signs that he must have ignored or missed otherwise during the height of his fame, which now came retrospectively to mind—but it was too late to account for these things. The change had taken hold across the continent almost as ubiquitously as in America, and despite an old hope that an interest might remain somewhere in some deep dark corner of the continent, there was simply an aversion to empathy artists too powerful for him to either deny or overcome.
Despite his desire, however, after years of mimicking disease, the empathy artist was simply too frail to continue his role in either the arts or medical education; his pursuit, over the last who-knows-how-many years, of empathy in its most ripe, perfect form had left him weak with exhaustion. There was no way he could take up his old post again as a standardized patient, he decided, even if there existed a medical school ready to hire him, which at the moment, and for the foreseeable future, there were not. Yet he could not accept this departure from his art. He had spent too much effort, and had gotten too close to give up in any appreciable way.
After some time of searching for the promise of compromise, however, he was left even more disheartened than before—not only were there no medical students in need of a standardized patient, but there seemed to be almost no regard for empathy at all (he had reverted to branding himself as a standardized patient, once again, to make his art sound less idealistic, and more marketable—yet competing with multiple choice tests was proving impossible, and the title empathy artist, as it were, existed now only as a relic of a far off past).
For thus began the second and final great act of the artist’s endeavor. Somewhere along his travels, the artist had given up hope of returning to his prior life. The fame and the stability, all of it he suddenly realized was useless to him; instead, and arising in its place one day, a single, glorious resolution took center stage in his thought, displacing every other conviction held there. He had been lying flat on the sidewalk, missing the sweet and smooth faux-leather of the examination chair, when the thought entered his mind. At first he almost missed it, it was so plain and unassuming, but then caught himself, and knew with all assurance what he had to do.
At its core it was in fact quite a plain idea—difficult in execution but a simple concept. His art distilled to a perfect form he had never attempted before, that being a final last act of empathy that would be so blinding he would not be remembered for anything aside from this one single act. In textbooks and museums alike, he would be enshrined in glory, and everyone would have forgotten all about his disgraceful fall from primacy. Interest in empathy would reemerge and he wouldn’t be around for it, having demonstrated its purest and most beautiful instantiation, and taking permanent leave from the practice forever.
He became obscenely happy for a brief period, as he pondered and theorized methods for his final and high-flying stunt. With his remaining money, which until that moment he had no need for, he rented a small, bare flat, and filled it with a mat to sleep on, as well as a wooden chair and table to write. He was once again re-engaged in his art, and despite the decrease in public interest, his unemployment, or his declining health, he had never felt so invigorated with the spirit of intrigue. If anything, these things pushed him even further into his fury—he was finally free to explore the deepest depths of his art without constraint, and although he had no audience at the moment, he believed his situation to be temporary: his health would improve, interest in empathy would return, and he would be re-hired. Still, and in the worst-case scenario, he was confident in his ability to find an audience—an artist’s work, he believed, would find its intended audience one way or another.
Still he kept in mind the reality of his grim situation, and wrote with a new speed and intensity as his resources and health further declined. Reams of paper piled around his small room—it was to be his final patient script, which he was simultaneously authoring and committing to memory. It contained a life in its entirety, from its very beginning to ultimate end. As if a spectator had followed this fictional character from his very birth, he noted the smallest and most particular aspects of this imaginary person’s life, sparing no detail, no matter how seemingly insignificant. He wrote with the scrutiny and accuracy of the universe itself, if the universe could write.
Included in the script were various aspects of his previous protagonists’ lives, a small detail here, a theme there—there was a kind of piecework to the whole project, as his memory contained a myriad of lives from the artist’s life of performance, but for the most part, the script was original, and as the sheets of paper accumulated in huge piles around his apartment, he knew that it was his finest one yet.
His health, however, was deteriorating faster than anticipated; he knew soon enough that he was dying—he had written enough untimely ends to know as much. Still he continued writing, memorizing, and applying to medical schools on the off chance that he would be able to exhibit his work. Despite his sickness, he abandoned eating and sleeping in order to be able to complete his masterpiece. But he grew weary, and began to lose hope that his project would ever be performed. After some time he had finished the writing, but the script itself, however, comprised only half of his masterpiece, and the less important half at that—he needed desperately to find and an audience.
The most daring part was yet to come, however. Having committed his script to memory, he was ready to perform. But it would be unlike all the rest of his performances—having committed himself to one final act and no more, there would be no constraints left on his art form. He would transmit the entirety of his life to an unsuspecting medical student, bearing down on them with the full force of complete and utter transparency. There was to be a brand new understanding of empathy, and just as Manet reigned in modernity or Newton physics, he was to be known forever as the one to bring it about.
Desperately he applied for positions across the globe, all the while the state of his health growing increasingly dismal. An entire year passed without a single reply. The stacks of paper in his apartment turned yellow, and his skin became loose and wrinkled.
But just when he had nearly lost hope of ever being able to deliver his revolutionary performance, a letter arrived in the mail one day, silently slipping through the mail slot of his door onto his dusty wooden floor. It was a response from a small medical school in the Caribbean hiring him for a month’s long rotating position as a standardized patient, included in the letter a patient script about one-and-a-half pages long—an uncomplicated appendicitis case he was to perform, of course. He mustered up the strength to let a chuckle escape from his lips, and tossed away the script. As fast as he could he booked himself a ticket, and bid farewell to his filthy apartment.
But no sooner had he gotten down the street than he lost strength in his legs all at once, and collapsed on the sidewalk. The next thing he knew, he was laying in a hospital bed in an emergency department, bandaged and pierced with intravenous lines, and although the familiar fluorescent light and crowded chatter of the hospital was somewhat reassuring, he let out a cry, for he knew surely that he was condemned to die here in this bed. He cried even louder when he realized that he would never be able to perform his life’s work for an audience. He had been so close—for that brief moment after exiting his apartment, he felt the sun reach down and coat his pale shoulders, the warmth on his skin was so reassuring… he envisioned himself on a boat, travelling in front of a wide, foamy wake, a deep blue ocean surrounding him on all sides, his final destination coming close. Instead he felt his legs turn numb, and all he saw instead was the sidewalk concrete rising towards his face, the world quickly losing definition, a black tunnel closing in upon him…
He lay there in the bed for several days without a doctor or nurse coming to visit him, and quickly wasted away. He didn’t know where he was or what kind of hospital he was in—he only knew that it was horribly run-down, and desperately in need of service. There were cracks running up the walls, the floor was covered in dust and blood, and patients were crying out for help in their beds by the dozens. His IV bag had run dry, and he began to sport greenish-brown bruises all over his arms and legs. He sank into his hospital bed, letting the soiled sheets and pillows bury him bit by bit, all the while falling deeper into a muddled state of confusion and delirium.
One day a medical student was passing by his bed when she turned towards his bed. She asked his nurses why this perfectly good bed should be left lying there unused with soiled sheets on top of it; nobody knew, until one nurse, checking the chart on the wall, remembered about the old man. She peeled off the sheets one by one and found him lying there. Terribly alarmed and confused, she asked, “Who are you? And what are you here for?” The empathy artist was not much more than an emaciated pile of bones at this point, glistening with sweat and his own waste, yet out of the deepest confusion, perhaps prompted by the medical student’s words he had heard so many times before, he was able to remember his mission. But he choked on his response and swallowed it. He had forgotten his script in its entirety. In fact, he had forgotten most everything aside from the fact that he was once a very famous and well-regarded empathy artist, and that he had been so terribly close to delivering the most perfect performance of empathy the world had ever known.
“Forgive me, everybody,” eked the empathy artist; from the crowd of nurses and doctors that had amassed, only the medical student, who had squatted down and placed her ears up to his mouth, could hear his barely audible whisper, “I was once a great empathy artist. I was meant to perform for the whole world, but I failed.”
“We forgive you,” the medical student whispered back.
“I always wanted you to admire my empathy.”
“We do admire it,” returned the medical student.
“But you shouldn’t admire it.”
“Well then we don’t admire it,” said the medical student, “but why shouldn’t we admire it?”
“Because I do not know who I am anymore.”
“I can see how that must be difficult for you,” replied the medical student, “can you tell me more about that?”
“I,” said the empathy artist, lifting his head a few inches off of the mattress and speaking right into the medical student’s ear, so that no syllable might be lost, “I never knew. If I had known, believe me, I should have made no effort and acted like you or anyone else.” These were his last words, but in his dimming eyes remained the firm though no longer proud persuasion that he was being empathetic.
“Well, clear this out now!” said a doctor standing behind the medical student, and they whisked away the whole bed, blankets and all. In its place they rolled a clean new bed, and laying on top of it a man groaning in pain and clutching his right lower abdomen, probably with appendicitis. Everyone was glad to see this new patient in the empathy artist’s place, even with his over-the-top moans and occasional yelps. For the man was all right. He had just gotten a CT scan of his abdomen, which was being interpreted by a radiologist in a far-off wing of the hospital. The operating room was being wiped down, surgeons were scrubbing their hands, and there was not much to say to the man.
Based on ‘A Hunger Artist’ by Franz Kafka