Last Updated September 5, 2023.
“The Empathy Exams” by Leslie Jamison is a 2014 essay that interweaves the author’s personal experiences in receiving an abortion with those of the fictional characters she plays as a “Medical Actor” in simulations for aspiring medical students. Jamison informs the reader early on that teaching hospitals hire her to act out a variety of disorders and patient backgrounds so that medical students can practice diagnosing her. Her “specialty case” is a woman named Stephanie Phillips, an emotionally-reserved young woman whose seizures are manifestations of the sadness she feels over the death of her brother.
Jamison intertwines the dynamics that she expresses through her fictionalized personas with her own experience of having an abortion. She talks about how medical students will come into her room, examine her, and how it is her responsibility to evaluate them on the degree of empathy they express toward her condition. But, for Jamison, empathy is not merely saying something like “that must be really hard.” Her character—Phillips—only reveals more intimate aspects of her life history and conditions if asked those questions that would only come from a person who demonstrates true empathy. As she says,
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.
To be truly empathetic, one must know nothing so that they will be open enough to feel the same way as the person they empathize for.
The emotional indifference of the character she plays for these students is reflected in her own uneasy ambivalance as she goes through the abortion process. In the days leading up to her operation, Jamison seeks consolation from her lover, Dave, but is unhappy because of his seeming inability to grasp the full gravity of the situation or of the life-changing decision she has made. At one point he coldly dismisses her emotional ambivalence by telling her that she must be making it all up. This further upsets Jamison, not just because of the solipsistic tone of the comment but also because she realizes that Dave is somewhat correct. In fact, the most emotionally damaging element of the decision she has made is the fact that Jamison does not feel remorseful for choosing not to become a mother, not to conceive life. She feels little at all, and she believes her very indifference to be a sign of her emotional shortcomings. Jamison wants Dave to feel these emotions for her both so that she may be validated in her decision and also that she may share in this suffering with him to an equal degree.
In the days leading up to her surgery, Jamison tells the reader that she required heart surgery at around the same time as her abortion. Her attending doctor, whom Jamison refers to as Dr. M., is a dispassionate woman. Her interactions with Jamison are entirely mechanical—a regimented set of steps that she takes with every patient without the slightest attempt to share a common sense of humanity: “engage the patient, record the details, repeat.” Dr. M.’s interactions with Jamison are part of a sterile, formulaic process that completely eludes the showings of empathy that are expected of the second- and third-year medical students, or which Jamison wants so badly to receive from Dave. Dr. M.’s behavior is, however, sharply contrasted by that of another doctor, Dr. G., who explains how her heart procedure will happen and informs her that she may need to wear a pacemaker if they are unable to fix the problem. Unlike many of the medical students, Dr....
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G. does not affect fake sentimentality when interacting with Jamison. He is kind yet direct, and she feels comfortable in his presence. She says,
Empathy is a kind of care but it’s not the only kind of care, and it’s not always enough. I want to think that’s what Dr. G was thinking. I needed to look at him and see the opposite of my fear, not its echo.
Shortly after Jamison has her abortion, she undergoes heart surgery. Although the doctors ablate away much of the tissue that they believe is causing an arrhythmia, her problem persists, and they decide a second surgery is necessary. Though the doctors tell her that she has a low risk of dying, burning away too much of the tissue may require the permanent use of a pacemaker. Dave stays with Jamison through the entire ordeal, and she begins to find some comfort in his presence. She reminisces about the time he was stricken with Bell’s palsy. His ensuing pain and the facial disfiguration he suffered remind her of her current predicament.
The story ends with a juxtaposition of the empathy of the medical students to that of Dave. The students whom Jamison played patient for had to be taught how to be empathetic of others. Theirs was a kind of rehearsal, approximating the right kinds of questions, assuming the correct tone of voice and the appropriate mannerisms. Jamison compares this very unnatural expression of empathy with that of Dave, who never left her bedside during her hospital stay. At first, she wants Dave to feel every sensation that she is feeling, to experience fear of the exact same magnitude as hers. However, she ultimately lets her guard down, saying, “You’re tired of grading him on how well he gives it. You want to learn how to stop feeling sorry for yourself.” Dave climbs into Jamison’s hospital bed and they fall asleep together.