The clinic’s fluorescent lights hummed quietly overhead as I reviewed the chart of my next patient during my outpatient medicine rotation. It was late in the afternoon, and the earlier rush had settled into a slower pace. The chart belonged to a middle-aged woman, a breast cancer survivor here for a routine follow-up. Her history, filled with dates and treatments, spoke of her long fight against cancer—a fight she believed she had recently won.
As I entered the exam room, I was greeted by the patient, whose presence radiated a mix of relief and weariness. Her smile was warm, the kind that lights up a room, yet her eyes held a depth of experience that spoke of trials overcome and battles fought. She was perched on the edge of the examination table, the paper crinkling under her as she adjusted her position.
“We got good news last week,” she began, her voice tinged with cheerfulness that momentarily lifted the room’s ambiance. “I’m in remission again.” Her relief was palpable, and for a brief moment, we shared a mutual celebration of her victory.
However, the atmosphere shifted as her smile faltered, and she looked away, her hands nervously playing with the edge of her jacket. “But I’m not done yet,” she continued, her voice dropping to a whisper. Just a week after her declaration of remission, she had been diagnosed with small cell lung cancer.
The joy of her recent remission was overshadowed by this new formidable challenge. As she relayed the news, tears welled up in her eyes and began to streak down her cheeks. The room, once filled with light, dimmed as the weight of her words hung in the air. She broke down, her body shaking with sobs, and I felt a profound helplessness wash over me.
In moments like these, I’ve often reflected on Dr. Michelle Kittleson’s poignant piece in Annals of Internal Medicine (1), in which she explores the emotional dimensions of patient care and how grief silently accompanies the work of medicine. Her words offered a framework I would come to lean on during the encounter that followed.
I was just a third-year medical student, equipped with knowledge yet so inexperienced in navigating such depths of human emotion. My mind raced for the right words, the proper medical reassurance I was trained to provide. But in that moment, all of the clinical responses seemed starkly inadequate.
Instead of reaching for my notebook or uttering rehearsed reassurances, I moved my chair closer, my presence offering silent solidarity. I realized then that my role was not to distract from her pain with medical jargon or to offer clichĆ©s but to simply be there, to listen and acknowledge her struggle without judgment. In this silence, more was said than any blanket statement like “I can’t imagine how hard this is” or “I’m so sorry” could ever convey. Although we may never truly be in the shoes of our patients, grief and the need for silence is a common theme relatable to us all.
Dr. Kittleson’s reflections stayed with me long after the encounter. She wrote with clarity and compassion about the emotional weight physicians carry—and about how bearing witness to patients’ suffering can be both painful and profoundly humanizing. Her writing helped me name what I felt in that moment: that the most meaningful thing I could offer wasn’t a clinical solution, but shared presence.
Like her, I am learning that the path to healing—for both patients and physicians—often begins with recognizing that we cannot always fix or control the outcome. In those moments, presence becomes our most honest offering. This encounter reminded me about the crucial role of empathy in medicine—it’s not just about treating a disease but about understanding the person living with it. As I continue through my rotations and into my future career, I carry with me the lesson of that day: that sometimes, the best medicine we can offer is our presence and our willingness to share in the emotional journeys of our patients.
References
- Kittleson MM. The privilege of grief. Ann Intern Med. 2018;169:729-730. [PMID: 30452577] doi:10.7326/M18-2049
Sathvik Srikalyani is a medical student at the University of North Texas Health Science Center in Fort Worth. He is from the greater Houston area and earned his Bachelor of Science and Arts in neuroscience from The University of Texas at Austin. His current focus lies in exploring how narrative medicine can foster stronger physician–patient relationships, promote empathy, and ultimately improve health outcomes. Sathvik is particularly drawn to the human stories that shape clinical experiences and believes that listening with intention is a vital clinical skill. He looks forward to practicing a narrative approach to medicine throughout his career as a physician.
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