The Shoe Will Never Quite Fit

This post was written by Maddy Kameny, a Patient Navigator at Squirrel Hill Health Center.

“Putting yourself in someone else’s shoes” is common discourse when we talk about privilege. This is a great technique and is imperative for developing empathy, but it can sometimes be difficult to do, and can result in pity and subliminal hierarchies if not carried out correctly.

The danger of stepping out of your shoes, putting on someone else’s, walking around a bit, and slipping your own back on is that it creates an illusion of comprehension. You may remember the discomfort you felt when you had on the other shoes and they didn’t fit quite right. Or, you may remember the relief you felt when you came back to reality and reminded yourself that these problems were only imagined. Both of these emotions help us create empathy, but we must be cautious not to be satisfied with the few steps we took – otherwise, we will gain a false sense of understanding, and, if the experience was uncomfortable, a desire not to repeat it. Most importantly, the shoes you put on never really belonged to the other person, but rather your own mental image of how their life must be.

Throughout my service, I have found that a more useful technique than trying on other people’s shoes is to challenge myself to remember a time when I actually did wear them – regardless of how mild or short-lived – and imagining I can never take them off. At the Squirrel Hill Health Center, we see locals, refugees, and immigrants, documented and undocumented, with and without disabilities, and with financial difficulties that span from short-term setbacks to adversity caused by generations of oppression. As a Patient Navigator, I spend a lot of time on the phone with patients to remind them of tests and appointments they are overdue for. It can be frustrating when people neglect to return my calls or show up to the appointments I made for them.

About a month ago, I got a call from my own endocrinologist’s office in my home state, which I went to regularly throughout college whenever I went to visit. They were calling to remind me of the appointment I’d made many months back, when I had no idea if I’d be in the area. I explained to the receptionist that I live out of state now and would not be able to come to the appointment. She asked, just as I do for my patients, whether I’d like to reschedule. I heard my voice give this answer: “Actually, I don’t really have a provider right now. I don’t know where I’ll be living in six months. I don’t know what my insurance will cover. I know I haven’t been checked in a while, but it’s going to have to wait.” This is something I hear almost every day – and it’s tempting to think, Wow, this person’s life is so volatile. She really doesn’t have it under control. When I put myself in her shoes, I feel bad for myself.

The reasons for my inability to reschedule my appointment are not the effects of racial, ethnic, or economic oppression – they are the effects of being 22 years old and having a lot going on. But after that conversation with the receptionist at my own health center, I felt the mild annoyance of receiving a spontaneous medical center call. I felt guilty for having to cancel the appointment, for not being more proactive about my health, and for not having a plan. For the first time, I felt embarrassed interacting with the healthcare system.

All it took to gain a new perspective on the patients I interact with on a daily basis was to remember a time when I was in a similar situation, even in just one small way, and challenge myself to think about how it would be if that situation lasted for years, or even forever. I didn’t have to imagine the discomfort; I already felt it. What I had to do was imagine that level of discomfort on a much greater level and for a longer period of time. What if this went on for years and I had to drive hours just to see my provider? What if, for whatever reason, I never really found a provider I trusted? What if I felt this discomfort in every institution I interacted with – education, law enforcement, politics, the workforce, people I interact with in public spaces – every single day? Chances are, I would have the same reaction that I did that day my health center called me: I would hesitate to deal with it in that moment, because there were other things to do that I perceived as being more important. I would not think about it, because thinking about it creates complications and forces you to face harsh unknowns about the future.

As someone who plays a small role in the enormous network that shapes our healthcare system, I challenge myself to deepen my understanding of what it means to “put on someone else’s shoes.” Of course, this technique does not work every time. There are some patients with stories so painful that I fail to find even one aspect that I can comprehend. In these cases, all we can do is open our hearts as wide as they go.