A resident on night call writes one word in a chart to describe his patient’s husband, a man in his 90s: “senile.” He thinks it means “very old.” The note gets corrected, but the word stays in the edit trail, and a few days later the record shows the patient has read it. Every instinct tells him to leave it alone. He calls the family to apologize anyway.

Dr. Aditya Pawar is a transplant nephrologist at Beth Israel Deaconess Medical Center and Harvard Medical School. That phone call became “Safe Space,” his essay in The New England Journal of Medicine. He joins Dr. David Spiro to talk about what the couple said to him on that call, why it took him years to understand it, and who a clinician’s “safe space” really protects.

In this episode:
– The apology he almost didn’t make, and why he says it would be just as hard tomorrow
– Why “safe space” in medicine often protects the doctor, and what a “brave space” with patients looks like
– Telling a patient you don’t yet know the best approach
– Practicing in India versus the U.S.: five-minute visits that never really end, and seeing your patients at the grocery store
– Why he calls paternalism “a protective mechanism”
– What he says to kidney patients who won’t let their own child donate
– What he tells first-year medical students about the 20-minute visit that needs an hour and twenty
– His uncle’s lesson from Sunday evenings seeing patients in a village in India: “As a physician, we’ve always lost”
– Six hugs from a grieving family after one of his first codes

Dr. Spiro also shares what it was like to lead his team’s debrief after a child died in his pediatric ER.

Read the essay: “Safe Space,” N Engl J Med 2026;395:840-843. https://doi.org/10.1056/NEJMp2518528

Chapters
00:00:00 “As a physician, we’ve always lost”
00:00:20 Meet Dr. Aditya Pawar
00:02:03 “It started from a mistake”
00:02:33 Night call, a couple in their 90s, and one word
00:04:27 The phone call he almost didn’t make
00:05:11 What the couple meant by “safe space”
00:06:37 Parents in the room during a resuscitation
00:08:20 Who is the safe space for?
00:10:03 From safe spaces to brave spaces
00:12:55 Medicine in India versus the U.S.
00:15:11 Sharp boundaries, and crossing the line
00:17:43 “Every single cell of my body is telling me don’t do it”
00:21:14 What safe space meant as a child in India
00:23:10 Family, elder care, and what gets lost
00:28:16 Organ donation: “Do not take away that decision from me”
00:30:00 Teaching first-year medical students
00:34:26 Dr. Spiro: the debrief after a child dies
00:38:06 His uncle, Dr. S.S. Jamwal
00:39:49 One of his first codes as a resident
00:41:11 “This concept of death, you have to get comfortable with it”
00:42:11 Six hugs from a grieving family
00:42:44 Closing

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