Brave Enough to Be Misunderstood: The Courage to Speak Even When It’s Uncomfortable

I take death very seriously.

I didn’t mean to write about something scary like death right before Halloween, but here we are.

The reason I take death so seriously, other than the obvious, is that the world of organ donation is changing. In my work as a pediatric intensivist and clinical ethicist, I’m pulled into many conversations about organ donation, from how scarce donated organs are (with both children and adults dying while waiting) to how we can help transplant recipients live long, full lives.

Organ donation itself is a young endeavor. It only became widespread in my lifetime (and I am very young, thank you very much). The methods we use to procure organs have evolved remarkably.

At first, the only people who “weren’t using their organs” were those whose hearts had stopped. But as ICU medicine advanced, we could restart hearts that had stopped, often leaving patients with devastating brain injuries. Ventilators could now keep oxygenated blood available for the body and keep those hearts beating. So, we (the “royal we”) had to redefine what it meant to die. Thus, the concept of brain death was born, not solely to serve organ donation but to acknowledge a new medical and moral reality.

Thousands of lives have been saved because families of brain-dead patients have chosen to donate. However, the demand still exceeds the supply, and technology continues to push the boundaries of what constitutes death. Now, we can sometimes restart circulation mechanically after a patient’s heart stops to keep organs viable for donation. More lives saved, but also more ethical questions.

As someone who stands at the bedside of dying children, I can’t help but ask: how far are we willing to move the line? Are we inching toward a world where we forgo the dying process altogether because healthier organs mean more transplants? At what point do good intentions tip into Dirty Pretty Things territory?

So yes, I take death seriously.

And sometimes, that makes me feel misunderstood.

I worry that my insistence—“we must be clear on what ‘dead’ means”—puts me at odds with my transplant colleagues. They walk with their patients from diagnosis to transplant to post-op setbacks and triumphs. They see the heartbreak of those who die waiting. Of course, they pound the table for more organs.

And I? I pound the table for a pause. For reverence. For the dignity of the dying process.

I worry they think I’m against organ donation (I’m not). I worry they think I’m difficult, or unsupportive, or cynical. I worry they inwardly sigh when I unmute myself on a Zoom call to say something uncomfortable.

But here’s the thing: I cannot prevent people from misunderstanding me.

No matter how carefully I word my emails, how gently I preface my comments, or how many disclaimers I offer, people will still form their own conclusions. That’s what humans do. And that has nothing to do with me.

Think about the last time you were misunderstood, even when you articulated your point well. Was there truly anything you could have done to guarantee understanding? Probably not. Because communication isn’t a one-person sport. It takes two fallible humans, both distracted, both tired, both carrying invisible stories.

When we shoulder all the blame for being misunderstood, we erase the other half of the equation.

Sometimes, being brave means letting misunderstanding exist without rushing to fix it. It means tolerating the discomfort of being seen inaccurately, because the alternative is self-erasure.

So when it’s your turn to speak, to disagree, to advocate: put on your big girl, boy, or gender-non-binary-kiddo pants. Know what you know. Say it clearly. And let others make of it what they will.

Keeping quiet out of fear of being misunderstood serves no one.

If You’ve Been Keeping Quiet Out of Fear of Being Misunderstood

Here’s how to start finding your voice again:

1. Name the fear, not the fiction.
   Ask yourself, “What am I actually afraid will happen?” Most often, it’s not rejection, it’s discomfort. And discomfort won’t kill you.

2. Anchor in your integrity.
   When your motives are clear and values-aligned, misunderstandings lose their sting. You’re not here to please; you’re here to practice integrity.

3. Assume partial comprehension.
   People rarely hear us perfectly. Don’t wait for perfect understanding. Say the thing that needs saying, and trust that what lands is what’s meant to.

4. Be willing to be the dissenting voice.
   Medicine (and life) needs people who ask inconvenient questions. That’s where safety, innovation, and ethics live.

5. Rest after courage.
   Speaking up takes energy. Afterwards, don’t spiral into post-meeting rumination; instead, practice recovery. Courage deserves rest, too.
   

Being misunderstood is often no big deal. But sometimes, it’s a matter of literal life and death. If you’re like me, you no longer have the time or energy to get worked up over things that don’t matter. So when you do feel that sting of being misunderstood, take it as a sign that what you’re saying does matter. Then, get honest with yourself about what role, if any, you’re playing in the misunderstanding. Be brave. Say your piece. And use the energy you once spent trying to be perfectly understood to move onto the next quagmire.  Your well-being, as well as that of your patients, depends on it.