Seeking Forgiveness

• Attitude to death
• Physician-patient relations
• Humanism
• Knowledge, attitudes, practice
• Grief

If there is a common theme running through the submissions to the On Being a Doctor section of Annals of Internal Medicine, it is the story of the physician suddenly confronted by his own humanity. In form, this most commonly centers upon a dying patient, the physician overwhelmed by emotion, all at once aware of the depth of his or her caring. Much of the poetry submitted to the Ad Libitum section takes this form as well, such that together, we, the editorial staff, have come to refer to these submissions collectively as the “death-and-dying” pieces.

Far less common, but still submitted often enough to deserve their own niche, are the pieces we have termed the “seeking-absolution” stories, to which belongs the excellent essay by Dr. Costigan in this issue (1). These pieces, all having the sharp sense of nonfiction, center on the bad result. A diagnosis is presumably missed. A patient, through a presumed lapse, does poorly. The patient dies despite all measures. The physician-author, usually young and new to the profession, feels deeply responsible. And profoundly guilty. And unforgiven.

Why is this so? The answers, I have come to learn, are not so easily arrived at. (It has taken me some 4 months to write this editorial.) The reasons for this recrimination are found in layers, the peeling away of which tells much about us, and about our profession. At the most superficial layer, but nevertheless no mean consideration, is the awesome responsibility that we are made to feel upon entering medicine—that, tinged with a secret sense of utter inadequacy. (It requires supreme arrogance for a young …