If forgiveness of others for wrongs done to oneself lifts an undue burden of physical and psychological stress, then forgiveness of oneself should remove twice the burden: the grudge as well as the guilt. However, it would not surprise me if this latter task is very difficult for physicians and physicians-in-training: part of our training involves our hypersensitization to the consequences of our treatments, decisions, and interpersonal interactions with our patients. I believe the hardest challenge for me will be to find forgiveness for my own actions that harm another person, especially a patient under my charge.
For the past year and a half, I have maintained an online journal to facilitate self-reflection, a practice that is essential for physicians through the provision of periodic assessment of skills and performance and identification of areas requiring improvement. Although such self-reflection need not be exercised through writing, I have found that expressing my thoughts and self-criticisms, especially with public disclosure, has given me the opportunity to carefully evaluate my development in a transparent and feedback-amenable manner. The title of the weblog, Apollo, M.D., arises from my interpretation of Western medicine’s origins with Aesculapius, the son of Apollo and the god of medicine and healing: I find this characterization arrogant or at least naively idealistic, as it expresses the deified ability of physicians to do good for their patients without acknowledging the equally potent ability of physicians to do harm. Apollo, unlike his offspring, was a bringer of both healing and plagues: I believe this is a more accurate model for the modern physician, as we venture into the realm of illness and health without full knowledge of the consequences of our actions, even if we bear good intentions.
One of the greatest burdens I carry is guilt for a single action: a few callous words I spoke to my mother not long before she died. My mother is the source of most of my inspiration to pursue medicine as a life and career path: her wealth of love and compassion, her long and painful battle with a rare leiomyosarcoma, and her indomitable capacity to forgive all slights and harm done to her by others and the slings and arrows cast upon her by life’s unfair circumstances. It seems unfathomable to me that she could forgive a mother who didn’t notice that her 7-year-old daughter came home with a broken arm and who denied her the opportunity to pursue a career as a physician, instead sending her to the slums of New York City to work in sweat shops to raise money for her brother’s medical education. It confuses me that she could forgive me, then a selfish, self-concerned, and ungrateful boy, when I showed no respect or acknowledgement of the life of sacrifice she led to better and remove the hardship she had suffered from the lives of my father, brother, and myself. I immediately knew what I said was wrong, and what followed was the most painful and remorseful letter I have ever written, expressing the apology I then was too ashamed to say aloud. As I later sat by her side as she slept in the hospital bed during the last two weeks of her life, it didn’t seem unusual or unnatural to me that I knew my future path would follow the “pay it forward” principle. After many more years of soul-searching to determine whether or not my reasons for pursuing this path were meaningful and enough to carry me through the hardship, I am back where I started: I have collected many new motivations and reasons along the road, but a significant portion of my motivation still draws from my burden. I could not undo the wrongs I had done before she passed away, and knowing her, she would not have wanted me to make any special effort to appease her. Instead, this burden is now part of my responsibility and my duty to serve the world she saw fit to love, despite the hardships in her life.
Since that time, I have often found forgiveness of others to be an uncomplicated if not easy goal. Self-forgiveness, however, has become a much more challenging task. I suspect that it is easy for most people, including physicians, to rationalize their actions to protect themselves from the emotional trauma of guilt or the affront (of being wrong) to their egos. I hope that as I continue on my journey through medicine that I do not become desensitized to the need to be aware of my actions and their consequences for others: being a physician at this time seems to carry with it a degree of magnetism for excess criticism. Many people might choose to ignore this excess criticism completely, and then as time goes on, all criticism. Where is the time to be concerned with false criticism, or even guilt? In writing and in self-reflection, I hope never to stop listening to the my own internal critic, whether it agrees with other critics or voices the pain of another who chooses not to speak.