“I made a big mistake a long time ago.”

These words snapped my concentration. I squinted at the computer screen, and even though it had been stable, I waited for Cindy’s pancytopenia to collapse entirely. I enjoyed seeing Cindy, the kind of patient who trusted my counsel and, just as importantly, needed my help. Sweet and cute, she gave me a real hug and a genuine smile every time I saw her. Cindy suffered from lupus, so I perpetually expected this condition to misbehave. In this regard, I did a lot of “babysitting” of her labs and worried about Cindy.

Like so many of my patients in West Virginia, Cindy was poor and still worked, even at seventy-nine years old. Widowed and living in a mobile home, Cindy often reminded me, “I have to work.” I cringed each time she narrated how she had “worked at the same diner since 1996.” In that same period of time, I had gone to college, medical school, and residency.

I stared at her lab work; Cindy’s pancytopenia was displayed in red, as was customary with abnormal lab values. I reviewed her chronically suppressed WBC count, which usually hung at a paltry 1.8. Was the collapse finally happening? I concentrated, and Cindy continued talking, oblivious to my inner monologue.

“I never got a divorce from my husband. He didn’t want one, and I didn’t have the money. So—I took care of it.”

I stopped looking at the computer but did not move. Cindy continued, even before I processed what she was saying. Oh–it’s happening, I thought.

“I was then with Jimmy; I know it was wrong, but he treated me better than my husband, who used to threaten me with a hunting knife. Jimmy drank all day—that’s true—but he treated me better. We were together for nine years.”

And, just like that, I leaped from lab work and landed in the impromptu confession booth. This “room of requirement” and role of confessor had arrived late in my career, the “gift” of being a confidant and counselor.

My patients have confessed their sins to me only recently, in the last five years. Each time it happened, it was a surprise, but once the moment revealed itself, it was not a surprise, really. Was I better in these moments, or just conditioned to freeze in place? If this was what psychologists called “holding space,” I did that, literally speaking. I didn’t remain frozen for long, knowing what I needed to do.

Without thinking too hard, I said, “It’s important for all of us to forgive ourselves for things we did in the past.” Cindy looked at me blankly. Should I have shared that? her expression seemed to say. “I bet if you told your story to a friend, they would tell you to forgive yourself and move on. You are a human being, Cindy. It sounds like good advice.” With that opener, we engaged in a conversation more pastoral than medical, not lab analysis, but spiritual gardening. I shared a few thoughts about mistakes made in my own life, and I knew that it is hard to forgive oneself. The weight of the cumulative guilt and shame was palpable as Cindy divulged more details. By the time her tears flowed, snot was wiped on my white coat as a part of a deep, long hug. I held on to Cindy and prayed she could discard some of her shame and pain.

I eventually cut her off, telling her, “I don’t need to know all the tiny details–I know enough.” She wiped away more tears. I had a strange form of exhilaration, the kind that emanated from knowing that this moment was, in fact, the reason I came to work today. I reminded Cindy I was honored by her trust.

“And this one time at the small church, there was a preacher and his wife. I said the sinner’s prayer with them and asked God to forgive me.” No sooner had she said this than Cindy walked slowly down the hall. And I was left with one more aspect of her life to know of and care about. The next time I saw her labs in red, I would be thinking of something else entirely.

Ryan McCarthy is an internal medicine physician.