I recently retired from practicing medicine after forty-three years, specifically in ophthalmology. Everyone I know seemed to bombard me with the same question: What’s it like being retired? I’ve been thinking about and preparing for this moment for quite some time. In the final days, I saw my last patient, relinquished my license and staff privileges, and completed withdrawal from all insurance plans. My family and I had a small celebration afterward, followed by hugs and well wishes. Later that evening, after my wife went to bed, I stayed up and thought about everything that had happened. My thoughts drifted toward an old episode of Night Gallery, one in particular titled “The Sins of the Fathers.”
The story goes like this. In Wales during the Dark Ages, people believed that if a man, designated as a sin eater, ate a meal at the side of a recently deceased corpse, all the deceased’s sins would be “eaten,” thus cleansing their soul before entering heaven. Over time, the sin eater would accumulate others’ sins each time they performed this ritual. Upon the sin eater’s death, someone had to eat all his accumulated sins to cleanse his soul, or the sins would accompany the sin eater to hell.
My first lecture in medical school began with the attending physician instructing us, “You have one job as a physician: You must provide relief to each patient at every single encounter. If you don’t, you didn’t do your job.” It took me forty-three years to fully understand and appreciate what that meant. Patients seek us out for relief from their problems, whether it’s a sore throat, chest pain, or concerns about a family history of cancer. In each situation, they bring us new concerns or symptoms that weigh heavily on them. Along with their symptoms, they also carry added anxiety and stress. Our job is to relieve some of that weight by taking it on ourselves.
Before a patient recently came in with uveitis, I had no clue she even existed. She carried all the burden, the red, painful eye, the worry, the fear, all by herself. After her visit, before any treatment started, she was already feeling better. Not because she had less inflammation or better vision, but simply because she was receiving care. The simple fact that someone cared for her helped lift some of the load. She left the office with relief; so far, the only treatment was having some of the load lifted.
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Where does that weight go? It goes right on us. Before clinic today, I did not know her. Now, part of the weight is on me. Did I make the proper diagnosis? Did I order the correct test? Is my treatment appropriate? Part of the weight always goes on us. And this pattern repeats all day long with each patient we see. Strangely, we physicians are all sin eaters. With each visit, each phone call, each email, we relieve the patients of some of their burden, placing it directly on ourselves. It is now our responsibility. Even giving a patient a terminal diagnosis provides relief. The mystery is over. Now they know. Until now, I never thought about the load my father’s oncologist took on by telling him he only had one month to live. We pretend to be stoic and tough, suppressing it without eliminating it, but it’s still there. We do our best to fool ourselves, calling patients “cases.” We’ve become so accustomed to it that we don’t even notice it until that final moment.
Before going to bed, I needed to sign one more piece of paper to finalize my retirement. As I sat at the kitchen table, pen in hand, the words on the malpractice tail coverage penetrated deeply: “I permanently and totally retire from the practice of medicine.” As I signed my name, the wave of relief started to overtake me. I felt the load leave my soul, replaced by an amazing feeling of calm and peace. After forty-three long years, by signing that final piece of paper, someone finally ate my sins.
Surprisingly, or maybe not so, a few weeks later, the elation faded, and I succumbed to a subtle shade of melancholy as I realized I could no longer eat sins.
Vincent A. Keszei is an ophthalmologist.
