By Nasser H. Hanna, MD
Life is simple until it becomes complicated. Keeping your eye on the big picture is not always easy. At difficult times, I like to break life down to its basics by recalling some universal truths of living a simple and honorable life detailed in one of my favorite books, All I Really Need to Know I Learned in Kindergarten by Robert Fulgham. Amongst many of his lessons are:
- “Say you are sorry when you hurt somebody.”
- “Put things back where you found them.”
- “Clean up your own mess.”
- “It is still true, no matter how old you are—when you go out into the world, it is best to hold hands and stick together.”
I like reminding my students of these life lessons. Most of my students will tell you that I tend to teach about the philosophy of taking care of patients as much as I teach medicine. Some of the common lessons I teach are just as simple as those of Fulgham:
- “Be kind to others.”
- “Learn to listen, to truly listen.”
- “Be a steady force for your patients.”
- “Be sure to regularly restore yourself.”
One of life’s most difficult lessons, though, is about forgiving… not others, but yourself. Just as forgiving someone can be emotionally liberating to both the forgiver and the forgiven person, forgiving yourself can lift silently held burdens that shackle you.
Why do we need forgiveness? I believe many oncologists carry an extra burden taking care of patients at high risk for suffering and death. When patients have complications from treatment or suffer debilitation from their cancer, it is easy to blame yourself for this suffering. The guilt can be paralyzing: “What could I have done differently? Did I give the best advice? Would they have been better off without treatment?” In addition, sometimes patients or their families shift the burden of their terrible circumstances onto you to fix…which implies that an inability to fix it is due to your shortcomings, not the reality of the dreaded disease and the imperfect treatments we have to offer.
Of course, guilt is not always a bad emotion; however, misplaced guilt is. I believe most oncologists suffer in silence. For me, an excellent illustration of the redemptive power of self-forgiveness is dramatized in one of my favorite movies, Good Will Hunting. Robin Williams plays the role of a therapist who is trying to understand and reconcile the tremendous emotional pain his patient, Will, has been acting upon—abuse, neglect, and abandonment. In a stirring scene at the movie’s end (spoiler alert—although the movie is 20 years old!), Williams’ character, having earned Will’s trust, simply tells him, “It is not your fault.” He repeats the line, softly but firmly, several more times. “It is not your fault.” Years of suffering and months of therapy culminate in this emotional moment of self-discovery, reconciliation, and forgiveness.
I have learned over the years the importance of being kind to oneself. It is not always easy. The oncologist’s “martyr” instinct sometimes intervenes. Nevertheless, we should strive to do the best we can to be kind to ourselves, for the sake of our patients, families, and loved ones, and ourselves. Forgive. The cancer is to blame, not you. It is not your fault. It is not your fault. It is not your fault.
Dr. Hanna is a professor of medicine at Indiana University. He specializes in the study and treatment of lung and testicular cancers.