Fallen

I have served on many committees doing hospital work but none was so intellectually and emotional challenging as the credentials committee. By and large, most physicians joining the staff, coming through this gatekeeper were straightforward. However, there was a smaller group with ‘issues’, one was tardy with their dictations, another had more than 20 settled malpractice cases, and of course, there was the occasional DUI. That is when it became clear that at credentials the issue was, do you believe in redemption? Are they truly repentant?

Morbidity and Mortality conference where I trained was a morality play of sorts I have been interested in the subject throughout my surgical career. As a fellow, I discovered Charles Bosk’s study of M&M conference, Forgive and Remember. Even during the MBA, I ran into the concepts, around regret and its effects on our behavior in the work of Kahneman and Tversky and in the discussions about apology for medical errors.

“Sin is about pretending that something is true when in fact it is not.. Repentance is about choosing truth over deception … sin is … more like an illness than it is like death… it’s a sense that there’s something wrong that needs attention, but its not something that is necessarily my undoing. … It’s a mistake. And a mistake can be atoned for, and it can be undone.”

All atonement, all 12-step programs begin with acknowledging the mistake. Acknowledgement is exceedingly difficult. Denial is often, for me and many others, our first response; because having violated our sense of self, acknowledgement disrupts our private persona and its visibility disrupts our public persona. Even when I am able to make the leap of faith necessary to accept my own failing in order to heal the private persona, attending to the public persona is more difficult. It requires vulnerability in public. That is a discomfort that I was able to work through at M&M (god knows, I spent enough time there in 30 years confessing my ‘sins’) but self-recognition was more evanescent at Credentials.

“… the rabbis have this extraordinary idea that if you need to repent to a person who’s died, you’re suppose to go to the grave of that person, and bring with you ten members of the community. …And in the hearing and the witness of those ten people, you apologize to the deceased. And thereby you do repentance.”

We bear witness in front of our peers acknowledging actions that have let us and by extension, our community, down. Repentance binds us to our community more tightly because it expresses shared values and frailties. To come to credentials, before a community you wish to make yours and acknowledge failings requires you to be open, exposed. I think the real emotive power underlying credentials, the reason I would leave the meeting exhausted was that individuals wishing to join our tribe would expose themselves in a situation that was not necessarily “safe”. Sometimes in those situations, the least transparent among us were the most vociferous against redemption. Perhaps those that hadn’t forgiven themselves were not ready yet to forgive others. Moreover, in the same situation, the recovering sinner empathized and made space for repentance.

Quotes are from Louis Newman, The Refreshing Practice of Repentance