Conclusions 299
starting to light Sabbath candles; Charles left the Republican Party after developing AIDS. Bradley was the son of an academic physician, and thus more committed than he may have otherwise been to helping those less fortunate. He started out more liberal than Charles, and grew up with a strong sense of social conscience, yet illness changed him, too. His depression prompted him to become more open to younger colleagues’ perspectives, and to less biomedical forms of spiritual healing.
Psychological traits also shaped these physicians’ responses. Inner sense of self and outward role molded each other. Dan, who had chest mets, had always been very assertive. Now, as a patient, he still‘‘ yelled and screamed’’ and got what he wanted. Juan, a gay Latino, had felt bad about himself growing up, and now clung to the role of physician as a key source of self-esteem, even as his disease worsened. Illness itself could also modify character traits. Frank became more relaxed about his cancer after his MI in the OR. Serious disease compelled these men and women to grapple with the most fundamental existential issues. All patients, not just physicians, wrestle with mortality, suffering, and pain. But physicians encounter death and dying daily as part of their job, and thus more than most others. They each developed their own responses to their patients’ pain, finding stances or styles with which they felt comfortable, even if at times becoming calloused or distanced.
Through these experiences, holding on to one identity appeared easier than combining two or more. Reinventing or reconstructing oneself takes energy and creativity. Their institutions tended to see these individuals only one way or the other— as functioning doctors or as patients— and could not widen this conceptualization. Institutions wanted doctors to be powerful, unimpaired. They tended to see ill physicians first as still doctors, and then later as‘‘ merely’’ patients. For example, Deborah was told she had to be at rounds at 9 A. M., even if she was receiving radiation therapy. No exceptions would be made. Later, her institution would not even give her back voice mail, appearing to have written her off as dead. Institutions had difficulty seeing these ill doctors as occupying both roles.
In part, as a result, these doctors had trouble integrating these identities, as demonstrated in their puzzlement over what to call themselves when no longer practicing. Importantly, others played vital roles in how one structured and viewed oneself. Disease altered one in one’ s own eyes, and those of others. Forging identity emerged as a complex and interactive social process.