34 Becoming a Patient
authority and protecting them against strangers’ bodies and disease. Such
authority and belief can reinforce one another. Charles added:
We have the right to give drugs and do things that no other human
being has. I can put a needle into your spine and thread a wire up it.
I have this tremendous power over people, and therefore maybe
over myself. Maybe I can keep anything bad from happening to me,
because I know that if I’m diligent, I can keep anything bad from
happening to patients. If something bad does happen to a patient,
I think, ‘‘How could it have happened? I was perfect.’’
Charles suggested here, too, the lack of self-reflectiveness that physicians
may often have toward their work.
Some thought that morally, physicians in fact somehow should not get
sick—that they implicitly had a contractual and moral imperative not to.
David, a practicing psychiatrist with HIV, said:
I tell myself, ‘‘You have to hold onto your end of the bargain. You
said you were going to take care of a patient and now you can’t.’’
People say, ‘‘Patients would understand.’’ But I know they
wouldn’t. They got screwed.
Intuitively, David felt that illness was not part of the agreement that
doctors make with patients. This attitude, instilled through years of
training, marks the thickness of the psychic armor that doctors don—the
belief that, for various reasons, physicians simply do not get ill.
These beliefs assume the status of myth, inculcated through train-
ing and reinforced throughout the culture of medicine. Deborah, a
psychiatrist-in-training with breast cancer, said:
It’s arrogance: ‘‘I’m a doctor, I’m protected.’’ It’s a myth: ‘‘I know
how to take care of myself and diagnose my problems.’’ Doctors
think it will never happen to them. But that is such a mistake.
Because it can and probably will happen.
Medical students identify first with patients, and only later with fel-
low physicians. Medical training radically challenges these trainees, taking
them apart psychologically, wounding them. They must then put them-
selves back together, and end up identifying with fellow doctors.
Yet given these defenses, carefully built over years, the eventual loss
of this sense of invincibility can prove devastating, undermining prior