An unneeded apology?

The three-year-old astronaut rockets through space and hurtling by the sun he takes a hard right around the coffee table. The gift, an ornate vase, tiny pale flower appliqués, fine glass vines, sits too near the solar system’s edge.  Disturbed, gravity throws it to the carpet where it is obliterated in an explosion of white shards, cascading water and fallen roses.  Loss in her heart, anger rising to her face, his mother turns toward.  Thus, begins the lesson.

Recently, I gave sad news to a patient and family.  Despite extensive therapy, to which this patient gave his all, the disease is increasing and the options are limited.  It was a tough meeting, which drained him.  A grim future is becoming clear; we all cried a little.  At the end of the meeting, as they were getting up to leave, the patient took my hand and said, “I am sorry you had to do that.”

After he left, I thought about his words.  He could have just said “thank you, for being honest,” or perhaps, “I appreciate your care.” Why his need to apologize?  I understand that he was expressing his appreciation for my care, and perhaps trying to tell me he had accepted the news, however he also felt guilt about what I had just gone through, as if he, not the dread disease, is responsible for my tears.

Patients and families often apologize.  Sometimes it makes sense, such as “I am sorry I’m late,” or “I am sorry to drag you in at midnight.”  However, it seems to me that at other times, saying “I’m sorry,” shows a peculiar side to human character.  We feel guilt about things we cannot control, and apologize to people who have made their own decision to be involved, either because they love us or because it is their calling.

When my patient said he was sorry for what he had put me through, he was taking responsibility for a cancer, which is not his fault.  His particular disease has no known cause, and if it is related to lifestyle, science has not figured that out. So, why should he feel guilt?  Is it a human tendency to try to control things, we cannot control?

However, even if he feels responsible for his illness, why apologize to me as if he has caused me unnecessary discomfort?  Is it that hard to accept that someone would want to be there, at his side, simply to support him, simply because he is special, simply because he is fellow man?  We have difficulty believing that other people, be it family or a professional caregiver, have chosen to be with us, and it is not and never could be a hardship.

Are we each so worthless, that we do not deserve care?  Are we taught as children that we let down everyone we love and therefore we cannot believe someone would sacrifice for us?  Is it so bizarre that a doctor would want to be at the bedside during the darkest hours, because the doctor believes every man and woman deserves support and love?

His mother pauses a vital moment. She sees his eyes round, corners moist, body frozen. She registers her own disappointment and tempter rising. She kneels down. “Are you OK?”  He nods yes. “Are you sure you are not cut? You didn’t hit your head?”  He shakes his head, no. “OK, be careful with the glass, while I clean it up. Maybe you shouldn’t be running around in the living room.”  “OK, Mom, I’m sorry.” “That’s OK, honey, I put the vase close to the edge.” 

Thus, I choose to hear apologies as “thank you;” my patient’s are not at fault. They do not give me unwanted pain, I accept loss is part of the work I do.  More than that, I yearn for a world where no person feels guilt and all know caring is not a burden.  Patients walk a difficult path, but it is not of their doing; not something caused or wanted.   Nevertheless, for me, it is what I have chosen, and I have decided we shall walk together.  For the hard journey ahead, I am sorry.


  • We all have different ways to communicate what we feel. And we empathy with our oncologists and medical teams who have supported us throughout. So it really means thank you for the extra time with our loved ones you have given us, so you are hearing them correctly.
  • Mary
    We apologize because in our life-before-illness, we were strong problem solvers and we are no longer; instead we are scared and vulnerable and we are now the problem needing a solution. We apologize because valuable time and resources are being focused our way and we struggle with the necessity of that reality. We apologize because the appointment, the phone call, the interruption or inconvenience always takes longer or is more complicated, and we don't like being "that" patient. We apologize because our medical team is forced to sweat and cry and battle the beast with us even though it is their choice. We apologize because we are ill - and maybe, just maybe, if we say a million "I'm sorry's" this will all miraculously go away and we can get back to our lives before illness. (I obviously haven't hit the million "I'm sorry" mark)
  • Angela Evans,R.N.
    I am afraid that you right on two points. First,we are taught and made to feel that we are unworthy of love,and of someone choosing to be with us simply because we have the need. Secondly,I believe that you are an exception to the rule rather than the rule itself. Most physicians do not take the time to sit and be with their patients in a way to truly meet their needs. Everything is always hurried. This is true of the good extremely qualified docs as well. If you don't go in prepared,and organized then you lose out. I know this is not purely physician choice. I understand it is survival and business for them. I miss the days where you saw your own doctor if were sick,and if you sick enough to be hospitalized,that same doctor admitted and followed you while you were there until discharge.
  • Karen Irwin
    I remember saying "I'm sorry" to my son's oncologists when he was in treatment before he died. But I wasn't feeling guilty for putting them through a difficult conversation; I wasn't feeling unworthy of their care. I simply felt sorry that they had to have heart wrenching conversations with parents of dying children. I simply felt sorry about that. I think you may be reading too much into it.
  • IBS
    If I was the patient and said "Im sorry," I would be telling the doctor, "thank you for trying to help me, but It's my time. Please do everything you can so I don't suffer on my journey. I have family waiting for me.
  • D Someya Reed
    Sometimes “I’m sorry” may have cultural roots and be considered politeness and humility. In China, if someone offers you something, it is polite to refuse it (repeatedly) just as it is polite for them to keep offering it even as you keep refusing. In Japan, if someone gives you a gift it is polite to give them a gift of equal value (and includes both parties going through the same series of refusals or saying “It’s too much,” etc.). It can be more of a humbling gesture for some than a feeling of worthlessness. My wife was Japanese and her Issei roots (first generation immigrants) were way back in her family; however, her family always taught these values through the generations. For her, the plentiful “I’m sorry(ies)” even to me were from feeling ashamed of having had put someone else in a position (to care for her). It didn’t matter that you’d chosen it, wanted it or just accepted it. The fact that her condition put someone in that position (as caregiver, doctor…whatever) was her “responsibility.” Apologies are a show of gratitude and respect for time, effort and care/caring spent on someone else’s behalf. When my wife was feeling bad and said “I’m sorry,” I would simply hug her and tell her how much I loved her. When she said it while feeling better, I would badly paraphrase a line from a movie such as “Well, I couldn’t think of anywhere else to be right now.” Then, with her photographic memory, she would tell me which movie it came from, what the real quote was, who said it and we would both laugh. There was always a hug and a kiss for this scenario, too. This reminds me of a bit of (somewhat appropriate…well, I think it is) dialogue from a movie we both liked (snuggled on the couch, eating popcorn…dogs begging). Points to anyone who can name the movie and bonus points for the names of the two actors playing the main characters. Here it is: Eve: Now hold on, hold on just a minute! In the first place I do not fall in love with weirdo's I've only known for four or five days! Troy: Yes you do. Eve: And I don't fall in love with grown men who collect baseball cards! Troy: Yes you do. Eve: Or pee in their pants when they see the ocean! Troy: Yes you do. Eve: Or have perfect table manners! Troy: You know, I asked him about that. He said, good manners are just a way of showing other people we have respect for them. See, I didn't know that, I thought it was just a way of acting all superior. Oh and you know what else he told me? Eve: What? Troy: He thinks I'm a gentleman and you're a lady. Eve: [disgusted] Well, consider the source! I don't even know what a lady is. Troy: I know, I mean I thought a "gentleman" was somebody who owned horses. But it turns out, his short and simple definition of a lady or a gentleman is someone who always tries to make sure the people around him or her are as comfortable as possible. Eve: Where do you think he got all that information? Troy: From the oddest place - his parents. I mean, I don't think I got that memo from mine.
    • James Salwitz, MD
      Absolutely wonderful thoughts and story. Perhaps saying "I'm sorry" is shorthand for "I respect and appreciate you, and maybe, just a little, I feel unworthy." My parents actually believed and taught me that perfect table manners were indeed a sign of respect. Thanks so much for your time and thought, jcs
  • D Someya Reed
    Also, I’ve been meaning to say this for about the last 4 or 5 of your posts but I’ve been “slumming” over at Kevin MD. Just kidding, but I have been reading a lot over there. Very different “style.” I don’t agree that you are rare and I hope I never come to feel that caring physicians or humans are in short supply. What is rare about you (and this is the difference between Sunrise Rounds and Kevin MD/other blogs) is that you are willing to put your feelings to page, not just your knowledge. I think all of us appreciate that.
    • James Salwitz, MD
      Patients have been opening up to me for so long, somehow it seems wise to return that passion. jcs
  • IBS
    Dear Dr. Salwitz, Because I've been always sick, I can look at a person, calling himself the BEST DOCTOR. Is his hair perfect? The best clothes, shoes polished, manicured nails trying to be a GQ model? That's a narcissist. I know many Narcissists; not an MD, even if he is a genius. He would never make a mistake, nor believe a patient because he would never err, or an MD who was jealous of another MD because her own showed up as he saw his patient from the ER board and told him to immediately leave. A patient was in the same room divided by a curtain praying with her family. Two nurses and another MD, the patient also knew, asked: " Does he know you?" Nope. You see, it wasn't the patient he was upset with. He never saw her in his life. It was the idea she wanted her own Doctor; a man with empathy, someone who actually cared about people and not cause undue stress nor judge; the BEST DOCTOR. Okay, he finally broke the dam, and the water went swirling around; slapping him in his face with sticks and stones, trees falling by his wayside because the Narissist forgot who he was, and the patient had to remind him. Not by cursing or yelling, but asking him why he doesn't like this patient? At first, he denied it, but he was calling out things that a person should never say. He then had to admit it and apologized. At that moment, he became a human again. Hopefully, he's kinder and learns to feel again. Dr. Kevin is just another narcissist.
    • IBS
      Make sure your toe nails are manicured too while you have a massage....Yes, you deserve it. I just went there before to see what you read. He's like a QVC person. "I'll cure your bad marriage" " Make your IQ 300"" What caught my eye was the article by Pamela Wible, MD. First I got teary, then I felt sick" and then her words made me throw up! She has to be a crazy maniac.

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