Takeaway
Mistakes happen. To move forward, reflect, speak with trusted colleagues and loved ones, and make amends where you can.
Lifelong learning in clinical excellence | February 27, 2026 | 2 min read
By Karl VanDevender, MD, MPhil, Centennial Hospital, Nashville, Tennessee
Mistakes of omission and commission are inevitable in the practice of medicine. And the spiritual injury incurred through mistakes is a contributor to burnout.
Burnout is a term that implies that the flame has died from lack of fuel. Fuel depletion does not seem like an apt image to me. Rather, the energies of guilt and responsibility can become an overwhelming fire within our spirit.
We may hope for things to be other than the way they are. We may hope that the flame will abate but not go out. In Greek mythology there is the story of Pandora’s Box. Zeus filled the box with greed, avarice, envy, and other potential human corruptions. As the king of the Greek gods predicted, Pandora’s curiosity caused her to open the box and free these sins to torment mankind. However, hope remained in the box.
Why was hope in the box?
The ancient Greeks believed that the world was the physical embodiment of the mind of Zeus. It was sacrilegious to hope for the world to be different than it was. In many Buddhist traditions, enlightenment is seeing and accepting the world as it is: impermanent, non-self, and inherently meaningful. In the Western tradition, atonement is interpreted to be a path to the washing away of the guilt that seems to haunt everyone at some point in life.
How we assuage guilt draws upon many traditions, most of which are deeply individual. In my own reflections on the life and death of my patient Dr. C (click here to read “The last appointment”), my intention was to help, and the act of listening was what I believed to be appropriate in that moment. His death was an unintended, yet not unforeseen, outcome.
Dr. C’s particular history and life were uniquely his. His life was defined by his choices and by realities out of his control. My part in his life was small. And my part in his death remains unclear to me. Time and rumination have brought me to a peaceful acceptance of his life, his death, and my role in them.
I offer this essay in the hope that it helps other healthcare professionals find companionship in carrying the weight of guilt, and move toward a compassionate acceptance that allows them to keep practicing with an enduring inner flame.
This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.