Taking the Hippocratic oath is, in some ways, like taking the vows of marriage. We dutifully sign on "for better for worse" and pledge our ardor "in sickness and in health." Mostly, though, we are healthy when we say these words, and things are generally "better." Despite our earnestness, it is difficult to imagine a time when things might be different, when the debt—so to speak— might come due. Similarly, when we become physicians, we commit (in a general and vague sense, and in the safe confines of the graduation hall) to caring for all those who present to us with their suffering.
Sooner in medicine than is usually the case in marriage, however, the dark side of the promise asserts itself. Patients we would rather avoid—because of their religion, race, sexual preferences, social habits, or the dangerous or disquieting aspects of their diagnoses—demand our attention, our compassion, and our