![\"painting](\"https:\/\/www.newsbeep.com\/au\/wp-content\/uploads\/2025\/09\/mattoonembed.jpg\"\/)
<\/p>\nSaint Roch was never supposed to touch his patients.<\/p>\n
According to medieval legend, that\u2019s what a hospital director tells the pilgrim and future plague saint when he arrives in Acquapendente, a village along the Via Francigena to Rome that was buckling under a wave of bubonic plague. Even in the fourteenth century, Europeans understood that the plague was contagious, and physicians advised caregivers to save themselves rather than keep a bedside vigil for the sick. But in his hagiography, Roch reprimands the hospitalist for this warning, asking \u201cWhy should we, who imitate Christ, be so sparing of life?\u201d Then, with a frightening certainty, \u201cLet me go to the sick!\u201d<\/p>\n
The morning after Roch makes his rounds through the village, the city is cured. After packing his meager belongings and swearing the townsfolk to secrecy, Roch sets off to continue his pilgrimage, repeating this miracle in the next Italian village.<\/p>\n
I first encountered Saint Roch\u2019s story in medical school while studying plague saint legends following the Black Death. Roch\u2019s cult spread just as infectiously via vox populi, yet wasn\u2019t recognized by Rome until over a century after his hagiography came into print. It\u2019s easy to see why the story was so popular. Even reading Roch\u2019s exchange with the hospital director today, his readiness to serve feels heroic.<\/p>\n
<\/p>\n
Jacopo Bassano, Saint Roch Visits the Plague-Stricken, 1575. Photograph by Peter Horree \/ Alamy Stock Photo.<\/p>\n
The first year of medical school was a time when expectations for the rest of my career were constantly being set by those above me. In my case, I was told how to \u201csurvive\u201d much more than I was told how to give. Lecturers employed the term \u201cburnout\u201d so often that it deserves a flashcard in my AnkiDeck. There\u2019s a reason it has become a buzzword. In 2022<\/a>, 46 percent of health care workers reported feeling burned out, and 44 percent intended to change careers. The solution to burnout, I have learned, is yet another popular buzzword: boundaries.<\/p>\n The use of the term \u201cboundaries<\/a>\u201d has climbed in the twenty-first century, but a similar concept has always been part of medicine. Even in the time of bubonic plague and Saint Roch, the limits on obligations to the sick were being muddled and debated. Domenico de’ Domenichi, the contemporary Bishop of Brescia, characterized flight from the sick as a natural extension of God-given reason, an instinct so natural that it was even granted to birds. In 1889, William Osler prescribed \u201caequanimitas\u201d to graduating doctors and nurses, a sort of stoicism and imperturbability to patient misfortune that is still the official motto of residency at Johns Hopkins Hospital.<\/p>\n In today\u2019s health care model, \u201cboundaries\u201d might mean interrupting a patient\u2019s story to wrap up a visit on time; limiting patient phone calls; or, in the case of shift work, leaving on time with robotic self-discipline. I think these efforts are well intentioned but not above questioning. As a buzzword, \u201cboundaries\u201d falls in the lexicon of therapy-speak<\/a>, which has been criticized for making human relationships feel transactional rather than collaborative. And even in plague times, writers like Giovanni Boccaccio in The Decameron characterized caregivers in flight as morally depraved, leaving their loved ones to die alone with doors locked from the outside. It\u2019s no wonder that the hero of plague times became a man like Saint Roch, a man willing to put the logic of self-preservation aside in order to care for the sick.<\/p>\n Saint Roch\u2019s journey through Italy forced me to grapple with my own questions about how far I might be willing to go for the patients around me. If the plague came today, I feared I would not be like Saint Roch, eager to make the sign of the cross on his patients\u2019 hands. Instead, would all I had been taught make me more like the cynical hospital director, erecting an antiseptic screen to separate myself from the sick?<\/p>\n The archetype of the \u201cgood doctor,\u201d continuing in the tradition of Saint Roch, often depicts a man or woman defined by a certain disregard for such boundaries. One example is Dr. Jim O\u2019Connell, the president of Boston\u2019s Health Care for the Homeless and the subject of Tracy Kidder\u2019s book Rough Sleepers<\/a>. While reading the book with classmates, a friend mentioned that O\u2019Connell\u2019s clinical care pushed our conceptions of standard clinical practice. What boundaries can you have, after all, in a clinic with no walls?<\/p>\n In Rough Sleepers, O\u2019Connell is a physician seen walking his patients to the pharmacy and putting his card down at the register. A physician who comes to his newly housed patient\u2019s home in the middle of the night after getting a call that the TV won\u2019t turn on. A physician who sometimes drives his patients to court. When I ask him about the first time he felt his boundaries start to shake, O\u2019Connell describes the transition from his medical residency at Massachusetts General Hospital to practicing medicine among the homeless. Rapid visits and rigid systems worked at a large academic medical center. But homeless folks have been failed by these systems, so it\u2019s natural for them to distrust the traditional medical model. In order to gain that trust back, O\u2019Connell found he had to go outside the traditional boundaries of a physician\u2019s job. \u201cYou have to share your own story with them while they share with you. You have to get coffee with them. Take time,\u201d he says. \u201cIt\u2019s no longer a fifteen-minute clinic visit in which you get everything done.\u201d<\/p>\n O\u2019Connell also notes that the notion of being embedded within a patient\u2019s life is not radical. \u201cWhen I grew up, we had a family doctor. The family doctor had delivered my mother, delivered me, delivered my sisters, lived down the street, often came over for dinner, and when we were out doing stuff in town we\u2019d often run into him,\u201d he says. \u201cI remember thinking in those days that the doctor is very much a part of the community.\u201d This medical ideal has always existed, but it\u2019s often absent from health care for the homeless, where physician turnover is high. \u201cThe other boundary that I wasn\u2019t really ready to broach but needed to was: Are you doing this for a short-term piece of good work, or are you doing this as your career?\u201d More than spending an extra fifteen minutes with a patient, O\u2019Connell needed to be ready to devote his life to the homeless.<\/p>\n As patients need time to learn to trust O\u2019Connell before they open up, this time spent with them also informs the so-called boundaries he chooses to cross as a physician. When I ask about the report that he used to slip twenties to patients during appointments, he admits that he wouldn\u2019t advise a new staff member to do the same. His giving was directed toward patients with whom he was familiar. \u201cAs I got to know people better, I felt much more comfortable if I knew them well and I knew what they wanted, just giving them some money,\u201d he says. However, he acknowledges that giving cash is a controversial practice for physicians, and his team now hands out gift cards to McDonald\u2019s or Dunkin\u2019 instead.<\/p>\n O\u2019Connell shrinks from allegations of heroism in his work, but his archetype in Rough Sleepers is also mythologized in modern storytelling. In the Emmy-nominated TV series The Pitt, a similar kind of physician is seen in Dr. Samira Mohan, who quickly became a fan favorite<\/a>. Nicknamed \u201cSlo-Mo\u201d by her more cynical colleagues, Mohan is constantly criticized for taking too long with her patients (her superiors are partially concerned that it harms the hospital\u2019s efficiency metrics). Yet Mohan\u2019s patience with every clinical case enables her heroic saves throughout the season. She sees a patient labeled \u201cdrug-seeking\u201d and discovers a sickle cell vaso-occlusive crisis, or reexamines a girl destined for the psych ward only to find that she actually has heavy-metal poisoning. Medicine stands at the forefront of Mohan\u2019s life; she mentions not having a romantic partner or family nearby, and other characters warn her that medicine can\u2019t be her everything. But that doesn\u2019t stop Mohan from staying hours after shift for the fun of it, smiling with a perky \u201cI love my life\u201d long after other colleagues have crashed.<\/p>\n In an interview with Harper\u2019s Bazaar<\/a>, actress Supriya Ganesh states that Mohan\u2019s character was developed in response to the \u201cbrokenness\u201d of the medical system, which often leaves women, and particularly women of color, feeling that they aren\u2019t taken seriously as patients. Even after being told to limit her time with every patient, Mohan chooses to spend it with the hospital\u2019s most vulnerable. This philosophy of practice mirrors that of Saint Roch and Jim O\u2019Connell, who also adjusted their norms of caregiving in response to social crises (plague for Roch, homelessness for O\u2019Connell). In pushing the boundaries of normal medicine, all three of these examples are celebrated for their heroics.<\/p>\n Yet for all three, there comes a point in the story where no good deed goes unpunished. Roch does indeed contract plague after all his healing endeavors. Instead of being cared for, he\u2019s driven from the city he was trying to help. In Rough Sleepers, O\u2019Connell experiences true grief over the death of a patient and calls it \u201cthe beginning of the end.\u201d And in The Pitt, one of Mohan\u2019s final scenes isn\u2019t one of victory but of despair. She\u2019s sobbing alone in a hospital restroom, throwing her paper towel into a blood-stained trash can.<\/p>\n The term \u201chealth care hero\u201d became popular around the time of the Covid-19 pandemic, but its use is not without criticism. Some <\/a>physicians<\/a> argue that comparing their daily work to heroics justifies their poor working conditions or outlandish quotas without calling on employers to actually support them. Yet stoic aequanimitas and rigid boundaries don\u2019t feel like the panacea for a profession designed to walk with patients from cradle to grave. In The Woods Hole Cantata<\/a>, Dr. Gerald Weissmann argues that aequanimitas was a practice \u201cnot only devoid of passion, but of joy.\u201d<\/p>\n