The Scarlet Letter: Stigma, Shame, and the Systems That Mark Us
“It meant Able; so strong was Hester Prynne.”
— Nathaniel Hawthorne, The Scarlet Letter (1850)
The Scarlet Letter might not seem like a Halloween story. There are no ghosts, no midnight bargains, no haunted houses. Sometimes, though, the most chilling places aren’t the fiery depths of hell; they’re the quiet, bureaucratic ones. The ones where everyone keeps going through the motions while something sacred rots underneath. In Dante’s Inferno, the earliest circles of hell are reserved not for the monstrous, but for the mediocre. The souls who simply refused to see, to act, to care. Hester’s world is that kind of ordinary purgatory: a polite society that confuses shame for morality and calls it order. And, if we’re honest, modern healthcare knows that kind of landscape too.
Every system leaves a mark.
In Hawthorne’s The Scarlet Letter, Hester Prynne walks through her town wearing a bright red “A” meant to define her forever. But she stays (quietly, stubbornly) and over time the letter changes meaning. It no longer stands for her sin. It stands for her strength. Healthcare has its own versions of that scarlet letter. And not just for patients. We’ve already talked a lot about the labels that harm patients — noncompliant, difficult, anxious, frequent flyer. But the system brands its clinicians too.
If you question a policy that hurts patients, you’re difficult.
If you believe the work could be done better, you’re idealistic.
If you say no to unsafe volume or hours, you’re not a team player.
These aren’t whispered judgments. They’re built into the culture. We carry them on our name badges, woven into “feedback,” tucked between performance metrics. And still, like Hester, many of us stay.
Staying Isn’t Surrender
When I think about Hester, I think about every nurse, NP, physician, and social worker, etc. who’s stayed inside a system that keeps calling them too much and not enough all at once. The longer you’re in healthcare, the more ghosts you accumulate… old notes, old expectations, the memory of a patient you couldn’t save because the system couldn’t stretch that far. Leaving is tempting. Some do, and, sometimes, that’s the healthiest choice. But, for those who stay. For those who still believe in the work itself, beneath the noise.. staying is not surrender. It’s a kind of redemption.
Like Hester, we stay not to prove we’re perfect, but to prove the system isn’t beyond saving.
Reclaiming the Mark
In the novel, the community tries to erase Hester with one letter. But, she keeps showing up. Sewing for the poor, nursing the sick, walking the same streets that once turned away from her. Over time, the townspeople start to see her differently: “It meant Able,” Hawthorne writes. There’s something powerful in that slow reframing; not by argument, but by presence.
Clinicians do that every day. We walk back into the same charting systems that break our hearts. We advocate for patients who’ve already given up on being heard. We write the same “unmet needs” line in every discharge summary, knowing it shouldn’t have to be there. And we keep showing up.
Each act of integrity is a small rewrite of the story. Each patient who feels seen again is proof that the letter doesn’t mean what they said it did.
The Quiet Work of Redemption
Redemption doesn’t arrive with policy reform or a new EHR update. It happens in quieter ways:
When a nurse pauses to explain a new medication, even though he’s supposed to keep moving.
When a physician tells a patient, “You deserve to understand this.”
When a care coordinator helps someone fill out the same form for the fifth time, because she knows that’s the only way it will actually get processed.
None of it changes the architecture overnight. But it changes the meaning of the work inside it. As Hawthorne wrote of Hester: “She had learned much through misery... She was patient, she was steadfast.” The scarlet letter didn’t disappear. It became a signal of resilience.
Staying Human in a System That Forgets
Healthcare today often forgets its human parts. Providers are rated, scheduled, and optimized until there’s no room for the small, unquantifiable acts that make medicine real. As we’ve reported before, the toll of that forgetting is staggering as nearly two-thirds of physicians report burnout symptoms, and moral injury and this continues to rise (Shanafelt et al., 2021; Dean et al., 2019). Yet, despite everything, many still stay. Not because it’s easy or comfortable, but because leaving the work entirely would feel like losing part of themselves. That’s what Hawthorne saw in Hester Prynne. A person who refused to let her calling be defined by other people’s fear. Who stayed, not to preserve the system, but to live differently within it.
The Letter Still Glows
By the end of The Scarlet Letter, Hester’s mark remains. But it’s changed for her, and for those around her. She’s still the same woman, but her presence has rewritten the moral code of her community. That’s the invitation for healthcare now: to redefine what it means to stay. Staying doesn’t mean agreeing. It doesn’t mean ignoring the harm. It means bearing witness long enough to build something better inside the cracks. The system may never fully understand the people who choose to stay. But those are the people who quietly change what the letter means.
From “difficult” to discerning.
From “idealistic” to anchored.
From “too much” to still here.
Because, maybe, that’s the redemption. Not escaping the system, but outlasting it until the meaning changes.
References
Dean, W., Talbot, S., & Dean, A. (2019). Reframing clinician distress: Moral injury, not burnout. Federal Practitioner, 36(9), 400–402.
Hawthorne, N. (1998). The Scarlet Letter. Penguin Classics. (Original work published 1850)
Shanafelt, T. D., Hasan, O., Dyrbye, L. N., Sinsky, C., Satele, D., Sloan, J., & West, C. P. (2021). Changes in burnout and satisfaction among physicians and the general U.S. working population between 2011 and 2020. Mayo Clinic Proceedings, 96(7), 1916–1928. https://doi.org/10.1016/j.mayocp.2021.03.026
