The situation described here is clear enough: the doctor must treat a hateful patient and restrain himself from acting unprofessionally. But the last stanza of the poem is provocative and begs for interpretation. During the night, without conscious volition, the doctor's instrument--his hand--has lost its efficacy. Why?On the one hand, if the doctor is physically unable to treat, then he is not responsible for withholding treatment. On the other hand, by being rendered professionally helpless (temporarily at least) perhaps he is being punished for not taking a moral stance against his patient. This interpretation seems to have validity because the last line recalls Psalm 137, which warns, "If I forget thee O Jerusalem, let my right hand forget her cunning."The poem is useful for a discussion of how physicians and other caregivers feel about interacting with hateful patients, and where the limits of professional responsibility lie. [For drawing attention to the biblical reference I am grateful to Dr. Danielle Ofri and Lara DeLong, Class of 2001, both at NYU School of Medicine.]