In the Field
The Case for the Elder Son
It is Lent. As I write this, today’s reading is the parable of the prodigal son in the Gospel of Luke. Most reflections linger on the younger son, his dissipation, his humiliation, and the astonishing mercy of the father who runs to meet him. I find myself drawn elsewhere. I am standing outside with the elder brother.
The younger son demands his inheritance, wastes it in reckless living, and returns in disgrace. The father restores him without hesitation. A robe. A ring. A feast. Music in the house.
The elder son has remained. He has worked. He has obeyed. He has not shamed his father. When he hears the celebration, he refuses to enter. His protest is simple and intelligible. “These many years I have served you… yet you never gave me a young goat.” It is not an extravagant complaint. It is a plea for proportionality.
His grievance does not sound foreign to me.
In medicine, particularly in emergency medicine, I often feel like the elder son. I followed the prescribed path. I deferred income and youth. I studied when others slept. I stayed within the boundaries. I did not squander my body with drugs. I did not abandon children. I did not drink myself into organ failure. And yet much of my professional life consists in cleaning up the wreckage left by those who did.
The overdoses return. The alcoholic bleeds again. The brittle diabetic ignores his regimen and arrives in crisis. The violent man cycles through the department for the fifth time this month. I stabilize. I intubate. I admit. I discharge. I repeat.
It is difficult not to feel that the distribution of effort and reward is inverted. The one who squandered receives urgency, resources, and emotional intensity. The one who remained receives routine. Stability is invisible. Crisis commands attention. The music is reserved for catastrophe and rescue.
I am sensitive to unfairness. Most physicians are. Our moral reflex toward proportion was not formed in the abstract. It was trained into us.
Our careers depended on measurable performance. High grades opened doors. Class rank mattered. Exam scores determined opportunity. A strong transcript led to admission to the next stage. High school performance determined college. College performance determined medical school. Medical school performance determined residency. Residency performance determined fellowship or a first job. At every step, achievement was supposed to be rewarded with advancement.
We internalized that structure early. Effort produced results. Discipline yielded advantage. If a grade was assigned unjustly, it was not a minor irritation. It threatened the trajectory of an entire life. We learned to protest when evaluated unfairly because fairness was not philosophical. It was existential. A single number could close or open a door.
Becoming a physician is a decades-long project built on that premise. Merit mattered. Performance mattered. Proportion mattered. We did not sit quietly when we believed those standards were violated, because our futures depended on them.
The father in the parable did not operate on that logic.
He does not deny the elder son’s faithfulness. He tells him that all he has belongs to him. The inheritance was never at risk. The relationship was never threatened. Yet he still celebrates the return of the one who rebelled.
The scandal of the story is not the forgiveness but the profound asymmetry. Mercy appears to eclipse merit.
There is another discomfort buried here, and it is less noble than I would prefer. The elder son wanted to be seen. He wanted acknowledgment. He wanted someone to notice that he had remained faithful. In my own frustration, it is not primarily the overlooked patient who troubles me. It is myself. I want recognition for the sacrifice.
Medicine demands a great deal. Years of study. Deferred earnings. Missed holidays. Nights without sleep. Exposure to suffering that most people never witness. I chose this path freely. No one compelled me. Yet I still find myself wanting something beyond a paycheck. Yes, physicians are well compensated relative to many professions. But compensation is not the same as honor.
In previous generations, doctors were often regarded with sober respect. Modern medicine was seen as a near miraculous force. The physician stood, however imperfectly, as its representative. That cultural posture has shifted. Many patients remain kind and appreciative. I encounter genuine gratitude every week. But the broader narrative is harsher. On social media and in popular commentary, doctors are portrayed as greedy, as profiteers on suffering, as inattentive, as agents of corporate interests, as pill pushers seeking kickbacks, as technicians who know less than they pretend. It has become fashionable to suspect the motives of the very people trying to help.
I feel that suspicion. I feel it when a patient records an encounter as if preparing for litigation. I feel it when institutional policies imply that my judgment cannot be trusted without layers of oversight. I feel it when the public discourse treats physicians as interchangeable cogs in a profit machine.
It is difficult not to bristle. I want fairness. I want others to say that what I do is hard, and that it matters. I want acknowledgment that skill and discipline were required to stand at the bedside. I do not want merely to be paid. I want to be esteemed.
That desire is not entirely pure. It shades into vanity. The elder son did not simply want his father’s property. He wanted his father’s praise. He wanted visible affirmation that his obedience distinguished him.
The Gospel does not indulge that instinct. Christ speaks of loving those who persecute you, of turning the other cheek, of doing good without expecting return. The standard is not transactional justice but self-giving love. When I read those words, I recognize how far I fall short. I want the ledger balanced. I want respect proportional to sacrifice. I want glory for endurance.
There is something profoundly un-Christlike in that craving. I cannot disguise it as righteous indignation. It is pride. It is a demand to be seen and applauded.
Lent, I think, is meant to strip away those rationalizations. It reveals that my resentment toward the prodigal is entangled with my hunger for honor. I serve, but I also want to be celebrated for serving. I heal, but I want to be praised for healing. I speak about justice, yet I am deeply invested in my own reputation.
The distrust is real. The caricatures are unfair. But the deeper spiritual problem may not be that I am insufficiently appreciated, but that I am too attracted to appreciation. I know how to argue about incentives, agency, and responsibility. I am less comfortable examining my own need for glory.
The elder son stood outside the feast because he believed he deserved something more than proximity. He wanted recognition that separated him from his brother.
I understand him. That is precisely what troubles me. I know the lesson I am supposed to draw. I am supposed to admire the father’s mercy without qualification. I am supposed to rejoice at the sinner’s return. I am supposed to release my ledger and enter the house.
I do not.
I still feel the resentment. I still want fairness. I still want the world to say that discipline, restraint, and sacrifice matter. I still want glory. If I am honest, I am not convinced the elder son is wrong to want those things. He worked. He remained. He bore the weight of responsibility while his brother chased pleasure. There is justice in his protest. He is reasonable in his demand to be seen.
I know that my religion calls me beyond that calculus. I know that mercy is not a market and that love does not tally goats. I know the standard.
But I am not persuaded in my bones.
I do not stand inside the feast. I stand in the field, arms crossed, hearing the music, unconvinced. I remain the elder son, and I am not sure I want to go in.