How is it different than the guilt he feels.
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Dimmesdale is constantly covering for and cpmpensating for his shame and guilt. While Hester is publicly shamed for the adultery, Dimmesdale must suffer the ignominy quietly since no one knows of his culpability. The suffering begins to take its physical toll, especially since Hester's husband Chillingworth seeks to destroy Dimmesdale and is a constant reminder of the guilt and shame he harbors from his affair with Hester. At the very end of the novel, Dimmesdale admits to being Pearl's father and reveals that he has a scarlet letter branded into his flesh. He dies upon the scaffold while holding Hester's hand.