in fact vs. in essence

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Senior Member
I was wondering why the author has drawn a contrast between "in fact" and "in essence" in this passage:

"I drew my coat around me and, like a little boy, a child alone, prayed to feel better. Isn’t feeling better, in a general way, what blood sacrifice is for? When we draw blood from another person, either in fact or in essence, aren’t we really trying to defend against our own fears, against our own desires, against loneliness?"

This is from The Hundred Brothers by Donald Antrim.
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