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Buddhadharma : Win 2012
62 BUDDHADHARMA: THE PRACTITIONER’S QUARTERLY WINTER 2 0 1 2 patients. This is a common misunderstanding, especially in the health care world. We are doing this to help ourselves. And the only way to fully follow this path is to do it along with “them.” This is our path to enlightenment. This path is all about the relationship with ourselves and the myriad dharmas—this great assembly of beings is one thusness. There is no hidden jewel outside or inside ourselves to discover. Living and practicing together in peace and harmony with other people is the jewel. This body does not exist. Where does this pain come from? Recently, I greeted a long-term cancer patient who had just turned twenty-nine. His illness had progressed, and he had been in and out of hospital several times. The caretakers had decided we should meet and talk about whether to continue chemotherapy or move on to palliative care. The patient arrived jaundiced and frail, using a walking aid. He had a shunt that drained his cerebral fluid and tubes to replace his bladder and bowel functions. While he prepared to sit down, I flashed back to a young, vital-looking father who talked enthusiastically about his work and was looking forward to his children entering their school-age years. Now it was hard to imagine this was the same person. Yet, he emanated contentment. He did not bring up anything additional; there was no reproach, no wrestling with his condition, no attempts to explain. In other words, I did not sense any separation between his expectations about his life and his current experience. There was no story. He simply told me, “I am fine. No nausea today. I slept well. I had an entire glass of tea.” If this body does not exist, there is no pain. There is only dissolving pain on the spot. We have no choice but to face the moment right in front of us rather than the many stories we choose to add. No matter what happens to us in our life, we have to live it in the here and now. Here is the present moment of the body. Here is the present moment of the mind. Each of them is a bright jewel. As physicians, we are trained to know. That is our job. If we don’t know, who does? Even in times of “informed consent,” our influence in decision-making is necessarily greater than that of the family or spouse. Confronted with a patient’s fatal illness, we are expected to know what to do. Without challenging the trust placed in physicians, one of the things I am learning from my Zen practice is not-knowing. How can this be applied to a science? Knowledge is good. I need knowledge to make an appropriate decision. But “knowing” the facts often impairs our ability to really listen to a patient. Dogen has taught me to drop the information in the file, my proposal, and first ask my patients, “What brings you here?” There isn’t always a response right away, and it can be difficult to wait and not jump in. Doing is easier than non-doing. In modern medicine, doing something, doing anything, can be so much more appealing than “doing nothing”—like sitting on a cushion and waiting for things to arise. The silence might bring up a question I did not expect. Someone whom I’m sure asked to see me to talk about the side effects of treatment might actually want to inquire about the risks of going to a dentist or taking a long-planned weekend vacation during their medical regimen. Occasionally, out of this silence, while discussing subjects that are mundane, intimacy arises: that unexplainable, unlearnable miracle when there is no gap, just confidence and trust. It sometimes feels like we’ve made a pact to go through this hand in hand. I have an unspoken obligation not to quit first, not to give up on the patient. This commitment reaches beyond personal preferences. The patient may have chain-smoked, tortured animals, mistreated a spouse, abused children—it does not matter. We are painting on a new easel—now. Our last chance in our dying moments should always be drawn on white paper. We bring in old colors, but we have a fresh white page to start with. Physicians committed to practicing mindfulness walk this path free of hesitation, without a need to reflect on what brought us to the profession. We are not doing this to help “them”—the poor Dogen quotations are from Treasury of the True Dharma Eye, edited by Kazuaki Tanahashi, Shambhala Publications, 2011