I recently read an essay in, “The Best Buddhist Writing 2007,” by Michael S. Krasner, M.D.. He is a professor of internal medicine at the University of Rochester Medical Center, and is trained in Zen and Mindfulness-Stress Based Reduction (MSBR).
He uses his training to access the needs of his patients by staying present without judgment, meaning he takes the time to not only listen to his patients, he also observes them. That’s an extraordinary thing for a doctor to do, since they typically see fifty patients a day. He wrote how he reminds his medical students how easy it is to “miss the forest for the trees” when diagnosing a patient’s illness.
He went on to write about how many times there is an attachment for a certain outcome when it comes to end-of-life-care. He gained this insight from observing the reactions of patients’ families. Many of us expect our loved ones (and ourselves) to experience a “good death” and sometimes that is not what happens. The example he gave was a family who knew their loved one was dying but wanted any issues resulting from his declining health to be addressed, in other words, they wanted his problems to be “fixed.” They focused on the patient’s weight loss, lack of energy, no motivation to exercise and blood sugar levels. “It seemed it would be acceptable for him to die only if the problems were successfully addressed.” The family reacted as though the patient was failing them. They didn’t see the bigger picture of the dying process, which included the patient’s physical and psychological state. The patient’s symptoms were normal for his state of health. When the family understood this they were able to shift their focus and care for their loved one with a fuller presence.
This got me to thinking back about the patient I was frustrated with last week. I wanted him to eat a snack because he was dropping so much weight. He refused to even drink an Ensure and I believed he was just acting stubborn (for whatever reason) — but what if I was wrong? Maybe he knows he is dying. I do think we all have that little voice inside of us that let’s us know when our body is ready to go. Maybe his refusing to eat is part of his end-of-life process. I am willing to bet his doctor knows what’s happening, even if his loved ones and myself doesn’t want him to give up.
I tend to get attached to patients and I know that is not good for me. I know there is a percentage of patients who do not get well. I am attached to the outcome and Buddhism teaches us to not get attached (to anything) it leads to suffering and it all boils down to Impermanence. Nothing, absolutely nothing lasts forever (except maybe that box of Twinkies). And who wants to live forever anyway? Did you ever watch the movie “Death Becomes Her?” It’s about two women who want to live forever and all the challenges that come with it.
Our limited time on this planet is a reminder to do stuff now. Don’t wait because we might not be around to enjoy the experience.
I plan to go back to the infusion center tomorrow with “fresh eyes.” I won’t push anyone anymore to do what I think is right for them. What was right for me might not work for someone else. I will let go of attachment and just be with that person in the present moment because that’s all we really have anyway. It’s all about living in the “now.”