I saw her again. She was very anxious and trembling. "It was very hard but I am here. I am trying to get healthy. I want to be healthy and beautiful. I am beautiful but when people see my teeth, I feel they are judging me. " She told me that she felt judged all the time. She had tears in her eyes. "I am working really hard to do the right thing. I am making sure my kids get a good start. Not like me." That desire had pushed her to seek help many times but each at each step she felt judged, mistreated, mislead, and came away more frustrated and more fearful. "Once, they extracted a tooth while I was telling them it wasn't numb. They didn't believe me. How could they do that?"
She was smiling as she left. She told the assistant, "I have never been treated like that." What happened? Nothing exotic or magical or clever. Her concerns were taken seriously, it was unhurried, it was careful, each step was explained, she was heard, she was believed.
Her cute little boy came back to the door after the rest of the family was headed to the car. He sweetly said, "Thank you for being such a nice doctor to my mom. But if you ever hurt her...." Then he made a slashing motion over his throat and a funny little swishy sound. That was the reminder to stay humble. She will be fearful next time and the next and the next. I am not curing her fear. I am just trying to do "the right thing."
Empathy and compassion are natural ways of being.
Many, many patients complain about "the shot". It can be painful and for some it either doesn't completely work or it takes a very long time to work. Dreadful. It is true, that there are anatomic reasons such as extra nerves or nerves that are placed differently. Infected areas don't numb easily either. If the doctor is very expert, takes time, and uses topical anesthetic, that helps. Still, it may be painful and not work. Why? The pH. Local anesthetic is very acidic. It must be or it quickly breaks down. But..for it to work it must be alkaline. The anesthetic must be made more alkaline either by the body or some other means. I have known this for years and experimented with indirectly increasing buffering. I had some success. When in my anesthesia residency, I saw some of the anesthesiologists mixing local anesthetic with sodium bicarbonate. Of course! They were directly buffering it, making it painless or much less painful, much quicker acting, and much more effective. People that wouldn't otherwise get numb, got numb. Quickly too. So simple. So what is the barrier? Dentists are so accustomed to premixed carpules that the idea of mixing your own anesthetic is very foreign. But it can be done. If compassion, the wish to relieve suffering of others, is important, than we must consider a simple, proven solution that solves a very real problem for patients.
I am one of those patients that doesn't numb well.
I recently saw a patient that was in a local dental office seeking help. She was very fearful and had avoided going to the dentist for weeks. (frequently, a very fearful patient will wait more than 3 weeks). She couldn't sleep and the pain was pushing her past her fear. I talked to her. Among other things, she said
"I'm so stupid for doing this." That is such a sad thing to hear. I know from experience that her past story probably includes a history of abuse as a child. She now blames herself for the situation. Every now and then a patient will share their story, usually with many tears. These patients need to be heard and need compassion. They need to know that it isn't their fault to have these feelings and someone will help them. There are people they can trust.
"...our capacity for empathy is the source of that most precious of all qualities, which in Tibetan we call nying-je. Now whilst generally translated simply as compassion, the term nying-je has a wealth of meaning that is difficult to convey succinctly, though the ideas it contains are universally understood. It connotes love, affection, kindness, gentleness, generosity of spirit and warm-heartednes. It is also used as a term of both sympathy and of endearment. But most importantly, nying-je denotes a feeling of connection with others, reflecting its origins in empathy...
...Although it is clear from this description that nying-je, or love and compassion, is understood as an emotion, it belongs to that category of emotions which have a more developed cognitive component. Some emotions, such as the revulsion we feel at the sight of blood are basically instinctual. Others, such as fear of poverty, have this more developed cognitive component.
We can understand nying-je in terms of a combination of empathy and reason. Empathy we can think of as a very honest person; reason as someone who is very practical. When the two are put together, the combination is highly effective. As such, nying-je is quite different from those random feelings like anger and lust which, far from bringing us happiness, only trouble us and destroy our peace of mind. This fact that we can enhance our feelings of concern for others is of supreme importance because the more we develop compassion, the more genuinely ethical our conduct will be. As we have seen, when we act out of concern for others, our behaviour towards them is automatically positive. This is because we have no room for suspicion when our hearts are filled with love. It is as if an inner door is opened, allowing us to reach out. Having concern for others breaks down the impediment which inhibits healthy interaction with others...
...Thus if I may give an example from my own experience, I find that whenever I meet new people and have this positive disposition, there is no barrier between us. No matter who or what they are, whether they have blonde hair or black hair, or hair that is dyed green, I feel that I am simply encountering a fellow human being with the same desire to be happy and to avoid suffering as myself. And I find that I can speak to them as if they were old friends, even at our first meeting. By keeping in mind that ultimately, we are all brother and sisters, that there is no substantial difference between us, that all others share my desire to be happy and to avoid suffering, I can express my feelings as readily as to someone I have known intimately for years. And not just with a few nice words or gestures, but really heart to heart, no matter what the language barrier."
--The Dalai Lama
Salmon Creek Legacy Hospital has a strong spiritual care department because they nurture it. One way is by inviting speakers to inform and guide the volunteers and chaplains. The most recent was the Tibetan Buddhist monk, Geshi Lharampa Tashi Gyatso. He was accompanied by my friend Lhalung, who translated from Tibetan to English. I am summarizing two hours of discussion.
Tashi started with, "Love is wishing a happy life for all sensient beings. Wishing them to be free from suffering. That is why I am here. Let me break it down more. "
There are three levels:
1. Wishing all sensient beings a happy life.
2. Believing that all sensient beings should have a happy life.
3. Resolving that I will cause sensient beings to be happy.
It is important to distinguish between love and attachment. For instance, you wish your parent a happy life and you are attracted to your spouse. The first is love, the second is attachment.
Much suffering and conflict is related to attachment of all kinds. Everything from world conflicts to arguments between three year-olds.
Working with difficult people gives us an opportunity to practice our love and compassion. Wishing others to be free from suffering is compassion.
Suffering is related to anger, attachment, and ignorance. Try to recognize the delusions related to these elements in yourself and free yourself from suffering as much as possible. It will make relieving the suffering of others more clear.
Meditation can be a tool to clear your mind of delusions.
In 1997 Reader's Digest ran a story that questioned the honesty and consistency of dentists. I think most of the dentists in the country found it very frustrating that their integrity be questioned. I certainly didn't like it. On the other hand, the article was instructive and even fascinating, given my interest in behavior. If you want to read the article, I have included a button at the bottom of this post that will allow you to do that. What struck me is that the 50 dentists never asked the author an obvious question. "What do you want?" To me, that was the single most important piece of information. What motivated the client to ask for help? Health? Esthetics? Peace of Mind? Pain? No mention of that.
Healthcare must be centered on the patient...the whole patient, which includes their history, concerns, preferences, and physical condition and not just what the doctor wants to do for or to the patient. With dentistry, much of it is elective. What I mean is that most dental problems are rarely lethal. Yes, an abscess can be lethal and 150 years ago was one of the most common causes of death. Not now. It is now uncommon that people die from dental disease. In modern first world countries, dentistry is a matter of life style and health. It is a decision about how to look, feel, and live. If we assume that to be true, then the most important single issue is what the patient wants. In the entire article, I read nothing regarding that singularly important question. Fifty opinions and fifty different solutions to many different sets of perceived problems. What struck home to me that the suggested treatment was more related to the education, preferences, and assumptions of the dentists rather than the needs and wants of the author/patient. Perhaps he was being dishonest to be inflammatory? I don't know. What I do know is that healthcare practitioners need to understand the mind of the patient. Be in the moment and try to be empathetic. Humans have one mouth and two ears. Ask "What do you want?" and listen at least twice as much as talk.
I serve in the Department of Spiritual Care at a nearby hospital. It is not new to me. I did the same thing in New York City. Each person serving receives a list of patients to visit. It is based on the patient intake forms stated religious preference. Each person on the list is visited and they can accept or decline. By far, most people accept. Sometimes people accept even when the preference is mistaken. Most people in that situation feel vulnerable and crave human contact. My approach is to enter into each situation "empty". I have no plan or agenda. My feeling is that I want it to be about them and their needs. If I have a plan, it is about me or too much centered on me. If they want a prayer, we do that. If they want communion, we do that. If they just want to talk, we do that. If they have some other need, I do my best to address it. Even people with dementia have emotional needs, so I talk to them. If a referral is needed for some other help, I do that. Empathy is the key starting point. Compassion drives the action.
I am not there to take on their pain. It is not burdensome. Bringing comfort in any form gives me peace.
Sharon, Davin, and I had dinner with Geshi Lharampa Tashi Gyatso at Lhalung and Laura's (Lhalung's spouse). It was a wonderful evening of Tibetan and Japanese food combined with a comparative discussion of western and eastern views on empathy, sympathy, and compassion. Comparing scientific research with the discernment of Tibetan scholars regarding the function of the mind was particularly interesting, especially since we seem to reach many of the same conclusions. I am particularly grateful to Tashi for his many insights into human nature as well as his counsel regarding the training of the mind. He has given me much to think about.
It was great fun to do a little comparative religion and philosophy. We laughed
and exchanged knowledge and opinions.
Then there was a lively discussion regarding whether the Buddha's parents were Hindu's. Tashi's theory is that they were not. That went against my Wikipedia knowledge but he had a pretty good argument. Since Tashi is a life long student of the Buddha, I concede to him until I can do more research on that topic.
Tashi went on to say that in his opinion, Tibetan Buddhism is the closest to the original philosophy taught by the Buddha himself. I can put forth no opinion on that but I have learned a lot from my discussions with him.
I must also say that it was a great honor to be able to chat with a man that has acted as a substitute and representative of His Holiness, the Dalai Lama.
He is an authentic and entertaining person.
Cognitive decline is an empathic challenge. Relatives can be challenging when healthy but much more so when age and disease affect mental processes. The need for people maintaining dignity and independence must be balanced with the need for physical safety and financial security. Understanding what is happening can be difficult. Understanding the often gradual process of loss and letting the elderly transition gracefully is even tougher when they are far away. Few people will admit disability even assuming that they know that they have disability. They fear that self respect and dignity will be ripped away when they prove they can no longer competently complete tasks such as balancing the check book, managing financial affairs, or finding their way to the local grocery store. Short term memory is usually the first cognitive skill affected followed by longer term memory and other mental abilities. The loss of memory is corrosive to relationships because they don't know and have no way to know that it has happened. Emotions and personality can remain intact for a long time, however. Therefore, empathy of others becomes essential to
being treated with respect and feeling respected. My mother-in-law is a good example. The medication pathway she had traveled had rendered her sleepy, mostly passive, and often staring out the window. She regularly lamented “this is no way to live”. My wife, believing that this could not be right, asked me to investigate what her drugs could be doing to her. There seemed to be a pattern, since the statin drug therapy starting 5 years ago could have caused confusion, memory, and behavior issues that caused the need of the next two drugs and she was the description of a person likely to suffer from these side effects. After consulting the family, all the drugs were stopped. Her cognition has quickly returned but her memory has not. That has led to an empathic challenge. How would a person behave if they could think but not remember? What happens if they need to check if the lights are turned off at night? A seemingly crazy behavior of checking the lights over and over makes perfect sense if you simply can’t remember. It isn’t her fault, she isn’t crazy, nor is it obsessive/compulsive. It is my deficit if I become impatient and short. I have to imagine myself in that situation. Then it makes sense. I lose my irritation and impatience. She is just my mother-in-law doing what she always has done, frugally making sure that the lights are off.