This past year I was fortunate to begin a fellowship in contemplative medicine at the New York Zen Center for Contemplative Care. Maybe this isn’t the extra-curricular activity you would expect from an orthopedic trauma specialist. Since I entered medical school almost 30 years ago, this has been the most rewarding experience by far.
Why? We all know our system is broken, but its brokenness goes beyond the “for-profits, occasionally also for patients” system we inhabit. Even those of us who would prefer a single-payer system on ethical grounds must acknowledge it won’t solve many of the issues that confront us daily. The metrics on inpatient days, hospital-acquired conditions, and efficiency won’t go away by removing profiteering from the system. Yet the practice of medicine – of health care – defies metrics. There will never be a valid measure for suffering, just as there will never be metrics for love, kindness, or sensitivity, or attentiveness. Everyone who has never been to medical school knows these are essential to be a quality doctor. Yes, we need knowledge, skill, and judgment. But in the absence of love, kindness, sensitivity, and attention, what kind of doctor could we possibly be? Certainly not one I would be proud to be.
And I know this from deep within because I must live with all the times I’ve been that lesser doctor. I have been unable to help as many patients, nurses, and residents as I should have; I expect almost all of us to live with this shame. How could we not be when we have been shaped by an unethical and immoral system? It is unethical and immoral, first and foremost, because it disregards any cultivation of the capacities essential to caring, which is the whole point of the endeavor. The assumption that these can’t be cultivated or that they are simply something personal that is an individual’s choice opens the door to the very system we have. We, too, value meeting metrics over meeting patients where they are in their suffering because that can’t be measured. We are taught that “caring” is something you have to do as an individual; all the while, the system we work in completely disregards any of us as individuals. We simply don’t matter. There will always be someone else to tolerate the work when you become ground to a pulp. And there will be another patient on the conveyor belt to treat, so we must move on.
But there is another way. We start with our suffering, understanding its creation, and how to make sense of and manage it. Only then, out of compassion for ourselves, can we attend to the suffering of others, extending that compassion to them. Is it really this simple? Yes. But “simple” is far from easy; it is work that is right in front of you every minute of every day. It is sacred work, boring work, joyful and tragic work. But it is there for you to do every minute of every day, as long as you want. You begin again and again with each day, each case, each meeting, each interaction, and each breath.
I can’t save every limb or life. I can’t restore every bit of lost function. But I can help alleviate suffering, always, every day. I have searched for this ability for more than thirty years, closing in on this practice of contemplative medicine over the years. It’s the most important surgical skill I have.
I hope you can find it sooner than I did.
Andrew Grose is an orthopedic surgeon.