My Secret for inner peace

One of the frequent questioned I have faced from both medical and non medical people  is – How do you deal with sickness and death on a regular basis. As an oncologist caring for cancer patients sickness and death is fairly routine. With out some defense mechanisms, burn out is inevitable.

During my early years in practice, the images of sick patients, especially if they were young kept me awake at night. I remember clearly how I used to excuse myself while seeing patients to wash my face to keep me awake. Cancer patients depend on their oncologists to give them hope. A sleepy and tired doctor cannot impart much confidence in patients suffering from potentially serious illness.

During a trip to India in 1978, i came across an article  in an airlines magazine about a message from  The Bhagavad Gita, often referred to simply as Gita.

Gita is set in a narrative framework of a dialogue between prince Arjuna and Lord Krishna who was his charioteer and his mentor, as part of Indian epic “Mahabharatha”.  Gita is a 700 verse Hindu scripture dating back to around 3000 BCE.

Gita is the eternal message of spiritual wisdom from ancient India.  It is not a religious discourse.   One  sentence from the article that cought my attention was

“Detachment Without Indifference”

This could easily be misinterpreted as not caring enough. That’s why the  key words here are,

“Without Indifference”.

Let me explain. With every patient I have seen I tried to  give them the best care possible based on latest guidelines. When I was unable, I sent them to someone who knew more than me. This is what any doctor would and should do.

In spite of the best treatments, some patients will have progression of their cancer. Guilt and sadness are common symptoms among oncologists, when a patient expires. It will be hard for cancer doctors to be effective with that mind set, not to mention the toll on their personal lives.

It took me years to try to understand and practice  Detachment while maintaining total engagement and compassion with patients.   It may sound selfish but in order for doctors  to be upbeat and project an optimistic (realistic) approach to patients and  provide the best care possible ,  it is vital that physicians take care of themselves .

Playing tennis and golf  and listening to music were the outlets that recharged my batteries.

Human brain cannot be turned on or off with a switch. Practicing detachment does not mean being indifferent. I cannot overemphasize this point. It also does not mean that we have to become like a robot.

How did it help me – Once I have done everything I can to offer the best available  care possible to my patient including referring to a larger center with more expertise, i have eliminated guilt, thus minimizing the  mental burden. It does not mean there is no sadness if the outcome was poor.

Practicing detachment without being indifferent has also helped in day to day  life and relationships. Practice of  detachment helped me to accept things that I have no control over. But, if I can play a role, I will take action.  An example is a natural calamity such as an earthquake or a financial help for blind in a poor country.

Detachment does not mean one has to act to be at peace. Feeling is natural. In the 40 years or so since I have come across the article  in the airline magazine, I can sincerely say that very few things upset me. Unless I am the culprit, guilt has not been a burden. I accepted the fact that  I have very little or no control over what is happening around me.

Only control I have is how react to happenings around me. I have a long way to go. But it has been a good journey.

If there is no inner peace there is no happiness.










Lessons that shaped my life

Over the years, I learned many lessons from patients, my parents and others. Some of what I learned had a profound influence on my future life.  One such lesson was in 1969 when I was in final year of medical school in Hyderabad, India.

I was posted to eye hospital as a part of the regular curriculum. One day during an outpatient clinic, a man in his 50s showed up with a towel covering his right eye. Attending ophthalmologist removed the towel from his face only to see the eye very swollen and almost popping out of the socket. As an inexperienced medical student, it was scary for me to look at it.   He appeared some what malnourished with wearing clothes with holes in his shirt reflecting his poor financial status.  He came from a village 30 miles from the eye hospital .

Cataract is a condition where the lens in the eye becomes opaque and as such interferes with vision. Once the opaque lens is removed, one can see better. This patient  was losing vision due to cataract. He was either unaware of the availability of government funded free eye  hospital or more likely couldn’t afford the expense to travel to the city.

Instead, he  went to local barber who has a quick fix for restoring eye sight.  Barber charged equivalent of a dollar for the procedure. He inserted a fine needle in the eye to push the opaque lens to the back of the eye with expectation to improve vision. This procedure has been banned long time ago by the British when they were ruling India. It is punishable by law .

Unfortunately, the needle often is dirty and can cause infection. That’s exactly what happened to this man. Whole of the right eye was swollen due to infection.  Attending doctor told the patient that the only option is to remove the eye.  I was a silent spectator through out the entire conversation.

Attending doctor asked the patient for the identity of the man who performed this  illegal procedure so that he can get compensation..

The response from the patient will live with me for ever.

The patient, in spite of his visible poverty said “I will not tell his name. Though I do not know him well, I do know that he has 2 children. If I tell his name he will go to jail and no one to take care of his wife and 2 children. I can see with one eye just well as 2 eyes”.

I will never forget his expression. He was not only  not angry, but appeared calm and meant exactly what he said. Of course he was not thinking of the negative consequences of not revealing the culprit’s name.

I learned that day the power of caring for fellow human being. It is the greatest feeling.

Redefining Hope in cancer

I spent 37 years caring for cancer patients. Cancer is a frightening diagnosis. Advances in surgery, radiation, chemotherapy, immune therapy and more recently targeted treatments ( designer therapy) not only increased cures but also increased survival rates for cancer patients.

Understandably, the definition of hope for those afflicted with cancer is cure. Unfortunately not every one with cancer can be cured. Does this mean they have no hope? Yes, they do have hope.

My definition of hope in those whose cancer has spread is “prolongation of quality and quantity of life”. This can be accomplished in many types of cancers with newer treatments. This message has to be shared by oncologists with their patients. A typical example of such hope is a woman I saw in 2005 with breast cancer. At the time of her diagnosis cancer already spread to liver and bones. Treatment resulted in disappearance of cancer in liver and changes in bones consistent with healing process, both documented in her scans. She maintained her job, maintained normal activity, watch her children finish college. As I write this, she has very tiny spots come back in liver and on a different treatment. She continues to be free of any symptoms.

How about in patients who have exhausted all treatments for their cancer. Is there any hope for them. Again my answer is Yes. At this stage of their illness definition of hope is “how to keep them comfortable”. Comfort can be accomplished by various methods including hospice, pain control, acupuncture and many more.