by Master Teacher John Carbone, MD
I thought doctors knew a lot more before I became one.
In 2002, during the first year of my Family Medicine residency training, I was part of a team of physicians on the inpatient medicine service. My duties involved taking a medical history (which included interviewing the patient, or their family and friends if the patient was incoherent or comatose), doing a physical examination, ordering labs, x-rays, EKG’s and other imaging studies, helping to interpret the results of the tests, and finally, making the diagnosis and implementing the appropriate treatment plan.
One evening an elderly man was admitted to the service. He had a fever and was delirious He was able to answer questions but sometimes made confusing or nonsensical responses. His blood pressure was low, heart rate and respiration were elevated. His labs showed some abnormalities, including elevated white blood cell count (suggestive of an infection), elevated BUN and Creatinine (suggestive of kidney insufficiency or injury), and elevated CRP and Sedimentation rate (which are markers of inflammation). However, all the specific tests we ordered, including cardiac enzymes (which are elevated when the heart is injured, such as during a heart attack), cultures (which involve testing for the presence of bacteria and viruses in the blood and/or other body fluids), spinal tap (test of the fluid which surrounds the brain and spinal cord for evidence of infection and inflammation), echocardiograms (ultrasound test of the heart), X-rays, CAT Scans, and various other tests all came back negative.
We diagnosed the man with Systemic Inflammatory Response Syndrome, or “SIRS”, which in layman’s terms meant the man was very sick. We started him on empiric broad-spectrum antibiotics to cover for the possibility of bacterial infection and on supportive care (meaning measures such as intravenous fluids and medications to support his body's ability to maintain blood pressure and oxygenation of his vital organs.)
Over the next few days, our patient's vital signs improved. His labs normalized. His mental status returned to normal, and he was able to return home.
As I considered the discharge summary, which is the document that summarizes the diagnoses, tests and treatment performed, along with the outcome and further recommendations, it occurred to me that the case could be summed up in just a few words: “Diagnosis: Sick. Hospital Course: Got better.”
It really bothered me that we never discovered the cause of the man's illness. I spoke to my colleagues and mentors about the case, some brilliant physicians for whom I have the utmost respect. I appreciated their humility and compassion as they empathized with me and shared their experience that, while it's possible to make a diagnosis, sometimes it’s not; sometimes patients get better, and sometimes they don’t.
I was struck by the thought that for these patients but every human being, whether or not the diagnosis is clear, someday everyone is going to get something they’re not going to recover from. At that moment, I began to wonder how to live with this fact. I asked myself, “how do I live in this world and fulfill my promise to care for people to the best of my ability, knowing that everyone, including me and everyone I love, will one day die?” While that might sound morbid or fatalistic, it wasn’t how I felt at all. I was humbled and sincere in my desire for an answer to this question.
Sometime later I was browsing the audiobook section of the Middletown Public Library and came across a volume entitled The Beginner’s Guide to Meditation, by Shinzen Young. “This looks interesting,” I thought.
I had first discovered meditation through martial arts as a teenager. My Tae Kwon Do instructor, Sensei Brian Douglas, would sometimes begin class with a guided meditation, and I found that the practice increased my sense of calm and focus. I continued to meditate on occasion since then but never with any real consistency.
Shinzen’s voice spoke from my CD player, “meditation is a set of skills of attention that can be cultivated with systematic practice.” He continued to define these skills and how a person could develop them. I was blown away; it was the clearest, most logical definition of meditation that I’d ever heard. It made perfect sense that these attention skills could be increased and that by doing so a person could become calmer and more focused, creative, and effective. My ears and mind were open to Shinzen’s statement that meditation could help a person to find “happiness independent of conditions.” This was it; this was what I was looking for.
The prescription seemed pretty severe, however. “Some regular meditation practice (if not daily then at least every other day) in addition to periods of more intensive practice (such as a weekend meditation retreat a couple of times a year, or a week-long meditation retreat once a year.)”
Whoa. I could imagine it might be possible to commit twenty to thirty minutes per day to meditate, but a whole weekend or week? I’m way too busy for that, I thought.
But I was hooked. I started to meditate more regularly using the guided meditations that were the last few tracks of the audiobook. After doing some searching around on the web, I finally booked my first silent mindfulness retreat. It was a weekend retreat for beginners, Friday evening through Sunday morning, at the Insight Meditation Society in Barre, Massachusetts. “No big deal”, I thought. “It will be relaxing.”
It. Was. Grueling.
Yet grueling in a good way, like from a really good workout. I was tired, but underneath that I felt something was changing for the better. A little less than a year later I spent the day at the Kripalu Center with Shinzen Young, who was teaching a mindfulness workshop. It was an honor and a privilege to meet my first mindfulness teacher in person and further deepened my resolve to continue practicing.
My journey into the world of meditation and mindfulness began with an existential question that was very important to me. It continues because I see myself changing for the better thanks to the practice. Not only does it help me personally; my practice makes me a better doctor, friend, family member, and person.