It’s not just family and friends who don’t know how to interact with the patient. I’ve witnessed many doctors who, while good at the practice and delivery of medicine are woefully inadequate in finding the balance between honesty and compassion. I’ll say this from my witnessing many doctor patient interactions, most doctors don’t know how to deliver bad news. Part of this comes from the sense of failure on the part of a doctor if they are unable to cure a disease or prevent death.
In my time working in a cardiac ICU I did see more and more younger physicians who were quite willing to be honest and had also mastered the art of doing so while being genuinely compassionate. They were quite skilled at speaking not just from a professional position but also from a humane voice. I benefited greatly during my time there from the many invitations by physicians to be present when the ‘bad news’ had to be delivered and I’ll say they did commendable jobs in the face of extremely emotional interactions.
Now let’s turn to Vimalakirti shall we. In the chapter Inquiring About Illness the famous lay practitioner and bodhisattva Vimalakirti offers several guides in how to comfort and instruct another bodhisattva who is ill. As I have thought about these I think that for most of them there is a universal truth though the words need to be changed for the individual and circumstances. I do believe that overall they are more helpful than such cliche expressions as given by many of non-Buddhist faiths who rely on an external source. Things like, it’s God’s plan, or God needs another angel in heaven, or even this from some Buddhist denominations, if you chant/pray enough you can overcome this. Well to that final statement I say, “how much chanting do you have to do to prevent death?”
So what are some helpful, and wholly Buddhist approaches to comforting a person who is ill?
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We should both keep in mind and also remind others that the body is impermanent yet we should not ignore the body or despise it. Simply because the body is subject to decay, disease, and death does not mean we can ignore our health. We can’t simply do as we wish and engage in unhealthy practices using the excuse of an impermanent body. This is contrary to Buddhist beliefs in the priceless gift of life. Time and time again, even though we are seeking anutara-sambyak-sambodhi, or leaving the stream of birth and death, the Buddha talks about the immeasurable value of life.
Because we are oriented to eliminating the cycle of birth and death does not mean we can devalue life. So, here we are instructed both as a point of comfort to other as well as an admonition to ourselves that it is incumbent upon us to make consistent effort to maintain our health. Which further means to work in harmony with the advice of skilled doctors; i.e. take your medicine, follow guidelines for activity, diet and so forth. When under the care of a doctor you have an important partner in your health care and it is a team effort.
The body, being material and subject to decay, disease, and death will experience suffering, and pain. It can be helpful to discuss this in an open and honest conversation. Talking about the nature of the pain, the limitations the pain is causing, the methods available for minimizing the pain, and how to transform the suffering caused by pain. Vimalakirti admonishes that in this conversation the goal is not to seek nirvana.
If considered from on definition of nirvana as a place of bliss like heaven, or the transcendence of individual consciousness and the elimination of desire then we can see that what Vimalakirti is imply that we should not encourage and escapist attitude. Rather than trying to escape the suffering, which is ultimately contrary to Buddhist ideals we should contemplate the ideas I stated in the previous paragraph. The approach of escaping pain and suffering has become the default practice of many doctors.
Currently the United States, and perhaps elsewhere in the world, there is an opioid epidemic which is taking the lives of hundreds if not thousands of people. I myself witnessed the effects of over prescribing pain medications when I worked in an inpatient detox unit. The potential for abuse of the powerful pain medications is far greater than the benefit.
Rather than steering patients to other pain reducing modalities doctors simply prescribe a pill. Not only does this frequently lead to addiction, even in patients who follow instructions and don’t want to be addicted, it also leads to a mentality of not being willing to try non-medicated solutions to pain management such as meditation, acupuncture, acupressure, massage therapy and others. There is reasonable evidence to support the fact that for many types of pain opioids do not eliminate the pain they simply disconnect a part of the brain.
It’s true that it takes more time to guide a patient to alternate therapies, it is also true that insurance would rather pay for a prescription than other more effective long term remedies. Escape, whether through medication of unhealthy religious ideations is not the solution and Vimalakirti thousands of years ago discerned this, and we ignore it at our peril.
We don’t often think about ego when we think of illness and suffering. Yet for the sick person suffering in any number of various ways it is frequently all about ego. The mind, perhaps as a survival strategy focusses sharply on self. Sometimes the focus on self is so intense that others and their needs are ignored. Sometimes this may cause the patient to seem demanding, or inconsiderate and it’s tough to endure this as a care provider.
The ego is a function of the mind, and Vimalakirti says that remembering that the body is without ego. The body is overruling the mind and it is important for us to help the patient we are supporting by reminding them of this. Helpful to this goal is to encourage them to teach others. I would add that though this is written from a Buddhist perspective and the assumption is that they will teach Buddhism, this can be applied to all sorts of aspects of the disease process. This is why support groups can play a huge beneficial role in disease comfort not only for the patient, but also for the caregivers.
People frequently are resistant to participate in support groups, often times saying there is nothing they need to hear from others in the group. What is being overlooked is the benefit of sharing and helping others. I’ve written before about the fastest shortest way out of the Four Lower Worlds of Hell, Hunger, Animality, and Anger is to strive for the realm of Humanity. It is amazing the restorative and healing and pain reducing benefit of helping others. When we can, even just a little bit, shift our focus from ourselves to others it has tremendous impact on suffering and pain.
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