Excerpted from Medicine and Compassion by Choknyi Nyima Rinpoche and David R. Shlim, MD.
When it comes to the healing professions, wisdom means knowing what it takes, understanding all the factors that are necessary in the healing process. It is not limited to making the correct diagnosis and applying the proper medication or surgical procedure. Wisdom incorporates the attitude of caring along with all of one’s training, experience, and knowledge of disease. It is the combination of all of these factors that we can call wisdom.
Practicing the art of healing clearly involves a great deal of wisdom. What I am calling “wisdom” could also be called “intelligence,” whichever you prefer. Intelligently caring for patients means finding the right solution to their problem: not only finding a cure, but finding it quickly, and choosing the treatment that is most effective in the long run. If you happen to know the answer already, that’s fine. However, if you don’t know, then finding the right answer requires skill and wisdom. A wise caregiver doesn’t hesitate to consult others. This willingness to consult others, and knowing when to do so, is part of what it means to have wisdom.
Other factors fall under the topic of wisdom as well, especially tolerance and perseverance on the part of the healing professional. Tolerance is incredibly important because dealing with sick people is not necessarily pleasant. They can be downright annoying. Sick people often lose their good manners. This is not something they consciously choose to do; they simply can’t help it. Whether it is the fear or the pain, or the drugs they are taking, patients can get intoxicated and lose their manners. They may insult you, not because they want to, but because they can’t help it. One sign of wisdom on the healing professional’s part is not taking this personally, thinking instead, “Oh, he’s disturbed, he can’t help it. He’s usually a gentleman, but today, unfortunately, he doesn’t behave like one. I don’t need to take it personally. He’s just not in control right now.” Some kind of tolerance is always necessary, but especially when caring for sick people.
As I mentioned above, the patient may relate to the doctor like a father or mother and begin acting like a child. When children are happy they hug other family members. When they are unhappy, they cry, and may even physically strike family members. It’s precisely those moments we need to have tolerance and patience. That’s when we need compassion and loving-kindness. If we can maintain an attitude of compassion at those difficult times, it provides the best opportunity for healing to take place.
If we really want to be more compassionate, we need to know when compassion can make the most difference. Otherwise, we may feel most compassionate only when taking care of patients who are kind to us and appreciate our help. When faced with difficult patients, we might think, “I’m doing my best, why are they treating me like this? This man or woman is ordinarily gentle and considerate. What happened today? I’m trying my best, but they are blaming me for their discomfort.” These kinds of thoughts can make you tired and unhappy—even disappointed and angry. At that point, the practice of medicine begins to feel burdensome. You might even consider giving up, thinking, “I can’t deal with this anymore.” You feel like you’re not doing a good job, that somehow you should have done better. Your sense of duty tells you to carry on, but you begin to think that you can’t take it anymore. There is a tug-of-war on your emotions. That tug-of-war robs you of your enthusiasm, disturbs others, and prevents you from doing your job smoothly. It even interferes with your ability to make good decisions. You lose your sense of wisdom, patience, and tolerance. You can begin to be disturbed in other aspects of your life as well.
With wisdom, we can see how this process works. Without wisdom, we may know that we should be more compassionate, but we just can’t figure out how to do it, and we end up feeling discouraged. Again, we need to understand that illness is not only physical—physical illness can lead to mental unbalance. We need to remember that the patient is unable to control what they say because they are too scared, too panicked, and in too much pain. If we have insight into the cause of their behavior, we can take it less seriously, less personally. It won’t become such a burden to us or make us discouraged. If we know the reason behind the patient’s actions and emotions, we become more tolerant, which allows us to be more compassionate. At the same time, we begin to feel more satisfaction and our hearts feel lighter. We think, “Even though I’m confronting these difficult problems, I’m actually doing well.” We can rejoice in ourselves.
From one perspective, we could say that all of this stems from the power of loving-kindness. For example, when a child has a problem, the mother has enough endurance to care for that child twenty-four hours a day. She will do whatever is necessary. If the child cannot sleep, the mother does not need to sleep. Of course her body gets tired, and mentally she gets fatigued, but she is very motivated to care for her dear child. Tolerance and patience are already present. The mother does not need to consciously work to build up the necessary patience or tolerance. All of these qualities arise naturally due to the loving-kindness of the mother. If your lovingkindness declines, then your patience and tolerance decline automatically. If you have no loving-kindness at all, then your diligence, tolerance, and interest in doing your work will all fall to zero.
In summary, the healing professional should not only deal with the patient’s body but needs to understand what it feels like to be sick. You need to comprehend how painful, how worrisome, and how disturbing it can be to not know what is going to happen to yourself. Understanding the interplay of all these factors requires wisdom. A true understanding of how these factors impact the behavior of a specific patient is what allows compassion to grow.