BLOG: On the personal discomfort with aging and death
Click Here to Manage Email Alerts
“I see my folks, they’re getting old. And I watch their bodies change. I know they see the same in me and it makes us both feel strange.”
- “Nick of Time” by Bonnie Raitt
Our daily interactions with people energetically change how we feel about ourselves and our own circumstances.
When interacting with patients with cancer, our discomfort with our own mortality can sometimes interfere. We may see our own lives reflected in our patients’, which may, in turn, color our treatment decisions.
Maintaining mindfulness about these changes is a minute-to-minute — actually, no, a second-to-second — practice. It is all about the pause ... accessed often by a deep inhaled breath followed by a slow, prolonged exhale. A pause, designed to ask perhaps, “Why am I feeling unease? Is this my ego talking, or is this my true nature?” Or “Is this reaction I’m experiencing based in ‘wrong knowledge’ about the sensory input I’m receiving?” And, in a more personal example, “Is the frustration I feel when my parents walk a little slower or forget something we discussed earlier really about my parents, or is it rather about me and my personal discomfort with aging and death?”
When considering our unease, it may be helpful to follow the guidance of the yoga sutras, where there is emphasis on being mindful of your “kleishas.” Kleishas, according to Pantanjali’s Yoga Sutras, are characteristics of thought/thinking that are based in wrong knowledge (the first Kleisha) and thus color our experiences. The other four kleishas include, hatred/disgust, desire/attraction, an inflated ego and a clinging to life. All these afflictions, per Patanjali, produce a sense of apprehension and unease. The purpose of yogic lifestyle is to calm the mind, and per Patanjali, identifying with your kleishas brings suffering of the mind.
In medical practice, our keishas can affect clinical patient interactions. Fortunately — or unfortunately, in my experience — it is easier for me to recognize and clear my mind of kleishas during patient interactions than it is when I am with my parents. Maybe this is because there is less of “me” reflected in the patient’s actions and thoughts. Yet my clinical thoughts can and often are “clouded” and “colored” by my ego or my “clinging-to-life” thought habits.
To explain, I might find myself wondering: Does this patient like me? Does she trust me? Does she have confidence in me? Or sometimes a different (but not better) version of my ego wonders, is this patient challenging my knowledge or my understanding of the situation? Or why isn’t she doing anything to help herself?
In both scenarios, the mantra of a quieted mind is and should be: “It’s not about me. Walk in her shoes and be here now.”
The desire to cling to any additional life (at all costs) is something that all humans often experience at some point in time. In this sense, we may see our own lives reflected in the experiences of our patients.
For instance, in the life of a 39-year-old with advanced inoperable recurrent cervix cancer, in the life of a 65-year-old with recurrent ovarian cancer and a partial small bowel obstruction, or in the life of a woman with untreated advanced endometrial cancer with respiratory distress from widespread pulmonary metastasis, we might feel there must be something we can do. And yet in all these cases, the ultimate outcome will — in almost all cases — be the same despite our wishful thoughts that she might be one of the few who respond even if just for a little bit of time.
The ego kleisha may influence our decisions about treating with the most “up-to-date” and “most aggressive” treatment or “newest targeted therapy” even if the data only suggest a 2- to 5-month increase in PFS but no improvement in OS. (Please don’t misinterpret this. Of course, there are in some specific situations, new fantastic treatments that do prolong OS).
The trick to serenity, I believe, is to balance the appropriate precise use of aggressive “heroic” and “new” therapies with an equally appropriate acceptance and gentle guidance toward releasing what is no longer a quality “physical” life. And further, how to “learn” to find peace of mind in these circumstances.
More is not always better, it’s just not. And, in fact, we are far from helping each other and our patients focus on the blessings of the present singular day in this fast-moving world and incorporating this important aspect of living into our oncology care and often in our own lives.
How do we balance “feeling strange” and uncomfortable with our own mortality and the mortality of our patients in order to compassionately guide them toward the most meaningful, last period of their lives? For me, the ultimate goal of my practice (and it really is a moment-to-moment “practice”) is to quiet my mind and try to recognize the kleishas when they appear and then remind myself that these feelings and emotions are often born out of thoughts and desires that cause suffering.
The “practice” is to find dual-pointed concentration on both being in and of this world of aggressive cancer surgery and targeted therapy while simultaneously being deeply connected and focused on that never-changing constant inner consciousness that can clearly recognize “that which we cannot change.”
Reference:
The Yoga Sutras of Patanjali. Translated by Sri Swami Satchidananda. Integral Yoga Publications, 2012.
Collapse
Lois M. Ramondetta, MD, C-IYAT, Diplomat ABLM, is professor of gynecologic oncology at The University of Texas MD Anderson Cancer Center. She can be reached at lramonde@mdanderson.org.
Click Here to Manage Email Alerts