Every once in awhile I look back on my most recent posts and see them as too highfalutin. Without doubt I work hard to grow, stabilize, and understand. So it seems appropriate to emphasize my insights and successes in these essays. But just like the admonition about not watching sausage manufacture if you enjoy breakfast links, readers of WillSpirit might be dismayed if they saw me in action.

Let’s not forget that just a half-dozen years ago a psychiatrist had me on five medications for my so-called mood disorder. Plus, I relied on a powerful opiate to subdue my chronic spinal pain. Back then I had few friends and lived a constrained life. Worry confronted me daily against a backdrop of ongoing despair. My self-esteem had bottomed out after neck problems ended my surgical career, and none of my efforts seemed to lift it toward the light.

Given that history, it’s a bit disingenuous for me to present myself as a paragon of wisdom. In the interest of full disclosure, this post will describe some of my less elevated behaviors during this recent illness.

When the pain first started, I suggested to my wife that a trip to the Emergency Department might be in order. During the years of confusion I just described, there were several occasions when palpitations, shakiness, or other symptoms compelled me to enter the ED for evaluation. In every case, the doctors treated me like the unstable mental patient they read about in my medical record, and they always sent me out with a clean bill of health. So my wife hesitated to take me in for this latest problem, even though it had been years since I’d sounded the alarms.

In the face of her refusal, I felt wounded and betrayed. I pouted and took a sleeping pill to get some relief from the belly pain and hurt feelings. It’s apparent to me now that waiting a little longer made sense, but I had no such clarity at the time.

The next low moment came as I obsessed about the possibility of pancreatic cancer. It sat prominently on the list of potential diagnoses, but in my mind it seemed a near certainty. The prospect of mortality hit me hard and led to one of the early posts in this series. Under the circumstances, there wasn’t anything wrong with considering the implications of terminal illness, but I held onto to the sense of doom much too long. Even as evidence increasingly pointed away from malignancy, I remained maudlin and fixated. This is hardly the sort of flexibility I announced at the end of another recent essay.

Then came my tantrum when the staff ejected me from my private room, which I’ve already described. As I wind up my stay in this hospital, the nurses still laughingly refer to the fit I threw. Evidently there is clinical need for single rooms right now, but they tell me no one would dare move me into a shared ward again given how I reacted the first time. This isn’t what one expects of the spiritually enlightened.

And there have been many occasions when the stress, pain, and fear have simply overwhelmed me and I’ve wept in anguish. My wife has watched me crumble under the pressure several times since this started. Although it makes sense to feel grief, and I have no problem with tears, some of my sobbing came from feelings of self-pity: Why do I have to face yet another hardship? Why me? Feeling sorry for the self is not a sign of transcendence.

Well, that’s enough in the way of examples, though I could go on. But the point has been made: although my words sound enlightened, my behavior often falls short of my ideals. This probably is no surprise to anyone, but it’s important to me to be honest in this work. And let me be clear that I recognize that none of these slip-ups are cause for ongoing shame or self-abuse. I’m OK with being human.

To drive home that final point: I just returned from a walk outside the hospital with my wife. We hoofed it to a small church a half-mile away. Feeling tired and ready to sit down, I looked forward to resting for a moment in the sanctuary. We got permission from the pastor and stepped inside. Unexpectedly, tears almost immediately flooded my eyes and I began to sob in great exhausted heaves. Yes, I felt relieved to be alive and not facing a malignancy. Yes, I felt fortunate to have access to good medical care and to be married to a loving nurse who can manage my home IV feedings. Yes, I felt fearful about the possibilities of permanent intestinal obstruction and further internal bleeding. But more than anything, I wept with an enormous sense of weariness.

It appears that despite my often-elevated language, I remain a fragile, frightened, and forlorn patient badly in need of rest.

So I still make mistakes and I occasionally break down, but as long term readers can probably tell, I’m getting better. My behavior and attitude have both improved over the years. The more uplifting pieces written here accurately reflect how I generally look at life and its difficulties. But I remain human and therefore fallible. At times I live up to my standards, and at times I don’t. The surest sign of my growth is that I am learning to accept my weaknesses even as I develop my strengths.

With luck, I’ll be leaving the hospital tomorrow. A long convalescence stretches before me, starting with a minimum of two weeks without any sustenance by mouth: I’ll be receiving nutrition only via intravenous infusion. An X-ray after the first fortnight will show whether my intestinal blockage has diminished so I can start to add in actual food. I’m hoping for the best in that regard, since the alternative will be surgery to bypass the obstruction.

My body has been weakened by this episode. After a week of starvation I have lost both abdominal fat (yeah!) and muscle mass (ouch!). How completely I can regain my conditioning while being fed with milky fluid streaming directly into my heart remains unclear. Most likely, robust health will only begin to return once I’m on solid meals.

A friend visited yesterday morning and I told her that my default position on hardship is that it teaches me about life. Looking at setbacks this way is my main mechanism for sidestepping discouragement. You’d think, perhaps, that simply living through this life-threatening episode would be sufficient, but I’m perverse enough to still worry about the fate of my acupuncture practice. And I’m carnal enough to feel frustrated that I couldn’t join my wife last night as she ate at a restaurant with friends. Only by seeking meaning can I quell the riot of discontent.

How can we be sure meaning even exists? Some of us are convinced the universe is random and pointless; others believe in a creative God; many find comfort in spiritual practice but resist religious dogma. Whether reality as a whole seems of deep significance varies accordingly. But there is a difference between unveiling the purpose of the entire cosmos versus finding meaning in the stories of our individual lives. We can all discover meaning in this smaller sense of the word.

In Man’s Search for Meaning, Viktor Frankl paraphrases Nietzsche: “He who has a why to live for can bear almost any how.” My own personal why has become a quest for ever broader understanding of human life, suffering, and fortitude. This means I look for patterns in the cosmos that illuminate our daily lives. It means I examine when and how difficulty gets transmuted into wisdom. And I investigate why most of us continue to value life despite its trials.

Here is one pattern I’ve tried to keep in mind throughout this ordeal: all living things are connected so intimately that it is artificial to conceive of individual persons as separate from the whole. The appearance of division is superficial, whereas the reality of unity is profound. All that I experience is part of what everyone goes through, and vice versa. As a result, I feel less alone and beleaguered. This conviction that life is shared greatly reduces my sense of suffering. Moments of hardship are like the troughs among ocean swells: they are transient depressions that blend seamlessly with the peaks. At this moment I may be far from the higher, more pleasurable heights of living, but somewhere out there a couple is making love for the first time, or cradling their new baby, or sitting on a veranda appreciating nature and retirement.

Here’s what this disease taught me about how hardship can transform into realization: When pain gets extremely intense, past and future recede from consciousness and only the present moment remains. During my most agonizing hours of abdominal pain and vomiting, I no longer worried about my acupuncture practice, or even whether I might have cancer. I remained utterly fixated on my body and its insistent sensations. Since absolute present-moment awareness is the goal of many meditative practices, I see the tendency of intense pain to focus the mind as a surprising consolation prize that ameliorates its awful sting.

And here’s something I’ve known intellectually but understand on a deeper level after spending so much time on an inpatient ward, where the mostly elderly population deals with so much disease and discomfort: No one gets through life without hardship, illness, and death. It may seem that the first two get distributed unevenly, but sooner or later every person sees his or her share of life’s dark side. And yet, everyone also enjoys moments of contentment and affection. Life is not as unfair as it seems, since all are privileged to live it, all must cope with infirmity and mortality, and all discover moments in the sun.

These observations place my current difficulties in a larger context. I see how my tribulations are balanced by others’ joys. I appreciate that pain connects me with the instantaneous jolt of life. I recognize that illness and death are universal, but so are pleasure and love.

This major illness has proven a wise teacher. How much it has enlarged me! Even though my recent problems have been uncomfortable and disruptive, I see so much meaning in them that I feel grateful. Because I find lessons, I embrace my troubles despite the agony, uncertainty, and grief.

Do my words sound like hollow rationalizations? I suppose people will interpret this essay according to personal beliefs, but I’m sincere when I say that these perspectives helped me find precious moments during the past few weeks, despite the arduous challenges.

Many times in years past I believed my trajectory so punishing that I planned to truncate it. Now that I’ve learned to create meaning out of those same hardships, I can’t imagine wanting to shorten this spectacular span of living.

With luck, I’ll go home tomorrow. With Grace, I’ll keep seeing humanity as shared, imminent, and balanced even as my life gradually returns to normal.

It’s funny how just when Western healthcare had almost completely alienated me, it saved my life. Having studied a holistic tradition (Chinese medicine) to a certain depth, my portrayals of conventional medicine had become dominated by the shortcomings of its clinical care: overly technological, narrowly focused, insufficiently personal. It seemed obvious that healing requires more human touch and less electronic gadgetry. Just six days ago I railed against modern inpatient treatment (see Hospital, Heal Thyself).

And then…

It turns out a ligament occluded my celiac artery, which supplies many abdominal organs. This led to enlargement of vessels around my pancreas, one of which became so thin and weakened that it bled. During a four-hour procedure, an interventional radiologist embolized this aneurysm to prevent further bleeding. But the hematoma remains in place, where it has totally blocked my small intestine. Since no food can get through my digestive tract, the doctors ordered a semi-permanent venous access and started IV feedings two nights ago. Without nutrients dripping directly into my bloodstream, I probably wouldn’t survive long enough to permit my intestine to reopen. And if the problem doesn’t correct itself with time, I’ll need surgery. My life is likely to continue, but only because of modern medical techniques.

So it appears I need to soften my stance against contemporary biomedicine. To remain contemptuous would be hypocritical and ungrateful.

I still see problems, of course. More artwork, nicer paint jobs, some soothing music, fewer computer screens, and more patient contact would all be nice. On the other hand, technology does demand we tolerate a bit of depersonalization and indignity.

This became clearest as I rested on a rigid radiology table during my procedure. After the third hour my bladder was so full that the discomfort made it difficult for me to remain still. The team members, who had already shaved my groin to my slight embarrassment, now placed a plastic urinal between my legs and dropped my appendage into it. While five people watched impatiently (four of them women) I was commanded to pee into the bottle. Can you imagine how difficult that felt? I tried very hard, which was of course the wrong approach. A nurse placed my fingers in a cup of warm water, but nothing flowed. Finally, I had to endure the dreaded Foley catheter, the fear of which was a large part of the reason I was so desperate to urinate on my own. As they inserted the tube, it hurt just about exactly as much as I’d expected. I felt mortified by the entire experience, though at least I managed to lighten the mood with a small joke about my situation.

Although the process involved pain and a dose of humiliation, the angiographic procedure clarified a confusing clinical problem. It cured me of my aneurysm. Yes, attempting to micturate publicly under duress felt embarrassing, but I don’t see how the awkwardness could have been avoided. Three of the staff were scrubbed and gowned, so they couldn’t leave the bedside. One was monitoring the equipment and the other dealt with positioning the bottle relative to my anatomy. It was dehumanizing but unavoidable.

There are trade-offs in life. Although I resist viewing the body as a device, it does have mechanisms that can fail, and which can be corrected by technological procedures. This requires a team of health care workers, lots of machinery, and sometimes compromise of modesty. But if the alternative is death, why complain?

Over and over in the course of writing this blog I’ve found myself modifying earlier narrow views with later expanded ones. These days a popular buzzword is integrative healthcare. It suggests that we can combine the best of technological and traditional healing. I suppose it’s our most promising option, as difficult as it might be to achieve. It would also be the equivalent of clinical medicine maximally enlarging its range and acceptance.

Unfortunately, we are in an era of diminishing resources, so integral approaches will need to be developed on the cheap. Yet that may be a good thing. It might force us to trim the waste of natural resources that is so rampant in hospitals. It might reduce the use of expensive and ineffective medications. It might result in fewer unnecessary procedures.

As always, life is teaching me to extend my awareness, soften my criticisms, and increase my thankfulness. This illness has been painful, frustrating, and discouraging, but it has aided my maturation. I now remember the tremendous power of a health system I’d nearly rejected. I recognize that although there are many insensitive hospital workers, there are also legions who are dedicated and compassionate. I better understand that you sometimes need to sacrifice dignity and comfort in service of survival. It’s been a tutorial, finally, in letting go of rigid demands.

I’m seeing, once again, that learning to be flexible and open-hearted in the face of fate’s trials is the ultimate lesson and reward of living. Adopting levity helps too, as in joking while trying to ‘produce’ under trying circumstances. It never hurts to milk a little humor from humiliation. Life is, after all, at turns both sublime and ridiculous.

Thanks to modern medicine, my life will go on despite this setback, and perhaps I will be wiser, jollier, and suppler from here on out.

Pain, illness, fear, and hunger make clear thinking difficult. They undermine efforts to behave well toward others. These effects have become obvious to me in this hospital bed, where I’ve hung out for seven days without eating, feeling pain ranging from mild cramping to agonizing pressure, and suffering with ongoing nausea that at one point morphed into twelve hours of retching.

To my chagrin, I’ve seen myself act more selfishly and distractedly than usual. When visitors arrive I sometimes talk about my dilemma non-stop, whereas other times I stare blankly without truly hearing what they say about their own trials. I try to remain focused on the needs of others, but it’s hard.

As never before, I understand how maturity and effectiveness can be undermined by adverse states of body-mind. But I’m trying to cut myself some slack and simply review the effects of starvation and pain on my actions and words. I want to learn from this experience but not suffer excessively because of it.

Life inevitably veers in unwanted directions. How much misery we feel depends to a large extent on how we respond to fate. This is true when life disappoints us, and also when we disappoint ourselves.

People sometimes slight us, leading to mild irritation. But as we mentally replay the offense later, we may build up resentment or even rage. Of course, we could instead view the occasion from a broader perspective and forgive the insult. Similarly, a personal gaffe can be made worse by negative obsession, or better by viewing it as a learning experience.

Before we begin to mature as adults, we may not be aware that such choices exist. Resentful obsession seems like the natural and inevitable response to an insult. Humiliated rumination seems like the deserved consequence of social mistakes.

Fortunately, as we gain skills we learn to transform resentment into forgiveness. We abandon narrow focus on a single slip-up for a broader and more compassionate perspective on our personality.

When we are faced with really serious illness or other trying circumstances, our resources can get overwhelmed. Our healthier skills are most likely to fail us when we are hurting, hungry, frightened, or lonely. Not only are we more likely to overreact to minor injustice, and to act childishly, we are more likely to punish ourselves afterward.

My system has seldom felt so physically stressed as it does now. As already mentioned (in this essay and the last), the duress has increased my tendency to behave with embarrassing immaturity and selfishness. Before I started paying attention to this cause and effect relationship, I had begun to berate myself for getting so far off track.

Yesterday during a conversation about these issues with a dear Buddhist friend, we talked about how the Buddha distinguished between what he termed the first and second darts.

Fate throws the first dart into our sphere. For instance, an unexpected major illness arises. It could be anything. For the sake of argument, let’s imagine sudden pain arises in the abdomen and doctors discover a nest of abnormal blood vessels near the pancreas, along with a bleeding aneurysm. Prolonged hospitalization becomes unavoidable, along with its discomforts and inconveniences.

We toss the second dart ourselves. Perhaps it penetrates consciousness in the form of worry: does a cancer lurk under that tangle of vasculature? Is death on the march? The second dart drives resentment and frustration: plagued by worry and feeling persecuted, we complain and act out. The second dart accentuates our misery. If we simply experienced unavoidable hardship without layering on toxic interpretations and retaliations, we suffer less.

During yesterday’s conversation with my friend, we came up with the idea of a third dart. We use this missile to attack our unskillful response to fate. Just as the second dart arises in reaction to the first, in that we worsen a bad situation by distorted thinking, the third dart flies as we reject our own negativity. We could choose to be compassionate toward the second dart: “Oh jeez, I yelled at that phlebotomist after he jabbed me a third time trying to suck blood out of my arm. How predictably human I am! When he comes back I’ll apologize.” Quite often, however, we instead launch the third dart and berate ourselves for shortcomings: “How ugly of me to sound so hostile! Didn’t I learn anything from all those years of meditation and acceptance practice?”

Notice we won’t be susceptible to such self-reproach if we don’t value skillful behavior. The red-faced tailgater leaning on his horn as traffic slows for a yellow light is unlikely to suffer from the third dart, though he is hitting himself hard with the second one. He probably won’t be blaming himself for his intolerance. In this sense, being self-critical shows more maturity than being self-righteous. Even so, the third dart does little to actually improve our responses. It simply makes us pay a higher price after we misstep.

The third dart is a danger to those of us who hope to tread a spiritual path, because we replace helpful noble intentions with damaging self-criticism. We feel painfully aware of our inadequacy compared to the highest exemplars, like the Buddha or Christ. To intend skillful behavior is edifying, but to punish ourselves for human failings is destructive. We gain nothing from the third dart.

I’ve been pulling a lot of third darts out of my butt lately. A prolonged hospitalization for a confusing, painful illness is a great way to lose one’s grip and begin acting unskillfully. Instead of giving in to my inclination to beat myself up afterwards, I’m working to recover my balance as quickly as possible: correct my behavior, apologize to whoever I hurt, and forgive myself. I yank out the third dart and keep aiming for my better path.

Criticizing people, systems, or the entire modern world has become too easy. My last post made some valid points, I’m sure, but it looks unbalanced to me as I reread it. Without doubt, since I entered the hospital occasional staff members have treated me with shocking insensitivity. On the other hand, there have been some pleasant interactions, especially during the past two days.

One older nurse took time to inquire about my dogs. It was the first set of truly personal questions I’ve answered, and it felt good to be talking about subjects that warm my heart rather than abdominal pain, nausea, and constipation. It felt delightful to be treated as a unique individual rather than just another patient.

Another nurse shared with me her feelings of conflict about whether to continue living far from her boyfriend or move closer to him. She grew up in this area and is loathe to leave it for a region she likes less; and yet, long distance relationships never fully satisfy. I appreciated her confiding in me, if only briefly. It increased my sense that we share the common human experience, with its constant ebbs and flows of pleasure and pain.

And I must admit that my behavior as an inpatient has not always been laudable. I’ve accepted cell phone calls while staffers took my vital signs, when I should have kept my attention on the living, breathing person next to me rather than tuning in to a plastic box. Even when the box is transmitting words from a loved one, and the person checking my blood pressure is a stranger, the latter deserves my attention more.

Plus, I’ve acted demanding and entitled at times. When they moved me out of my private room into one with three beds, I raised a fuss. Indeed, the shared room robbed me of sleep and raised my anxiety, but why should I feel myself above experiencing such duress when someone must? What makes me so special? They eventually isolated me after I spent twelve hours vomiting: obviously a distressing experience for my fellow patients. But I feel a little chagrined, looking back on my whining.

In my defense, I haven’t eaten a meal (or at least not one that stayed down) for six days. I’m in constant pain and sleep poorly. I’m worried about my future and discouraged that my budding acupuncture business has been dealt another body blow. But don’t we all have excellent reasons for acting like jerks? The trick is to be kind regardless.

The point isn’t to punish myself here. I’m only human, just like everyone else. We all need to work on improvement; it’s a never-ending call. I still believe that modern health care could be enhanced with more attention to personal warmth and less emphasis on technology, but I need to remember that many people who work in the field feel strongly about their mission and strive to provide compassionate care.

Criticism is easy, but so is praise. In the end, we do best with a little of the former and a lot of the latter. This is true whether we are on the sending or receiving end of things. The health care system needs reform, but it also deserves praise for managing so much suffering, day after day.

The Face of Modern Care

Two hospitalizations in the past ten days have updated my views on modern medical treatment. As a physician who used to practice a standard (albeit obscure) specialty and now provides acupuncture services, I interpret events during my inpatient stays from a unique perspective. As you read the following critique of inpatient care, keep in mind my past sufferings with awful medication side effects, and the fact that I’m currently sitting in a cramped and ugly hospital room.

Skeptics dismiss acupuncture as a ‘mere’ placebo. Although reams of research demonstrate that people improve after treatments, the mechanism remains uncertain. Relevant neural pathways seem to be altered, but these changes can be subtle and may not suffice to explain acupuncture’s effects. Bodily energy (Chi) remains a possible agent, but since it has not yet been proven to exist, it cannot be invoked in a Western context. In short, the data establish that people feel better after acupuncture, but there remains much mystery. It may well be true that much of the improvement is due to placebo action.

Here is my preferred definition of the placebo effect: the triggering of the body-mind’s innate healing response by an external signal. This description is broad enough to encompass sugar pills, hypnotic suggestions, and hugs. The unifying factors are trust, intention, and expectation. If a respected physician prescribes a pill and calls it potent medicine, the chance of improvement is high. This is true whether the pill contains a sophisticated drug or only sugar. (Pharmaceutical researchers often find it difficult to prove that a medication works better than sugar.) Recent work shows that patients may even feel better after knowingly taking inert pills, if they are assured that healing will follow.

Notice that context matters, and that trust is a big part of it. Hugs make us feel good, but not if offered insincerely or by those who abuse us. In a hospital, trust gets fostered by personal attention, smiles, and small acts of kindness. As a patient, you’d like the staff to ask how you feel while looking you in the eyes with genuine interest. You’d like to see a warm smile on the face of the person checking your vital signs. You’d like your nurse to notice if the room feels chilly and bring you a warm blanket.

Although I experienced each of these gestures during my hospitalization, I regret to report that they were rare. Usually, questions about my status were asked as the nurse faced his or her mobile computer cart. Blood was often drawn grimly by technicians who said few words and hardly looked at me. I had to ask for blankets repeatedly, even when being wheeled through drafty public corridors, where the need for coverage seemed obvious.

On a clinical pod of ten rooms containing fourteen beds, I counted two dozen computer screens. At any given time, nearly all the nurses and aides were working on computers rather than caring for patients. Even when they visited my room, which happened rarely, they spent most of their time entering data and asked only those questions mandated by the online forms. I was treated like a mechanical device in a repair shop rather than a flesh and blood human in a center for healing.

In my acupuncture office I keep the surroundings comforting and calm. Meditative music plays in the background and art adorns the walls and shelves. In the hospital the corridors were painted institutional green. There was no music and only a few token photographs. The background noise consisted of a near-constant cacophony of beeps and alarms emitted by all the technology. I didn’t see a single houseplant.

Don’t get me wrong. Sterility of equipment and surfaces is vital in a hospital. But does that require a sterile ambiance? Professionalism is important too, but does it rule out humanism?

Once after midnight I rang the call button. A young man barged into my darkened room and immediately turned on the brightest overhead light. When I told him I had abdominal pain he asked sarcastically, “so you’re having gas?” Worse, he didn’t seem phased by my response: “No, I have internal bleeding.” He simply stalked out of the room to summon the medication (and would have left the light glaring if I hadn’t stopped him).

This wasn’t an isolated incident. To cite one other example: when I was in the ICU I needed the nurse’s help to reach the nifty toilet that rotates out of a cabinet next to the bed. When I asked for assistance onto the commode, she suggested: “can’t you use a urinal?”, which forced me to spell out my bodily need so she’d see that her solution wouldn’t work. After I was in place and she left me to my business, she failed to close the curtain across the glass wall separating my room from the corridor. She expected me to defecate in full view of all the staff and visitors walking by.

I could go on, but you get the picture. This experience wasn’t healing, it was exasperating. At least the doctors seemed highly competent, though they failed to communicate a unified message and often contradicted one another. On the one hand, I was glad of my medical training, since it helped me sort out my options in a confusing situation. On the other, I was saddened to see how hospital care has deteriorated. Apparently, many young people entering health fields have neither empathy nor sense of mission. Computers win more attention than patients.

We hear a lot about evidence-based medicine. It is a good idea, but let’s add in a little placebo-based healing, too.

Most of my blog posts get titled after completion. Only rarely do I start with the caption and build an essay out of it. This morning the two words above best express what’s going on in my little world. In truth, I could stop there. It probably isn’t necessary to write anything more, but I’m going to anyway. Don’t expect too much from the text that follows, since my creativity feels dulled, and my energy is flagging.

The past eight days have been among the most trying of my adult life. First came the abdominal pain, internal hemorrhage, and hospitalization. My confinement taught me a lot about modern inpatient care, little of which was comforting. After discharge I tried for three days to get by without analgesics until the pain became so overwhelming that thought nearly evaporated, leaving nothing but raw suffering. So on the advice of my doctor I finally gave in and started taking a Percocet twice a day. This enabled me to start functioning again, but now I’m stuck on narcotics (exactly what I was trying to avoid). Since getting off them the last time was such an ordeal, I’m very worried about this necessity for pain relief.

A close friend of mine visited me the day after I returned home. He confronted me with some very upsetting opinions about our interactions on a day when I felt highly vulnerable. This makes me feel wounded and sad.

I’m worried about dying. Looking around I see how my life, as humble as it is, has so much precious beauty. It contains far more of value than I ordinarily acknowledge. For all my years of suicidal thinking, I don’t want this show to end right now.

A cousin of mine and I have been carrying on an email conversation that has expanded my understanding of our families and my own past. This feels quite useful to my growth, but it adds to my sense that everything that seemed solid in my life is dissolving.

The doctors still have no idea what went wrong inside me. Although they tell me not to worry about malignancy, my own medical training tells me that it remains distinctly possible. I realize that many people battle cancer, and that many survive. I’ll fight the good fight if necessary. But at this point there isn’t any disease to battle, only uncertainty.

The weather here was gloomy until yesterday: chilly, damp, and gray. Before this week the winter climate had little effect on my mood, but now I’m feeling oppressed by it.

The discomfort continues, even with the pills. In addition to pain I feel fatigue, malaise and nausea.

In short, there is a great deal going right now, I’m a bit overwhelmed. It feels like living does when it gets challenging. I am feeling life.

There is much psychological literature on sensitivity, which is no doubt familiar to many readers (see this Wikipedia article for a good summary); what follows is my poetic and non-scientific take on the subject.

Some people seem to feel life more deeply than others. Culturally determined preferences may judge high sensitivity as better or worse than its alternative, but in my opinion the trait requires no such valuation. On the other hand, those of us with systems wide open to pain and pleasure must comprehend our true nature so we can learn to function comfortably in a world that seems designed to challenge the heart.

Did you spot the lie in the last paragraph? The truly sensitive soul will never find lasting comfort save by rejecting the very quality that defines it. To feel life in the abyss of the self is inherently agitating; moments of peace will ever alternate with moments of distress. This is why exquisite sensitivity is commonly viewed as a deficiency.

Imagine for the moment a sentient God who watches our lives from on high. My position on whether such a deity exists is nuanced, complex, and changeable, but right now I don’t want to get into that tangle. Instead, just try to picture how humans would appear through the sagacious eyes of an all-knowing God. From that vantage, does the sensitive person look like he or she is lacking? Doesn’t it rather look more like the sensitive soul is the one who is paying the most attention?

Let’s face facts. Death hurts. Even birth hurts. Romance is seldom forever sweet, as most married couples can attest. Children bring joy to families, but not infrequently they also bring grief. Illness strikes us all, sooner or later. And these are just the ordinary, inevitable trials of life.

Add in earthquakes, hurricanes, famine, wildfires, and tsunamis, and you begin to feel the true impact of our dilemma. Then include the human-generated miseries of war, torture, exploitation, environmental destruction, child-abuse, racism/sexism, and so on. By this point we have before us a panorama sufficient to demoralize anyone who opens to its import. No wonder a responsive heart is often considered an infirmity.

Fortunately, there is more to life than heartache. We can appreciate the intricacy of a spider’s web, the majesty of the moon on a cloudless night, the joyous warmth of a rising sun. We can feel the heart’s faithful beating, the innocence of a child’s smiling face, the palpable waves of love in a family. We enjoy the delicate aroma of a field of wildflowers as we take a morning stroll in springtime, and we feel invigorated by the blustery swirl of leaves as we walk through a park on a windy autumn afternoon. We can meditate among granitic monoliths in the high mountains or feel lulled by waves lapping along the shore of a broad, clear lake.

The trick to embracing this infinite universe of splendor and terror is to remain, yes, sensitive to its charms.

There are two basic strategies for surviving life’s ordeals. One is to harden the outer walls and live protected from fate’s sting. The other is to open the windows wide and let the full blast enter, keeping faith that bereavement and dismay will be more than balanced by blessings and delight.

Sealing the mental house tightly shut keeps out the cold, biting winds, but also the butterflies and sunshine. Opening wide invites life’s full complement of chaos, but also its magnanimous smile.

The sensitive soul faces this choice early in life. In my own case, my upbringing felt overwhelming, so in response my young adult years became a study in progressive cynicism. By my age of twenty-five anger was the only emotion that remained easily accessible. Training as a physician completed the tempering begun years earlier; through medical education I became skilled at participating in the most affecting dramas without feeling affected.

That transformation led me to many of my most disastrous decisions and lasting regrets. I became cut off from my ethical foundations and acted on the basis of superficial logic fueled by deep-seated angst.

How much better it would have been to leave my gentle heart on my sleeve, where it naturally wanted to perch. How much happier I’d have been following my quirky inner leadings rather than society’s call to ambition.

No matter. In the end I found my way back to my true nature. And indeed, as I mentioned in the last post it may be that this current epoch will be my ending turn on life’s wheel. Yes, I feel terribly pained by how much I may be losing before long. I feel even more sorrow about how much was lost through mistaken efforts to protect my heart from breaking. But better to return to feeling at last than never return at all.

Poets, artists, reformers, healers, and saints all rely on sensitivity. The majority probably were born into this world with giant, vulnerable hearts. Many may have lost their way for awhile. But in the end, the sensitive person can neither be happy nor effective except by allowing his or her insistent affection and exquisite tenderness free reign.

The best way to achieve this freedom is to keep the eyes open as wide as possible. Don’t close off to the pain you see, but don’t ignore the beauty of life’s spectacle either. Watch how the winds blow from all directions. Sometimes bitter Northers strafe us with ice, and sometimes balmy desert breezes blow in the darkest night. Sometimes death, sometimes birth. Sometimes cruelty, sometimes compassion. Sometimes illness, sometimes health.

Life is a circle. Live in the middle of the largest circumference you can imagine. From such an axis, no matter how much distress you feel, you will discover a greater measure of Bliss.

The fear of death remains foreign to me, but for the first time I truly feel the tragic gift of mortality.

Many of my early memories revolve around my mother’s depression and her subsequent dying from it. During my fourth through sixth years, my mom had no will to live and expressed little joy. Her suicidal despondence taught me to think of death as a friend to invite, not an enemy to avoid. After her departure from this life, I spent the rest of my childhood fitting human impermanence into my worldview. It wasn’t easy, and along the way I also learned to fantasize and wish for different truths. But in the end the stark reality of love’s transience became solidly fixed in my adult philosophy.

You can spend a lifetime thinking of life as temporary and of limited ultimate value, but when you glimpse the unplanned end of your own time on this planet, mortality becomes far less abstract.

My last four days were spent in a hospital. Severe abdominal pain kept me awake most of Monday night, and by Tuesday morning I had no choice but to stretch out in the back seat of our truck while my wife drove me to the Emergency Department. It hurt too much to sit up, and the entire short drive was spent shivering from the frosty cold and cramping pain. After several hours of workup, the doctors informed me that a liter of fluid had been found next to my pancreas. They believed this was very likely blood from a sudden internal hemorrhage, but they were uncertain about its cause.

After a few days in the hospital the diagnosis remained unclear. The first considerations of pancreatitis and perforated ulcer were ruled out by further tests, and my wife and I were left with a short list of exotic benign problems but also the real possibility of pancreatic cancer.

As a physician, I know that this particular malignancy is highly lethal. It kills quickly and the longterm survival rate is extremely low. We hope, of course, that something else will explain my condition, but now that I’m back home awaiting additional studies, I’m finding mortality staring me down like never before.

You can contemplate suicide a thousand times and so convince yourself that death would not trouble you. But let the Reaper come knocking at your door in the form of a dangerous disease, and suddenly you realize that life is more precious than you ever admitted.

Any longterm reader of this blog has seen me become more welcoming of life’s uproar. I now find beauty in even the hardest circumstances, and I love all beings with more depth than I could have imagined in younger years. But although I’ve endeavored to walk through my days with increasing mindfulness, and to appreciate the shifting weather and achy momentum of my human body, this morning I am feeling life’s tender majesty with greater acuity than ever.

On our fence outside hangs a ceramic sun made in Mexico. It is a cheap item that we bought long ago. But seeing its bright, shiny face this morning nearly brought me to tears. How many more opportunities will I have to gaze upon this innocent bauble? How many times have I glanced its direction without noticing the serene, eternal message? Or appreciating my spouse’s sweetness in hanging an uplifting decoration where it can be seen every day whether I choose to look or not?

The clay sun is just a tiny example of how powerfully everything is hitting me right now. I hesitate to describe the wrenching, simple joy I feel in my humble stucco house, or how potent my wife’s worried smile feels to me as she gazes at me typing here next to the fireplace. So many heartrending gifts that I take in every day but seldom really feel. So much life surrounds me, and so much of it has passed me by as I obsessed about past mistakes or future problems.

Well, it all may turn out fine. Maybe it was just a burst aneurysm. Maybe I can go back to ordinary life without fear that the next six months will trace a slow, agonizing spiral toward extinction. But either way, I now see the futility of complaining about the problems we face. They will end soon enough, whether we want to let them go or not. In the meantime, our task is to embrace this terrible, spectacular, agonizing, and gorgeous moment of living. Most of all, we must love everybody and everything that shares our time on this plane, while we still can.

My blog’s tagline includes the word spirituality, which has devolved into a vague term that can mean almost anything. In the interest of clarity and to balance the two previous posts that emphasized material takes on human life, this essay will outline my spiritual path and beliefs. Readers may or may not be interested, but it helps me to spell out my philosophy from time to time, especially since it’s still maturing.

What follows rambles through my ideas about different metaphysical stances, to my own personal experiences with them, to a description of my current stage of development. Since my understanding of the world’s religions is superficial, at best, don’t be surprised if my statements about faith and practice sound obvious or naive.

Two posts back I stated that our animal identity constitutes “the most central and accurate description we could give of ourselves.” After all, it seems unarguable that humans are mammals with large brains. Even while writing that sentence, however, I remained aware that many resist considering themselves ‘mere’ biological organisms. Indeed, when I posted the same essay on my Psychcentral blog, the following comment came in:

Hmmmm, so we are reduced to “cycles of carbon and calcium?” I prefer that we are “fearfully and wonderfully made” by our creator. As a believer, I will be returned to Him.

This reader’s opinion probably resonates with many who consider themselves religious or faithful. Here’s an edited version of what I wrote in reply:

You bring up the other common opinion about ultimate identity: that we are best described as conscious entities (souls) inhabiting organic forms. But even if one takes that view, at death the body is still reduced to its constituent elements and recycled in the biosphere. The two viewpoints are not mutually exclusive. In fact, since our biological form is apparent, while our spiritual nature remains debatable, even believers should look for ways to interweave the two perspectives. To deny our biology is to deny material reality, just as to deny our divinity is to deny higher meaning.

Divinity, as I intend it here, is a loose term meant to suggest that we have inner measures of soulfulness that go beyond the solid, predictable qualities of organic matter.

In the opinion of Christians and Muslims, each person has an immortal soul that is born once to this world and then consigned to eternal bliss or damnation based on a lifetime’s accounting of virtue, sin, faithfulness, and redemption. The sensible person thus works toward righteous behavior in order to secure a place in Paradise.

According to many Hindus and Buddhists, a soul (or its equivalent) is reborn repeatedly through time because of karmic entanglements accrued in previous incarnations. The wise soul engages in right action to limit such attachments and thus escape the cycle of death and rebirth.

Not all religions postulate an eternal and personal soul. For instance, Western Buddhist teachers seldom mention reincarnation. They discuss the basic principles of detachment and right behavior without reference to rebirth. This obviates the need to discuss a soul-entity, and in fact the Buddha himself rejected the existence of a discrete soul, since he found no evidence for any consistent, fixed self in his deep explorations of mind. Most Buddhists in the USA seek direct, meditative insight into the nature of consciousness as the ultimate goal of practice and don’t worry about escaping the cycles of birth and death. The focus is on mental process without invocation of any divine or eternal soul.

Many contemplative traditions (including some strains of Sufism, Christianity, Buddhism, and Hinduism) also reject the personal soul-concept. However, they do so by invoking a universal consciousness that subsumes the individual. This is the non-dual stance, which sees no meaningful distinction between soul and body, or between spirit and matter, or between God and individual souls. According to this philosophy, all beings arise as creative expressions of one vast Presence that manifests in myriad forms but retains core unity, which unenlightened humans fail to grasp. Such analysis rejects boundaries as illusory, whether between individuals, between people and animals, or between people and Divine Nature. We are viewed as all of one body, in the deepest sense. This perspective is essentially ecological and fits well with what we see in the biosphere.

Those of conventional scientific persuasion bristle at mention of either soul or universal consciousness. They see any suggestion of mystical reality as unfounded, infantile, and dangerous. But there is no scientific evidence that rules out either individual souls or cosmic consciousness. Quantum mechanical principles such as entanglement and non-locality provide plausible, if completely unproven, mechanisms whereby enduring impressions of mental life could be retained in the cosmic matrix without violating established physical laws. These ‘recordings’ could possess all the qualities we expect of discrete souls or universal awareness.

Over the years I’ve explored many different metaphysical positions. Raised as an atheist and educated extensively as a biologist, I never seriously questioned the strict materialist perspective until age twenty-nine. At that time, as I entered Alcoholics Anonymous and felt encouraged to find a ‘higher power,’ fate connected me with the Religious Society of Friends (Quakers). Quakerism eschews dogma and doctrine in favor of direct, experiential discovery of ‘the light of Christ’ within each of us.

In 2000, after a series of profound (even shattering) spiritual experiences, I converted to Catholicism. For many years I went to mass several times a week and tried hard to buy into the Roman Catholic worldview. But although I appreciated the call to mysticism and the sacred rituals, the Church’s dogmatism, reactionary sociopolitical views, and rejection of female priesthood alienated me.

As an alternative, I explored Buddhist meditation. For two years I went to local meditation centers for weekly sittings and occasional longer retreats. At the same time, I undertook an intensive program of reading about Buddhism. The emphasis on silence and detached observation of thought felt quite helpful and fit with the clinically oriented mindfulness meditation I’d learned ten years earlier in classes at a local medical center. But in the end, I had trouble with Buddhist emphasis on emptiness and detachment. Although I see the value of exploring these qualities, they offer little in the way of felt love or sweetness. Meditative consciousness is vast and reverberant, but not inherently warm.

Next, I explored a Hindu offshoot at a retreat center that opened a couple of miles from my home. The monastics taught me to visualize my soul as residing in the area of the third eye in the middle of my forehead. I learned to concentrate on my soulful qualities rather than my bodily identity. This approach challenged me at first, because so much noise and confusion seems to arise in my head, and focusing my attention there failed to quiet the uproar. At the suggestion of a skilled meditator, I adjusted the technique by moving my conscious centerpoint to my heart, where there is more peace and warmth. Before long, I awoke to the powerful illumination of an ancient inner awareness that has little use for my day-to-day worries, ambitions, and desires. This inner light feels like a combination of personal soul and universal Presence arising from the cosmos itself.

Oddly, and beautifully, I now find myself having gone full circle. After all my explorations I am back at the Quaker starting point, only with a much more palpable sense of that divine light within each of us. This is experience and not belief. I cannot justify it in rational terms and see no reason to try. All I can do is describe what happens when my meditations go well. It matters little to me whether my direct apprehension of love, unity, and rightness resides only in my brain or truly connects, as it seems to, with a cosmic consciousness. Because it is experiential and not referential, it feels quite solid and unshakable. Some days I interpret my soulfulness in mystical terms, and other days I think about it in purely neurological ones. But no matter what I believe about this state of mind, it brings me peace.

Every person must choose her or his own path, and I have learned to judge no one’s, not even my own. Those who prefer material atheism have adopted a belief system that requires no leap of faith and has a logically satisfying internal consistency. Those who believe in heaven or reincarnation, and who view souls as eternal and individual, have found a comforting formula that gives meaning to what happens here on earth. Those who meditate mindfully to enter spacious states of consciousness experience inexpressible mental stillness. Non-dualists, in turn, use their practice to find (what seems like) experiential confirmation of an ageless and infinite cosmic unity.

For my part, I know only that there is something that feels divine and non-egoic in the center of my chest. It beats like a spiritual heart throbbing in unison with the biological pump that moves my blood. My metaphysical position is neither more nor less valid than any other. It has features in common with the tenets of materialism, since my bliss seems deeply rooted in my biology. It shares some aspects of the soul-religions, because the brightness within acts like an eternal spark that illuminates my better nature. Consciousness also feels enhanced, as I tune into the infinite harmony that comes with silent meditation. My practice has non-dual aspects too, since in its highest expression I feel merged with all beings and all Nature.

This is my spiritual trail, which has been blazed through two-and-a-half decades of searching and introspection. I believe each of us must choose whatever path feels right. We should seek the tradition(s) that can heal both our own wounds and the troubles of the larger world.

So although I spent two posts honoring humans as living, breathing organisms, it feels vital to round out the discussion with my conviction that we also embody a loving, timeless Presence that permeates and transcends our material forms. This may be a personal soul, or a universal one. It may be pure consciousness or an artifact of brain physiology. No matter. It dwells within each of us, waiting for the day we abandon our desperate scheming and open to Life in all its terror, splendor, and Grace.