Religion: Say 'Om' and call me in the morning
Western medicine has a lot to learn from the East, according to David Shlim, author of Medicine & Compassion: A Tibetan Lama's Guidance for Caregivers. In 1979, then 29-year-old Shlim was a newly minted emergency room doctor in Portland, Ore., with a passion for mountain climbing. His hobby took him to Nepal, where—after a few three-month stints—he decided to stay for 15 years practicing travel medicine, treating trekkers and diplomats for such things as diarrhea and other infectious diseases. While there, Shlim also volunteered once a week at a Tibetan monastery, where he began exploring the Buddhist concept of compassion. Now back in the United States, Shlim hopes his new book will help western doctors incorporate compassion into their practice. From July 7 to July 9, Shlim will cochair a program on compassion and western medicine at the Harvard School of Public Health. The main presenter will be Tibetan Buddhist teacher Chokyi Nyima Rinpoche.
When did you first notice compassion affecting you as a doctor?
As I got more serious about Buddhism and compassion, I found that my medical practice was benefiting. I had thought, OK, I work 12-hour shifts, and some days at the end of the day I feel beat up, and some days I feel OK. What's the difference? It wasn't based on who came in and what their problems were like—it was my ability to connect with them and find out why they came in. For instance, I had a 26-year-old woman with rib pain come in at 2 a.m., and she's crying. It doesn't seem so bad, but I do all these tests. Finally, she asks me, "Could this be cancer?" It turns out her grandmother had rib pain and six months later was dead of cancer. If she had not been able to reach that question, we would not have connected. I would have wondered why she came in, and she would still feel scared. There's a way you can be more present at the bedside that allows people to trust you and open up.
When people feel cared for, they're also less likely to sue, right?
One of the big problems with our healthcare system is everyone goes through it, but no one is happy. For instance, I did a follow-up with a surgeon who went through my course. He told me he took a patient to surgery, and there was an anesthetic disaster. It wasn't his fault, but he went right to the family and offered support and kept seeing them long after the surgical problem was resolved. A year later the family sued every person involved except for him.
Why did you decide to stay in Nepal for so long?
It was on my third trip to Nepal. I was sitting on a mountain, and I thought, you know, the American emergency room is hard. People come in drunk; they yell at you. And this was back in the early '80s, during the Reagan years, when a lot of societal programs were cut. A lot of psychotic people were turned loose on the streets, and there was nowhere to put them. When I heard about a clinic in Katmandu, I decided to join. It turned into an international clinic for travelers, diplomats, and aid workers. After a year, I became the director and stayed there for 15 years.
How did you get involved in Tibetan Buddhism?
A lot of people forced out of Tibet resettled in Nepal. During my first year at the clinic, I heard about a Tibetan Buddhist monastery, and I thought, why don't I go there one day a week and have a sick call, because it seemed like a nice way to give something back. The head of the monastery, Chokyi Nyima Rinpoche, invited me for tea, and we'd sit and have a chat and start talking about stuff.
How did you get interested in teaching western doctors compassion?
In 1998 I left Nepal and moved to Jackson Hole, Wyoming. I had this idea that I could put on a conference about compassion and have Chokyi Nyima be the teacher. All of these very remarkable compassionate doctors and nurses came. One of the best qualities of compassion is feeling that you're not compassionate enough.
How do western and eastern ideas about compassion differ?
Compassion is not a fixed commodity that you're born with a certain amount of. That's how we [mistakenly] view it in the West. In Buddhism, compassion is malleable. It's our natural state, but sometimes we just can't access it fully or very well because attachment, irritability, or anger obscures it.
Don't medical schools already teach compassion?
There are programs addressing the need, but they're not very effective. They teach empathy, which is a process of experiencing feelings from a patient's viewpoint. You take in a little bit of the suffering. The problem with that is that at first, doctors are like everyone else—the experience of seeing suffering is raw. To protect against that, a lot of practitioners develop a professional detachment. Compassion increases the capacity to take in a patient's feelings without being adversely affected by them.