While applying to medical school in my early twenties, I read an article by a plastic surgeon. He said modern cosmetic surgery is much the same as tribal scarification, because they both carve skin to match a societyās ideas about beauty. I rejected the comparison. I imagined modern medicine to be informed by science, while tribal practices seemed based on superstition. The two had little in common.
But after I began medical training and then entered surgical practice, I often noticed ritual elements in clinical settings.
There were steps taken in sequence: hands are scrubbed outside the operating room; hands held up, the surgeon backs into the door to the OR, pushing it open while keeping the hands clean; a nurse holds out a sterile gown, and the surgeon steps into it; sterile gloves are presented and hands slide in.
Clinicians speak an esoteric language that might soundāto an attuned earālike incantations. Even the background beep and hum of medical machinery can seem potent, reminding patients of the technology coming to their aid.
These ritual undertones seemed interesting, but they had no direct bearing on patient care. So they werenāt relevant to my life.
That changed in my forties, when health problems transformed me from physician to patient, and I groped for meaning during storms of illness. Later, in my fifties, I underwent a series of invasive procedures. At first, these clinical ordeals felt stressful and frightening. Strapped atop procedure tables, my view of clinical interventions differed from the one Iād known standing over them. I felt vulnerable and powerless, as is natural when our lives are entrusted to strangersā care. The doctors, nurses, aides, and technicians involved seemed barely aware of the psychological power they wielded, and they made little effort to use it as a tool for healing.
I began to see unacknowledged shamanism hidden in modern medicine, just like the plastic surgeon had suggested. Yet precisely because everyone pretends it isnāt there, it often seems more harmful than helpful.
I was just as obtuse during my time as a surgeon. Clinical training does not cultivate the mindset and skills needed to use ritual power with conscious intent, and professional norms would prohibit the use of them. Everything is supposed to be objective, scientific, and antiseptic.
Could medicineās primal underbelly be made as helpful to healing as its bright technological face? I didnāt start out wanting to experience medical procedures differently. What happened was more dramatic. Because of the intensity of my clinical experiences and my innate tendency to slip into non-ordinary awareness, some of what I endured opened me to profound feelings of awe, oneness, and love. In short, some of my procedures became mystical experiences without me doing anything besides trying to survive them.
That realization struck me deeply, but I realized that leaving things to chance was selling myself short. I believed it might be possible to nurture spirituality within any and every clinical experience. And because my clinicians werenāt helping with that, I realized Iād have to take charge of my own psycho-spiritual care. Using a mix of medical background, meditative training, and spiritual creativity, I took steps to make my clinical experiences feel more mysterious and enriching, rather than simply harsh and depleting. By the time of my fourth major procedure, I had gotten pretty good at it.
The problem this time was atrial fibrillation, an irregular heart rhythm that causes fatigue and can occasion strokes. For months it had limited my lifestyle, so I decided to give the recommended cardiac ablation procedure a try.
As my date with the hospital approached, I contemplated my history of trauma and stress. I thought about my lifelong tendency toward negativity, chronic muscle tension, and self-defeating behavior. I thought of the times Iād pursued life paths that didnāt suit while neglecting interests that fulfilled. It struck me that although atrial fibrillation is common and might have happened anyway, my emotional style and personal choices likely played a role. Perhaps this heart affliction was telling me to take my wellbeing more seriously.
To avoid a ninety mile drive through rush hour traffic on the morning of the procedure, my wife and I spent the night before near the hospital. Though I awoke cranky and Amanda had slept poorly, we stuck to our plan and went to church together the next morning. Two decades earlier, when my health problems began to intrude on our life, weād found solace in the Catholic Church, the religion of Amandaās youth. Back then, as we grappled with the disabilities that ended my surgical career, Christian liturgies felt stabilizing. Weād long since transitioned to Buddhist meditation and yoga, but in the unfamiliar neighborhood near the hospital, attending a Catholic mass was easier than finding a suitable yoga class.
We stopped at a church halfway between our lodging and the hospital. The procedure wouldnāt begin for some hours, but I was already feeling stressed and dazed. The service is a blur in my memory, but I remember feeling soothed by it. Iām not a staunch believer in the power of prayer, but the ritual of mass helped me emotionally prepare for a potentially lethal procedure. Iād been told the risk of life-threatening complication was only about one percent, so perhaps I neednāt have bothered with church. Yet despite the low risk and my limited buy-in, attending mass helped me feel a little more open-hearted as we drove the final distance to the hospital.
After checking in, undressing, and lying down on a gurney, I submitted to the attachment of monitoring leads, the placement of an intravenous line, and the shaving of my lower belly, upper thighs, and genital region. Iād been through similar preps before, and I donāt find them particularly embarrassing. But the sense of vulnerability was undeniable as one nurse shaved me, the other placed the leads and IV, and the two chatted amiably as they worked on my aging, ailing body. From a conventional perspective, ministrations like these are routine care, but I choose to experience them as a ritual cleansing. The mystical flavor would have been heightened by music and spiced oil, but I tasted it even with the utilitarian delivery.
After the prep, Amanda returned to sit with me, but I soon shooed her away. Two of her friends who lived in the area had come to the hospital to support her. She seldom sees these women and was happy to spend time with them. After she left, closed my eyes and began to focus inward.
I spent the next two hours in meditation, awaiting my turn in the procedure room. I did my best to remain present for my body, breath slowly and deeply, and invite relaxation. This wasnāt easy given the busyness of the ward, where a dozen other patients were being prepped before procedures or monitored afterward. Still, I grew calmer and more grounded than I would have otherwise. I also grew more aware of rippling fear and poignant sadness in the face of the real (however remote) risk of death. Iād have felt less emotional if Iād simply watched TV or listened to an audiobook during those hours, but Iād have missed an opportunity to honor the impact of what was happening.
At last the staff rolled me down a corridor and into a room overflowing with technology. A bank of monitors towered over the procedure table to which I was soon fastened, swaddled like a giant infant in a papoose of white linen. A rack of servers loomed in the background, the broad saucers of OR lights hovered above, and assorted medical devices stood in the corners, like dormant robots. When the nurses told me sedative medications would soon start flowing, I asked them to use little or no Versed. Itās a commonly used sedative that also blocks memory formation. I felt calm enough already, and I wanted to remember the procedure.
Soon I felt awash in mind-softening medications, and the experience took on a dreamy quality. The wetness of antiseptic solution swabbed the area previously shaved. Sterile blue paper settled over me, leaving only my groin and face exposed. The team gathered around, looming above me in gowns and masks, and the main work of the four-hour procedure began. From the outside, I must have looked like a specimen undergoing dissection. But on the inside, I was floating in a broad, intoxicated sea of fear, curiosity, submission, and awe. My interior state seemed limitless and contradictory. Part of me watched with intense, vested interest while another remained detached. Part of me wanted to understand what the cardiologist was doing, while another drifted unconcerned in the tides of narcotics. For large blocks of time, I simply slept.
Then the pain kicked in. The procedure had reached the stage where probes cauterized the inside of my heart and thenāsometime laterāfroze it with liquid nitrogen. With every blast of fire or ice, intense aching bloomed in my chest. Each time, the dreaminess vanished, replaced by an unwavering focus on my heart as volcanic and glacial forces sculpted its conduction pathways. But eventually the pain ended, and I drifted off to sleep.
I awoke back where Iād started, in the ward filled with gurneys occupied by heart patients awaiting or recovering from procedures. The staff kept me overnight in the hospital, where I spent sleepless hours meditating as waves of physical and emotional pain washed over me.
Before the procedure, the cardiologistās assistant warned me Iād feel battered after it was over. She hadnāt exaggerated. My groin felt and looked traumatized, throbbing and swollen with dark purple stripes that ran down my upper thighs. My chest felt sore, as if it had been punched, hard. Walking out of the hospital, I felt shaky and depleted. For the next two weeks, and especially during the first few days, I labored with exhaustion and a strong but tender ache in my chest. I modified my mindfulness practice, spending twenty minutes twice a day in recumbent meditation with hot packs atop my chest and groin. I was raw, sensitive, and prone to tears. Depleted and humbled, I lost all inclination to argue with people or circumstances. Life flowed easily, and I moved through it gently, grateful for its loveliness and aware of its fragility.
My heartās rhythm had returned to normal, yielding a sense of bodily rejuvenation. But I also felt more open-hearted, less trapped by my defenses. It seemed that the ablation had improved both the medical and metaphorical functions of my heart.
A month to the day after the cardiac intervention, I woke from a dream I knew well, one that had recurred often over many years. The setting was an old house Mandy and I once owned. As I wander through, I discover rot along the foundation and gaps in the roofing. The more I look, the more trouble I see. I feel overwhelmed, unable to imagine how all these defects could ever be repaired.
In the past, Iād always awoken at this point, in the midst of dread. But now, on the one month anniversary of the procedure, the dream went further. Workmen arrived and stripped the house to its framing, revealing a huge but dying tree upholding the entire building. I expected them to build scaffolds to reinforce it, but instead they cut it down. Bereft of its walls and without central support, the house almost vanished, open on all sides and spacious in the middle. To my surprise, I didnāt feel sad; I felt relieved of a great burden, and I awoke fulfilled.
I thought about the dream for days afterward, thinking how some psychologists view dreams about houses as dreams about the self. This interpretation fit, since my identity felt softened and opened by the work inside my heart. Then one morning I awoke remembering the Buddha is said to have spoken after attaining enlightenment:
Oh house builder, thou art seen at last! Smashed is the ridge pole, broken the rafters. Open to the freedom of the world, no longer imprisoned by sorrow am I.
The words now meant more to me than before, as if the heart procedure had implanted them deep inside. Realizing this, I grew more convinced of the subterranean connections between modern medicine and tribal practices, which the plastic surgeon had spotlighted decades before.
Yet if I hadnāt actively worked to bring its tribal, shamanic qualities, the procedureās psychospiritual potential would have been squandered
Medical interventions transport us to depths that are both terrifying and transformative. They summon the same psychological energies as shamanic healers. Medical technology bears little outward resemblance to masks, chants, drums, and dances. Yet within a patientās psychology, itās at least as evocative.
Because these energies are summoned incidentally and arenāt considered therapeutic, they seldom have beneficial effects. Often, they simply leave people feeling traumatized. Every day, in hospitals everywhere, opportunities for growth and healing remain overlooked.
Of course, there are important differences between biomedical and shamanic practices. The former are for more likely to cure illness. Infections can be eliminated. Traumatic damage can be repaired. Intense pain can be reduced. Biochemical imbalances can be lessened. Many cancers can be cured. And where medicine faces limits, as in the treatment of many chronic illnesses, research is making inroads.
But for all the power of modern medicine, traditional healers are better at reaching patients where they live: in their complex, emotionally responsive body-minds. They are better able to engage the human psyche in the healing process, embed illness in a communal and global context, and help patients find meaning in their experiences.
Someday, perhaps, hospitals will hire greeters to offer a selection of rituals as weāre admitted, and train surgical personal to pray or chant during induction of anesthesia, according to patient preference. Until then, we can devise our own methods for recruiting the emotional power of biomedical interventions. Rather than letting them deplete the human soul, we can enlist them to enlarge and strengthen it.
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