One of the inspirations for The Seed House was to create a resource that would foster compassion in health care providers. Being a surgeon, I have special interest in the challenges of providing care in an increasingly financially oriented medical system and rekindling the original sacred intention to relieve suffering that most doctors dreamt of when starting down this road. My personal journey and academic inquiry led me to learn more about the constituents of compassion and understand how what seemed like a natural inclination could get utterly shipwrecked. Most of the programs, now mandated by hospital accrediting organizations, to address and remediate behaviors that interfere with the safe and civil delivery of care are diagnostic and punitive, laying the blame on basic character flaws in errant providers. Given that every medical student I knew had a dream and that current data shows that nearly half of all medical students have signs or symptoms of burnout by the end of the second year of medical school and before actually beginning the clinical part of training or having regular patient and clinician contact, it made sense to me that whatever process appears to swallow our ability to relate to the suffering of our patients or even to their individuality and experience happens along the way. It’s not the result of choosing the wrong applicants.
The very best and most prescriptive work I have found comes from Roshi Joan Halifax, Ph.D., a medical anthropologist by training and abbotess of Upaya, a Buddhist monastery in Santa Fe, NM. Her blend of centuries old Buddhist practices centered on ending suffering and neuroscience research are providing some surprising and practical guidance for understanding and nurturing compassion. Perhaps most surprising is that “burnout” or compassion fatigue actually seems to originate not in a low capacity for caring but in the setting of hyper intense caring and taking on the pain of others without adequately separating from them. She distinguishes empathy, the emotion of feeling inside oneself what another person is feeling, from sympathy, the state of feeling alongside another person, of being attuned to and present with another person’s suffering but sustaining awareness that it is their feeling, their pain. This requires a kind of balance of cognition and sense of self along with the attunement to others. She argues that empathic hyperarousal is a more accurate, descriptive term than “compassion fatigue.” This would explain another contradictory finding in my research about disruptive physician behavior: the majority of doctors referred for counseling or remediation are actually more concerned about their quality of care and dedicated to their practices than their colleagues.
Interestingly, mindfulness practices, such as meditation and embodiment practices like yoga asana practice that refine our capacity to sense what we feel in our own bodies and modulate our emotional responses utilize shared neural pathways with compassion and can help us bear witness to suffering without moving into personal distress. As we approach the one year anniversary of The Seed House, it is a good time to reflect on and share what inspired the creation the space. The yoga studio and the cafe are just the tip of the iceberg. There’s purpose and hope and intention underneath. I am humbled, as I make my way along the Camino de Santiago very slowly this time, how easy it has been for me to slip into habits of work that were detrimental to my wellbeing as a surgeon. This walk is a chance for reflection, removed from the immediacy of The Seed House day to day operations (capably being attended to by the other practitioners and staff there) and to have time and concentration to consolidate some of my findings into a handbook for surgeons and other care providers. Like my walking, the process is slow but steady. And when I return, I will be on my yoga mat and zafu, practicing, exploring the mind-body connections that help build true compassion and ease suffering, always returning to home.