A Strong Back & a Soft Heart
With gratitude to Roshi Joan Halifax
I enter the sparsely decorated examination room, feeling my heart tied in knots. My brother follows behind; the clacking of his cane is an unmistakable mnemonic for what I would love to forget. A young doctor marches in. I detect a familiar accent and feel relieved. I had requested a Spanish-speaking physician for Oscar, whose accident had taken away partial movement, speech, and most of his vision. To my disappointment, the man passes by us without a greeting and throws questions about my brother as if he were not in the room.
Como se siente él? Oscar hears the question and answers with the only mode he knows: “Bien, bien, bien!” Each word a heavy pebble under his tongue, not big enough to stop the laughter that invariably follows anything he struggles to enunciate. The white uniform remains immune, throwing more mechanical, laconic questions for which he doesn’t seem to need answers. I settle back into my breath, feel my feet, and ground myself. I hear Joan Halifax’s wisdom: “Compassion is the intention and commitment to alleviate the suffering of others in a non-transactional way.” After navigating his emotions and possible exhaustion, I trust the young doctor will get there. I trust I can get there, too. I notice the unkempt clothes and the bags under his eyes. Double shift, I tell myself.
Today is our first visit to the trauma center, following up an MRI that revealed a brain aneurysm and the vastness of the injury that radically changed Oscar’s life. Yet the doctor encapsulates his condition in a “great, everything is fine, then.” I introject — but, how about the aneurysm? He looks at me, puzzled, and turns to the computer. After a brief moment, I hear: “Oh, not big enough to be a concern,” he walks out of the room with the same urgency he came in.
Minutes later, a nurse appears with an angelical smile and tells me we are all set. Perplexed, I attempt to settle my heart, hotness saturating my body and clouding my mind. I want to inquire, “All set? What did he do for us?” Instead, I break down. The nurse soothes me and asks if I want her to reschedule me immediately with another neurosurgeon in the practice. I nod yes. She brings us to the waiting room. Half an hour later, she returns and announces the new doctor will call me to arrange a virtual visit. We return to the car, Oscar’s cane and the doctor’s indifference rattling my nervous system. We all carry trauma in our bodies. I can feel the energy of mine traveling through nerves endings; it is a sluggish, thick energy that has been stagnant for years.
A week later, I am perched in front of my computer, full of hope. Hope is a perilous but necessary distraction. Is it an emotion? Certainly not; it involves emotions, but it is not one. It is more a mindset, a state of being. I have written a long list to share with the assigned neurosurgeon/mess cleaner. I am more in the mode of “I got this.” Unlike wishing, hope moves us to action, and I was full of it. I have written many questions about where to go next in Oscar’s healing journey. Two minutes into the conversation, my hope bubble bursts. My body feels as numbed as Oscar’s or his eyesight cataloged “legally blind.”
The hospital evangel gives me a litany of conditions that will worsen. “Listen, you must come to terms with it; your brother is operating on half his brain. There are things he will never be able to do again.” He says all in Spanish as if Oscar were not there. By training, I know how to put one foot on the gas and the other on the brake. Except, right now, I am still determining which one is which. I find my way out of the situation with an almost inaudible “Gracias. Have a good day.”
One can imagine how delivering life-altering news to patients is one of physicians’ most challenging tasks. A great deal of stress might be involved during the actual conversation. I know the SPIKES protocol, which stands for: setting, perception, invitation, knowledge, emotion, strategy, and summary, is intended to alleviate suffering when delivering bad news. A skillful delivery can alter the way we move forward. I don’t want to lose faith in humanity, but I am running out of fuel. The experience brings me back to an afternoon in New York when my thirty-two-year-old niece was diagnosed with metastatic breast cancer thirteen months before she took her last breath. The doctor, a pregnant woman sipping tea, showed us images of a devastating, rampant storm raking Nieves’ body, as if she were showing us a clothing catalog.
The news delivery lacked humanity and left me at a loss for words. I leaned on what I knew. I invoked the Heart Sutra. I picture Avalokiteshvara, the great bodhisattva who embodies loving-kindness and compassion. I asked the great being to wrap us in a radiant white light. It did not happen that day. I left the room, angry and resisting, my niece a bundle of sorrows. It took months for me to develop some version of a soft heart, but when it happened, compassion for our suffering melted away my resistance. It came when I heard Thich Nath Hanh say: “We are made of a nature that dies.” I have forgotten how these words re-centered me when my father died and helped me settle into his transition.
Before leaving the virtual room, the hospital evangel warns me to prepare because a traumatic brain injury shortens a person’s life. I turn off the computer and grab my Standing at the Edge copy. Joan Halifax’s voice, her tending to death and dying, and her cultivation of GRACE remind us of our capacity to build an equanimous and aware heart. What will it take for me to regain balance amid pain and uncertainty? I cannot stop the machinery of life events from turning its wheel, but I can choose how to show up to each iteration of pain.
In hindsight, circumstances on each occasion informed how the doctors responded; the three were young, closer to Oscar’s and Nieves’ ages. Did they see their humanity reflected? Could they not bear the thought of their mortality? I don’t know. I now recall my intention to be loving and compassionate, not transactional but warm-hearted. Ultimately, that is the only truth I can access. I wanted the doctors, in each circumstance, to see our pain, to feel the burning candle of my relatives’ lives. I know I am far from the non-dualistic intention Halifax gently invites us to enter, and closer to self-pity, which is self-centered. To access my integrity, I must go beyond any egocentric need. Or else, I won’t be able to tap into the source of compassion and universal love within. I am not there yet, but I know in my bones, our human suffering becomes a pathway to liberation.
I close with the commitment not to turn away but to turn around and face the reality that we are all imperfect beings striving to do the best we can. Halifax’s voice chants my favorite invitation: Grow a strong back and a soft front.