A conversation with a Dhamma Doctor

Discovering Meditation:

In my early twenties I went through a period of severe depression and insomnia, and at the eye of the storm I experienced total de-realisation, as though I was observing life through a foot-thick pane of glass. Meditation was introduced to me as a tool to get to sleep. Time, hope and persistence with the practice led me out of the depression without having to turn to medication. My mood stabilised, concentration improved and sleep became restful again, all of which helped me through hoops of medical school. When I studied the effects of Mindfulness Meditation for patients with chronic pain during my BSc dissertation, I found that the literature corroborated my experience: meditation has been proven to enhance sleep, concentration, memory, pro-social behaviour, mood and indeed resilience to chronic pain. The benefits are indisputable in the light of this growing body of data.

But one can and usually does fall off the path at times (if life is seen as one long meditation, returning to practice should be done in the same way as one returns to the focus of their meditation after recognising their mind has wandered – attentively, lovingly, always without judgement).

In the run up to finals, when a medical student would benefit from it most, I fell out of practice. Instead, I got hooked on the toxic dopamine drip of online multiple choice question

banks, which has become central to modern study culture of medical schools. Medical students become like lonely drunks slotting pound after pound into the fruit machine, dead behind the eyes, hoping for a bright green tick affirming their knowledge or trying to minimise the scary red crosses and a low % score. The exam-frightened ego is stirred either way to answer more questions.

Even the most stead-fast and strong willed of my friends descended into misery, then turning to alcohol to celebrate, forgetting much of the information they had tried to remember for exams. I sensed spiritual turmoil within myself, and needed solitude and silence to reconnect, so I signed up to a vipassana meditation retreat before starting FY1.

A Vipassana Meditation Course:

The Vipassana Centre was near a village called Samdong in the foothills of the Himalayas, in the Sikkim region of Northeast India. The colossal mountain range welcomed me with surging monsoon rain and a nasty case of gastritis. It was not to be a peaceful retreat to sooth a weary mind, but instead a boot-camp for serious meditation: 11 hours a day of sitting, rising at 4am and staying in silence for 10 days.

The Vipassana centre in the hills of Sikkim

I went through whole seasons of experience, encountering and overcoming demons residing in my unconscious mind as a rite of passage to experience inner peace.

Mysterious Dr Durga:

One of the other meditators on the course had a particularly intense air to him: eyes religiously downcast, always the first into the mediation hall and the last out, totally locked into his inner world and observing every Adhisthana without fail. This was Dr Durga Mani, a veteran meditator on his 9th 10-day silent retreat.

At the end of the course, Dr Durga invited me to stay with him at the farm he grew up on near a mountain village called Pakyong. It was an oasis of organic crops, flowers, animals and people from child to elder living together harmoniously with the land. Dogs of varying ages rolled about and played in the garden outside the house. Goats were kept as lawn mowers, and there were two sacred cows who provided milk to be enjoyed fresh each morning to be turned into butter, Ghee, yoghurt and cheese.

Durga carried himself with a presence that was instantly admirable. No taller than 5’6, with serene yet ardent and watchful dark eyes and a friendly smile. He spoke soft and only necessary words that garnered attention without a hint of force. He laughed gently and often

His Father was the old headmaster at the local school whose football pitch was an overgrown and rocky field, shared with two crazing goats and some chickens. It was situated on a hilltop, looking out eastward. The eye gets lost in the horizon of interlocking valleys, progressively gaining in size until breaking through the ceiling of cloud.

Dr Durga's childhood school playing field, and one of the resident goats.

Himalayan foothills viewed from the Dr Durga’s mountain school.

Durga is a 36 year old doctor who worked as a GP for underprivileged factory workers and their families in Sikkim, India. He began meditating as a child. “Growing up in a Indian society there is an inclination towards meditation”, he says. But it wasn’t until he was 26 that he learnt “a proper technique” for meditation by sitting his first 10-day Vipassana course.

He says that Vipassana meditation has changed his personality and helped him be a better person and doctor: “I used to be a very angry kind of personality. Tiny things used to anger me, and I used to lose my temper often, one time with a drunk patient in my outpatient clinic.”

Dr Durga and his father.

“After my first course of Vipassana, I totally lost my anger. I found I could easily look into my emotions, and I felt a lot of peace. When that same patient visited again, I could feel my compassion for him. I could handle him properly. I could feel the sense of empathy growing for my patients. So, it really helped my medical practice. It gave me deeper insight into my patients’ issues and allowed me to connect with them more easily.“

When I asked what it was about Vipassana that changed him, it was that the technique “gets you to look into what you have accumulated within yourself.. then you start to realise that what whatever your problems come from your own accumulations. “

Referring back to the reaction to the drunk patient, he said his anger came from “memories of the past...anger that I had accumulated within myself that had erupted during that moment.. the man who was standing in front of me, hadn't reacted in the violent manner that I had. He was drunk. That is true. But there was no need for me to react so badly with a patient who had come to me for help”

He says “It wasn’t just anger [that Vipassana changed]. I also got free from my doubting nature. Before I went for Vipassana meditation, I used to doubt each and everyone who was around me. And even in my relationship I used to have a sense of doubt - if they are cheating on me or something like that. But after my first course, I realised that doubt was a thing which was making me heavier and heavier day by day. I feel that I have lost it completely after learning Vipassana meditation. It gives me so much peace.”

He notes that meditation has helped him work in a more relaxed and efficient way. There is less stress but greater productivity. Durga meditates for at least an hour day and attended a

10-day vipassana course every year until the birth of his first child. Readers may feel its wishful thinking to find that much time to meditate. To Durga, this is like a fish saying ‘I don’t know where the water is’. “We are in time”, he says, “time is always there. It is all about how you prioritise it.” He suggests even starting with 15-20 minutes and as one sees the benefits it will automatically become a priority.

Durga noted the difference between meditators and non-meditators amongst his colleagues. Those without a practice seemed “so stressed they need to go home. They need to drink or drug themselves down to sleep...they have to act compassionate rather than being compassionate, they have to act empathetic, rather than being empathetic. It doesn’t come naturally, and that itself is so exhausting for doctors because they are trying to be someone else other than who they actually are.“ Parallels with the NHS instantly came to my mind.

Part of the problem is compassion fatigue. “But once you are into deeper meditation in Vipassana”, Durga says, “you look into yourself, and you start to see compassion and empathy come naturally. It's like breathing in, breathing out. It's very obvious that doctors and health workers who are into meditation are less stressed, more compassionate and more connected with their patients, and their practice is always better. “

Instead of the bleak tidings we often hear in the UK media and from doctors on the wards, Durga’s outlook is refreshingly bright: “I think no other profession can give the kind of chance to be compassionate than a medical career. You can see the sick. See the dying. You start to feel the temporariness of life. You start to understand that there are obviously more complex things in life than just earning money and having a good house and a good car. There are there deeper things to humanity than materialism.. only a person into in a healthcare career gets to work in such a conducive environment for developing compassion and compassionate care.”

But here doctors may find themselves walking knifes edge between the despair of pain and suffering and the beauty and privilege of working amongst them. There can be a unique intensity of aliveness when you are dealing with those natural aspects of human life and death, yet in our medical culture it often seems to feel hellish. Durga believes this is because we are always blaming “the outside for everything that is happening within us.”

Durga believed in leading by example and not waiting for system change to initiate a shift in culture. “They [non-meditators] will look at you and be curious about how this guy is able to handle everything with compassion and empathy...and love for others without being exhausted? Naturally they will want to learn what you are doing...while we are speaking with them we should make sure we empathise with them, because then they will connect with you. They'll bond with you, and slowly, slowly, like all humans do, they'll fall into it. Rather, they will rise out of it”.

How can we build a culture of meditation in the NHS and medical school?

But can we teach compassion? I feel it’s more realistic to equip students with tools, such as meditation, so they can learn for themselves to stay present and balanced.

Hospitals are objectively challenging workplaces with their incessant alarms, windowless offices, offensive smells, patients in distress and pain, quick -fix sugary snacks and caffeine, all the while being the epicentre of a communities’ disease and suffering. Little spoken about is the metaphysical energy of such a space which must be held, consciously or unconsciously by health workers and patients. Meditation, however, may be the medicine that Medics need to help them work amid the storm and mitigate its trauma long enough to bring about meaningful change. It could be that having ability to look within ourselves – to sense what ‘accumulations’ we bring to work each day, and recognise how we interact with the emotional energy of the what’s around us, will allow us to be more present and responsive, rather than reactive to that environment. Maybe this is how we will find the clarity of mind needed to protect our energy, nurture working relationships, and provide effective compassionate care.

When I began FY1 shortly after returning from India, I continued to meditate. I found the only quite place in the hospital – the chapel – and used my lunch times to practice. I am so grateful for that space. To me it feels just as Durga describes: a superpower that recharges empathy and compassion, especially ‘metta’ meditation, which is the practice of bringing feelings of love and hope into oneself and emanating them outwards.

The hospital chapel, a perfect place for finding presence amid the chaos!

But medical culture does not inspire peace and presence in healthcare workers. The consultants at the top are themselves highly stressed and overworked, many of them prematurely greying, gaining weight and becoming chronically bitter as their coping habits turn maladaptive. We don’t have to wait for the system to change, but we should not use that as an excuse for it to never change. This is where the systemic approach and the individual approach intertwine: the system could indeed be designed to facilitate resilience- building practices such as meditation, with protected time and space for care of the inner world of health workers. But in the meantime, we have to organise as individuals and collectives at the grass roots to keep our minds clear and hearts open.

‘Sabka Mangal Hoye Re! – May Goodness Happen for All!’