Meditation, Malpractice, Mortals, and Mom

a reflection by Dr. Brent Spears

Forty years ago, in 1976, when I was in my thirties, my Dad died and I started getting chest pains.

view of pond from inside on a foggy day

As a physician, I did not think that my symptoms were suggestive of heart disease or indigestion. Could it be that I was experiencing this huge loss psychosomatically? At that time, Transcendental Meditation (TM) was quite popular and available locally. I plunked down several hundred dollars, spent a weekend to begin to learn this new habit, started journaling, was given a secret mantra, and began practicing TM twice daily for twenty minutes.

Initially, it seemed silly to silently repeat my mantra over and over, while letting intrusive thoughts just pass through my head, then returning to the mantra. But over the years, as I have regularly practiced TM (while developing other spiritual tools such as long distance running and day hikes, insight oriented psychotherapy and Bible study), there is little doubt that I have become calmer, happier, and more effective. Maybe this is a consequence of aging, but I think it's due to the time I have invested in cultivating these habits which give me perspective.

Shortly after this initial foray into TM, I discovered Herbert Benson’s book: The Relaxation Response, which sought to describe the scientific basis and clinical usefulness of meditation. This book has been a best seller since its first publication in 1976. At the time I viewed myself as a mainstream primary care physician, so I was glad to see that my own personal experiment had not ventured so far out of the mainstream of Western medicine as to put my career in jeopardy. Currently, in 2016, a cousin of TM, Mindfulness, is all the rage in various settings.

When Mom died a quarter century later I was briefly a mess, but I found that my spiritual tools, including TM, helped me to eventually right myself. Moving professionally thereafter into geriatrics, and particularly to offering late life medical care via home and assisted living visits, I encountered new stresses that I found I could usually master. This was partly due to experience and professional training, but partly because I now had a different cognitive and emotional perspective.

Nowadays, I have some responsibility for over four hundred declining persons and their families. There are often difficult problems to which I must respond. Generally I feel adequate to these situations, not afraid to face the emotional challenges these interactions present. While each individual family is intensely involved every day with the care of one person, as a physician I am involved with many such persons, episodically. My role requires that I see the context in order to be useful and helpful to all of my patients and families.

The most extreme geriatric circumstances to which I must respond in depth are malpractice suits. For the past decade, I have been an expert reviewer for a large New York medical malpractice insurance company. I have completed dozens of analyses, each of which includes a chronological summary of medical records, a statement of the standard of care, and an opinion as to whether the defendant committed malpractice. In the course of these investigations I find myself worrying about the adult children of the deceased, who felt they had to sue in order to get over the loss of a loved one. Even if the suit results in awarded “damages”, does that help the survivors to move on in their own lives? Could they have found peace in the face of inevitability if they were grounded in a spiritual or mindful habit throughout their journey with their loved one?

Dr. Gawande, author of the best seller "Being Mortal” [reviewed elsewhere on this site] seeks to help doctors and caregivers better cope with inevitable decline and death of a loved one. Until doctors in large numbers learn to speak effectively with families on this forbidden subject, (documentation of which is rarely found in voluminous malpractice records), then family members must teach themselves habits which will allow them to become purposefully more centered and calm in the face of a rolling crisis.

If my mother had suffered from advanced dementia and a host of other symptoms, would she have experienced an improved quality (or quantity) of life with a gastric feeding tube surgically implanted in her abdomen? How could I, the health care proxy, find peace with the idea that not doing something can be morally equivalent to doing it? Could a meditation or mindfulness practice prepare a caregiver to reach a calmer place so (s)he can live with big decisions made on Mom or Dad’s behalf? How might the anger of a malpractice suit be addressed in a life-giving manner and possibly be healed?

My chest pains after my father's death did go away in time. A "broken heart" is much more than a figure of speech. I am certain that my meditation habit facilitated my own self-healing.

Whether or not I am the primary care physician for your loved one, I am keenly interested in learning of any experiences you may have had which assisted you in mastering this difficult period. What have you learned about yourself that helped you surmount this experience? What do you think might help others achieve mastery and peace?