The pursuit of perfection is built into every professional training. But wholeness lies beyond perfection. Perfection is only an idea. For most experts and many of the rest of us it has become a life goal. The pursuit of perfection may actually be dangerous. The type A person for whom perfectionism has become a way of life, is vulnerable to heart disease. Perfectionism can break your heart and all the hearts around you.

A perfectionist sees life as if it were one of those little pictures that used to appear in the newspapers over the caption “What’s wrong with this picture?” If you looked at the picture carefully you would see that the table only had three legs or the house had no door. I remember the, “Aha!” that these pictures evoked in me as a child. I wonder now why anyone would want to take such satisfaction in seeing what is missing, what is wrong, what is “broken.”

The pursuit of perfection has become a major addiction of our time. Fortunately, perfectionism is learned. No one is born a perfectionist, which is why it is possible to recover. I am a recovering perfectionist. Before I began recovering, I experienced that I and everyone else was always falling short, that who we were and what we did was never quite good enough. I sat in judgment on life itself. Perfectionism is the belief that life is broken.

Many adult perfectionists had a parent who was a perfectionist, someone who awarded approval on the basis of performance and achievement. They learned early that they were loved for what they did and not simply for who they are. Sadly, for a perfectionistic parent, achievement is rarely ever good enough. The lives of their children can become a constant striving to earn love. The confusion between love and approval is so common in our culture that we have found it necessary to create a special rare sub-category of love, “Unconditional Love.” Of course love, like grace, is never earned. All love is unconditional. Anything we need to earn is only approval.

Long before I went to medical school I was trained as a perfectionist by my father. A ninety eight on an exam got the same unfailing response, “And what happened to the other two points?” I adored my Dad and my whole childhood was focused on the pursuit of the other two points. By the time I was in my twenties, I had become as much a perfectionist as he. It was no longer necessary for him to ask me about those two points. I had taken that over for myself. It was many years before I found out that those points don’t matter. That they are not the secret to living a life worth remembering. That they don’t make you loveable. Or whole.

Life offers us many teachers and many teachings. One of mine was David, who was an artist and my first love. The living proof that opposites attract. While we were together, my driver’s license came up for renewal. And I needed to take a written test of the traffic laws.

The DMV had sent a little booklet. I studied it for days. All the while I was memorizing the meaning of the white curb and the yellow curb, David would try to persuade me to join him for a walk or to go to a party or out to dinner or dancing or even just to talk. I told him I couldn’t take the time. Of course I got 100% on the test. Triumphant, I rushed into his studio shouting that I had gotten 100% on my driving test. David looked up from his painting with an expression of great tenderness. “My love,” he said, “why would you want to do that?”

It was not the response I had expected. Suddenly I understood that I had sacrificed a great deal to get 100% on a test that I only needed to pass in order to drive. I had spent days studying for it that I could have spent in much better ways. I had learned many things that I did not even want to know. It had felt as if I had no choice. If my father could not approve of me with anything less than 100% I could not approve of myself with less than 100% either. Even on a written driving test. Like most addicts, I was out of control, pursuing something that had no meaning or even reality in preference to all that life can offer.

Fortunately, David did not play by these rules. He didn’t even know the game.

When I teach, I often ask medical students and doctors: “How old were you when you first realized that the needs of a living thing — an insect, a plant, an animal, a human being — mattered to you?” “How many people were between the ages of 20 and 25? How many between 15 and 20? How many between 10 and 15? How many people were younger than 10? Over the years I have asked these same questions of many thousands of physicians and students. The great majority of those I have asked say that they were under 15 when they first responded to the needs of a living being with intent to make a difference. About half of any medical group was under 10. So perhaps medical expertise is only the most recent set of tools with which we have responded to the needs of the life around us. We responded long before we were experts, from the time that we were very young. Perhaps we are in this work not because of what we know but because of who we are.

I love asking groups of medical students and physicians to share their earliest memories of befriending life. Most of these stories are very simple. A trustee of the AMA once told me that when his mother gave him his lunchbox each morning before he went to school, she would also give him a clean folded handkerchief. He remembers that whenever she would do this he would ask her for a second handkerchief “in case someone else needed one.” He was in kindergarten at the time. Doctors in white coats have told me how important it was to them as children to be able to catch flies in their hands and take them outside before others in their family would notice them and kill them. Many of these stories are about a natural caring and compassion. Some of them are deeply moving. One internist remembered that as a little boy his mother often took him to visit his elderly neighbor. He hated these visits because the neighbor had an old dog that smelled bad and was blind. He didn’t like the dog because it snapped at him and often barked for no reason and frightened him. But once his mother and the neighbor were in the kitchen drinking tea and he was left alone watching TV in the living room with the dog. He remembers noticing that the dog was rubbing its eyes on the edge of the couch, slowly and patiently, over and over again. He remembers thinking that the dog was trying to see, hoping to see, and suddenly realizing that it was hopeless, that the dog would never be able to see again. He felt his heartbreak and he burst into tears. His embarrassed mother took him home because he could not stop crying. He was about four at the time. Sometimes the stories are about going along with the guys and hurting an insect or an animal. And carrying the memory to this day with the kind of guilt and shame that comes from violating your most basic values. For many physicians, values such as compassion, caring and the intention to make a difference to the needs of others, go back to their very beginnings. Perhaps this is what a calling actually looks like. Not some miraculous happening but just discovering, when you are very young, a set of innate values in yourself that will eventually determine your direction in life.

These deeply held values underlie the practice of scientific medicine and form the foundation of a community of service that is more fundamental than the expertise that divides us and more universal than our nationality or our religion. These values come alive in our stories

Our Finding Meaning in Medicine (FMM) program encourages groups of doctors to meet on a monthly basis and share with one another stories about their common experiences as doctors. Stories of compassion, of grace, of love, of healing, of courage, of loneliness and of commitment and valor. These stories enable doctors to remember who they are and what really matters to them. A good story is like a compass which points to something unchanging and reminds us of how we might live our lives. If you go into your day carrying your stories and the stories of your community with you, you have a permission and a support to live closer to the values that have been important to you ever since you were a child despite the pressures in your everyday work.

I believe that the real stress in today’s medicine is in large part the outcome of a conflict in values. It has to do with a system, an infrastructure that makes it difficult for people to live by their life values and relate to others in ways that express their calling. Our present system imposes a value set, which is driven by economic and time pressure and the policies and regulations that come from these sorts of concerns. It makes people unable to practice their medicine according to the best they know and the best that they are, not just scientifically, but also spiritually.

When you separate people from the values that they have held closely from their earliest childhood, they lose their sense of meaning, integrity and commitment. They feel helpless. They become cynical and depressed, hostile and alienated. Medicine is a way of life. It can survive as a work of integrity only as long as the innate values of those who are called to this way of life — of compassion, caring, service, harmlessness and respect for all beings — are supported and nurtured by the system itself; passed on and strengthened from teacher to student, from generation to generation. In the words of Maimonides ”Inspire me with love for all of thy creatures. May I see in all who suffer only the fellow human being.”

Like most of us I am a passionate change agent. After all, who would spend a third of their life accumulating all that knowledge and skill if not for the hope of making a difference?  So it is surprising how long it has taken me to recognize the power of a simple story to make change.

I have always been a story teller. In the past this tendency was viewed by my medical colleagues as, to say the least, dubious. In Medicine a story is often dismissed as  “anecdotal evidence”, a sort of second class data far less relevant to a physician’s work than the outcome of a well designed scientific study.  “You only have the one example?” my colleagues would ask me when I told them a story.  “What you’re describing only happened to one person?  How important is that?” But over time I have learned that a story about just one person can change everything. Easter only happened to one person.

One of the most skilled social activists I know is a genius of change, a woman who can enter a room of people who have held opposing positions for years and in a matter of a few hours enable them to work together as colleagues.  I asked her how she manages to do this. “Simple, “ she said. “You just change the story they are holding about themselves and each other.”

A new story is a place of greater freedom and possibility.  This is as true of the stories that we hold in common as an organization, an institution or a nation, as it is about the stories we carry about ourselves.

We all have stories about ourselves that diminish us, stories we sometimes believe for years which are not true.  Often these stories rob us of our strength and our potential.  When I was 15, the doctor who told me that I had Crohn’s disease also told me a story. “Rachel,” he said “You have an incurable disease. You cannot expect to live a full life.”  But my story has been far different than that.

As a writer, I have learned not to rush to fill a blank page with words. I have learned the patience to sit before a blank page and wait. A blank page is a place of revelation. I have learned to trust that something will happen there over time that has never been seen before. A diagnosis is like that too. A place of discovery. An encounter with the Unknown. The wisdom may lie in labeling only the disease process; and then accompanying people as they write their story and its possibility.

As change agents our stories empower or diminish us too. Our change agentry is only as good as our personal cosmology, our story about the nature of the world. The closer our personal cosmology comes to the nature of reality, the more effective we are in making a difference. I come from a medical family, so when I was young it seemed obvious to me that the world was broken and people were broken too. Change was simply a function of acquiring the knowledge, the technique, the science to fix things. I no longer see things in quite that way. One of the oldest Wisdom stories about change, a story from the 14^th century, offers a somewhat different viewpoint. This story tells us that in the Beginning the world was whole, but that at some point in the history of things there was a great accident which scattered the wholeness of the world into an infinite number of tiny sparks of wholeness. These sparks fell into all events, all organizations and all people, where they remain deeply hidden until this very day. The story goes on to say that the whole human race is a response to this accident. We have been born because we can discover and uncover the hidden spark of wholeness in all events, all organizations and all people…we can lift it up and strengthen it and make it visible once again … and by doing so we can heal the world back into its original wholeness. So restoring the wholeness of the world is not only a function of our expertise, it is also a part of our birthright as human beings. We have the power to further the wholeness of things just as we are, with our listening, our belief, our encouragement and our love.

So perhaps change is less about fixing a broken world and more about uncovering hidden wholeness in all events, all organizations and all people and remembering our personal power to make a difference. This old story has greatly changed the way that I am a physician and also a teacher. It has given me new eyes. Everyone and everything has in it a seed of a greater wholeness, a dream of possibility. Perhaps what I once saw as “broken” or “lacking” might just as easily be seen as the growing edge of things … a place to be valued and nurtured in our patients, our students and in ourselves.

Blessings,

Rachel

During the second session of this five-session course at every school that teaches the Healer’s Art, there is a moment that makes a difference.  As students are preparing to break into small groups to share their personal stories of vulnerability, loss and healing; a basket filled with small, fuzzy, multicolored “feely hearts” is passed around the room.  Each little heart is handmade and no two are alike.  Students are invited to take one and carry it with them as a reminder to hold their own hearts and the hearts of their patients and colleagues tenderly.

These hearts are made by local volunteers, for each one of the 1500 or more beginning students who take the The Healer’s Art class every year.  Over the years, we have heard many moving “feely heart” stories as students nationwide carry their feely hearts in their pockets throughout medical school and out into the world of medicine. Doctors have loaned their feely hearts to their patients in times of need and shared them with their own students. They have taken them into their churches where the women’s auxiliary has made them for those who grieve.  On many occasions after I have given a talk to the medical society or a hospital in some far flung city, a middle aged woman or man who I have never met before has pulled a threadbare feely heart from the  pocket of an expensive suit and told me that they have carried it with them for years. Perhaps your doctor carries one too.

Long ago, I asked a first year medical student at UCSF what he had learned in the Healer’s Art course. Without hesitation he replied “ I learned I can heal with my humanity things I can never cure with my science.”  So there you have it.

Blessings,

RACHEL

Anna Maria is Coming, or Maybe Thomas Barton, or Max!

HEALING LIBRARY: BOOK & VIDEO CLUB

The many wonderful books by Oliver Sacks

SELF-CARE

Two Dark Side of Perfectionism

HEALING LIBRARY: LITERATURE & HEALING

Learning from Literature

So I’d like to begin with some thoughts on healing. In 1962 when I graduated from Medical School the goal of medicine was cure. Anything less was failure. But there is a great deal more to wholeness than the recovery of physical health and so much more to medicine than curing disease. Not everything can be cured. Fortunately cure is not the only successful outcome of our relationships to our patients. Over time I’ve come to think of physical health not as a goal but as a means that enables people to pursue what has meaning and value in life. But people often do this whether they are physically healthy or not. People even respond to significant illness by growing in their capacity to love and feel compassion for others, in their sensitivity and understanding, and in their courage and passion and wisdom. Because of this they may be able to affect the world around them in ways that would not have been possible before.

Sadly many of us may never have the chance to see this. In the time structure of today’s medicine we may meet a patient in the depths of crisis, make a time limited intervention, and never get the chance to see how things play out. The physician who first diagnosed me with severe Chrohn’s disease when I was 15 years old, told me and my family that I would be an invalid and could expect to live at most another 25 years. I met him again when both of us had grown old, at a book signing on the east coast for my New York Times best seller, “Kitchen Table Wisdom”. He told me that he had come to see if I was the daughter of the desperately sick young girl he had known so many years before. When he discovered I was that young girl, tears filled his eyes. We may have failed far fewer people than we know.

Over the past 55 years many physicians have failed to cure me, but many have helped me to heal. Healing is a potential in all relationships and at all times. Our power to heal is far less limited than our power to cure. Healing is not a relationship between an expert and a problem … it is a relationship between human beings. In the presence of another whole person, no one needs to feel ashamed of their present pain or weakness and be separated from others by it. No one needs to feel alone and small.

To help others heal we need to bring our own wholeness with us into our examining rooms: our strengths, our courage, our caring, our vulnerability, even at times our anger and our fears. We may need to become more than we have been trained to be. Our training may have caused us to focus so narrowly on our professional skills that we have sold both ourselves and our patients short. Perhaps our power to make a difference in the lives of others is far greater than the sum of our techniques and expertise. Perhaps we can tend the will to live in others with just our bare hands.

Everyone alive has suffered. The wisdom gained from our own experiences of woundedness and healing can empower us to help others. It may help us to recognize the beginnings of strength in a present vulnerability and enable us to better accompany others as they discover ways to heal. It can enable us to trust the process of healing, not as an idea but as a lived experience. It can help us be less afraid.

According to Jung, wounded people are healed by other wounded people. Other wounded people understand that what is needed for the healing of suffering is compassion and companionship, not expertise. Many times my expertise has been far less critical to the eventual outcome for my patient than my presence and my remembering the hidden capacity for wholeness in myself and everyone else…even under extraordinary circumstances. I am humbled by how often what helps a patient find themselves and their strength in hard times and begin the direction of a new life has nothing to do with my hard won medical knowledge. I have often made a difference because of something I learned about life in my garden, or from my Russian grandmother, or even from my own dark times.

Remembering the power of our own humanity and the power of the humanity of our patients opens doors of possibility. To quote Bruce Barton

“Nothing splendid has ever been achieved
except by those who have dared to believe
that something in them was superior to circumstance.”

I believe this about my patients…sometimes long before they can begin to believe it about themselves.