Medicine and Compassion: A Tibetan Lama's Guidance for Caregivers
By Chokyi Nyima Rinpoche
with David R. Shlim

Somerville, Massachusetts: Wisdom
Publications, 2004.
192 pp. $19.95 (hardcover).

Like most doctors, I sometimes lack compassion. Once, as an intern, exhausted beyond caring, I discharged a favorite patient from the hospital despite his obvious downward spiral due to renal cell carcinoma. My so-called excuse? I needed to lower my inpatient census! Today, almost 30 years later, I am still pained when I remember the baleful looks that he and his wife cast my way when he was readmitted the following morning. They knew that I had abandoned him, and so did I.

At other times, I have been compassionate beyond the call of duty, returning to the bedside of a patient who had received an infectious diseases consultation but who could no longer be helped by heroic antibiotic therapy-or by any treatment, for that matter. That I can clearly recall such moments is telling, however. Buried and forgotten-figuratively and literally- are many more people whom I did not comfort during their final days and hours.

Medicine and Compassion: A Tibetan Lama's Advice for Caregivers is a slim volume of 3 sections and 22 chapters that is full of wisdom for any doctor whose well of medical empathy has at some time run dry. It represents the collaboration of a Tibetan Buddhist monk from Nepal and a Western-trained doctor, David Shlim, who first crossed paths when Shlim was director of the largest Western medical clinic in the Kathmandu Valley in Nepal. Shlim now lives in Jackson Hole, Wyoming, and has recently led several courses with his longtime friend and teacher, Chokyi Nyima Rinpoche. In writing this book, the two have tapped a genuine need in contemporary American medicine.

The first section of the book ("Human Nature") touches on universal truths, as well as classic Buddhist teachings (as a small aside, readers should be prepared to judge for themselves whether compassion is indeed a natural human state and whether life's blows are the result of karma, as opposed to chance). However, a central theme of this section that is beyond debating is the profound influence of emotions and mental attitude on the experience of aging, sickness, and death. Another inarguable fact is that many health care professionals, from rookie interns to senior surgeons, have not yet experienced a serious illness themselves. If they had, the authors remind us, they would be far more likely to strive to alleviate the suffering of patients, rather than to merely focus on "solving their problems."

The second section of the book ("Training") examines our potential for and various means of achieving a greater level of compassion. In Tibetan Buddhist practice, these means include a disciplined, daily focus on doing good, as well as regular relaxation, meditation, and monitoring of one's own mental state. In the third section ("Practical Advice") come simple but profound thoughts on how to render the best possible care to all patients-including the aged, irritable, aggressive, or uncooperative- as well as how to nurture lifelong attitudes that ease the process of dying. The book ends with an overview of the 2500-year-old tradition of Tibetan medicine, in some ways a surprisingly modern "science" in its broad application to physical illness, bad energy or evil in- fluence, and emotional disorders.

Medicine and Compassion is easy to recommend, because it squarely confronts one of medicine's perennial challenges- namely, how to grow in wisdom and kindness, as well as in knowledge, and how to care for patients with all of the above. In my view, these matters are not given suf- ficient attention in many modern clinical purviews. Admittedly, the book also presents Tibetan Buddhism with an eye towards attracting and educating adherents. But this too raises a question often overlooked in the midst of a hectic medical career. How do personal theologies and/ or religious practices inform medical work today-and how should they?

From the ancient Jewish philosopher and physician Maimonides ("Medical practice is not knitting and weaving and labor of the hands, but it must be inspired with soul...the soul is subject to health and disease, just as is the body") to the 19th century's Sir William Osler ("We are here to add what we can to life, not to get what we can from life"), many great doctors throughout history have unabashedly combined medical and spiritual teaching. But in this data-driven, technologic era of doctoring, the spiritual focus is easily lost. Medicine and Compassion is a good reminder of the lessons that ancient teachings and contemporary religion can offer to our collective 21st century profession and to our individual humanity as healers.

Acknowledgments
Potential conflicts of interest. C.B.P.: no
conflicts.

Claire B. Panosian
Division of Infectious Diseases,
David Geffen School of Medicine
at the University of California,
Los Angeles