Routine as an Anchor through Winds of Change

The early morning routine in Ayurveda is a sacred opening act of its treatise called DINacharya (din=daily, charya=routine, that which walks forward).  As I prepare my digestive fire and try desperately to rekindle it through the winds of change that are blowing heavily on me this spring, I decided to engage more actively in my daily early morning routine. 

The Early Morning Routine

rise before dawn: 96 - 48 min prior to sunrise (use

lay still in bed & assess digestion

thank Mother Earth before placing feet down to walk on her all day

morning ablutions: go to the toilet & check for your "daily news"

wash hands

wash face with water

wash eyes with COLD water

rinse  nostrils with cool water

swish & spit water from mouth

brush teeth (tooth powder is ideal)/ (floss)

scrape tongue (elongated Silver spoon optional) then rinse mouth

look at face in mirror, present self to self

go to sacred or auspicious object, look with intent

chant or listen to sacred sound

go to kitchen space, prepare and drink first glass of freshly boiled water

This routine has been written in two classic texts, the Caraka Samhita (circa 1000 BCE) and furthered by Vagbhata’s Astanga Hrdyam (circa 800 BCE).  My dog-eared copies have been read intellectually, and now it is time to make it work in this body, this mind.

The first couple of days I re-assess what I am already doing each morning, moving around a couple of rituals to get them into the order given.  Then each day, I add in one or two new things until the 15 steps are on auto-pilot.

The hardest ones to remember are the symbolic blocks in our lives. Sometimes, I have forgotten to look intently at the sacred object, activity being more comfortable than Being-in-the-moment-with-Auspiciousness.  This is my clue that I need to be perceptive of the auspiciousness I have in my life now.  Santosha, the art of being consciously content, learning to want what we have over having what we want manifests more and more each day.

Other days, the hardest one is looking in the mirror and presenting myself to my Self.  Why is that so hard? I just forget.  So, do I appreciate who I am?   When I stop to look, I usually find a girl and have to search for the woman. The girl is easier to see: she has made less mistakes. But the woman has compassion and victory over years that have worn over her. 

Each day I step out of the bathroom and as I boil my water, I realize how much this Routine is truly a cornerstone of building Trust in my physical world: taking care of me, cleaning my senses and getting into my body. Why was this not taught in medical school, I wonder, as I sip my hot boiled water and step into my day.

Papa-Centered Care

June 23, 2013

Why do I care so much about patient-centered care, when most doctors seem not to give it first priority?

Perhaps the fact that my father was chronically being treated for his declining health also contributed. His excellent insurance predisposed him to whimsical testing by doctors who never coordinated their testing or medications with other specialists.

He was tested for every disease that could be billed by insurance, had 17 medications, which increased every time I left the country and was unable to supervise. For example, his doctors refused to discontinue his Coumadin for years, despite the scientific, evidence-based medicine that prescribed it unnecessary. My sisters contributed with their fear and their blind trust of what the “real” doctors advised. Wars broke out at home over what should be done.  My mother was exhausted with all the routines, all the pills, and all the testing.  Her cooking and care kept him alive much more than any of their drugs. 

Three years before he died, he insisted that he wanted to stop all the drugs. My mother panicked, aware of the rage of physicians who depend on the visits for their income.  It took three months to help him discontinue all his medications, even those that doctors insisted were life-sustaining: he did fine. We substituted them with herbs like Triphala for his constipation instead of Dulcolax, gave him brahmi and shankhapushpi instead of Lyrica, Wellbutrin, and Aricept. Many of his conditions disappeared, and his memory and functionality continued. He died peacefully just before his 83^rd birthday.

Lesson learned:   physicians who are not centered in their own souls practice medicine that is not evidence-based, not patient-centered, and not in the best interests of the medical ecosystem surrounding the patient.

Leaving the Road More Travelled

June 16, 2013

In 2008, a series of hospital cutbacks forced our senior administration to a series of closed-door meetings. Physicians, who had the official power of medical decision-making, were asked to use more hospital resources to keep the doors open. Fear of liability was driving up the hospital’s liability coverage of physicians.

In English, that means – order more tests. Increasing suggestions were made to order those procedures that had high reimbursement rates.  Medical liability and need to observe the standard of care was emphasized. Uninsured patients were to have what was medically necessary, of course.  But the message was clear: order more tests with high DRG codes, decipher the reimbursement rate languages, known as medical coding,  and bill more. 

Nowhere was patient-centered care ever mentioned in these meetings.

Perhaps because I believe in the inalienable right of each of us to make our own choices for our own bodies, I found these meetings to resemble medical bullying.

Of course, I had experienced it since medical school, but things seemed to be turning toward the slippery slope of corruption.

I made the decision that staying in the system in my salaried role would make me victim to the corruption and bind me to the politics of games of selfishness that fuel the medical-industrial complex and keep it from being an institution of healing.

The first step was to leave the hospital weeks after my student loans were paid off.  My medical director had made a practice to take me out quietly for drinks every 2-3 weeks, and had confided in me about certain decisions.  He had urged me to start a private practice so that I could develop independence, a sense of entrepeneurship and creativity in my own business, and ultimately not depend on others for income.

The hospital had already forced all physicians on payroll to start our own practice, “to help us.”  It was actually so that they could unload us from their books and thereby decrease the time we spent under the hospital medical malpractice insurance.  Of course, we still had to do all the administrative work in the hospital, but we were paid less.  After a few months, I quietly departed, just before the 2008 financial crash.

Ultimately all these events and observations led me to yearn for a way to observe the elderly excellent physicians who practice a timeless science of medical wisdom, where we practice medicine to actually help people and advocate using our intelligence on their behalf.      

It took me five years to get here, and now I begin to try to practice the real art of medicine.

Redefining Tradition

June 9, 2013.

Twenty years later.

On June 9, 1993, I delivered a speech that changed my life. In it, the activist and precocious physician-to-be  spouted philosophy about Redefining Tradition – the title of the Oration ­– and gave us an earful on my views on tradition and its purposes and propagations.

The faces of the men sitting behind me are a symbol of what I would go through for the twenty years that followed….!
 

https://www.youtube.com/watch?v=gdEawXyyho4

That speech was one of my greatest achievements at Harvard, because I had the courage to do something I was warned not to do: Dean Cassandra Simmons (a black female) warned me not to apply for the competition because ‘they only pick white boys.’  I was the first Indian, and woman, to have that podium, to write my name in the Harvard Big-Leather-Book-of-People-That-Give-Commencement-Speeches-at-Harvard. 

That fall, I applied for a Fulbright and was rejected because Harvard forgot to mail my transcript to them and because I was less meticulous and less meticulously-intuitive than I am now.  Here I am twenty years later, on the precipice of another thing I was warned not to do:  go beyond conventional medicine, since I was trained in conventional medicine. All the laws are against my work both here and in India, since Indian conventional doctors cannot teach or practice Ayurveda … but laws are meant to be … evolved.

the new F* word.

7/24/12.

It was a hot, empty day in late July. My email had a reminder from Fulbright: since I had been on their website in February 2012, if I wanted to complete an application, I had to do it by August 1.  

In fact, instead of being empty, I had planned to fly to India with a group of my Ayurveda students in mid-July. But the unpredictable had happened. On July 13, all semblance of peace had disappeared as one student after another reported death and destruction in their lives, backing out from the journey, and leaving me with a non-refundable ticket and a bunch of train, plane, hotel, and car bookings….  I had decided to cancel the trip and eat JetAirway’s cancellation fee of $995, a fee that was only possible because AirIndia was on strike, leaving other airlines to price-gouge freely.  My mother had experienced her own destruction, walking into her home and finding that the guy living above had an exploded water pipe that made her ceiling fall into her bathroom tub and floor.  With the week suddenly free of flights, I spent the time in Princeton, overseeing renovations, and spontaneously upgrading her bathroom significantly, since the guy upstairs had his insurance pay for it. 

The email reminder came at a time when renovation of life was in the air.  As we stripped away the protective plastic sheets in her apartment and the new bathroom emerged, I decided to renovate my life too. 

For many years, I had been yearning to study abroad.  Shortly after residency, I had received an award from the Clinton-supported America India Foundation-AIF, but had declined, as my student loans needed to be repaid.  With the $401,000 paid off now, I was itching to do some much-awaited research in India.  My hospital was in trouble, downsizing from budget cuts and corruption.  I had left in 2011.

Two decades before, in 1993, I had applied for a Fulbright fellowship and was devastated when they informed me that Harvard had not yet sent my MPH transcripts, so my file was disqualified. Harvard’s holy Office of the Registrar was filled with people that …..well, did not attend Harvard….!  They had “forgotten” my transcript in a To Do pile that was Not Done.   So my file was ignored, my life path disrupted, my whole world interrupted by their neglect.

Lesson of Life Learned: smile at others, but always check their work when you are the one that will benefit from their labor.  

After a strong meditation, and several deep dharana sessions as I had grouted tile in my mother’s new bathroom, I dreamed up a project I loved, that would benefit the people who assisted me in the field, and that would help the Americans that paid for my grant.  In a week, I had an essay. Then three letter of recommendations promised, then reminded, then chased, then begged, then done by three benevolent angels of change who believe in the work of explaining Ayurveda in medical language. An essay, a language competency verification letter, a slew of demographic questions, a summary of the field, with references. Then I sat on July 31, reviewing and satisfied before hitting the SEND button. 

The Fulbright Scholar grant is a long application, and my sincerity in finishing all the research and writing and compiling was an exercise in self-confidence. The biggest reward was the realization that I still have the focus to complete long applications. I also got a lot of credential papers organized along the way. I threw out a lot of old papers while hunting for things they requested, like transcripts and technical articles. Whether or not I received fruits from my labor, I knew that my idea to conduct interdisciplinary research on Ojas in Ayurvedic pockets in India would be a great clinical tool. If I did not get funded, I still wanted to go to India and try to finish the research with the elders over several years.

Anyway, I argued, it was a good way to spend the empty last days of July.

In the late summer, my diksha guru told me NOT to mention the application to anyone, not to even utter the F-------- word. Not even to my mother. Food cooks better when the lid is on the pan; things can simmer quietly without outside interference. I had to keep the lid on!

When my referees asked for status updates, I referred to the application as ‘the F* word,’ determined to value the magic of cooking, and the command of my guru. Through silence over the 6+ months, until the F* Board agreed the project was worth funding, I learned about the space, the abyss, between the words, where personal hopes and determination mix with surrender and resignation, where decision occurs.

The biggest lesson to learn from ‘the F* word’ is that the true victory is to survive the rigor of the application process. It will remain as a very personal growing experience that belongs to noone else.