By Rob Lamberts, MD

There is nothing exciting or glamorous about doing what I am doing: building a new practice from scratch.  It’s a slow and often mundane process that takes far longer than it looks like it should.  There are a thousand questions I need to answer: Where will my office be?  What will my logo look like?  Does it matter what my logo looks like?  Can I get the video of my presentation done?  Why is it taking so long?  Which EMR system will I use?  Will I use and EMR at all, or will a PHR product suffice?  Who will I hire?  What will I pay them?  When will I start?  How many patients will I accept at the start?  What will I do about my website?  Who should design it?  Can I do that myself?  Who should run it?  What about a phone system?  Each day uncovers a new set of questions that need answering, and each day passes with most of them left unanswered.

There are two things I’ve been doing which have kept me from becoming discouraged or overwhelmed by this process.  The first thing is something called Centering Prayer, which is well-described in the book Into the Silent Land by Martin Laird.  Whether from the tradition of the middle ages or from eastern religious practice, meditation is upheld by many in science as a sound life-practice.  What makes centering prayer, a form of meditation out of the Christian Tradition, different from other forms is the way one deals with distractions or worries.  I’m not an expert on eastern meditation, but my understanding is that the goal is to clear the mind from any thoughts and worries, coming to a place of peace and rest in the mind.  Centering prayer, however, does not push away worries or distraction, it changes the perspective on it.

This is why most people do not stick with a contemplative discipline for very long; we have heard all sorts of talk about contemplation delivering inner peace but when we turn within to seek this peace, we meet inner chaos instead of peace. But at this point it is precisely the meeting of chaos that is salutary, not snorting lines of euphoric peace. The peace will indeed come, but it will be the fruit, not of pushing away distractions, but of meeting thoughts and feelings with stillness instead of commentary. This is the skill we must learn.

Laird, Martin (2006-07-01). Into the Silent Land:A Guide to the Christian Practice of Contemplation (p. 79). Oxford University Press. Kindle Edition.

Laird points out that we are often overcome by our fears (I’ve got plenty at this time) and distractions (ditto).  This leads to acting in ways that are unhealthy or self-destructive.  He gives historical perspective on this self-defeating practice:

Evagrius is not telling us not to have these thoughts; for the attempt to have no thoughts simply produces more thoughts. As Teresa of Avila would put it centuries later, “The harder you try not to think of anything, the more aroused your mind will become and you will think even more.”1 Much less does Evagrius want us to run from thoughts or to suppress them; this would be more mental commentary on them. His advice is to turn the tables on all this chatter and simply observe without commenting. Observe everything about the thoughts. “Let him keep careful watch over his thoughts. Let him observe their intensity, their periods of decline and follow them as they rise and fall.  (pp. 81-82)

He recommends that we become observers of ourselves.  When we can look at our fear from the outside, it is no longer bigger than us.  He recommends we look at our distractions or emotions as we would see the weather: something that happens, affects us, that we don’t have direct control over, but something that doesn’t need to control us.  Even those painful things in our lives don’t need to be overwhelming.

Pain obviously remains; anger remains; we play our mind games (probably to a lesser extent); passing joys and fleeting fears all remain. This is the human condition. But what we realize is that all these distractions are so much weather appearing on Mount Zion. When we recognize that we are Mount Zion, God’s holy dwelling place, and no longer suffer from the illusion that we are the weather, then we are free to let life be as it is at any given moment. We are no longer the victims of our afflictive thoughts, but their vigilant witness, silent and free, no longer requiring pain to be gone if it happens to be present.  (p. 91)

I like this.  It is not a sense of denial of what is there and what I experience, but it is not acquiescence to it either.  We are not defined by that which happens to us or what we experience, but by our reaction to that experience.

When we realize we are the awareness and not the drama unfolding in our awareness our lives are freer, simpler, more compassionate. Fear remains frightening but we are not afraid of fear. Pain still hurts, but we are not hurt by pain. (p. 116)

I have honestly not had the opportunity to be still on a regular basis until this time off, so practicing any sort of meditation has been something done only in spurts and fits.  Being raised in the protestant tradition, meditation was never emphasized, and being immersed in a scientific/rationalist perspective, my solution has always been to figure things out.  Medicine, of all tasks, should show me there are many things I cannot ever hope to figure out: suffering, pain, self-destructive behavior, and suicide, to name a few.  If for no other lesson that this one, quitting my old job and taking time off has been well worth it for me. I commend this book to anyone so inclined, and recommend taking time to stop and be silent to everyone.

The second great teacher from this time has been running.  In my middle age I’ve become soft, both literally and figuratively.  I knew that this time would offer me a chance to get my body back into shape like no other, so I’ve been running 3-4 times per week, between 4 and 5 miles with each run.  I have yet to run the full course, but have made progress, cutting time off of my runs and being less overwhelmed when I finish.  Here are a few lessons learned from this rugged discipline:

• I must pace myself. This is true on individual runs and in my progress toward running the full course without stopping.  If I try too hard early on I will pay for it later.  This applies to the marathon-like task of building my new practice, which takes much work and more patience.
• Focus on what’s in front of me.  If I think about the whole run ahead of time I will be discouraged, as it is tiring and painful for this out of shape body.  I do best when I just pay attention to where I am at now, getting past the next mailbox or up the hill I am climbing.  Again, this applies well to the big task of building the new practice.  It’s easy to get discouraged by the seeming lack of progress if I focus on the big task, but breaking down into a bunch of smaller tasks helps a lot.
• Get out there.  I can always decide to not run, and seldom do I really want to go out there and do it yet.  But when I am out there doing it, and especially after I’ve done it, I am glad for the will to do something hard.
• Expect it to be hard.  I’m 50, and even though I’ve run half-marathons in the (distant) past, my body hasn’t found this process easy.  I ache a lot more than I did when I was in my 20′s.  I’m not sure why this would surprise me, but it still does.  I also can’t have this illusion with my practice.  Some days will be painful, and I just need to deal with that.  It doesn’t mean it’s not the right thing to do, it’s just what it is.
• The big picture is more important.  Running is not the end; the end goal is to get healthier and live better.  This means that the daily work and the pain will eventually have a good outcome.  Remembering that fact gives me both the ability to crawl put my achy body out on the street again and to spend the time needed to build the practice right.

End of sermon.

Rob Lamberts, MD, is a primary care physician practicing somewhere in the southeastern United States. He blogs regularly at More Musings (of a Distractible Kind) where this post first appeared. For some strange reason, he is often stopped by strangers on the street who mistake him for former Atlanta Braves star John Smoltz and ask “Hey, are you John Smoltz?” He is not John Smoltz. He is not a former major league baseball player.  He is a primary care physician.