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Join Koshin Paley Ellison, a psychotherapist and author of Untangled: Walking the Eightfold Path to Clarity Courage and Compassion. Explore the transformative power of contemplative medicine as we delve into topics such as reconnecting with patients, navigating difficult emotions in the workplace, and cultivating resilience and compassion in health care practice.

Koshin Paley Ellison is a psychotherapist and author of Untangled: Walking the Eightfold Path to Clarity Courage and Compassion.

He discusses the KevinMD article, “Embracing vulnerability: a doctor’s journey of healing and connection.”

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast, and get CME for this episode by clicking on the CME link in the show notes. Today we welcome Koshin Paley Ellison. He’s a Zen teacher and psychotherapist. He’s the author of the book Untangled: Walking the Eightfold Path to Clarity, Courage, and Compassion. There’s an excerpt from that book on KevinMD titled “Embracing vulnerability: a doctor’s journey of healing and connection.” Koshin, welcome to the show.

Koshin Paley Ellison: Thank you so much. It’s a pleasure to be here.

Kevin Pho: Let’s start by briefly sharing your story and journey.

Koshin Paley Ellison: Yeah. So when I was eight years old I told my mother I wanted to grow up to be a Zen Buddhist monk, and the short story is, I did.

And along the way I had the pleasure and privilege of caring for my grandmother, who was an incredible immigrant from Hungary. And she was the one who, seeing how many clinicians were so well-meaning, as she said, she said, so many of them are so well-meaning, the doctors, the nurses, all these clinicians are so well-meaning, but they somehow forget what is most important, which is to actually just be where they are. They’re so distracted, so anxious. And who’s caring for them?

And she said, you and Chodo should start a center where you teach people about Zen and how to care. And so now, 18 years later, we have done that, and we created the New York Zen Center for Contemplative Care. The true founder of it is a woman named Rachel Schwarz, who is my grandma.

Kevin Pho: Yeah. So tell us today how clinicians can use that concept and philosophy of contemplative medicine. How can that help them today?

Koshin Paley Ellison: To me it’s really about learning how to slow down and really listen, which is the contemplation piece of it. Really, how do you take a moment to pause? And many of us say, oh, we don’t have any time, and we know the average clinician visit can be three minutes, but there’s a lot that can be done in three minutes. And learning how to be right where you are and nowhere else, and what that feels like both inside of yourself and for others.

And the other piece of it is that the word medicine itself has often become so different from what it originally meant, which is, what is healing, what is helpful, what is nourishing? And so those two words together, like, how do we stop and realize what is the actual nourishment that we need?

And the other word that’s very important to us in terms of our contemplative medicine fellowship is the word fellowship. I met so many clinicians who have done fellowships and they have never really felt a sense of fellowship. There’s still a deep sense of loneliness and detachment from others. And so, how do we learn how to have loving, caring relationships with other clinicians and with the people in our life?

Kevin Pho: Yeah. So I’m sure you talk to so many physicians, so many clinicians, where they are distracted, where there are so many obstacles that prevent them from slowing down and developing those relationships. So tell me some stories, and what are some specific examples of how some of your teachings have helped these clinicians who come to your center?

Koshin Paley Ellison: Yeah. Well, the one I wrote about in that piece from Untangled is an attending physician, midcareer, and she came to this fellowship to really understand how to do things differently. And there was this listening to this discontent, and the burnout. And burnout actually can be very helpful if we can actually realize, oh, I need to do something differently, I can’t function in the same way. So she did that, which to me was so amazing.

So, as she self-described, crawling into this training, and realizing that she had never really looked one of her patients in the eye for many, many, many years. Because when she was in her fellowship, in her specialty, she was not taught how to have difficult conversations. And so the first conversation she had to have was very painful, and giving someone really bad news. And since that time she had not looked someone in the eye. So this is just an example.

And what she realizes is that over time it was wearing her down. She felt depersonalized in her work, she felt that she didn’t know how to just look at someone, and she didn’t really know how to look at herself. And so these behaviors, all of our habits, need to be cared for.

And so over time, what she learned how to do was to realize, well, maybe it’s not such a big idea to be uncomfortable, that many times during the day I’m going to have to share uncomfortable news, and how do I find the support that I need so that I can be in the discomfort in a new way?

And it was amazing to see what happened to her in terms of her sense of joy, and her sense of that vulnerability of just looking at someone and sharing what’s difficult. It actually became what was nourishing to her, that she felt more connected at work.

And actually what over time happened was also her relationship with her partner. They began to look more carefully at each other with more care, attention. And she began to build friendships again, having that sense of connectedness, which we often are longing for. As we know, over 35 percent of people, in just at least the United States, report not even having a single friend. And that is even people in marriages. So we’re in that world, and we know that social connection is everything.

Kevin Pho: Short of taking a contemplative medicine fellowship, what are some things they can do, short of taking that fellowship, to incorporate some of those teachings into their daily lives? Because the situation you describe in terms of those obstacles and burnout, it’s so prevalent today. So what are some, I guess, low hanging fruit? What are some things that they can do to incorporate more contemplation into their professional, personal lives?

Koshin Paley Ellison: Yeah, there are many things that we can do. Well, one of them is learning how to pause. It’s so interesting, that is just something that we talk about on the first day of the fellowship, and it is often the one thing that is most significant.

But the thing is, really learning how to practice pausing. Like, oh, how have I paused this morning? To ask ourselves that question. And many of us don’t pause because we feel so uncomfortable, and we don’t want to feel that feeling. So how do you practice even like a little micro pause, just for a moment coming back? And I often encourage people to put their hands on their lower belly, just below their belly button, and just feel your breath there, pause, and take three breaths. Everyone has time to do that.

And look, the other thing I often encourage people to do is, see if you can find something new between when you leave your house, if you leave your house, and when you get to the next place. Can you notice something new that’s beautiful? Very simple. And actually some of the folks I know, they take photos. So, like, find something. It’s like realizing that your life could be like a treasure hunt. It’s very wonderful.

And how do you find beauty in the midst of your life? We forget how important beauty is, and it can be just the shape of an iron fence, something very ordinary. It does not have to be a flower or whatever that is. Find some beauty, to pause.

And the other is, actually, how do you learn the names of the people that you depend on, like in the grocery store, or if you go to a bank, remember when there were banks and people used to go there? But in a grocery store, or in a little coffee place, how do you learn the people’s names, and figure out, how do you learn a couple things about the people in life that you depend on?

Actually, one of our physicians, who’s one of my students, he asked, how’s my practice going? And I said, you know, the key question is, tell me about the checkout people at the supermarket where you go. And he was so surprised. He’s like, what’s that have to do with anything? I said, well, it has to do with who you depend on, and what’s your relationship with those people?

And it turns out, from the research, in particular the longitudinal study from Harvard, that it completely matters. Our life becomes richer and more meaningful when we know those things, when we have those relationships. When you make just a little bit of effort, it goes a long way.

Kevin Pho: Your book is titled Untangled: Walking the Eightfold Path to Clarity, Courage, and Compassion. What are some of the key messages that you want readers coming away with after reading your book?

Koshin Paley Ellison: I think the main thing that is most important for me is, like what I learned when I was 11 years old, when I went to karate. And the teacher, his name was Sensei White, and Sensei White used to have us sit in seiza, which is where you have your legs underneath yourself. And he would walk around really steadily and say, you’ll never be free until you can be still with your pain.

And I remember thinking that that was like a superpower and an amazing thing. And I think that, while we don’t have to do something so extreme like sit on our knees for 15 minutes, and yet, we can really learn how to pause in the midst of our life when we feel entangled in something. Learning how to pause and breathe through the difficulty. And for me that’s where the freedom actually lies.

I’ve yet to experience awesome change when I didn’t experience the struggle also. So I think that change requires, very often, a willingness to also struggle.

Kevin Pho: In terms of the response that you receive from the medical profession after reading your book, or going to your center, completing a contemplative medicine fellowship, what do people say, from the physicians that you talk to?

Koshin Paley Ellison: Well, I was just teaching in Japan, and I’m with a group of about 300 clinicians there, and the message is pretty much the same cross-culturally too, is, wow, I never thought about including myself in the care that I’m offering.

And even, you know, doctors and nurse practitioners and different folks that maybe don’t identify as a caregiver, but it’s still part of the culture and it’s part of the norm. And really turning that around, realizing that we can be a partner in this, and that the depth of my care for you is only going to be equal to the amount of care I’m offering also to myself. So it’s like giving and receiving equally.

And so that message tends to be very powerful and helpful, because we have these things in the medical profession, the clinical professions, like, oh, go home and do your self-care, go home and work on your work-life balance. Well, we only have one life. We don’t have a work life and a home life, we have one life. And self-care is more isolating.

In my experience, whether I’m teaching in England or in medical schools in the United States or in Japan, the same stories: I’m so bad at my self-care, and I’m so lonely. Or now people are saying, like, I’m so bad at my self-compassion, and I’m so alone.

So how do we realize we can actually remember that care and compassion don’t need that self part on them, but just, like, how do I learn how to be more caring, compassionate, that includes me? So that the way I’m with you, Kevin, is also the way I am with myself. If I’m resourced, I can offer you that feeling, as opposed to, if I’m feeling totally burnt out and under resourced and undernourished, that’s what I’m bringing you. Who wants that? Not I.

Kevin Pho: We’re talking to Koshin Paley Ellison. He’s a Zen teacher and psychotherapist. He’s the author of the book Untangled: Walking the Eightfold Path to Clarity, Courage, and Compassion. Koshin, we’ll end with some of your take-home messages that you want to leave with the KevinMD audience.

Koshin Paley Ellison: So the main take-home for me is, we only have the time that we have, actually, what we have. And so, how are you attending to the time you have? Are you actually doing what is nourishing? And what are you waiting for, if you’re not?

And in our place, we recite a poem that for me is very exciting, and I just want to leave you with this short poem, which is: Let me respectfully remind you, life and death are of supreme importance. Time swiftly passes by and opportunities are lost. On this day, the days of my life are decreased by one. Each of us must strive to awaken. Awaken. Take heed. Do not squander your life.

Do what you need to do to not squander.

Kevin Pho: Koshin, thank you so much for sharing your perspective and insight, and thanks again for coming on the show.

Koshin Paley Ellison: Thank you so much.