JONATHAN PAGE. How Buddhism helped this cancer doctor care for his dying patients (ABC Science interview)Oct 6, 2018
Medical oncologist Jonathan Page says being more in the moment helps him to be a better doctor. His relationships with his patients were once characterised by “coldness…. and a lack of grieving”. But a mental health crisis that led him to Buddhist meditation helped change that.
One day in 2003, medical oncologist Jonathan Page was working hard at his computer when he felt a weird “melting feeling” in his head. It was so powerful he thought he was having a cerebral haemorrhage. “I was left not being able to think or maintain my posture on the chair,” he says. “It felt like a disintegration of the mind.” Dr Page ended up collapsing on the floor for a couple of hours before managing to phone for help.
Up until then, he had been working non-stop, often weekends and on call, in a pressure-cooker environment, looking after many gravely ill and suffering patients. “You’ve got to be at your best because you’ve got all these patients and their families depending upon you,” he says. “I was a driven person. I was working on all sorts of issues, and worrying about things. Work was full-on.”
The collapse turned out to be a severe case of depression and burnout. “I had been so inattentive to my own wellbeing,” he says. “It was the accumulation of years of self-neglect.” Dr Page was referred to a psychiatrist but didn’t find much relief from the pills he was prescribed.
He went back to work and the stress kept building up — he even felt suicidal. “I would be sitting in a room with a desperate patient and family, and a couple of medical students, and be thinking ‘what am I doing here?'” he says. “It was so hard. I don’t know how I got through. I had no idea what was going on.”
Then one day, he reached out to Buddhist meditation — something he’d first been exposed to 30 years earlier, as a young university student. When Dr Page was a medical student at the University of Sydney in the 1970s, the student union organised for a Buddhist monk to come in at lunchtime to teach meditation — as a way of helping students and staff to manage stress. At the time, Dr Page and his mates dismissed the monk, but the moment proved seminal. Over the years, his interest in Buddhism and its central practice of meditation increased.
Decades later, he was desperately seeking help for his burnout, when he saw a sign for meditation at a Buddhist centre near where he lived. “I sat in there week after week,” he says. The urge to end his life dissolved and after many months he experienced “profound” changes. Through exploring Buddhist philosophy and meditation, and its focus on being “mindful”, Dr Page became more aware of how stressed he was.
It also led him to reflect on how, in the extreme busyness of his life, he had behaved quite badly to those around him — with irritability and a lack of sensitivity. “In slowing down you’ve got time to review your own life. In my case it was the first time I’d seriously done that as an adult,” he says.
As a medical oncologist, Dr Page is faced with many of his patients dying within a matter of months of meeting them. Before the influence of Buddhism on his practice, he says his relationship with patients was characterised by “coldness, a lack of engagement and a lack of grieving”. This only added to his feelings of depression and burnout, he says.
Dr Page says Buddhist philosophy helped him get in touch with ways of being, characterised by compassion, loving kindness and equanimity. Accepting the impermanence of things was also key in helping him confront his own mortality.
All this changed his practice as a clinician. “It’s affected the way I see people and treat people,” Dr Page says. “I reconfigured my job.” Despite resistance from the hospital he was working for, Dr Page lowered his patient load. These days, he spends more time with each patient, mainly at Manly Hospital and the Mater Hospital in North Sydney.
He still practices conventional medical oncology, explaining the pros and cons of different treatment options, supervising chemotherapy and arranging radiotherapy where necessary. But he also pays close attention to his patient’s mental and spiritual health. “I’m more in the moment, more mindful, more present and better able to engage with patients”, he says.
Dr Page says when people diagnosed with cancer ask him questions such as ‘Why me?’, ‘What will happen next?’ or ‘How much time have I got?’ he sees an opportunity to have a deeper discussion. “I make a great effort to listen, and make it clear to them I am listening, rather than tapping away at the keyboard and saying ‘I’m listening’ when you’re clearly not”, he says. The result is the patients open up.
Dr Page believes alongside providing conventional cancer treatments, one of his important responsibilities is to help patients confront their mortality — and reduce their fear of death. “I try to use the ‘d’ word rather than other euphemisms like ‘passing on’,” he says. “It makes it easier to talk about life as a very real experience that — like a holiday — is going to end.”
He says this is important at any stage in life, but perhaps especially important for patients with a short time to live. “A patient could spend the rest of their life — if they’ve got six months to live — just thinking about chemotherapy and hoping that it’s going to work, without looking at the nature of their mortality and meaning in their life”, he says.
Alongside providing drugs and radiotherapy aimed at extending his patients’ lives, Dr Page encourages meditation to help them become mentally more comfortable with death. He sometimes gives people a CD (recorded by himself) or advises them to attend meditation classes (including one he runs himself). Sometimes, he recommends people literally meditate on their own death. While this may seem like a macabre thing to do, Dr Page says it is all part of normalising death and removing people’s fear of it.
As a Buddhist, Dr Page believes suffering is universal, but it can be reduced if we meditate. This brings the mind into the body and enables us to identify the cause of our suffering, he says. “People discover a new way to see the world. They look into their mind, see the thoughts that are creating turmoil and chaos, and in the process find peace and comfort.” He says when a patient is at peace with the idea of their own death it means they can then “get on with the important business of living. Often people have not really thought about this at all until they’ve got cancer — or in my case, until I got depression”, he says.
Dr Page says he does not need to talk explicitly about Buddhist philosophy in order to help patients benefit from meditation and self-reflection. In the process of considering the meaning of their life and their mortality, he has seen patients take a degree of “agency” about their own life which they had previously not. “Most people — and I was the same — live their lives in response to pressures from outside,” he says. “At no point have they stopped and asked ‘What should I really be doing’?
“So, often in oncology we may see patients reviewing their lives, aspirations and relationships.” This might include asking themselves who they need to forgive before they die, or who they need to say ‘I love you’ to. “Often patients talk about other things they want to do while alive — completely unexpected and unpredictable things”, he says.
Dr Page says death is such a taboo in our culture that most of us keep a lid on our fear of dying — and this includes clinicians, who tend to skirt around the topic and don’t invite the discussions it can open up. He says his approach has only been possible because of the self-reflection Buddhist meditation has given him. “If you are going to be in this business, you have to have addressed your own mortality so you have a deeper understanding of what the patients are going through.”
Dr Jonathan Page is a medical oncologist in Sydney.
ABC Science interview by Anna Salleh, 22 September 2018