Editor’s Note: Dr. Lobsang Dolma, 40, is chief physician of the Tibetan Medical Center of the Dalai Lama in Dharmsala, India. She was born in Keron, Tibet and was a physician for 11 years in Keron, Katmandu, and Dalhousie. She visited Durham earlier this year to exchange ideas with doctors here and tour several hospitals.
Her hands are graceful, forceful, certain. They move through the air like swift, impassioned birds, emphasizing her words, as she explains about medicines of flowers and fruits for craziness, diagnosing pregnancy by feeling the pulse in the ring finger, the difficulty of curing heart disease when there are evil spirits, the importance of the doctor’s own dreams before the patient arrives, and, with the same matter-of-factness, about cancer. She is sitting cross-legged on the pillow, her eyes dark and active, her voice calm: why tumors grow; karma; the presence of evil spirits.
I can’t remember the exact words. Probably something trite, and overly dramatic. Doctors watch too many movies, too, wear the same mock-heroic masks as the rest of us, masks of compassion and wisdom and bravery. Upon them rests the awful obligation of making dignified sense of what they can’t understand. They are the high priests of the culture, and perhaps it is the awful pomp of their office that makes them look so unhealthy. Overworked and overfed. Not to mention overpaid. Of course, I am being unfair, but as the doctor himself suggests, life is unfair — otherwise, how explain my father’s suffering. Sympathy is written all over his face like a bad check, but I suspect there is a more profound forgery somewhere, back in the schools of medicine, back in the long, sterile hallways of Western thought — proud, antiseptically rational, and immunized against whatever virulent germs of intuition, faith, and plain common sense linger in the blood.
All pleasure and pain has mental origins, she explains, and so no disease is unrelated to mind. Specifically, the balance of winds, phlegm and bile within the body determines how healthy a person is. Imbalance leads to disease. This is similar to the idea of bodily ‘humours’ current in the Middle Ages. In Tibetan medicine, which is faithful to Buddhist philosophy, any imbalance is a result of desire, hatred and confusion — the basic ignorance arising from false perception.
“Illness,” she says, “is caused by your own actions in this or a former lifetime. Killing, stealing, and lying can draw illness to yourself.” In one out of ten illnesses, she continues, an evil spirit is present. “We don’t attack spirits. We handle them with compassion. We give the spirit something else to feed on. When a spirit is taken out of someone’s body, it dissolves like a cloud. It no longer has a reason for being.”
A physician may recite a mantram, or magical chant, 100,000 times to effect an exorcism. Other rituals that are attached to the giving of medicine act as what Western science might call psychotherapy.
He thought the pain was from intestinal gas. “Why can’t they do something for the gas?” he asked, over and over. It wasn’t gas; it was the tumor growing, fouling his intestines, advancing on his liver, and cruelly upsetting the delicate chemistry that we, who enjoy it, take for granted. The doctors assured him they were doing all they could — except, of course, telling him the truth, which he eventually figured out for himself.
In Tibet, she explains, there are 1,500 medicines, made of minerals, leaves, bark, earth, roots and fruits. Medicine is used before other treatments. Surgery is rare. The instruments are burning cones and needles, similar to those used in acupuncture. When a tumor is found, a needle is inserted and a cone with burning incense placed on top. The tumor dies, and is expelled.
“Are you afraid?” I ask.
“Of dying.” The word, once said, doesn’t seem so evil. Why won’t anyone else talk about it?
He shrugs, as if the answer is obvious — or perhaps simply impossible, as if the kind of introspection I’m demanding is worse than the pain already lacing his insides. “I’m just sorry,” he says, “we didn’t get to be together more.”
An imbalance in the body, usually because of non-digestion of food, leads to disease, she explains. “If you avoid eating bad foods and bad combinations of foods, diseases can be avoided.” Some foods that are healthy become injurious when mixed with others. Some bad combinations, she says, are radishes and mushrooms; fish or meat, and butter; red, or black pepper, and orange juice; ice cream taken after meat. Meat and fish are not innately harmful, although mixing them is. Also, “There is great fault in eating until your stomach is full.
Think of your stomach as having four sections. Fill two with food, one with drink, and leave one for the winds to circulate.”
Thinner than I’d ever imagined I’d see him, the intravenous feeding keeping him alive now. His lips are dry. My mother sends me to the grocery to buy him a soda. Years earlier, I had pleaded with him to change his diet, to stop eating foods with preservatives, to cut down on meat. He sat there, sipping a Pink Grapefruit No-Cal, challenging every statement, as I grew more shrill. Once again, we were arguing less from conviction than from that fierce, dimly understood need to change one another, to shape each other’s lives to designs more of our own choosing. Downstairs, I buy him two bottles of No-Cal, flavors I hope he’ll like.
“Sleep on your right side,” she says,“ with your head to the north and your feet to the south. Your head should not face the south. The Lord of Death is in the south.”
He is lying on his right side, uncomfortable, yet too weak to move. He asks me to help him turn over. I want to help, of course, but I hesitate. His flesh is sagging and yellow, tattooed like hospital meat with needle marks and small bruises. It is a body mortgaged to death and, like any animal, I would rather give it wide circle. But we have surrendered so many of our animal privileges — living naturally, dying naturally — in order to go poking among the crumbs of what we call our common humanity for other nourishment. The animal within notwithstanding, I am as hungry to help as he is for it. I lift him, the gift of whatever strength he has nurtured in me finally returned. It is, save mourning, the last thing I do for him.
After studying medicine for nine years, a Tibetan doctor spends three years studying the pulse. A diagnosis is made by placing the three middle fingers of each hand on the patient’s pulse and also by sight from a urine specimen. Someone in the audience, who the doctor had diagnosed earlier, is said to have winds in his stomach, making it hard for him to digest milk and sweets. A friend who knows him whispers that this is true.
He doesn’t look any different. His eyes are half open, his mouth small and tired, the early morning sunlight bathing him. He seems almost relaxed. It takes me a few moments to realize what has happened. “Mom,” I say, stepping away from the bed, “I don’t think he’s breathing.” I reach for her, as much to steady myself. I am frightened, I think, by the sheer mystery of it. It’s as if his lifeless body is a kind of vacuum sucking all meaning from the air around it, all the explanations, all the medical terms and medical excuses and medical prayers — everything, perhaps, save the medical bills. My mother calls for a doctor, who takes one look and tells us to wait outside. As we stand there, another doctor goes in. And another. It’s ten minutes before one of them emerges to tell us what we already know. I can’t remember the exact words. Something about how they tried their best. I believe him. Not believing sours the insides, makes you old before your time.