The Medicine of Transparency

You have been chosen, You are sound and whole…

Do not be afraid to suffer, give

the heaviness back to the weight of the earth;

mountains are heavy, seas are heavy.

Even those trees you planted as children

became too heavy long ago – you couldn’t carry them now.

But you can carry the winds….and the open spaces

~Rainer Maria Rilke

Every physician can look back over years of medical training and remember the experiences that shaped them as a physician and healer. The stories we carry in our hearts are timeless reminders and a continual source of inspiration and love for our work.

I completed my medical training in New York and San Francisco in the early to mid-1980’s. At that time elusive the HIV virus, was infecting patients being admitted with opportunistic infections.  A majority of them required hospitalization as they were very sick and would have died quickly without inpatient care.

My first experience with patients infected with the HIV virus was on the medical wards at Montefiore Hospital in the Bronx, New York. The unknown viral contagion that was damaging their immune system was poorly understood. We needed to take all precautions, including PPE (Personal Protective Equipment) to protect our immunocompromised patients from being infected by any stray bacteria we may unknowingly bring into their room, and also ourselves from the unknown contagion that was making them sick.

I was 22 years old and felt overwhelming empathy for these patients. How must they have felt to be so isolated? Imagine the vulnerability and fear they must have felt day after day till they were discharged or died.

Maybe it also was because of the way these patients were marginalized, cast aside and discriminated against that evoked a special kind of love and compassion for them in me. When I began my internship at UCSF in 1986, I requested that the majority of my rotations to be at San Francisco General Hospital, where a special ward was created for patients infected with HIV.

On the AIDS ward in the mid-1980’s, many of my patients were dealing with an intense fear of death with extraordinary courage. A large percentage of them were young, highly creative, artists, very bright, at the climax of their careers.  On the ward, I felt more like their student rather than doctor. I felt divinely placed with them to learn about courage and compassion, life and death, and a broader and deeper perspective of Medicine. In my mid-twenties, I was impressionable as a doctor-in-training, and intuitively knew this experience would profoundly impact my journey as a doctor and healer. In fact, I welcomed it.

My patients with AIDS were transparent and authentic in expressing their feelings, and freely shared with me the perspective and wisdom they had gained through their confrontation with death and the unexpected yet impending end of their life in the weeks or months to follow.

In the early hours of the morning while on call, tired from shifts that lasted up to 2 days with little sleep, I would find a quiet spot in the piano room on the ward, close my eyes, and bask in the energy that filled the space with its numinosity.  This had become sacred space, where the sublime experience of living and dying was acutely palpable. An overwhelming feeling of love also filled this space. It transcended all daily struggles, neuroses and provisional values.  It felt essential for me to lean into this as sacred and profoundly sublime, as I intuitively knew it would make me a more authentic physician along with a courageous human being.  It would open my heart to a deeper love for my patients and immunize me from the denial and closed-heartedness I was being imprinted with during my medical training.

I’ll share one experience on the ward with you. One foggy San Francisco morning, I remember while rounding on one of my patients, as I was checking his vital signs, he asked me how I was doing.  I said, “If there was only more sun today, I would feel better,” to which he responded, “Dr. Kumar, there is no such thing as bad weather when you have AIDS. Every day is precious.”

His simple, sublime response left its mark deep inside of me. It was like a Satori experience that pierced my negative attitude.  His words still reverberate inside me. He offered a perspective during a difficult time in my life that I still consider a precious gift, a grace. It is a sublime sort of Medicine, a salve, that keeps my perspective in check when I feel down or negative about the ‘small stuff,’ that easily piles up during our daily routine threatening my connection with meaning.

I cherished my time on the AIDS ward. There, my patients were my teachers, as were the nurses who tirelessly cared for these patients. They took me under their wing and taught me how to be a good physician, to have the courage to love and feel.  They modeled the importance of being transparent and authentic as a kind of Medicine that many times had far greater value than book knowledge and rational expertise.

Being transparent is a gift we often suppress as physicians. Our culture leads us to believe that showing our feelings is a sign of weakness. On the contrary, it is a sign of our humanness. It makes us trustworthy. It also offers safety to those who depend on us for their healing. During my residency, I was told that as a physician it was my obligation to hide my feelings. This felt counter-intuitive to what I felt and also terribly wrong. I was unable to adapt to this injunction. The nurses on the AIDS ward reinforced the power of that transparency has for healing. They were unafraid to show their feelings, love their patients and care for them in ways that were such a contrast to the disconnected physician-patient relationship expected of us during our training.  Because of what they taught me, they will always be my heroes and mentors. I watched them care for patients with such openness, compassion, and love that I vowed to similarly keep my heart open in my work.

When my patients share their deepest struggles and sorrows with me, I receive them with love and transparency. They feel witnessed and validated. This is deeply healing for both them and for me.  True healing is relational and reciprocal. This also honors the Feminine Principle. Every day, I feel grateful for the privilege to be able to serve the sacred contract of witnessing and healing my patients, where the mutuality of process between us adds depth and meaning to both their life and mine. This is the kind meaning physicians are starving for in corporate healthcare today.  It is what they are expected to betray to keep the (toxic patriarchal) corporate machine alive. I left corporate healthcare to practice medicine with transparency and love. I created a healthcare model  where sacred space is created to sanctify every office visit, so love and transparency can be part of the healing process.

I will be forever grateful to my patients on the AIDS ward in San Francisco nearly four decades ago. They were my greatest teachers and I owe my openheartedness as physician to them. The many months spent that ward will remain sacred to me forever. I will always remember their courage to be transparent through the most difficult time of their lives.

©November2022, November2014 Kalpana (Rose) M. Kumar M.D., CEO and Medical Director, The Ommani Center for Integrative Medicine, Pewaukee, WI. www.ommanicenter.com   Author of Becoming Real: Reclaiming Your Health in Midlife (2^nd Edition), Medial Press, 2014. Dr. Kumar is currently accepting new patients. Call 262.695.5311 for an appointment, either virtual or in-person for those free of symptoms.