STOICISM: An Adaptation For A Medico

In May last year, when the entire country was under a complete lockdown, I realised the pillars of our healthcare system had started to crumble. At 12 in the night, as I loaded yet another syringe with tramadol in the labour room of the hospital I worked in, I received the dreadful news that the blood bank of the hospital had shut down. Even before I could analyse the implications for the lady who urgently needed FFP (fresh frozen plasma) or the severely anaemic woman, a wave of franticness engulfed me. As I made my way through the commotion to talk to my senior about the latest development, I took a humble seat and went over the situation with a certain sangfroid.

Countless such days had made me tumble and finally knock on the doors of stoicism. But then, having been ignorant of philosophy, I realised I was wrong about it, just as people were about Severus Snape from Harry Potter. Like a calming balm to a festering wound, stoic principles are precisely what a burned-out physician needs, getting suffocated under a colossal amount of work, administrative challenges, rising expectations, declining autonomy and the unpredictability of medicine.

A Little About the History and Roots of Stoicism

Stoicism was founded in Athens by Zeno in 300 B.C. and later flourished in Rome. Its many adherents were Emperor Marcus Aurelius, Seneca and Epictetus, who emphasised that “virtue is sufficient for happiness”. They focused on promoting a life in harmony within the universe, over which one has no direct control. In the literal sense, stoic has since then come to mean “unemotional”, but this is a misconception.

Their idea was to be free of suffering through “apatheia ” or peace of mind by being objective or having “clear judgement ” and maintaining composure or “equanimity” in the face of life’s highs and lows.

Some Useful Principles And Practises

That hard-pressed doctor running around in the emergency room juggling dozens of patients efficiently, straining his emotional, mental and physical faculties, or that young medical student buried under the weight of books and expectations, all require a stoic armoury. The reflections of Marcus Aurelius to the rescue!

Here is an excerpt on how to keep calm in the worst of today’s raging storms of this capricious world.

Trichotomy of Control: Focus on what you can control, accept what you can’t, or partially control

“The chief task in life is simply this: to identify and separate matters so that I can say clearly to myself which are externals not under my control, and which have to do with the choices I actually control. Where then do I look for good and evil? Not to uncontrollable externals, but within myself to the choices that are my own.”

-Epictetus

Responding to external stimuli with a negative response such as rage and contempt will only cause distress to our minds, with a never-ending cycle of disparagement and turmoil. Examinations cancelled at the last minute, that patient battling with cancer which you cannot do anything for, the intransigence of that colleague you have to put up with, the project you burnt the night lamp for the last quarter, turned away by your senior without a look; countless such circumstances and countless such exhaustive negative emotions.

Instead, if we were to accept whatever the universe throws at us, reacting pragmatically, and compensating our energy somewhere we can make a difference, it would bring us much greater peace.

Fatalism: Amor Fati or the Love of Fate

Viktor Frankl was a Jewish psychotherapist who lived during World War 2. Witnessing the horrors of the various concentration camps, he wrote a book called “Man’s search for meaning”. He propagated a very straightforward philosophy,

“You cannot control what happens to you in your life, but you can always control what you will feel and do about what happens to you.”

There is something to learn from even the worst of the misadventures and hardships.

The labour room is busy? Good, It is an opportunity to learn!

You have to reach the eleventh floor, and the elevator isn’t working? Good! A remarkable opportunity to burn off calories from that pizza last night.

Spin it positively before it spins you off your track.

Code of honour: leading a virtuous life

“Waste no more time arguing what a good man should be. Be one.”

– Marcus Aurelius

‘Virtue’ in stoicism is an amalgamation of four cardinal values- wisdom, courage, self-control or moderation, and justice – all of which are interdependent. As long as one walks on the path of righteousness by holding one’s beliefs, no wealth or financial security, popularity or personal achievement is imperative to live a contented life.

The beauty of these ethical ideals is that nothing or no one can take them away from you, and this is empowering in itself.

You might be familiar with the term “stoic mindfulness”, vitalising the love of truth, the labyrinthine of the conviction that genuine wisdom consists in grasping the truth about the essential things in life. A person who cannot appreciate what will help him flourish or achieve fulfilment and what will harm his growth is a person who will most certainly take a while in his pursuit of happiness.

As practising physicians, we must focus on the process without worrying about the outcome, delivering our best, “endure and renounce” (Epictetus), deftly adapt to our external circumstances and prepare ourselves for any forthcoming events.

Medicos are probably the most courageous out there – constantly putting their best foot forward in trying cases, never complaining and never turning their backs. Nonetheless, to prevent burnout when the outcomes are in disarray despite all your efforts, take a step back, focus on deliverance and the divinity that you acted virtuously and that in itself is enough.

Law of nature and reason

“For good or for ill, life and nature are governed by laws that we can’t change.

The quicker we accept this, the more tranquil we can be.”

-Epictetus

Epictetus and Marcus Aurelius believed that to navigate life’s cruise; one must be in line with nature’s processes and understand his place in nature’s will. Moreover, as the divine essence behind the universe’s unravelling is distant and unreachable, it implies that the events in people’s lives are not under their control. It may seem too stand-offish of our nature, but it is not entirely random. Thus, to Epictetus, to go against this substantially, arguably living with viewing reality irrationally, one can never assist in making one’s life better.

The best thing to do? Assume little control over life’s unexpected events and go with its flow; it will make it easier.

Unfortunately, these principles of ancient stoicism have not been able to shed light upon regarding the practice of medicine. Let us change the perception towards philosophy, an exceptional remedy of emotional exhaustion, which is a burden on our plates. Behold the powers gifted by this stem of wisdom, and remember:

“It is the power of the mind to be unconquerable.”

References:

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