How strange to think that great pain may be impermanent. Something in us all seems to want to carve it in granite, as if only this would do full honor to its terrible significance. But even pain is blessed with impermanence...
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No matter what means we use, service is always a work of the heart. There are times when the power of science is so seductive that we may come to feel that all that is required to serve others is to get our science right, our diagnosis, our treatment. But science can never serve unless it is first translated by people into a work of the heart.

"Human being" is more a verb than a noun. Each of us is unfinished, a work in progress. Perhaps it would be most accurate to add the word "yet" to all our assessments of ourselves and each other . . . If life is process, all judgments are provisional, we can't judge something until it is finished. No one has won or lost until the race is over . . .

In our instinctive attachments, our fear of change, and our wish for certainty and permanence, we may undercut the impermanence which is our greatest strength, our most fundamental identity. Without impermanence, there is no process. The nature of life is change. All hope is based on process . . .

It is taken me somewhat longer to recognize that a diagnosis is simply another form of judgment. Naming a disease has limited usefulness. It does not capture life or even reflect it accurately. Illness, on the other hand, is a process, like life is.

Much in the concept of diagnosis and cure is about fixing, and the narrow-bore focus on fixing people's problems can lead to denial of the power of their process. Years ago, I took full credit when people became well; their recovery was testimony to my skill and knowledge as a physician. I never recognized that without their biological, emotional, and spiritual process which could respond to my interventions, nothing could have changed at all. All the time I thought I was repairing, I was collaborating.

While attachment has its source in the personality, in what the Buddhists refer to as the 'desire nature,' commitment comes from the soul. In relationship to life, just as in human relationships, attachment closes down options, commitment opens them up. Modern life has made us people of attachment rather than people of commitment. Indeed, many people have found that it is difficult to tell the difference between attachment and commitment in their own lives. Yet attachment leads farther and farther into entrapment. Commitment, though it may sometimes feel constricting, will ultimately lead to greater degrees of freedom. Both involve in the moment an experience of holding, sometimes against the flow of events or against temptation. One can distinguish between the two in most situations by noticing over time whether one has moved through this activity or this relationship closer to freedom or closer to bondage. Attachment is a reflex, an automatic response which often may not reflect our deepest good. Commitment is a conscious choice, to align ourselves with our most genuine values and our sense of purpose.

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When we approve of people, we it in judgment of them as surely as when we criticize them. Positive judgment hurts less acutely than criticism, but it is judgment all the same and we are harmed by it in far more subtle ways. To seek approval is to have no resting place, no sanctuary. Like all judgment, approval encourages a constant striving. It makes us uncertain of who we are and of our true value. This is as true of the approval we give ourselves as it is of the approval we offer others. Approval can't be trusted. It can be withdrawn at any time no matter what our track record has been. It is as nourishing of real growth as cotton candy. Yet many of us spend our lives pursuing it.

Freedom may come not from being in control of life but rather from a willingness to move with the events of life, to hold on to our memories but let go of the past, to choose, when necessary, the inevitable. We can become free at any time.

One of the reasons many physicians feel drained by their work is that they do not know how to make an opening to receive anything from their patients. The way we were trained, receiving is considered unprofessional. The way most of us were raised, receiving is considered a weakness.

"A label is a mask life wears. We put labels on life all the time. "Right," "wrong," "success," "failure," "lucky," "unlucky," may be as limiting a way of seeing things as "diabetic," "epileptic," "manic-depressive," or even "invalid." Labeling sets up an expectation of life that is often so compelling we can no longer see things as they really are. This expectation often gives us a false sense of familiarity toward something that is really new and unprecedented. We are in relationship with our expectations and not with life itself."