by Rachel Naomi Remen, MD

One of my former patients, Josh, is a gifted cancer surgeon who had sought help because of depression. “I can barely make myself get out of bed most mornings,” he told me.“ I hear the same story day after day, I see the same diseases over and over again. I just don’t care any more. I need a new life.” Yet, through his extraordinary skill, he had given just that to many hundreds of others.

Proust has said that the voyage of discovery lies not in seeking new vistas but in having new eyes. New eyes can often be found in very simple ways. Drawing on the wise work of Angeles Arrien, the author of The Four Fold Way, I sometimes suggest to people like Josh that they review the events of their day for fifteen minutes every evening, asking themselves three questions and writing their answers down in a journal. The three questions are: What surprised me today? What moved me or touched me today? What inspired me today? I tell people that they do not need to write a great deal: the thing that is important is to re-examine the day from a new perspective and not worry about the amount they write about. I asked Josh if he would like to try this as an experiment.

“Less expensive than Prozac,” I told him. He was doubtful but he agreed to try. After a few days I got a phone call. Josh sounded irritated on the phone. “Rachel,” he said, “I have asked myself these questions for three days now and the answers are always the same: ‘Nothing…nothing and nothing. I don’t like to fail at things. What’s the trick to this?”

I laughed. “Perhaps you are still looking at your life through your old eyes,” I told him. “Try looking at the people around you as if you were a novelist, a journalist or maybe a poet. Look for the stories.” There was a brief silence. “Right,” he said. I sighed.

Josh did not mention the journal again for several weeks. Our sessions focused on relieving some of his stress and reducing his workload a bit. He seemed to be getting better and I was optimistic. And then, six weeks after his phone call, he came in with a little bound book and began to tell me about what was really helping him.

He had had trouble with the journal at the beginning and had wondered how he could be so busy and living such an empty life. But slowly he had begun to find answers to the three questions. He opened the journal and began to read some of these to me.

At first the most surprising thing in his day was that a patient’s cancer had grown or shrunk two or three millimeters, and the most inspiring thing was that a new or experimental drug had begun to work. But gradually Josh had begun to see more deeply. Eventually he saw people who had moved through times of despair and darkness by holding onto the power of love, people who had sacrificed parts of their bodies to affirm the value of being alive, people who had found ways to triumph over pain, suffering and even death. Listening, I was deeply moved.

The going had been slow, he told me. For a while he would only notice the things that surprised him, moved him or inspired him several hours after they happened, in the evening in the privacy of his home. “It was like one of those fairy tales,” he said. “Like being under a spell. I could only see my life by looking backwards over my shoulder.” But gradually the time lag became shorter and shorter. “I was building up a capacity I had never used. But I got better at it,” he told me. “Once I began to see things at the time they actually happened, a lot changed for me.”

I was puzzled. “What do you mean?” I asked him. “Well,’ he replied, “ At the beginning I couldn’t talk about it and I just wrote everything down. But I think when I began to see things differently, my attitude started to change. Maybe that showed in my tone of voice or in some other way. Some people seemed to pick up on it because their attitude seemed changed too. And after a while, I just began talking to people about more than their cancer and its treatment. I began talking about what I could see.”

The first patient he spoke to in this way was a 38-year-old woman with ovarian cancer who had undergone major abdominal surgery followed by a very debilitating chemotherapy. In the midst of a routine follow-up visit one morning he suddenly saw her for the first time, her four year old on her lap and her six year old leaning against her chair. Both little girls were shiny clean, happy and obviously well loved. Aware of the profound suffering caused by her sort of chemotherapy, he was deeply moved by the depth of her commitment to mother her children, and for the first time connected it to the strength of her will to live. After they spoke of her symptoms he had commented on this. “You are such a great mother to your kids,” he told her. “Even after all that you have been through, there is something very strong in you. I think that power could maybe heal you some day.” She smiled at him and he realized with a shock that he had never seen her smile before. “Why thank you,” she told him warmly. “That means more to me than you know.”

He was very surprised at this but he had believed her. Encouraged, he began to ask other people one or two questions that he had not been taught to ask in medical school. “What has sustained you in dealing with this illness?” or “Where do you find your strength?” and found that people with the same diagnosis had very different things to say. Things that he really wanted to hear about. In some way what they said was true for him too as he struggled with the difficulties of his own life. “I knew cancer very well but I did not know much about people before,” he told me.

Josh had always been a superb surgeon but over a period of several months, for the first time people began to thank him for their surgery and some even gave him gifts. At one of our meetings, he sat in silence for a few minutes, and then he reached into his pocket and brought out a beautiful stethoscope engraved with his name. “A patient gave me this,” he said, obviously moved. I smiled at him. “And what do you do with that, Josh?” I asked him. He looked at me puzzled for a moment and then he laughed out loud. “I listen to hearts, Rachel,” he said. “I listen to hearts.”

Most of us lead far more meaningful lives than we know. Finding meaning is not about doing things differently, it is about seeing familiar things in new ways. We can see life in many ways; with the eye, with the mind, and with intuition. But perhaps it is only for those who have remembered how to see with their heart that life is ever deeply known or fully served.

To experience the power of keeping a Heart Journal click here for some simple guidelines.