by Arnie Kozak
Last fall I had a minor surgical procedure on my right knee. This was the second time that I had arthroscopic surgery so it felt familiar, and was not a big deal. Routine, in fact. As with the first surgery on my other knee, I had no postoperative pain and no need for the narcotic medications that were liberally dispensed. After my first surgery, I was golfing within a week.
This time, I was also looking forward to getting back into my usual routines. I did notice, however, that I had a pain in my calf that felt like a trigger point — tight muscles that radiate pain — similar to those I get from frequent trail running. I remembered that my sister gave me a gift certificate to a spa for my 50th birthday. “Might as well use her gift for this situation with my leg.” At my appointment, we talked about my surgery and I assured her that the pain was just a trigger point. Indeed, I had some confidence in that proclamation because I had mentioned the pain in my follow-up appointment with my surgeon and nothing was said further about it.
The massage therapist goes to work on the spot. While it feels like a trigger point with tightness and radiating pain, it also feels pressure-packed. That piece of information goes into the back of my mind. Despite her focused efforts, the pain persists.
A couple of days later, I was getting ready to go out of town — on my way to the Kripalu Center for Yoga and Health for a workshop with my favorite poet, David Whyte. As I am packing my bag, it suddenly dawns on me that the pain I am experiencing in my calf could be a blood clot from the surgery. It is in the right location, just downstream from the surgical knee. “Why didn’t I think of this before?”
The forces of mindlessness and mindfulness were both at work. I had been mindlessly locked into a narrow interpretation of the pain. I hastily put it into a familiar category and did not step back and mindfully try to put it in a broader context. Mindless errors can be persistent as it was through my follow-up visit with the orthopedist and the massage therapist. It wasn’t until days later that my mind opened to new information and I recognized what might be happening.
I called my orthopedic surgeon and my PCP and began a descent down the medical system rabbit hole. I was referred to the vascular surgery department where they did an ultrasound and confirmed a DVT — deep vein thrombosis — the medical term for blood clot. Vascular surgery sent me to hematology where they put me on a sinister drug treatment regimen. First I had to inject a very expensive drug into the skin of my abdomen for a week. It burned upon entry and caused significant bruising. Then I had to take a blood-thinning agent.
This process of appointments takes hours and there is no way that I will make it to the opening session of the workshop. It is November, and I had just purchased my season’s pass for Stowe and I was looking forward to a great winter of snowboarding. When taking blood thinners, you have to avoid injuries because thin blood causes bruising, especially head injuries due to the risk of cerebral hemorrhage. My season was over because treatment was anticipated to take months.
My initial reactions were frustration, anger at myself, and an admixture of horror and relief, much like experienced after a near miss of an accident in a car. I was relieved yet shocked that I had been endangering myself. I was also saddened that I would miss the opening session with David Whyte and the lost snowboarding season was also weighing on my mind. This moment was a microcosm of much of emotional life and also an opportunity to let go into equanimity.
Under the veil of an arrogant familiarity — an attitude incompatible with mindfulness — I exposed myself to a potentially life-threatening situation. If the blood clot were to have dislodged and traveled through my blood stream it could have wound up in my lung causing a pulmonary embolism. The massage treatment amplified this risk. It’s pretty much the last thing you should do for a DVT.
Due to mindlessness, I was especially vulnerable to death, injury, and disappointment. My lack of mindfulness — not zooming my attention out to the right magnification and integrating the available information put me at risk. Now, it required mindfulness to recover my emotional balance moving forward.
Equanimity is an evenness of mind in the midst of adversity, disappointment, and loss. Here was the reality of my situation presenting itself in unambiguous terms. There was no time to get the medicines I needed, go home and pack, and drive the four hours I needed to drive to get to the workshop. I had a choice. I could continue castigating myself, or I could accept what was happening and re-engage my efforts to live mindfully in the next moment. I decided to release myself into the present moment and I had a relaxing drive down, listening to David Whyte CDs along the way.
Moving forward, I took my medicines and accepted the limits the DVT imposed. By turning toward the experiences of frustration disappointment, and loss, I was able to restore happiness in the moment.
There’s a humorous postscript to this story that occurred while I was on a silent meditation retreat.
Soon after I was diagnosed with the DVT, I went on meditation retreat at the Insight Meditation Society (IMS) in Barre, Massachusetts and I was doing walking meditation in the basement. There is an old, out-of-service, single lane candlepin bowling alley there that is a nice tract for practice.
About halfway down the lane the ceiling drops a couple of feet and for someone my height, you need to turn around at that point or duck. During one of my cycles of back forth perambulation, I forgot to turn around because I was nursing some story in my mind. Bam. My forehead slams into the crease of the lowered ceiling. That was a wake-up call. Welcome to this moment!
At first, I didn’t think twice about it, but then later remembered the blood-thinning medicine and wondered whether this was a sufficient impact to cause a cerebral hemorrhage. The catch-22 I confronted was that this incident occurred in the context of a silent retreat. I could certainly break the silence for an emergency but did this qualify?
I decided to proceed empirically — paying careful and objective attention to my body — looking for any changes in my vision, balance, or the way I felt. If my brain were bleeding, there would certainly be signs. I continued to meditate in silence and no changes were noted.
From time to time, my mind would take hold of this uncertainty and blow it up. “What if my brain is bleeding but slowly? Maybe I’ll wake up dead?” As practice dictates, I returned my attention from each of these fantasy excursions to the reality of the moment that gave every indication that I was fine. And, indeed, I was fine. I would have had to hit my head much, much harder to cause the damage that I feared.
We spend much of our lives moving into and out of mindfulness. Indeed, each time we practice, that rhythm will be obvious. We are mindfully with breathing and then mindlessness caught up in a story. Awareness asserts itself and mindfulness is re-established. And thus the process goes.
In my teaching and writing, I try to emphasize this back and forth nature of attention because it helps us to escape from the tyrannical assumption that our attention should always be affixed wherever we want it to be. The life-changing value in mindfulness practices comes from training our attention to catch itself and return. It is not reasonable to expect that attention will always sit still. Our job is to bring it back each time it moves away, which will likely be a lot!
Arnie Kozak, Ph.D. is a clinical assistant professor in psychiatry at the University of Vermont College of Medicine and author of many books, including, “Wild Chickens and Petty Tyrants: 108 Metaphors for Mindfulness,” “Mindfulness A-Z: 108 Insights for Awakening Now,” and “The Everything Guide to the Introvert Edge.” He teaches workshops at the Barre Center for Buddhist Studies and the Kripalu Center for Yoga and Health, and will be offering Solitude and the Virtuous Life at Copper Beech Institute February 24–26, 2017.