Mind over cancer

Michelle Gossett has ovarian cancer that has metastasized to her liver, colon, bladder and uterus. She had just had a punishing chemotherapy treatment that will make her feel intensely ill in a day or so. But on this night she is participating in a session on mindful meditation, one in a series of eight led by Michael Baime, a physician who has just been named director of mind-body medicine at the Abramson Cancer Center of the University of Pennsylvania.

Gossett says these sessions have been "life changing," and that she no longer "catastrophizes" about her future. "My whole focus used to be on cancer so that I became my cancer," she says. "Now I realize I have the power within me to live and enjoy life."

She is one of 11 cancer patients who, once a week, have sat in a circle in a second floor room of the university's Ralston House. Some like Gossett are in the midst of treatment; others have completed it recently or as long as five years ago.

Their two-hour gathering on this recent Sunday night begins with the sweet sound of the tingshas, a set of two Tibetan bronze cymbals that Baime strikes, signaling that it is time for his patients to close their eyes and open their minds to meditation.

His goal is to teach them how to concentrate on the here and now, on this moment, dismissing the past which cannot be changed and snuffing out thoughts of the future which is uncertain.

He does it by suggesting, in a velvet voice, that they gather their attention around their breathing. When thoughts and sensations intrude, as they inevitably will, he directs that they "let them be," but urges that they refocus on their breath.

As students advance, he may ask that they focus on a sound or smell or a beautiful flower. "Eventually they learn the ability to be in complicated situations while maintaining the simplicity of present moment attention," Baime says.

In ten minutes, when the tingshas sound again, those in the circle open their eyes. Some blot their tears on a tissue and begin to speak softly about what they are thinking.

This is the first formal group of cancer patients led by Baime, a doctor of internal medicine. Since 2002, he has been been director of the Penn Program for Stress Management, an arm of the University of Pennsylvania Health System that has taught 5,000 people how to meditate.

Baime is a Buddhist and believes that meditation is compatible with any religion or no religion at all. He is convinced that everyone - not just cancer patients - can benefit from his teachings. Baime has worked with police officers, heart patients, teachers, public school students, hospital employees, accountants, and adults with attention deficit hyperactivity disorder. In February, he will be leading a national conference for educators in Philadelphia.

But meditation is exquisitely suited to those fighting cancer because of the severity of their treatments and the agonizing mystery about what lies ahead for them.

"They are willing to take a chance on living fully now because they realize how precious life is," he says. "They want to experience the beauty of their lives."

"It doesn't just give them a couple of helping techniques," he continues. "It gives them a fresh start and adds a different dimension to their lives. The change in eight weeks is startling."

Baime, who meditates daily, may be his own best example. In 2002, he was diagnosed with a rare condition - central serous retinopathy - that has robbed him of the central vision in his right eye. He was only moderately concerned as long as his left eye functioned normally.

But three years ago, he developed the same condition in his left eye. "I began not recognizing faces, and I couldn't do physical exams because I couldn't see what was happening in my patients' eyes or throats or ears," he remembers. "It was devastating. Meditation kept me from losing my mind."

Baime was lucky. He entered a clinical trial to have his eye injected with the drug Lucentis, often used with patients who have macular degeneration. It seemed to work. His vision, which had deteriorated so much that he could not read a newspaper, was back to 20/30. But the improvement lasted only four months.

"It was heartbreaking," he remembers. "A lot of my identity was in the role of being an internal medicine doctor, and I knew I'd have to give up my practice."

Another experimental treatment - photodynamic therapy - suggested by his doctor as a last resort, produced almost miraculous results. Sight in Baime's left eye was largely restored. Still, he can't see well enough to return to his practice right now, and he lives in the same kind of uncertainty as many of his patients.

His doctor has predicted " 'three good years' and then he doesn't know," Baime says. "So I have this window, a few years to make a difference in the world, to get this [mindful meditation] program into government, education, corporations, to make it a routine part of training for professionals.

"I don't know how people live in 2008 without something, some form of discipline to help them feel whole and balanced," he says. "We have made a decision as a culture to sacrifice quality of life for what we do and what we can consume. The time urgency, the unmet demands, the frustration of not being able to fulfill our deeper hopes, the lack of time to feel, to cultivate friendships, the loss of community all create unbearable tension. It's in our bodies so we can't sleep at night. It's in our hearts so we feel alienated even from ourselves, from our deeper nature. It's not just common, it's endemic."

Baime believes he was born to meditate. He has been doing it, in a way, since he was 6. Without understanding what was happening to him, he remembers experiences of a deep, profound peace that would come over him suddenly, inexplicably. He could bring on that feeling by walking at a certain pace or counting slowly or just looking up at a slice of sky.

"I spent my whole childhood trying to make that happen," he says. "I didn't think it was anything special. I thought it was what everybody was doing."

As he approached puberty, the ability to re-create those peaceful interludes eluded him. But for his 14th birthday, his parents gave him meditation instruction. In his twenties, he met Chogyam Trungpa, his lifelong teacher, who changed his life forever. He has been meditating ever since, training in Tibetan Buddhism and authorized as a teacher in 1983.

Ron Krasnick, an orthopedic surgeon in Burlington, N.J., who suffered from prostate cancer, became one of Baime's students. "I came to manage stress," he says, "but I didn't expect to learn to appreciate life. If I never had cancer, it would have never happened. I would still be worrying about things that don't matter, and not seeing what does."

Since the early 1990s, the view of meditation among physicians has meandered from skepticism to appreciation. Along with other alternative therapies, it has found its way into traditional medical schools; it is an elective course for medical students at the University of Pennsylvania. And it is impossible for even the most orthodox of practitioners to ignore the compelling results of studies using neuroscientific measures - functional brain scans and meticulously designed survey tools - which reveal heightened activity in the brain and the increased blood flow that results.

For instance, an ongoing study of 47 health care providers who completed Baime's meditation program reveals that they experienced a 45 percent reduction in anxiety; a 37 percent reduction in depression; a 52 percent reduction in fatigue and a whopping 64 percent reduction in anger. "Imagine what an incredible difference that can make in any workplace!" Baime muses.

The remarkable, yet unpublished, results of eight weeks of meditation training with a class of 33 professional and graduate students demonstrated stunning improvement in short-term memory, the ability to hold many things in memory at one time, and in their resistance to distraction.

"Stress taxes short-term memory," Baime says. "That's why under stress people tend to do things like forget their keys and lock themselves out of the house. It is astonishing that after meditation training, short-term memory does not deteriorate under pressure."

A startling scenario unfolded in 2003 at Penn's Scheie Eye Institute where most of the staff took a 16-hour course in mindful meditation. Patients said they noticed more sensitivity and compassion from their doctors, even though no physician had taken Baime's course.

"Something had happened in that institution," Baime says. "Everyone seemed more cheerful. The employees were less stressed and more helpful to doctors who, in turn, became less stressed themselves. And patients could feel it."

Michelle Gossett feels as though she owes her life to Baime. "Not only do I use mindfulness to deal with pain," she says, "but my definition of happiness has changed. It used to be that the carrot was what motivated me, the prospect of achieving and making more money. I was driving on autopilot and not present in conversations I was having with others.

"Now it has become so simple. I learned how to meditate for 40 minutes every day and went from being agitated over my diagnosis to having the tools to make me stop, breathe, let things be and be mindful of everything going on around me."

Gossett is writing a series of letters to her 20-year-old daughter, Natalie, a student at Columbia University and a jazz dancer, to be read on special days in her life.

Her scrapbook includes a letter in progress for Natalie's wedding day. It reads: "My daughter, my angel, my sweet, my lovely vision in white.

"I hope that I'm sitting beside you as you read this. . . . If not, I hope you feel my presence and my love that will surround you. . . . Envision yourself with your strength and beauty within the depth of your soul, sharing this life with your soul mate. I wish you joy. I hope you always dance."

These are meditation programs in the area:

Penn Program for Stress Management, University of Pennsylvania, 215-615-2774, www.pennhealth.com/stress

Jefferson University Hospitals, Jefferson-Myrna Brind Center of Integrative Medicine, 215-955-1376, www.jeffersonhospital.org/cim/ article5030.html#eightweek

Philadelphia Shambhala Meditation Center,

2030 Sansom St., 215-568-6070, Philadelphia.shambhala.org

Clear Light Meditation Group, 610-293-9133, office@clearlightmeditation.org, www.clearlightmeditation.org

The Mindfulness Series: Mindfulness and Learning, weekend conference sponsored by Penn Program for Stress Management. Keynote speaker: Jon Kabat-Zinn, Feb. 6-8, 2009, 215-615-2775. https://mindfulness.

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