James G Beckerman, M.D.  
Portland, OR

Specialties: Cardiology

Interests: Weight Loss, lifestyle changes, healthy diet
Author of The Flex Diet (January 2011)
Providence Heart and Vascular Institute
(503) 216-0900
Portland, OR
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Zen and the Heart of Medical Maintenance

Jul 24, 2009 - 13 comments

Between college and medical school, I spent a year living in Spain.  It was one of those “discovery” years you now only dream of, a delicate balance of academics and culture, with an appropriate complement of red wine.  It was Spain, you know.  In the midst of it all, I found myself with a lot of time on my hands, and spent much of it reading – reading about other people’s journeys and the paths they took during their own formative years.  There were the classics like On the Road, Siddhartha, and even Catcher in the Rye – but what impacted me the most were Zen and the Art of Motorcycle Maintenance and its sequel Lila, both by Robert Pirsig.

Part novel, part philosophy text, and partly meandering, Zen and Lila take the reader on an intellectual journey through morality, purpose, and of course, motorcycles.  One concept that has stuck with me after fifteen years is an idea stated in the conclusion of Lila: “Good is a verb.”

The first time you read that sentence, something doesn’t feel right.  We typically think of “good” as an adjective to describe our core values.  It may define who we are or who we’re not.  It’s a group we want to belong to, and sometimes exclude our enemies from.  But using “good” as a passive descriptor takes something out of the equation - choice.  By thinking about goodness as a verb, as an action, our choices can change who we are and where we belong.  Good is a process.  Good is a journey.

So after spending a year trying to find myself, I ultimately found myself in medical school and specialty training, spending a lot of time with people who are often categorized by a different system – wellness and disease.  Doctors, patients, and insurers judge themselves and others by this simple metric all too frequently.  And we all know that illness places us in a less desirable grouping, populated by symptoms, hospital stays, and medications.  Having an illness shifts us away from the happy-go-lucky and pushes us toward the somber.  Nobody wants to be ill.  And nobody wants to be part of the group of people who experience illness.

But I’ve learned that this way of thinking about health and disease, or wellness and illness, is an oversimplification – because it implies that our health status defines who we are, and takes away the element of choice.  Obviously, no one chooses to be sick.  Genetics and environment conspire to create illness even in those with the best of intentions.  But we can’t ignore the impact of the lifestyle choices we make every day on our health, whether positive or negative.  Sure, there’s genetics and bad luck, but there’s also the saltshaker on the table.  There’s the extra slice of chocolate cake on the plate.  There’s the cigarette in your hand.

The choices my patients make and the ways in which they approach their own health have shown me that an eighty-year-old recovering from heart surgery can sometimes be my healthiest patient, whereas a twenty-four-old on no medications can be my sickest.  Wellness is partially about choice.  Wellness is sometimes about change.  

Wellness is...a verb.  So do well, and share your challenges and successes with us!

For more observations join me at www.twitter.com/jamesbeckerman - thanks!  This blog entry also appears on the website www.healthin30.com - a great blog maintained by Barbara Ficarra, RN, BSN, MPA, the host and executive producer of the Health in 30® Radio Show.  Enjoy!

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by sarah117, Jul 24, 2009
I just joined this site and enjoyed reading your journal entry. It is so true how all of us want to be associated with all the good thing. However i find that everyones defenition of  this word "good" is different. Some even believe that there is no good and bad. both are the same entity. I could relate to what you wrote however i still don't know how to define this word good. what is good?

Avatar universal
by heartca, Jul 25, 2009
Just a quick note to say hi!..i know it sound strange cos so many questions but no real answers so maybe you could be pro-active and try alternative methods like meditation..get some dvds or books from the library and learn yourself..good luck..
PS.If you really read Siddhartha well then,you would fully understand what is happening to you and rest of mankind...Hesse expresses it so well

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by Barb135, Jul 25, 2009
That's an excellent journal entry.  Being in the group of those with an illness, I can certainly agree that it's an undesirable place to be.  

I was a smoker for many years and a couple of years ago, I quit - that was probably the best thing I ever did for myself; however, prior to quitting smoking I had begun gaining weight at an alarming rate and nothing I did seemed to budge even an ounce.  At first my doctor thought the weight gain was due merely to quitting smoking; however, I was sure it was NOT that since it started BEFORE I quit.  At the same time, I was extremely tired all the time, but then it seems like I've been tired for a good share of my life.  Anyway, I managed to pick up over 30 pounds in a matter of about 3-4 months and I've never had a weight problem before.  

After another year of feeling tired and gaining even more weight, along with a whole shopping list of other symptoms, my doctor finally checked my thyroid and ....bingo, we have the problem.  That was a little over a year ago and today, I struggle with the weight issue just as much as I did before the diagnosis.  I exchanged the possible repercussions of smoking for being overweight.  I chose to quit smoking, but I don't choose to be overweight.  I can't say that every single choice I make is the very best, but I most certainly make the effort.

I rarely use the salt shaker on the table, I can't tell you the last time I ate a slice of chocolate cake and there's no longer the cigarette in my hand.  I eat my fruits and veggies, I get my exercise every day and still my "good" choices don't seem to be enough to budge off the weight.  I'm constantly looking for things I can change and keep praying that one of those changes is going to make a difference - that one day I will have made enough changes to experience wellness, in spite of a disease that will never go away.  

That's my challenge - I wish I could claim success.  

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by Lulu54, Jul 25, 2009
So often in the forums someone will write  "I have heart disease, it doesn't have me," or " I have MS, it does't have me."  On paper it sounds good, but in practice it is so much more difficult a mindset to achieve.

Both of those diseases are part of my daily existence and impact my awareness on multiple levels. Finding balance with the rest of who I am is a constant struggle that takes hard work but is worth the effort.  

Thanks for reminding us that the things we can control should stay in sight as a target rather than letting the uncontrollable variables take over our lives.  

be well, do good.
MS Forum co-cl

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by joanincarolina, Jul 26, 2009
I love part of your title 'medical maintenance'; you did an excellent job of placing your readers where they think they are, and where they can or should be. Then you accurately placed a reader like me that are in the category of having NOT brought on their 'medical maintenance' by any design. Genetics just places us in the category of "It is what it is'. I would like to share my story with you and others here at 'joanincarolina' so others can learn from my medical maintenance journey. Thanks for a good essay! Joan in Carolina.  

Avatar universal
by ptadvoc8, Jul 26, 2009
Having just spent several months working my way through Jon Kabat-Zinn's book, Full Catastrophe Living, in order to come to terms with the specific challenges of my own "genetics" and move ahead with my life by actually seeking some medical care (rather than avoiding it completely out of fear and mistrust!), I can't tell you how refreshing -- and reassuring -- your journal entry is to me. Thanks for sharing your special perspective!

Avatar universal
by distrustful, Jul 26, 2009
I have tired of the medics and their philosophies of patients.  This is an interesting view-point writing and doesn't change my tiredness.  I have dealt with the silliest circumstances with nothing life threatening, and I believe by the time I age and decline enough to be in that category, I will be so worn of it all I will choose death over medics and their medicines.  Maybe God heals best through His "GOOD"ness.

Avatar universal
by Jaquta, Jul 28, 2009
And red wine has medicinal properties.

Perhaps 'good' is a short hand way of applying process (or more specifically, is the end product of that process).  
Good is a judgment.

Wellness and disease are just more examples of good and bad.  They are both subjective and objective judgments.

Illness has a way of showing us who we our.  It can highlight both our strengths and weaknesses (again good or bad).  I suppose illness (and badness is also a process, a journey.)

Health status does define who we are, doesn't it?  Health issues can place limitations on us (and at times, on our ability to choose).
I guess if you are speaking generally then yes, lifestyle can significantly impact on our lives.  Lifestyle for the majority of us probably does defines our health status.

I was just musing over this.  I found it thought provoking.

Ultimately we do all try to strive towards something better, healthier, etc.  Sometimes it is good to reflect on that process and to congratulate ourselves on our progress and achievements.  Life is a journey and one to be enjoyed.


Avatar universal
by Mavieboy, Jul 28, 2009
Love your journal entries.  Please keep writing them!!!

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by James G Beckerman, M.D.Blank, Jul 29, 2009
I want to thank everyone for your thoughtful comments!!!  Your participation in the forum is what makes MedHelp so great.

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by Fatpig, Jul 30, 2009
Wow. Very inspirational. Thank you for this journal entry and your unique perspective. I'll have to keep in mind to do "well" in not only my health, but in all fields of my life.

Avatar universal
by Jaquta, Jul 31, 2009
Dear Dr Beckerman,

I was wondering if you would consider putting some of the links to the medical articles on your twitter page somewhere on this forum so that people can access them here.  I hope I haven't insulted you by asking you that.  I did check out your twitter page briefly but felt I was intruding on your space (and didn't understand why people would follow me because I followed you just one time).

Human behavior (like for example, why you changed your photo) intrigues me but following you on twitter feels like stalking and just feels so intrusive.  (Possibly because I am an extremely private person??)
Is twitter an opportunity to let members get to know you a little more?  I don't understand its role.


Avatar universal
by missy240, Aug 09, 2009
I would like to know if your single.because I would like to have a date with you.you may email me at [email protected] let me know either way.thank you and have a great day.Melissa

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