SGO Wellness: Yoga Therapy for the Oncologist: A Personalized Approach to Reducing Burnout and Compassion Fatigue | Lois Ramondetta, MD

Lois Ramondetta, MD

Keishas and Svadhaya

In my 26 years as a gynecologic oncologist, I can now reflect-with a healthy degree of separation-on a mid-career crisis I experienced approximately 3 years before my 50th birthday. The pressures of working in an academic medical center, the daily interactions with patients facing the end-of-life, difficult surgeries and treatment decisions can be taxing and lead to shortened reaction time, compassion fatigue, as well as a compromised sense of self-worth outside of resume-defined ego. During this period, I experienced many of these symptoms.

Often focused on achievement, more so than the journey, I had a tendency to ruminate on never doing enough, never good enough, needing to accomplish more academically and even nighttime rumination about the surgeries I did earlier in the day. The EOL discussions also sat heavy on my heart and required a decided personal separation in order to walk in refreshed for the next patient in need of my attention.

The spiritual aspect of self-care and the care I provided for my patients was lacking during early years of training. I medically cared for patients and yet I had no access to the fountain that was not made by the hands of man* to replenish me. In 1999, one woman in particular, Deb Sills – a world religion professor – was a bright light in the darkness. Actually living fully with ovarian cancer, now “her Dharma,” her “way of going” as she called it, reignited my interest in exploration of the philosophy of life and living in the midst of cancer treatment. Together we studied, did yoga, and wrote and published about spirituality in medicine.

For years, I had been enjoying regular yoga classes – yet, yoga was still primarily a physical practice. In 2015, I participated in a 40-day yoga program designed by Baron Baptiste. Weeks 1, 2, and 3 were titled Presence, Vitality, and Equanimity and weeks 4, 5, and 6 were titled Restoration, Centering, and Triumph. The program required daily meditation, healthy eating, yoga, and journaling. This “immersion program” re-emphasized that grounding and replenishing “the fountain” of resilience is not a diet, but a minute-to-minute lifestyle focus. Of course, this modern program finds its core in the basics of yogic philosophy even if it doesn’t use Sanskrit terms.

Around my 50th birthday, I was asked to make a shift in the primary location of my clinical practice. This change from “known to unknown,” although unnerving, offered opportunity. Yet, I was keenly aware that my “ways of being,” laden with goals, self-criticism, and ego were easy to revert to when challenged. I was also beginning to learn that being a yogi was much more than accomplishing poses. Using my mat as the training ground, I was learning to manipulate my sympathetic and parasympathetic systems. Over the next few years, I engaged in Svadhaya by enrolling in yoga teacher training programs and finally a 3-year yoga therapist training. Through these efforts, I continued my self-study, asana practice, and meditation and surrounded myself with others who were also “doing the work.” Importantly, the training emphasized the concept of Choice as an everyday opportunity, specifically the choice on how I respond to difficult situations and the choice to take a treasured pause before responding. Not to say I didn’t and don’t still fall off the so-called wagon (sometimes even daily), but I am quicker to recognize when I do and quicker to try to remedy situations caused by wrong personal response choices. My physical practice remains the key to my peace. I have also learned how to become more meditative within an asana, my favorites of which are trikonasana and tadasana. The degree and variety of subtle movement and redirection of prana while in these two poses have allowed the asanas to be sanctuaries of stillness and presence.

Yoga Therapy, Medical Training, and The Light Within…

I can’t say that my medical training and questioning mind hasn’t caused me to challenge quite a bit of what I have been taught in yoga training and yet certain aspects of my experience have been easy to “understand” innately. It seems wholly obvious to me that western medicine is excellent at healing acute trauma from the neck down and not impressively successful at healing from the neck up. Medical science has made huge strides to understand and heal the intricacies of the human body – and for this and my training I am forever grateful. That said, none of us get out of here alive and unhappiness and/or lack of contentment is extremely prevalent especially as the end of physicality draws nearer. Yoga as an ancient therapy and science reminds me that it is the mindful movement, controlled awareness of breath and focused concentration that can not only prevent illness but also reduce physical suffering and, more importantly, heal the mind. Through reading of sutras, yogic philosophy, and surrounding myself with others doing the same work, I can clear the smoke screen around my own inner light and become more loving and accepting of myself as a contented “healer” rather than a rajasic “achiever.” Yoga therapy has brought me out of a period of burnout and has made me a better oncologist, colleague, and family member.

Lois Ramondetta, MD, 500 RYT, C-IAYT (Self-Proclaimed-Wannabe Yogi), is a Gynecologic Oncologist at UT MD Anderson Cancer Center in Houston, TX.

*Lyrics from Ripple- Garcia /Hunter

Sanskrit Terms

Keishas = causes of suffering (ignorance, ego, attraction, aversion, clinging to life)

Svadhaya = the process of self-reflection and self study

Trikonasana = triangle pose

Tadasana = standing/mountain pose

Asana = the physical poses of yoga

Rajasic = a fiery/passionate energy form

References

Ramondetta LM, Sills D. Spirituality and religion in the “art of dying.” J Clin Oncol. 2003;21(23):4460-2.

Ramondetta LM, Sills D. Spirituality in gynecological oncology: a review.

IJGC. 2004;14:183-201.

Ramondetta LM, Sills D. The light within: The extraordinary friendship of a doctor and patient brought together by cancer. New York, NY: William Morrow; 2008.