As much as Christopher’s teachings about the Opposite and about Presence made sense, reinforced each other, and enriched my life, I continued to have trouble applying his views on the nature of time. He’d stated, in no uncertain terms, that time as we know it—chronological time—is an illusion. In reality, he taught, there is only one moment—God’s moment—and it contains all time.
I’d encountered this concept before, but I always had a hard time wrapping my head around it. Mystics East and West, grappling with the nature of time, talk about the Eternal Present: God exists outside time. A pretty abstract concept, I thought, because people exist within time. We live our lives within time and the chronology of our lives describes how we change, how we grow.
My favorite course in college was devoted to the bildungsroman, a German word meaning “a novel of education.” The bildungsroman is by definition the story of a young person growing into adulthood and learning to understand the world. The best-known English examples were written by Charles Dickens: David Copperfield and Great Expectations. The bildungsroman is by nature a chronology of personal growth. There was one that baffled me by suddenly abandoning time and presenting a vision in which all things happen at once: Siddhartha, by the German novelist Hermann Hesse, first published in 1922.
For most of its length, Siddhartha tells its story like every other bildungsroman. The protagonist, whose Sanskrit name means “he who has found what he searched for,” makes many mistakes, learns from them, struggles with loss, and uses his misadventures to develop special skills that enable him to overcome obstacles. Then suddenly, toward the end of the book, for no reason that I could discern, he has a revolutionary vision of the world and his own evolution in it. He sees that time is an illusion and everything happens all at once, even the process of reincarnation. In this vision, every previous incarnation of his soul and every moment of his present life are occurring simultaneously. There is no progression, just one great, jubilant moment. Modern psychologists call this state of mind “simultaneous awareness.” Frankly, I just didn’t buy it, but Siddhartha’s vision was so much like Christopher’s revelation that I decided to revisit Hesse’s novel.
I was amazed at what I found. After his revolutionary vision, Siddhartha spends his final years as a ferryman and becomes known as a wise man. The wisdom he imparts is that everything contains its opposite within it and that for every true statement, there is an opposite statement that is also true. Two of Christopher’s gifts paired in the same novella!
I decided to take a closer look at simultaneous awareness. In order to really grasp its impact, I had to start by examining its opposite, which lies at the core of my understanding of the world. It’s called “sequential awareness.”
We live in a world that’s constantly changing. Change occurs as a function of time. Time that passes—chronological time—keeps moving forward, like an arrow. Living in chronological time, we experience life as a sequence of events. An idea like cause and effect depends upon awareness of the sequence. Sequential awareness is required for analytical thinking. It forms the backbone of science, medicine, law, and language. It’s essential for analysis, reasoning, planning, and experimentation. As a doctor taking a medical history, I attempt to unravel the chronology of my patient’s illness, the order of events, in order to obtain a clear understanding of the nature of her problems.
My commitment to the arrow of time connects me with who I am. I’ve always believed in the possibilities of progress. Things can get better. I can help to make them better. I myself can get better. Finding ways to make things better has always felt like the path I was to follow. Improvements don’t have to occur on a large scale. They don’t even need to be observed by anyone but me. But their absence creates stagnation, which is something I abhor.
The steps I’ve taken to change the practice of medicine start with instilling and enhancing sequential awareness in those I teach. My main argument with conventional medicine is that it has strayed from its commitment to sequential thinking, because it’s come to rely on static concepts of disease.
As I’ve explained in books, articles, and lectures over the past 30 years, in the conventional medical worldview, people get sick because they contract diseases. Each disease can be understood as its own entity and can be described without regard to the individual person who is sick. The treatment that follows, therefore, is the treatment of the disease, not the person. This notion has become so ossified that every ailment must be described by a code number (the ICD—International Classification of Diseases). Every consultation, examination, and treatment has a code number as well (CPT or Current Procedural Terminology). If the ICD and CPT numbers don’t line up, insurance won’t cover the expenses and the doctor is susceptible to punitive action. Almost everything that’s wrong with medical practice today, from depersonalization of care to excessive reliance on testing, can be traced to this disease model of illness.
For most of my medical career, I’ve tried to find means through which science could support, rather than suppress, an individualized approach to health, which recognizes that each person’s illness is a unique and dynamic process. In The Four Pillars of Healing, I described a solution called Person-Centered Diagnosis. It relies on a narrative approach to understanding illness by recognizing the Antecedents, Triggers, and Mediators of disease as they impact each individual patient. In Four Pillars, I illustrated its application in detail, with story after story of real people I’d treated.
Person-Centered Diagnosis requires a thorough commitment to sequential thinking: this event happened to this person, and as a result, these next things occurred, which led to that treatment, which had those effects. Knowing what the person was like before the initial event is of crucial importance. With a new patient, I’ll sometimes spend half an hour forming a picture of what that person’s health was like before getting sick, trying to answer the question Who was the person in whom this illness occurred? Although the data gathered are comprehensive and holistic, the mode of thinking—the awareness of events and their connections—is intrinsically sequential and highly dependent upon the clock and the calendar. It’s worked so well for so many people that I would never consider moving beyond it.
Christopher had no use for sequential awareness. It was completely irrelevant to the way he lived his life. Christopher’s innate mental state seemed to depend on simultaneous awareness, the recognition of multiple events impinging on one another at the same time. Dick Apell at the Gesell Institute reached that conclusion when evaluating Christopher’s visual processing. At the time, I didn’t understand its significance. Apell found that Christopher’s visual world consisted of multiple, sometimes unrelated, images converging on his brain at once. Maybe this was not a disability or even an accident. Maybe it was the expression of the way in which Chris understood the world. Living this way, I thought, it would be natural for Chris to dismiss sequential thinking as illusory. To someone like me, so deeply enmeshed in sequential awareness, so strongly wedded to the arrow of time, Christopher’s mental state seemed like chaos and confusion. Which of us was right?
Psychologists who have studied simultaneous awareness never dismiss it lightly. They see in it an instantaneous processing of so many different inputs that the rational executive function of the brain can’t possibly sort it all out. They’ve concluded that simultaneous awareness expresses itself as intuitive thinking. It’s the origin of intuition. Intuition is based on simultaneous awareness in the same way that analytical thinking is based on sequential awareness.
According to neuropsychologists, intuition requires a perception of “the whole picture,” or the total problem, by seeing all its parts at once. Its conclusions may be right or they may be wrong, but the process is instantaneous. Intuition, like Presence, cannot be willed or planned, because there’s too much going on at the same moment for the executive functioning of the brain to guide it. I’d never thought of Christopher as being intuitive, but his uncanny ability to instantly sense each person’s beliefs about themselves fit the description of intuitive understanding based on simultaneous awareness. Living that way, he’d be perfectly at home in God’s moment. I wasn’t.
Because Christopher had directed me to follow his lead, I thought I should explore episodes of simultaneous awareness that had been meaningful in my life. I don’t generally rely on intuitive thinking, but there have been times when intuition dramatically forced itself on me.
Three months into my internship at Bellevue Hospital, I was called to see a new admission at two in the morning. I’ll call her Maria. I quickly reviewed the note written by the physician in the emergency room, who had sent her up to my ward: “26-year-old Cuban-born female with fever, malaise, and fatigue of 48-hours duration. Temperature 101, pulse 96, blood pressure 90/60, grade 2 systolic heart murmur.” All other findings were normal, but the ER resident admitted her anyway, with the unconvincing diagnosis of “R/O SBE,” which stands for “rule out sub-acute bacterial endocarditis,” an infection of a heart valve that was highly unlikely but impossible to rule out on the spot. From his note, I could see no reason why she couldn’t have waited till morning to be admitted.
Then I looked at Maria. She lay on a stretcher moaning softly, her skin mottled like marble—a condition called livedo reticularis, which I had never seen before. I’d only read about it in textbooks, and I had no idea what its significance was. Despite my inexperience, I was suddenly sure that this woman was deathly ill and needed to be in the intensive care unit, even if the admitting diagnosis and details of her physical exam did not seem to warrant an ICU admission. So, without delay or further reflection, I grabbed the head of her stretcher and pushed Maria by myself straight to the ICU, where she promptly lost consciousness, went into shock, and almost died. Within 12 hours, the lab tests revealed that she had a severe bacterial infection in her bloodstream, far more catastrophic than SBE, but readily cured with the right antibiotics.
Had I delayed her transport by a few minutes to analyze her condition and formulate a plan, her blood pressure would have crashed while she was still on the medical ward, a place with so little staff and supplies during the night shift that I could not have brought her back before irreparable damage was done to vital organs. Had I been asked to justify my decision to move her immediately to the ICU, I could only have said, “I felt that’s what was needed.” It was only the force of intuition—my instantaneous, unreasoned response to what I saw in front of me, and related thoughts that I could barely identify—that led me to the right decision. At the moment her moaning stopped and her blood pressure fell to zero, she had been moved to the only place in the hospital where she could immediately receive the treatment she needed to keep her alive.
Maria’s survival was an unusual triumph and the subject of much discussion and acclaim at Bellevue. Once the discussion ended, I rarely thought about the decision that had saved her life. I just accepted it. Quick reflexes. We were both lucky. After Christopher’s revelations over 20 years later, I reviewed her case for inclusion in The Four Pillars of Healing. I realized that the decision had been intuitive, not exactly automatic but beyond my conscious control. It was not based on knowledge or experience—I had so little then. I couldn’t even track all the factors that led to my actions. They included her glazed expression, her strangely mottled appearance, her soft moaning, the darkness of the medical ward, its loneliness, my recognition of my own inexperience, and my need at that moment for the support of a team. An intuitive decision had saved her life.
The power of simultaneous awareness was undeniable, but there was nothing in my saving of Maria or in Christopher’s uncanny ability to look into the souls of other people that defied the arrow of time. They both fit comfortably within chronological time. If each intuition, each episode of simultaneous awareness, is like a jewel, they’d be embedded in the arrow. They wouldn’t replace it. My arrow would be hard as steel, with occasional jewels as decorations. Christopher’s arrow would be made entirely of jewels strung together. And God’s moment would be just a metaphor, not a description of a deeper reality.
Then, one summer afternoon, the most harrowing experience of my life crushed the arrow of time. I’d been swimming in heavy surf off Cape Cod for over two hours. Although I was very tired, every time a wave brought me to shore, I’d feel so exhilarated that I’d turn around, dive over the next one, and swim out again.
I’ve been bodysurfing as long as I can remember. As kids, we used to call it “riding the breakers.” As I got older, I added equipment like fins, a bodyboard, and a wet suit. On this particular day, I had no plans to swim, so I had no equipment. I’d taken a long run in the morning and was just planning on relaxing and doing some reading. But the waves reached higher than I’d seen in years and I couldn’t resist their lure. As lunchtime approached, I thought of taking one last ride to shore, but noticed that I had actually drifted quite far out. I was about 100 yards from the beach. I didn’t worry because there were several other swimmers around me. I failed to notice that they were all about 18 years old. All of a sudden, I noticed that I was alone and farther out. The swells were so high I could barely see the shoreline. I was being pulled out by a strong rip current. I tried swimming parallel to shore, in order to escape the rip. The unthinkable happened. I couldn’t move my arms. Paralyzing muscle fatigue set in.
This is really dangerous! I thought. My first instinct was to signal for help, but I knew that if I acted as if I were in trouble, I would panic and drown. My only hope of survival was to stay absolutely calm and tell myself that there was no problem at all, that I could just float out here for a while and appreciate the blueness of the sky and the greenness of the water. I needed my mind to control my brain.
Scientists like Sir Francis Crick believe that the brain creates the mind. There is no separate mind; it’s just a derivative of the activity of networks of nerve cells. At that moment, I knew beyond a doubt that brain and mind were separate. My brain wanted me to call for help, but my mind told me the opposite. I knew that my mind had to be in charge or I would die.
The problem with simply floating in the North Atlantic is the coldness of the water. No longer working my muscles hard, I was beginning to lose heat. I could feel muscles tighten and my temperature drop. I couldn’t continue this for very long. The situation was not improving, and the thought that I was soon going to drown entered my head. For some reason, I didn’t feel connected to that thought. I couldn’t argue against it. It just seemed strange. With a jolt, I remembered that Christina and Jordan were on the beach. He’d be playing ball on the sand and she’d be watching him with one eye and the surf with the other.
My detachment evaporated. I couldn’t allow myself to drown out here while they watched from the shore. That would be terrible for them. It would scar them for the rest of their lives. I felt anxiety rising, cut short by a sudden, remarkable shift in awareness.
“I don’t drown out here today,” my mind told me. “This is not my time to die.” Peace and joy replaced anxiety and fear. I focused my mind on the love I have for my family and thought of nothing else. In a short time, I could feel the surf around me. I was out of the rip and inside the breakers and knew I was safe.
There was nothing supernatural about my survival. The rip current had behaved as rips usually do: sucked me out to sea and released me, so that incoming waves could carry me to shore. I lived because I didn’t fight it. That was not remarkable. My clarity of mind, my certainty that this was not how I die—that’s what was remarkable. Facing extreme peril and driven by deep love, my mind had switched gears, shifting from my usual sequential mode of awareness to a simultaneous mode that allowed me to see my whole life at once, if only for an instant. This moment of awareness was not just a jewel embedded in the arrow of time. It surrounded the arrow.
I realized that my life with Christopher, before and after his death, had always been a dialogue that pitted his way of seeing the world against mine. When I explained that to Christina, she laughed and said, “He won!”