Dr. Thimmapuram: He wants you to lengthen your telomeres

Jayaram Thimmapuram, M.D.

Let me tell you a story. We are somewhere in the south of India. The man sits perfectly still and erect with his eyes softly closed. He seems to be doing nothing. His son Jayaram thinks he looks silly. But as he watches his father do the same thing day after day Jay becomes intrigued. He needs to know more, so he asks. 

His father, a zoologist, quietly replies: “If you are interested to find out what this business of doing nothing is all about, try it out for a few weeks. See if this is something that would help you. If it helps you, carry on with it. If it doesn’t help you, it’s okay, you have still learned from it. And you can make your future choices based on that.”

Jay dutifully listened to his father. He sat down, closed his eyes, and did “nothing.” But his thoughts kept coming. It was not easy to face his “inner chaos,” said Dr. Thimmapuram, an academic internist at the York Hospital. After a few weeks of trying this, he wanted to stop and just walk away. But he continued, and he worked with a trainer to help him with the meditation practice. One day he had a totally unexpected “wonderful experience.”

Jayaram told me that it felt as if his “mind was removed, put in pure water, and put back in again.” He had never before experienced “such clarity.” And this was not just a subjective feeling, it affected his behavior as he found that interactions with family and friends were simpler. At 18, he was beginning to feel more comfortable, or at ease with himself.

Don’t turn your head
Keep looking at the bandaged place
That’s where the Light enters you
And don’t believe for a moment that you are healing yourself

(Rumi)

The meditating affected everything he did. He was on track. But he was young and lacked commitment, and Jay didn’t stay with the practice consistently. He told me, for example, that when he was in medical school and meditated regularly his grades were much better than when he slacked off and didn’t. This pattern of on-and-off practice continued for a while.

Chaotic bicycle "contraption" parked by the York hospital (Photo by SC)

But “something happened” after his residency here in York, as he felt “a calling to get back to that inner discipline state” that helped him before.  And when he once again meditated faithfully, set aside time for it, it felt as if his “inner alignment was coming back.” An alignment that sharpened his focus on his career path in medicine. 

But let us step back first and trace the beginnings of Jayaram’s medical journey.

His father, as mentioned, is a zoologist, a scientist who studies the behavior, classification, and “vital phenomena” of animals (according to Merriam-Webster). His mother (she passed away in 2017) held a doctorate in linguistics, the study of the “structure and nature of human speech”  (again, from Merriam-Webster), the study of how we communicate and connect with one another. 

So Jay was raised in a home atmosphere infused with the biosciences and its probing and questioning. His brother and sister are both physicians, so it was “normal” for him to “be inclined” toward the field of medicine, he told me. 

After secondary school, he went to Gunter Medical College in Andhra Pradesh on the southeast Indian coast nestled by the beautiful Bay of Bengal. When he finished medical school he wanted (maybe he needed?)  to explore the outside world, and to find himself.

Jubilant Gunter graduates. What's next?

How do you know that I do not know 
that the fishes are enjoying themselves? 

(Kazuko Okakua in Langer)

Well, one of his brother’s friends had gone to the U.K., and at 24 now, and not too picky, this seemed like a good enough destination. You see, the young Dr. Thimmapuram was a practical man, and as he found out that the requirements for a position in the U.K. could be satisfied easier and more quickly than for a spot in the U.S. He decided to take the shorter route to the West.

He first landed a job as a house officer at Norfolk and Norwich Community Hospital. He then worked as a Registrar (equivalent to a Fellow) in internal medicine at Borders General Hospital in Scotland. Following that stint, Jay studied and did gastroenterology for a few years.

As we sat in my living room Jay quietly told me that the pace of medicine in Great Britain was relaxed, as morning hospital rounds, for example, could start at a leisurely nine-ish instead of a crazy five-thirty here (yikes!). He greatly enjoyed the hands-on clinical style of the Brits and even had time to hone his cricket skills. 

His role on the pitch (as they call the field) was as a “one-down” (whatever that is) with the Melrose club in Scotland, where he merited a few fondly-recalled mentions in the local sports pages. 

Cricket pitch by the Borders General Hospital (Can you squint and maybe spot Jay?)

(An aside: Our cab driver in Bermuda tried to explain the rules of cricket to me and my husband. I was completely lost after the first few seconds. It seemed like he was speaking gibberish, and I zoned out. You see, watching baseball bores me to tears.  My mind becomes blank and still. Blank and still ...maybe even Zen-like...I think I’m falling asleep...asleep...asleep.)
   
Anyway, after seven years of tea and crumpets, Jay felt the need to move further west, to the States, and he gamely took the (unexpectedly) long and arduous USMLE exam. His first interview for a position was here in York. He was impressed by the staff, and it seemed like a nice fit. So he added to his training and did a three-year general internal medicine residency. He said that he learned something from each of his attendings. When he found things that “resonated” with his “heart” he accepted them.

Dr. Wolfe Blotzer (we have met him before in these stories) was one of his important role models. Jayaram said that “he is an encyclopedia, (and yet) his primary concern was always to the patient.” Wolfe’s physical examination skills were “great” and since this part of the craft of medicine is slowly fading away, watching Dr. Blotzer was as if he was “seeing someone from another planet.” 

From IMDb

Jay has also learned a great deal from Dr. Sharon Scott, a fearless member of the academic inpatient team (whose own story can be read on this site here). 

Jayaram certainly enjoyed clinical work with patients but felt especially drawn to teaching, so he joined the faculty.

Leonard Bernstein noted that the words for teacher and learner are nearly the same in German and Yiddish-Lehrer/Lerner. 
(From Langer)

As he practiced hospital-based medicine and mindfully taught the students and residents he continued to meditate routinely. And “as a scientist” Dr. Thimmapuram remained intrigued by this practice and wanted to know more about what happens to us by “the simple act of closing our eyes.” 

So he was primed when his program director had a request. Dr. Robert Pargament had just read an interesting article and came to Jayaram and said: “I know you meditate. Can you do something with our residents?” The paper was about “burnout” in medicine, an important and timely topic. Jay recognized this and quickly agreed to help, and he suggested doing a formal study.

Dr. Thimmapuram told me that there are a “lot of stresses and a lot of strains” for those working in the caring and healing professions and that “we take those (stresses) home to our families and loved ones, who may become the victims.”  The stress level is particularly high during the training years, and as this affects the physician it affects their patients.

Another linguistics point: The word “Patient.” From the Latin “patiens,” the present participle of the verb “patior,” meaning “I am suffering.” 
(Wikipedia)

Burnout, according to the upcoming ICD-11, is defined as an employment condition, not a disease (the code-everything has to be coded, you know-will be QD85). It is defined by the three dimensions of emotional exhaustion or depletion, depersonalization with cynicism towards work, and lack of personal accomplishment (“professional efficacy”).  

Dr. Thimmapuram said that at any given point “at least half of physicians suffer from burnout.” Half! 

This can lead to anxiety, depression, addiction, and, especially sadly, suicide. Physicians commit suicide at twice the rate of the general population, and we lose nearly 400 U.S doctors yearly as a result. How much of this is triggered by burnout is not known. 

Physician suicides by specialty (from Dr. Pamela Wible)

So Jay designed a twelve-week study of residents, nurses, and faculty members. One group did “heartfulness” meditation an easily-learned practice that Jayaram, himself, has used for years that focuses on one’s “inner alignment.” The other group “carried on as usual.”

At the end of the study, the group that meditated showed improvement in all three burnout dimensions compared to the group that did not. Jay noted  that measures of “anger, anxiety, stress, fear, irritability, jealousy, addiction, apathy, cynicism, and impulsiveness, all decreased.” 

And the “positive” attributes of concentration, calmness, clarity of goal, harmony, sleep, joy, positive thinking, self-confidence, and honesty to oneself increased. 

Dr. Thimmapuram wanted objective data in addition to the subjective reports. He wanted to see if there were quantifiable physical effects of short-term meditation. (He knew that such effects have been found in expert meditators after decades-long practice.)

Once again, everything is the same until it is not.

 (Langer) 

He chose to measure the lengths of the telomeres. These are the caps that are at the tips of the chromosomes. They prevent the degradation of DNA and end-to-end fusion of chromosomes. Their lengths reflect the state of our well-being and lifestyle and may predict longevity. Jay said that chronic stress shortens telomeres. 

He found that the subjects who meditated (especially the younger ones) had an increase in telomere length from the beginning to the end of the three-month study.

(An increase in telomerase, the enzyme that adds to the ends of  telomeres, is also seen with regular physical exercise, a body mass index less than 25, not smoking, and a healthy diet.)

Stresses shorten telomeres 

The study showed that even short periods of regular meditating can alleviate some of the manifestations of occupational burnout and can provide broad health benefits.  (Of course, addressing the many causes of burnout is the other half of the equation that needs attention.)

Each time that we awaken to no longer being present to ourselves or to another is, paradoxically, a moment of presence.
 (Santorelli)

Hearing the result of his study, and knowing that a form of meditation is found in many diverse cultures and religious traditions, I wondered if Dr. Thimmapuram meditates within a specific spiritual background.

While he said that he was born into a Hindu family and that he respects those who adhere to that tradition, he doesn’t like such labels. He would rather be considered simply “as a human being more than anything else.”   

He feels that “identification (with a group) is okay, but when it crosses its (useful) limits it causes problems.” When we feel that we are better than others we erect barriers and promote separation. If we feel great, or superior, maybe we should consider the other greater. This will “balance things out.” 

But we should not go too far in the other direction, he said, and believe that we are substantially less than others. Neither superior nor inferior “we are what we are.”

As we live in the world with others we create stories. We are, in fact, the story-telling animal, and as the split-brain researcher Michael Gazzaniga showed, “left brain interpreter” tries to make cohesive sense of our experience. Jayaram noted that the most important such story is the one we tell ourselves about ourselves. The story about who we are in our hearts. And the story of how we fit in the interconnected world. 

I wondered how he came upon this insight so early in his professional life. He said that he found it through the “heartfulness” meditation practice of understanding of himself and the universal human dilemmas. One of these, he noted is that we carry unprocessed “emotional baggage all of our lives.” 

He said that with the eyes closed in steady repeated contemplation “the body does the chores it has been longing to do.” (The body, our evolved physical body, and our heart-mind, “know” more than we can be aware of.)  

The human heart is a listening device far more perceptive than the ear. 
(Santorelli)

Because others selflessly helped him on his own journey, Jay feels the urgency to share what he has received by “paying it forward.” If someone, for example, “wants to explore” any of the various meditative, or even the specific heartfulness practice with him, and wants to be “the best that he or she can be,” Jayaram is happy to assist. And he gently encourages practice; nothing is forced.

When it comes to teaching students and residents at the hospital, sure, he helps with the “medicine” and the “studies,” but he is also softly supportive as he tries to find out where they are in their career development, and then meeting them and working with them from there. He told me that his pupils respond best when they feel respected. 

And when they need more concrete general guidance he tells them about two important words; Excellence and Acceptance. 

Dr. Thimmapuram said that “when we try to excel and do not accept the results, it leads to frustration. But if we keep accepting things as they are and do not try to excel, this is laziness.”

This balance of striving for excellence and accepting the outcome, whatever happens, leads to a state of inner rest and equanimity. But if we fail to do our best, and if we fail to accept the consequences of what we do, there is unrest and tension. Jay believes that this friction of unrest, this dis-ease, bothers us almost more than anything else.

Whether offering or seeking help, we are all wounded and we are all whole.
(Santorelli)

“I tell the residents,” he said, “that when we simply sit down and close our eyes it almost feels as if we are doing nothing. It might look silly, but perhaps we are putting up with our own selves. And then we realize it’s not so easy. And if it is difficult to put up with ourselves, how do we expect others to put up with us!”

With the practice of heartfelt meditation what we do is very gently restore attention on the source of light within our own heart. We strive to “refine ourselves” in an effort to be better as human beings, as members of the genus homo sapiens ("wise man"). 

“I cannot say that one form of meditation is better than another, as what works for one person may not work for someone else. You have to find what resonates with you,” he told me. “When the heart is at peace, the mind is at peace.” And you have to put the knowledge you have gained into practice, into encountering the world, encountering others.

Speaking of others, I wondered about Jay’s family. His wife (she was two years behind him at medical school) is an internist with the WellSpan Hospitalists. Their daughter plays basketball and is learning the piano, and she and her brother play tennis. (Neither child has shown any interest in dressing up in whites and trying to figure out the best way to handle a sticky wicket.) The rest of his family has remained in India, and Jay visits them at least once a year.

As I listened to Dr. Thimmapuram tell me about his wandering journey to this point I was reminded of Thich Nhat Hahn’s walking meditation; mindful walking “to establish calm in ourselves and to be nourished by the wonders of life in the present moment.” 

The Vietnamese Zen monk taught young French children to use two special words: Oui and Merci. When walking and breathing in, they say “Yes” to life and to the Earth. When stepping gently and mindfully, and breathing out, they say “Thank you” to the Earth and to life.  Their feet caress the Earth with love. And their hearts are opened to their own special odyssey. 

Do you have the patience to wait
till the mud settles and the water is clear?
Can you remain unmoving
till the right action arises by itself? 
 (Lao-Tzu Trans. by Stephen Mitchell)

Untitled (Charcoal on paper by Anita Cherry 1982)

Selected Readings/References:

1. Langer, Ellen. The Power of Mindful Learning. Cambridge: Da Capo Press, 1997.

2. Mitchell, Stephen. Tao Te Ching: a New English Version. New York: Harper Perennial, 1988.


3. Santorelli, Saki. Heal Thy Self: Lessons on Mindfulness in Medicine. New York: Bell Tower, 1999.

4. Thimmapuram, J., Pargament, R. et.al. "Effect of heartfulness meditation on burnout, emotional wellness, and telomere length in healthcare professionals." Journal of  Community Hospital Internal Medicine Perspectives, 2017 Jan 7(1) 21-27.

Anita Cherry 1/3/20