Practicing Healing—Cleaning the Back of an Elderly Tibetan Woman


James Lake, MD

Perm J 2017;21:16-059 [Full Citation]
E-pub: 01/16/2017

Among dozens of patients I evaluated and treated when volunteering at a Tibetan hospital in August 2015, a remarkable encounter with an elderly woman shall always remain a vivid memory. In some sense this unnamed woman has become an icon of Tibetan stoicism in the face of suffering. On that particular morning our team of 8 “foreign doctors” was busy caring for a steady flow of patients who seemed to have materialized from unknown hamlets and nomadic encampments in the high plains surrounding the town of Malo. At one point I was asked to do a procedure called “dry cupping”a followed by “hot needles.”b My patient was a woman who complained of chronic back and hip pain. She was bent over as she waited by the clinic door to be seen so it was difficult to estimate her height. Had she been able to stand upright she would have probably measured less than 5 feet in height. I think she was in her 70s though it was impossible to guess her actual age; 50, even 40 years of daily physical toil in the extreme conditions of the high Tibetan plateau may have accelerated aging, engraving deep, thin lines at the edges of her eyes and on her cheeks and bowing her spine into a sinuous arc.

the tiny woman sitting on a wooden stool

Because an interpreter was not available, I did not have a detailed history. I approached the tiny woman sitting on a wooden stool crouching over elbows that brushed her knees. We communicated using gestures and a few Tibetan phrases. “O Koga?” (as I touched points on her back and neck). “Is this painful?” After these preliminaries I had the impression of diffuse back pain. I proceeded to palpate her spine through her thin cotton blouse starting at her neck and continuing down to her lumbosacral vertebrae. When I reached her lower spine she bent over and—without speaking—pulled her blouse to the rims of her shoulder blades exposing her back. Standing in a blue protective paper gown spotted with blood stains from procedures on other patients over the past week, I wasn’t sure what I was seeing. Her skin was mottled in brown and orange from the back of her neck to the waist sash that held her skirt in place and had the tarnished appearance of weathered copper. I recall another “foreign doctor” gently touching my arm motioning me to a box of latex gloves on a dirty window sill “first wash the skin before using needles.” In that moment I realized I had been staring transfixed at the woman’s back not knowing how to proceed. The risk of a Staph infection caused by inserting acupuncture needles into dirty skin had not occurred to me. I snapped on blue latex gloves and started to identify the anatomical landmarks that would guide me in placing dry cups and hot needles indicated for her chronic pain condition.

I wiped her skin with cotton balls

As if in a trance, I wiped her skin with cotton balls soaked in isopropyl alcohol. After a few minutes I realized that gentle pressure was ineffective. I rubbed more firmly and the cotton ball absorbed what I can only assume was the accumulated grime of months. I do not remember how many cotton balls I eventually used or how long this process lasted. At one point I found myself staring at blue encapsulated fingers grasping discolored cotton and realized they were my hands. I had lost track of time—I had become absorbed in a ritual act of cleaning the back of an unknown woman and I had lost my “self.” In the moments that followed I was aware of my psychiatrist’s mind reaching for explanations—what was taking place inside me; what transpired inside the soul of this woman and in the sacred silence we shared? Did the woman regard me as a “foreign doctor” who had come to this remote place to learn about the nature of suffering? Did she feel shame at the knowledge that her poverty had been revealed to another human being? Or—and I think this is most likely—after years of meditation was this woman capable of “letting go of attachment to self” and “sitting with suffering” in a state of equanimity?

she voicelessly repeated a mantra

The skin of the woman’s back gradually emerged as white, shiny, and pliable under my gloved fingers now covered with a sticky coat of brownish-yellow grime. Realizing that I needed to preserve my gloves for future patients I took a few steps to a small metal sink, scrubbed the plastic gloves with soapy water then rinsed them with isopropyl before patting them dry with coarse brown paper available for this purpose. I returned to the woman, sat on a wooden stool at her side and began the process of systematically applying six small brass cups to her upper, middle and last, her lower back. This proved challenging as the woman had severe scoliosis and the indentations of her ribs were palpable. After several minutes I managed to apply the first copper cup to a patch of skin just below her left shoulder blade. I resumed palpating her back seeking a smooth area of skin over the tender points she had identified earlier and I was eventually able to secure all six cups. Throughout this time the woman did not move from her crouched posture. It was then that I noticed, concealed in a fold in her skirt her right hand delicately touching a malac as she voicelessly repeated a mantra. I observed her lips moving but there was no sound and I realized that performing this ritual had permitted the woman to remain immobile and alert during a lengthy procedure that could have easily caused a great deal of stress.

I continued on to the next procedure and started to insert acupuncture needles in her lower back along a line from the iliac crest through the upper lumbar area indicated for treatment of the lower back pain she had complained of. After twirling the needles for the best energetic effect I applied a glowing moxa stick to the needles 7 times in slow repetition, each time using my right thumb to “press” the heat into a point close to where each needle entered the skin. The woman remained absolutely still. Trying to observe without her awareness, I briefly stood back from her, tested the seals of all 6 cups on her back, and saw her gently touching her mala while silently voicing a mantra. From the faint movement of her lips my impression was that she was repeating “om mana padme hum” though she did not give voice to the words. After 20 minutes it was time to break the suction of the brass cups and soon after remove and discard the needles. As I went through these steps the woman began to rock gently back and forth—absorbed in reciting a mantra to sustain her focus—perhaps distract herself from anxiety she was experiencing in response to being treated by an unknown “foreign doctor.”

She nodded her head and smiled

I stepped to her side and told the woman the procedure was finished and had gone well, that she could expect to feel less pain now. All the steps beginning with the ritual “cleansing” of her back, continuing with the placement of hot cups and then “hot needles” may have taken an hour, perhaps a bit more. I was aware of a feeling of deep stillness, and there was a sense of reverence as though I had just shared in silent prayer. The woman pulled her blouse down over her back, wrapped her traditional Tibetan gown around her waist and slowly rose from the wooden bench. Facing me she looked into my eyes for a few very long seconds, nodded her head and smiled. Ever so slowly and soundlessly she then walked down the clinic steps, crossed the courtyard and disappeared from sight among people and sheep gathered on a deeply pitted road strewn with trash adjacent to the clinic. I imagined that in the hours that followed the woman gradually re-entered the society of nomads in the wide open spaces of the high plains surrounding Malo—perhaps starting out on a bus, then finding a lift on a motorized cart or a horse, and in the final kilometers journeying back to her yurt by foot. As I tried to visualize her journey home I recalled her silence and the profound simplicity of her practice—and I realized I was smiling.

a place of profound stillnesS

Reflecting on this encounter while walking back from the hospital later that day it occurred to me that I had been caught up in a meditative reverie the entire time. As I was “treating” this woman using the ancient techniques of Tibetan medicine, her spirit was “entering” me and imbuing me with peace. The spaciousness of the silence created by prayer had “brought me” to a place of profound stillness in the absence of language, gestures and, I assume—though cannot know—in the absence of any conscious intention. Through prayer a nomad woman had created a sacred “space” between us in which I experienced the peace of her mind. As I reflected on the deeper meanings and teaching, it became clear that the act of reciting a mantra when there is fear or other forms of suffering probably sustain this woman—and millions of others who are invisible and unknown to Western eyes—through hardships I cannot imagine. As the sun faded in a hazy late August sky I felt deeply humbled by the realization that I had participated in a sacred space with a patient—and I felt awake. I found myself contemplating how many “exchanges” of spirit I had missed during the weeks in Tibet, how many encounters between one sentient being and another might have taken place had I paid closer attention and taken more time to be present with an open heart while doing the hard work of healing. Months later, as I remember and reflect on these impressions I know that the full “teaching” is not yet clear to me. I know I will return to my memories throughout my life to seek deeper meanings in the journey ahead. Finally, as a physician I am bound by an oath I took decades ago to bring the insights and humility learned from a Tibetan nomad who became my unexpected teacher into my practice.

a Dry cupping: A technique used in both Chinese medicine and Tibetan medicine in which a vacuum is used to apply cups made of brass or glass to the skin with the goal of increasing local blood flow and restoring healthy energetic balance to the affected area. Cupping is used to treat a broad range of medical and psychosomatic conditions and is often used in combination with acupuncture and herbal medications.
b Hot needles: A technique used in Chinese and Tibetan acupuncture in which acupuncture needles are warmed by moxa applied to the needle itself or at its point of insertion to remove excess “wind” or other humoral energy and restore healthy energetic balance.
c Mala: A string of beads used by Buddhists and Hindus for keeping count while reciting, chanting, or mentally repeating a mantra or the name of a deity.

How to Cite this Article

Lake J. Practicing healing—cleaning the back of an elderly Tibetan woman. Perm J 2017;21:16-059. DOI:


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