I sit quietly, breathing, and gaze out over the Hudson River. The winter sun explodes: fingers of clouds extend as though in supplication, stained pink by the sun’s last vermillion flare. An I.V. tube protrudes from my arm, and I wear a light blue patterned hospital gown.
I am in Pre-Op, awaiting my fourth hip surgery in eight years due to one hospital and two doctor errors. I have logged nearly ten years on this journey. Much of it has involved prepping for surgery, rehabbing from surgery, planning my teaching and travel schedule to allow time off for surgery, and intermittent discomfort between surgeries, all with little respite. My body has long been the instrument of my creativity, my work and joy and pain. The people I entrusted with its care have violated it. They have broken and re-broken my heart. Despite this, my heart is full. It knows its vulnerability deeply, and still it opens.
All day, walking the streets of New York City, I am my usual self. I make eye contact and engage in deeper-than-surface conversation with nearly everyone I meet: the barista at an independent coffee house. The guy behind the deli at Whole Foods. The woman in CVS in a leopard-trimmed red Santa hat whose face at first is closed (no one home) but who, under the unexpected duress of hearing that her Santa hat “totally rocks,” tells me a story of wanting to be different, to stand out, when she chose it. The look in her eyes tells me we both know she isn’t talking about her hat. When I leave, her visage bears the look of someone who hears once again the siren call of possibility.
My backpack and yoga therapy balls rest next to the hospital gurney in defiance to the nurses’ wishes; they want everything gone, want me to sit with untold time on my hands. They purse their lips, affronted by my rebellion. I relish this a little, this reminder that I am not another number. The doctor comes in; unlike the nurses, his gentle presence barely ripples the surface. We touch base about what he’s going to do; he’ll debride damaged tissue and sew together a hole in my hip capsule, among other things. We joke about the therapy balls. I give him a piece of chocolate that I’ve brought from home. In this simple interchange, my body knows: this doctor understands without pretense or preamble the importance of my body, will treat it with respect. This time will be different. This time they will see me.
There is not much time left. I place my hands on my abdomen, palms overlapping slightly. I do the Embodied Belly meditation: I inhale and feel the fullness in my belly. I exhale and feel its growing lightness. I inhale and exhale, slowly, like I’ve instructed so many others to do. It calms me. It tethers me to the intelligence of my interior. It solidifies my connection to my center. This is where I want to be, this center, when they cut me open for what I hope is the last time.
Soon, the anesthesiologist parts the curtain and perches on the radiator. He crosses his slender limbs, enshadowed by the spreading stain of twilight. I tell him that I’ll be fully awake for the surgery: no anesthesia except for the spinal. He has never had a patient request this before, so we go through it three times. He is torn; I can already tell that he’s an empath by the way he responds, repressing the smallest shudder. He tells me that inserting the needle into my spine is usually quite painful, and he’ll need two of them, so he’d prefer to put me under for that portion of the procedure. We negotiate: if I can’t handle it, they can put me out just for that part. My intention rings out like a bell, clear and loud and piercing. I will be fully present with and in my body, no matter what happens.
They wheel me down hall after hall to the operating room, talking about the Jets-Patriots game. They’re surprised when I join the conversation; they aren’t used to patients talking back. We arrive in the O.R., where the surgical team transfers me onto the operating table. “Petite!” they say. “I am NOT petite,” I shoot back. “I’m strong.” They laugh in surprise, and one good-naturedly tells the other, “No skinny shaming.” I am so grateful just to participate in this repartee, to feel myself some small part of the process.
The anesthesiologist starts the procedure to insert the needles. There is a sudden tension as the memory of his previous words surfaces. I hear the beginning of a narrative in my head: “this will be painful.” It collides with my sense of strength, and the narrative begins to lose traction. I remind myself of what I teach so often: there’s the mind’s narrative—and then there’s the body’s sensory awareness. I can decide, in each moment, to which I want to pay attention.
I take a deep breath, let it out slowly. I feel his hand on my back. “Round your back into my hand,” he says, and I do. “More,” he says, and I increase the curve. This is familiar; I know exactly what to do, how to activate the part he touches. I wait to feel pain, but there is only the smallest pinch. I wait some more, but he’s finished. He tells me, a note of wonder in his voice, that he’s never done this on a patient who’s awake. To his surprise, it was easier—I could move exactly the way he wanted for ideal positioning, and he didn’t need the second needle. I draw strength from this, allow it to seep in and bolster me for what’s ahead. In the ensuing moments before they begin, I wonder: How often would it be helpful—not just empowering, but instrumental to the outcome—to have patients more awake, more embodied, during surgery? For whose sake are we put to sleep? Could it be a cultural default setting that we’ve outgrown, a choice that isn’t offered out of habit? Later I will wonder: in how many other areas of our lives might we ask a similar question?
The team turns me onto my side, where I’ll remain throughout the procedure. I feel the anesthesia move up my legs, and remember from the previous time how it crushes the chest for just a moment. I remind myself to breathe. But something isn’t right. There is time only to say “My legs and chest feel funny” before I pass out. As I come to, a pair of luminous gray eyes hover, wide open in alarm, inches from my face. The anesthesiologist tells me my heart rate went down to 30; I can feel his distress more acutely than my own. The surgeon pokes his head around the screen. “I’m giving you one more chance, Bo,” he says, not unkindly. I understand: pass out again, and the privilege of being awake, being present, will be taken away.
Quickly, I begin to problem-solve, to try to figure out what’s making this position so difficult. My left arm rests on top of my body, and is putting pressure on my heart. This makes it hard to breathe deeply. My neck is bent sideways toward the operating table in an uncomfortable position. My right wrist, broken just a year ago in a car accident, is cocked at an odd angle, as though offering half a queenly wave. I hold an impromptu propping session with the poor anesthesiologist: at my direction, he puts a pillow under my left arm to unweight my heart, two under my head, and one under my wrist. It feels like I’m back in the restorative yoga training from the previous week, showing people the art of propping. I wonder how many patients need more anesthesia because the weight of an arm impacts their heart rate, or wake up with neck pain due to insufficient propping. What would happen if we looked at surgery in a more holistic way?
I hear my surgeon’s soft-spoken instructions to the surgical team, his requests for instruments. They move in synergy, back and forth, over my body. The cadence of their quiet conversation is muffled by their surgical masks. I hear the words “yoga teacher,” “around the world,” “unusual.” They are cool with me being awake, I realize, and that makes me unaccountably happy.
As I deepen my breath, my heart rate begins to increase. The anesthesiologist hovers, concerned. My top arm is still adding weight to my heart; I feel a fair amount of the strangeness I felt just before passing out. I begin to notice a pattern: every couple of minutes the anesthesiologist comes into view and worriedly asks “Are you OK?” I reassure him that everything’s fine. To ease his anxiety, I ask him the best range for my heart rate. “Don’t worry about that,” he says. But the monitor is in full view. I notice that every time my heart rate dips under 80 or rises above 100, he appears again to ask how I am. So I attempt to calibrate my breathing: when I see my HR go down to 80, I speed up my breath, and it recovers. When I see the number rise above 100, I slow my breath and lengthen my exhale, and it moves back into range.
We enter the heart of the procedure. My breath and awareness fall into a rhythm. I summon the strength to hold my left arm in the air above the side of my body so that it won’t compress my heart. Though it aches, it feels like part of the process. It is a small price to pay for being awake. I can hold it like this for an hour or more.
I feel my awareness move further into my body. It’s as though I’ve entered Narnia. Unfamiliar sensations paw at the ground like strange, feral creatures. A small cacophony of feelings chitters away in the background. I listen acutely, but there are things in this Narnia which cannot be named. Every so often, surges of primal fear or something like it rush up from the depths. They feel unrelated to the surgery. They are more deeply embedded as though, lodged inside long ago, they are longing to escape. Every so often, new sensations come to life and taking winged flight, rise up and out of me. I am cowed by the majesty of these inner creatures, and by this world which teems with vibrant life.
The surgery becomes an extended meditation. I hug the nest of pillows to my chest. I imagine embracing my body, this childhood friend or adversary who I meet again after so many years. At times, I am flooded with a nearly transcendent sense of connection. At other times, fear arises: not the blackbirds of my inner world but thought-vultures on the surface that peck away at my confidence, telling me that it’s too much, that I can’t do it anymore. At certain intervals, the focus of my meditation takes a surprising turn: I put together yoga outfits in my mind. Will my mermaid Teeki pants go better with the garnet-colored top or the gray one? Which Converse sneakers do I wear with them? What about the dark green harem pants? To my surprise, these “embodied fashion meditations” are nearly as calming as the yogic ones, and they dance back and forth in two-part harmony.
Just as the ache in my arms, neck, and shoulders becomes so intense that I don’t think I can hold them in place any longer, they tell me it’s nearly over. Buoyed by this, I breathe deeply, one eye on the monitor. After some time, the surgeon comes around the screen and finds me with my eyes closed: Is she asleep? he asks. The anesthesiologists barks out a laugh. Asleep? Are you kidding me? I say, and he chuckles too. He tells me it went beautifully, that he was able to repair the damaged tissue. He turns to go. Turns back again. Looks into my eyes. “You’re one of a kind, Bo,” he says. I have no strength with which to respond, but crush his words to my chest where I will let them take root later.
One of the physician’s assistants is closing the incision, and I balk momentarily. They all assure me that he’s a better “seamstress” than my surgeon, and I let go of the control. We all talk about yoga for athletes, and I tell them about my work with mindfulness, yoga, and performance enhancement with several professional sports teams. I am absurdly grateful for this conversation, for having my wishes honored, for being able to be open and vulnerable and this time, not being hurt in the process.
The hospital has no idea what to do with a patient who is fully awake, so I languish for hours in Post-Op. Fully alert, I read and listen to music. I patiently tell them over and over again that I don’t feel pain and don’t need any pain medication. In contrast, patient after patient is wheeled into the room incoherent and fearful. There is a shift change, and one nurse instructs the other that a female patient is to have morphine as requested, along with Xanax every few hours. It is so hard, this kind of threshold experience, so intensely difficult to be present. I understand why many people wouldn’t want to be awake for it, if given the choice. Yet being asleep seems to have a debilitating influence on lucidity, pain management, and even, in my four experiences, the quality of the recovery process. I remember my time in Belgium, where I taught people about to have surgery a special form of breathwork pre- and post-op. To my surprise, none of the patients I worked with needed pain medication, while the others did. A steady line of patients—and staff—came to my room after that, day and night, for this strange method of “yoga therapy.”
The day following my surgery, my only full day in the hospital, is punctuated by two happenings. First, I become aware of a burning sensation when I use the bathroom. “I have a urinary tract infection,” I tell the nurses. Impossible, they say: there’s not enough time for bacteria to colonize and cause symptoms. But they run a test anyway. Since the test takes two days, they give me medication, which I agree to take despite my preference to avoid antibiotics. The medication helps instantly. Several days later, after I return home, the nurse calls to tell me that a tiny cluster of cells had colonized; when grown in the lab, they colonized into a full-blown infection. There’s no doubt in my mind that being so deeply present in my body helped me to feel what was happening, to take an active role in my medical care. How many other patients could embodiment help, and how many outcomes might it influence?
The morning of my discharge, just 36 hours after surgery, I awaken at 2:00 a.m. with the only pain that I have felt so far. My heart starts to race. The nurse offers me something for the pain, and another medication to offset the side effects of the first. I decline, but feel adrenaline coursing through my abdomen. My narrative starts up in full force: I’ve should have listened to the nurses and waited too late, got “behind the pain,” and won’t be able to sleep. In this midst of this strong story, I put my hands on the site of the pain. I direct my awareness there and take several long, slow, deep breaths like I have taught the injured practitioners in my restorative class to do. I feel, alongside the pain, the integrity and strength of my body. The next thing I know it’s 6:30 a.m. Light is streaming into the room. The same nurse is standing at my bedside, smiling down at me. “You slept,” she says. The pain is a distant memory, but the lesson of this experience lingers.
The experience of being awake and embodied during surgery reverberates through many areas of my life. I’m highly aware of the physical space around me, of keeping my body safe. It is two weeks before Christmas and everywhere I go, there are disembodied people. Unaware of the physical space around them, glued to their smartphones, they accidentally bump me, without looking up to see who they’ve run into. They race to squeeze through doors ahead of me, taking the crutches as a sign to outrun their bearer. How did it get to the point where we pay so little attention not only to our inner lives, but to our awareness of the space that surrounds us, and of the way our bodies and others dance in that space?
During the days and weeks that follow the surgery, I reflect on many things. When we have suffered trauma of any kind—sexual assault, physical abuse, emotional mistreatment, neglect, accidents—we can feel that the body is “ruined.” We’ve lost our chance at having a “good body,” whatever that means to us, or even a good-enough one. Going out-of-body is an intelligent strategy that offers temporary respite for the abuse or neglect we’ve been forced to endure. The thing is, this strategy was never meant to be permanent. To be sure, the experience of trauma makes it hard to inhabit our body. Yet not being in the body is itself a form of trauma. It’s not an occasional happening, this disembodiment, but a global epidemic.
Anxiety, depression, chronic pain, addictions, eating disorders, and even gut issues are now being referred to by professionals in many fields as diseases of disembodiment. Embodiment is deeply important to the brain. When we don’t inhabit part of our body, our brain sounds the alarm, often in the form of pain but also with an inflammatory response. The pain or inflammation are adaptations. Yet they are something more; they are also a call to embodiment.
I also reflect on my training in contemplative practice, particularly at the Mind and Life Summer Research Institute. I wonder if, in the face of difficult bodily experience, equanimity may not be our primary goal. What if, instead, it’s more important to deeply, even uncontrollably, feel what’s happening in the body: the blackbirds of fear, the searing fire of rage, the bitter inner twisting of envy, the adrenaline surge and pounding drumbeat of the heart that tells us a partner may no longer be nourishing, or even safe. Embodiment has the capacity to benefit our physical health, our modulation of pain, our emotional well-being, our creativity, and our inner wisdom. It might even have a global effect, helping more people to manage their own health care, and reducing the need for or reducing the intensity of more intrusive medical procedures and pharmacologic interventions.
Our ability to immerse ourselves in our moment-to-moment visceral experience—incredibly difficult, deeply pleasurable, and everything in between—gives form to our bodily self. We need the presence of this bodily self. Without it, we fail to thrive. Without it, the immune system, nervous system, pain regulation pathways, and other systems are compromised. Threshold experiences like surgery, illness, divorce, or a loved one’s death bring us face-to-face with this bodily self. Small wonder that we may run from the wildness of this self, assume it cannot be trusted, imagine that it means us harm, or try to recover the body we had before. It is a foreign and frightening thing, to befriend this new body, this strange other. And yet, our task is to not turn away. Our health and vitality depend on our willingness to press pause, move into the bodily self over and over again, and integrate it with the well-formed workings of our conscious mind.
Just over a year ago, I broke my wrist in a car accident and taught for a while with a bright pink cast. After a workshop on the West Coast, a participant came up to offer solace. “Don’t worry,” she said encouragingly. “I broke my wrist three times… and each time, I was back to handstand in just four weeks!” Her forearm, which she held out to me with pride, was marked by calcified knobs of tissue. It’s so easy, I thought at the time, to want to restore our body to its previous function, to override any internal boundaries to do so.
After my last hip surgery, I taught a master class on crutches. When it ended, a student approached to offer encouragement. “I had hip surgery too,” she shared excitedly. “And I was back to full Lotus Pose with a bind in 4 weeks flat! If I can do it, so can you.” I looked at her corded, sinewy arms, at her state-of-the-art knee brace, and felt ineffably sad.
An inconvenient truth: just because we practice yoga doesn’t mean that we’re embodied. Nearly every week someone comes to my class, announces a 15-year yoga practice, and proceeds to share that they’ve just now discovered that they’re hypermobile—or that their practice is injuring them, or aggravating an emotional imbalance—and they’ve come to me for help. Sometimes they come without this knowledge, expecting to find the affirmation deserved by “advanced” yogis. It falls to me, time and time again, to deliver the news that countless others have not shared. Many feel betrayed by the teachers to whom they entrusted their body and who simply encouraged their mobility beyond its end range. It’s flexibility, after all, that buys us purchase into the “inner circle” of yoga.
And yet, there’s something more at play here than the primal command a teacher might wield over his students, the pull for approval that she might give and withhold in turns. We are a disembodied culture. Sometimes, this could be said of the yoga world as well, as much as it hurts to hear it—and to say it. It’s a cultural thing, this predilection for physical prowess. We value it so highly, pursue it to the exclusion of internal awareness. Why is it so, when the two can co-exist so seamlessly? If we taught interoception—mindfulness in the body—along with asana, we might have a different collective relationship with our yoga practice. Or at the least, there might be fewer injuries.
In sharp contrast to the mind, the body exists in a world of non-linear time. There is a quiet here reminiscent of two friends, or lovers, or family members who share an understanding so profound that words need not be spoken aloud. is is a world without goals, or even definitions. I don’t know where it will take me, this serpentine path of embodiment, but within me grows a new willingness—a need, really, to let my body lead the way.
In the weeks that follow my surgery, my physical therapist worries about my hypermobility and how it will affect the recovery process. His approach is ultra-conservative; apparently, yoga teachers have a reputation of “pushing it,” of driving the body past its limits. For me there is no sense of hurry. I don’t race to restore my previous functioning. I don’t even practice yoga for six full weeks—for the first time in twenty years. I teach on crutches. Being awake in my body makes things easier:I can feel the components of a pose or movement and in response, my body sends a clear “no” signal when it’s not yet time to try something again. In contrast, it emanates a “leaning toward” something when it is time. There is a harmony, a filled-out dialogue between the intelligence of my body and the needs of my mind.
This leads me to wonder: do we need these larger-than-life challenges, these threshold experiences of trauma, surgery, illness, or loss, to bring us back into our body in a deeper way? Is it possible to move toward our inner-ness voluntarily, without the impetus of trauma, the pain of suffering, or the urge to reprise the accomplishments of our former bodily self? I think sometimes that without the initiatory experiences of repeated surgery, I might have stayed closer to “Instagram Yoga,” to the physically challenging practices that drive our modern yoga culture, and even its economy. I love them too, these intensely physical practices, but they only take us part of the way in. I have come to so deeply respect the transformative power of embodiment, its role as an integral part of mindfulness, that I’ve made it my life’s work.
Why is it, these days, that we have to study and practice self-compassion, when it’s been present in the body all along? The body knows self-compassion; the beauty of restorative yoga is that it brings us into contact with this knowledge, at least to a point. How can we make our yoga practice more contemplative, and restore to ourselves what we may not even know is missing?
It is no easy thing to enter the field of our bodily self, to re-immerse ourselves in its primal language, to re-member it piece by piece, breath by breath, sensation by sensation. And it is no easy thing to do so without compass or map or plan, and without the need to change what we find. It is a meditative and deeply devotional practice. It is also an act of great courage.
How do we know if we’re on the Path to Embodiment? The terrible beauty of embodiment is that we don’t know. There’s a feeling, perhaps, of something resonating. An irreverence for how long it takes, or whether others will admire or affirm us. And there’s the answering swell of an unstruck chord in the distance that may make us want to weep with longing.
Not far off, I can see another doorway into Narnia. Unpainted and unmarked, it betrays nothing of the savage, strange, and noble terrain that lies beyond it. My hand rests on the trellis. I push the door open, and take another step toward home.