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"Buddhism has as its purpose the attainment of indestructible happiness in this lifetime," he says. While our society emphasizes "relative happiness"--the kind that depends on having the right job, house, looks, etc.--Buddhism encourages people to strengthen their life condition and find happiness within. The stages of life force are compared to ten different worlds, from worst to best: hell, hunger, animality, anger, humanity, rapture, learning, realization, Bodhisattva, and Buddhahood. Those who reach Buddhahood have a constant sense of fulfillment and joy, with all adversity becoming a "springboard for growth," says Lickerman.

Using medical terminology, he adds, these worlds can be equated to psychological conditions. "Hell is really the Buddhist equivalent of major depression," he explains, later likening Buddhism to "the ultimate psychologist." Life condition fluctuates, and all people are capable of either sliding into hell or attaining Buddhahood. Today, Lickerman tries to bring the students a little closer to Buddhahood by leading them in a support-group-like session. First he admits his own weaknesses.

"There are days when I don't want to listen to my patients. I want to smack them and tell them to stop complaining," he confesses. At those times, he says, he tries to recognize that his feeling isn't permanent but a temporary, low life condition and that he needs to give himself a break. Wood agrees. Though not a Buddhist, when something is amiss in his day, he will take a three-minute "bathroom break" to be alone and focus on what is wrong rather than let his negativity build.

And of course, life condition affects not only doctors but also patients. In breaking bad news, Lickerman says, doctors have to accept that both the patient and the doctor will feel worse after the visit, not better. It's important to monitor your patients' life conditions, he says, and adjust your interactions accordingly, just as it's important for physicians to attend to their own life states.

At 3:30, a cart of cups and soft drinks is wheeled in, and the group disperses for ten minutes. When class resumes, Wood distributes the readings for next week, when they'll discuss praying with patients. Then the therapeutic discourse picks up where it left off.

A student asks for advice on communicating with patients on days when she's feeling low: Should she spare them by cutting conversations short? Lickerman suggests telling them she's having a bad day, and urges the students not to be too hard on themselves. "We expect ourselves to be perfect because the work we do is so important," he says, noting they may find themselves especially challenged as interns, when administrative duties leave little time for patients. "That's okay," he says, "because that's your job as an intern." Although it's a hard lesson to learn, Wood adds, "Every time I've made myself vulnerable, that's had a humanizing effect on the interaction."

The same student discloses that sometimes it's difficult to keep her emotions under control: Patients who see that she's upset by their pain seem to appreciate her concern, but she wouldn't want to cry in front of them. Patients do want to see their doctors as all-knowing, Lickerman admits, but they can tell when you're not 100 percent confident. Maybe, he suggests, it's OK to cry sometimes.

Another woman wants to get back to the idea of monitoring one's own mood: What should she do if she realizes her bad day was caused by someone else's words or actions? Lickerman offers the Buddhist take, comparing life to a glass of water with sediment at the bottom. When someone comes along and stirs it, the water becomes cloudy. "Whose fault is it?" he asks. "The person who stirs or the person who allowed sediments in her life?"

Finally, a student asks, "If you think someone would benefit from your beliefs, do you share them or not?" Lickerman responds that he's "extremely cautious" in approaching this subject, and waits until patients ask him. He warns students that doctors' influence on their patients is similar to that of a teacher's on students. He's willing, though, to share elements of his beliefs that he thinks patients may find useful, to introduce them to new concepts that provide a new approach to a problem. "In general medicine, there's a lot of psychiatry," he says. "To ignore those issues, you're focusing on the disease and ignoring the patient."

But, as Wood points out, spending a lot of individual time with patients can cause problems with superiors who expect a certain amount of efficiency. How to practice the kind of medicine you want to practice, the balancing act between personal and professional life, and the importance of knowing your limits all crop up as concerns. There's not enough time to analyze it all, but Lickerman's closing admonition strikes a common chord:

"If we are not practicing and living in a spirit of compassion, we are not living a very wise life."--K.S.