Dr Roger Cole

Raja Yogi, Oncologist and Palliative Care Physician Dr Roger Cole has been caring for the terminally ill for the last fifteen years. He is the Director of Palliative Care for the Illawarra Area Health Service in NSW where he lives with his wife and two children. His books Mission of Love and Healing Heart and Soul have become best-sellers in Australia. Mission of Love has also been published in the United States and Latin America in translation.

Roger’s dedication to the care of the dying followed an enlightening experience in 1984. Since then he has sought to integrate spirituality and his medical role through meditation, with a vocation to bring hope, comfort and healing to his patients and their families.

Roger has appeared in several TV documentaries, including a personal profile of his work on the ABC. He was also featured in Bryce Courtenay’s book April Fool’s Day, as Damon Courtenay’s palliative care physician.

Roger has toured Australia and overseas extensively, giving public talks on hospice care, meditation, inner-healing and spirituality. He speaks on the sensitive issues that face us in death and is equally versed in how to maintain inner peace and happiness. He believes in the connection of mind, body and spirit, the power of positive thoughts and how attitudes influence healing.

His published articles include grief repression in breast cancer, caring for people with advanced AIDS, symptom-control in palliative care, meditation for health-professionals and spiritual care of the dying.

Interview with Dr Roger Cole

Do you see yourself as a leader? What is your vision?

Actually I never really have seen myself as a leader, yet when I reflect I have often held leadership roles, even from childhood. Things like house captain, soccer club captain, prefect and the like. I have never thought about leadership or considered the qualities that make people leaders. Some people simply are, its in their make-up and others look at them and follow their ideas or example.

I think in the early formative years my leadership roles were the result of enthusiasm, self-confidence, determination and commitment to what I was involved in, as well as the capacity to instil those same feelings in others. In more recent times, in becoming a palliative care physician, there were other factors. In fact being a director of services wasn't the outcome of leadership, although it has challenged me to develop and understand what is needed to keep the respect and cooperation of others. When I set out in palliative care it was still the mid-eighties and modern hospice as we now know it didn't exist. I just wanted to express my medicine in a more compassionate way. There was no structure, just a burning desire to make a difference. Undoubtedly this was, in part, about ego-gratification, to be recognised and to be a hero! (Possibly a common trait in leaders of today.) As there was no structure I was advised by my oncology supervisors that there was no future in the direction I was taking. However I could feel the need out there, and shared the vision with a number of other doctors who were breaking the mould. I didn't believe the advice I was being given and determined to follow my heart.

I became one of the early pioneers of modern hospice in Australia (there were good overseas models at the time it must be said). As people witnessed the value of my clinical work a position was created for me at the Prince Henry and Prince of Wales Hospital in 1988 as the director of Palliative Care, so I was thrown into leadership. This time it was because there was no-one else to lead! The qualities that got me there probably included those listed above but you could now add the word vision. I had seen a need and focused myself on an approach to meet it. I wasn't put off by those who sought to undermine this new direction and completely believed in myself. I was 'sent' the right people who could materialise the vision, including those with power over resources and funding. I just kept on working, demonstrating the value of serving with compassion and focusing on suffering. A team began to grow around me as the palliative care association of NSW made political inroads into resourcing palliative care as a mainstream service in medicine.

At first there was the pioneer spirit, then the need to adapt and become a sustainer of an established service . Many of the pioneers fell away at this stage. As we became established it was no longer the same energy. It was no longer about satisfying ego, challenging the establishment and winning a battle. Now it was becoming more the challenge of longer term goals, strengthening our position and having more sustainable aims and objectives than just saying how needed we were. At this point leadership was about the power to accommodate others, to take a gentler approach, to provide education and support to other health workers, and to be humble. One challenge I had when taking my current position was to improve the quality of care being provided by less experienced doctors in a hospice setting. I quickly realised that my extra knowledge could be used to good effect. However, if I was too arrogant and assertive with it I would have undermined their confidence. It was a delicate balance. What point is having extra knowledge and experience if you make people lose their self-respect, or if they don't like you or want to listen to you? Leadership isn't a popularity contest but imparting your values does require an open, honest and friendly nature that will acquire trust and cooperation. It is also really important to respect everyone.

Always remember: When you give trust to someone they will acquire self-respect. They will also respect you and be cooperative. And when you communicate your motives people will feel valued and they will feel that they belong. They will also be understanding when you fail to do so. Good leaders are always forgiven when they get it wrong!

My mother and a frog. My mother definitely wanted me to be a doctor, in fact it was her own unfulfilled wish. From the cradle it was, 'Be a doctor, be a doctor'! I was completely brainwashed. When I was around ten years old, however, a neighbouring (older) child dissected a frog. I was fascinated by what lay inside and, from that day on, began to study biology which became my favourite subject. Actually it was from that defining moment that I decided to be a doctor, a direction that would never falter or change. Destiny had called.

Being attracted to oncology wasn't a particularly deep affair either! In fact I was going to be a cardiologist. Cardiologist was more in line with my ego-image of 'hero who saves lives'. But it's very interesting how our destiny is shaped. What happened next would be connected to my future spiritual journey, bearing in mind that I was an atheist at this time. One night at 3am I woke up and found myself sitting bolt upright in bed with one thought in my mind: 'Become an oncologist'. It really seemed as if it had come from somewhere else. The following morning I approached our oncologists at the teaching hospital I was training in and they accepted me. The door opened fully when I passed my specialty exam and a colleague who was competing and preferred for the training position failed. Such is the nature of destiny. When you step forward with courage everything comes easily, doors open wide and it's as if it was meant to be. And of course it always is!

In the next year as an oncology trainee I had an awakening of compassion and empathy. As you can see these weren't the motives that had taken me there so far, more it had been about keeping a date with destiny. Now I wanted to understand the suffering of my patients and their relatives. I begin to think less about the medicine and more about the experience of going through cancer with the threat and reality of death. What was it like? How could I help? Why did it happen?

I got more involved with my patients and listened to them. To my surprise they appreciated me in a way I hadn't expected. I was interested in what they were going through and they felt this to be human kindness. I was just beginning to understand that empathy, listening to and understanding the feelings of others, is as helpful as anything we can do. I started to communicate and educate in my role as a doctor, making sure my patients had all the information they needed to be clearer about their position. This gave them a sense of control and a feeling of mastery about their situation and a sense of what they had to do, instead of being in fear and limbo.

At this point I went to a workshop on death and dying with Elisabeth Kubler-Ross. She did a lot of teaching on death and dying in the seventies and eighties, and wrote the landmark book, 'On Death and Dying'. Elisabeth believed that workers in palliative care have to face their own losses, the sources of grief and anger that rest in our subconscious, before we can adequately respond to the despair of others. During the workshop I broke down and grieved the loss of my sister who died a 'cot death' when I was ten. What followed was remarkable. From the moment my heart emptied of grief I experienced total peace and silence, then the purest love I have ever known. I felt myself 'expand' into a love that was all-inclusive. Every aspect of life, the universe, nature and all souls were there. I was, quite literally 'one-with-all'. This was my defining spiritual experience. I had been an atheist. Now I recognised this was an experience of God's ever-present unconditional, spiritual love. I had just let go and fallen in it!

It was this new-found spiritual awareness that drew me to work in palliative care, where I felt I could better express my 'whole self' in serving people who were suffering.

Discovering that I was an eternal being, a spirit and a child of God changed everything about my life. It inspired me to seek the wisdom of that experience, and to develop its understanding and expression in my daily life. I began to meditate. This was eighteen years ago now. I studied 'A Course in Miracles' and various other texts as an adjunct to meditation, and meditation was my way of being absorbed into God's purity and silence. The study enabled me to develop the power and virtues of my mind, while meditation drew purity and divinity into my heart. I found myself able to discern more clearly the truth behind our life, and I developed the courage and faith to live that truth. I found that as I 'cooperated with the universe' in this way 'the universe would cooperate with me'. My life became simpler and I could trust in outcomes. Conflict began to leave me alone and everything I did succeeded, in fact I began to view success as my birthright. Happiness came first, success second. The world outside had it all wrong. They think it's the other way round...but then they have forgotten the magic that a pure and direct realisation of your soul can bring.

That we are spiritual beings, that we are all children of the One God and that we can transform the world we live in. Developing our spirituality through knowledge, yoga (union with God through meditation), divinity and service is a way of cooperating with God to create a new world. In truth this is the only real leadership that remains in this world. It brings us into our highest values and makes us act only according to these. Ultimately this will end ego and all illusions will fade into the truth and certainty of the unseen world of spirit. When we make this apparent and revealed the whole world will follow because we will have succeeded in becoming free instruments of divine will.

I heard of a recent executive meeting where palliative care was discussed. Someone was asked to approach me about something. The medical CEO quipped, 'Has anyone seen Roger Cole recently...is he still on earth!' Everyone laughed. I like the story and I like to be different. My medical colleagues like the message but it takes effort and discipline to become the embodiment of the message. My medicine is orthodox, based on good rapport, communication and effective prescribing. My mind is unorthodox and I am willing to openly live my beliefs. My feet are grounded in this world, my intellect connected with the world of spirit. Because there is this balance of spiritual with worldly life my colleagues respect me, and sometimes wish they could have the same peace of mind. They like the message but few understand or know how to heed it.

Doctors are a product of the society we live in. We look at them and wish they were different, better communicators, etc. Sometimes we get angry with them. But we are unwilling to look at ourselves and say, 'It's my fault that doctors are like they are. I have to change.' Until we are willing to change ourselves, to begin the journey of purifying our attitudes, vision and actions we will not see that consciousness expressed in our society. Our doctors, politicians, scientists and businessmen will continue to be as they are. What you see is a reflection of what you have become. Now believe in making a difference. I have been studying Raja Yoga meditation for the last ten years. Our slogan is: When we change the world changes.

First and foremost I don't think in terms of right and wrong. I accept the world as it is and have no tensions with its values. If you take this position you can look on the world as an observer and develop the inner wisdom required to change and recreate the society we live in. Western society has trapped the spirit in three forms of lower consciousness - body consciousness, role consciousness and ego consciousness. We have lost our innocence to these three 'dark forces', which have modelled and limited our perception. Greed, self-gratification, conflict and competition are the outcomes of these perceptual states of mind. Deep within our subconscious we live in a state of fear, yet fear can be best understood through the mnemonic: False Evidence Appearing Real.

To effect change the world tries to isolate problems externally and enforce change. This always fails to create the world we want, and I believe it always will. When we change the world changes. If we have deep courage, faith and conviction we will begin to understand that only a change in consciousness, and a radical shift in our 'being' will lead to a peaceful community. We need to understand that the true underlying personality of every human soul is peace, and the foundation for peace is purity. If we awaken these powerful qualities through meditation and contemplation we become the living solutions. And when the world plunges further into darkness those who pay attention to this awakening now will become the living lighthouses of the future - spiritual beings become the embodiment of solutions instead of problem-solvers.

To effect change keep remembering you are a peaceful soul. This tunes your awareness to the nature, form and divinity of God. God does the rest. Your responsibility is to change the self. God's responsibility is to change the world. This is known in Raja Yoga as: Self-transformation for World-transformation.

I now feel that truth lies in the experience of soul, and that God is the source of truth - the all knowing, ocean of love, peace and happiness. The word experience is the key to understanding the self, the cycle of life called the drama, the unique role each human being plays in this drama and the opportunities of the age we live in. I believe this is the time to become living angels who reveal God. For this I believe we need to solve the question: 'Who Am I?', and ask two other questions: 'Where do I come from?', and 'Who do I belong to?' These questions will never be answered through the head. They need to be experienced repeatedly until we feel we have a relationship with God. With the feeling of relationship comes knowing, and with knowing comes faith. Faith is really living your beliefs in four aspects: faith in drama (everything is in divine order, nothing to fear), faith in the family (all are my brothers, each playing his or her part accurately), faith in the self (I am a soul, God's child) and faith in God (the Supreme is the One who inspires action and gets everything done, I am simply an instrument).

Faith in four aspects allows us to be detached and beyond the illusions of roles and ego. Our loving and compassion is then unconditional, we become servers in our communities, and peace messengers in our world. This moving beyond illusion is the result of living the truth of our spiritual identity, that is of becoming soul conscious. Soul conscious love is the foundation and the essence of truth in all our religious philosophies, and it was in the message of all our religious founders. Unfortunately in their expansion religions have lost this original essence. This is true of east and west. Raja Yoga is more a contemporary study of the self, of God and the cycles of life than a religion.

I have respect for all the religions of the world and believe that each soul has their own unique family of souls, and that this is a unique age for experiencing God in our own special way. It doesn't matter if you break with the traditions of your religion to do so. If you love God, or you love the journey to wisdom and understanding you are 'allowed' to give yourself the freedom to create your own journey. At some point, though, you will need to follow some directions other than your own to experience the humility that brings you into unity with God's spirit.

Accept the person you are caring for and accept what you have to do at this time. I wouldn't pretend that caring for someone who is dying is easy, in fact it can be physically and mentally draining. It can also be a time of real beauty, learning and growth for carers. But remember some of our greatest moments of growth come through the difficulties and challenges of our lives. Living with feelings of helplessness and inadequacy are commonly experienced. The situation can feel overwhelming and much greater than us, and there is the feeling that we have lost control. When you are able to do things for the person your helplessness is, at least, alleviated but you have to temper this with respect for the independence of the individual who needs to keep their sense of identity. Some people are very stubborn. If this is the case your great challenge is to accept them as they are and negotiate safety if they are weak and at risk of falling. It is better that they fall and find out for themselves, however, than you spend weeks in conflict trying to protect them.

When there is suffering (in the carer and the person who is sick) spiritual ideals and philosophies may not be helpful. Going through the experience may be the only way to freedom. Steering away from religion and being practical with your support and care is most useful here. If you have religion but the person you are caring for doesn't just let them experience the love and peace of your faith. Its good to talk about things to do with dying but not essential if that's not the way for that person. People are still people and have the same needs as always for lightness, superficial chit-chat and humour. We don't have to be deep about dying. Be natural, don't make people feel uncomfortable but be willing to sit with your grief and to let your feelings show. This encourages the person who is sick to allow their feelings to surface, otherwise the whole period can become a kind of frustrating emotional 'hide and seek' where everyone becomes more afraid of their feelings showing than of the situation that they are in.

Please remember there is a spiritual dimension, that all suffering is a temporary adjustment for the soul and that it doesn't matter whether you believe or not. Every soul is accountable for its actions but will experience liberation and peace once the account has finished...and the account always finishes. Never give up hope, always be loving and learn the compassion that difficulties bring.