Before sunrise in a small home office in Virginia, a physician sits cross-legged on a pillow on the floor, back straight, counting breaths. One. Two. Up to ten, then back to one again. When his mind drifts to the bird chirping outside the window, to his aching legs, or to the busy clinic day ahead, he gently returns his attention to the breath. Eventually a bell on his phone rings, and he sits for one more moment before standing up. That simple, disciplined routine, described by Samuel Cross, MD, of the University of Virginia Health System in a personal essay published in the Journal of General Internal Medicine, has become the foundation for how he practices medicine. The essay, titled after a classic Zen proverb, offers an intimate look at how contemplative practice can reshape the daily work of a primary care pediatrician, one patient encounter at a time.
The proverb from which the essay takes its name runs: “Before enlightenment, chop wood and carry water. After enlightenment, chop wood and carry water.” Its implication, as Cross explains, is that meaning can be found even in mundane-seeming activities, and that paying attention, moment by moment, to simple daily tasks can be a powerful practice in itself. For a clinician, whose days are filled with repetitive examinations, similar symptoms, and seemingly endless documentation, that message lands with particular force. The essay does not present meditation as a miracle cure or a productivity hack. Instead, it describes a slow, unglamorous transformation in how one doctor relates to his own wandering mind, and how that shift changes what happens in the examination room.
Cross is careful to correct a common misconception about Zen meditation, known as zazen. It is not, he writes, about emptying the mind. Minds do not empty; his certainly does not. Rather, zazen involves bringing the mind to the present moment. When the mind inevitably wanders, the practitioner notices and brings it back, again and again, without drama or self-criticism. The mechanical core of the practice is deceptively simple: sit still, follow the breath, count each inhalation and exhalation cycle up to ten, and restart whenever attention slips. Each act of noticing a distraction and returning to the breath is not a failure of the practice but the practice itself, a repetition that trains attention the way repeated lifts train a muscle.
The essay is candid about the author’s lifelong struggle with attention. As a child sitting in church with his family, he never heard an entire sermon. During college lectures, he drifted off every few minutes. And in clinic, when he runs behind schedule, his mind tends to race ahead, producing what he describes as an uncomfortable, burning feeling in his chest, a physical awareness that families are waiting for him. That sensation will be familiar to nearly any practicing physician. Time pressure in outpatient medicine is chronic and structural, and the cognitive cost of feeling behind is paid not only by the clinician but by the patient in front of them, who receives a distracted half-presence instead of full attention.
What makes the essay compelling is the contrast it draws between that old pattern and the present one. After years of zazen, Cross writes, he has learned to notice when his mind is wandering and to bring it back. The burning feeling still arrives when he is running late, but he recognizes it now, stops thinking about what comes next, looks the parents in front of him in their eyes, and listens. In the essay’s central scene, those parents are young, exhausted first-time parents with a newborn wrapped in a fluffy tan blanket, armed with a list of questions: What about these hiccups? Is it possible to overfeed a baby? How often should a temperature be checked? None of the questions has a dramatic answer, and the physician does not have all of the answers, but he works through them one by one, and the parents smile with relief when told they have a healthy newborn. He reports, simply, that he enjoys being with them.
The winter clinic that Cross describes is a study in repetition. An eighteen-month-old sits turning the pages of a book with clear nasal drainage pouring out, coughing and pulling at an ear. The next two patients, close in age, have exactly the same symptoms. The clinical findings accumulate in small, precise observations: a faint macular rash on the chest and back of one child, a thin rim of fluid behind the left tympanic membrane of another, very mild subcostal retractions in a two-year-old, a cry in a three-year-old that is more hoarse than at the last visit. Most of what he notices will not change his management. Some of it will. In either case, he writes, he finds a sense of pleasure in the repetition and enjoyment in the attention paid to small details. Chop wood, carry water.
That framing speaks to a tension at the heart of modern clinical medicine. Repetition is often treated as the enemy, something to be optimized away through templates, protocols, and automation. Yet diagnostic skill in primary care depends on exactly the kind of fine-grained, repeated observation that boredom erodes. A hoarse cry that has changed since the last visit, a subtle retraction beneath the ribs, a faint rash that could be dismissed as irritation: these are the details that separate careful practice from careless practice, and they are available only to a clinician who is actually present. The essay suggests that contemplative training offers a way to sustain that presence not through willpower or guilt, but through a genuine, cultivated interest in what each moment contains.
The day ends with a teenager being treated for depression, sitting on the examination table and leaning forward with her elbows on her knees, smiling. Fluoxetine has been effective, though she thinks an increased dose might help. She is not seeing a therapist, but she is open to the idea. Cross sits on his stool, turned toward her, while she tells him about her school year. It feels good, he writes, to hear her talk and open up. Even here, at the end of a long day, with sore feet, unfinished charts, patients to call, and a long drive home ahead, he reports that he is not thinking about any of those things. His patient is talking, and he is in the room with her. His closing line is a single sentence: “And I am happy.”
Woven through the narrative is a reflection on ambition and its limits. Cross writes that he has been striving toward something for most of his life, that he has always had goals, and that he would not be sitting on that stool in that examination room without years of work in school and medical training. But Zen has brought a different perspective. He sees that no achievement is ever truly satisfying, and that happiness is not down the road with the next achievement, promotion, or publication. Happiness, he writes, is available here and now, in this moment, with this patient. For a profession in which burnout is widespread and in which clinicians are often caught in a cycle of deferred satisfaction, always working toward the next milestone, that reframing carries real weight.
Published open access, the essay is a work of narrative medicine rather than a research study; no datasets were generated or analyzed, and the author reports no funding. Its contribution is not statistical but observational and personal, a first-person account of how a contemplative practice translates into clinical presence. It joins a growing body of writing on mindfulness and well-being in medical training and practice, fields concerned with self-regulation, metacognition, and the cultivation of attention as a professional skill. What distinguishes it is its refusal to romanticize. The meditation described is uncomfortable, the legs ache, the mind wanders constantly, and the author still considers himself a beginner. The clinic is still behind schedule, the winter still brings the same coughs and ear infections in an endless loop. Nothing external changes. What changes is the quality of attention brought to each ordinary moment, and with it, the experience of the work itself. Before enlightenment, chop wood and carry water. After enlightenment, chop wood and carry water. The wood and the water are the same; the person carrying them is not.
Subject of Research: Zen meditation and mindful attention in clinical medical practice
Article Title: Chop Wood, Carry Water
Article References: Cross, S. (2026). Chop Wood, Carry Water. Journal of General Internal Medicine. https://doi.org/10.1007/s11606-026-10863-z
Image Credits: AI Generated
DOI: 10.1007/s11606-026-10863-z
Keywords: Zen meditation, zazen, mindfulness, primary care, physician well-being, narrative medicine, attention, burnout, pediatrics, self-regulation, metacognition, clinical practice
News Source: Ophelia Keating. (October 5, 2026). Chop Wood, Carry Water: A Physician’s Case for Mindful Attention in Medicine. Scienmag.
