Key points

In the brain, dopamine drives anticipation, not pleasure, and too many spikes leave us wanting more rewards.

In the heart, a slow dopamine drip increases contraction, heart rate, and blood pressure; a spike can harm.

In life, equanimity is sustained by practices that create a steady, balanced dopamine flow in the brain.

I was a third-year medical student at Northwestern on my ICU rotation the first time I saw a dopamine drip. The patient was pale and motionless, his blood pressure dropping by the minute despite large volumes of IV fluids. My senior resident said to the bedside nurse, “Let’s start a dopamine drip at five micrograms per kilogram per minute.” I stood at the foot of the bed, watching the monitor as the patient’s heart rate and pressure began to climb. “It’s wo

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