Only Forever

 I have been sitting and looking at this photo, which is from before i was born. It's a photo my Mom gave my Dad, and as she so often wrote to him, "only forever."

Tow weeks ago, my Mom passed away pretty suddenly, she was 91. The two qualities that really defined her were her willingness to reach out and help other people, and her tenacious desire to be independent.

She had been battling rheumatoid arthritis for quite a few years, and though sometimes a challenge, i viewed my responsibility as to assist her in living as she wished., not as i thought "safest."

And things went well till late Wed evening when we had to call 911. She made it to the ER but was in "medical terms" desatting, simply put, short of breath from a cardiac event.

The ER offered to put her on life support and she said, "no, its time for me to join your father" (my Dad transitioned in 1986). I asked her to consider allowing me some leeway on her advance directives, and she did allow the doctors to do some treatments.

It is interesting that in Hospice we so often talk about families "not on the hospice page," and i found myself thinking that sometimes, people rebound from cardiac events and maybe we could get to "rehab."

But two days later things had declined and she couldn't eat or talk very much, since when she took the oxygen mask off she got short of breath. We talked with the Hospitalist and Hospice doctor about options, "Mom you can make it to rehab if you wear the mask all the time" and she said "no, i want hospice." Both doctors thought this was best.

We moved to the Hospice unit after my Mom signed her own papers. She was mentally clear, and she was giving me a whole slew of instructions, who to call, where things were, what to do, but mostly she was talking about joining my Dad.

She got a little bit of medication to be sure she was comfortable, and we were surrounded by my Team, so different for me not being the doctor in charge, just being family .....

Lauren helped her take her mask off, she didn't want to wear it anymore, and i just held her hand. It was so calm and peaceful. She passed unconscious after awhile and we all just waited ..... and at one point spirit moved me to kiss her forehead and say to her, "Mom, Dad's waited long enough, you can go now." I could in a spirit way, feel his presence, its hard to explain that in words.

She took a huge deep breath, let it out and she was gone ......

She never seemed to suffer. It was tranquil and peaceful. And we can still perceive the gifts from people who love us...... only forever.

The soft voice in the lotus

For people who come to my Hospice unit, they are not without Hope, but they have been failed by conventional science. And for each and every one we seek to find the strength that they have within them .... for some it is family, and community, and their organized religion, but for others they are alone, and conventional ritual doesn't resonate for them. After all .... when I enter each room, it is not about me, but about the person i am trying to help.

A Reiki friend wrote that "in spite of the best efforts to stamp it out, the voice of the compassionate elemental still whispers in the ears of our collective consciousness."

What do we mean by "compassionate elemental?" We were trying to seek not that quality which is represented by a "word" or "name" but the underlying quality that each culture is seeking to grasp, understand and name. For while concepts like "God" or "Ki" may translate language to language, culture to culture, human beings using these words are enmeshed within their own cultures concepts of the word ...... they are seeking something common, but they know they are referring to something slightly different.

This concept of syncretizing" is commonly discussed ....for example in Japan, there were Maria-Kannon statues during a time of persecution of Christians, the statue representing to some the Goddess of Compassion widespread in Buddhist Japan, yet at the same time to the adherent representing Mary, the mother of Jesus. And in the same way, as Christianity was sustained in a hidden way in Japan, throughout Africa, and Central and South America the Goddesses of the communities were suppressed in favor of Mary, but within the churches of communities adherents knew that the statue of the Mother of Jesus for them was Tonantzin, or Yemaya or other Goddesses, unknown perhaps by some - but revered by tens of thousands of adherents, even after generations of suppression.

Buddhism, Christianity, Islam, and Judaism all embody a concept of God, compassionate, gracious, and merciful. And yet what sometimes would seem so simple can seem so difficult, being kind and compassionate to others, especially those whose words for describing that which we hold most dear are different.

So what we need to seek sometimes is something deeper than simply clarity, or compassion, or peace of mind, but a mindfulness that leads to peace of spirit. A quiet place inside ourselves where all universes meet...."for the whole universe is him and he dwells within our hearts."

www.lotusheart.us/index.html

So we can .... keep in mind all our science and conventional knowledge, and at the same time, listen to that quiet voice that has not given up trying to reach us. It urges us when we have the honor to care for anyone, to approach them from "their own place." And in a time when they are the most fragile, assist them in using the voice they hold most dear. It places us beyond compassion, in a place of tranquility....

a mission from the heart

From the Long Term Care Medicine 2012 meeting in San Antonio, AMDA dedicated to Long Term Care Medicine, "A Mission from the Heart."

Two years ago, and again last year, we presented sessions asking physicians to have open minds and open hearts, and to open dialogue regarding complementary medicine. Both of the past two years we had 35-40 attendees in what are known as "concurrent sessions." But this year, our session on Pain Management: Pharmacologic and non Pharmacologic drew nearly 200 attendees and our session room was closed due to capacity 10 minutes prior to our session.

The weight of evidence is compelling many physicians to express interest - and one of the most moving parts of the day is having some physicians publicly and some privately, acknowledge their own experiences and interests.

My colleagues for this session were Dr Michael Gloth, who teaches at Johns Hopkins Medical School and Dr Chuck Crecelius, a past president of AMDA and chair of our public policy committee. Neither of my colleagues themselves practice complementary techniques, but they were supportive of having open minds and open hearts, and I am grateful to them for supporting this dialogue.

The program committee also permitted me to do a one hour session demonstrating techniques from a perspective of Komyo Reiki Kai. I was careful to be supportive of all styles of Reiki, but wanted to use Komyo at this session for its simplicity, its motto "Go placidly in praise and blame" and its use of Hatsurei Ho as a Shoden technique. There was no thought of teaching a "level" of doing any Reiju in this setting today, but there was an intention of allowing physicians to feel Reiki energy, and to learn a few limited Reiki tools for self mindfulness. Our Keynote Speaker, Dr. Robert Wicks had set a tone by stating that physicians can share a sense of their own peace with others. He stressed the "necessity of appreciating the building blocks of mindfulness," and i was seeking to provide some simple tools - for use only on oneself.

What i was able to demonstrate is the Gokai, the 5 principles of Reiki, breathing, Gassho, and I was able to take 50 physicians through the elements of Hatsurei Ho as described in the Komyo Style, Sitting, Mokunen, Kenyoku, Joshin Kokyu Ho, Seishin Toitsu, and Mokunen.

Perhaps the ripples from this will include some physicians being more open to work with Reiki practitioners, perhaps a few physicians will seek a Reiki teacher - at the least I believe there will be more discussion - and hopefully more open minds and more open hearts.

My colleagues still know me as a conventional evidence based physician, I have been fairly clear that there are Reiki practitioners and teachers far more knowledgeable about Reiki than myself - and that my mission in the sessions was to share my own practice experience, and to encourage dialogue for our patients.

Stories....

One thing that has been important in the Hospice movement since the very beginning, is stories. We see moments of caring, heroism, courage and love ..... and in sharing the stories we make them continue to grow. People that we knew, in a way departed, but in a way living on in our memories of their courage and faith, and having their spirit spread by ripples of word of mouth - resonating from soul to soul.

One of my nurses attended a funeral last week - it is not uncommon in hospice, nurses can become a part of precious moments, and sometimes being present is not a simple action of supporting a family in bereavement, but a part of our own closure..... we learn we can at the same time maintain professional boundaries but also let ourselves care, i refer to it as having boundaries but breaking down barriers..... (or sometimes "taking off the white coat.")

She brought me a copy of words from the memorial service, and here was a paragraph, quoting a song "If I could have another dance" by Everett Badmarsh......

"do not mourn the flower as the fruit grows on the tree,

Do not mourn the crested wave returning to the sea,

Do not mourn the starlight at the first glow of the dawn,

Though I might leave, I'm never gone."

The wonderful Buddhist teacher Thich Nhat Hanh teaches that "death ....is the moment when we can feel much regret." At the same time, death can be a time of "happiness and peace." "As soon as we begin to practice the mindfulness trainings, .....we have happiness right in this life, and we do not have to wait for the moment of death.....then we shall know the happiness.....and shall have nothing to regret."

I had some months back the honor to care for a physician colleague in the last weeks of his life. He came to us expecting to be gone in a day, or two at the most, and lived more than 8 weeks. It was .....while not far away or in an exotic place or in a time of war or turmoil - an incredible "profile in courage." No - we do not need to go "over the mountains or across the seas" to see humanity, and caring and courage in the face of suffering .....what he said many times was that, "in hospice we treated him like family." And so many patients express this to us - they know we cannot cure them, but they want to feel that we care. And i have heard it over and over, "I'm not dead yet, i know you can't cure me but i want people to treat me like I'm still here."

Moments that we have can be golden moments, being present, just present, for a life review can be an act of significant caring.

I was speaking with a person recently who has lost a loved one, had actually been present, and told me that it was "the first time" that she had been present at the moment of death ..... and we in hospice are here day after day, in a place that becomes familiar for us ....,never ever mundane, always a sacred place of awe, always an honor to be present, but even when we cannot cure we can assist as a guide - each journey is new, each different, but we have traveled on this river before.

And so - for those of us not able to be Masters or Teachers, but wanting to make a difference, this is what we can do ....

if we cannot embody wisdom and compassion we can hope to accept from a greater power, just a little bit and to use it just for the moment, just for today....

if we cannot hope to end the suffering of all beings, let us strive to reduce the suffering of just one being, if we cannot remove it completely to just reduce that suffering just for the moment, just for today

if we cannot find perfect wisdom, let us hope to be wise enough to work together in a common cause for our patients

if we cannot have perfect faith then let us strive to act to serve the spirit we hope is present, even though we do not have perfect knowledge

if we cannot learn enough to be a teacher than let us continue the journey as students

And share the stories ........today

A wonderful thing!

As a new year starts, i am seeing suggestions that a wonderful thing is happening, which is that healers coming from different perspectives are beginning to look at what each other is doing - and learning from each other.

We aren't past a lot of the old history, and sometimes we are still lost in arguing about language or distinctions, or which one way is the right way ..... but that issue not withstanding minds and hearts seem to be opening --- and that likely is a good thing for all of us.

The past few months I've been learning from Tom Rigler, it is a wonderful opportunity - to say it most simply Tom is a good person, and tries to faithfully transmit what he has learned. In any case the past month we've been working on Munay Ki .....a series of Rites originating in Peru .... that led me to watching some You Tube sessions led by Dr Alberto Villoldo .....who left medical school to study in Peru ....and as one of his interviewers said "the rest is history."

Dr Villoldo said the following about American Medicine .... now some call what i do "Traditional Medicine" from the perspective that within American culture mainstream is traditional, and some call what we do "Conventional Medicine" - since many reserve the term "Traditional Medicine" for older wisdom and feel that what is mainstream is simply conventional .....lest anyone think "language" is not important there is now a serious dispute within Conventional Medicine about what to call phD level professionals within hospitals, that is since Nurse Practitioners now are designated doctorates in nursing - an NP working in a hospital is a doctor, but not an MD (or DO or equivalent degree from a foreign school) ..... but in any case .....

Here is what i heard Dr Villoldo say .... that Emergency Medicine is wonderful in the United States and that "if you get bit by a snake, don't go to a Shaman - go to an Emergency Room." And he added .... "but then go to see the Shaman to see why the Snake bit you."

What is important here is that a representative of what some call Traditional Medicine (and some would not allow the use of the term since he is a phD and not an MD) - VALUES what conventional medicine does well.

And at the same time we are seeing "Conventional Medicine" including Complementary techniques ...because increasingly there is a recognition that on an evidence basis these techniques often are helpful and rarely (far less often than some conventional techniques) harmful. In Hospice especially - and in Long Term Care in general .... even non-hospice .... the recognition that human connection can assist in calming people, and help with their rehabilitation, and reduce their rate of decline ..... that we can Care when we are unable to Cure ....this notion is becoming widespread.

It is because i am - really - Conventional - (though Thanks (!) to some of my Reiki friends who say, "oh no - we accept you as non-conventional" .....) within Conventional settings i am increasingly able to have these discussions with my colleagues .... and the discussions are respectful, there exists curiosity - when we made a presentation at an AMDA meeting - a national meeting of physicians in the Long Term Care Continuum we were nervous - we really worried -- but we had no need to !!! Many people stood up and said, "we need more of this type of discussion."

So in November i was able to share a presentation with a colleague acupuncturist at the State Chapter meeting of AMDA in Maryland, and in March i will do a brief Reiki demonstration at Long Term Care Medicine 2012 in San Antonio - but day by day - week by week - as we have meetings about hospice care (my national hospice, Seasons Hospice has engaged Joyce Simard, author of "The End of Life Namaste Care Program" as a consultant, and daily nurses and medical residents are asking me about how we are integrating complementary techniques into hospice care.

For now - i believe that my "Conventional Colleagues" are opening their minds, and my fellows in discovery of energy based methods are being patient with my lack of experience in ancient wisdoms. In Hospice, at the bedside, it remains my job to do the best i can to care when i cannot cure, to assist people in a transitional time .....

If people are reaching out - sharing - respecting others for what they do well .....that's a wonderful thing. This is a wonderful "ripple" to be a part of .....Thank you to all who share the journey!

Upekkha revisited

At the time of my Reiki attunements with my first teacher, Robin Hannon, i had certain thoughts that led Robin to do the drawing at the top of this Blog, and led to reflections on Reiki in Hospice which i reflected in the term Upekkha Reiki, and gifted these concepts to Robin.

There is a certain tradition in medicine that we use scientific knowledge as far as it goes, but at the end of knowledge there remains caring. And for the physician who can care, there need never be a sense of futility or defeat, the process of caring itself is a gift.

Albert Camus reflected this in his book, "The Plague," through the first person narration of Dr Rieux, faced with a plague and no treatment, yet they did "what had to be done." And Camus himself, writing this novel, trapped within a Europe rules by Nazi force.

I saw the term Upekkha used - not in terms of Reiki - but in terms (very much like Camus) of a universal struggle - in the book "The Lizard Cage" by the young and talented Canadian author Karen Connelly. Her character, the musician Teza, trapped in confinement in Burma - Connelly like Camus writing from a sense of entrapment ....and what is common in sharing stories is that "some memorial might endure."

For a hospice physician, faced every day with dying patients, suffering human beings, - we cannot cure but we can care, can do what can be done, can be present, and can tell some of the stories. In acceptance and tranquility, in finding Upekkha, we move beyond simple compassion - we find what in Pure Land Buddhism might be called a path to the other shore.

The picture is simply of the Bodhi tree, leaves lost, burning in flame, existing, light shining through .....ready to take on leaves again.

In facing life from a place of calm, and acceptance, we can be present and caring.

We are honored to do Reiki in such a place or time. For Robin,there is an attunement with this, and for me i am not yet sure if there is any different attunement that the one's we are already taught to perform. It is for me a path, a way of looking at the world and our place in it, a guide to being present for people who need our presence.

This year I had the opportunity to study Komyo Reiki Kai with Hyakuten Inamoto. And the motto he teaches is simple, "go placidly in the midst of praise or blame." ("Even as a solid rock is unshaken by the wind, so are the wise unshaken by praise or blame." Buddha, Dhammapada 6/81)

For those who cannot be cured, who are trapped in a "cage" - we who cannot cure and perhaps cannot even offer adequate compassion can be present, and remember the human stories.

For those who share the work in Hospice or Reiki, Happy New Year, with Reiki Blessings and thanks.

What really matters .....

This week i heard Rabba Sara Hurwitz speak, and for those who may not know she is the first ordained woman Jewish Orthodox Rabba (or Rabbi). It may be hard to imagine the tumult her "conferral" (or ordination) has caused, but in this Blog i want to focus on something she said that really hit home as a Hospice physician.

For all the dispute over what it means to have a Jewish Orthodox Rabbi, and i understand that may not matter for many people, certain things are clear, that Rabba Hurwitz has worked extremely hard, she is extremely bright, and she has not simply learned "just as much" as a man seeking to be a Rabbi - she is a gifted and learned human being. But in talking about being a Rabbi, the day to day stuff, it really hit home when she said, "the most important thing is really .....showing up --- being present for people."

For a physician that may often be the case. Yes - we train hard and work hard, and dream of saving lives, but when a patient has an incurable illness - "being present" can be the most important thing.

Rabba Hurwitz talked about counseling a married couple in trouble, and she talked about being present for a holocaust survivor who lost her son in an accident, and shortly thereafter lost her husband. And i think to how often i have seen patients who could not be cured, but simply wanted their doctor to care for them - care about them - just be present.

Somehow - they view us as knowledgeable in life cycle events, little do they know in medical school and residency how little is taught about dealing with feelings - it isn't a question "on the boards." How much more joy in quoting the most recent article in "rounds," or in making an astonishing diagnosis - and yet -- sometimes people are so willing to forgive us for so much - if we can just be present. The fact that we can't cure someone doesn't mean that we can't care for them.

I must admit as a Hospice doctor - there are these joyous incredible moments when i make a diagnosis everyone else has missed, and cause the turn around of a severe illness and actually discharge a patient from Hospice. Yes - it does happen. It is like hitting "the shot" in game 7 of the NBA finals or hitting a 9th inning home run, but it doesn't happen that often. Most days - i come to work, and not being able to cure anyone under my care, i continue to care for them, and most importantly be present with them --- as so many people have said to me "I wish they wouldn't treat me as if i'm dead already, I may be terminally ill but for now I'm still living."

I went to hear a speaker talk about what it meant to be the first woman Rabbi, and what i really took home was a reflection on what was the most important thing in my own job - yes I bring hard work and long years of study, but so often for the people who come to me the most important thing is that I showed up, and that for them - for that moment, I was "present," and that even though I couldn't cure them I could still care for them and share the moment with them.