Tuesday, June 23, 2009

Head toward the light

My wife and i had a wonderful opportunity to travel to Scandinavia, and saw the work of art, "The Scream" by Edvard Munch. The curator at the National Gallery of Art in Oslo, described this existential moment as coming from "anxiety, alienation, and loneliness."

In stark contrasts of orange and blue, a man with blurred facial expressions and open mouth, is screaming in a primal way. He stands on a bridge, amidst passer bys who ignore him and go their own way.

And in that moment looking at that picture, i thought about the difference between what happens in traditional medicine when someone cannot be cured. Too often, "professionals" wear the "white coat" and maintain "objectivity," and we hear phrases like "nothing can be done," or "put your affairs in order," or "you have only a few weeks or months to live."

Hospice is about doing better. Evidence based studies show that Simple Human touch through methods like Reiki can reduce "worry." Focus on the preciousness of the time we share can reduce "worry." Accepting the possibility that Death is but a "Transition" and not a "finality" can reduce worry and offer Hope.

It is amazing to me that almost all indigenous cultures believe in a after-life. Almost all major religions - East AND West, have a faith a some sort of "world to come." Jewish faith calls this "Olam Ha-Ba" or the "world to come." Christianity, Islam, and Buddhism all assert faith in the continuation of the soul or consciousness in some way, and yet, faced with an inability to prove scientifically one way or the other what occurs on the "other side," science tends to presume that "death ends it all," leaving the sick patient deprived of hope.

Worry, alienation, and loneliness are scourges of modern medicine. We must use evidence based practice whenever we can, it is a wonderful tool, but we must realize when evidence based medicine reaches its limits, the human spirit is connected, and faith and hope can be given when "cure" cannot. We can continue to care.

In seeing this painting, i committed to rededicate my own efforts that in hospice, we would not leave our patients alone, to face the primal scream of anxiety and alienation. Those who we cannot cure, we can still connect with, we can share precious moments with them. we can alleviate their pain, abolish their sense of alienation, and make sure that they do not live alone or die alone.

With commitment to the spiritual strength that each human being carries through their personal history, using methods such as Reiki to assist us in focusing on connection, and presence, and simple touch when appropriate, we can add the color of the sun to the canvas, and assist our patients in heading toward the light.

Life is a Gift

I received an email from Judy, one of our nurses, and it touched me as being part of the heart and soul of hospice, as well as my Reiki method. So i asked for her permission to include her note in my Blog.

Thought I'd share something with you all, since I was kind of surprised
when just seeing the email that Ms. Campbell died today. When I saw
her for Jen about 2 of weeks ago, Ms. Campbell looked at me and said, "So...how much time do you think I have...2 weeks?"

I was surprised she said that, since she looked fairly "stable." My answer was not exact, since I don't feel comfortable giving a definite time. I tried to reassure her that we'd just take things day by day and she seemed comforted by that answer.

With many of our patients, they do seem to "know" when their time has come, and with this case, she really did know.

Just a reminder to us all how "precious" those last days/weeks are for our patients, and how it's not a coincidence that they die on certain dates or predict a certain time to leave this world. Life is a gift.
Take care,
Judy H. Johnson, RN, BSN, CHPN
Resource Nurse
Seasons Hospice and Palliative Care--Baltimore cell (443)615-4169

Monday, June 8, 2009

don't cash in your chips

One of the things that amazes me is that we cannot always imagine who we can learn from, if only we are open.

Today i was visiting in a Nursing home, and came upon a patient who was quite dissheleled. He was in his wheelchair, unkempt, unshaven, and not appearing to be a source of wisdom.

He surprised me. James usually is quiet, sometimes surly, rarely open and frankly - often rude to others, but today was different. He seemed to want to talk.

"Doc, I'm disabled," he said, "but I've never been an invalid." "That's true," i said, curious to what more he might say.

"You meet the best friends in the strangest places," he said. I listened. "When my wife left me, i thought i was done with - you know - caring about the other sex, but i found someone here i care about."

"I was fine until 2000," he said, "when i had a heart attack and the quadruple bypass. I recovered from that, but then i had a stroke. Then my wife walked out on me and divorced me. I fought me way back, worked hard at rehab and i went home. I could walk a mile a day until the accident."

Aware of his amputated right leg, i asked, "how long ago was the accident." "Three years," he said. I knew that but wanted to keep talking. "I'm waiting for my prosthesis to come in. I've been waiting three years." He had had an infection and his stump was not suitable for a prosthesis, but i kept that information to myself today. "When the prosthesis comes in I'm going to walk again," he added.

"Life is like the stock market," then adding, "you haven't really lost as long as you dont cash in your chips. And I'm not ready to cash in my chips."

"No your not!" I said emphatically.

"I have a lot to live for," he told me, " 3 grandchildren and a fourth on the way this October. And i have a friend here i really care about, never thought that would happen again."

I put my hand on James shoulder, "thank you for sharing so much."

"Thank you for listening."

I felt a tremendous light streaming into our nursing home. I would not have thought James could have accomplished this. And i was thankful for being a part lof the moment.

There is a Gendai Reiki prayer i was taught. As we are connected to the light of this pure energy, we are taken to "a higher dimension. You are blessed with the healing energy of love and harmony. And any unbalanced energy such as worry, anger, sorrow, pain and anxiety simply cannot exist at this level."

Every day we need to keep in mind, that as we strive to help others, we need to be open to receiving lessons from them. One never knows where one can find a teacher.

A Time for Change

This post is devoted to an email sent to me by Reiki Master, Hospice RN, friend, and author Janny Adkins, of Nashville, Tennessee.

I ask that prayers be offered for Janny's daughter-in-law, Brook, and that Reiki Level 2 and above practitioners send Reiki healing and support for Brook and for Janny. Brook was just discovered to have a pelvic mass.

Janny's email was moving in its appeal for Brook, but as well, it set off memories in my own mind both of childhood, and of last week.

Last week my partner, Dr Deborah Burton, gave Grand Rounds on Hospice for the Johns Hopkins Residency in Internal Medicine at Sinai Hospital, Baltimore. And one of the things she talked about was that, the time has ended for dismissing patients with bad news in a non caring "scientific" way. No longer should a patient be told "get your affairs in order" or "you are beyond hope."

About 50 years ago i can remember my Mother being extremely upset. Upset, and angry as well. A second cousin in Boston, a child i did not know well, but someone whose parents were dear to my Mom, had just been diagnosed with leukemia. Of course today, modern science cures some cases of leukemia, kids have a fighting chance, but at that time, science did not as yet have any answers. And when the parents of this 5 year old about to die broke down crying, he said, "the crying room for parents is there." He felt the need to retain "scientific objectivity" and "just do his job."

In some regards, the job of a doctor or nurse always has been to care, and it remains so. The fact that science allows us to cure some illnesses, does not change the human equation, that many illnessess still lead to death (what in Reiki we call transition), and all human beings eventually pass on from this mortal life.

The fact that we cannot cure does not mean that we cannot care and connect, and Graduating Medical School should reinforce this concept, not absolve one from it.

Dr. Burton and Janny are so right, the time has come when this horror has to change. Doctors need to be aware of the importance of their timing, and how information is delivered. We must never forget that science is sometimes "trumped" by that which we do not yet understand, and that where there is prayer there is hope. Where there is human connection, there is not loneliness. Where there is Hospice and where there is Reiki, there is Caring even if there is not Cure.

Janny is such an eloquent person, i ask that we read her email and think about how important Hospice is, how important our mission is, and how Reiki can help in this mission. And i ask that prayers be sent to Brook, since we can show that we care whether or not we can cure.

"Harold, Thanks for updating me. I enjoyed your Blog, and the news about your hospice team and Reiki is very exciting. It is the future of healthcare now. Reiki is such a reliable tool for me. It continues to grow in my heart that when a hospital gives me an opportunity to teach staff and patients the info in the book, I will accept that challenge immediately. I do not know what God's plan is for me but working with people like yourself, continuing the pursuit of integrated healthcare is what I want to do on the planet. Healing must happen within all of us in order that healing can be integrated into the traditional health care system.

My recent family experience with my 37 year old daughter in law has confirmed the thoughtless manner in which traditional healthcare treats people. She has been diagnosed with cervical cancer, invasive...and the CAT Scan last week indicated she has a golf ball sized mass outside of the uterus and near her spine. The angels tell me that this situation is not as bad as it seems, so I am holding on to that. Realistically she could have had this mass for a long time and it could be benign. There are two spots on her liver, which I hope are cysts.

But, it is how this information has been delivered and the timing, and the overall approach that is convenient to the system and not Brook or her family that is so distressing. That so has to change.

Please send Reiki to her and her family. You are a light for me Harold. You always bring hope for change with your email.

Thank You for Being You. Love and Light,

Janny E. Adkins, RN,BS,HS-BCBoard Certified Holistic Nurse
Spiritual Coach Nashville Metro Area 615-210-5083
Janny's new book "Help Healing Happen A Holistic Guide To Redefining Health,Hope & Healing" is available on Amazon.com

Saturday, June 6, 2009

Turning points

It is sometimes with reflection that i think on various turning points in my life. Things happen to us, and our lives change course.

There was such a moment early in my 3rd year of medical school. I was with a large group of students and interns making rounds, and we came upon a very alert, but elderly and frail African American women. She politely asked my senior resident, "am i a diabetic."

He ignored her but she politely persisted, "my tray came today and it said diabetic, no one ever told me i was a diabetic." And i can remember the moment vividly, he turned on her and said "shut up and eat what i tell you." And in a flash i could not stop myself from saying, "you can't speak to a person like that."

The matter went to the Dean. And like so many things in life, fairness is not always apparent in the moment. The senior resident was validated and i got into serious trouble. "Who did i think i was?"

There had been some other issues on campus, i had supported some "radical" changes in health care such as "patient bill of rights" (now long a reality), the right of a patient to make health care advance directives (now long a reality), and the need to integrate Medical Schools both in gender and race (now long a reality). But in 1970, over 20 years after Jackie Robinson had first played for the Dodgers, there had not been an African American in a New York State medical school, and a class of 114 had 4 women and was all Caucasian.

My Dean reflected that i was a "self styled new breed of Physician."

And in that moment, i took to heart that becoming a physician was something precious for me, an opportunity that i did not wish to lose - but at the same time, that within my own practice and effort i would do what i could for social justice and for fairness.

I have spent many years in primary care, working in Nursing Homes, and working in Hospice. Some of the "social change" that i advocated years ago, has occurred within the time of my career.

Overriding this has been the nature of being a physician caring for patients near the end of mortal life - that sometimes we can cure, and always we can care. It seems perhaps, that the most important aspect of the equation has never really changed.

Everyone who works in Hospice has a story, a reason why, an aspect of their lives that made them choose to do this work.

Bringing Reiki to Hospice, i find that Reiki is very simple. It is a method that attempts to connect to the Spiritual Energy that unites us all. It isn't a religion, and for sure it is not the only method of "connecting."

In finding our own "turning points," and in connecting, with one method or another, to our patients and our co workers, we sustain our need for the energy to do this precious yet challenging work.

Tikkun Olam

Tikkun Olam is a Hebrew term and it means to repair the world, or as i prefer to think of it, to heal the world.

Hospice brings about a state of Tikkun Olam, because our Team reaches out to connect with human beings in need. It does not matter their background or our background, and it does not matter that we cannot cure them. What matters is that for a moment in time, they are struggling with a part of life, and we are reaching out to connect and to help. Caring can occur even when their is no "cure," and that is the essence of "healing."

During my time as Medical Director of Seasons i have been very moved by the caring of the whole Team, reaching out to the patient at home. While some of our patients receive "in patient' care, most by far are at home.

Because of my own commitments to caring for disabled patients in nursing facilities, i have not had adequate time to make home visits. The home visits Dr Rajapakse or Dr Burton or myself have made have always been very moving, but we have not been able to make enough.

Recently, Dr Gary Applebaum agreed to join our Team, and not only help in Team meetings, but also to do home visits.

Dr Applebaum for those who don't know is an experienced Geriatrician, was one of the first Geriatric fellows to train at Johns Hopkins in Geriatrics, and was the chief medical officer of Erickson communities. He did not require a position of this type, and accepted this mission only as an act of caring for other people, a desire to make the world a better place, an act of "Tikkun Olam."

I wanted to in this Blog, thank Gary for joining Seasons, and most of all thank him for doing the home visits he is doing. And to thank the social workers, chaplains, music therapists, home health aids, volunteers, bereavement counselors, nurses, pharmacists and all the Team members who reach out to allow patients to live meaningful days in comfort at home. We neither prolong nor shorten life, but we make sure that patients are not alone, know that someone cares, and relieve pain and suffering.

Everything in the world is connected, when we give caring and compassion to even one person, we help to heal the world - we bring light to combat loneliness and hatred, worry, anger and despair.

This is what Hospice care is all about. Thank you all for being a part of this Journey, to help to heal the world.