Saturday, October 23, 2010

a Journey of Spirit

This Blog reflects on my journey, caring for hospice patients living the later days of their lives. It compares aspects of my own spiritual upbringing to that which I experienced in my journey to Japan, and reflects in some ways on the connections between Pure Land Buddhism and the challenges we sometimes face caring for patients in hospice.

Visiting Usui Sensei's resting place in Tokyo, one finds oneself at a peaceful, meditative place which is a Pure Land (Jodo sect) Buddhist cemetary. In biographies about Mrs Takata, an "Archbishop of the Jodo sect" is mentioned, but one cannot know with certainty exactly what this realtionship represented. Many of Mrs Takata's stories were allegorical, and she was writing at a time of intense prejudice in America.

Respected sources record Usui Sensei as a Tendai monk, and suggest that he was originally laid to rest in a Tendai cemetary and then moved to his current site. Others have recorded Usui Sensei as Christian, which is doubtful, or Pure Land Buddhist. The truth in history is beyond my grasp, but the fact is that Usui Sensei lays to rest at a Pure Land cemetary and that fact led me to reflection on the serenity and connection of Pure Land thought. I am not a Buddhist, but, people in moments of need seek a connectivity that seems to me best represented by what the great religions have in common, not in the qualities that make sects distinct.

Recently I was caring for a patient with cancer. Randy was unsconscious, he had suffered through surgery and chemotherapy and radiation therapy. Every conventional modality had been tried. He had been rejected for stem cell treatment (though I have had patients who have been through even that in their struggle). We were able to control Randy's pain, but his family family were suffering. They looked to the hospice team for help and support. Time and again in hospice, we are faced with patients and their families who look to us for guidance and for caring, when we have no tools for curing. What do we do? It just doesn't feel right to button up the "white coat" and walk away in these moments.

In these moments, all members of the hospice team become equally important. When all we can do is connect and support at a human level, there is no hierarchy. Every member of my Team is valued.

Honen was a Buddhist monk who lived from 1133 to 1212 Common era in Japan. He studied at Mt Hiei and was ordained a Tendai sect Monk at age 15. He founded the Japanese Pure Land or Jodo sect. Usui Sensei is laid to rest in a Pure Land cemetary in Tokyo. It is likely that Usui Sensei was a well educated man, aware of the teachings of many sects of Buddhism, and of Christian, Jewish and Muslim teachings as well.

One of Honen's principal teachings occurred when followers of his Jodo Shu sect saw both Honen, and his student Awanosuke, studying the meaning of "Nembutsu." "Of course," one said, "Honen's Nembutsu practice is better than Awanosuke's." Honen answered, "there is not the slightest difference between the two, because both of us have the same intention of wanting to attain birth in the Buddha's Pure Land."

What was the nature of this practice "Nembutsu?" It is repeating the affirmation, "Namu Amida Butsu" often translated as "homage to Amida Buddha," - a simple statement of faith. I have also seen this described as "save us oh Amida Buddha"using the term of Buddha as a manifestation of God the creator who is still active with compassion in the world.

There is a comparable Jewish prayer in the mystical "Hallel." It is a most basic affirmation of faith. "Ana (and then a Hebrew name for God) ho-shi-a na." It translates "please God (creator and ongoing ruler of the universe) save us."

In hospice, at moments when science has failed, a simple reaffirmation of faith and acknowledgement of a higher power that connects us can mean so much to patients and their loved ones. So much often pours out, "we didn't think we could talk about this with you." At a time when people need connection the most, and when more surgery is not an option, science should not "sterilize" the discussion of a creator from the room.

Honen was known for another teaching, and that was his belief that attainment of enlightment was not limited to the rich or to fellow Monks. Honen believed that women and men, rich and pure, fisherman and Samurai, Monks and laypersons, could all attain enlightenment, and this was revolutionary in his time at Mt Hiei. Honen defended his position based on stories and teachings from the historic Buddha, Shakyamuni.

Honen taught that in seeking enlightenment it was not enough to seek just for oneself. The search for enlightenment required assisting others. It was a similar dilemma that led the great Jewish scholar Hillel to teach, "if I am not for myself, who will be for me? but if i am only for myself, who am I?"

For those who do not believe in the revelation that there is a God who created and still cares for the world, and that all human beings are connected through that spirit - it is not for me to convince or convert. But in those moments when transition seems near, it is reasonable to talk about those strengths and connections by which the patient and the family have lived. Those who make simple affirmations of faith seem to suffer less, if at all.

Whether Sensei Mikao Usui was a Christian or a Buddhist, and if a Buddhist a Tendai or Pure Land follower, he lived a secular life and passed to the world a very non sectarian message that without religion allowed for connection to a Universal spirit through simple method.

These 5 affirmations seem consistent with most of the major religions, and seem to help reduce suffering.

1. We will not worry just for today (since we Affirm faith in a Creator)

2. We will not be angry just for today (since we ask the merciful Creator to forgive us all our errors just as we forgive others)

3. We will work hard today (since human beings of all stations in life can reach enlightenment, we all need to do our own share)

4. We will be grateful just for today (for what the Creator does for us)

5. We will do kindness just for today (to enlighten and connect oneself one must attempt to help others - we send ripples of compassion into the world)

When we return to that which we all have in common, rather than focus on that which makes us distinct, we are more able help others through a difficult part of their journey.

Saturday, October 16, 2010

Sometimes Life seems hard

Sometimes Reiki meditation helps us in keeping a perspective, and understanding what it means to "be grateful." Right now, it is difficult to be a primary care doctor in this country, and in talking with colleagues every day, I hear and am aware of the frustrations. And this Blog is not intended to enumerate these concerns, nor to minimize them, when young physicians are choosing not to enter primary care, and experienced physicians are leaving their careers prematurely, it is a cause for concern, but the intention of this Blog is to reflect on other stories, of people who overcame tough challenges in life, and made a difference.

Reiki as we know it in North America became widespread due to the efforts of Mrs. Hawayo Takata. People are seeking to understand more about her allegorical stories about Reiki, and to understand more about her life. Much is private and some that was taught in allegory is not clear, but certain things are clear. Mrs Takata had many difficult challenges in her life. Things did not always come easy.

Before she was 30 years old, her beloved husband passed away of lung cancer, and she raised two children as a single parent. She had to work hard. She had health challenges herself. When she was 40 years old, her Reiki mentor died, and she was alone in Hawaii as a widow with children, an American of Japanese decent, at a time when Japan and America were going to war. Perhaps the truth most important to keep in mind as we seek to understand what she gifted the world with, was the simple fact that in the face of personal hardship she worked very hard, and gifted the world. Her biographies mention some of her hardships, and some of the prejudice that she faced, but do not dwell on them. The common thread to the stories about Mrs. Takata is that she maintained a cheerful countenance, used her talent to help other people, and sent forth ripples of compassion that still spread.

This past week, I had the honor to hear another such story. A nurse, Deb and I were making a home visit together to meet a new hospice patient. We went to her home, where her husband was caring for her, as she continued her long struggle against Alzheimers Disease.

With all the stresses on our time, we feel it is important to take the time to get to know our families, and in this case her husband gifted us with his story. He is a retired fellow physician, and the story of his life as a healer is one all doctors today need to keep in mind.

He went to Meharry Medical College, until the early 1970's, almost 25 years after Jackie Robinson played for the Brooklyn Dodgers, African Americans were only admitted to 2 medical colleges in America. It is hard to believe. But true.

He shared that his father was also a physician. And he remembers when his brother's high school was closed down, his brother had to walk 7 miles a day each way to go to school. His father, in 1947 began a lawsuit against the school district, but things moved slowly, and they lost at local court levels, with the justice system permitting racial segregation in schools and lack of equal opportunity in education. As a child, he remembers then NAACP lawyer Thurgood Marshall, coming to their home, and listening to his dad and brother's stories. When lawsuits from several states were "merged" to be presented by Thurgood Marshall to the Supreme Court, this case was one of the cases which became a part of what was named "Brown vs Board of Education." And in 1954, the Supreme Court of the United States declared that segregated schools were illegal.

Sitting in that room I felt a sense of awe and honor. I came to help this family, but his story was helping me. It was placing the challenges of my own day in perspective. My patients husband was facing life as he had always faced life, as his father had taught him to face life, without worry or anger, but with a determination to be a physician and spread kindness to others.

Deb and I were sitting in a room connected to a moment of history most important to our country, but we were being gifted as well with a perspective on how to face challenges.

When things are difficult as a health care provider, all I need to do is see the challenges my patients are facing. They are so often stories of courage.

In a prior Blog I wrote about one of my patients who was brought to my in patient unit, with the intensive care facility of a referring hospital expecting him to die in a day or two. He was bowel obstructed, and medically we saw no hope. We cared where we could not cure and our chaplain prayer with him, and did Reiki with him, and somehow, he did not die right away. After a month, we agreed to send him home, and he lived another five weeks - it seemed whenever we talked with him he was praying for other people he loved, Blessing other people, or thanking God for what he had been gifted with in life.

Some people see the challenges they face, and do not allow themselves to absorb the worry and anger of the moment. A doctor who had to face terrible prejudice just to be a doctor, persevered and took part in a quiet action that changed the soul of America, and Mrs Takata, a facing personal loss, and at times prejudice in her new land, left a legacy of compassion that has a very wide impact today.

Whatever the details of the stories, and however they are written or not written by history, there is a precious human lesson - we are gifted when we listen to it.