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.

Reiki Byosen for the Physician or Nurse

We have been working with a simple technique to allow non Reiki trained physicians and nurses to be more aware of natural channels. I often feel that as a teacher, the task comes down to helping people to be aware of those things that they already have the natural talent to be aware of if only they "listen" closely to the world around them.

Doctors and Nurses are trained in classical physical examination to "Observation, Palpation, Percussion and Auscultation." It resonates with health care professionals, because we all understand the tendency to rush to auscultation (listening with a stethoscope), and we all know from our training that observation and palpation are classic techniques that matter.

Studies consistently remind us that about 70-80% of accurate diagnosis comes from careful history taking, and that an additional 15-20% comes from observation and physical examination, and yet, laboratory testing - which only accounts for about 10-15% of accurate diagnosis becomes the reference point too often. We sometimes forget that when a lab test does not correlate to the history and physical exam, what is really "going on" - it is often the laboratory which is not correct.

So with student doctors and nurses rounding with us in hospice, we focus on classic physical examination - we focus on observation and palpation prior to auscultation. In fact, in hospice, we so rarely use laboratory testing, that use of our physical examination skill becomes even more important.

Palpation over the pre cordial impulse, the middle of the chest, corresponds to the Heart Chakra. And from the perspective of physical exam there is so much we can appreciate through our hands. Breath sounds and murmurs heard through a stethoscope are "vibrations" - so often they can be "palpated" and we can appreciate heart rate, heart regularity, many murmurs and breath sounds. In dehydrated patients (which hospice patients often are) - often sounds are missed with stethoscopes - but corresponding vibrations can be palpated. Training our hands to be more sensitive is just like training our ear to discriminate more with the stethoscope.

But so often - by spending a little more time observing and in contact with patients, we become aware of more than just the physical vibrations. If nothing else, when we ask patients for permission to examine them (and we always ask permission before touching anyone), the contact and the time spent are important. For people with intuitive tendencies, they often become aware of more of what is actually "happening" to the patient, on a spiritual as well as a physical level.

It is not always easy to integrate "scientific" observations, with intuitive observations happening at the same time. So often, people lock out one or the other thinking the "signal" will be clearer if not "confused" - but in fact with time and practice for an experienced clinician (and of course only a licensed clinician can diagnose) - being holistic and bringing all our sense to bear improves our accuracy. At the least - it improves our contact with our patients at a time when a sense of connection is often what the patient wants, since in hospice, cure is already not scientifically possible.

It is important as a physician to realize what a precious gift our scientific training is, but at the same time respect what Reiki Practioners can accomplish with years of practice - Reiki after all is a healing art form and not a scientific process - and it really cannot be "distilled" in the same way as our "material" observations and tests.

From the Reiki classes i have participated in, I have an awareness of how much talent that some of my teachers and classmates have. One can become a Reiki Master in a relatively short period of time these days, but that is the "beginning" of studying Reiki as a method or process. Several years along, having been trained as teacher in multiple styles, having participated in shares in Japan and Vancouver, Barrie Ontario and in Maryland - having visited Kurama - I can reflect on how early in the Reiki journey I still perceive myself to be.

Integrating holistic care at its best doesn't mean a physician becoming a Sensei, it means physicians opening their minds and hearts to new opportunities, and experienced Reiki practitioners being available to assist as participants in an overall plan of care. This is most evident in Hospice, where Spirituality is so central a part of the mission, where Science alone has failed the patient, and where Hope stems from connection and continuity.

We need to be cautious with certifying "Complementary" methods within the health care professions. "Alternative" pharmaceuticals, minerals and nutritionals certainly can be tested in classic scientific ways, and brought into the mainstream. Art forms such as Music and Reiki touch the spirit, and are skills that having a Health Care degree may not make us more qualified to assess.

I would rather have Musicians judge intonation, and Reiki Sensei who have devoted their lives to Reiki method set standards for Reiki - than those of us who have spent so much time learning anatomy and physiology and pharmacology.

We are all still on a journey of learning more - in acknowledgement of those things which we have yet to learn, we are likely better at what we do for keeping a sense of humility.

Robin's Song

I receive many messages every day through my connections through Reiki. And today i received a message from my first Reiki teacher, Robin Hannon, which moved me to share on my Blog. Robin placed on You Tube a version of "Amazing Grace" which she sang commenorating her father, and it was rendered in Cherokee.

"I am on YouTube singing Amazing Grace in honor of my father

http://youtu.be/zrXphbyrTOk

Robin Anekehee Littlefeather"

When we connect to spirit, it enriches us. When we are compassionate to others, it heals us. There are in each of our cultures "noble spirits" who represent the best of what each culture can attain. They provide examples for us. And at our best we see the connection between one culture and another, the common traits that bind "noble spirits" of one culture with those of another.

If you forget the words, remember that there is a tune. If you forget the tune, remember that there is a song. If you forget that there is a song, retain within you the spirit and the memory, and some day you will hear the song again.

Whatever language it is in - it brings us together. And thanks to Robin for sharing.

Transitions

We have been having a dialogue within my Hospice regarding the use of the term "death" and the the term "transition."

It has been said that "words have power," but in the process of this discussion we have all learned that different people use words in different ways, and that what matters most is what each person actually means. Respecting each other, and respecting each other's words, is an important part of working together as a Team.

To some degree this dialogue began when my friend Jackie Vance RN, who directs the Clinical Practice Guideline program for AMDA (a conventional national organization for physicians who work in the Long Term Care Continuum) wrote in her Blog that the term "discharge" should not be used. This reflected a thought of the AMDA "Transitions of Care" committee that people "transition," they are not "discharged."

And I reflected in a comment to Jackie that language reflects how we look at our patients, and at ourselves.

The TOC committee felt that patients should not be viewed as gotten rid of, and that communication should reflect continuity. And continued caring.

In a paper presented in March, myself, Dr Rajapakse, and Dr Crecelius (a former president of AMDA and Chair of Public Policy Committee) reflected on discharge by "death" vs the term "transition"

Death to us implied "the end -finality - fear of the unknown - loss - hopelessness - loneliness - lack of connection - anxiety - fear"

Transition to us implied a sense of "hope - connection - ainticipation of a journey - a focus on living the current moment - calm - peace - harmony"

And I concluded "death like transition are words draped in despair." Jackie published my comment with her excellent Blog

http://www.mcknights.com/transitions-of-care-part-ii-so-you-know-they're-eventually-gonna-have-to-leave-right/article/208210/

When i published comments within my Hospice, many of my co workers began to follow my terminology and talk in terms of patient "transitioning."

And the good part of this is the opening of dialogue, and the openness to spirituality. But we have had some problems - just as some co-workers feel uncomfortable having spirit suppressed by the term "death" - some co-workers feel uncomfortable with the term "transition." We speak of "time of death" in a professional way because it is clear and succinct; and some people do view death and the terminology surrounding it in a spiritual way.

And I have come to believe that it is important to promote dialogue and respect everyone's words. What is important is respecting the spiritual history of the patients, and being present and caring as well as being technically skilled and accurate.

In the bond between human beings, we are team mates and patients and parents and children - and we all matter more than our physical form. And hospice to some degree is about that - not simply the relief of physical pain, but as well the relief from "suffering."

When I started this discussion about the difference between the words "death" and "transition," I was more certain of the importance of the difference between the words, but as time goes on, I am more certain of the importance of the dialogue, and of the need to proceed with respect always for patients and for colleagues. I am happy to work with a Team where the dialogue is carried on with respect, and where the spirit behind the words really does matter.

Komyo Reiki Kai in Barrie Ontario

In my own ongoing Reiki journey, a recent weekend in Barrie, Ontario was very moving for me. My friend Lorinda Weatherall was hosting a class in Komyo Reiki Kai taught by Hyakuten Sensei, and i decided to attend. There were 20 students, all experienced Reiki teacher-practitioners, including 8 "retaking" the class. By Sunday afternoon we realized that at lunch or dinner or over coffee, effectively each of us had gotten to know each and every one of us - no formation of cliques, everyone outreaching and connecting, and that made the sessions and the energy very special.

Hyakuten Sensei teaches a style of Reiki which is both simple and elegant. He was taught by Chiyoko Yamaguchi (1921-2003) who herself was a student of Chujiro Hayashi (1879-1940).

At all levels Komyo Reiki Kai focuses on the Five Precepts, which are translated slightly differently than what is taught in Takata based lineage.

Kyo Dakewa Today Only

Ikaruna Do not anger

Shinpai Suna Do not worry

Kansha Shite With thankfulness

Gyo Wo Hageme Work diligently

Hito Ni Shinsetsu Ni Be Kind to Others

And a "motto" - "Go placidly in the midst of praise or blame"

And how wonderful for conventional physicians and nurses to have access to this philosophy, which is so complementary to conventional care!!! How can we calm others, and bring compassion and hope to a situation if we cannot first focus and calm ourselves, and be free as we can be from rushing and worrying?

How sad it is to see physicians and nurses, healthy and with a wonderful career, who are so caught up in the frustrations of the health care system that they lack gratefulness for their own day to day lives.

It seems to me that this approach, assists us in being better doctors and nurses.

As i continue in my own Reiki journey, i find that empowering others is increasingly important to me. Patients with incurable illnesses feel their lives so out of control. Helping them find a sense of control in the smallest things in life, starting with their own breathing, is so important.

We have been Blessed with volunteers who want to provide Reiki. Even if I could be just as effective as all my Reiki volunteers, and so many of them are so well trained, it makes more sense for me to empower others to participate in helping patients, and focus on working with my team and maximizing the conventional tools that we have. Full time Reiki practitioners should not fear physicians being trained in Reiki and "taking it over." The more one practices Reiki on oneself, the more on is guided to having less ego, not more, and to doing that which is most constructive for bringing compassion into a situation.

Today i received a wonderful email from a local Reiki practitioner who found my program listed on the Center for Reiki Research list of Reiki programs.

To be a volunteer in a Hospice in the United States, one must simply take a brief volunteer qualifying course, taught for free by all hospices. It is then good nationwide. Whether Hospices understand Reiki or not, Volunteerism is a part of the formative heart and soul of the Hospice movement. And you will find an increasing number of Hospices overjoyed to have Reiki volunteers.

The fact is in my area, most of my "competitor Hospices" are happy to have Reiki volunteers. And continuing to be a conventional physician, my day is long and complex enough that it makes the most sense for me to do those things that others cannot. Reiki is simple - and spiritual - in can include touch but as we have been taught in level two, Reiki does not even require touch - it is not massage.

Hospices are increasing coming to understand though that versions of "simple touch," just simple human contact, holding a hand, can be reassuring and calming to people caught in a web of suffering. Even non verbal patients can be aware of simple touch, or Reiki with or without touch.

Presence matters. It matters to not be alone.

To Lorinda for organizing the weekend, to Hyakuten Sensei, and to all the Reiki Practitioners who shared the weekend in Barrie, Ontario with me - thanks and gratitude.

Is Reiki Still Alternative?

For those who want to be volunteers in Hospice, and practice Reiki or other forms of integrative care, it is important to be aware how far "conventional medicine" has traveled in the past few years. Thus - the question - is Reiki still "alternative."

From a definitional point of view, the NIH //nccam.nih.gov

defines Complementary medicine as "together with conventional medicine, such as use in addition to usual care to help lessen pain."

Alternative Medicine is defined as "in place of conventional medicine."

Is conventional medicine limited to only treating disease and not treating the whole person? Is conventional medicine limited in its scope? Do medical school fail to recognize the growing evidence base involving not only Reiki, but music, aromatherapy, and other modalities.

I wanted to list a few web addresses that would suggest that Integrative Medicine in general, and Reiki in particular, has become far far more "conventional" and mainstream than we sometimes realize.

At the least - for those wanting to become involved in Hospice Programs, and wanting to approach medical directors armed with information, these websites provide at least a substantive argument that an end of life program not offering integrative options is itself out of step with evidence based practice and the leading edge of thought in medical schools.

www.umm.edu/shocktrauma/patient_information/laura_forsythe_success_story.htm

This is a story from the famous Shock Trauma center, of a young leukemia patient, assisted in care by Reiki, who recovered and is now a Reiki Master.

http://www.columbiasurgery.org/news/healthpoints/2011_spring/p3.html

An article about Reiki used at Columbia Presbyterian Hospital for breast cancer care.

http://nccam.nih.gov/training/videolectures/mindbody.htm

A Continuing education for physicians (open to public) by a professor of medicine and associate chief of Psychiatry Stanford School of Medicine

http://nccam.nih.gov/training/videolectures/integrative.htm

A continuing education for physicians open to the public by the emeritis Chancellor Duke University School of Medicine

www.siib.org

a not for profit think tank doing research on care of wounded warriors for the US military

http://my.clevelandclinic.org/departments/integrativemedicine/default.aspx

the Cleveland Clinic website for integrative medicine

http://fontherapeutics.com/integrative-medicine-centers/

the Mayo Clinic website for integrative medicine

The wave has not fully run its course, but mind, body and spirit in a holistic framework are certainly being included within the conventional mainstream. Continue to share stories - the sharing of stories is a part of the ripples in the wave. Stories remain a part of the heart and soul of Hospice.

Thanks to Lorinda Weatherall www.a-w-etherapies.ca/

for sending me some of the links.

Reiki Ripples

The question of whether Reiki works by, or without, intention (this question keeps raising itself in varying discussions) perhaps is best approached not with specificity of language, but with stories that illustrate how the twists in life may somewhat bring us to a place where we smile.

Sometimes the path is as easy as "hands on hands off," and sometimes, the path may wind through the forest until it reaches a quiet place, and we hear music through the trees.

This past month was sort of like that.

Three years ago I began, with the assistance of my first Master Teacher Robin Hannon, a Reiki program within my hospice. I requested approval of a Reiki policy, and we began training staff and volunteers who wanted to participate. Slowly, the culture in our hospice changed. Without reducing our commitment to evidence based conventional practice, we began adding Reiki and Complementary techniques with the mantra that we could care even when we couldn't cure; that spirituality and connection were important at end-of-life.

Staff, even those who had no Reiki training, began to refer to death by a different name, "transition." And staff began to talk about their own feelings of spirituality as they helped patients face the later days of life. And the focus became more how people lived than how they died. "Burn out" became less a problem. We saw surprising results, and it was moving to be part of.

This past month, our national program sent a consultant to start a new program, and our site was a pilot. Joyce Nimard, author of "The End of Life Namaste Care Program for People with Dementia," came to elevate our focus and sensitivity in these areas. And she did. Because even though she found a medical director who was committed to the program (the fear was that the medical director would be the obstruction, and, while in some places that may be true, increasingly, physicians have been exposed to Reiki, and more and more physicians are "open" to mindfulness techniques.)

Joyce looked at everything we were doing, and made wonderful suggestions - it was great synergy. And as we talked it also helped to point out how much change has occurred, and how Reiki is becoming a part of the mainstream, Joyce's husband, who has supported her program and wrote a forward to her book, is Ladislav Volicer, MD who just retired as Clinical Director of the Geriatric Research Center for the VA in Boston, one of the most respected geriatricians in the world.

I also found out that a Reiki colleague, has been asked to consult with one of my competitor hospices. And this week I had lunch with one of my favorite Social Workers, a caring professional who has recently completed Level 2 Reiki, and he has accepted a promotion to go with another competitor hospice, part of his position to assist in the expansion of a new Reiki outreach to patients program.

This month I visited Nursing Homes in a more distant portion of my state, and rounded with a Nurse Practitioner colleague who I had encouraged in Reiki. She had been suffering from headaches and conventional medicine was not sorting it through for her, I helped her with some Reiki and she and her husband went away together to take a class with Amy Rowland, one of my teachers. Her headaches went away. Nurses and an Administrator were talking about how they could put together a Reiki class, and Dementia care could be changed by adding Reiki, Music, Aroma therapy, and a patient centered approach to rooms and life in facility. Ripples keep spreading.

Three years ago, I did not know exactly what path Reiki Ripples would take. I have not controlled the Ripples. One could perhaps simply say, "Reiki on, Reiki off." But in another sense, not from a place of "ego" and "self" but from a place of connection and wonderment, we may reasonably have "intention" that compassion may flow. Less perhaps as a sense of "power" or "I" - than from a connected place as part of an infinitude of life. A "prayer" - that suffering may be alleviated (for an individual or for a community).

Discussing a presentation we had made at Long Term Care Medicine 2011, I was surprised to find out that we are now "mainstream" - can't call ourselves "alternative" anymore, since increasingly evidence based studies are supporting Reiki as complementary care to conventional medicine. Many medical schools include introductions into their curriculum, and many Hospitals include Reiki Nurses into their programs.

It is not what i expected when I started this journey. I could not have controlled what happened, nor could I have predicted it.

I suppose there may have been a sense of intention in all this; not the intention of power, or increased vibration, or even the intention of asking for a specific result, but intention as a form of humble request to the llife spirit that connects us all.

There is less a sense of accomplishment here than a sense of awe. And a hope (or intention), that as more ripples come together more compassion will spread through the world.

Reiki and a place of calm

In demonstrating Reiki at Long Term Care Medicine 2011, almost every participant described a sense of relaxation and calm. From a Reiki prespective, this is not unusual, Focus, Breathing, Reiki Energy, an awareness of precepts avoiding worry and anger and expressing gratefulness and compassion, lead to a sense of calm.

...Recent studies suggest however that these attributes are especially important for physicians, and as a result, for their patients. American Medical News, a publication of the AMA noted a study just published that concluded "The hypothesis of a positive relationship between physicians' empathy and patients' clinical outcomes was confirmed, suggesting that physicians' empathy is an important factor associated with clinical competence and patient outcomes." (Academic Medicine, 2011 Mar;86(3):359-64 Hojat M, Louis DZ, Markham FW, Wender R, Rabinowitx C, Gonnela JS)

...For doctors, nurses, and volunteers seeking to introduce Reiki programs into their institutions, Reiki being a method that has a focus on connection and calm is reinforced. Another powerful study was published in JAMA (2009 Sep 23;302(12):1284-93 Krasner MS,Epstein RM,Beckman H,SuchmanAL,Chapman B, Mooney CJ, Quill TE). This study, "Association of an educational program in mindful communication with burnout, empathy, and attitudes among primary care physicians," concluded, "Participation in a mindful communication program was associated with short-term and sustained improvements in well-being and attitudes associated with patient-centered care. Because, before-and-after designs limit inferences about intervention effects, these findings warrant radnomized trials involving a variety of practicing physicians."

...Evidence is piling up in such a way that colleagues since our presentation at LTC Medicine 2011 last week have commented to me that, modalities such as Reiki, Acupuncture, Aromatherapy, and Music Therapy "have so much support that they are now being considered evidence based."

.... I want to keep promises in this Blog to people I met last week in my journey. Flying from DC to Tampa, I shared the journey with a man traveling to see his 39 year old daughter, Lisa. She had a terminal illness and had recently entered hospice. Hearing that I was a hospice physician, he shared her story, and I promised to add my prayer on her behalf. I have done so every day since. Flying back home I sat next to a Wounded Warrior. Derek had served his country in both Iraq and Afghanistan, and he was in prolonged recovery from serious wounds. His bravery in service to our country, and the sacrifice he and his family have made and continue to make are compelling. I continue to keep him in mind in my prayers.

....My teacher Amy Rowland, reminds me how transformative shared experiences can be, both for ourselves as individuals, and collectively to the human race, at a time when we so need (both individually and collectively) connection and healing. Methods that bring us to a place of calm, and allow us to provide empathy and compassion to others, make us more effective health care providers and happier human beings.

...A new friend wrote me this week of her efforts to start a Reiki program in her hospital. She had done a lot of work, and collected a tremendous amount of supporting information, to do a presentation - when the time came, her hospital CEO said, "we don't need a presentation, just add Reiki to your department and just start doing it."

.... Things "grow from experiences shared" - just for today, don't worry and be grateful - and please add a prayer for Lisa and Derek who I met on my journey.

Note: - the photo at the top of this Blog is of a work by Apache Sculpture, Bob Haozous. It was erected by the city of Tampa, in memorialization of the Seminole Indians forcibly removed from their homes and relocated to Seminole, Oklahoma. It reflects on the interconnection of all human beings, and on the obligations of all human beings to the planet.

Reiki at Long Term Care Medicine 2011

Yesterday at Long Term Care Medicine 2011, the annual symposium of physicians caring for patients in the Long Term Care Continuum, I presented a session on "Complementary Medicine for pain management in end of life care" with Dr Chuck Crecelius and Dr Sharlene Rajapakse. While this session was not "about" Reiki directly, we did use Reiki as a demonstrated modality - not endorsing any single modality as an organization (though Reiki is clearly mny modality), but asking people to keep an open mind to having low cost minimal to no side effect methods to continue to care when we cannot cure.

We presented an increasing growing body of scientific evidence that Complementary techniques work. With the permission of the Samueli institute we presented a few slides showing acupuncture being done on wounded warriors. Especially in cases of dementia with agitation, where some conventional prescription drugs are now labeled by the FDA as "not effective" and "black boxed" as "harmful" - complementary techniques can have value. Certainly evidence based studies have shown that when chemotherapy is not working, cancer patients live longer with palliatiuve techniques than "one more round of chemo."

And what were the goods and the bads? It will be weeks until I have particiopant evaluations. Of 1700 physician registrees, of which about 1000 were present yesterday, only 40 physicians chose to attend this session (the bad) - and - 40 physicians were drawn to attend our session. (the good)

We had two 50 minute breakouts where in each session about 15 docs were exposed to a limited demonstration of Reiki. What to do in 50 minutes? Well - here were my take homes - to start with I talked about Mikao Usui and about the 5 basic precepts of Reiki. I think these precepts resonate, and telling a little about the founder of Reiki is critical. Next - I wanted each attendee to have something to take home for themselves, not as a treatment for anyone else, but simply being able to experience the energy - and connect to it for a minute a day. So I chose to teach Hatsurei Ho. With everyone sitting I taught Focus, Breathing, connecting to the energy, Joshin Kyoku Ho (though not by name), Gassho, and releasing Focus. And then I taught Ken-yoku (not by name) simply as a technique for separating the mundane from the sacred - and we did the whole meditation again. Almost everyone was moved, and it is something they can take home and do daily themselves if they choose to.

I teach health care providers a specific technique - it stems from classical physical examination which is taught in nursing and medical school (but rarely performed) - observation, palpation, percussion, and auscultation. Everyone ignores everything but auscultation, and it resonates because everyone knows that is sloppy and wrong. And so i pair participants off and have them do pre-cordial palpation (corresponding to the heart chakra). We can feel heart rate and quality of heart beat, murmurs, normal breath sounds, rales and wheezes and rattles if present - and doctors and nurses come to realize that they can perceive vibrations through their hands. I give the example of hearing impaired people sensitive to vibration, and then ask them to be open to preceiving how "the patient" feels - and more often than not a light bulb comes on. For those who are ready.

After that we sat in a circle and talked. Some asked if they knew enough to do Reiki, and no, I explained, they need to go home and find a Reiki teacher offering a course of at least 8 hours. This was just a demonstration. It was to make them aware of the energy that they could perceive. I talked about what we do as not being something of "power" but simply a way to connect and open a sacred space "within which miracles could happen." I offered to do a few Reiju for volunteers.

I explained that no one should have a Reiju who did not really want it, that it could impact them, that it was not a "Reiki level" and that if they wanted to learn more they needed a class. I had time to do Reiju on the first 9 volunteers - there would have been more accepting Reiju if I had encouraged them to do so, but I only wanted eager volunteers who knew they wanted this experience. 8 of 9 felt deeply moved. They described some of their experience. I explained i did not want them to discuss highly personal feelings in this format (and that i would not do "readings.") A couple spoke with me privately about experiences, and challenges they are facing that came to surface. Several I believe will go home and take classes.

For a brief time, some physicians felt open hearts, and wanted to perceive a connection to the life force within, around and connecting us. The interest physicians have to care when we cannot cure is heartening.

More work is to be done.

My thanks to Dr Rajapakse, an RM, for presenting with me; to Dr Crecelius, a past president of AMDA, not an RM but a compassionate human being who believes that the best of physicians consider both evidence based medicine and spirituality in end of life care; and to Dr Matt Wayne, incoming president- elect of AMDA who is not an RM but introduced this session to demonstrate personally how important he felt this was. Without their help, and the help of all the patients I have had the honor of treating, and all those who have taught and shared Reiki to or with me, this experience would not have occurred. Thank you as well to my friends who sent energy in my direction yesterday :)

Treat each other with Compassion

At our Seasons Hospice of Maryland Team meetings yesterday, we kept in mind the suffering of the the people of Japan, and offered prayer that many if the missing would yet be saved.

Hospice workers deal with situations "one at a time." It is our coping mechanism. We focus as we can on the moment, and on the person or family we are assisting. The enormity of what has happened in Japan, and the amount of suffering - and the shear number of spirits in transition is simply overwhelming. It was like there was a Tsunami in spirit throughout the world, after the Tsunami of water.

We have needed to focus on the moment, and do our own work, in each one's assigned place, but the tsunami of spirit let loose in the world has made it a little harder to focus on defintions and immediate tasks. Hospice workers have continued to focus and care for individuals even as their hearts prayed for people suffering all over the world. That's what Hospice workers do - care and offer compassion, even when they cannot cure or fix a problem.

Joining in shared sorrow and shared energy is comforting. We know that soon we will see the Cherry Blossoms open again, but right now the trees all seem bare.

This morning there was a World Peace Meditation, and a Meditation for those suffering in Japan. Any time today that one has the time to keep others in mind, I believe it will join the millions who have and are doing so.

Today the Emperor of Japan made a rare but brief statement. He expressed "deep worry and deep sorrow for people who suffer from this natural disaster."

He went on "I hope from the bottom of my heart that the people will, hand in hand, teeat each other with compassion and overcome these difficult times."

Becoming a Reiki Volunteer in Hospice

I have been asked many times, "how do i get to do Reiki in hospice?"

This week I was trying to answer this question on the Tera listserv, and some answers starting pouring out - so I am going to paraphrase some of them here.

"Be patient, be open, don't force it when it isn't meant to be. Know that your power is in stories."

Last weekend I was listening to a radio interview from 2009, with Legacy bearer Phyllis Furomoto interviewing Anneli Twan - and they were ......sharing stories. Stories of their childhood, and learning from Takata (that is how they refer to their beloved teacher).

Now there thought to be more than 1 million Reiki practitioners world wide. How did Takata present a wisdom that she had learned in Japan, and teach it in such a way that it resonated across the world? One gains a better understanding of the essence of Reiki through stories. Takata told stories. And after her transition, her students told her stories. And as I have visited Reiki shares in my own community, in Vancouver, in Kyoto - across different lineages and styles of Reiki what has stayed with me are the stories that have been shared. People speaking from their hearts, sharing from their hearts, telling how they came to practice Reiki and what it has meant to them.

Physicians and nurses who work in hospice often face situations where their authority means nothing, where they face unknown, where they face challenges they themselves are not fully prepared for.

It is not so widely known that Hospices are required to have a certain percentage of their care to be provided by volunteers. There is a national course in the United States that must be completed to allow one to participate as a hospice volunteer - and hospices must offer the course. If they do not have volunteers they cannot continue as a hospice and participate in Medicare. Why? Because the spirit of volunteers was central to the formation of the Hospice movement, and is embedded in its regulations.

Here are two books about Hospice - these authors were prominent speakers at the American Academy of Hospice and Palliative Medicine symposium this year. Sandra Bertman wrote a book, "Facing Death." And Sherry Showalter wrote, "Healing heartaches." And both of these books are filled with stories - of people dying, of people caring for them, of sharing and of compassion. This is the essence of Hospice.

Someone whose heart is not drawn to these stories will not last in Hospice, they will burn out. So walk away from them. Offer to help, be low key, take the volunteer course, and if a program will not allow you to do Reiki within your volunteer hours - simply walk away to another program. You are needed. You will be wanted.

Here are some web sites

www.hospicevolunteerassociation.org/hvaOverview.aspx

www.nhpco.org/i4a/pages/index.cfm?pageid=4813

www.hospicefoundation.org/volunteers

If you talk about your own story, how you were drawn to Reiki, how that drew you to want to be a Hospice volunteer, explain simply the five basic precepts of Reiki - you will find resonance - Reiki precepts resonate with Hospice, they are embedded in its soul.

If I had one simple message about Hospice it is that there are places where you are needed. Now. Know that. Trust the spirit guides to put you in the right place at the right time. Then get out of the way, and let it be about the energy and the connection. You will find sponsors and people who appreciate you. Think on what Usui started with. Think on what Takata started with.

Be patient, be open, don't force it when it isn't meant to be. Know that your power is in stories. Be prepared to be present and give compassion when others are willing to receive it.

The conversation

For all the benefits of evidence based conventional medicine, a point comes when science does not have all the answers, and when we need to acknowledge that fact to our patients and their families.

For some "the conversation" is dreaded, because hope is equated to science. But physicians need a broader education, and a realization that most people have Hope that is based upon a sense of being connected, and cared about, and that runs on faith.

Dr. Lucille Marchand, a mentor to family physicians and palliative physicians at the University of Wisconsin School of Medicine, phrased it this way in the Summer 2010 issue of the AAHPM Bulletin, "Hope is not an outcome, it is the process of living fully."

As a prelude to the conversation I always sit down, and I tend to take off the "white coat." I convey as much as I can, simply by not being rushed, that as a fellow human being "I care."

I ask more questions and do more listening - and very often I find that patients gift me with surprising wisdom.

In any case - "the conversation" is not always so difficult, and this weekend - I had a nicer one.

Carl is an 84 year old man who entered a hospital 10 months ago, he later said he "didn't feel well so he went to the hospital." Nothing was found (as so often happens since nearly 50% of patients with small strokes have CT scans that do not show the strokes, especially in the first ew days). He was agitated and hard to manage and was felt to have irreversible dementia and was placed on a high dose of an "atypical anti-psychotic" class medication. For patients with agitated dementia, it remains a serious problem, since these medications are not indicated for long term usage, but there are few options pharmacologically for safely and effectively managing agitated dementia patients (why not use non-pharmacologic methods one might well ask - a very good question)

I decided to slowly take the risk of tapering Carl off his medication. Rapid dose reductions can cause problems as well. For months Carl appeared as he had been labeled by the hospital - simply demented and near the end of life, listless, confused, mumbling and totally dependent. Slowly he began to be a little more alert, but as we continued to reduce the medication - a startling event happened this weekend, Carl really woke up!

He wheeled his wheelchair over to me as I came onto his unit, and said to me, "your the doctor aren't you. What day is this? What month is this? How long have I been asleep? Where is my family and do they know where I am?"

I sat down and talked with Carl for a long time, and explained what had happened, and he told me about what his life used to be like, what work he had done (a very responsible job).

And then I had to have "the conversation." I called his family. Only this time - it was a "good conversation." "You may have noticed a change in your dad, " I said." "Well - we noticed something last week - my daughter wouldn't enjoy visiting her grandpa, but last weekend he was more alert." And I explained how I had been slowly tapering him off his medication - "I can't guarantee how long this will be for," I had to add. "But it would be great if you could come over today, he is very alert and really wants to see you."

The thing is - with an approach of palliative care, "the conversation" is often one filled with hope. We accept we cannot cure yet we continue to care, and we give hope simply by connecting and caring. And sometimes, when conventional treatments cannot actually cure, patients are better off without them - sometimes using futile medications for "hope" doesn't make sense scientifically or humanistically.

Dr Lucille Marchand wrote in her article that physicians "don't take hope way by running out of conventional, curative treatment options; rather, we discourage hopefulness by not being present and listening to what our patients truly need from us."

I agree. And the fact that within conventional medicine, there is increasing recognition of the import role a physician can play in nurturing hope elevates the spirit. Palliative care is a specialty that brings conventional and complementary methods together by its very essence, and makes a more human model. It makes "the conversation" a little easier. It enriches all our lives.

Finding Hope on a Hospice Unit

Health care at its best is scientific and evidence based, but often the complexity is to understand "which science." Long ago science recognized that the universe as we perceive it with out current methods is made up of matter and energy, but since "energy" was harder to measure, we focused on a Newtonian-Cartesian science that viewed "matter" as - well - what "mattered."

Discussions about "energy" in health care, as with the Eastern models, didn't make sense in terms of Newtonian-Cartesian science. And that all held together until Einstein came along, and after him, current physicists with Quantum theory, Gill Edwards writes in "Conscious Medicine" (a marvelous book well worth reading) "as physicists looked at tinier and tinier particles o what makes up our physical reality, they concluded that there simply isn't any solid stuff. There is only energy, or in quantum physics terms "waves of probability."

While I do not agree or endorse all of Ms Gill's statements about "conventional medicine," what is important in her argument is that complementary approaches cannot simply be invalidated because they do not fit someone's view of the Newtonian-Cartesian models (which are useful but no longer accurate as we assess sub atoic physics and the essence of things.

The NIH suggested that both conventional and complementary techniques should be viewed in light of an evidence based approach - and often complementary techniques are lower cost, lower side effects, and "do no harm."

Some techniques used routinely in conventional medicine can be high cost high risk with limited proof of efficacy, but we can get very caught up in the mantra of "fighting for someone." Using chemotherapy for a cancer that is sensitive to the agent, makes sense, but continuing a toxic sustance when it is clearly not helping may be sapping the body of its own natural defenses - using anti psychotics in some circumstances can effectively save peoples lives but in other circumstances they are being used where they are frankly "black boxed" by the FDA as not approved for use due to potential harm and lack of effectiveness.

For anyone in medicine humility is a valuable commodity - I can remember in my conventional medical school training, one wise physician pointed out to me that we get a small percentage of patients better through our interventions, most would heal anyway naturally, but that we injure some as well in our treatment. I always held the "do no harm" mandate to be important. Our professor of Public Health in medical school pointed out that changes in life expectancy tables correlated more to infectious disease limiting measures (such as control of sewage and quarantine of certain illnesses) than advances in medications and surgical techniques.

Europe seems to utilize less aggressive surgical approaches than we have as standards in the US (in act an element of our health debate is the argument of hypothetical "waiting lists" in Europe, when in fact, age adjusted most European countries have lower mortality figues and longer life expectancies that in the US).

And so - particularly for those patients who have diseases that are viewed as "incureable" by conventional medicine, asking "energy based" questions seems to make sense. Sitting down with a patient and asking "what do you believe happens with your spirit or consciousness when your body dies" expresses - most importantly - a sense of humility, and a sense of a willingness to listen, and a genuine caring for the person we are talking with. Our acceptance of their faith or belief set is supportive of them - and it allows for acknowledging our inability to "cure" someone, without taking away their own intrinsic sense of hope - separating out our lack of skill to cure from their future - not saying "you are going to die" but asking them what journey they perceive themselves to be on.

Patients and families are almost always positive in their responses. Some simply appreciate a doctor sitting down and taking the time to talk with them - and demonstrating the one thing we can clearly do when we cannot cure, and that is care. More importantly, patients have a natural tendency to hope, if only we do not crush that hope or invalidate it, in our need to be "scientific."

Rarely - I find an atheist, and it is never my job to convince or convert - but every atheist I have met has been more than willing to tell a listening doctor how he/she feels, and more than happy to review his/her life experiences with someone who cares.


When I came back to work on my in patient hospice unit, after my week at the AAHPM meeting, two patient experiences reminded me what my job was all about.


Sharon is 69, she was declining and suffering from severe pain and emacia. We had controlled her pain on our unit - she was hearing impaired, but was very alert to a patient listener. When I asked my one question, here were her responses - we just listened. "I don't know what to expect and I guess that's why you have anxiety, when you don't know what to expect. You're not going to be here on earth anymore, you're going to be with God. I'm not worried about that, I'm worried about what's in between - and everyone else suffering on account of me."



Mike was 80. He suffered from renal failure and was not eating, he was unconscious. A family member was present and in vigil. We asked her what she thought her loved one believed was happening to his spirit. She stopped crying to think about that question. "He is hard of hearing and his speach is impaired. He had no formal education. He was ignorant really in many ways. He never really expressed himself on heaven, he would have had a hard time expressing himself about that. I don't know how to explain it - he was just there - just him. He and Mom went to church almost every Sunday, though, for 50 years till she died. Then he lost his house and car. He lived an uneventful life, he was just there. He just lived his life, he never hurt anyone or did anything mean to anyone - sometimes he would just mow peoples lawn in the neighborhood without even charging them."



Sharon's pain was controlled on our unit, and went home to spend additional time with her family. Mike made transition free of pain. In both cases, their presence enriched us because we took the time to listen to the spirit that connects us all - spirit that resides in each human being.

In the best of worlds, we will use conventional medicine wisely and scientifically, we will use penicillin (or a more modern antibiotic) to save lives, and we will reduce cardiac risks and forstall cancer as best we can. We will avoid using the modern equivalent of "leeches" and be open to complementary medicine, or forms that Gill Edwards calls "conscious medicine" - to encourage the natural healing processes.

And most importantly we will face each day with humility, and continue to care for fellow human beings even when we can't cure them. Hopefully acts of compassion will make a difference in a world that so badly needs positive energy.

Vancouver and Reiki

This past week I had the opportunity to visit Vancouver for a meeting of the American Academy of Hospice and Palliative Medicine. The conference itself was a meaningful experience, but the visit was enhanced by my Vancouver Reiki experience.

After studying Usui Reiki Ryoho with my first teacher, Robin Littlefeather Hannon, I was trained and attuned to Gendai Reiki by Amy Rowland, and after that learned and received attunements from Rick Rivard.

http://threshold.ca/reiki/home.html

One of the wonderful "perks" of learning with Rick, is participation as a former student in his "Tera" listserv. Rick was one of the founders or URRI - Usui Reiki Ryoho International, that ran from 1999-2003 and brought Reiki masters together from all over the world. "Sharing from the heart" (as Rick usually signs his emails) is a part of Reiki, and sharing Reiki experiences with Master teachers and new students worldwide is an enriching opportunity. As valued as this experience has been, I had wanted to meet Rick, receive "in person" attunements from him, and meet some of the other compassionate caring human beings who post on "Tera."

It is sort of fitting that Vancouver be such a hot bed of Reiki - not only was the first URRI session held there in 1999, but as well, Mrs Takata taught in a limited number of venues, and she lived with the Twan family in British Columbia, and taught there for a significant period of time.

So when I emailed Rick letting him know that I would be in Vancouver for a few days, and would like to meet and receive attunement from him - little did i know the treat that was in store for me. Rick and Peggy arranged for an exchange and about 20 practitioners turned out for an evening at the beautiful Canadian Memorial United Church at 15th and Burrard in Vancouver. Rick picked me up from my hotel, showed me quite a bit of Vancouver, the Sylvia Hotel where the Japanese masters stayed in 1999, the beach, views of the mountains, and finally we were at the exchange. There is a certain feeling that occurs when so many Reiki practitioners are together - my wife and I felt this when we visited the Temple in Kyoto where the Komyo exchange meets every week.

We gathered in a circle, and Peggy led a meditation. Energy flowed in the circle, and members of "Tera" who were not physically present "joined in." There was a sense of renewal, and connection, and ripples of compassion. A picture of Usui Sensei and the Japanese rendition of the Reiki precepts graced the front of the room, turning the church into a "dojo" - Rick and Jaime gave Reiju to all present.

Sitting in the circle, each of us shared our stories. And then we divided into groups working 4 or 5 practitioners to a table so that each of us received 10-15 minutes of Reiki.

I want to express gratitude to Rick for his years of commitment to Reiki, teaching, and for his constant sharing from the heart; to Peggy for helping with arranging the evening, and for doing a wonderful meditation, to Jaime for the Reiju - and to everyone who shared (in physical presence, or by distant Reiki) this exchange.

I do want to add to this Blog a poem I wrote earlier in the day. At the AAHPM meeting I participated in a section on working to relieve Lateral Violence in Health Care. This is a huge problem, and responsible practitioners and Health Care systems are facing this issue of mistreatment of health care workers by health care workers. To bring out issues, we broke into groups of 8 physicians and nurses, these were "mainstream" docs and nurses, not a Reiki group, but stories poured out. We had a reading based on experiences of an Intern, and we then each did a Reflexive Writing exercise.

I felt such incredible pain and anger around me - and people poured out their hearts. Perhaps with the help of Reiki, I am holding very little anger in - anger and worry are so harmful to us when we hold it in - but even before hearing everyone else's stories (some of the physicians and nurses said that what they wrote in their exercise they had never told anyone in their lives - and seeing people through the week you could see the healing).

But I wrote this poem - it reflected on the intern who, exhausted, and mistreated himself, had a dying patient who he could not save.

A last breath is taken

The wind goes through the trees

A noble spirit emerges

I see your pain.

You saw me suffering

And you were powerless to help me

But it is OK

I know that you cared.

Do not worry

Let go of your anger.

You have more energy within you than you know

You can heal.

I am grateful that you were present for my transition

It is OK

Let go of your own pain.

Do not despair.

You have compassion.

Form sacred spaces with others

And find the strength present for you.

Two days later I was listening to another session at the AAHPM meeting, and I heard a quote - I do not know from where it initially derived. It stated - "we do not do miracles, we form sacred spaces where miracles can occur."

And so I will always remember my time in Vancouver, where a group of conventional doctors considered the possibilities of Sacred Spaces - and I experienced the sharing of a Reiki exchange with so many compassionate people.

I am grateful.

Reiki Contra Ross

There is sometimes in hospice a spiritual tendency to refer to the moment of cessation of physical function as "transition" rather than as "death." With all respect to one of the great contributors to compassionate care in the Western World, I have thought of this dilemma as "Reiki vs Ross." What exactly is this about?

Some time ago I was talking about an upcoming presentation on "End of Life Care" with a main stream Protestant Bishop, and he said to me, (in a friendly yet "older brotherly" way "young man, you doctors have no expertise to speak about End of Life, you have only learned about mortal life."

And in fact, Islam, Christianity, Buddhism, and Judaism all share similar beliefs in Heaven. When I ask patients and families what they believe happens when their heart stops (in an open ended way "permitting" them to tell me what they really think) - over 90% of patients say they believe in Heaven - one way or another. Many say, "I'm not religious, but I believe in God." Some have said to me, "thank God we finally found a Christian doctor" (though I am Jewish - my tendency is to be there for my patients, when I am in the room of a patient nearing "transition" I like to think of myself for that moment as whatever THEY are in support of THEM in that moment).

Yet in a recent article in the highly respected Journal of Pain and Symptom Management (Jan 2010 Vol 39 #1) an article scientifically assesses by Questionnaire "the Quality of Dying and Death."

Pragmatically, once we say that the patient must "deal with death and dying" we have, from a Spiritual perspective already condemned the patient and family to a cycle of suffering. We have denied the beliefs of the major faiths, and asserted a hypothesis of science that has no conceivable scientific capacity to test. Yet - I ask myself, if all the major faiths on our planet assert a continuation of spirit after death, and over 90% of the thousands of patients I have spoken with have had such a belief, is this "random" (in a scientific sense). If I tossed a coin and it came up "heads" over 90% of the time could I say, "that doesn't matter."

What if - patients ought to be encouraged to speak of "transition" rather than "death?"

When I have visited Jerusalem and when I have visited Kurama Mountain (a place that a Japanese Hotel clerk who was not involved in Reiki described to me as "the Jerusalem of Japan") - I sensed in both places 3 different "levels" of thought.

At one level there is a perception that God exists - far away - beyond one's own capacity to understand, but exists. It is an incredible feeling that we are not "alone," that we are "connected," and that the world has order and hope, and a reason for compassion.

At another level one senses that one can follow a path, that if only one adheres to a proper path one can be at one with the Creator - and the problem here is that we as human beings, often have difficulty respecting one another's path. We see "far in the distance" what some call "Heaven," what Buddhists call the "Pure Land," but it is far away from us.

At another level we understand what is said in Deuteronomy 30:11 "it is not hidden from you and it is not distant. It is not in heaven or over the seas, but in your own heart." Thict Nhat Hanh, a Buddhist scholar reminds us that the Pure Land is within our own heart, "Buddha did not choose any other place to become enlightened than in our own world."

The language of transition then becomes a language permitting patients and families to make these moments precious, and to allow in these moments the faith hidden within their own heart to emerge. Reiki assists in doing that - whatever the faith - by simply opening a door and being present. We are here and in a compassionate way we care enough about you to simply "listen." We do not see you as "dying" or leaving the "living," we see you in a more important fashion, a human being near a journey of "transition." We sit with you, not in judgement of you. We do not place you neatly into categories of "grieving" - but as a flower that is opening. We are - quite simply - here.

The patient in this moment is not condemned to the path of suffering that follows from the confrontation with impending "death," or the process of "dying." The patient - if they choose, has the opportunity to share with us the journey they perceive happening within themselves, what we call a transition to "the bonds of eternal life" or "life everlasting" and what the Buddhists call the opening of the Lotus.

Are we up to the challenge of simply being present and compassionate at a time of "transition," or does our training and "white coats" - (all of which have failed the patient to bring the to this moment) - need still to assert our "control" and scientific evaluations of the quality of dying?

For some of us, our goal is to assist the patient in living as well as possible - for the precious time that exists. Allowing with humility that faith may have value where science has limits, we may help our patients (and ourselves), to turn toward an infinite light, rather than demand that we face a limitless void.

Mickey's Blog

We had a guest visiting our hospice unit today, and she shared the story of the loss of beloved colleagues who had worked at our hospital.

There are certain things we strive to attain every day, and if I were to try to describe these I would say, first, excellence in scientific care and scientific method, and at the same time, human caring and compassion. And it isn't always easy to integrate these qualities - qualities that focus on "both shores." Mickey Barron and Rhonda Fishel brought this excellence and this spirit to our hospital system for many years. Mickey was a Nurse Practitioner who practiced with excellence in our ER and ICU, and Rhonda for many years was the Chief of our Surgical ICU.

For those who might not know, Dr Rhonda Fishel had earned a reputation of being an incredibly gifted trauma surgeon and criticalist. Training, skill, discipline and hard work brought miracles from her hands. But what so touched so many of the nurses in the units, was that they knew Rhonda as a caring, humble human being, who on a daily basis gifted everyone she could with compassion.

Mickey and Rhonda were inseparable in life, passed a way a short time apart, and were buried in a touching ceremony. This is described at http://mickeybarron.blogspot.com

The ripples of the memories of noble spirits are intended to spread compassion through the world, as they did through their actions when they shared the journey of living with us.

I hope people interested in Hospice take a moment to read Mickey's Blog.

A poem

As we transition between years, I am drawn to a poem written by the late Abbot Zenkei Shibayama of Nanzen-ji temple in Kyoto. It was quoted in "A Raft from the Other Shore" by Sho-on Hattori.

"A flower blooms in silence, falls in silence.

And never returns to its stem.

Ina moment, at just one place,

It forgoes all its life,

The voice of a flower,

the reality of the flower stem.

There the happiness of eternal life

is shining without regret."

Sho-on Hattori comments, "as there is eternal life in a moment of blossom, so do we strive to realize the eternal wisdo in the "moment" of our life."

As people in hospice merge their spirits to help others, their compassion builds the "tree" of humanity, as leaves build a tree. Jewish mysticism reflects on this interconnectedness as the "Tree of Life."

Hattori reflects that Buddha (could we not say the leaders of other great spiritual movements as well) observed the sorrow or darkness of this world that we live in, and looked across to the distant shore of spiritual light, and "showed all humankind the means of crossing the ocean of darkness to the realm of light on that shore."

In facing difficult moments, I cannot scientifically prove "the other shore." But we can talk about it. Last week I was faced with a suffering woman, whose husband had forgone dialysis, and who was unconscious and rapidly declining. She was drenched in suffering, what to do, what to say?

I asked her, "What would your husband have said he believes will happen to his spirit when his body dies?"

And she stopped crying, and answered me, "Doctor, he believed with all his heart that he would be going to a better place."

She had found a "raft." And we were able to talk. Not about suffering and not about the dying process and not about the labs but about him, and who he was, and what he believed. And it mattered.

"The voice of a flower,

the reality of the flower stem.

There the happiness of eternal life,

is shining without regret."