Friday, December 30, 2011
Thursday, November 17, 2011
Saturday, October 29, 2011
Wednesday, September 7, 2011
"I am on YouTube singing Amazing Grace in honor of my father
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.
Tuesday, August 16, 2011
Friday, July 8, 2011
Sunday, June 5, 2011
Monday, May 30, 2011
Thursday, March 31, 2011
Friday, March 25, 2011
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 :)
Wednesday, March 16, 2011
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."
Wednesday, March 9, 2011
Sunday, February 27, 2011
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.
Saturday, February 26, 2011
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.
Monday, February 21, 2011
Monday, January 31, 2011
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.
Tuesday, January 25, 2011
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.