Monday, January 31, 2011

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.

Tuesday, January 25, 2011

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

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.

Sunday, January 2, 2011

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."