Friday, November 23, 2012

Wisdom from patients

Every day on the Hospice unit we seem to learn from our patients. Just before Thanksgiving we were talking with a patient who came to us for pain symptom management related to the cancer she was suffering from. Her oncologist had pretty much told her to get ready to die ..... but without curing her we had gotten her pain and shortness of breath under control, and were talking about sending her home - possibly Thanksgiving at home and encouraging her to pray for Christmas at home - no guarantees - but we were optimistic. She smiled and said, "every day above ground is a good day."

We were all touched by her smile and her positive spirit!! And i started to look for similar quotations - it turns out a movie used the same quote my patient had used, and there were many other versions.

"Badger" Bob Johnson, a famous hockey coach, suffering from brain cancer lifted his team reminding them "today is a great day for hockey."

And the fictional character Worf, in Star Trek Next Generation before a battle was frequently reminding all who would listen "perhaps today is a good day to die."

But my recollections date back to philosophy courses when i was reading a book by Carlos Casteneda, he was learning Native American wisdom from don Juan Matus, and was taught that a "warrior" has a certain way of living such that, "if one quickly looks back over the left shoulder, then it is possible to catch a glimpse of death."

Whether it is from conventional religion where we learn of "heaven," or from don Juan who seemed to perceive a mystical world from which spirit guided signs could lead to a different perception of reality, to agnostics who don't "know for sure" but want to be connected to the spirit of others in the world they live in ..... there is a common focus not on the decline trajectory leading to death but a focus on the moment, that the time we have is a time to live a part of life, a focus not on how we die but how we live the time we have.

Science and conventional medicine often seem to speed everything up - the clock is "ticking," when what we need most is to "slow everything down." Einstein said that time was "relative," and indeed for patients much depends on how they perceive it .....

This past week we had another patient come in for pain management. She had tumors spread to her jaw and simple eating had become a painful chore. We were working on just making her comfortable - but guess what? - she did not want us to change her medication, she wanted us to talk with her and listen to how she felt about things. Two days later we had not made any changes in her medication - she had refused my medication suggestions - and she felt MUCH better ...... what did she say?  We "were so nice to her" we "cared about her" and for her it made "all the difference in the world." She was ready to go back home and face some of the time she had, knowing that if she needed to she could come back to our unit, and we "would respect her wishes."

Our unit has had quite a few visitors lately - we always enjoy other professionals coming to share experiences with us. Many have been on other hospice units, and consistently what they are saying they notice about our unit is "the sense of calm." Our unit has a lot of ICU "step down" so we really are not a "low acuity" unit - quite the opposite, but one consequence of offering Reiki on our unit was not simply the impact on patients but the impact on us ...... and how we approached each day. We started to refer to death as "transition" and started to think about what we do as helping people to live, rather than helping them to die. We started to focus on how they could find "golden moments" rather than how hard it was for us to watch their "suffering." (we also unless a patient wanted it very much banned loud TV shows from our unit and focused on calmer sounds).

And so we seek not a "good day to die," but whether today can be simply a good day to live.

Tuesday, October 2, 2012

A simple clay vessel

Hospice remains a special field of healthcare, be it conventional or alternative, because in general we understand that a condition exists that we do not have the knowledge or tools to cure. Recently, I have had the opportunity to present to hospitalist physicians, and to some other interested groups - as regards the dilemma that we continue to care in cases where we cannot cure.

While our training and accomplishments may give us pride, this situation draws from us another need .....sometimes hard to define within our western accomplishment driven, personal growth driven, credential driven culture. I am not reflecting that any of these values are lacking in importance - simply that some situations ask of us another pathway .....

Some years ago I heard a tape of a mainstream Protestant Bishop - I do not mention his name in respect of his own requests - he was speaking to a Bishop's convocation and both exhorting to a higher level of faith, yet at the same time in some regards reflecting on his own career - as the invitation to deliver such an address at such a convocation is an incredible honor reflecting accomplishments that touched (directly or indirectly) the lives of 10's of millions of people on several continents. And what he reflected was that in every single one of his accomplishments he had simply been "an empty clay vessel." It was not because of his hard work, or his talent, but in  his reflection simply that although he may have been unworthy the higher power (he would say God) acted through him for God's own purpose.

In the Bible we see this sort of reflection - Moses sees himself not chosen because of his worthiness, he has a speach impediment, he lacks faith, he killed a man, he ran away ...... he does not ask to be called or seek the role he is given - the spirit chooses the prophet .........

In this struggle to define ourselves - caught between a culture which views attainment often as personal, and a result of hard work or talent which lead to deserved credentials and authority - and a spirit tradition that those who are chosen are not so selected for talent or worthiness but for the spirit or creator's undiscernable reasons is interesting to reflect on some work coming out of South America today, particularly the work of Nobel prize winner Mario Vargas Llosa .....

Llosa in an interesting person in his own right, lost in a bid to be president of Peru, and having written extensively with novels reflecting a tension consistent with the mixed culture of South America - the blood and the history of both indigenous people and European cultures mixed together ...... In "Death in the Andes" he reflects on cultural issues seeking to understand what is occurring in the high mountain country - certainly a different view of Incan tradition than we would receive from a purely "western" analytic rendition..... and in "The Way to Paradise: a novel" he reflects on the experiences of the famous impressionist artist Gaugin, in Tahiti, juxtaposed with reflections on Gaugin's less well known but fascinating grandmother of mixed Peruvian and French descent who was a founder of the socialist and feminist movements in France ......

In Llosa's novels there is this tension between the western culture - and the indigenous - both present within the same person. And this different way of looking at the world ...... spirit acts and moves through us, not as a result of our attainment or worthiness - but because it happens that way, or - we are who we are as a result of our talent, hard work, and earned attainment.

Do we call upon "spirit" or does "spirit choose the" recipient for its own purposes? When we have a patient who our skills and education and experience can no longer cure, does our simple presence offer both a human connection and - as one speaker at an American Hospice and Palliative Care Meeting once said - "create a sacred space within which miracles can happen."

We all see in hospice, some recoveries that scientifically we absolutely cannot explain - in these moments do we search what we have done to determine which skills of ours were at play, or do we accept that we simply had the honor to be "present" - and that which worked in our presence was not related to our talent or merit?

Sunday, September 9, 2012

Humility and Hospice

It occurs both in Medicine and in Reiki, that as we learn methods we have a tendency to think we have acquired "power." It is a special situation to work in Hospice, because here we have an awareness of our own lack of "power," and yet when we bring a sense of calm caring we find that those people who we cannot cure yet feel better from our presence.

Mrs Takata taught, it seems to me, a method of elegant simplicity, where we simply place our hands and let "Reiki" do the work.

If in some way we are capable of "connection" to a great source, (however we may name it), does it matter how much finite power, or energy, or vibrational level we ourselves have?

My Mom transitioned in April, and our tradition has us repeat on many occasions a "mourner's prayer." But the translation of this prayer (from the Hebrew to English) does not reflect at all on being in "mourning," it simply reflects praising and glorifying God's name, and giving thanks to the Creator of the Universe. This same prayer in a slightly differerent format is used almost as a "punctuation" to begin and end prayer services.

This is very much as a "doxology" in Christian faith, for example added to the "Lord's prayer" - "thine is the kingdom and the power and the glory." Some thought reflects this prayer as coming from Chronicles 1 - 29:11 and this specific prayer is utilized as well in the Jewish prayer sequence upon removal of the Torah Scrolls - the sheepskin scrolls upon which are written the 5 books of Moses - "Yours Lord is the greatness, the strength, the splendor, the triumph and the Glory."

In Chronicles, in context, what is occurring is that King David is dedicating the beginning of the building of the Temple in Jerusalem, and telling "the entire congregation" that all his successes and acts belong to the Creator. "For we are like sojourners before you."

Well - as physicians we are taught method, and in an evidence based way we use this method as best we can. With Reiki, we are taught a method, and we use this .....and in some places and in some times we can see incredible results and we can think that we accomplished something!

In Hospice we walk with much more humility. Our patient is with us because they have been "certified" as being beyond the scope of cure by evidence based medicine, and yet ...... we ..... and our patients, feel a positive benefit from our presence and our caring. Every so often - against all odds and for reasons we often do not understand, people rally and improve!!

When this happens, we may be wise to reflect that ours was not the power or the cure .........ours is a journey, and we strive to share the methods we have learned, and our caring and our presence. Sometimes we have the awesome joy and honor to be present when healing happens.

Thursday, August 23, 2012

Reiki for Roger

I have had the honor of knowing Roger for about 9 years, he held court, that's the best expression i can say for it, at one of my Nursing Homes. Although he was limited by paraplegia and suffered from many ailments from before i knew him, he was of indomitable spirit, and his transition saddened me.

I have for some time been on his email list and he kept me up to date on the parties he had in, or went out to ....few patients in all my years working in Nursing Facility Care have had as many visitors or been taken out for as many activities as Roger.

And he was forgiving of my limits, of the fact that we could not cure his illnesses, or even make his symptoms go away, but that we could continue to care for him and be present for him.

On day Roger showed me with the greatest pride a photo album his friends made of one of his birthday parties. The joy he received (and gave) from (to) other people was truly astounding.

When he sustained a leg fracture, his orthopedist recommended either very taxing surgery or amputation which i felt was not necessary ..... as i discussed it with Roger without the surgery he could never bear weight on the leg, and as he said "I"m not stupid, I haven't been able to walk on that leg in over 10 years." We tried Reiki and eventually we reduced the pain, and Roger got what would be called a "fibrous union" - it didn't allow him to bear weight, but allowed him to sit up in his wheelchair, and go out with his friends, and avoid a major operation.

Roger in spite of all that was stacked against him won, because he did not focus on his limits or wait to die, he lived the days he had and sent incredible ripples to his friends and through the world - people are sharing stories about this incredible loving human being and are inspired.

In another case, Molly one of our music therapists played (and recorded) a version of "Heavenly Days" - the favorite song of one of our patients who recently transitioned, Gwendolyn. Gwendolyn loved this song more than any other, and was going to be played at her funeral, and remind her friends and loved ones of her spirit - and send ripples through the world.

And i met with another family member today, we were just being present as we waited for her Mom to transition. Her hospice room was a peaceful and comfortable place, and family were present and sharing stories. They had some questions for us about the health care process, and i explained that there were no medical treatment options, but sometimes people improved when we least expected it, and encouraged their prayers in their own way. And after we talked the daughter told us, "Thank God I found believers here, this could have been much harder. What we can see with the spirit eye is amazing, there are spirits all around us - if i didn't believe in that I would have no hope."

And so in honor of Roger, i would suggest that we go beyond the tenets of "do no harm" and "practice evidence based medicine" and suggest that we never take away hope, and that we remember those who we have had the honor to be present for, and let them continue to live by telling their stories.

When we could not cure Roger's leg by conventional means, Roger asked me to provide him with Reiki, and, he was able to get out again with his friends. Now that he is outside my site, i will continue to remember him in my sending of Reiki, and remember the power of his hope when i find other patients who we cannot cure.

Sunday, August 19, 2012

From the Heart

It was in 1987 that i visited Jerusalem for the first time, and visited "the wall" (the "kotel") for the first time. This is a place that is sacred to Jewish people, in that it is viewed as the last vestige of the wall from "the Temple" that stood in ancient times. And within about 200 yards of this place is both the Church of the Holy Sepulchre, felt to be the site of "Golgotha" - the place of the death of Jesus, and the Mosque built on the sacred site from which Muslim's believe that Mohammed ascended to Heaven.

Lore has it that if one writes a message on a small piece of paper and stuffs it between the cracks in "the wall" the first time one visits, that the dream is likely to "come true." There are stories of families being reunited, and all sorts of miraculous stories surrounding this legend of leaving a message in the wall, miraculous healing, you name it - and so i took this moment very seriously. I thought about it for a long time.

In the end the message which i left in the wall was simple and brief, and not for anything specific materially, it was simply "open my heart to you God" (or in Hebrew taken from a brief prayer - literally open my heart to your Torah, which at some levels could be translated as the sheepskin scroll upon which is written the 5 books of Moses, the centerpiece of the ancient Bible, and for some would reflect "the law" as specifically represented by 613 commandments, and for some the "letters" or tools with with God creates our world, but for me the simplest meaning would simply reflect on Torah as God since the essence and spirit and soul and thoughts and wishes of God make up all of our world and connect us........)

As i have tried in my Hospice journey to explain to the numerous people who have asked me "how can you do this work" and "isn't it depressing" - that no, it is an honor, and the having people allow me to share and assist them in their journey is both a mission and a chance to grow, a "job" for sure, but more that that, and bottom line a place for the heart, where beyond being a "science" person or applying skill, I am often simply present for people to keep them company or be a witness of their journey, to help in small ways not just to relieve their suffering but to assist in a focus for them not on "how they die" but how they live the portion of their lives that they are journeying through.

And in Reiki more and more i read and hear and feel the spirit of masters seeking their own highest potential through a journey that is centered and moved by our hearts.

For some it is attaining a higher level or a higher vibration or having more power or being able to heal, and for some it is simply being "present" and being in a state of acceptance or submission to the creative energy that sustains (not simply created but continues to create in each moment) us and our world.

Recently - in one of my favorite Reiki list servs, there has been an extended discussion about Reiki Tummo, a specific path taught by I Effendi ("Reiki Tummo, an effective technique for health and happiness"), and a quote from the master "you have written your book of Life from the perspective of your brain, are you now willing to re-write your book of life from the perspective of your Inner Heart?"

Having had the honor of being present and sharing countless journeys in hospice, and from the little i have learned of Reiki, i can't say that i have more specific answers to questions than on the day 25 years ago when a placed a small note in a crack between stones in a sacred wall, asking the creator to "open my heart" has been and remains a Journey.

Thursday, July 19, 2012

A Reiki Opportunity

There is a unique situation for Reiki practitioners, and in fact, for Complementary practitioners in general that exists this year. So many times I am asked, (and i am seeing courses put together to assist Reiki practitioners in this area) - "how do we approach conventional doctors and hospitals?"

So here are two  topics to think about -

1)  CMS - The Center for Medicare and Medicaid services, the government agency that pays conventional health care providers, and to some extent regulates them - has identified a concern ..... something that is a national priority to change ..... and it involves how patients who suffer from dementia are treated in nursing homes. This issue is huge, and in the next year every nursing home in America will need to be concerned about this issue....... patients with advancing dementia often suffer fears, agitation, hallucination and aberrant behaviors ..... it is sad and it is a major human challenge, as well as a professional one. What has been happening is that physicians, well intentioned, have been prescribing "psychotropic medications" - that is pills - to stop the behaviors. And what is a nurse to do? A patient suffers from dementia, and they get agitated, they holler out, sometimes they hit or bite or scratch someone else and because of their disease they can't be "reasoned with." What to do? And what has most often been done is to prescribe and give a medication.

Over the past few years evidence has piled up that many of the medications used have no "evidence basis" for use in these situations - that is - conventional physicians are supposed to be "evidence based" and they are using medications here for situations where studies do not clearly support the usage --- well --- of course there can be honorable differences of opinions and the manufacturers may believe studies support usage - but bottom line it has been found that often such medications are used in cases where the FDA judges the medication "ineffective." Since the aggregate costs of these medications nation wide run into the billions of tax dollars ...... this has caught CMS' attention (as in billions of dollars, no evidence of benefit). But what has really changed the playing field is recent data that in some cases these medications in the elderly actually are thought to shorten life....... and so in some cases the FDA has "black boxed" these usages .... that is ordered docs not to prescribe them in certain circumstances ....... and ...... well ...... they are still being used ........

While the evidence supporting the use of Reiki to calm agitated patients is not "certain" - and mostly "needs more study" ..... what is evident is that conventional nursing facilities will need to attempt "non pharmacologic methods" to calm agitated patients ...... and that Reiki is low cost and low side effect (whether effective or not - i tend to think it is effective) and is thus more "evidence supported" than products that are high cost, felt to be ineffective, and in some cases labeled by the FDA as "harmful."

AMDA, the professional organization representing doctors in "the long term care continuum" is actively encouraging (without support of any specific modality) trying non pharmacologic remedies for agitated dementia .......

So .... consider offering your services to nursing facilities in this area ...... facilities that are aware of the torrent of regulatory initiative in this area should welcome Complementary modalities such as Reiki ......


2) If you are approaching Hospitals ...... remember that Hospitals are now based upon "short term stays" .... in many states 4 days in the Hospital will be viewed as too long ...... and this is a dilemma as - while Reiki can be offered for pre op surgical patients ..... while in the hospital there isn't much time to get to know people.

Here is what is new : from Oct 1, 2012 Hospitals will be penalized financially by Medicare if patients are readmitted to the Hospital within 30 days of discharge ...... it is a major concern to almost every Hospital in the country.

Hospitals are looking for programs to assist patients who have gone home ...... to succeed at home ...... so.....if you are looking to offer a program more likely to catch a Hospital administrator's interest, consider a program that might meet patients once at the Hospital, but most importantly help them at home ...... one of Reiki's strongest values is reducing worry and anxiety ...... and patients with less worry and anxiety (all other things being equal) are less likely to need to return to an Emergency Room.

This posting is pretty limited ..... it doesn't have any Reiki wisdom, and it doesn't have the joy of getting together for sharing with other Reiki folks, but it does tell you two areas where huge tidal waves of change will be impacting on the conventional health care system. Understanding the challenges that are being faced, and being prepared to offer programs that help in areas of concern, may help open a door.

May your method and your compassion have a chance to help others and make a difference.

Thursday, June 28, 2012

What is Reiki really?

I have been reading so many posts and emails lately that purport to argue what exactly is Reiki ..... there are so many differing "shiki" or methods .... which one's are really authentic?

Sometimes, Reiki is decribed as "enhanced" and sometimes it is described as exactly as taught by .........., sometimes it is "pure" and sometimes other modalities are added in ..... how do i know what is "right" or "correct?"

I have taken to explaining to groups of physicians - when i attempt to demonstrate Reiki that - there are many people more well trained than i am .... and that whatever method i use is simply a method that resonates for me .... it isn't the only method and i cannot even say it is the best method.

And sometimes in trying to understand what exactly i am doing, in adding Reiki as a complementary technique to care near the end of mortal life, where conventional medicine has failed to cure people, and i am still struggling to care for them, i am moved to realize that simply being present and being caring is important. And strangely we find that some techniques existed prior to Usui ..... and that while perhaps all Reiki comes from Usui not all that is useful exactly does ......

Recently i was in Alaska and visited a Heritage Museum ..... here are some native wisdoms that i found personally moving.

1 - Ten Universal Values - from the Alaska native knowledge network

Show Respect to others - each person has a special gift
Share what you have - giving makes you better
Know who you are - you are a reflection on your family
Accept what life brings - you cannot control many things
Have Patience - some things cannot be pushed
Live Carefully - what you do will come back to you
Take Care of Others - you cannot live without them
Honor your Elders - they show you the way in life
Pray for guidance - many things are not known
See Connections - all things are related

2. Michel Perrin wrote a book in 1976 about the Wayuu Indians and the Guajiro culture "Guajiro Myths and Symbols." He likely did not know of Usui or Takata. The Guajiro are one of the largest Indian ethnic groups in the lowlands of S America. He wrote, "reclining in their hammocks in the evening, a time that lends itself to the excavation of memories, men and women repeated the words of their ancestors. Day after day they became engrossed in painting a picture of the world they had created, the heritage they had received from their forebears, which to their sorrow, they dimly felt was in the process of disappearing. The originality of that world was immediately apparent in every one of those stories, which were the result of centuries of community life and shared thoughts."

3. At the Native Heritage Museum outside Anchorage, with Bear and Moose still wild in the land near the museum, there is a quote from Dolly Komakhuk, Inupiaq, White Mountain : "My grandmother was raised before there was any contact with the outside world. She taught me in the old traditional ways and those traditional ways are caring, sharing, and loving.... today it helps me to know who i am and where i stand."

When conventional science cannot help us, we have the right to seek human wisdom found not only in what we are taught exactly by a teacher, but in originality and stories that bring us to caring, sharing and loving. When we remember the Inupiaq, or the Guajiro, we enrich our own lives - which we are still living even with an incurable illness.

Takata told stories ..... whether they were precisely true or not, they remind us of ancient wisdoms that we can access. Do not worry and do not anger might also be said as pray for gudiance, many things are not known, see connections - all things are related. And for the Guajiro, the Pulowi of the seas and the Pulowi of the land still live. For the Inuit there is a magic mountain and they called it Denali, and for the Guajiro there is a magic mountain that still lives in spirit called Yaulama. Kurama seems to me not just a "physical place," but a magic mountain - when we keep the stories alive, it seems authentic to me.

Hopefully the stories that remind us of caring, and sharing and loving will not disappear - so that - when conventional methods fail us we can still be present and still heal when we cannot cure.....

Tuesday, June 5, 2012

Hope in Hospice

It has been 6 weeks since my Mom passed away, and I continue to reflect as I continue my own work in end of life care. We continue in American health care to leave patients and families difficult choices between transitions that are calm and compassionate, and those that are infused with aggressive futile care and "fighting for someone." The "fighting for" mantra - "I will fight for you" (and make your body and life a virtual battleground rather than a place of calm approaching a natural event) cdrtainly makes sense in those cases where a reasonable possibility of success (not even to say "cure") might occur ......

And so I want to relate two cases i have seen in the past month ..... these cases are in fact not so "rare" - we see about 100 new cases on our symptom management unit, some just for stabilization and symptom management, but many with death felt by highly trained and experienced hospitalists to be inevitable .....and about one case in every hundred really surprises us ...... so that with each family who asks me "how long" I always add the proviso that I believe there is a "higher power" who often makes fools of doctors, and that, our Hospice unit is the one place in the Hospital where doctors can "hope to be wrong."

A patient came to see me recently who was not responsive in any way suffering from a glioblastoma multiforme, an aggressive brain tumor. He was also suffering the ravages of aggressive chemo and radiation therapy .....and he was thought to be "imminent." We made as we often do some minor medication adjustments - in our unit we never really try to shorten or lengthen life, simply to seek "palliation" - this might include readjusting anti-convulsant medications and other sedatives and slightly increasing medication that can temporarily reduce the edema surrounding the cancer (and the brain irritation from the "battle" fought by the chemo and radiation agents....) ....... this patient slowly woke up ...... we dared to try to feed him and he ate ...... and when safe we got him up in a chair....... and he ended up leaving our Hospice unit - a place some say is a place to die, for a Skilled Nursing Facility.

To be sure he isn't "cured" whatever extra time he has is likely short. We make no claims of cure ..... only that we used what limited  conventional skills we had to stabilize medications and turned a "battle for his life" into a place of calm where he had the opportunity to live.

A few days ago another patient came in for a taper of levofed, a "pressor" agent. This is a medication that ICU's tend to use to stabilize blood pressure when it is too low and there is a sense of desperation. The patients family entered into vigil and the medication was tapered away ..... and indeed the blood pressure was very very low..... some would say "incompatible with life" but the patient was awake and comfortable and talking with the family.

Again ..... no cure ..... nothing magic ..... no huge claims ..... simply exchanging a sense of crisis and running around in circles with a place of calm, a place to live the time one has - and sometimes - for reasons we do not understand .....with calm and serenity and support human beings sometimes live longer than we doctors can imagine possible.

I am acutely aware that this journey is more difficult as a son than as a doctor ....and having been through it in a personal way, it never will be quite the same for me as a professional. I do know in some ways what families are going through (though - each personal journey is different and unique).

If I were to offer one reflection it is that giving up on futile aggressive medical intervention that is obviously not working, does not mean giving up on "hope" ........and that on an evidence basis we do not know what lies beyond death. It seems that most Americans believe in some spirit beyond the physical form, some studies suggest 90-95% and it would seem odd that absent any "evidence based" way of testing that "science" would think it could claim "hope" to be its domain, or to deny the deeply felt beliefs of most people.

It might seem - that absent the ability to prove or disprove a "hypothesis," evidence based practitioners might   not undercut "hope" that emanates from simple human faith, and assist in doing what we can to provide calm and compassion, where sometimes for reasons that astound us "miracles seem to happen."

Saturday, May 5, 2012

Only Forever

 I have been sitting and looking at this photo, which is from before i was born. It's a photo my Mom gave my Dad, and as she so often wrote to him, "only forever."

Tow weeks ago, my Mom passed away pretty suddenly, she was 91. The two qualities that really defined her were her willingness to reach out and help other people, and her tenacious desire to be independent.

She had been battling rheumatoid arthritis for quite a few years, and though sometimes a challenge, i viewed my responsibility as to assist her in living as she wished., not as i thought "safest."

And things went well till late Wed evening when we had to call 911. She made it to the ER but was in "medical terms" desatting, simply put, short of breath from a cardiac event.

The ER offered to put her on life support and she said, "no, its time for me to join your father" (my Dad transitioned in 1986). I asked her to consider allowing me some leeway on her advance directives, and she did allow the doctors to do some treatments.

It is interesting that in Hospice we so often talk about families "not on the hospice page," and i found myself thinking that sometimes, people rebound from cardiac events and maybe we could get to "rehab."

But two days later things had declined and she couldn't eat or talk very much, since when she took the oxygen mask off she got short of breath. We talked with the Hospitalist and Hospice doctor about options, "Mom you can make it to rehab if you wear the mask all the time" and she said "no, i want hospice." Both doctors thought this was best.

We moved to the Hospice unit after my Mom signed her own papers. She was mentally clear, and she was giving me a whole slew of instructions, who to call, where things were, what to do, but mostly she was talking about joining my Dad.

She got a little bit of medication to be sure she was comfortable, and we were surrounded by my Team, so different for me not being the doctor in charge, just being family .....

Lauren helped her take her mask off, she didn't want to wear it anymore, and i just held her hand. It was so calm and peaceful. She passed unconscious after awhile and we all just waited ..... and at one point spirit moved me to kiss her forehead and say to her, "Mom, Dad's waited long enough, you can go now." I could in a spirit way, feel his presence, its hard to explain that in words.

She took a huge deep breath, let it out and she was gone ......

She never seemed to suffer. It was tranquil and peaceful. And we can still perceive the gifts from people who love us...... only forever.

Saturday, March 31, 2012

The soft voice in the lotus

For people who come to my Hospice unit, they are not without Hope, but they have been failed by conventional science. And for each and every one we seek to find the strength that they have within them .... for some it is family, and community, and their organized religion, but for others they are alone, and conventional ritual doesn't resonate for them. After all .... when I enter each room, it is not about me, but about the person i am trying to help.

A Reiki friend wrote that "in spite of the best efforts to stamp it out, the voice of the compassionate elemental still whispers in the ears of our collective consciousness."

What do we mean by "compassionate elemental?" We were trying to seek not that quality which is represented by a "word" or "name" but the underlying quality that each culture is seeking to grasp, understand and name. For while concepts like "God" or "Ki" may translate language to language, culture to culture, human beings using these words are enmeshed within their own cultures concepts of the word ...... they are seeking something common, but they know they are referring to something slightly different.

This concept of syncretizing" is commonly discussed ....for example in Japan, there were Maria-Kannon statues during a time of persecution of Christians, the statue representing to some the Goddess of Compassion widespread in Buddhist Japan, yet at the same time to the adherent representing Mary, the mother of Jesus. And in the same way, as Christianity was sustained in a hidden way in Japan, throughout Africa, and Central and South America the Goddesses of the communities were suppressed in favor of Mary, but within the churches of communities adherents knew that the statue of the Mother of Jesus for them was Tonantzin, or Yemaya or other Goddesses, unknown perhaps by some - but revered by tens of thousands of adherents, even after generations of suppression.

Buddhism, Christianity, Islam, and Judaism all embody a concept of God, compassionate, gracious, and merciful. And yet what sometimes would seem so simple can seem so difficult, being kind and compassionate to others, especially those whose words for describing that which we hold most dear are different.

So what we need to seek sometimes is something deeper than simply clarity, or compassion, or peace of mind, but a mindfulness that leads to peace of spirit. A quiet place inside ourselves where all universes meet...."for the whole universe is him and he dwells within our hearts."

So we can .... keep in mind all our science and conventional knowledge, and at the same time, listen to that quiet voice that has not given up trying to reach us. It urges us when we have the honor to care for anyone, to approach them from "their own place." And in a time when they are the most fragile, assist them in using the voice they hold most dear. It places us beyond compassion, in a place of tranquility....

Saturday, March 10, 2012

a mission from the heart

From the Long Term Care Medicine 2012 meeting in San Antonio, AMDA dedicated to Long Term Care Medicine, "A Mission from the Heart."

Two years ago, and again last year, we presented sessions asking physicians to have open minds and open hearts, and to open dialogue regarding complementary medicine. Both of the past two years we had 35-40 attendees in what are known as "concurrent sessions." But this year, our session on Pain Management: Pharmacologic and non Pharmacologic drew nearly 200 attendees and our session room was closed due to capacity 10 minutes prior to our session.

The weight of evidence is compelling many physicians to express interest - and one of the most moving parts of the day is having some physicians publicly and some privately, acknowledge their own experiences and interests.

My colleagues for this session were Dr Michael Gloth, who teaches at Johns Hopkins Medical School and Dr Chuck Crecelius, a past president of AMDA and chair of our public policy committee. Neither of my colleagues themselves practice complementary techniques, but they were supportive of having open minds and open hearts, and I am grateful to them for supporting this dialogue.

The program committee also permitted me to do a one hour session demonstrating techniques from a perspective of Komyo Reiki Kai. I was careful to be supportive of all styles of Reiki, but wanted to use Komyo at this session for its simplicity, its motto "Go placidly in praise and blame" and its use of Hatsurei Ho as a Shoden technique. There was no thought of teaching a "level" of doing any Reiju in this setting today, but there was an intention of allowing physicians to feel Reiki energy, and to learn a few limited Reiki tools for self mindfulness. Our Keynote Speaker, Dr. Robert Wicks had set a tone by stating that physicians can share a sense of their own peace with others. He stressed the "necessity of appreciating the building blocks of mindfulness," and i was seeking to provide some simple tools - for use only on oneself.

What i was able to demonstrate is the Gokai, the 5 principles of Reiki, breathing, Gassho, and I was able to take 50 physicians through the elements of Hatsurei Ho as described in the Komyo Style, Sitting, Mokunen, Kenyoku, Joshin Kokyu Ho, Seishin Toitsu, and Mokunen.

Perhaps the ripples from this will include some physicians being more open to work with Reiki practitioners, perhaps a few physicians will seek a Reiki teacher - at the least I believe there will be more discussion - and hopefully more open minds and more open hearts.

My colleagues still know me as a conventional evidence based physician, I have been fairly clear that there are Reiki practitioners and teachers far more knowledgeable about Reiki than myself - and that my mission in the sessions was to share my own practice experience, and to encourage dialogue for our patients.

Sunday, February 12, 2012


One thing that has been important in the Hospice movement since the very beginning, is stories. We see moments of caring, heroism, courage and love ..... and in sharing the stories we make them continue to grow. People that we knew, in a way departed, but in a way living on in our memories of their courage and faith, and having their spirit spread by ripples of word of mouth - resonating from soul to soul.

One of my nurses attended a funeral last week - it is not uncommon in hospice, nurses can become a part of precious moments, and sometimes being present is not a simple action of supporting a family in bereavement, but a part of our own closure..... we learn we can at the same time maintain professional boundaries but also let ourselves care, i refer to it as having boundaries but breaking down barriers..... (or sometimes "taking off the white coat.")

She brought me a copy of words from the memorial service, and here was a paragraph, quoting a song "If I could have another dance" by Everett Badmarsh......

"do not mourn the flower as the fruit grows on the tree,
Do not mourn the crested wave returning to the sea,
Do not mourn the starlight at the first glow of the dawn,
Though I might leave, I'm never gone."

The wonderful Buddhist teacher Thich Nhat Hanh teaches that "death the moment when we can feel much regret." At the same time, death can be a time of "happiness and peace." "As soon as we begin to practice the mindfulness trainings, .....we have happiness right in this life, and we do not have to wait for the moment of death.....then we shall know the happiness.....and shall have nothing to regret."

I had some months back the honor to care for a physician colleague in the last weeks of his life. He came to us expecting to be gone in a day, or two at the most, and lived more than 8 weeks. It was .....while not far away or in an exotic place or in a time of war or turmoil - an incredible "profile in courage." No - we do not need to go "over the mountains or across the seas" to see humanity, and caring and courage in the face of suffering .....what he said many times was that, "in hospice we treated him like family." And so many patients express this to us - they know we cannot cure them, but they want to feel that we care. And i have heard it over and over, "I'm not dead yet, i know you can't cure me but i want people to treat me like I'm still here."

Moments that we have can be golden moments, being present, just present, for a life review can be an act of significant caring.

I was speaking with a person recently who has lost a loved one, had actually been present, and told me that it was "the first time" that she had been present at the moment of death ..... and we in hospice are here day after day, in a place that becomes familiar for us ....,never ever mundane, always a sacred place of awe, always an honor to be present, but even when we cannot cure we can assist as a guide - each journey is new, each different, but we have traveled on this river before.

And so - for those of us not able to be Masters or Teachers, but wanting to make a difference, this is what we can do ....

if we cannot embody wisdom and compassion we can hope to accept from a greater power, just a little bit and to use it just for the moment, just for today....

if we cannot hope to end the suffering of all beings, let us strive to reduce the suffering of just one being, if we cannot remove it completely to just reduce that suffering just for the moment, just for today

if we cannot find perfect wisdom, let us hope to be wise enough to work together in a common cause for our patients

if we cannot have perfect faith then let us strive to act to serve the spirit we hope is present, even though we do not have perfect knowledge

if we cannot learn enough to be a teacher than let us continue the journey as students

And share the stories

Monday, February 6, 2012

A wonderful thing!

As a new year starts, i am seeing suggestions that a wonderful thing is happening, which is that healers coming from different perspectives are beginning to look at what each other is doing - and learning from each other.

We aren't past a lot of the old history, and sometimes we are still lost in arguing about language or distinctions, or which one way is the right way ..... but that issue not withstanding minds and hearts seem to be opening --- and that likely is a good thing for all of us.

The past few months I've been learning from Tom Rigler, it is a wonderful opportunity - to say it most simply Tom is a good person, and tries to faithfully transmit what he has learned. In any case the past month we've been working on Munay Ki .....a series of Rites originating in Peru .... that led me to watching some You Tube sessions led by Dr Alberto Villoldo .....who left medical school to study in Peru ....and as one of his interviewers said "the rest is history."

Dr Villoldo said the following about American Medicine .... now some call what i do "Traditional Medicine" from the perspective that within American culture mainstream is traditional, and some call what we do "Conventional Medicine" - since many reserve the term "Traditional Medicine" for older wisdom and feel that what is mainstream is simply conventional .....lest anyone think "language" is not important there is now a serious dispute within Conventional Medicine about what to call phD level professionals within hospitals, that is since Nurse Practitioners now are designated doctorates in nursing - an NP working in a hospital is a doctor, but not an MD (or DO or equivalent degree from a foreign school) ..... but in any case .....

Here is what i heard Dr Villoldo say .... that Emergency Medicine is wonderful in the United States and that "if you get bit by a snake, don't go to a Shaman - go to an Emergency Room." And he added .... "but then go to see the Shaman to see why the Snake bit you."

What is important here is that a representative of what some call Traditional Medicine (and some would not allow the use of the term since he is a phD and not an MD) - VALUES what conventional medicine does well.

And at the same time we are seeing "Conventional Medicine" including Complementary techniques ...because increasingly there is a recognition that on an evidence basis these techniques often are helpful and rarely (far less often than some conventional techniques) harmful. In Hospice especially - and in Long Term Care in general .... even non-hospice .... the recognition that human connection can assist in calming people, and help with their rehabilitation, and reduce their rate of decline ..... that we can Care when we are unable to Cure ....this notion is becoming widespread.

It is because i am - really - Conventional - (though Thanks (!) to some of my Reiki friends who say, "oh no - we accept you as non-conventional" .....) within Conventional settings i am increasingly able to have these discussions with my colleagues .... and the discussions are respectful, there exists curiosity - when we made a presentation at an AMDA meeting - a national meeting of physicians in the Long Term Care Continuum we were nervous - we really worried -- but we had no need to !!! Many people stood up and said, "we need more of this type of discussion."

So in November i was able to share a presentation with a colleague acupuncturist at the State Chapter meeting of AMDA in Maryland, and in March i will do a brief Reiki demonstration at Long Term Care Medicine 2012 in San Antonio - but day by day - week by week - as we have meetings about hospice care (my national hospice, Seasons Hospice has engaged Joyce Simard, author of "The End of Life Namaste Care Program" as a consultant, and daily nurses and medical residents are asking me about how we are integrating complementary techniques into hospice care.

For now - i believe that my "Conventional Colleagues" are opening their minds, and my fellows in discovery of energy based methods are being patient with my lack of experience in ancient wisdoms. In Hospice, at the bedside, it remains my job to do the best i can to care when i cannot cure, to assist people in a transitional time .....

If people are reaching out - sharing - respecting others for what they do well .....that's a wonderful thing. This is a wonderful "ripple" to be a part of .....Thank you to all who share the journey!