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."