a Journey of Spirit

This Blog reflects on my journey, caring for hospice patients living the later days of their lives. It compares aspects of my own spiritual upbringing to that which I experienced in my journey to Japan, and reflects in some ways on the connections between Pure Land Buddhism and the challenges we sometimes face caring for patients in hospice.



Visiting Usui Sensei's resting place in Tokyo, one finds oneself at a peaceful, meditative place which is a Pure Land (Jodo sect) Buddhist cemetary. In biographies about Mrs Takata, an "Archbishop of the Jodo sect" is mentioned, but one cannot know with certainty exactly what this realtionship represented. Many of Mrs Takata's stories were allegorical, and she was writing at a time of intense prejudice in America.

Respected sources record Usui Sensei as a Tendai monk, and suggest that he was originally laid to rest in a Tendai cemetary and then moved to his current site. Others have recorded Usui Sensei as Christian, which is doubtful, or Pure Land Buddhist. The truth in history is beyond my grasp, but the fact is that Usui Sensei lays to rest at a Pure Land cemetary and that fact led me to reflection on the serenity and connection of Pure Land thought. I am not a Buddhist, but, people in moments of need seek a connectivity that seems to me best represented by what the great religions have in common, not in the qualities that make sects distinct.


Recently I was caring for a patient with cancer. Randy was unsconscious, he had suffered through surgery and chemotherapy and radiation therapy. Every conventional modality had been tried. He had been rejected for stem cell treatment (though I have had patients who have been through even that in their struggle). We were able to control Randy's pain, but his family family were suffering. They looked to the hospice team for help and support. Time and again in hospice, we are faced with patients and their families who look to us for guidance and for caring, when we have no tools for curing. What do we do? It just doesn't feel right to button up the "white coat" and walk away in these moments.



In these moments, all members of the hospice team become equally important. When all we can do is connect and support at a human level, there is no hierarchy. Every member of my Team is valued.


Honen was a Buddhist monk who lived from 1133 to 1212 Common era in Japan. He studied at Mt Hiei and was ordained a Tendai sect Monk at age 15. He founded the Japanese Pure Land or Jodo sect. Usui Sensei is laid to rest in a Pure Land cemetary in Tokyo. It is likely that Usui Sensei was a well educated man, aware of the teachings of many sects of Buddhism, and of Christian, Jewish and Muslim teachings as well.


One of Honen's principal teachings occurred when followers of his Jodo Shu sect saw both Honen, and his student Awanosuke, studying the meaning of "Nembutsu." "Of course," one said, "Honen's Nembutsu practice is better than Awanosuke's." Honen answered, "there is not the slightest difference between the two, because both of us have the same intention of wanting to attain birth in the Buddha's Pure Land."

What was the nature of this practice "Nembutsu?" It is repeating the affirmation, "Namu Amida Butsu" often translated as "homage to Amida Buddha," - a simple statement of faith. I have also seen this described as "save us oh Amida Buddha"using the term of Buddha as a manifestation of God the creator who is still active with compassion in the world.

There is a comparable Jewish prayer in the mystical "Hallel." It is a most basic affirmation of faith. "Ana (and then a Hebrew name for God) ho-shi-a na." It translates "please God (creator and ongoing ruler of the universe) save us."

In hospice, at moments when science has failed, a simple reaffirmation of faith and acknowledgement of a higher power that connects us can mean so much to patients and their loved ones. So much often pours out, "we didn't think we could talk about this with you." At a time when people need connection the most, and when more surgery is not an option, science should not "sterilize" the discussion of a creator from the room.


Honen was known for another teaching, and that was his belief that attainment of enlightment was not limited to the rich or to fellow Monks. Honen believed that women and men, rich and pure, fisherman and Samurai, Monks and laypersons, could all attain enlightenment, and this was revolutionary in his time at Mt Hiei. Honen defended his position based on stories and teachings from the historic Buddha, Shakyamuni.


Honen taught that in seeking enlightenment it was not enough to seek just for oneself. The search for enlightenment required assisting others. It was a similar dilemma that led the great Jewish scholar Hillel to teach, "if I am not for myself, who will be for me? but if i am only for myself, who am I?"

For those who do not believe in the revelation that there is a God who created and still cares for the world, and that all human beings are connected through that spirit - it is not for me to convince or convert. But in those moments when transition seems near, it is reasonable to talk about those strengths and connections by which the patient and the family have lived. Those who make simple affirmations of faith seem to suffer less, if at all.



Whether Sensei Mikao Usui was a Christian or a Buddhist, and if a Buddhist a Tendai or Pure Land follower, he lived a secular life and passed to the world a very non sectarian message that without religion allowed for connection to a Universal spirit through simple method.

These 5 affirmations seem consistent with most of the major religions, and seem to help reduce suffering.


1. We will not worry just for today (since we Affirm faith in a Creator)


2. We will not be angry just for today (since we ask the merciful Creator to forgive us all our errors just as we forgive others)

3. We will work hard today (since human beings of all stations in life can reach enlightenment, we all need to do our own share)

4. We will be grateful just for today (for what the Creator does for us)

5. We will do kindness just for today (to enlighten and connect oneself one must attempt to help others - we send ripples of compassion into the world)

When we return to that which we all have in common, rather than focus on that which makes us distinct, we are more able help others through a difficult part of their journey.

Sometimes Life seems hard

Sometimes Reiki meditation helps us in keeping a perspective, and understanding what it means to "be grateful." Right now, it is difficult to be a primary care doctor in this country, and in talking with colleagues every day, I hear and am aware of the frustrations. And this Blog is not intended to enumerate these concerns, nor to minimize them, when young physicians are choosing not to enter primary care, and experienced physicians are leaving their careers prematurely, it is a cause for concern, but the intention of this Blog is to reflect on other stories, of people who overcame tough challenges in life, and made a difference.

Reiki as we know it in North America became widespread due to the efforts of Mrs. Hawayo Takata. People are seeking to understand more about her allegorical stories about Reiki, and to understand more about her life. Much is private and some that was taught in allegory is not clear, but certain things are clear. Mrs Takata had many difficult challenges in her life. Things did not always come easy.

Before she was 30 years old, her beloved husband passed away of lung cancer, and she raised two children as a single parent. She had to work hard. She had health challenges herself. When she was 40 years old, her Reiki mentor died, and she was alone in Hawaii as a widow with children, an American of Japanese decent, at a time when Japan and America were going to war. Perhaps the truth most important to keep in mind as we seek to understand what she gifted the world with, was the simple fact that in the face of personal hardship she worked very hard, and gifted the world. Her biographies mention some of her hardships, and some of the prejudice that she faced, but do not dwell on them. The common thread to the stories about Mrs. Takata is that she maintained a cheerful countenance, used her talent to help other people, and sent forth ripples of compassion that still spread.

This past week, I had the honor to hear another such story. A nurse, Deb and I were making a home visit together to meet a new hospice patient. We went to her home, where her husband was caring for her, as she continued her long struggle against Alzheimers Disease.

With all the stresses on our time, we feel it is important to take the time to get to know our families, and in this case her husband gifted us with his story. He is a retired fellow physician, and the story of his life as a healer is one all doctors today need to keep in mind.

He went to Meharry Medical College, until the early 1970's, almost 25 years after Jackie Robinson played for the Brooklyn Dodgers, African Americans were only admitted to 2 medical colleges in America. It is hard to believe. But true.

He shared that his father was also a physician. And he remembers when his brother's high school was closed down, his brother had to walk 7 miles a day each way to go to school. His father, in 1947 began a lawsuit against the school district, but things moved slowly, and they lost at local court levels, with the justice system permitting racial segregation in schools and lack of equal opportunity in education. As a child, he remembers then NAACP lawyer Thurgood Marshall, coming to their home, and listening to his dad and brother's stories. When lawsuits from several states were "merged" to be presented by Thurgood Marshall to the Supreme Court, this case was one of the cases which became a part of what was named "Brown vs Board of Education." And in 1954, the Supreme Court of the United States declared that segregated schools were illegal.

Sitting in that room I felt a sense of awe and honor. I came to help this family, but his story was helping me. It was placing the challenges of my own day in perspective. My patients husband was facing life as he had always faced life, as his father had taught him to face life, without worry or anger, but with a determination to be a physician and spread kindness to others.

Deb and I were sitting in a room connected to a moment of history most important to our country, but we were being gifted as well with a perspective on how to face challenges.

When things are difficult as a health care provider, all I need to do is see the challenges my patients are facing. They are so often stories of courage.

In a prior Blog I wrote about one of my patients who was brought to my in patient unit, with the intensive care facility of a referring hospital expecting him to die in a day or two. He was bowel obstructed, and medically we saw no hope. We cared where we could not cure and our chaplain prayer with him, and did Reiki with him, and somehow, he did not die right away. After a month, we agreed to send him home, and he lived another five weeks - it seemed whenever we talked with him he was praying for other people he loved, Blessing other people, or thanking God for what he had been gifted with in life.

Some people see the challenges they face, and do not allow themselves to absorb the worry and anger of the moment. A doctor who had to face terrible prejudice just to be a doctor, persevered and took part in a quiet action that changed the soul of America, and Mrs Takata, a facing personal loss, and at times prejudice in her new land, left a legacy of compassion that has a very wide impact today.

Whatever the details of the stories, and however they are written or not written by history, there is a precious human lesson - we are gifted when we listen to it.

Reiki Treatment and a new evidence based article

An important event has occurred for those having an interest in Reiki treatment, and that event was the recent publication of an article by a team that included Reiki Master Pamela Miles, and a group of Yale researchers.

I urge Reiki practitioners - especially those attempting to integrate Conventional Medicine and Complementary techniques - to be aware of this new contribution.

Pamela Miles web site is http://reikiinmedicine.org/ and the discussion of this specific article is at

http://reikiinmedicine.org/clinical-practice/reiki-heart-attack-reik/

There have been prior preliminary studies suggesting possible interaction between Reiki treatment and the autonomic nervous system, but this study in the Journal of the American College of Cardiology is a significant randomized controlled study carried out at one of the most prestigious academic institutions and published as Pamela notes "by one of the most prestigious peer-reviewed conventional medical journals."

The article is "Effects of Reiki on Autonomkic Activity Early After Acute Coronary Syndrome," Rachel SC Friedman, Matthew M. Burg, Pamela Miles, Forrester Lee, and Rachel Lampert J Am Coll Cardiol 2010; 56; 995-996

This article leaves us much to ponder on - but just for today, consider the reasons for doing Reiki treatment on yourself.

Reiki Shares

In the last month I have been blogging less and learning more, my own perception both as a Hospice physician and as a Reiki practitioner is that continuing to learn, grow, evolve is an important part of living.

This month our own share had 9 masters and one new practitioner - since we are not teaching as a class within our share I will not say "student" - though I believe in fact we are all "students" learning from each other.

It is an incredible experience to "exchange" or "share" with many Reiki practitioners from different traditions. There are commonalities: - sharing a philosophy that flows from the five basic Usui principles - the fact that doing Reiki causes hands to heat up - and a sense that connecting to "energy" changes one's life for the better.

For some of us, having a very defined curriculum or method is very important - and for others of us, the energy that flows and the way we interact with it varies with the history and nature of the person, and what that person needs.

I think it is important to recognize the commonalities and to respect the differences.

We had a very special treat in our September 7 share as Hazel Numsen, who learned with both Dr John Upledger (cranio-sacral therapy) and Dr Fritz Smith (zero balancing) gave a demonstration. It seemed when I visited Japan that many people viewed a broad spectrum of spiritual approaches to energy as "Reiki" - but here in the United States it seems to follow a more defined approach - yet - there are many other approaches to what we call "energy."

Dr Upledger describes his own approach, SomatoEmotional Release, as follows in his book, "Your Inner Physician and You:" In SomatoEmotional Release , the approach is quite different. Here we simply place our hands on the patient. We then give silent permission for the patient's body to do whatever it deems appropriate at the time. We offer to put energy into the patient."

Now one may come to conclude that Dr. Upledger's approach is not Reiki, (or -perhaps one may conclude that it is - end of day not so important to me) he is an Osteopath, and comes from a traditional that does not include Usui, or Hayashi, or Takata. And yet reading his book, it seems fairly clear that his intention is to work on the same "energy" that Reiki works on - and that we can all learn from each other.

Last week I went to learn Reiki from a distinguished Reiki Master - notwithstanding that I have received the Master symbol four separate times now, formally, I still feel a benefit from continuing to learn. Seeing patient every day with incureable illnesses is simply a humbling experience for me. I use conventional medicine when ever it has a reasonable answer, but I simply cannot cease trying to "heal" because I am unable to "cure."

And this person pointed out that the energy he was working on with me "was different from Reiki." The intention is to grow and "be who you are." Or perhaps more "who you can be."

It is - perhaps naively - my hope that we can remain inclusive, and consider healing energies as being in synergy, when their intentions are to heal, and their techniques are not invasive, but rather gentle encouragements to what Dr Upledger would call "your Inner Physician."

My own sense - if this led one to avoid anger, just for today, to avoid worry just for today, to work hard, and to be grateful, and to offer a kindness today; if this caused your hands to heat up, if this had an intention to heal by gentle touch (or perhaps by energy not even transmitted by actual physical contact) - then the great masters would see it as their own.

If not, then we can still be grateful for the opportunity to assist others, and or the opportunity to continue to grow. My appreciation remains for all those who share this journey.

Just for Today

Patients often come to my Hospice unit, with a prediction of imminent death. "If you remove the ventilator they will die," but they not always do so; "if you stop dialysis they will die," but they do not always do so.

It does not mean that doctors' training is faulty, it simply means that we are trained to make decision based on statistical probabilities, and life does not always proceed as expected. I tend to answer questions as to prognosis as honestly as I can, but try to add, that in my job, I "hope to be wrong more often." If the Creator tosses a proverbial "pie in my face," I need to have joy for my patients good fortune.

Recently we received two patients coming to our unit with aggressive life support, their blood pressures maintained by articial intravenous medications. In both cases, excellent specialists spelled out correctly what the numbers meant, and what the expectations were. If the medications were stopped, they "would die." And there is no question how the numbers looked. In both cases though, as in so many of these cases, continuing aggressive medication was not a panacea; first of all such modalities only work for so long - they are not ongoing answers or cures. And secondly, the patient in such a situation is "hooked up" - loses all sense of freedom.

In some cases, such as being on a respirator, the patient is unable to talk, and often needs to be heavily sedated to keep the machinery in place.

In both of these cases this week, the patients decided to withdraw the "life sustaining medication." Our intention is never to "end their life," but to affirm their right to choice and empowerment over their own existence, and to give them a chance, a hope, an opportunity, to live free of being "connected" or "hooked up." Being "open" to Spirituality, helps us turn a certain death into a chance for life. Even if that living is only for a short time, sharing love and memories with loved ones can be precious and important.

Usually - the docs are right, but not always. And fortunately, everyone was wrong in our recent "dobutamine" cases. Slowly we weaned the patients off the medication, and one of them actually began to improve. He became more alert, he started eating, he got up, and started walking around our unit. He decided it is "time to go home."

Our other patient who stopped his aggressive medication is still with us. He is surrounded by family with love pouring into him. When we cannot cure, we can join a family in caring, and in prayer.

This is a part of the nature of Hospice; accepting that we use our scientific skills as best we can, but that human life is more than lab tests and numbers. Sometimes we can do nothing more than make someone comfortable. But sometimes, we can do something more, we can have someone prove us "wrong," even if "just for today."

Climbing the Reiki Mountain

It was only two months ago that we were in Japan, visited Kyoto, and climbed to the Temple on Mount Kurama. Mikao Usui had a vision there, which started a chain of events that led to many people, perhaps millions of people, being attuned to a spiritual energy and learning a method of healing.



It doesn't seem yet so long ago, nor in truth so far away (though the flight seemed to go on and on and on at the time). We live under the same sun (even if day here is night there) and the same energy flows through us all. Today I saw another "climb" - and it taught me something - that Kurama isn't only in Japan. The spirit surrounds us wherever we are.



Philip is a man who is living the last days of his life, i will not say dying because he does not think of himself in that way. He has a rapidly spreading cancer which has caused an intermittent internal blockage - the medical details really do not matter. He has wanted to receive artificial intravenous feeding, and we have followed his requests. In hospice my mantra is to empower the patient and follow their wishes as much as possible.



On the television it said today was going to be a sunny day, for me, that reminded me of my day climbing the steps of Kurama, but for Philip, it made him want to go outside. He has not been in the sun since he entered the hospital. He wanted to walk around his room, and walk to his wheelchair, and as he said, "I can only do that if someone helps me."



The effort that it took him to walk around his room, even with his walker, even with help, exceeded the effort it took for me to climb Kurama. More exhausting than the travel, the security, the flight, the bullet train, and finally the half day climb up the steps.



But today he made "the climb." Walked to his wheelchair, and a volunteer took him outside, and he sat in the sun for 15 minutes. I asked him how he felt, and he said simply, "good." He was focused on living - just for today.

Reiki and a Hospice Team

Every Hospice Team every week has a brief ceremony that memorializes the patients who passed away that week. Each name is read, and discussions often ensue on bereavement needs. We try to remember and learn from each and every person who entrusted us with their care.

Each week, we try to add something that makes the moment meaningful, sometimes a music therapist plays a song, sometimes a candle is lit, sometimes the chaplain says a prayer.

This week, one of our chaplains who is also a Reiki practitioner asked if she could do a different sort of reading. We each closed our eyes, and with her voice asking for energy to be open us, there was a feeling of a Reiki shower, and she read a form of a "Boddhisatva Vow"

"May I be a guard for those who are protectorless,
A guide for those who journey on the road,
For those who wish to go across the water
May I be a boat, a raft, a bridge.

May I be an isle for those who yearn for landfall
And a lamp for those who long for light
For those who need a resting place.

May I be the wishing jewel, the vase of plenty,
A word of power, and the supreme remedy
May I be the trees of miracles
And for every being, the abundant cow.

Like the great earth and the other elements
Enduring as the sky itself endures,
For the boundless multitude of living beings.
May I be the ground and vessel of their life.

Thus for every single thing that lives.
In number like the boundless reaches of the sky
May I be their sustenance and nourishment,
Until they pass beyond the bounds of suffering."

There is in hospice a very special bond, that has to do with the honor of being committed to relieving suffering in sentient beings. So often in healthcare, there exists a sense of loss and futility. In hospice there exists a sense of Purpose.

We can nurture people who we can no longer nourish, heal people who can no longer be cured, and care for people until they transition "beyond the bounds of suffering."

This brief ceremony is always very meaningful, and thank you to our chaplains and music therapists who add a special sense of spirit every week.