Stories....

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 ....is 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 ........today

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!

Upekkha revisited

At the time of my Reiki attunements with my first teacher, Robin Hannon, i had certain thoughts that led Robin to do the drawing at the top of this Blog, and led to reflections on Reiki in Hospice which i reflected in the term Upekkha Reiki, and gifted these concepts to Robin.

There is a certain tradition in medicine that we use scientific knowledge as far as it goes, but at the end of knowledge there remains caring. And for the physician who can care, there need never be a sense of futility or defeat, the process of caring itself is a gift.

Albert Camus reflected this in his book, "The Plague," through the first person narration of Dr Rieux, faced with a plague and no treatment, yet they did "what had to be done." And Camus himself, writing this novel, trapped within a Europe rules by Nazi force.

I saw the term Upekkha used - not in terms of Reiki - but in terms (very much like Camus) of a universal struggle - in the book "The Lizard Cage" by the young and talented Canadian author Karen Connelly. Her character, the musician Teza, trapped in confinement in Burma - Connelly like Camus writing from a sense of entrapment ....and what is common in sharing stories is that "some memorial might endure."

For a hospice physician, faced every day with dying patients, suffering human beings, - we cannot cure but we can care, can do what can be done, can be present, and can tell some of the stories. In acceptance and tranquility, in finding Upekkha, we move beyond simple compassion - we find what in Pure Land Buddhism might be called a path to the other shore.

The picture is simply of the Bodhi tree, leaves lost, burning in flame, existing, light shining through .....ready to take on leaves again.

In facing life from a place of calm, and acceptance, we can be present and caring.

We are honored to do Reiki in such a place or time. For Robin,there is an attunement with this, and for me i am not yet sure if there is any different attunement that the one's we are already taught to perform. It is for me a path, a way of looking at the world and our place in it, a guide to being present for people who need our presence.

This year I had the opportunity to study Komyo Reiki Kai with Hyakuten Inamoto. And the motto he teaches is simple, "go placidly in the midst of praise or blame." ("Even as a solid rock is unshaken by the wind, so are the wise unshaken by praise or blame." Buddha, Dhammapada 6/81)

For those who cannot be cured, who are trapped in a "cage" - we who cannot cure and perhaps cannot even offer adequate compassion can be present, and remember the human stories.

For those who share the work in Hospice or Reiki, Happy New Year, with Reiki Blessings and thanks.

What really matters .....

This week i heard Rabba Sara Hurwitz speak, and for those who may not know she is the first ordained woman Jewish Orthodox Rabba (or Rabbi). It may be hard to imagine the tumult her "conferral" (or ordination) has caused, but in this Blog i want to focus on something she said that really hit home as a Hospice physician.

For all the dispute over what it means to have a Jewish Orthodox Rabbi, and i understand that may not matter for many people, certain things are clear, that Rabba Hurwitz has worked extremely hard, she is extremely bright, and she has not simply learned "just as much" as a man seeking to be a Rabbi - she is a gifted and learned human being. But in talking about being a Rabbi, the day to day stuff, it really hit home when she said, "the most important thing is really .....showing up --- being present for people."

For a physician that may often be the case. Yes - we train hard and work hard, and dream of saving lives, but when a patient has an incurable illness - "being present" can be the most important thing.

Rabba Hurwitz talked about counseling a married couple in trouble, and she talked about being present for a holocaust survivor who lost her son in an accident, and shortly thereafter lost her husband. And i think to how often i have seen patients who could not be cured, but simply wanted their doctor to care for them - care about them - just be present.

Somehow - they view us as knowledgeable in life cycle events, little do they know in medical school and residency how little is taught about dealing with feelings - it isn't a question "on the boards." How much more joy in quoting the most recent article in "rounds," or in making an astonishing diagnosis - and yet -- sometimes people are so willing to forgive us for so much - if we can just be present. The fact that we can't cure someone doesn't mean that we can't care for them.

I must admit as a Hospice doctor - there are these joyous incredible moments when i make a diagnosis everyone else has missed, and cause the turn around of a severe illness and actually discharge a patient from Hospice. Yes - it does happen. It is like hitting "the shot" in game 7 of the NBA finals or hitting a 9th inning home run, but it doesn't happen that often. Most days - i come to work, and not being able to cure anyone under my care, i continue to care for them, and most importantly be present with them --- as so many people have said to me "I wish they wouldn't treat me as if i'm dead already, I may be terminally ill but for now I'm still living."

I went to hear a speaker talk about what it meant to be the first woman Rabbi, and what i really took home was a reflection on what was the most important thing in my own job - yes I bring hard work and long years of study, but so often for the people who come to me the most important thing is that I showed up, and that for them - for that moment, I was "present," and that even though I couldn't cure them I could still care for them and share the moment with them.

Reiki Byosen for the Physician or Nurse

We have been working with a simple technique to allow non Reiki trained physicians and nurses to be more aware of natural channels. I often feel that as a teacher, the task comes down to helping people to be aware of those things that they already have the natural talent to be aware of if only they "listen" closely to the world around them.

Doctors and Nurses are trained in classical physical examination to "Observation, Palpation, Percussion and Auscultation." It resonates with health care professionals, because we all understand the tendency to rush to auscultation (listening with a stethoscope), and we all know from our training that observation and palpation are classic techniques that matter.

Studies consistently remind us that about 70-80% of accurate diagnosis comes from careful history taking, and that an additional 15-20% comes from observation and physical examination, and yet, laboratory testing - which only accounts for about 10-15% of accurate diagnosis becomes the reference point too often. We sometimes forget that when a lab test does not correlate to the history and physical exam, what is really "going on" - it is often the laboratory which is not correct.

So with student doctors and nurses rounding with us in hospice, we focus on classic physical examination - we focus on observation and palpation prior to auscultation. In fact, in hospice, we so rarely use laboratory testing, that use of our physical examination skill becomes even more important.

Palpation over the pre cordial impulse, the middle of the chest, corresponds to the Heart Chakra. And from the perspective of physical exam there is so much we can appreciate through our hands. Breath sounds and murmurs heard through a stethoscope are "vibrations" - so often they can be "palpated" and we can appreciate heart rate, heart regularity, many murmurs and breath sounds. In dehydrated patients (which hospice patients often are) - often sounds are missed with stethoscopes - but corresponding vibrations can be palpated. Training our hands to be more sensitive is just like training our ear to discriminate more with the stethoscope.

But so often - by spending a little more time observing and in contact with patients, we become aware of more than just the physical vibrations. If nothing else, when we ask patients for permission to examine them (and we always ask permission before touching anyone), the contact and the time spent are important. For people with intuitive tendencies, they often become aware of more of what is actually "happening" to the patient, on a spiritual as well as a physical level.

It is not always easy to integrate "scientific" observations, with intuitive observations happening at the same time. So often, people lock out one or the other thinking the "signal" will be clearer if not "confused" - but in fact with time and practice for an experienced clinician (and of course only a licensed clinician can diagnose) - being holistic and bringing all our sense to bear improves our accuracy. At the least - it improves our contact with our patients at a time when a sense of connection is often what the patient wants, since in hospice, cure is already not scientifically possible.

It is important as a physician to realize what a precious gift our scientific training is, but at the same time respect what Reiki Practioners can accomplish with years of practice - Reiki after all is a healing art form and not a scientific process - and it really cannot be "distilled" in the same way as our "material" observations and tests.

From the Reiki classes i have participated in, I have an awareness of how much talent that some of my teachers and classmates have. One can become a Reiki Master in a relatively short period of time these days, but that is the "beginning" of studying Reiki as a method or process. Several years along, having been trained as teacher in multiple styles, having participated in shares in Japan and Vancouver, Barrie Ontario and in Maryland - having visited Kurama - I can reflect on how early in the Reiki journey I still perceive myself to be.

Integrating holistic care at its best doesn't mean a physician becoming a Sensei, it means physicians opening their minds and hearts to new opportunities, and experienced Reiki practitioners being available to assist as participants in an overall plan of care. This is most evident in Hospice, where Spirituality is so central a part of the mission, where Science alone has failed the patient, and where Hope stems from connection and continuity.

We need to be cautious with certifying "Complementary" methods within the health care professions. "Alternative" pharmaceuticals, minerals and nutritionals certainly can be tested in classic scientific ways, and brought into the mainstream. Art forms such as Music and Reiki touch the spirit, and are skills that having a Health Care degree may not make us more qualified to assess.

I would rather have Musicians judge intonation, and Reiki Sensei who have devoted their lives to Reiki method set standards for Reiki - than those of us who have spent so much time learning anatomy and physiology and pharmacology.

We are all still on a journey of learning more - in acknowledgement of those things which we have yet to learn, we are likely better at what we do for keeping a sense of humility.

Robin's Song

I receive many messages every day through my connections through Reiki. And today i received a message from my first Reiki teacher, Robin Hannon, which moved me to share on my Blog. Robin placed on You Tube a version of "Amazing Grace" which she sang commenorating her father, and it was rendered in Cherokee.

"I am on YouTube singing Amazing Grace in honor of my father

http://youtu.be/zrXphbyrTOk

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.

Transitions

We have been having a dialogue within my Hospice regarding the use of the term "death" and the the term "transition."

It has been said that "words have power," but in the process of this discussion we have all learned that different people use words in different ways, and that what matters most is what each person actually means. Respecting each other, and respecting each other's words, is an important part of working together as a Team.

To some degree this dialogue began when my friend Jackie Vance RN, who directs the Clinical Practice Guideline program for AMDA (a conventional national organization for physicians who work in the Long Term Care Continuum) wrote in her Blog that the term "discharge" should not be used. This reflected a thought of the AMDA "Transitions of Care" committee that people "transition," they are not "discharged."

And I reflected in a comment to Jackie that language reflects how we look at our patients, and at ourselves.

The TOC committee felt that patients should not be viewed as gotten rid of, and that communication should reflect continuity. And continued caring.

In a paper presented in March, myself, Dr Rajapakse, and Dr Crecelius (a former president of AMDA and Chair of Public Policy Committee) reflected on discharge by "death" vs the term "transition"

Death to us implied "the end -finality - fear of the unknown - loss - hopelessness - loneliness - lack of connection - anxiety - fear"

Transition to us implied a sense of "hope - connection - ainticipation of a journey - a focus on living the current moment - calm - peace - harmony"

And I concluded "death like transition are words draped in despair." Jackie published my comment with her excellent Blog

http://www.mcknights.com/transitions-of-care-part-ii-so-you-know-they're-eventually-gonna-have-to-leave-right/article/208210/

When i published comments within my Hospice, many of my co workers began to follow my terminology and talk in terms of patient "transitioning."

And the good part of this is the opening of dialogue, and the openness to spirituality. But we have had some problems - just as some co-workers feel uncomfortable having spirit suppressed by the term "death" - some co-workers feel uncomfortable with the term "transition." We speak of "time of death" in a professional way because it is clear and succinct; and some people do view death and the terminology surrounding it in a spiritual way.

And I have come to believe that it is important to promote dialogue and respect everyone's words. What is important is respecting the spiritual history of the patients, and being present and caring as well as being technically skilled and accurate.

In the bond between human beings, we are team mates and patients and parents and children - and we all matter more than our physical form. And hospice to some degree is about that - not simply the relief of physical pain, but as well the relief from "suffering."

When I started this discussion about the difference between the words "death" and "transition," I was more certain of the importance of the difference between the words, but as time goes on, I am more certain of the importance of the dialogue, and of the need to proceed with respect always for patients and for colleagues. I am happy to work with a Team where the dialogue is carried on with respect, and where the spirit behind the words really does matter.