Jeff Rubin's blog

Guest blogger: Mr. Dan Cayer

I first met Dan Cayer at an Unconditional Healing workshop almost ten years ago. He was probably the youngest person there,  and I thought how brave of him to join in and share his story.  Dan's story, a mysterious illness which robbed him of the use of his arms and hands due to constant burning pain, resonated with me. Partly because I also suffered from a mysterious illness, but also because of his gentleness, lack of self-pity and desire to be of help to others.  Dan has made great strides in his life, and recently recounted his story for the Elephant Journal, and with his permission, I re-post it here. It is entitled, "What No One Told Me about Chronic Pain".  

 

http://www.elephantjournal.com/2015/03/what-no-one-told-me-about-chronic...

Embodiment Practice: Respecting, Honoring and Inhabiting the Body

I'm just coming back from a fabulous Unconditional Healing weekend program in Los Angeles. We had our largest gathering yet at 33 participants and it was a powerful manifestation of the teachings and playful energy of Unconditional Healing.  One theme of the weekend was disembodiment, how we “live in our heads” not connected to our body, the majority of the time. While obviously metaphorical, it actually feels like we reside as an entity in a physical location of our brain. I'd like to share some of the highlights of the weekend and offer some ways to practice embodiment on the meditation cushion and off. 

As part of this disembodiment dynamic, the body is considered an afterthought, existing only to carry this “controller” in our head from place to place, and having little intelligence or wisdom of its own.  Everything becomes objectified from the controller’s viewpoint, an “other” if you will, including the body itself, which we treat as an object rather than a subject.

In simplest terms, we become disconnected from our body, and we walk around in a disembodied state most of the time.  We’re like phantom people, there but not there, and operating from a vantage point of either the past, which already occurred, or the future, which doesn’t yet exist.  We’re not really in touch with our body itself - we relate to a psychosomatic body, filtered through the controller’s agenda, fears and biases.

As a consequence, we not only miss the present moment constantly, which is alive, vibrant, and energetic, but we create an exceptionally unhealthy environment for ourselves.  We are out of touch with our feelings, spending more time thinking about them than experiencing them.  Now the body is actually connected directly to wisdom - it is wisdom itself;  so by relating to it as a glorified mule, we lose touch with that direct wisdom quality completely.  The body, interestingly enough,  constantly takes in and processes experience and information directly and accurately without an agenda, but the controller ignores this, because often this info doesn’t jibe with the controller’s self image. In other words, the controller accepts some messages from the body and rejects others, all at very rapid speed.  Those it rejects may not even register consciously in our mind, they just stay within the body.

For example, suppose the body experiences anger,  but that emotion doesn’t mesh with the controller’s self-image as being a peaceful, gentle person.  So even before that anger arises as a conscious emotion, the controller represses it, because it doesn’t fit its agenda.  What happens to that repressed anger?  Well, usually it’s stored somewhere in the body in sort of a very gray area between consciousness and unconsciousness.  If we’re lucky, it might manifest as pain or discomfort, or some other physical manifestation.  We might go to a massage therapist who works on that area, and we experience, (much to our surprise and possibly for the very first time) that unprocessed emotion and the circumstances that invoked it. 

During the weekend, we practiced meditation as a somatic, not mental exercise.   We also practiced a guided meditation that utilized the body’s own self-healing mechanisms, activated through visualization.  Visualization from this viewpoint, is considered a very healthy, sane use of the mind to assist and honor the body. This is an example of mind’s rightful place in the mind/body hierarchy, rather than the body being completely subservient to the controller in the head.

I’ve been emphasizing embodiment practice in all my teaching these days, so here are some ways to connect with the body as a wise, compassionate and powerful entity rather than as a mere object to cart around our craniums.

1.     When you practice meditation on the cushion or chair, begin by having a sense of sitting on the Earth. Like us, the Earth is alive, energetic and not an object. It is considered a macrocosm of the human body, that's why it's often called Mother Earth. When we connect to its energy, we also connect to our own body, so feel that connection as much as possible.

2.     Then start with a body scan from head to toe.  Working down from the head, bring awareness to each part of the body, relaxing any tension or dis-ease you find there.  If one part of the body is particularly stiff or tense, breathe into that area which brings healing energy to it.

3.     For the main shamatha (peaceful abiding) practice, emphasize breathing from the hara, the area of the lower belly, roughly 1 1/2 inches below the navel.  Breathe from there rather than focusing on the breath leaving the nose, and direct your attention to that part of the body. This will bring a greater sense of body awareness, especially if you are feeling disembodied and “in your head”.

4.     Off the cushion, inhabit the body throughout the day.  First thing in the morning, don't immediately go into your head, (or your phone) with the day's tasks and worries.   Instead from your bedside, swing your feet onto the floor, sit on the edge of the bed and take stock of your body.  Notice how it feels, especially noting any stiffness and residual tension, and breathe into that area. If it's really stiff or uncomfortable, you might massage the area. The point is to take a moment to feel the body, to BE your body as the first act of your day.

5.     During the day, at odd times; in your car, at your desk, in front of your laptop, do the same exercise. Relax and feel the body, possibly doing a body scan from head to toe. Breathe into areas of tension and dis-ease.  

6.     Adopt a regimen of bodywork along with sitting meditation.  It could be yoga, qi gong, massage therapy, mindful walking or running, or simply gentle stretching.  The idea though is to do your practice while inhabiting the body versus distracting yourself by retreating into your head.  Don’t simply put in the time as a self-improvement project for that "thing" that carries us around.  Embody your practice and you’ll find it invigorates your life, and brings a sense of deep connection to yourself and to the world around you.

After the weekend, in a bit of synchronicity, one of the participants found the following fascinating article in her inbox. The article is an interview with Philip Shepherd by Amnon Buchbinder, where Shepherd extols the existence of a second brain that exists in the belly, but which has become completely overshadowed by the dominance of the cranial brain.  Shepherd’s insights closely resonate with many of the principles I presented at the  Unconditional Healing weekend, especially the belief that our identification with our head in the form of a controller has completely reduced the role of the body to a dumb transport mechanism for our cranium.   The article can be found here.

 

 

 

Happy New Year

It seems like only yesterday we were worried about the Y2K anomoly shutting everything down, but amazingly, it was a full fifteen years ago. The older we get, the faster time passes, or so it seems.

Sometimes the world seems so crass and unforgiving and we feel overwhelmed, which is why it's so important to look deeper and realize the  pristine and unsullied quality of both ourselves and our world.  That quality of basic healthiness is always there, always available, always beckoning us. 

I'd ike to wish everyone in our Unconditional Healing community a healthy,  happy,  and vibrant 2015.  Let's make this the year of  being unconditionally kind to ourselves, and by extension, kind to those close to us,  and to those we don't even know.  May it be a year of further opening, gentlenss and strength, a year of "feeling what we feel" deeply and without reservation. May we experience the blessings of this world in all our endeavors, realizing  that blessings often come disguised as pain.     And lastly, may we realize that happiness can never be found by grasping and chasing after epehemeral things, but comes to us when we relax, and give up the struggle to be happy.  

I recently gave a live-streamed talk on Unconditional Healing.  Please find the link to the talk here, if you are so inclined.

 

Healing blessings for 2015,

-Jeff

 

 

 

 

Radio Interview on Unconditional Healing

Hi everyone,

On Friday night I was interviewed on the show "American Buddhist Radio" on WMUA, 91.1 FM, which serves as the radio voice of Univ. of Mass at Amherst. The topic was Unconditional Healing; specifically working with illness and adversity in a sane way. We also discussed the Healing Circles that are now operating in four cities - NYC, LA, Albany, NY and Northampton, Mass.,  and which I'm hoping is just a beginning.

The moderator of the show is Jesse Schwalbaum. Jesse recently attended the Unconditional Healing workshop that I directed in Northampton, Mass.  

 

You can download the podcast below: Download Episode 10

http://wmua.org/podcastgen2/?name=2014-07-25_abr10podcast.mp3

 

Warm regards,

-- Jeff

 

 

Electronmagnetic Radiation (EMR) and your health

Recently I started working with a new doctor who is a disciple of Dr. Dietrich Klinghardt.  Dr. Klinghardt, whom I was already familar with, is one of the leading medical experts in the treatment of chronic illness using both conventional and alternative medical approaches and techniques.  Before my first visit with my new doctor, she asked me to view a video by Dr. Klinghardt on the harmful effects of electromagnetic radiation (EMR).  Basically this term covers the radiation from a variety of new electronic devices, the electrical grid, wi-fi, cellphone towers, and one of the most insidious, smart meters put on the home by the electric companies to read your meter wirelessly.  

To say I found the video compelling would be an understatement. My wife Halice and I immediately started to make changes in our home to reduce our exposure to EMR, especially in the bedroom at night while sleeping, when cells regenerate.   Just to give one example, who knew that cordless phones attached to landlines give off a very powerful radiation constantly all over the house?  The other compelling aspect of the video is Dr. Klinghardt's claim that exposure of the fetal brain to EMR is the leading cause of autism and other neurological illnesses in children like ADHD, OCD, etc. The effects of EMR on the fetus are hundreds of times more destructive than on an adult brain.

I ignored this issue for a long time but can't any longer discount it as a factor in my own health and healing.  I'll let you decide for yourself though. You can view the video here.  https://www.youtube.com/watch?v=b_wxM6IAF1I&feature=youtu.be

 

"I can't go on, I'll go on"

 

A doctor is diagnosed with cancer and faces the illness from the other side of his desk, as a patient.  Paul Kalanithi, neurological chief resident at Stanford University, writes eloquently in the NY Times about groundlessness and ambiguity, and his futile attempt to pin down the future.  In his fight for survival, he comes to some important conclusions about what it means to live in the present moment authentically.

 

 

 

 

*************************************

SUNDAYREVIEW | OPINION

How Long Have I Got Left?

By PAUL KALANITHI JAN. 24, 2014

 

AS soon as the CT scan was done, I began reviewing the images. The diagnosis

was immediate: Masses matting the lungs and deforming the spine. Cancer. In

my neurosurgical training, I had reviewed hundreds of scans for fellow doctors to

see if surgery offered any hope. I’d scribble in the chart “Widely metastatic

disease — no role for surgery,” and move on. But this scan was different: It was

my own.

 

I have sat with countless patients and families to discuss grim prognoses:

It’s one of the most important jobs physicians have. It’s easier when the patient

is 94, in the last stages of dementia and has a severe brain bleed. For young

people like me — I am 36 — given a diagnosis of cancer, there aren’t many words.

My standard pieces include “it’s a marathon, not a sprint, so get your daily rest”

and “illness can drive a family apart or bring it together — be aware of each

other’s needs and find extra support.”

 

I learned a few basic rules. Be honest about the prognosis but always leave

some room for hope. Be vague but accurate: “days to a few weeks,” “weeks to a

few months,” “months to a few years,” “a few years to a decade or more.” We

never cite detailed statistics, and usually advise against Googling survival

numbers, assuming the average patient doesn’t possess a nuanced

understanding of statistics.

 

People react differently to hearing “Procedure X has a 70 percent chance of

survival” and “Procedure Y has a 30 percent chance of death.” Phrased that way,

people flock to Procedure X, even though the numbers are the same. When a

close friend developed pancreatic cancer, I became the medical maven to a group

of people who were sophisticated statisticians. I still dissuaded them from

looking up the statistics, saying five-year survival curves are at least five years

out of date. Somehow I felt that the numbers alone were too dry, or that a

physician’s daily experience with illness was needed for context. Mostly, I felt

that impulse: Keep a measure of hope.

 

These survival curves, called Kaplan-Meier curves, are one way we measure

progress in cancer treatment, plotting the number of patients surviving over

time. For some diseases, the line looks like an airplane gently beginning its

descent; for others, like a dive bomber. Physicians think a lot about these curves,

their shape, and what they mean. In brain-cancer research, for example, while

the numbers for average survival time haven’t changed much, there’s an

increasingly long tail on the curve, indicating a few patients are living for years.

The problem is that you can’t tell an individual patient where she is on the curve.

It’s impossible, irresponsible even, to be more precise than you can be accurate.

 

One would think, then, that when my oncologist sat by my bedside to meet

me, I would not immediately demand information on survival statistics. But now

that I had traversed the line from doctor to patient, I had the same yearning for

the numbers all patients ask for. I hoped she would see me as someone who both

understood statistics and the medical reality of illness, that she would give me

certainty, the straight dope. I could take it. She flatly refused: “No. Absolutely

not.” She knew very well I could — and did — look up all the research on the

topic. But lung cancer wasn’t my specialty, and she was a world expert. At each

appointment, a wrestling match began, and she always avoided being pinned

down to any sort of number.

 

Now, instead of wondering why some patients persist in asking statistics

questions, I began to wonder why physicians obfuscate when they have so much

knowledge and experience. Initially when I saw my CT scan, I figured I had only

a few months to live. The scan looked bad. I looked bad. I’d lost 30 pounds,

developed excruciating back pain and felt more fatigued every day. My tests

revealed severely low protein levels and low blood counts consistent with the

body overwhelmed, failing in its basic drive to sustain itself.

 

For a few months, I’d suspected I had cancer. I had seen a lot of young

patients with cancer. So I wasn’t taken aback. In fact, there was a certain relief.

The next steps were clear: Prepare to die. Cry. Tell my wife that she should

remarry, and refinance the mortgage. Write overdue letters to dear friends. Yes,

there were lots of things I had meant to do in life, but sometimes this happens:

Nothing could be more obvious when your day’s work includes treating head

trauma and brain cancer.

 

But on my first visit with my oncologist, she mentioned my going back to

work someday. Wasn’t I a ghost? No. But then how long did I have? Silence.

Of course, she could not stop my intense reading. Poring over studies, I kept

trying to find the one that would tell me when my number would be up. The large

general studies said that between 70 and 80 percent of lung cancer patients

would die within two years. They did not allow for much hope. But then again,

most of those patients were older and heavy smokers. Where was the study of

nonsmoking 36-year-old neurosurgeons? Maybe my youth and health mattered?

Or maybe my disease was found so late, had spread so far, and I was already so

far gone that I was worse off than those 65-year-old smokers.

 

Many friends and family members provided anecdotes along the lines of myfriend’s-

friend’s-mom’s-friend or my-uncle’s-barber’s-son’s-tennis-partner has

this same kind of lung cancer and has been living for 10 years. Initially I

wondered if all the stories referred to the same person, connected through the

proverbial six degrees. I disregarded them as wishful thinking, baseless delusion.

Eventually, though, enough of those stories seeped in through the cracks of my

studied realism.

 

And then my health began to improve, thanks to a pill that targets a specific

genetic mutation tied to my cancer. I began to walk without a cane and to say

things like, “Well, it’s pretty unlikely that I’ll be lucky enough to live for a decade,

but it’s possible.” A tiny drop of hope.

 

In a way, though, the certainty of death was easier than this uncertain life.

Didn’t those in purgatory prefer to go to hell, and just be done with it? Was I

supposed to be making funeral arrangements? Devoting myself to my wife, my

parents, my brothers, my friends, my adorable niece? Writing the book I had

always wanted to write? Or was I supposed to go back to negotiating my

multiyear job offers?

 

The path forward would seem obvious, if only I knew how many months or

years I had left. Tell me three months, I’d just spend time with family. Tell me

one year, I’d have a plan (write that book). Give me 10 years, I’d get back to

treating diseases. The pedestrian truth that you live one day at a time didn’t help:

What was I supposed to do with that day? My oncologist would say only: “I can’t

tell you a time. You’ve got to find what matters most to you.”

 

I began to realize that coming face to face with my own mortality, in a sense,

had changed both nothing and everything. Before my cancer was diagnosed, I

knew that someday I would die, but I didn’t know when. After the diagnosis, I

knew that someday I would die, but I didn’t know when. But now I knew it

acutely. The problem wasn’t really a scientific one. The fact of death is unsettling.

Yet there is no other way to live.

 

The reason doctors don’t give patients specific prognoses is not merely

because they cannot. Certainly, if a patient’s expectations are way out of the

bounds of probability — someone expecting to live to 130, or someone thinking

his benign skin spots are signs of impending death — doctors are entrusted to

bring that person’s expectations into the realm of reasonable possibility.

But the range of what is reasonably possible is just so wide. Based on today’s

therapies, I might die within two years, or I might make it to 10. If you add in the

uncertainty based on new therapies available in two or three years, that range

may be completely different. Faced with mortality, scientific knowledge can

provide only an ounce of certainty: Yes, you will die. But one wants a full pound

of certainty, and that is not on offer.

 

What patients seek is not scientific knowledge doctors hide, but existential

authenticity each must find on her own. Getting too deep into statistics is like

trying to quench a thirst with salty water. The angst of facing mortality has no

remedy in probability.

 

I remember the moment when my overwhelming uneasiness yielded. Seven

words from Samuel Beckett, a writer I’ve not even read that well, learned long

ago as an undergraduate, began to repeat in my head, and the seemingly

impassable sea of uncertainty parted: “I can’t go on. I’ll go on.” I took a step

forward, repeating the phrase over and over: “I can’t go on. I’ll go on.” And then,

at some point, I was through.

 

I am now almost exactly eight months from my diagnosis. My strength has

recovered substantially. In treatment, the cancer is retreating. I have gradually

returned to work. I’m knocking the dust off scientific manuscripts. I’m writing

more, seeing more, feeling more. Every morning at 5:30, as the alarm clock goes

off, and my dead body awakes, my wife asleep next to me, I think again to

myself: “I can’t go on.” And a minute later, I am in my scrubs, heading to the

operating room, alive: “I’ll go on.”

 

Paul Kalanithi is a chief resident in neurological surgery at Stanford University.

A version of this op-ed appears in print on January 26, 2014, on page SR9 of the New York edition with the

headline: How Long Have I Got Left?.

© 2014 The New York Times Company

Medicine and Unconditional Healing

Following is a wonderful article from the New York Times about the attempt to train would-be doctors in the inherent qualities of goodness, compassion and empathy as a guiding star in their practice of medicine.  The resonance with Unconditional Healing is unmistakable, especially the reference to the power of silence as an aid to more effective communication.  Unfortunately many doctors have been trained to equate  feelings of compassion with unprofessional behavior, and a loss of "perspective", which the course referenced in the article seeks to remedy through practice and education. 

 

*************

 

September 18, 2013, 10:45 am

Medicine’s Search for Meaning

Every day, we are reminded that the health care system is in crisis. We are going bankrupt. There are too many lawsuits. We practice defensive medicine. We restrict access. But surveys of doctors indicate a problem that penetrates much deeper than this. Today, almost 50 percent of doctors report symptoms of burnout — emotional exhaustion, low sense of accomplishment, detachment.

Medicine is facing a crisis, but it’s not just about money; it’s about meaning.

We often think of medicine as a science, and many doctors do come to think of themselves as technicians. But healing involves far more than knowledge and skill. The process by which a doctor helps a patient accept, recover from, adapt to, or endure a serious illness is full of nuance and mystery. I was often moved by how much my father-in-law — an actor who died from a form of leukemia — drew comfort and even inspiration from the relationship he had with his hematologist (who requested a Shakespeare recitation at each visit).

Great doctors don’t just diagnose diseases, prescribe medications and treat patients; they bring the full spectrum of their human capabilities to the compassionate care of others. That is why doctors, upon entering the medical profession, speak noble words like the Declaration of Geneva (“I solemnly pledge to consecrate my life to the service of humanity…”) or the Oath of Maimonides (“May I see in all who suffer only the fellow human being.”)

Yet by then, considerable damage has already been done. Nearly half of medical students become burned out during their training. Medical education has been characterized as an abusive and neglectful family system. It places unrealistic expectations on students, keeps them sleep-deprived, overstressed, and in a state of fear of making mistakes, and sends the message that doubts or grief should be kept to oneself. While the training formally espouses the ethics of empathy, compassion and altruism, doctors and researchers say that the socialization process — the “hidden curriculum” — teaches something very different: stay detached, objective, even a little cynical. Five out of six doctors say that medicine is in decline and close to 60 percent would not recommend it as a career for their children (pdf).

As administrative and documentation burdens have exploded in the past three decades, doctors find themselves under pressures to work as quickly as possible. Many have found that what is sacrificed is the very thing that gives meaning to the whole undertaking: the patient-doctor relationship.

“These high levels of distress, depression, loss of satisfaction, fatigue, and burnout have big repercussions for quality of care,” explains Dr. Tait Shanafelt, director of the Mayo Clinic Department of Medicine’s program on physician well-being. It leads to medical errors, substance abuse, and doctors quitting — something that a country with an aging population and a shortage of doctors can ill afford.

How could we help medicine overcome its own illness?

That’s a question that has occupied Dr. Rachel Naomi Remen for decades. Remen is a clinical professor of family and community medicine at the U.C.S.F. School of Medicine and the director of the Institute for the Study of Health and Wellness, at Commonweal. Over the past 22 years, she has been advancing a powerfully subversive addition to the medical curriculum, a course called The Healer’s Art.

For the first six years, Remen taught it with 10 friends, all community physicians drawn from outside the school. She was half afraid that her dean would discover it and throw her out. But gradually, the course began to spread by word of mouth, to two schools, then four, then 16, then 25. It is now taught annually at 71 schools in the United States (half of the nation’s medical schools) and schools in seven other countries.

More than 1,600 students take the course each year and about 13,000 have gone through it. And while it is described as a simple elective — a 15-hour course given in five three-hour sessions — many of the doctors who teach it, and the students who take it, see it as part of a movement. In evaluations, large majorities of students say the course fills a gap in their medical education. It helps them to feel more committed to medicine, more supportive of their classmates, more confident that they can be good doctors, and more clear about what they can personally offer patients. More than 95 percent of them say they will recommend it to other students.

“What our students say loud and clear is this course helps to keep their spirits alive as they go through the training,” explains Nancy Oriol, dean for students at Harvard Medical School.

Remen’s life has been shaped by her own experience living with illness. By her own admission, she has not been well for 60 years. When she was 15, she was diagnosed with Crohn’s disease. She underwent nine major surgeries and took large doses of steroids daily for 15 years. “My doctors told me I would be dead by the time I was 40,” she says with a laugh. She’s now 75 and has been a doctor herself for 50 years.

After medical school, on her first day in training as an intern, a 3-year-old was brought into the emergency room after a car accident. The doctors were unable to save the child’s life. Remen accompanied the chief resident as he met with the parents to inform them that their child had died. When they broke down, the sadness was too much. Remen found herself crying, too.

Afterward, the chief resident took Remen aside and said that her behavior had been highly unprofessional.

The message stuck. By the time Remen was senior resident, she hadn’t cried for years. That year, another child, a baby, was brought into the hospital after drowning unattended in his bathtub. The doctors were unable to resuscitate the baby. This time, Remen was the one responsible for informing the parents that their only child had died — and as they held each other and fell apart sobbing — she stood silently by in her white coat, maintaining her professional distance. After a while, the baby’s father, with tears running down his face, apologized. “‘I’m sorry, doctor,’ he said. ‘I’ll get a hold of myself in a minute.’”

How had she become the person a grieving father apologizes to? This is a common outcome of the hidden curriculum.

The Healer’s Art is predicated on the idea that medicine is an ancient lineage that draws its strength from its core values: compassion, service, reverence for life and harmlessness. When students and doctors connect to these values in a community, they derive meaning and strength, and can “immunize” themselves against the assaults of the medical curriculum and even the health care system itself.

To help people tap into these deep currents, the course is delivered in an unusual manner. Students and faculty members meet together in small groups in the evenings, participating side by side as equals. There are no experts, no hierarchies, no wrong answers; anyone may speak about his or her experiences or simply listen.

It begins by reminding people that it is not by chance that they are in the room. “We ask: ‘How old were you when you first realized that the needs of a living thing mattered to you?’” says Remen. “For most doctors and students, the impulse to respond to the needs of others, plants, animals, insects, and even people, goes back to early childhood, sometimes as far back as they can remember.”

Remen recalled a student who told the class that his mother used to bathe him in an old claw-footed bathtub. “At the end of his bath, she would pull out the stopper, reach behind him and get a towel, sit him on her lap and dry him. One day he stepped on the drain and it was sharp — there was pain and blood — and his mother said, ‘Never stand on the drain again.’ A few weeks or months later, as he was waiting for her to dry him, he noticed the water circling the drain as the tub emptied. He remembered how sharp the drain was and worried that the water was being hurt. After that, when his mother pulled the plug, he would drop his washcloth over the drain to protect the water.

“This is magical thinking. He was probably about 3,” said Remen. “Now he is a pediatrician and he brings the same intention to make a difference in pain and suffering to his little patients himself.”

Every culture approves and disapproves of different qualities. As the price of admission, medicine implicitly asks its members to leave aspects of themselves behind. The course explores this idea, what Carl Jung called the “shadow.”

“Everybody’s given a box of crayons and a big piece of paper like in first grade and they are asked to draw a picture of the parts of themselves they feel they can’t bring into their work as doctors,” explains Joseph O’Donnell, a Senior Advising Dean at the Geisel School of Medicine at Dartmouth, who has taught the course for more than a decade. First-year students do the exercise alongside doctors who have been practicing for decades. “Then everyone holds up their picture. You see ‘curiosity,’ ‘love,’ ‘compassion,’ ‘kindness,’ ‘creativity.’ And people say, ‘I thought I was the only one experiencing this.’ ”

The session on grief and loss is among the most powerful, adds O’Donnell. “Students and faculty are asked to become still and quiet,” he explained. “They’re asked to think back to a time when they experienced a loss, and remember the feelings, and think about what someone may have done that was helpful, or unhelpful.”

They write it down. Then the students are asked to say what was helpful. “You hear things like: They held my hand. Gave me a hug. Brought me food. Sat silently and listened.” For unhelpful, you hear things like, “They said, ‘I’d better leave you alone” or “You’ll be fine in no time.’”

When O’Donnell graduated from medical school in 1973, there was no place to discuss such matters openly. “It wasn’t safe to say, ‘I’m really bothered by what I’m seeing today.’ You just took care of it. You read the scientific articles, but you put your heart and soul aside. Here you are allowed to bring those things to the forefront in a valid way with colleagues who are esteemed.”

Dean Parmelee, the Associate Dean for Academic Affairs at Wright State University, who has taught the course for several years, recalled an incident shared by a fourth-year student who had been part of a team when a baby was stillborn.

The mother was 16 or 17 years old and she was with her boyfriend, he recalled. There were some psychosocial issues. “After the delivery, the student said, shockingly, everyone just left the operating room,” said Parmelee. “He was the only person left and the only sound was the air-conditioning and the ventilation.” The mom had started to cry; her baby lay still on her abdomen. The boyfriend was crying, too. The student said nothing. He simply reached out and took the mother’s hand and with his other hand he reached out and took the father’s hand, closed his eyes and stood there with them for a few minutes crying silently together.

“The student said that if he hadn’t taken the course, he would have left the room like everyone else,” added Parmelee. “Or he might have said something like, ‘You’re young, you can have another baby.’ ”  “Instead,” commented Remen, reflecting on the story, “he offered them and himself the healing of a common humanity.” This is not how doctors are accustomed to managing grief and loss. “We intellectualize it, minimize it, become numb to it,” O’Donnell said.

There is an enduring belief in medicine that if you feel strongly it will cloud your judgment. But research indicates that emotional attunement can improve critical thinking, decision-making, and the ability to act quickly in crisis moments.  Moreover, we need to feel to connect with other human beings. “If patients see that you care, they can trust you enough to tell you the truth and are more likely to follow your advice,” observes Remen. Parmelee, who has been an expert witness in malpractice cases, has found that most cases boil down to physicians “not really listening or making themselves available emotionally for a patient.”

And then there is the simple truth that buried feelings don’t just go away. “When I took The Healer’s Art, the session on grief and loss brought up a whole period in my life that I must have tried hard to not think about,” recalled Parmelee. “I was totally unaware of its continuous impact on me, and how much was still there after more than 30 years.”  In medical school, students rarely hear their teachers speak this way. Brent Aebi, a third-year medical student at Wright State University, said that hearing veteran doctors speak about their struggles helped him to see a path forward that felt right to him. “I saw that you don’t have to become hardened,” he said.

The same holds for peers. The combination of hyper-competition and self-doubt in medical school can work against the development of supportive relationships. “This way of listening to others’ stories is not present in the normal medical training,” observes Rhianon Liu, a third-year medical student at Johns Hopkins School of Medicine. “And it showed me that the most important protective mechanisms are the relationships we build with our classmates and faculty.”

Indeed, the importance of listening comes across as one of the course’s biggest lessons. “Students comment that they never realized how powerful silence is in communication,” said Parmelee. For O’Donnell, who oversees oncology at the Veterans Administration Hospital in White River Junction, Vt., the course has helped him learn to listen more deeply. “I hear themes I might have missed before,” he says. “Not just the symptoms, but the story — how scared the patient is that this ache might mean a recurrence. It brings you back to taking care of people. Because the world isn’t made up of atoms. It’s made up of stories.”

The Healer’s Art is an entry point: an attempt to anchor a cultural shift in medicine. Some students who have taken the course have formed groups so they can continue to uncover the meaning of their work after the course ends. They are building an alternative socialization process. The Institute for the Study of Health and Illness also helps doctors, nurses and other health care professionals form groups dedicated to “Finding Meaning in Medicine.”

But the course and similar programs need to be given much higher priority if we are going to attack burnout. “Because it has strong links to the quality of care,” says Dr. Shanafelt of the Mayo Clinic, “promoting wellness is a shared responsibility of individual physicians as well as the hospital or practice group.” However, if hospital administrators are going to allow doctors to cut back on “productive” activities so they can take time to focus on self-care, he adds, “We’ll need to provide hard evidence for people making financial decisions that this is a good investment.”

For doctors, this investment could mean the difference between succumbing to burnout and finding ways to practice that deepen their sense of purpose. “When doctors learn to read the affective domain, they are shocked to discover that they have gone right past experiences of profound meaning without seeing them,” says Remen. “They say, ‘I was colorblind.’ Medicine offers you a front-row seat on life. Meaning is all around you. When you can see it, it gives you a sense of gratitude for the opportunity to do this work.”

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David Bornstein is the author of “How to Change the World,” which has been published in 20 languages, and “The Price of a Dream: The Story of the Grameen Bank,” and is co-author of “Social Entrepreneurship: What Everyone Needs to Know.” He is a co-founder of the Solutions Journalism Network, which supports rigorous reporting about responses to social problems.

 

Death and dying up close and personal

This is a wonderful piece from the New York Times on loss by a writer living with her ill husband.  It speaks to many of the issues we all face in dealing with impermanence, denial and loss of control.  Very often the subject of death can become very clinical and abstract, but the author here shares the very intimate details of her interactions and feelings, and in so doing, communicates some important truths about courage and healing.

 

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September 18, 2013, 9:08 pm

A Decade of Goodbye

These weeks after the passing of my husband, Stuart, I often think of Joan Didion and her book “The Year of Magical Thinking,” and about how her beloved husband, John Gregory Dunne, died suddenly of cardiac arrest while sitting in his living room.

During Stuart’s illness, I considered Ms. Didion fortunate to be spared a long goodbye. How much more difficult it is when one suffers a decade of caregiving — the dash to hospitals, the languishing in emergency rooms, the years of chemo and radiation. A path that leads only to degradation as a 175-pound man, who scaled mountains and joyously ran marathons, one day transmogrifies into a 118-pound skeleton, with a failing liver and kidneys.

For the last decade death has been hovering, but now it scratches at our door.

“I always hoped in the end the docs would pull one last trick out of their hats,” he says.

Then, “What is it like to die?”

“I don’t know,” I answer.

Departure grows near. He knows it, but rejects the idea. For me, illness has so permeated our lives that I can’t imagine it will ever end. Time has been our only friend. His illness will get worse, of course, but not for a while. There will always be just a little more time.

Then he turns yellow, like a summer squash. But we still watch “Jeopardy” and Brian Williams; traces of normalcy remain.

Until finally, in March, there is the conversation.

“We can’t offer you anything else,” reports the oncologist. Suddenly, the moment is at hand, not unexpected, of course, but somehow unbelievable.

Hospice arrives. He hates the word “hospice” because it solidifies reality.

“People leave hospice,” I offer.

“In a box,” he snaps.

The plan is that Stuart will die at home. The hospice program delivers a walker, an oxygen machine, a hospital bed, a portable potty and a package of medicines, which I am forbidden to open without the nurses’ permission. The critical medicine is morphine, to be administered by mouth in droplets.

I am told Stuart needs 24-hour nursing care. He doesn’t want strangers in the house and protests. I am afraid to be alone with him when he dies. What will happen if I cannot ease his pain?
Each morning he is a micrometer sicker.

On the morning of June 21, he rises and walks to the bathroom without using his walker.

“Please,” I beg, “use the walker. If you fall, you will break bones, and the pain will be unbearable.”

“I can do it. I can do it.”

The night before, the nurse offered to give him a sponge bath, and he refused, saying he was too tired. Days have passed since he has properly bathed.

“Let me give you a sponge bath now,” I volunteer.

He has never let me tend to his most personal needs, but today he willingly sits on the corner of our bed as I help him disrobe. His entire body is jaundiced. I soap a sponge, gather towels and wash him. The moment is intimate, a rarity for us. I massage his back, chest, arms and legs with moisturizer.

“That feels so good,” he murmurs.

Joan Didion never had such a moment, I think.

I dress him, and he asks for his walker. But I am not finished. I want to comb his hair. In 52 years of marriage, I have never combed his hair.

“O.K.,” he says. And smiles.

I am meticulous in this act of grooming. Then I step back and study him.

“You look handsome,” I say, and mean it.

The night nurse has left, and the day nurse has yet to arrive, so I help him into the living room and into his favorite chair. I prepare breakfast. I can see him from the kitchen. He reads the paper and briefly chats with his broker, then says he doesn’t feel well and wants to go to bed.

“Don’t move,” I say. “I will help you.”

As he grips the handles of the walker, I slip my hand under his armpit and with all my might strive to lift him. He rises almost fully and then, abruptly, his arms and legs become as lifeless as a puppet’s as he falls back, unconscious, into his chair. His eyes are closed. He is dead, I think.

I rush to call hospice.

The nurse arrives as Stuart slowly revives; he twists in agony. Morphine is administered, but the pain does not ease. The nurse tells him he needs hospital care — an IV, stronger drugs — and that he will not be able to die comfortably at home.

He ignores her. He wants to rise and walk, but he can’t. Most of all, he wants to live.

“You are dying,” the nurse flatly tells him.

Anger fills his eyes. He will not give in.

“These are probably your last lucid moments,” she continues. “Your wife is here. What do you want to say to her?”

I see something different in his eyes, a softening. Maybe, finally, an acceptance. He looks at me; I am shaken and silent.

The nurse grabs my hand and pulls me to his side.

“Stuart,” the nurse urges, “what do you want to say? This is your last moment.”

He speaks to me. But he says the words so quickly that I now can’t remember exactly what he said. Then he falls into unconsciousness, and swiftly the ambulance carries him to Calvary Hospital, where he peacefully dies.

We were married 52 years. What reasonable person could ask for more? And yet, if I had one wish, I’d add just five more minutes. Even though the last decade was a misery, I feel luckier than Joan Didion.

In my bereavement group, a participant mourning the death of his partner talked about the “honor of being present on the last journey.” I understand what he meant.

Joan Marans Dim is an author, with Antonio Masi, of “New York’s Golden Age of Bridges.”

 

The Value of Suffering

This is a wonderful article by Pico Iyer on our relationship to suffering that appeared in the NY Times.  In Unconditional Healing, we often talk about the 2 kinds of suffering, the first that is inevitable and unavoidable just by virtue of our being alive, and the second, that consists of our relationship to that suffering, that is optional and manageable.

 

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September 7, 2013

The Value of Suffering

NARA, Japan — Hundreds of Syrians are apparently killed by chemical weapons, and the attempt to protect others from that fate threatens to kill many more. A child perishes with her mother in a tornado in Oklahoma, the month after an 8-year-old is slain by a bomb in Boston. Runaway trains claim dozens of lives in otherwise placid Canada and Spain. At least 46 people are killed in a string of coordinated bombings aimed at an ice cream shop, bus station and famous restaurant in Baghdad. Does the torrent of suffering ever abate — and can one possibly find any point in suffering?

Wise men in every tradition tell us that suffering brings clarity, illumination; for the Buddha, suffering is the first rule of life, and insofar as some of it arises from our own wrongheadedness — our cherishing of self — we have the cure for it within. Thus in certain cases, suffering may be an effect, as well as a cause, of taking ourselves too seriously. I once met a Zen-trained painter in Japan, in his 90s, who told me that suffering is a privilege, it moves us toward thinking about essential things and shakes us out of shortsighted complacency; when he was a boy, he said, it was believed you should pay for suffering, it proves such a hidden blessing.

Yet none of that begins to apply to a child gassed to death (or born with AIDS or hit by a “limited strike”). Philosophy cannot cure a toothache, and the person who starts going on about its long-term benefits may induce a headache, too. Anyone who’s been close to a loved one suffering from depression knows that the vicious cycle behind her condition means that, by definition, she can’t hear the logic or reassurances we extend to her; if she could, she wouldn’t be suffering from depression.

Occasionally, it’s true, I’ll meet someone — call him myself — who makes the same mistake again and again, heedless of what friends and sense tell him, unable even to listen to himself. Then he crashes his car, or suffers a heart attack, and suddenly calamity works on him like an alarm clock; by packing a punch that no gentler means can summon, suffering breaks him open and moves him to change his ways.

Occasionally, too, I’ll see that suffering can be in the eye of the beholder, our ignorant projection. The quadriplegic asks you not to extend sympathy to her; she’s happy, even if her form of pain is more visible than yours. The man on the street in Calcutta, India, or Port-au-Prince, Haiti, overturns all our simple notions about the relation of terrible conditions to cheerfulness and energy and asks whether we haven’t just brought our ideas of poverty with us.

But does that change all the many times when suffering leaves us with no seeming benefit at all, and only a resentment of those who tell us to look on the bright side and count our blessings and recall that time heals all wounds (when we know it doesn’t)? None of us expects life to be easy; Job merely wants an explanation for his constant unease. To live, as Nietzsche (and Roberta Flack) had it, is to suffer; to survive is to make sense of the suffering.

That’s why survival is never guaranteed.

OR put it as Kobayashi Issa, a haiku master in the 18th century, did: “This world of dew is a world of dew,” he wrote in a short poem. “And yet, and yet. ...” Known for his words of constant affirmation, Issa had seen his mother die when he was 2, his first son die, his father contract typhoid fever, his next son and a beloved daughter die.

He knew that suffering was a fact of life, he might have been saying in his short verse; he knew that impermanence is our home and loss the law of the world. But how could he not wish, when his 1-year-old daughter contracted smallpox, and expired, that it be otherwise?

After his poem of reluctant grief, Issa saw another son die and his own body paralyzed. His wife died, giving birth to another child, and that child died, maybe because of a careless nurse. He married again and was separated within weeks. He married a third time and his house was destroyed by fire. Finally, his third wife bore him a healthy daughter — but Issa himself died, at 64, before he could see the little girl born.

My friend Richard, one of my closest pals in high school, upon receiving a diagnosis of prostate cancer three years ago, created a blog called “This world of dew.” I sent him some information about Issa — whose poems, till his death, express almost nothing but gratitude for the beauties of life — but Richard died quickly and in pain, barely able to walk the last time I saw him.

MY neighbors in Japan live in a culture that is based, at some invisible level, on the Buddhist precepts that Issa knew: that suffering is reality, even if unhappiness need not be our response to it. This makes for what comes across to us as uncomplaining hard work, stoicism and a constant sense of the ways difficulty binds us together — as Britain knew during the blitz, and other cultures at moments of stress, though doubly acute in a culture based on the idea of interdependence, whereby the suffering of one is the suffering of everyone.

“I’ll do my best!” and “I’ll stick it out!” and “It can’t be helped” are the phrases you hear every hour in Japan; when a tsunami claimed thousands of lives north of Tokyo two years ago, I heard much more lamentation and panic in California than among the people I know around Kyoto. My neighbors aren’t formal philosophers, but much in the texture of the lives they’re used to — the national worship of things falling away in autumn, the blaze of cherry blossoms followed by their very quick departure, the Issa-like poems on which they’re schooled — speaks for an old culture’s training in saying goodbye to things and putting delight and beauty within a frame. Death undoes us less, sometimes, than the hope that it will never come.

As a boy, I’d learned that it’s the Latin, and maybe a Greek, word for “suffering” that gives rise to our word “passion.” Etymologically, the opposite of “suffering” is, therefore, “apathy”; the Passion of the Christ, say, is a reminder, even a proof, that suffering is something that a few high souls embrace to try to lessen the pains of others. Passion with the plight of others makes for “compassion.”

Almost eight months after the Japanese tsunami, I accompanied the Dalai Lama to a fishing village, Ishinomaki, that had been laid waste by the natural disaster. Gravestones lay tilted at crazy angles when they had not collapsed altogether. What once, a year before, had been a thriving network of schools and homes was now just rubble. Three orphans barely out of kindergarten stood in their blue school uniforms to greet him, outside of a temple that had miraculously survived the catastrophe. Inside the wooden building, by its altar, were dozens of colored boxes containing the remains of those who had no surviving relatives to claim them, all lined up perfectly in a row, behind framed photographs, of young and old.

As the Dalai Lama got out of his car, he saw hundreds of citizens who had gathered on the street, behind ropes, to greet him. He went over and asked them how they were doing. Many collapsed into sobs. “Please change your hearts, be brave,” he said, while holding some and blessing others. “Please help everyone else and work hard; that is the best offering you can make to the dead.” When he turned round, however, I saw him brush away a tear himself.

Then he went into the temple and spoke to the crowds assembled on seats there. He couldn’t hope to give them anything other than his sympathy and presence, he said; as soon as he heard about the disaster, he knew he had to come here, if only to remind the people of Ishinomaki that they were not alone. He could understand a little of what they were feeling, he went on, because he, as a young man of 23 in his home in Lhasa had been told, one afternoon, to leave his homeland that evening, to try to prevent further fighting between Chinese troops and Tibetans around his palace.

He left his friends, his home, even one small dog, he said, and had never in 52 years been back. Two days after his departure, he heard that his friends were dead. He had tried to see loss as opportunity and to make many innovations in exile that would have been harder had he still been in old Tibet; for Buddhists like himself, he pointed out, inexplicable pains are the result of karma, sometimes incurred in previous lives, and for those who believe in God, everything is divinely ordained. And yet, his tear reminded me, we still live in Issa’s world of “And yet.”

The large Japanese audience listened silently and then turned, insofar as its members were able, to putting things back together again the next day. The only thing worse than assuming you could get the better of suffering, I began to think (though I’m no Buddhist), is imagining you could do nothing in its wake. And the tear I’d witnessed made me think that you could be strong enough to witness suffering, and yet human enough not to pretend to be master of it. Sometimes it’s those things we least understand that deserve our deepest trust. Isn’t that what love and wonder tell us, too?

Pico Iyer is the author, most recently, of “The Man Within My Head,” and a distinguished presidential fellow at Chapman University.

 

 

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