Posts Tagged ‘medicine’

Have you started at the beginning?

Have you read my first two posts on the 5 precepts of being a compassionate companion?

If you haven’t seen the my introduction or the First precept, please click these links before you read about Frank Ostaseski’s Second Precept.

. . .

Now that you are up to speed, let’s take a look at the Second Precept:  Bring your whole self to the experience.

I don’t want to sound redundant, especially if you just read my introduction and what I wrote about the first precept, but suffice it to say, that I will.  .  . There is nothing simple about this precept and yet, if healing is to occur, bringing our whole self is vital.

My training is in humanistic/existential therapy and I have had some amazing teachers along the way.  I had a teacher my first year in college in NY tell us a story about a client that used to come to therapy every week, dressed to the 9s.  It was as if her clothing was her protective mask, the image she wanted to portray and to use as camouflage from letting her true self come to the relationship.

He told us that every week he wore jeans and a sweatshirt on the day he saw her.  It wasn’t like it was a mission but he just “came as he was”.  He said over time she experienced him as genuine and heartfelt and well, real.  She connected with him and as she did, that protective mask started to chip away.  When she could come into the consultation room, “just as she was”, with mascara running down her face, or scuffed sneakers, or cheeks inflamed from anger, her healing could begin.

Bringing your whole self to the experience means not relying on technique, distance, or feeling like you have some magic that the other person doesn’t.  It’s not about you fixing your family, the person whose home you are volunteering in, your elderly grandmother who is living with dementia.  It’s about being present and being genuine and congruent.  It’s about understanding that in any relationship there are two people who create the space.

There is no time when faced with dying to stand on ceremony.  There’s no time for platitudes like, “I know just how you feel.”  When we use nothing but techniques and hide behind our title (whatever it might be — daughter, therapist, best friend, lover, etc) we stay in the realm of false pity rather than being able to be truly open to one’s pain with genuine empathy.

Our head nurse at hospice used to say leave your baggage at the door (before going in to be with a family) and while that was true, you didn’t want to let your frustration about traffic distract you from your encounter, we can’t leave the important parts of ourselves by the welcome mat.

Bringing your whole self to the experience.  Frank suggests, in his training, that it is in our exploring our own suffering that helps us to create an empathetic bridge with the other.  I love that idea and believe it is because of this very thing that healing takes place.  And I think we have to be honest and face facts. . . whether you are a therapist or a companion to the dying, when you are together you are both touched, both changed forever, both healed.

Not too long ago, someone complimented me on my “skills” when talking to someone who was in the midst of grieving.  Although I knew the compliment was being truly offered in a sincere way, I chuckled to myself.  There was no pretense on my part, no thinking in my head, “what would Roshi Joan say” or “what task would Teresa Rando say this person is on in their grief process.”

It was about opening the heart, extending one’s self to a person whose heart might be hurting.  It’s about every so lightly, touching the memory of my own grief experiences and allowing that to be close to me.  It was about a genuine care and concern for another individual, even though it was someone I do not know very well.

And with that came curiosity, not rubbernecking, morbid curiosity but wanting someone to know that I wouldn’t side step her grief just because we were at work.  I wanted that person to know that I was open to listening if she wanted to tell her story.

To me, bringing your whole self to the experience is about not sitting with a desk between you and your client.  It’s not about wearing a white jacket.  It’s none of that professional coldness that gets drilled into us.  It’s not about never touching a patient who is struggling to talk and having difficulty breathing from the intensity of their anxiety about death approaching.

It is about being vulnerable and at the same time not letting the situation be all about me.  It’s about meeting a situation and being okay to see where it takes you, or more appropriately, allowing yourself to be led instead of trying to fix the other person.

Can you have enough compassion for yourself and the person you are with so that you can be open to the reciprocal gifts of the moment?

Bring your whole self to the experience.

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“You cannot go into the room where someone is dying

and not pay attention.  Everything is

pulling you into the moment.”  ~~ Frank Ostaseki

In 1987, Frank Ostaseski helped form the Zen Hospice Project, the first Buddhist hospice in America. In 2004, he created Metta Institute to broaden this work and seed the culture with innovative approaches to end-of-life care that reaffirm the spiritual dimensions of dying.

I love listening to his 3 tape series entitled, Being a Compassionate Companion.  It has so much heart and he conveys the teachings of the Buddhist Path and the hospice experience in such a natural, gentle way.

In these three tapes, Frank gives guidance and explains these important teachings for cultivating a compassionate presence at the bedside:

Over the next few days, I will be sharing more about each of these precepts (teachings).

I hope that I can share what I learned from Frank and from working at hospice.  Most importantly, I hope that when you encounter another person, you learn to take a deep breath and settle in and truly open yourself to the experience.

More to come.

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Clinical research shows Buddhist mindfulness t...

Clinical research shows Buddhist mindfulness techniques can help alleviate anxiety , stress , and depression (Photo credit: Wikipedia)

Here is a simple to read article by Rick Hanson.


Here is a small excerpt:

When your thought processes are tired, it doesn’t feel good. You’re not relaxed, and probably stressed, which will gradually wear down your body and mood. You’re more likely to make a mistake or a bad decision: studies show that experts have less brain activity than novices when performing tasks; their thoughts are not darting about in unproductive directions. When the mind is ruminating away like the proverbial hamster on a treadmill, the emotional content is usually negative – hassles, threats, issues, problems, and conflicts – and that’s not good for you. Nor is it good for others for you to be preoccupied, tense, or simply fried.”

I really liked this article and would totally use it with caregivers, professional or otherwise.  It’s a skill we can all benefit from in one or or another, in our career and private lives, whether we are young or old.

I sometimes don’t like certain “techniques” because they feel so artificial.  They can seem a bit contrived but what Rick shares here, like much of the mindfulness practice work that is out there from Jon Kabat-Zinn, Daniel Goleman, Tara Brach, Chade-Meng Tan, Susan Bauer-Wu, Daniel Seigel, Jeffrey Brantley, Ronald D. Seigel, and so many more.

Take a second right now and do what Hanson suggests in this article from windmind.org. . . look up from your computer screen and breathe in and as you are breathing out, allow your exhale to be deep and long-lasting, really use the abdominal muscles and allow your whole body to benefit.

I did it as I was reading the article and I noticed a definite shift.  As I exhaled, I realized that my shoulders were sliding down and moving to the place that they were designed to be in, not clear up to my ears.

I noticed a bit of an electrical current and any fleeting bit of anxiety dissipated effortlessly.  And I had a shift in thinking.

Now, it’s easy to do this on a good day — little in the way of demands, pain, stress, etc. . . but the whole point is to do it on this kind of day so that when everything gets fired up — when the anxiety, discomfort, and frustration kick into high gear, that exhale just comes. . .

When we start a “practice”, things feel like a technique.

But they probably felt that way when we were learning to sit with a client or use proper body mechanics by the bedside but as we used the technique, to the point of it being burned into our muscle memory, it shifts from being a technique to a way of being.

And mindfulness is no different.

We practice on good and bad days, despite the weather or what else happens so that no matter what is going on, we can bring about calming the mind/body with the breath and with our mindful attention.

Check out some of the resources that I have linked with the author’s names above in this blog.  They are some extraordinary people bringing mindfulness to different populations and in slightly different ways.

Embrace mindfulness and give your brain (and the rest of your system and being) a much-needed break in this worrisome world.

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This is probably one of my favorite “go to books” when I hear of someone dying of something like cancer, ALS, or living with dementia and other forgetfulness disorders, etc.

Our hospice used to give this book to any family that was open to it.  Maggie Callahan has been a hospice nurse for a long time and has great insights into the journey toward dying and death.

Here is an excerpt:

“Caring for a dying person is hard work, especially at home.  There are medications to be given, often around the clock, personal care to be done, meals to prepare, and sometimes dressings or treatments to do.  And despite all of this, the tide of usual day-to-day responsibilities continues:  bills must be paid, children must be cared for, laundry must be done.  Families are frequently tired and it’s a massive job merely to focus on a particular day or a given moment.  The future holds grief and loss, so many families and friends avoid looking ahead.”

~~ Maggie Callahan and Patricia Kelly — Final Gifts:  Understanding the Special Awareness, Needs, and Communication of the Dying.

There is a fine line with being present at the bedside, planning for the future, and forgiving the past if necessary.  We are embodied beings, living in our temporal lives.  We cannot ignore any of these three time elements.

But we can learn to a balancing dance between them and often we find that it is in being fully present to right here and now, accepting our fatigue and frustration, not glamorizing the past, and not fretting about an hour from now, that we find some sort of peace.

No one can tell you not to live in the past or future. . . it doesn’t work to just say that… but if you can practice living now, with the awareness of the past and future that you may have more peace.

Like when we are on the cushion, we bring our full attention to the experience of the cushion.  But the past, future, sensations, thoughts, feelings, etc come up. We lightly touch them and let them go.

It is the same with caregiving and grieving. . . we attend to here, whatever here and now is.  We don’t push away what comes up from the past or the future but we don’t entertain those things either.

Don’t set out the Pepperidge Farms cookies and a pot of tea for these things that come up.  You want to foster equanimity toward them, not make best friends with them.

Make friends with what is right now and know that when things from the past or future come up, they will — that’s how your brain is designed.  Acknowledge them and let them drift away.

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“Recognizing our intereconnectedness is the heart of giving no fear. . . Life connects us to one another, as do suffering, joy, death, and enlightment. . . Our unconditional goodness connects us. . .”

Roshi Joan Halifax, Being with Dying

Roshi Joan Halifax

Roshi Joan Halifax (Photo credit: Mari Smith)

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“No matter how busy we are, we can bring simple contemplative elements into our caregiving practice that will help us to follow the dying person’s lead and to give no fear.  Sharing practice or prayer, silence and presence, with a dying person also services the caregiver’s well-being.  When you find yourself caught up in the events around you or in your own hope and fear, slow down.  Even stop.  Cultivate the habit of attending to the breath continually; use the breath to stabilize and concentrate the mind.”

~~ Roshi Joan Halifax, Being with Dying

No matter how long you practice, there are times that your breath gets caught… sometimes we find ourselves gasping, sometimes holding our breath… we forget how stabilizing our breath is and how it is the “stuff” of life.

I find myself at work, shoulders scrunched up, after counting data and updating excel spreadsheets for hours.  I realize several things…

I’ve not seen another human for a while.

I’ve not seen anything green for some time.

I’m slumped over and my heart is contracted.

I’m barely breathing.

At that time, I don’t need a chime to go off.  It’s too late and just the right time. It time to let my shoulders drop.  Let my heart open up.

Close my eyes… walk away from the graphs and spreadsheets and do something in like child’s pose or downward facing dog to bring myself back to my center.

It’s time to pick up one of the two Dharma books on my desk and read a sentence or two and remind myself that this moment is a gift.  It is the only thing that matters and I can let it pass by mindlessly or I can attend to it.

Knowing that we only have so many moments in each of our lifetimes, do we really want to let one go by without savoring it with a deep, slow breath?

As caregivers, we often forget ourselves … we’re not always 100% present to the one before us but maybe we are caught up in all of the tasks that are required… caregiving is hard work… but if spirituality is about chopping wood, carrying water, and washing dishes, than what a great gift caregiving is to us… to attend to “the baby buddha” that is within the person who we are caring for…

And if the person before us is a buddha, how do we want to meet the Buddha?  Too busy to say hello as we walk in the door?  Too busy looking for the pail to empty?  Or do we want to meet heart to heart, breath after breath, at the deepest level that we will allow ourselves and they will allow us to meet at?

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“What happens in a changing field of medicine, where we have to ask ourselves whether medicine is to remain a humanitarian and respected profession or a new but depersonalized science in the service of prolonging life rather than diminishing human suffering?”

~~Elisabeth Kubler-Ross, On Death and Dying

We should still be asking ourselves this question.

But Elisabeth didn’t stop there.

“If we could teach our students the value of science and technology simultaneously with the art and science of inter-human relationships, of human and total patient-care, it would be real progress.  If science and technology are not to be misused to increase destructiveness, prolonging life rather than making it more human, if they could go hand in hand with freeing more time rather than less for individual person-to-person contacts, then we could really speak of a great society.”

I love the conscience that Elisabeth brings to her discussion.  She doesn’t just talk about what the life-world of the patient is… she goes so much farther, as if that wasn’t enough.  She looks at the societal ramifications of our fear of death.  She looks at how our science and technology is light-years ahead of our morals and ethics that need to be fostered in step with our technology.

She talks about the real blocks to great quality care. . . starting with training. . .

“They [students] learn to prolong life but get little training or discussion in the definition of ‘life’.”

I know, you are asking yourself, where are those darned stages… hmmm, that’s the point… look how much we have lost in only being focused on the stages. . .

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“If we cannot face death with equanimity, how can we be of assistance to our patients?”

~~ Elisabeth Kubler-Ross, On Death and Dying

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When discussing a case in her book, On Death and Dying, Elisabeth Kubler-Ross states that her patient had “anger displaced in all directions and projected onto the environment at times almost at random.” She discusses this patient’s feelings of “anger, rage, envy, and resentment.

But more importantly, she says this next:

“The problem here is that few people place themselves in the patient’s position and wonder where this anger might come.”

Did you ever stop to think about this?

I’m not the nicest person when I’m at the dentist office… I’m fearful, probably in pain when I arrive, projecting into the immediate future, worried, did I mention in pain?

How often do we stop to think about how someone is feeling and how it might be justified, to them?  Not right or wrong.  And I’m not even saying that we have to condone it, just…. wow, I can see how she might feel this way… I wonder what that’s like for him…

We live in a world where it is too easy to throw some sort of label on them. . . denial, angry, non compliant, depressed, borderline, etc.  And don’t get me wrong, I know people have life threatening problems that need help. . . there is no denying that.

But what happens when we are more concerned with treatment planning than we are than attending to the person from whom we sit across?

I have to believe, no matter how long I meditate, no matter how many chants, prayers, or hands I have to hold, I might feel anger if I knew that my death was coming.

And let’s look at when Kubler-Ross was working with patients… before I was born.  Think about the de-institutionalization that happened just in the 80s because we thought people’s care was not humane.

This was the end of the 60s, when doctor’s didn’t have to have informed consent.  When they didn’t tell their patients what was going on with them or their test results.  This is when people did whatever their doctor’s told them to; no finding a second opinion.

These were people who were gravely ill, who weren’t given treatment options… let alone anyone saying to them, you know, you could go home with these people called hospice and be comfortable at home with your loved ones and die peacefully.

We judge these words by our world today, that has come a long way, in some respects.

I’ve read some angry accounts of Elisabeth’s work and I feel badly for those people who have written them.  No, I don’t agree with some of the things she has written and I certainly don’t understand how she could have helped to write On Grief and Grieving on her death bed when there was already so much confusion about her work.

But I do know this… we could still be in that dark place if not for her “at the time’ pioneering work.  And given that most doctors today still don’t need to have a course in death and dying, I would prefer that they have Elisabeth’s work in their bag of tools than just what big pharmacy tells them about magic pills and new techniques to try.

If you are a caregiver of any kind, the next time you start to feel yourself tighten because of the anger, frustration, annoyance, or other difficult emotion from the person you are caring for, think of this:

Elisabeth suggested that this was the patient’s “cry, “I am alive, don’t forget that.  You can hear my voice, I am not dead yet!”  And when you think of it, think about how many quote the lines from the poem, Do Not Go Gentle Into That Good Night by Dylan Thomas.

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“Whether the patient is told explicitly or not, he will nevertheless come to this awareness and may lose confidence in a doctor who either told him a lie or who did not help him face the seriousness of his illness while there might have been time to get his affairs in order.”

~~ Elisabeth Kubler-Ross, On Death and Dying

So, stage one is supposedly denial.

I really like this part of the book.

She says that there is a direct proportion of denial in the patient as their is in the doctor.

If we cannot handle ourselves or if we cannot handle feelings about death, or we have not dealt with the important losses in our own lives, how can we be there and be fully present and supportive of our patients?

So whose denial is it?  I think it is ours collectively.

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