A Change of Plan

Recently I learned that my friend Hester had been suddenly diagnosed with Stage 4 cancer.  She had been focused on daily living, her long road stretching out to the horizon, attending to friends, creativity, work, and related pleasures and struggles.  Within days, her life abruptly made a hairpin turn into a new path, narrow and poorly lit, and short.  One week after I spoke to her, she died.

It is at these times that the veil, which protects us from certain knowledge of our impermanence, draws back and we glimpse the evanescence of all life.  This happens rarely for most of us, and we usually focus our attention on the events and circumstances of our lives as if we will always be living, here on this Earth.  Younger people, especially, tend to feel personally immortal, even when they know people who have died.  At a certain age, that veil becomes thinner, and somewhat frayed.  We have family and friends who have life-threatening illness, or who have died.  The numbers increase with our own age.  It becomes easier to imagine “that could be me.” 

Still, the veil is there, even if thinner, and those moments when we recognize the brevity of life disappear back under the veil. 

How do we live life fully, completely, inhabiting each moment we are granted?  In those moments when the veil is drawn aside, can we still live in the present?  Is it possible to do so despite knowledge of what awaits us at the end?   Or is the veil necessary, like blinders, to keep us focused in the present?  Is this a universal phenomenon, or just a product of our own culture, which keeps illness and death at a distance, and encourages everyone to hold on to the appearance of youth?

Certainly there are other cultures in which illness and death are regarded as part of life in a different way from our own, in which people are cared for at home among family of all ages.  Also, there are places where death comes more frequently to people at a younger age, because of infectious diseases, hunger, and war.  In these circumstances, there may be very little left of the protective veil.

Though the many religions and spiritual traditions of our world offer guidance, ultimately we each find our own way to co-exist with these questions.  Like many of us, I spend most of my time focused on the details rather than the overview.  I attend to my family, do my exercises, see my patients, care for our pets, plan and cook dinners, go out with my husband, my attention directed to the events carefully listed, by color and category, on my phone calendar. 

These last two weeks, however, my veil has thinned, and I know that, as I go through my day of details, my life, too, could change suddenly and irrevocably.  This awareness brings so much discomfort that I immediately turn away into mindfulness practice, name it “anxiety,” and return my attention, not to my breath, but back to the specifics of daily life.

Still, I find my mind meandering at odd times, wondering about meaning.  What are humans here for?  Why does each life seems so expansive, and yet so brief?    When people die, how can they suddenly not be here?  What am I here for?

I sometimes see time stretching in a line from the past to the future, or not in a line at all, with everything happening, in some way, simultaneously, and all life connected into a vast web.  In some way, everyone who was ever here, is still here.   In some way, it is life itself that is the meaning.

Physicians Have a Natural Role as Advocates

 

This is an article I wrote that was published on Kevin Pho's blog:  KevinMD.com 

As physicians, we are often called upon to be advocates for our patients.  Sometimes they have no other person to turn to.  At those times, in particular, we evaluate their health in the context of relationship, family, and workplace.  Having practiced family medicine for so many years, and now in counseling medicine, I have had the responsibility of advocating for my patients with their health insurance companies, within their families, and with their employers.  I take this responsibility very seriously.   more

 

New Year’s Resolution

 

Tradition asks us to use the onset of the New Year as a time to make resolutions for changing our behavior for the better in the coming year.  In fact, making – and breaking – those resolutions is the topic for conversation and news articles every year at this time.

I actually get this opportunity twice a year: January 1, with everyone else, and in the fall during the Jewish holidays of Rosh Hashanah and Yom Kippur, with others of the greater tribe.  One would think that I would get used to it, perhaps even good at it – that somehow my resolutions, like the bare root trees of winter, would ground themselves in the fertile soil, and grow strong and leafy, signaling my success to everyone.

Instead, I find myself revisiting the same basic resolutions twice a year (at least!), though the context and details may vary slightly. 

So, again, it’s January, and I plan, over this next year, to take better care of myself and to put myself and my own needs, first.  Just writing that I will “put myself first” makes me so uncomfortable that I feel compelled to add, “most – or more- of the time.”  Then, feeling that I have chickened out, I go back to the stronger statement, and say “yes, I will put myself first.”

Why is this so hard for me that I must resolve, over and over again, to make these particular changes in my life?  The concept is not foreign to me; as a physician, I advise my patients not only to take care of themselves first, but how to do it.  With this advice, I have told my favorite parable (“Reflections”), familiar to all who travel by airplane, where, at the beginning of each flight, the flight attendant tells the passengers “In the unlikely event that the cabin should lose pressure, and the oxygen masks are released, put on your own mask first, before you help others who need assistance.”

What would it mean for me to put myself first?  Certainly, it means prioritizing behaviors and activities which make me strong and diminish pain, decrease stress and make me happy.  These include exercise, regular rest, meditation, creative expression, and attentive scheduling.  In reality, I actually do these things, but not consistently and not enough.

So it is ironic that I have counseled innumerable people, my patients, through these same lifestyle changes.   The results are varied - often people make at least some changes, but sometimes they don’t.   Perhaps most of them, similar to my own experience, do take on practices that help them focus on their own health, but can too easily get derailed by the needs of others.

Our personalities, experience, and training influence the direction of attention.  Some of us tend to turn our attention first to those around us who are in need.  As a woman, a mother, and a physician, my natural predisposition to notice and attend to those in need became more compelling.  It is what I tend to do first.  It becomes automatic. 

The antidote to automaticity is mindfulness.  When we notice our thoughts and feelings as they occur, we can recognize that we have options, and choose what to do in that moment.  In choosing, we do not react automatically, but thoughtfully.  If I plan to go to the gym and exercise, but before I leave my daughter tells me her computer isn’t working and I need to fix it so she can do her homework, my automatic response would be to try to fix the computer because her homework seems more important than my workout.  But if I stop and examine my options, I realize that this is the only time today I could go to the gym, that my exercise is very important, that she could clean her room first, or hand-write her work for now, and that I can easily look at the computer when I return, while I rest after exercise. 

We don’t usually think about heroes as making choices to care for themselves.  Heroes traditionally care for others at the expense of themselves.  Yet when we examine the qualities of heroism, we find courage, steadfastness, and the ability to make split-second choices which save lives.  The hero does what is right, regardless of the expectations of others. 

Sometimes we find the qualities of heroism inside ourselves, and apply them to situations which do not seem like the stuff of legends.  Still, they are the same qualities, which we use on a micro-scale every day.  With them, we do things to save our own lives, a little bit at a time.  In the Jewish tradition, the person who saves one life saves the world.

The Longest Night - Finding Light

It’s dark – the darkest time of year.  Short days and long nights, however cold or warm the climate, evoke the search for light.  Many of our traditional holidays at this time of year have imagery of bringing and sustaining light out of the darkness.  My own tradition of Judaism builds the light, increasing candle by candle, over 8 nights.

Our DNA fears the dark, prehistoric dangers remembered in the primitive brain.  We light fires and candles at this time of year as an anodyne for fear.  Imagine our distant ancestors wondering if the sun would really return.  Even now, our children often need a nightlight so they can go to sleep.

When we are ill, or in pain, or depressed, or things are not going well, it feels sometimes like being surrounded by the dark - not a warm friendly dark, but rather the dark of winter, cold and bleak.  At those times, without even knowing it, we crave the sun’s light – hours of it.

Imagine that inside you, in a safe place, is your own life-giving sun, containing light and warmth.  Imagine its rays carrying healing light through every fiber of your being, floating gently, exactly where you want it to be.  This lovely sunlight wraps around you, inside and out, completely relaxing you, reminding you of your own well-being, and wholeness.  Finding the light inside you can transform the dark of the year into a soft dark, a velvet dark, the dark of being tucked into your own bed by someone you love, and snuggled under the covers.  With your own light inside, you are always safe, and all is well.

I wish everyone a New Year filled with good health, happiness, and joy, and always, peace.

 

Vaccines, preventable disease, and the nature of risk

This is an article I wrote that was published on Kevin Pho's blog:  KevinMD.com

Two nights ago, I was watching, with my family, an old episode of Dr. Quinn, Medicine Woman, in which a young woman is bitten by a rabid wolf, develops rabies, and dies. That same night, I read a post on Facebook decrying the dangers of immunizations, with a link to an online “news” article blaming immunizations for everything from spreading cancer to HIV.

My mother, as a girl, was bitten by a rabid dog. More...

Kinship

This year we celebrated Thanksgiving with a family dinner at our home, bringing together family from both sides and various parts of the country.  This morning I woke up reflecting on families and how we think about them.

Most physicians majored in science as undergraduates in college.  I majored in anthropology.  A generalist even then, without even the hint of medical school on the horizon, I was drawn to the study of humans, especially within the social and cultural matrix. This gave me license to also take any courses that interested me, which I happily did, including literature, psychology, sociology, the arts, language, and a variety of student-initiated courses through a pioneering and activist program called the Center for Participant Education (CPE), where I was part of the student staff. 

In anthropology, we studied kinship, drawing elaborate diagrams of personal connection. It was important to understand that in different cultures, the meaning of family is also different, that the mother's brother might have a role in one culture which the father has in another.

I think that I have always perceived all humanity as connected in a vast web, ultimately kin, though the details at the edges vary in ways that can define separation and difference.

My family has its own definitions.  I’m the oldest of three, with a sister 2 years younger and a brother 7 years younger.  My parents divorced when I was young.  My mother Adele’s family was enormous and present in my life.  People traveled across the country to attend weddings, Bar/Bat Mitzvah celebrations, other important life events, and funerals.  My father Leonard’s family was distant; his parents were people from whom he escaped as soon as he could, and who, after the divorce, weren’t there at all.  Somehow we also lost touch with the rest of his family, though many years later, there was a marvelous reconnection with his brother’s family and his aunt and uncle and cousin. My mother remarried to Phillip when I was 15, and I suddenly had 2 stepbrothers, and there were five siblings instead of three.`  My father remarried once, giving me 2 stepsisters, then again, then again, finally giving me a wonderful “wicked stepmother” Judie, and turning me into a “wicked stepdaughter.”  My mother and Judie became close, supporting each other through each husband's last illness, and still calling each other "my wife-in-law."

When my mother remarried, she invented a new kinship category that described the relatives of her husband’s first wife, who had died.  They became “our third family relatives.”  She continued to use that descriptor, without explanation, into the present, as if everyone knows the meaning of this kinship term. My mother also fostered many teens, who came to her for respite and an accepting environment.  This included some nieces and nephews as well as friends of friends of her own teens.  These latter sometimes became permanent family members, especially Bayla, who we always considered to be another sister.

When I married Steven, not only did we now have each other’s family as our own, we also took on all the official and non-official family that each of us had accrued.  Thus, his brother, Charles, became mine, but also his brother-in-law Calvin from his first marriage, became my brother-in-law as well. 

There have always been different ways that we have the children that we raise. However they come to us, they are our children, the foundation of our families.  We give birth to them, we adopt them, we foster them, we are drawn to each other as adults and adopt each other.  Their children are our grandchildren.  We also foster, adopt, and choose each other as grandparents and grandchildren.

Often, we become such close friends, that the relationship transcends even friendship and becomes family.  This has happened to me, to my husband, to our children, and to so many others. 

What is really important, it seems to me, is to acknowledge and cherish our families; however they come to be our fathers, mothers, children, grandparents, sisters, brothers.  And then to do so for their fathers, mothers, children, grandparents, sisters, brothers.   And moving on and outward through every connection and every generation, until we know without a doubt that we are all indeed part of the same family, connected irrevocably, our fortunes and fates linked forever.

Giving Thanks – Opening to Hope - Making Peace

My teens remind me that this holiday of Thanksgiving has a checkered past.  Its origin reminds us of when the generosity of one people was met with oppression by the other.  Yet the tradition of giving thanks for a successful harvest, and later, gratitude for making it through a variety of difficult times, is a long one and is shared by many people of different cultures.

What keeps us going in difficult and challenging times?  We are certainly living in such a time now, with widespread economic hardship and disparity.  Is there something essential that we can access under any circumstances that gives us strength and brings us peace?

The practice of gratitude allows us to find the beauty in our lives, acknowledge the love we give and receive, and experience ourselves as grounded and balanced.  It is not the same thing as being in denial of adversity.  It does not preclude realistic analysis of the situation, or take away from tough decision-making and planning.  Rather, it helps us appreciate and understand what we have, which is necessary to illuminate our view of the path ahead.

So for me, Thanksgiving is an opportunity for gratitude practice within the context of the greater community.  It’s important to know its checkered past, to do everything in our power to transform a history of oppression into appreciation and gratitude for diverse cultures and peoples.  And, of course, we celebrate with a great feast of thanks for the delicious harvest.

Two years ago, my son was a junior in high school and studying in Israel for the fall semester.  He was about to travel with his group to Poland to study the Holocaust.  The parents were asked to write letters which would be given to the students while they were there, for support during a difficult time, while they visited the death camps.  I wanted to write something for him about hope, and started writing a poem, but it morphed itself into a poem about bread and peace.  I think the two are strongly related, for we must have hope to be able to envision a world in peace.

Recipe for Peace:  Bread of the Earth

Take a very large bowl

And put the world into it.

Stir carefully while adding:

-1 measure of pure warm rain

-a double measure of the milk of human kindness

-1 teaspoon of wildflower honey

Sprinkle with your hands full of the leavening of humor.

While it starts to rise

Go away and leave it alone.

Use the time to lie in the sun

With your ancient Labrador retriever,

Arm resting on her lumpy softness,

Her breath whistling in your ear.

After all, DOG IS MY COPILOT.

After she gets too hot, check the bowl.

The bubbles are proof that it will all come together.

Time to add more ingredients, this time by feel:

-seeds of change – be sure to put in enough

-breezes of hope fanned by millions of wings

-a mixture of human endeavor soaked in spirits

-some squeaky wheels liberally greased

-a few salty tears to bring out the flavor

Knead it with compassionate hands,

All the hands around the table,

Each sliding off the others

As the dough is stretched and compressed,

Formed, shaped, irrevocably changed by every touch.

While you are kneading, sing –

Find the notes that bring

The work and the workers together into harmony.

Then – you will know when – rest the dough.

Cover with good intentions.

Use this time to learn someone else’s language,

Talk to a stranger,

Or wonder who lives in outer space.

The time has come.

Now the dough can be brought

Into alignment with the stars,

Shaped into the peace that will perfectly fit

The pan it was meant to inhabit.

Slipping the pan into a crucible

Of uncounted starfire, you wait.

The scent is tantalizing –

It is what you have always longed for,

Yet do not know.

Finally, it is here, in your own kitchen.

And you sit with all the others,

Feeling the purr of your warm cat

Extending her vibration from your lap

Out to the universe,

While inside is Peace.

Danielle Rosenman

c. November 11, 2009