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

Occupy Hope

This week Occupy Oakland, in solidarity with the Occupy Wall Street movement, sponsored a General Strike, which culminated in a 2 mile march to the Port of Oakland.  I was not there.  All that I am, forged in the heat of the protest marches and demonstrations against the Vietnam war, in favor of ethnic studies classes at U.C. Berkeley, in support of the people’s right to the use of land, sent my heart and my husband out to march.  My body, constrained by chronic back pain and more recently chronic foot pain, was unable to be there.

Invisible disability is more common than anyone knows.  There are so many of us who look just like everyone else, but who live with limitations of physical, mental, emotional, or intellectual function. 

Our nation, and indeed the world, is impaired by dysfunction that has been increasing, under the surface of awareness, for a long time.  As a society, we have been living with invisible disability.  Just as the individual’s unseen disability is so difficult for others to recognize, most people simply have not noticed the magnitude of the dysfunction in social institutions, or its affect even on the people that they know.     

Now the dysfunction, the disability, in our nation has become so widespread that it has broken the surface, and everyone can see it.  No longer invisible, it affects 99% of the people, and it can be experienced personally with all the senses, and not just seen as affecting someone else.  We and our friends are burdened with financial difficulties, worried about caring for our aging parents and getting our youth through college without leaving them crippled with debt.  We and our acquaintances are struggling to keep our homes, or have lost them, or never had a chance of owning them.  We and our families have lost our savings, or lost our jobs, or can’t get a job.  We all know single parents who can’t afford childcare or someone who retired after a full work life who must now try to find a job to pay the bills.  Around us, schools and universities and libraries and community centers and services for the aged, ill, and disabled are being closed, unfunded, unstaffed.   And, as my disability is something I cannot ignore, that of our society also must be addressed by us all.

If we are to engage with these issues, it helps to understand more about ability and disability.  The World Health Organization International Classification of Functioning, Disability and Health (ICF) has updated the discussion of ability and disability.  It defines “disability” as “an umbrella term for impairments, activity limitations and participation restrictions.”  The ICF emphasizes that anyone can experience disability, which thus becomes a “universal human experience.” 

Even more important, the meaning of a disability depends on the context of a given environment.   The environment can make a difference between the “level of capacity” and the “level of performance.”   If my environment is my home or my office, where I can sit on my reclining chair, I have less back pain, and my “performance,” or what I can actually do, is close to my “capacity”, or what I can do under ideal conditions.  On the other hand, if my environment is marching in a demonstration in the streets, my “performance” is less than my “capacity,” and I will have to stop in just a few blocks and go home.

The importance of these definitions is the concept that changing the environment can completely change the meaning of the disability.  The word “ability” can be defined as “the power to act.”  The previous, or medical, model is to try to fix the disability.  As a physician myself, it is always very tempting to put energy and resources into fixing the problem.  However, as an experienced physician, I know that this is not enough, and that the results are often limited.  The new model is to bring the person with the disability into balance with the environment, by changing the environment.  

Now we are in the realm of healing.  As physicians, we support healing, which derives from the word for wholeness.  As such, we are obligated to attend to the whole person within the whole partnership/family, within the whole community.  It is attention to the wholeness of our community, in the broadest sense, which inspires the Occupy movement. 

What else does the Occupy movement have to do with healing?  I’m not referring to the fact that so many people in this country have limited or no access to medical care, that the chief cause of bankruptcy is medical bills, that people die because they do not have health insurance (I personally have 2 friends whose death certificates should have included the diagnosis “due to lack of health insurance”).  I’m not discussing the lack of preventive medical care, which drives up unnecessary health care costs on top of the enormous human costs of illness.  I’m not even talking about the differential between the 1% and the 99%, and how the worth of a life and of health is measured in money.

The Occupy movement, grassroots assemblies across the whole country, is composed of a true representation of the 99%, different ages, genders, races, ethnicity, religions, work histories, interests, and ideas.  These assemblies promote wholeness, coming together for group consensus decision-making, helping each other with the activities of daily living of a society (housing, food, etc.), and focusing on healing the dysfunction of society as a whole.  It is a movement that rejects special interests, has no leaders, and has a single issue:

people together making change, resisting greed, corruption, and the hoarding of resources by the 1%.  They are changing the environment in the process of trying to fix the problem.  

This movement is our hope.  Any physician can tell you that we must have hope to go on, even in the most desperate circumstances.  When we have hope, we can tolerate the most difficult treatments, smile despite the pain, and plan for the future, to make a better world for our children’s children’s children.

Living with Invisible Disability - 1

 Isn’t it more interesting to skip around the details of our life stories, to tell the part that seems important right now, without the need for strict chronological order?

Today’s story is about invisible disability, mine, but perhaps it could be similar to 

yours. 

The short version begins many years ago with a car accident, two months after I got married.  We were going to Macy’s to exchange gifts.  Another driver turned her car left without stopping or looking, and hit our car in the intersection.  I was left with neck and back pain, eventually taking time off work because it kept getting worse, returning to work, and continuing to work, with more or less pain, for many years as a family practice physician.  Eventually, over a period of years, the pain in my low back kept worsening, until finally, I couldn’t work as a family physician any more.  After a while, I created a transition into a different kind of practice, in which I can use a reclining chair to sit more comfortably, and offer counseling to those who see me, usually people who live with illness, stress, or medical conditions.  I feel incredibly fortunate and grateful that I can still use my experience as a family doctor and also my personal experience as a patient.

There are so many of us who have an invisible disability, something that disrupts our lives and causes discomfort or pain, that nobody can tell is there.  Sometimes people who are very close to us, family and friends, don’t “get it.”  They hear us talk, they know the facts, we tell them the things we can no longer do, but it just doesn’t seem real.  Seeing is believing.  I have talked with a number of people about how painful that can be, experienced it as well. 

We find support from those who see us truly and completely, often our partners who live with us and help us, and from each other.

What qualities does it take to make a good life with a disability, invisible or visible?  How do those qualities relate to our search for the hero?  Where can we find our inner courage, fortitude, and perseverance, and how can we accept ourselves on the days those qualities seem out of reach?  Is a sense of humor heroic?

I’d appreciate your comments…

Ay Chihuahua!

Meet Laverne.  She’s a nine year old Chihuahua, and she is now ours.  Yes, my horizons have expanded beyond Labradors despite every expectation of my own or, for that matter, that of anyone I know. 

I am well known to be a dog person, and have been all my life, moving from the Collie of my childhood (Lad) to my first Labrador (Chaos), born from my friend’s dog and not quite the right color for a Lab.  My next Labrador, Samba, was well-bred and gentle, and by then I knew that if you are to be a dog breeder, you must be very responsible to improve the breed as much as possible.  Samba was the perfect mother, and I kept her daughter Cuica, and then Cuica’s granddaughter Clave.  Though I really wanted to get a puppy when Clave was 10, because of my chronic back disability, I couldn’t do all the bending and picking up that comes with a puppy, so it didn’t happen.  After Clave died, we turned to Rescue, and we adopted our next Labrador, our chocolate, Grace. 

 

Cats came into my life when our daughter was 2.  We adopted 2 Abyssinian sisters, Penny and Poppy.  Our daughter, Clave, and the 2 cats were all the same age.  Penny died some years ago, but Poppy is going strong and is about to turn 16.  Two years ago our daughter asked for a kitten for her upcoming birthday, so Mimsy came into our home.  So I am a dog and cat person.

However, I have never been a Chihuahua person.  I couldn’t even imagine it.  So how does a “big dog” person end up with a Chihuahua?

Understanding this transition requires knowing something about our daughter, like Poppy, almost 16 years old.  She is passionate about animals, all of them.  She believes with all her heart in animal Rescue.  As part of her high school, she has been working as an intern at the local animal shelter, and this summer, as I wrote previously in The Summer of Impending Loss, has fostered a kitten (so far not adopted).  At the shelter, she was attracted to a small dog in the shelter with her sister.  The two Chihuahuas were named by the shelter “Laverne” and “Shirley”, after the TV show.  Now, Laverne was being fostered and our daughter asked if we could adopt her.  She presented us with a careful and well-written set of arguments why this would be good for her and for our family.  We agreed to meet the dog.  She was brought over to our house by her foster, who turned out to be an old friend of mine, and someone our daughter knows from the shelter.  We were unexpectedly charmed by this very tiny dog who has her own dignity and is calm and affectionate, and not at all yappy. 

So that is how we are now a family with a Chihuahua.  I feel as though my acceptance muscles have been stretched wider than her 5 lb. frame accounts for.  My friend who fostered her told me that she adopts dogs from the shelter that would have difficulty finding homes because they are old or blind or both.  I admire my friend and my daughter for their open hearts, their love of animals and willingness to take them into their (our!) homes, and the hard work that this entails.

In thinking about the qualities of heroes, I wonder about love.  We are impelled to many acts of courage and selflessness by love.  Animal Rescue is driven by love, but it takes many other qualities to rescue and care for animals.  It requires that we set our own needs aside to care for the needs of others who are different from ourselves, that we find the special inner vision which allows us to see each life as significant, and most of all, reverence for and fostering of life itself.

He’s Gone

This was written right after our son left for his gap year in Israel, at the end of August.

My son is gone, having offered himself, arms stretching up to be caught by the enormous silver bird which will fly him to Israel.  His room is more than empty, it is void.  He considerately put all his things in the closet and drawers.  There is nothing on the walls, and only my old copy, loaned to him last year, of “The Folksinger’s Guitar Guide” on the shelves.  I appreciated his consideration until the moment when I opened the door, stared at the blank walls, and felt the pain of loss shoot into my gut and twist, thinking “oh no, I made a terrible mistake – I should have had him keep his things out so it would still look like his room.”

Anticipation of pain is not anything like feeling the pain.  Expecting to feel sad, I was surprised to feel devastated.  Telling myself that he’s alive and well, happy and excited, that I’m lucky in these and so many ways, didn’t help.

So many of my friends - my family - have already sent their young men and women off to college, to travel, to work, to live close-by, to live across the world.  Their support and their wisdom wrapped around me, holding me through the first few days which have been the hardest.

There are books and movies and poetry and songs about young people starting   their journeys into the future.  We don’t hear so much about the journeys of their parents, left behind to face a road that changed while they weren’t looking, suddenly facing a different direction with no signposts or maps.

Now I am half on that different road, with one gone and the other here.  And I am looking in a different way at parents who have traveled this road before me.  With children, everything is, in some way, related to their presence.  When they have gone, and we are without them, the empty spaces in our homes reflect those in our lives and hearts.  Eventually, after years of focus on getting our children to the next step, and the next after that, we begin to think about our own future. 

Joseph Campbell has written extensively on the mythic journey of the Hero, through a series of stages from the “call to adventure” through trials and important meetings with guides, to a supreme ordeal that changes the Hero forever, ultimately leading to return with inner powers and rewards.   When our young people set out on their own, they, too, experience a “call to adventure” which leads them into the lives they ultimately make for themselves. 

This stage of the journey for parents is also impelled by a “call to adventure,” but the “call” does not come to us.   As the ones left behind, how do we move beyond loss to envision a different direction for our lives?  What qualities can we find inside ourselves that help us to choose a direction and start moving?  How is the hero inside the parent different from that of the youth? 

The Summer of Impending Loss

As the weather warmed this week in October, I was thinking again about the summer.  This was written 8/27/11, a few days before our son left home for a gap year in Israel.

 This has been the last summer our son was going to be with us, before leaving the family to go to a gap year in Israel and follow his life.  At the same time, our daughter fostered a kitten all summer long, destined to leave her for another home. Every moment of this summer has been bittersweet, knowing that things would change forever at its end.  It has also been full, with many long deep talks, and with four of us hanging out around the dinner table until late, enjoying each others’ company. Just as I stand this morning in my bathroom eking out the last drops of hair gel to save every bit, I know that these last 3 days with my son are totally precious; I can’t ever buy any more of these moments, and the ones in the future will never be the same.  My daughter and I are united in the anticipation of loss. My husband turns away from it as much as possible to support us all.  He spends time with our son watching “Die Hard with a Vengeance.” They plan to bake challah together the last day. For our son it has been the summer of anticipation of a different kind, that of freedom, adventure, exploration, adulthood.  He can hardly wait to go, and his imagination explodes with fireworks of possibilities.

For those of us who remain here, in the family home, we are already drawing closer to each other, getting used to plans that are for three instead of four.  We have redistricted the lines of responsibilities.  We remind him to leave his room clean and spare, so it can be used for…something.  We watch him look at everything with the eyes of one who is leaving, we watch him with eyes of the ones who are left. 

I remember leaving my mother, my family, to go to college.  I could hardly wait.  The short distance from the San Fernando Valley of Los Angeles to Berkeley seemed so satisfyingly far away.  The unknown was sweet and enticing. 

Many years later my mother told me how she made herself wait until I was on the airplane before she cried.

Now my mother lives ten minutes away.  She will be with us when my son has gone, coming over for Shabbat meals on Friday nights, asking what we have heard from him.  I will turn on my computer to show her his blog from Israel.  We will all talk on Skype, but he will not be here to make me feel small against his chest when he hugs me goodnight.

Continuing the Path: Highways and Byways

Do you remember when girls were overtly discouraged from choosing careers in science?  I never thought it was happening to me.  I just thought I was bad at science - struggling with poor grades in high school chemistry (completely forgetting I had just completed biology with the highest grade in the class!).  And if I couldn’t “do science”, I couldn’t be a doctor.  How many of you had an experience like that?  

How many of you, as I did, returned many years later to something that you loved, or perhaps went on a different path completely?  Many of us discovered eventually that we could do science, or whatever it was we had been told we were no good at.  What was it for you?  For me, I was shocked, when, after graduating from U.C. Berkeley in anthropology, and then living for a year in an anarchist collective (getting work typing manuscripts for professors), I figured out that I wanted to be a doctor, after all.  Two years of pre-med science and four years of medical school later, I was deliriously happy to graduate from medical school.  I was a doctor.

I’d appreciate comments with your experiences…

Reflections

There are times when we stop doing and focus on being.  We spend time with ourselves looking inward instead of outward.  For physicians this is unlike most of our lives, in which attention, focused primarily on the needs of others, drives us in an often hectic schedule in which any reflection must be fitted into other activities.  

 

Thus we have short times for thinking when we are driving, as we walk from one room to another, as we eat lunch, or in the moments of blessed peace in the bathroom.  When we do think, it is still likely about others, about our work as detectives in figuring out just what is wrong and how can we fix it.  Sometimes we wonder if we are doing the right thing, or if there is anything else we can do, or if we have made a mistake.  Sometimes we agonize over a mistake. 

 

Physicians are trained, sometimes severely, to not think about ourselves.  In training, we learn to turn away from our own needs for sleep, food, exercise, emotional support, and time for reflection.  We are supposed to be available to work long hours (the number of hours is now regulated, which was not the case when I was in training) no matter what we personally feel.  In one extreme example, when I was an intern, the senior resident on call took care of the emergency room in the small community hospital, and the back-up physician was a faculty member who was on call to come in to the hospital when he was needed.  One night when I was on call, I went into the resident lounge and saw the senior resident sitting on the sofa with an IV in his arm and a bag of fluid dripping into his vein.  He was ill with a stomach virus and was so dehydrated that he needed the IV fluid to be able to stand up.  I was shocked and asked why he was doing that, and was told that the particular faculty physician (who felt that residents should work under any circumstances) refused to come in to the hospital, and had told him to use IV fluids and go back to work.  The senior resident felt that he had no choice but to do what he was told and kept working.  In this way, we acquire the habit of putting our own needs last.

We learn that to serve others, we do not think about ourselves and turn our lives to “doing.”  We are tremendously busy; it takes a lot of everything we have to care for our patients.   And yet we have so much to think about.  When we do stop, and be with ourselves, it takes time to move the focus in, to sit with our breathing and feel the boundaries that delineate who is “me”. 

When I stop to think of myself as body-mind-spirit-together, to consider “me”, I create and reinforce a pattern of self-care that spreads out to nurture the wholeness in those around me, including my patients.  I believe that when we can see the wholeness in people, and let them see that we see them, they are strengthened and can more readily find their own wholeness.  Here is where healing begins.

Another way to think about this is the airplane analogy (one of my favorites - it may come up again).  Every time you get on an airplane, you are told that in an emergency, if oxygen masks are released, you are supposed to put your own mask on first, before helping the person next to you. 

Many traditions help people stop their usual activity and go inward to care for their wholeness, sometimes during particular holidays, others suggesting more frequent practices.   Many people find times for reflection that are unrelated to any traditional practice, and can range from quiet time going fishing, running, doing music or arts or crafts, cooking, or sitting in the sun.  I find quiet time for myself in music, meditation, and increasingly, in writing.

In my tradition, this is the Jewish New Year, Rosh Hashanah, the day the world was born, and the Days of Awe, Yom Kippur, in which we stop everything to be with ourselves.  This is the time of reflection, when each of us asks ourselves “How did I do last year? Where did I stay on track?  Where did I miss the path?  What do I need to do in order to find the trail and start again?  Where am I going?”  And as a physician, “How can I be aligned with the path of service and still care completely for myself?”

And so I am reflecting also on the qualities of heroism, and what we do when we focus our attention inside. The physician is considered a hero for saving lives.  But most of us don’t save lives in that dramatic way every day.  I wonder if this process is part of what allows us to continue to persevere, to move through our lives with courage, to act from selflessness that actually is based on self-knowledge of our own wholeness.