Begin again

2nd CPE unit commences in January.  I confess to missing this work - this despite being up to my eyeballs in finding my way in a new job.  But the lesson of that new job, of the year's challenges to my health, family, and sanity - is that everything is chaplaincy.  That is, everything comes down to the single instances of presence and connection.  Connection with others.  Connection with that which lies quiet beneath the "self".   Each moment is complete in itself.  Though looking back on the year, I see the habit of trying to see them as a continuous whole - stringing each together - as bright as dew drops on the thin strands of Indra's net - and a construct as impermanent.  And I note - the drops are many.  It was a good year.

Wrapping up notes from 2012

Here are some notes on a memorable set of recent articles and books on EOL issues - scattered across papers and apps and devices and oy - what a 1st world 21st century problem

• Joe Klein's TIME ">video on his piece in the NYT in June - The Long Goodbye.  I liked his statement about candor.  The video link appeared at the bottom of a TIME magazine piece with Five Tips on EOL care that seemed a helpful summary of what I've been reading of late.  What's not explicitly stated is the advice to ask for a consultation with the palliative care team.  Oh, but wait, it seems such teams re not in every hospital.  That was an eye opener to me when I interviewed at a local hospital.  Yikes!
• My LibraryThing notes in Never Say Die by Susan Jacoby:  Really good read.  Reflects fully my experience as a chaplain where patients struggle to reconcile their experience with the frankly offensive "boosterism" of the culture.  Busy blaming themselves for aging, or feeling guilty because they can't see the bright side of suffering, all distract from an ability to approach what are dwindling opportunities for integration and peace.  I think I'll own that anger as Jacoby suggests and see if I can do something with it!
• Excellent Hasting Center post on language at end-of-life.  I especially liked calling out the consumer-ification:  "The second is that the reframe prompts a shift away from a rhetoric of “choices” to one of making decisions, some of them hard. It may seem counterintuitive, but the current trope – patients and families are making choices – promotes the illusion that there is some “right” choice out there and that if they only knew or studied enough, they would make it. It’s a consumerist logic, and it translates easily into thinking that the patient’s situation can be fixed by having plenty of the “right stuff’’ – more tests and procedures."    Read more:http://www.thehastingscenter.org/Bioethicsforum/Post.aspx?id=5109&blogid=140#ixzz2GfAn6leJ
• NYT on older couples facing dementia  http://nyti.ms/IEexYs
• Quotes from The End of Faith:  "The rules of civil discourse demand that reason wear a veil whenever she goes out in public.".... "Theology is now little more that a branch of ignorance, ignorance with wings."..."What can be asserted without evidence can also be dismissed without evidence. - Christopher Hitchins"
• Pain is inevitable, but suffering is optional. - Thich Nhat Hanh, The Nobility of Suffering
• Came across a quote from someone very wise at SJR:  "When you deal with grief all the others (griefs) that are unresolved come forward for attention as well."  This has proven true over and over again.
• Poured through some notes I took on becoming a board certified chaplain.  In truth, it seems ever more unlikely.  But I will do the work as a volunteer nonetheless.  I appreciate the training and despair of the hoops and hurdles.

Notes on couples from April

Last week I met three different couples whose stories were fundamentally the same - long marriage, geographically distant children, one partner losing to dementia or Alzheimers, the other struggling to imagine what to do next.  The encounters were heartbreaking and inspiring at the same time.  


My favorite was the outrageously sweet Italiam man married to a “Scotch Irish and you know what their temper is like” woman with Alzheimers.  Both in their 80s, he’d been caring for her for over three years.  Now it has become too hard.  After this stay in the hospital she would go to a nursing home; but he would be there every day.  With each scattered phrase she uttered, his attention, devotion, and care were evident.  He would have said, as another woman said of her husband of 61 years (the last 5 years with Alzheimers) - "He’s my bashert."

I spoke with the wife of the third couple.  She shared a bit of who they were and where they found themselves now.  She spoke softly when she talked of the unexpected anger that had emerged in her husband’s illness.  She then turned to me and asked: Isn’t it just depressingly sad to hear these stories?  


Yes, I answered, the stories are sad, but they also give me hope.  I can see more clearly that we are all in the same boat - and I wonder how I can get us all to pull together so we can feel less alone.

Never Say Die: The myth and marketing of the new old age by Susan Jacoby c2011

Juicy bits:

"I do not believe in an immortal soul independent of the human body, because I do not believe in God or any form of supernaturalism.  Nor do I argue, as some psychologists and philosophers do, that there is a mind or consciousness independent of the intractable materials mass of gray matter that is the human brain.  To contend that consciousness (like spirituality) is a phenomenon separate from or greater than the brain itself strikes me as just another refusal to acknowledge that homo sapiens, with the most sophisticated brain of all species on earth, nevertheless belongs to the animal kingdom.  What others call the mind or the spirit is the literally marvelous result of what the brain, a physical organ, has made of its encounters with stimuli over a lifetime."

Notes undertreatment of pain in Alzheimer patients because they can't express their circumstances clearly.

"One of the most frequent promises that husbands an wives makes to each other is that neither will put the other in a nursing home."  So you'd think we'd judge the avail drugs by their ability to keep people out of institutions.  They do nothing - merely palliative.  Give us the sense we're doing something. The drugs given are palliative."

Old age is a woman's issue.  Decries the puffery about the wisdom of old to identify a purpose for the longer lives lived today.

"I do not know whether any death can truly be called good, decent, or dignified.  For me the physical reality of the end, the flickering out, whether slow or fast, of brain neurons that have communicated with one another so brilliantly to form the life experience of one member of our species - one beloved member - overwhelms everything else.  To an atheist, death -whether it comes as a thief in the night or through sudden. violent confrontation - is no more and no less than he fate all humans share.  Take away supernatural hopes and one is left with nature, which is neither decent not indecent.  The difference between "do everything" and "do everything - but stop when there is no more to be done" lies not in any spurious distinction between the "unnatural" (ventilators and tubes) and the "natural" (palliative care at home or in a hospice) but in the recognition that human intelligence itself is a part of and not the master of nature. Acceptance of the point at which intelligence and its inventions can no longer battle the ultimate natural master, death, is a true affirmation of what it means to be human."

"The issue is not whether it is morally wrong to want to live longer but whether it makes sense for a society to assume the costs that will inevitably be associated with a longer period of old age for more of its members.  ....as long as Americans continue to believe in the myth that each of us possesses the power to create our own economy, we will be paralyzed, as a society, in our effort to meet the huge challenges to our institutions posed by the impending old age, and old old age, of the boomers."

"The central emotional challenge of advanced old age, as distinct from financial issues, is the establishment of a livable balance between autonomy and dependence."

"Laying claim to the right to feel rotten about what is happening can free up energy for the fight to live as well as possible through whatever life hands us as we grow older."

"The case against the propagation of [the myth and marketing of young old age] is much clearer when considering large social issues in an aging society, because faith in the future victory of science over old age and its discontents is bound to divert energy and money from the urgent task of devising new institutions and strategies to meet the needs of the old as they are now.  But it is more difficult to make the case, on an individual basis, against the [xxx] of hope for a new old age....Even if there is little fact based justification [can it be no more deleterious to adults than he myth of Santa Claus to children?]  ...adults are not children, even though they are often treated as children.  Hope is not incompatible with realism, but it is incompatible with the expectation that things are going to turn out well if we only conduct ourselves well.  Inflated expectations about successful aging, if the body imposes a cruel old age, can lead to real despair....

"The myth of the young old age spreads a miasma that obscures the intensity of memory and vision - not wisdom - that is the gift of sentience if one is fortunate enough to remain aware until the end."

Poem by Ch’ang-hui

on a peak standing still

only clouds coming and going

a thousand misty mountains below me

in the open sitting straight

nothing false  nothing real

shapes of light and dark before me

Zen and Pure Land from Bill Porter's Road to Heaven

From interview with hermit Hsu-tung (p95)

Question:  What is the difference between Zen and Pure Land practice

 In Zen, we keep asking who is chanting the name of the Buddha.  All we think about is where the name of the Buddha is coming from.  We keep asking, until we find out who we were before we were born.  This is Zen.  We work with one mind.  And if the mind runs off somewhere, we follow it whereever it goes, until the mind finally becomes quiet, until there’s no Zen to Zen, no question to question, until we reach the stage where we question without questioning and without questioning we keep questioning.  We keep questioning until we finally find an answer, until delusions come to an end, until we can swallow the world, all its rivers and mountains, everything, but the world can’t swallow us, until we can ride the tiger, but the tiger can’t ride us, until we find out who we really are.  This is ZenIn Pure Land practice, we just chant the name of the Buddha, nothing more.  We chant with the mind.  We chant without making a sound, and yet the sound is perfectly clear.  And when we hear the sound, the chant begins again.  It goes around and around.  The chant doesn’t stop and the mind doesn’t move.  The sound arises, we hear the sound, but our mind doesn’t move.  And when our mind doesn’t move, delusions disappear.  And once they’re gone, the one mind chants.  The result is the same as Zen, and Zen practice includes pure land practice.  If you don’t practice both, you become one-sided.  

Question:  Is Pure land more appropriate for the present age?

All practices are appropriate.  ....All practices are related...All practices are like candy.  People like different kinds, but its just candy.  The Dharma is empty.

Busyness

Been saving this link from the NYT to post on The 'Busy' Trap.

I agree with the assessment...


"....Almost everyone I know is busy. They feel anxious and guilty when they aren’t either working or doing something to promote their work. ....The present hysteria is not a necessary or inevitable condition of life; it’s something we’ve chosen, if only by our acquiescence to it. .... Busyness serves as a kind of existential reassurance, a hedge against emptiness; obviously your life cannot possibly be silly or trivial or meaningless if you are so busy, completely booked, in demand every hour of the day."


And the sane response....


"...I am not busy. I am the laziest ambitious person I know. Like most writers, I feel like a reprobate who does not deserve to live on any day that I do not write, but I also feel that four or five hours is enough to earn my stay on the planet for one more day. On the best ordinary days of my life, I write in the morning, go for a long bike ride and run errands in the afternoon, and in the evening I see friends, read or watch a movie. This, it seems to me, is a sane and pleasant pace for a day. .....Idleness is not just a vacation, an indulgence or a vice; it is as indispensable to the brain as vitamin D is to the body, and deprived of it we suffer a mental affliction as disfiguring as rickets. The space and quiet that idleness provides is a necessary condition for standing back from life and seeing it whole, for making unexpected connections and waiting for the wild summer lightning strikes of inspiration — it is, paradoxically, necessary to getting any work done...."

Yard work

Beads of sweat drop to the earth beside my knee

Birds cry in joy at my industry

I stand to leafy applause

As the breeze drinks from my brow

Sky mind

At last

sky mind

all is encompassed

treetops

birdsong

insect hum

pine scented loan

the industry of ants beneath my hammock

the innumerable labors of all being that have gifted this breath

the vow to bring this mind to my actions

but now

just now

I spread my arms wide to love the world

TEDMed - Challenge #35

See the top 20 challenges identified at TEDMed.  (Robert Wood Johnson Great Challenges Program)


One that didn't make the top 20, but which really connects to my experience and interest in fostering alternative living communities is this one:

...an overlooked problem, “Many people wouldn’t know there was an epidemic of loneliness,” said Jacqueline Olds, advocate for Challenge #35, The Epidemic of Isolation and Loneliness, and Associate Professor of Clinical Psychiatry and Harvard Medical School. It’s been gradual but marked, said Olds, who shared the statistics that 20 years ago people used to have an average of three confidantes they could talk to—now, as a nation, we’re down to an average of one. Loneliness and isolation are linked to a wide range of diseases and undesirable health behaviors, from depression to self-neglect and more. Some solutions could include getting doctors to ask about loneliness as a vital sign, and putting out a national media campaign to educate about the ill effects of isolation.

More on Olds:  

Dr. JACQUELINE OLDS’ research includes the effects of social isolation and helping people become more connected in relationships. In addition to her teaching and clinical duties, she has authored three books with her husband, Richard Schwartz, M.D., including Overcoming Loneliness in Everyday Life and The Lonely American: Drifting Apart in the Twenty First Century, and is working on a new book about connections made in major life transitions like retirement, bereavement or geographical moves. 

So much for social media providing a bulwark against the Bowling Alone view of the world that Robert Putnam described!

Ariadne's cord

Started a lecture series, The Great Ideas of Philosophy (2nd edition) with Professor Daniel N. Robinson.  The prof starts the series with the tale of Ariadne.  I had not thought of this story very deeply, but coming fresh from a day as a hospital chaplain, found myself engrossed in the use of it as an expression of life review.  Stated simply, we find our meaning by retracing our steps.  

Ariadne was so in love with Theseus that she defied her father to give him a golden cord that would guide him back through the labyrinth.  (She also gave him the blade that was used to slay the Minotaur at the center of the labyrinth aka a slaying that will yield freedom from primal desires.)

To find ourselves, to grow and evolve, we need to take the time to make sense - to review what we have done and to see who we are.

So what or who is the love that gives us the cord?  What is it we slay?

As a chaplain it seems an apt metaphor for the opportunity the emerges to help someone in life review.  What is slain is the hardened idea of I (see post on  Uchiyama).  In the recounting there is broadening to where it seems we all walk this wide path together - myriad individual actions dissolving into a more universal truth.

At least that is my current experience of this myth!

___________

In the same intro lecture Robinson calls myth a tool for civic coherence - helping us to relate to each other and to our past.  Philosophy, by contrast, more destabilizing, seeking not to enshrine a POV but to seek out truth.

Claiming that mythology and philosophy do, however, set out to answer similar questions, Robinson notes three overarching areas of questioning:

1. knowledge (how do we know anything)
2. conduct (how do we live, assuming we can know our options reliably - and the assumptions made here determine our ethics), 
3. governance - how shall we live together (what are the political realities available to us so we can resolve conflicts at the level of conduct)

Robinson contends that responding to these questions was first handled heroically, i.e., via myth embodied by persons and communities as in the Upanishads and the Illiad and the Odyssey.  Philosophical consideration was a later development.

All I could think: Is this why I have so loved myths and the art of storytelling?

Should be a fun lecture series!

Owning my own view

So as I debriefed from a patient encounter, my supervisor challenged me to say something that would get him to think / see things differently?  The answer was that I could offer something from my point of view.  

I felt equivocal about that answer, saying I often feared it was imposing me on you (aka my story being imposed on the patient /client). 

Upon reflection, I see it is the only thing I really can do, especially in a 'new' relationship.  I  don't know another's experience and intellectual orientation.  But neither do they know mine.  The only thing I could reliably offer that might offer a new perspective or challenge IS something from my point of view. 

I don't think I quite embraced this truth before. The risk remains that someone would say - no, that is not so, but they can't really refute my perception, just offer to amend it.  

And what my Zen practice tells me is that a universality of experience is more likely to emerge than is difference: at core we hold the same existential concerns, and we all have the same habits of mind that avoid suffering, deny impermanence, and cling to difference.

Here's to owning my own view!  

Life-and-Death by Kosho Uchiyama

I have read this poem at a bedside and have thought of it often, forgetting it is written by one of my favorite teachers!  Posted here so I can find easily!

Life-and-Death by Kosho Uchiyama

Water isn't formed by being ladled into a bucket

Simply the water of the whole universe has been ladled into a bucket

The water does not disappear because it has been scattered over the ground

It is only that the water of the whole universe has been emptied into the whole universe

Life is not born because a person is born

The life of the whole universe has been ladled into the hardened "idea" called "I"

Life does not disappear because a person dies

Simply, the life of the whole universe has been poured out of this hardened "idea" of "I" back into the universe

What does it all mean by Thomas Nagel

I know I quoted him earlier this year.  Found my notes on the book.  Here are some more juicy bits:

If God is supposed to give our lives a meaning that we can't understand, it's not much of a consolation. 

The idea of God seems to be the idea of something that can explain everything else, without having to be explained itself. 

If God and his purposes are offered as the ultimate explanation of the value and meaning of our lives, that precludes asking 'What's the point of God.'

 If live is meaningless there is no point.  It wouldn't mater if I didn't exist at all, or if I didn't care about anything.  But I do.  That's all there is to it.  Resisting this is a compulsion to take ourselves too seriously.  We want to matter to ourselves from 'the outside'.  (this is the impetus for many ambitions)  

If we can't help taking ourselves so seriously perhaps we just have to put up with being ridiculous.  Life may be not only meaningless but absurd.

I was so desperate for useful information.

Journalist Lisa Krieger's experience of the death of her 88 year old father was recounted in a recent issue of "The Soul of Bioethics", which in tern led me to the Bioethics Forum of The Hastings Center.  

I was struck by the many ways in which she said that the need was for information.  As a librarian and as a chaplain, I think this is a need that can be addressed!

"I was so desperate for useful information." 

[On being asked what advice she would give now...]  "This is what I would have done differently: I would have asked for a road map. A plan. Even if it’s just a back-of-the-envelope flow chart. What are we doing, and why?  I would have asked earlier: “Where are we headed, with all this? What’s the view from 30,000 feet up? Let’s say he survives and makes it out these hospital doors. Then what?” 

I wish someone had told me about the range of choices. Not just: “Do You Have a DNR? Treatment or not?” Rather: “We can do everything. Or we can do some things, but not others. Or we can do nothing, but keep him comfortable.” That conversation never happened. 

I think it is possible to have a conversation about options in aggressive treatment and palliative care at the same time-- early on, maybe upon entering the ER, or even when there is the initial dementia diagnosis. Not when things go south in the ICU. Because then you keep waiting for the perfect time to stop. There is no perfect time. 

Why does this happen?  "It happens because people don’t have enough information, and support, to trust their decision."

The Dax Cowart Case

CPE Reflection - The Dax Cowart Case, 3/26/2012

The Dax Cowart case, as narrated in series of videos done in the early 1980s, is a moving exploration of how societal perspectives on the right to die and patient autonomy have evolved.  Considered along with a second video series done in the 1990s and Mr. Cowart’s own writings,  the case offers a reflection on the challenges a society has in assessing its own ethics (standards that encompass the norms of the community) while holding to individual ideas of moral behavior (e.g., ideas of right and wrong). (All sources are available on YouTube retrieved with the search "Dax Cowart.")

In 1973, Dax Cowart suffered third-degree burns over two-thirds of his body.  Concurrent with the devastating pain and impact of those burns, he was immediately rendered blind and without the use of his hands.  From the moment of the accident and through the initial and subsequent treatment, Dax Cowart maintained and strongly expressed a wish to die:  He asked the farmer who found him at the accident site to give him a gun so he could end his suffering.  He asked to be allowed to die while in the ambulance.  He asked to be allowed to die before and during treatment.  He produced a video in 1974, while he was in one of the two hospitals where he was treated, titled “Please Let Me Die.”  He attempted suicide when he was subsequently released.

His mother also received Mr. Cowart’s repeated requests to die.  Her role is especially poignant since she has lost her husband in the same accident.  She reports that she relied on the advice of the many physicians in assessing what was “right” for her son.  Since Mr. Cowart could not sign consents for treatment, and since his requests for death were initially deemed to be irrational and hysterical, his mother bore primary responsibility for her son’s initial treatment authorizations.

The treatment he received for his burns, reflecting the state of the art of the time and the profound physical crisis of third-degree burns, was extraordinarily painful.  Mr. Cowart describes it as being “boiled in oil” and “skinned alive” for several hours each day for a period of months.  This torment was experienced by a man was never shown to be anything other than fully alert and mentally competent.  
Both in initial interviews and those offered years later, it is clear that his experience of suffering was one altered and defined his world view - in ways that he would have preferred to avoid.

To the extent possible, Mr Cowart attempted to deny treatment, and subsequently accepted treatment only in the hope that he could ultimately leave the hospital and take his own life.  I heard in his account of his return to his mother’s home both the frustration of a young man having to return to a childlike state and the amazing endurance of that same “young” man in trying to understand what was possible to him in his current circumstances.  Nonetheless, his conclusion was to attempt suicide twice, despite the extraordinarily limited ways in which a sightless man without hands has to accomplish this.  

What is most striking to me is the role of his anger at injustice  The energy of Mr. Cowart’s anger comes through in his speech, but also in this subsequent life’s work as a businessman, lawyer and advocate for patient’s rights.  As an advocate he has repeated his fundamental argument:  the decision to accept or deny treatment, to continue in this life or not, was his.  While he has attained a measure of happiness in the circumstances that he has found himself in, nonetheless, this was not the life he would have chosen at the time of the accident.  He claims the right to have said no and remains passionate in his defense of that right.  

“The right to control your own body is a right you’re born with, not something that you have to ask anyone else for, not the government, not your treating physician, not your next-of-kin. No one has the right to amputate your arms or your legs without your consent. No one has the right to remove your internal organs without your consent. No one has the right to force other kinds of medical treatment upon you without your consent. There is no legitimate law, there is no legitimate authority, there is no legitimate power anywhere on the face of this earth that can take the right away from a mentally competent human being and give it to a state, to a federal government, or to any other person.” 

As evident in a published 1994 dialog between Dax and one of his physicians, the perspective of years and several life accomplishment have not diminished the animating anger at the injustice he feels he experienced.  If anything, those years have sharpened his reasoning in defense of his initial position.

One of his treating physicians, Dr. Robert Burt, argues that, particularly at the time of the injury, Mr. Cowart’s expectations of the outcomes of treatment and of his future life were necessarily colored by his youth, his inexperience with injuries of this type, and his cultural biases as an “able-bodied” person assessing the life experience of a “dis-abled” person.  The role of the physician is to take the wishes of the patient seriously, but also to challenge them with new information; in fact, to “argue strenuously” if the doctor believes those wishes to be grounded in false assumptions.  Dr. Burt notes that such a conversation is not one that can be had in a matter of moments.  It takes time for concepts to be explained, for argument and understanding to take place, and decisions to be reached.  The Dr. stands by his original position to deny Mr. Cowart’s request to not be treated and to be allowed to die.

Given that he achieved much of what is accepted as “success” despite his disabilities - professional accomplishment, marriage, and financial independence, it would be easy to look at the full trajectory of Mr. Cowart’s story and serve up rationalizing platitudes:  see, he found happiness in the end; his suffering had a purpose; think of all the good he has done; his mother was right; or the one I find most challenging - God only gives us what we can handle.

Further, I am struck by how the conversation would be different if Mr. Cowart had been 17 instead of 26 - the decisions of his mother and guardian would have been unquestioned and his wishes would have had even less weight.  This would have been the same outcome if Mr. Cowart had been deemed mentally incompetent or mentally disabled.  Alternatively, if disfigurement and treatment were the sole issue versus blindness and disability resulting in the loss of independence; in that instance would the arguments of Dr. Burt about treatment outcomes and future prospects have been better received by the young adult Mr. Cowart?  And how different would the conversation be if the current understanding and tools for pain management were in play?  

Mr. Cowart is explicit in stating that his primary reason for wishing to die was not about future independence; in fact, he acknowledges that the concerns he had then have been proven to be overblown.  His wish to die was motivated by his difficulty in handling the profound “excruciating” pain of his injury and treatment.  He believes it was his right at that time - and now - to say he had had enough.  Further, he contends his decision was both “informed” and “voluntary” and nonetheless he was denied its execution because to others it was deemed a “bad” decision.  Mr. Cowart argues that this is an abrogation of a fundamental right:

Justice Louis Brandeis wrote in one of his Supreme Court opinions: “The makers of our Constitution sought to protect Americans, and their beliefs, their thoughts, their emotions, and their sensations. They conferred as against the government the right to be left alone, the most comprehensive of rights and the right most valued by civilized man.”    Warren Burger, who later became chief justice, referred to Justice Brandeis: “Nothing suggests that Justice Brandeis thought an individual possessed these rights only as to sensible beliefs, valid thoughts, reasonable emotions or well-founded sensations. I suggest that he intended to include a great many foolish, unreasonable and even absurd ideas that do not conform, such as refusing medical treatment even at great risk.”    Justice Burger did not want to encourage foolish, unreasonable, or absurd conduct, but he did recognize the importance that the individual has in making his or her own decision. He understood that what some of us might think of as foolish, unreasonable, or absurd can also be something that is very precious and dear to someone else.

I view human life and sentience as a unique opportunity.  Aware that our span is brief and that we will all die, we nonetheless project ourselves forward - reproduce, create, dream - and like the animals we evolved from - feed, flee, fight, and fornicate.  Meaning in this brief span is what we give it.  Some choose awareness and compassion.  Other the advancement of knowledge and altruism.  Others the acquisition and expenditure of wealth.  Others may chose endurance or violence.  No matter the choice of meaning, it is the energy of personal agency that animates individual actions.  It is personal autonomy in making a daily roster of choices that ultimately define who we are and constitute the summative measure of our time.

Ethically, I agree with the principle of patient autonomy.  Mr. Cowart’s statement is one I would echo for myself.  I do not think there is a moral absolute that can guide this decision; it is a personal one.  For me, it would be grounded in my perspective of this human life as a singular opportunity to learn and do and experience.  To the extent that I those actions would be compromised, I would have to assess whether I could fulfill my expectations of this life.

I am moved by  Mr. Cowarts embodiment of something I have often thought was true - it is often harder to live than to die.  Hard in that we know best how to suffer in this life - how to deny, cling, strike out and strike within; but seem less knowledgeable and confident in our ability to endure, and to them receive - let alone to give - empathy and compassion.  

Despite his circumstances, Mr. Cowart - who was forced to endure - surmounted his injures and had a life that would be deemed rich by any standard.  The man of 26 may or may not have been the man in his 60s who wrote the flagrantly emotional, loving poem that he recited at a July 2011 trial lawyers conference.  My Cowart had a life, despite himself, and grew.  He may have wanted to grow differently, but this is the one life he got.

Citizen Conn by Michael Chabon (New Yorker Feb 13 & 20, 2012)

Everything is chaplaincy?

I usually skim or skip the fiction in The New Yorker.  But then I unexpectedly found myself pulled into this piece.  The narrator is a female Rabbi in an assisted living facility (hard to call them homes);  key characters are two men who had been partners in creating sci-fi comics in the 60s and 70s.  The 2nd page yielded this observation by the narrator when offered a cup of tea:

Naturally, I wanted to reply that he ought not to bother, that he should just sit down and rest and let me put the kettle on for him.  But over the years I had seen enough of the assiduous cruelty of children and grandchildren, in suppressing old people's vivid hunger for bother, to know better.

That phrase - assiduous cruelty - arrested me, reflecting a studied non-seeing that belies the notion of "help" that can underlie encounters in pastoral visits.  The truth of that observation changed the story for me - from a piece of fiction to an opportunity to observe how this (fictional) Rabbi interacted with her clients is connecting and offering care.

The partners had suffered a falling out.  One is desperate to make amends, the other denies him that closure.  The fault line in their relationship had likely been there since the beginning, which allows the story to also offer a reflection on what we understand of friendship.  The fault (line) is described at the very end of the story as "our everlasting human cluelessness".  It is so vivid in the story - the inability of one friend to really see the basis for friendship with the other, despite years of knowing each other.  Wow - what a testament to the value of cultivating present moment awareness.

23rd Psalm

Always a beautiful verse, this is actually quite new for me when you swap he for she.  McFerrin recorded this in tribute to his mother.

23rd Psalm by Bobby McFerrin

The Lord is my Shepard, I have all I need,
She makes me lie down in green meadows,
Beside the still waters, She will lead.

She restores my soul, She rights my wrongs, 
She leads me in a path of good things,
And fills my heart with songs.

Even though I walk, through a dark and dreary land,
There is nothing that can shake me,
She has said She won't forsake me,
I'm in her hand.

She sets a table before me, in the presence of my foes,
She anoints my head with oil, 
And my cup overflows.

Surely, surely goodness and kindness will follow me,
All the days of my life,
And I will live in her house,
Forever, forever and ever.

Glory be to our Mother, and Daughter,
And to the Holy of Holies,
As it was in the beginning, is now and ever shall be,
World, without end. Amen

CPE Reflection #3

CPE Reflection #3, due 2/13/2012

"...if then I bend over and pick up a stick, he (Monty) is instantly before me. The great thing has now happened. He has a mission. It never occurs to him to evaluate the mission. His dedication is solely to its fulfillment. He runs or swims any distance, over or through any obstacle, to get that stick.

And, having got it, he brings it back: for his mission is not simply to get it but to return it. Yet, as he approaches me, he moves more slowly. He wants to give it to me and give closure to his task, yet he hates to have done with his mission, to again be in the position of waiting.

For him as for me, it is necessary to be in the service of something beyond the self. Until I am ready he must wait. He is lucky to have me to throw his stick. I am waiting for God to throw mine. Have been waiting a long time. Who knows when, if ever, he will again turn his attention to me, and allow me, as I allow Monty, my mood of mission?..."

                              Alan Wheelis, The Listener (a memoir)

Wheelis makes an analogy between a dog’s expectant waiting for purpose (fetch the stick) and our own expectancy (and need for) a purpose that is articulated externally (from God).  The poignant closing words of hope and expectancy evoke one particular encounter with a patient a year ago"  "Why was I spared - again and again?  To do what?  Did I miss [the message]?"

I am struck by how distinct this external seeking is from my understanding of Buddhist thought, as well as how explicitly contrary it is to several recent readings that made sense to me - Sam Harris’ The End of Faith (holding us fully accountable for our beliefs, and urging that we look within to understand their source and value), and Karen Armstrong’s Twelve Steps to a Compassionate Life (proffering that compassion should be sufficient to animate purpose and a better world for all).  

From my Zen practice,  I experience meditation (turning the light inward) as a means to experience (brief) insights into the true nature of reality (impermanent, empty, undifferentiated), which leads to .....and here is a leap that I can’t yet explain fully or well ....compassion and a commitment to compassionate action.   Simplistically (because really, that’s where I am right now), this reflects a truth of no-difference, i.e., that we are all confronting the same challenges and that we sink and swim together.  In this vein, I understand my “purpose” to be compassionate action that flows from the realities of the moment.   That purpose is further animated by continued (Zen) practice -dedication to inquiry about the truth of the present moment and a wish to be attentive and available to what emerges.  It is renewed with each breath.  (Hmmm...which must mean that when I act like a dolt...I stop breathing.  Gonna keep an eye on that.)

Would that I had the skillful means to guide a patient in an existential crisis to a reaffirmation of their own universal nature and the ability to draw strength (and purpose) from its expression in the moment.  A patient recently expressed being trapped (by her life circumstances and illnesses).  I have been thinking about how that perspective occurs and what it takes to get un-trapped.

(Any resemblance to the Deathly Hallows is just plain...funny.)

Our cultural and social norms define the options for purpose and action.  Within those norms, the accidents of birth (nature and nurture) define a view of what is possible for each of us.  (I am willing to argue for the role of karma here, but not now.)  Within that view we define an individual sense of role and capabilities.  If we are fortunate, we can see a reasonably full spectrum of possibilities (and purposes), but in all likelihood, we will have blindspots as peer at the world from the Johari House of our life’s design.  

We exist nested within these structures.  What is it to have a view of the nest itself? Like the fabulous ending to Men in Black, how do we draw back far enough for that view?  

I think such a perspective is necessary to understand purpose.  Alternatively, purpose-seeking will lead with the blindspot-ladden self.  Looking externally for purpose, looking from within our nested worldview (and biases), how can we expect to see what is needed?  It appears all to easy to default to a judgement-rich “acceptable” view of purpose, expediently defined by socio-economic circumstances, peer groups, and chance.  


Does such a default position serve? Can useful purposes be articulated from that vantage point?  My biases point to no.  I fear the world we have is the result of these blindspot-ladden, self-directed determinations of purpose:  a world in which caring for each other, our communities, and our earth is somehow not quite grand or sufficient a purpose; instead we leave that work to an unknown, undefined, and poorly valued other.  (My experience in service professions is certainly showing itself here!)

Perhaps the sense of purpose I am proposing is too relativistic.  But then, not holding to a belief in an external God from whom an absolute worldview is drawn, it seems appropriate.  My focus is on the moment to moment understanding of what is present, what there is to work with, what emerges in response to the suffering (physical, existential) that may be present, and in response to the amazing wonder of life that is before us. For me, this inquiry is sufficient to animate a sense of purpose.

As I write that last line, I am reminded of the parable of the blind sea turtle.  Adrift, it only surfaces every 100 years. Now imagine there is a small ring in this vast sea. It is more likely for the turtle to accidentally poke its head through that ring than to be born a human being.

This gift of our lives deserves the inquiry of purpose. The existential inquiry (and pain) that drives us to inquire about purpose - whether through religion, philosophy, communing with nature, etc. - is an attempt to honor that gift.  

Circles, wheels, spirographs

The Motivation Futility Cycle is from a perversely funny source called Despair.com, which offers a brilliant response to all the annoying motivational messages that assault in a corporate setting.  (Read through the roster of "demotivators" and tell me which aren't true statements?!!!!)

Initially I saw this as a witty take on how businesses trying to strategize their way out of a bad business situation:  Hmmm, let's reorganize (shift the deck chairs on the Titanic).  Yeah, that'll do it.  Awe, results not so good.  Must have done it wrong. Pinterest, that's it.  Hmmm, no success.  I got it, let's Tweet more!

This takes a more menacing tone when seen as a reflection of patient thinking as they confront illness and diagnosis:  Seek out a new motivational stimulation (hope in a treatment), roll with it enthusiastically (it'll all get better now), learn that it has limits, and crash down into despair, which necessitates seeking out a new motivational stimulation.

Hope is good, new treatments are good.  What is demotivating and exhausting (to me) is not seeing the cycle in perspective (as the flow of samsara and part of the journey on the wheel of life).  More troubling still is not having any idea of what it could mean to step out of it!   Lacking that perspective, all contracts to the energy of three poisons (greed, anger, delusion)as it spins that wheel.

Wheel of Life

A recent patient encounter made me think of this most keenly.  Chaplaincy in that instance seemed most like an opportunity to walk with someone fo a moment in that cycle (since we're both on the wheel of life, it's could be like the intersecting segments in a spirograph) and maybe step with them - if just for a second - onto a by-road for a breath.

Hmm...did I finally discard that spirograph?

A 21st century Rohatsu exhortation

If Eihei Dogen had a daughter in the 21st century, perhaps he would have encouraged her to be "steadily intimate in [her] mind field" in this way:

You have my okay
   to suck the marrow out of life
   to break through the effervescent exterior of the moment
   and bite into its dark, rich truth.

You have my blessing
   to do only what you can do with attention
   to not layer in more because you ought, should, or were told to
Breathe, then ask your heart if this is what you intend.
If the answer is yes, go forth.

You have my support
   to be less of the person you thought you were
   and more of what you are fully in this moment,
   to be aware of what drives you,
   be they habits of mind, aspirations, delusions,
   and to give yourself the liberty to chose which will surface today.

To know the world, start by knowing the knower - nothing is excluded.

Blindness

Saw this "improv" link a few days ago.  Jaw still on floor.

But then it is all of a piece with the Human Zoo videos we're watching in CPE training..and the brown eyes/ blue eyes "lesson" conducted in the '60s by Jane Elliot ....

...and the genuine 'need' for the diversity initiative just launched in my organization, which may the 3rd or 4th within my tenure.  All similar ways in which the world reminds us to wake up and turn the light inwards, if only for a second of self awareness.

I am not immune from this blindness, but I find that I am certainly drawn toward efforts to counter it.  Hence the practice of meditation, the reflective confronting of 'self' in retreats, in CPE, in my work as a manager (though I could wish it were less confrontational...working on that).  I think it is an outcome of something that happened early and indelibly - my bones and muscle memory have never forgotten being a minority - the other race, the "disadvantaged" economic group, the kid who stuttered and couldn't run fast enough, the smart/wise-ass who didn't fit in so stood out.  Rolls reversed, deficits countered - and those memories still waft through actions to this day.

Zen's teaching of "no difference" has always made bone-deep sense.  And my experience in chaplaincy has never failed to confirm it - who is suffering...who is the patient...this time you, next time me.  All that seems to matter is how we meet each other in this moment.  Anger, tears, frustration, hope, joy - are any of these "other"?

Can't help but consider that the way I've seen folks respond to kirtan is also proof of no difference.

A "found" quote

...in the closing pages of Head Off & Split, poems by Nikky Finney.

Absolutely unmixed attention is prayer.  - Simone Weil

CPE Reflection 2

CPE Reflection 2, Due February 6, 2012

“...as we contemplate our coming life, we are like children in a theater before the curtain is raised, sitting there in high spirits and eagerly waiting for the play to begin. It is a blessing that we do not know what is really going to happen. Could we foresee it, there are times when children might seem like condemned prisoners, condemned, not to death, but to life, and as yet all unconscious of what their sentence means.”"

(Arthur Schopenhauer, German Philosopher 1788-1860)

The last words I read before turning to this assignment were in a book by Thomas Nagel called What Does It All Mean.  The book is a brief narrative of how philosophy approaches several key questions, building up to “What is the meaning of life?”  (Alas, the answer is not Adams’ “42”.)  Nagel is dissatisfied with a religious answer to the question (i.e., that we can’t know beyond the fact that it is God’s will or purpose) because it precludes our asking and being able to get a satisfactory answer to “Why” or “What is that purpose.”   “Can there really be something which gives point to everything else by encompassing it, bit which couldn’t have, or need, any point itself?  Something whose point can’t be questioned from outside because there is no outside?”  

Nagel appears to lead to a conclusion that life may be fundamentally meaningless, but since we as individuals determine to care about our lives and each other, that’s gonna have to be meaning enough.  He notes that some are troubled by this and ascribe it to a tendency toward taking ourselves too seriously, needing some larger sense of purpose or importance to energize our actions.  To give this up a larger/higher purpose would be to acknowledge the ridiculousness of taking ourselves so seriously.  “..if we can’t help taking ourselves so seriously, perhaps we just have to put up with being ridiculous.  Life may be not only meaningless but absurd.”  


Let’s take the above as true - that life does not have inherent meaning and may indeed be absurd.  Then indeed the children are “condemned” to a meaningless existence.  But it is their existence and their opportunity to explore its breadth and depth.  

The children in the relatively affluent United States (even those comfortably swaying in Mitt Romney’s imaginatively well-woven safety net) as well as those in nations from Afghanistan to Zimbabwe have the opportunity to not just discover an answer to the question of the meaning of life, but to create one.  It is an opportunity, not a destiny. Many things are stacked up against such discovery, from being able to rise one's head above subsistence to developing the capacity for reasoned exploration. And then there is how little introspection most bring to the project of their lives.  It often seems that only in the moments of crisis - illness and death - the question of meaning surfaces strongly enough to be considered if not addressed. But then, those moments eventually come to us all.

There is a Buddhist parable of the burning house from the Lotus Sutra that is relevant to this reflection in that it captures why I think of the children not as condemned but as having a real chance to realize if not create meaning.  The story goes like this:

One day, a fire broke out in the house of a wealthy man who had many children. The wealthy man shouted at his children inside the burning house to flee. But, the children were absorbed in their games and did not heed his warning, though the house was being consumed by flames.

Then the wealthy man devised a practical way to lure the children from the burning house. Knowing that the children were fond of interesting playthings, he called out to them, "Listen! Outside the gate are the carts that you have always wanted: carts pulled by goats, carts pulled by deer, and carts pulled by oxen. Why don't you come out and play with them?" The wealthy man knew that these things would be irresistible to his children.

The children, eager to play with these new toys rushed out of the house but, instead of the carts that he had promised, the father gave them a cart much better than any he has described - a cart draped with precious stones and pulled by white bullocks. The important thing being that the children were saved from the dangers of the house on fire.

The father represents the Buddha (aka the awakened one, a perspective and realization available to each of us) and we are the ones trapped in the burning house. The burning house is the life we are “condemned” to, which inherently includes the “fires” of sickness, old age and death.  The father/Buddha is calling the children out of the house - out of the delusion that the house is not on fire (the spectacle we will see on stage) - and into the possibility of awakening to a larger truth - and meaning.  (The strategy the father uses is referred to as skillful means, i.e., means appropriate to the understanding of the children, so yeah - it was fine to lure them out of the house with treats;  but this has limits - it wouldn’t be okay to say come out or I’ll kill your sister.)

Is it condemnation to know that the play will end or that it will have tears as well as joys? Knowing that the curtain will eventually come down is one thing. Not having an opportunity to influence the quality of the play, or to dream up an alternative plot, is another. It is a “blessing” that we do not know what is really going to happen in so far as it allows us to discover for ourselves. In Zen this is expressed as “beginners mind.” This idea is part of a key line in a Zen koan: “not knowing is most intimate”, i.e., it makes it possible to meet life without preconceived ideas, interpretations, or judgments. We can then discover what will happen for ourselves; that discovery may in fact be the “larger sense of purpose” that animates my activities. 

Guess I get to own my ridiculousness!

CPE Reflection #1

Weekly Assignment for CPE Unit, Due 1/30/2012

““The astonishing hypotheses is that you, your joys, your sorrows, your memories, and your ambitions, your sense of personal free will, are in fact no more than the behavior of a vast assembly of nerve cells and their associated molecules

- Francis Crick

This statement was designed to challenge the bright line drawn between science and religion.  Crick intentionally sought to invite scientific exploration of the mind, contending that the consciousness that we associate with spirit (or soul) may prove - upon exploration by neurobiologists - to be less mysterious and unknowable than religious traditions imply.  

This exploration has been notably taken up by Buddhists. Tibetan Buddhist practice has long offered a focus on a science of mind that offers practices aimed at training the mind to cultivate a more expansive, positive state of being.  Currently,  the 14th Dahlai Lama is known as an active supporter of studies that examine what neuroscience can tell us about the patterns of behavior that drive craving and suffering as well as empathy and compassion.  This interest is reflected in Chinese and Zen Buddhist traditions as well.

Inherent in Buddhism’s Four Noble Truths is a view of the mind and self as something impermanent and ever changing. One Zen teacher refers to thoughts as being the brain’s saliva - thoughts and their content being that out-of-control and unstoppable.  Among the ways suffering emerges is through our investment in our thoughts - our habit of giving them weight and of identifying with them - the creative and affirming thoughts, as well as the self critical and troubling thoughts.  I always think here of A Christmas Carol and the thunderous chains that Marley’s trails behind him into Ebineezer’s bed chamber.  The clanging is the sound of the mental chains to which we cling, which is a root cause of suffering.  

Buddhist practice is one in which awareness of the present is cultivated to challenge habitual behaviors, yet another expression of clinging.  Ultimately, in identifying less tightly with our thoughts, we are compelled to consider what it is that constitutes the self.  The past is here only as thought, the future is here only as thought.  The self that emerges in this moment is as defined and certain as the thoughts we are able to or choose to entertain.  It is liberating to consider how much real autonomy may exist in the choices made in this second, and the next, and the next.

From the Buddhist perspective, I find Crick’s hypothesis not astonishing, but entirely reasonable.   Especially knowing that, physiologically, cells and neurons are always changing, renewing, and dying off.  What is more astonishing is that we can witness this daily miracle of life and be so ho-hum.  The phrase “no more than” seems way too dismissive of what is really a daily wonder.  

What is astonishing is that what is taken as truth is a profound degree of separation - we solidify our notions of self - even in the face of science and experience that challenges those barriers. An extension of the mind-science work mentioned earlier is the emerging field of social neuroscience, which is uncovering how our cells and neurons may in fact be instrumental in allowing us to perceive and connect, revealing even that we may be wired for empathy.  (See this 2006 interview with Social Intelligence and Emotional Intelligence author Daniel Goleman for a romp through the subject.) . From the amusing science that tells us that we are breathing the same atoms as dinosaurs to a recognition that we are all equally subject to the forces of both nature and nurture, how is it that we do not express empathy more actively as we consider our shared challenges?  

A phrase I heard just today was that there are so many interacting karmas, there is no way to really understand what we are to each other.  This was in the context of a story told by an American singer of Indian devotional music, Krishna Das; the gist was this:  He sought for and experienced great love in the presence of his guru. When his guru died Krishna Das was bereft.  It took decades for him to come to a fleeting understanding that “his guru was looking out now through his eyes,” i.e., it took him time to really hear the words of his teacher, that we are all one.  In the presence of his teacher, Krishna Das was able to see the equanimity that was in his own nature, and after his teacher’s death, he needed to learn to summon that for himself.

Daniel Goleman would have said that the experience Krishna Das had was one of “neural interconnection” that fuels the Asian cultural tradition of darshan, i.e., simply being in the presence of a realized being. 

In darshan, "People go to be with someone who has stabilized in an equanimous, loving awareness. And because the social brain makes their state of mind contagious to anyone in their presence, those beings transmit a taste of their mind-state to those around them. So the point of darshan is just going to be in that presence, because you come away with a bit of what they have.”  

So it would seem that the seemingly random behaviors of cells and neurons may actually have a critical function in allowing us to live together.  In Zen, this “neural interconnection” is expressed as “no separation.”  So if there is no separation, no unchanging, independent self, what is there?  The opportunity that opens up is for vast union with all beings.  Circling back to Crick’s hypothesis, the “vast assembly” is of nerve cells and their associated molecules, but also is an assembly of Us.