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.  

Two poems of form and emptiness from Jane Hirschfield

Both from October Palace.  Not my favorite collection, but a few pieces stayed with me.


The Kingdom

At times
the heart
stands back
and looks at the body,
looks at the mind, as a lion
quietly looks
at the not-quite-itself,
not-quite-another,
moving of shadows and grasses.

Wary, but with interest,
considers its kingdom.

Then seeing
all that will be,
heart once again enters -
enters hunger, enters sorrow,
enters finally losing it all.
To know, if nothing else,
what it once owned.


Ripeness

Ripeness is
what falls away with ease.
Not only the heavy apple,
the pear,
but also the dried brown strands
of autumn iris from its core.

To let your body
love this world
that gave itself to your care
in all of its ripeness,
with ease,
and will take itself from you
in equal ripeness and ease,
is also harvest.

And however sharply
you are tested - this sorrow, that great love -
it too will leave on that clean knife.

Healing Zen, Ellen Birx, 2002 (R2012)

Collection of talks.  Student of Roshi Kennedy and a nurse.  A flavor of applied zen!

(23) Exhaust yourself:  Citing Zen Master Mumons exhortation to exhaust yourself in sitting zazen.  "You are not daydreaming or fantasizing.  All of your energy is being used to be awake and present in the moment.....Wake up, sit up, pay attention, and be fully present with every cell in your body."

(57) Ghandi:  May I live simply that others may simply live.

(76) Openness:  When I am open to the patient, the patient is free to speak and question openly and to hear the answer that lies in his or her own heart.

(107) Hyakujo and the fox:  Hyakujo believed it was punishment for a mistake that caused him to be reborn as a fox for hundreds of lifetimes.  Not a view of the whole.  He enjoyed hundreds of lives of grace as a fox.

(126) Zen meditation can be seen as a wordless prayer.  It is not a means to an end.  It is simply being with what is already here.

(130) on Hui-ko, letting go can sometimes feel like death, but it does not result in death.  Letting go opens you to new life - a life of clear awareness of the whole.

(193)  Seeing, insight are not ends in themselves.  Seeing and responding go hand in hand.  Zen insight leads you back into the world where you continue to ask "What do I see?" and "How do I respond?"

CPE Unit 1 begins with the hospital orientation

Takeaways from hospital orientation:

The organization is trying hard.   Orchestrating a day where each department steps forward to explain itself and attempt to engage new employees is no small thing.  Presentations were not rote, though there was much that could have been done to make them a bit more lively.  (Send us the materials in advance then let the participants do a self-quiz to see what they can recall prior to the presentation?)  Interesting that the younger nurses seemed especially antsy.

Chief Medical Officer struck a good tone.

• QCAMP - if we can get these things right, we succeed:  Quality, Culture & Communication, Access (service availability - new approaches like MRI scheduling on demand 24/7), Marketshare (local area branding), Physician alignment (the hospital's direct customers).  Ah, the power of a good acronym!
• At a community hospital, physicians are voluntary, not employees of the hospital.  
• SJR was the only hospital in NY state in 2010 with a positive financial report? (Ouch!)

Human Resources - I think this is the group that presented their employee recognition program (STARgram).  Mesage about personal responsibility for customer experience writ broadly.  CARE (Connected, Attentive, Responsible, Enthusiastic).  Actually, I got that impression from staff, which was ...surprising.
LOVED Maya Angelou quote:

I've learned that people will forget what you said...people will forget what you did ... but people will never forget how you made them feel. 

Pastoral Care department: The key four letter word in a hospital, loss.  Implied that what makes something a spiritual matter is whether it addresses why, why me, what's next?

Also covered:  infection control (MRSA can live on an uncleaned surface for 9 months, HIV exposure - optimal time for treatment is 2 hours, wash hands before and after use of gloves), risk management, security (disaster planning, red code book at each station, bands on patients, fire - RACE, PASS, i.e., Rescue, Activate, Contain, Evacuate and Pull, Aim low, Squeeze, Spray), privacy/HIPPA (just don't).

Met two of my unit colleagues.  Both M.Div.  Both expressing the same trepidation that I believe I expressed when starting at BI.  Now, I'm just excited!

Past tense

Found my notes from a discussion held at my zen center last summer.  The theme was "what emerges and how do we support each other when a sangha member is suffering or dies?"  I started the conversation, allowing that it could be thought of in terms of other communities with which we feel connected.  Three specific questions were raised for discussion - they are below along with what I had prepared to start the conversation, including a poem by Marie Howe.  I recall that the group was engaged - we all had experience to share.  As always, I was moved by how respectful and generous a conversation in this context can be.

1. What has surprised you or what have you learned or observed most recently about the impact of change/illness/death on yourself or others?
2. What have you noticed as unhelpful or helpful?  Where have you wondered if an action of yours was helpful or unhelpful?
3. And as a Buddhist/practitioner of Zen - how have you responded (or thought you should respond)?

The Last Time   (by Marie Howe)

The last time we had dinner together in a restaurant

with white tablecloths, he leaned forward

and took my two hands in his and said,

I’m going to die soon, I want you to know that.

And I said, I think I do know.

And he said, What surprises me is that you don’t.

AndI said, I do.  And he said, What?

And I said, Know that you’re going to die.

And he said, No, I mean know that you are.

This spring a dear friend died; she was a family friend, someone who came to work for me, so a part of a work community; and someone who was actively part of many local political and arts communities - so a model of someone doing her part to care for the larger world.  She became ill just as I was starting a 10 month training on how to work with people who were sick and dying.  Don’t think that helped; the program was no guarantee that I would do or say the right thing and familiarity didn’t dull the impact of the loss.  Like Marie Howe, the author of this poem, I was intimately present for the reality of my friend's illness and was stunned at the persistence of alternating insight and denial of death.


What I’ve noticed is that at one time I lived in relationship to her; now I live in relationship to her memory.  I think this is why we say people live on in others.  It is the way their memory shapes our behaviors.  And it is an active thing - from the reminder to live life fully now - she died, I can and will to not necessarily at a time of my choosing - to a more subtle integration of her “perspective” on a current problem.  Her voice is still fresh in me as I internally share a story with her and “hear” her perspective.  The outcome is generally a kinder action, the kind she would have advised.


On the second question:


The program I started as she became ill was very rich.  Two things are relevant here.  To be of any use I had to learn to see and learn to stay. To see, I found that when walking into a hospital room or to a bedside, it was valuable to consciously pause to notice sights, sounds, smells, even energy.  Were there flowers, were there tears, were there distractions, was there a feeling of healing or suffering?  Perhaps more importantly, I learned to check in with myself at the threshold and ask: what was I holding on to and could I genuinely let it go so I could meet the patient fully.  Then, whatever emerged, I found that all I needed to do was stay - breathe and respect what was present - anxiety, fear, pain, annoyance, even anger.  Not change it, but respect and acknowledge this person’s experience of their life in this moment.  I found these learnings reflected in a more pragmatic, even funny piece of advice in a really good piece from the NYT on what not to say to someone who is seriously ill and how to help.