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.

A whole-hearted, unrestricted cooperation with the unavoidable

Bowing had long felt right physically and befuddling mentally.  The dissonance stopped a few years ago so that it encompasses everything - aspiration, acceptance, union, and most deeply - gratitude.

I love this exploration of bowing and the conceit of self, because it did seem that I needed to get over myself - but I had never thought of it as needing to actually bow to my idea of self in appreciation and affirmation.  Conceit "manifests in the ways we contract around a sense of “self” and “other”; it lies at the core of the identities and beliefs we construct, and it enables those beliefs to be the source of our acts, words, thoughts, and relationships..." rather than what is taking place in this present moment.  This concept of self (the article explicates this nicely) is yet another daydream.

A teacher was asked, “What is the secret to your happiness and equanimity?” She answered, “A whole-hearted, unrestricted cooperation with the unavoidable.” This is the secret and the essence of a bow. It is the heart of mindfulness and compassion. To bow is to no longer hold ourselves apart from the unpredictable nature of all of our lives; it is to cultivate a heart that can unconditionally welcome all things. We bow to what is, to all of life. By liberating our minds from ideas of “better than,” “worse than,” or “the same as,” we liberate ourselves from all views of “self”and “other.” The bow is a way to the end of suffering, to an awakened heart.

(Clearly, I should have read the Fall 2008 issue of Tricycle sooner.)

What is this?

I was wading through some old, unread Buddhist magazines and came across this piece by Martine Bachelor on a Korean Zen koan (Tricycle 2008).  I am noting it here because something about the use of this question to cultivate a bone deep sense of perplexity resonated.  (Honestly, I think I live in a state of perplexity!)  


Perhaps it was how Bachelor described how to work with the question:

The practice is very simple. Whether you are walking, standing, sitting, or lying down, you ask repeatedly, What is this? What is this? You have to be careful not to slip into intellectual inquiry, for you are not looking for an intellectual answer. You are turning the light of inquiry back onto yourself and your whole experience in this moment. You are not asking: What is this thought, sound, sensation, or external object? If you need to put it in a meaningful context, you are asking, What is it that is hearing, feeling, thinking? You are not asking,What is the taste of the tea or the tea itself? You are asking, What is it that tastes the tea? What is it before you even taste the tea? 

My own teacher, Master Kusan (1909–1983), used to try to help us by pointing out that the answer to the question was not an object, because you could not describe it as long or short, this or that color. It was not empty space either, because empty space cannot speak. It was not the Buddha, because you have not yet awakened to your Buddha-nature. It was not the master of the body, the source of consciousness, or any other designation, because those are mere words and not the actual experience of it. So you are left with questioning. You ask, What is this? because you do not know.

I learned today that here is a distinction between formal koan practice (in which you verify with a teacher that you've "passed" the koan) and working with a question; in the Korean tradition it seems this can be a question you work with for a lifetime, uncovering and looking more deeply as new layers of meaning are revealed.


What engaged me most was the illustration of using this koan to address working with old patterns of behavior, specifically daydreaming!  Here's how Bachelor characterizes daydreaming:

Imagination is a function of the mind, but daydreaming is a proliferation of the imagination with disadvantageous consequences. It takes you away from what really is happening, and it can cause frustration, because what you daydream of often does not happen.

 I have always taken pride in my imagination and can clearly narrate a long line of stories that are a background narrative of my life.  Each day taking place in relationship to the story that I tell myself about the meaning and measure of the day.  This is a problem?  Yes, in the context of my Zen practice and a vow to live mindfully, to be present, and to fully live and act from this moment.  Living in these dreams is not where I want my life to take place, but after all these years, can I even be sure when I am here and when I am there? I don't just daydream occasionally; thinking back to the days on the swings in Bronx playgrounds, weaving stories of my future life as I looked across to High Bridge, I see a practice of putting myself deep into those dreams. 

..Meditation can also make you discover the specific taste of thoughts. Daydreaming is very seductive; when the thoughts “If I were. . . If I had. . . ” come up, they pull you in; they taste yummy, like something sweet and gooey, with their promise of enchantment. If you are a prisoner in a jail, then daydreaming is vital, it helps you to survive. But as I was discussing this specific pattern of mind with a young prisoner I met in South Africa who was keen on meditation, he told me that he would daydream in moderation and only used it as a safety valve when he felt very oppressed by his incarceration. If he did too much daydreaming, then he became frustrated and aggressive. 

Try being conscious,of how often you slip into dream; do it just for a day.  I tallied 9 times just on the 40 minute ride to work - and I consider myself to be a pretty attentive driver.  (All the more reason to stay in the right lane on cruise control...)  The rest of the day just became a wonder.  And I found myself wistful; I am my dreams - for a better life, for a better world, for possibilities of love and compassion.  But perhaps if I can reclaim some of the dreamtime, I can find more time to make those dreams happen!

Bachelor is not saying to not daydream, rather to be aware when it takes us away from being fully in our lives.

So the point is not that we cannot daydream, but that we should see the effect this pattern has on us and know when it is useful and when it is detrimental. When we ask the question What is this? it will bring us back to the moment. 

If you see me muttering to myself, looking a bit perplexed, now you know... 

Cave in the Snow

Vicki MacKenzie, c1998

Biography of Jetsunna Tenzim Palmo. Read this after I read Into the Heart of Life, which was after I got to meet Tenzim Palmo at one of her last US lectures (May 2011).

Found her story to be really inspiring. She expresses such clarity of purpose, resolve, and goodwill. Her path seems to be one she was both destined to take and one that was enabled by her commitment and clear purpose to achieve enlightenment. I am amazingly moved by her commitment to achieve enlightenment as a woman as a way to shift the balance of power within Buddhism and to bring the power of women more fully into the world.

The journey that she undertook to spend her 12 years in the cave was pretty amazing. The time in te cave was a different kind of amazing - challenging, even life threatening, and perfect all at once. (I confess to it all having a certain intoxicating appeal from the perspective of this over-scheduled, deluded existence...)

Some quotes:
“The only problem with bliss is that because it arouses such enormous pleasure, beyond anything on a worldly level, including sexual bliss, people cling to it and really want it and then it becomes another obstacle.”

Her description of the perspective gained after those 12 years is exactly what I had imagined:
“...while I was in retreat everything became dreamlike...one could see the illusory nature of everything...because one was not in the middle of it. And then when you come out you see that people are so caught up in their life - we identify so totally with what we’ve created. We believe in it so completely. That’s why we suffer, because there is no space for us.....Now I notice that there is an inner distance towards whatever occurs, whether what’s occurring is outwards or inwards. Sometimes, it feels ike being in an empty house with all the doors and windows open wide and the wind just blowing through without anything obstructing it. Not always. Sometimes one gets caught up again, but now one knows that one is caught up again......[This is not] a cold emptiness but a warm spaciousness. It means that one is no longer involved in one’s ephemeral emotions. One sees how people cause so much of their own suffering just because they think that without having these strong emotions they’re not real people.”

What moves?

"May the sound of this bell dispel greed, anger, delusion, and all of the hardships suffered by all beings.

A week at the Great Springs Temple in PA. Percussion crazed, I get to ring the bell (bansho) most of the mornings I was there. 18 strikes. 60 seconds apart. After each, a full bow and recite the gatha above.

And the world moved....for me; so I guess at minimum I moved.

The crack of the wood against the metal that preceded the resonant thrum of the world's chord must be what did it. Cracking a heart like cracking the shell of a macadamia nut. It took work.

And now I am back home. No bell. Just cracks.

Instead I say "May this practice dispel...." Somewhere around the 10th or 15th bow, the words drop and bones feel the truth of it. It is not MY practice, but this practice, being done not by me, but through me.

Maybe a small flake of that hard shell around the ego is what moves....taking at least one small hardship with it....

She whispered

So this was the first time I have been present for someone's death.  10 months of training in pastoral care just completed, but the focus was on anticipation and change.

JD was in her 60s.  Retired early, I think.  She was a middle school art teacher and artist (watercolors).  Just one living relative of whom we were aware.  Her "family" was a network of people from work, the community, and the sangha.  

JD was simply kind to me whenever I encountered her.  She appeared to be someone who had slowed down - her speech was slower, her body less reliable; but then she’d comment on something - a softly delivered joke, a heartfelt comment on a dharma talk - and I'd understand that she just listened and processed differently.

I am so grateful to have been present today. I wanted to be there in part because I was acutely aware of how relatively little I knew about this sangha member from whom I had received so much goodwill. A woman who always had a kind word for me, who loved when I showed up dressed nicely because I'd come straight from work - unprepared to shift into the dark, simplicity of zen-wear, who asked after my kids and my husband, and who was clearly struggling a bit more in the last few months.

Just last year she completed jukai. I learned today that JD had been unable to do the small stitches that form the jukai robe, each stitch to be taken with a vow - to do cease doing harm, to do good, to live for the benefit of all beings. So others made the stitches, with JD seated close to them, whispering the vow into their ear.

Such is the surprising intimacy of zen practice.

And could it be my most recent prior thought had been to idly wonder why she kept dropping off to sleep in the zendo? Was that the heart condition manifesting itself? Will I ever really get it that saying goodbye should always be full and complete; you never know if you get to do it again.

To the last, she accommodated. Most of us had to leave by 5. The service was done by 3:30 and shortly after 5 she took her last breath. During he service, I felt she heard even if she could not understand the chants. She understood the message - you are not alone, you are part of us all, you are loved, you can move on to whatever comes next. A nurse commented that she usually felt like crying to see such a sweet woman die, but everything felt so peaceful that she simply felt happy for her. The nurse, with joy, urged JD to let go and get "up there" to look after us.

Absent breathing tubes and the sound of machinery, JD was peaceful. Labored breathing slowed; less wildness in her eyes. As I held my hand to her chest, I eventually felt the rough rumble of breathing ease and then stop.

This is how it unfolds. Life, suffering, flashes of joy, struggle, a moment of change, and the course is set, the scene changes so quickly.

Thank you JD for being present, for letting us all in, for vowing in our ears....sometimes we need to be close to hear.