Enlightenment moving again eludes me once more.
Each time I grasp it
Carried with joy
However fleeting.

Poem from 2010

I have had intimations of my own mortality. 

Not willfully but thrust upon me by life's cadence. 

It's endless march of life and death

The slow wheeling of the seasons. 

A crisp river frozen In moonlight,

Birds nest hanging

Bird in flight

Your face leaned over me in ecstatic repose

Drinking in life without delay. 

I suppose we do all possible 

To escape that day,

To live again without thought or care

In time but not of it

Imagining and struggling to loosen it's meaningful bonds that tie us to each other

To the earth where we will rest 

To once more become part of that 

Whence we came. 

I have intimations of my mortality

And struggle for acceptance

Yet to stave off death may not be so sweet

As the moments and years and decades that make a life. 

It is that time between death and birth

That drives us in our search for meaning

For love

Fulfillment

Commitment to a cause greater than ourself

To a life filled with meaning and 

A death that has been filled with love

A life that has been well lived

Echoes of our own mortality

Intimations of my own mortality

Resound upon the water 

The meadow

My heart held by your love

Eyes locked to yours

Hand to hand 

Heart to heart

Beating

Holding

Loving. 

David McCullough

September 17, 2010

 

Laughing

Laughing

In silence of course

At our busy minds

And hearts too sore

To bear the aching and breaking

Of living and dying

But of course we do

We bear it

The tenderness

The vulnerability

The gentle unsparing and vigourous discipline

Of investigating to know what it is like 

to not know. 

Posting this again in case I forgot to!

I wish it had been you

That had sped the plough

And sowed the seed

And harvested the soul 

Of my memories of you

But alas it is I

To lay my hand upon your furrowed brow 

And wash the aching loss of a grieving heart

It is the nurse and doctor and I and you and my brother, sister, father and lover …

that speeds the morphine,

that slows the heart,

to ease the pain of love torn apart

I wish it had been you 

But it is me it is you and you and you

That plants the ground,

Upon which love grows. 

I wish it had been you. 

I wish it had been you. 

I wish it had been you. 

My Fathers Jacket

I remember my father's jacket.  It was white, a smooth white cloth made of thin material.  It had a thin liner and it was more of a light winter jacket - not for the snow or extreme cold.  The collar was not a collar that stuck up and it was white too, woven, ribbed and it must have had elastic woven into it.

I can see it clearly as this day.  It was not a fancy jacket.  It was well used, loved and his 'go to' jacket for a lot of things.  Nothing as noble as a thinking jacket or what they use to call a smoking jacket.  This jacket had had a full life with a few slight stains here and there and I remember oh so clearly a slight rip in it where I could see the insulation.

I remember this jacket now because of the Metta Institute.org training I am in right now.  We are doing walking meditations - learning to train our minds to see clearly.  But as I walk my mind wanders and then I bring it back to each step and each feeling I have in each step. But as I walk and walk and walk I remember my father's jacket, the look and feel of it and the smell of my father when I was his son so long ago and he towered over me.  The jacket was my father.

I remember this jacket and walking with my father through the forest one late night in the dark.  Maybe, to him, it was just another walk in the night, in the dark forest night to smoke a cigarette.  Maybe it was time to escape the house or maybe he just wanted to walk and I like to think, I want to think . . . with me.

We did not say a thing that whole long walk down the road in the darkness through the forest.  We were just together, he with his long strides in is black lace up Air Force boots and his white jacket, torn near the collar, smelling like Brylcreem or whatever he put on his hair.  I had to scamper at times to keep up with him.  I remember that jacket and loving him and being honored that my dad asked me to go for a walk.

Funny isn't it?  The little things that are not so little that loom so large in our consciousness over the years.  That was the night of our walking meditation, a son and his father, without words, not needful of words but just being together and loving each other without words, without thought.  There was no intent to teach but to simply be . . .  but that being, and silence in that being was my lesson and teaching that I have not understood till now.

I remember this jacket and my father.  For years I searched for the jacket but of course it was long disappeared.  Then I found it again in memory still as bright and precious and fresh as the night I remember and the walk we shared, in the night, down the road, through the forest of our memories.

My Metta Institute Presentation

Improving the Experience of Dying Patients and their Families

 in the Emergency Setting

Hello, Aloha and Namaste – welcome to this training about how we, as caregivers and providers, can bring renewed and invigorated meaning to providing and caring in the seminal moments of our patients and their families lives. The dying process can often be less then peaceful and very difficult. My invitation to all of us is to make it our goal to improve the physical and spiritual treatment of the dying patient and their families in the hospital Emergency Room (ER).

For the purpose of this training we focus solely on patients who are expected to die and not the sudden, unexpected or traumatic death (however, some of what we will discuss is useful in all circumstances). We will discuss the purely physically based task first and then the manner in which we approach and carry out those task with an emphasis on the spiritual aspect. The integration of the heart, mind and body is paramount.

Part One

The Physical / Task Based Care of the Dying Patient and their Family.

The following points are largely task based. The mind / intellect approach is hugely important in the ER as it pertains to assessment and treatment options – all essential to quality patient care. However . . . our cognitive ability and listening skills are vital to feeling what is happening in our body to tap our deep intuition about what may be going on with our patient and their families – more on this in the second part of our training.

Pure task based ideas can include:

• move to a quieter room if possible and transferring out of the ER
• if possible go one to one with this patient (ask for help!)
• lower the lights, provide extra chairs for family (check in with the patient/family)
• page palliative care team & involve them as quickly as possible
• inform staff about this pt, use placards, disturb the patient/family as little as possible
• Create a 'spiritual crash-cart' (toolbox) that has electric candles, tissues, signs, CD player, tape for family pictures, etceteras
• work with kitchen to provide 'comfort food' (tea, coffee, water, cookies, etc.)
• provide the family with a booklet on what to expect during the dying process
• inquire / assist family in after-death care (rituals such as washing the body)
• Lets take five minutes and add to this list. What can we do better?

The pitfall of a task based approach alone is that it disallows for the spiritual care / needs of the dying patient and their family. Only focusing on task allows us, as providers, to protect ourself from the difficulties and/or pain inherent in dealing with the spiritual needs of the dying patient and their family. The takeaway lesson for all of us is to not just get caught up in task. Most of the essential task listed above can be accomplished fairly quickly. This is important so we can move on to what I consider our most important focus.

Part Two

An Inquiry into Spiritually Centered Care of the Dying Patient and their Family.

In Part One our focus was task based. But we know the dying process calls for much more than simply performing robotic task on a check off list. It is paramount for us to remain centered and present so we are better able to care for our patients and their families. So let us ask and inquire . . . how do we remain centered and present? How can we care for this patient and their family beyond just the physical task despite the busy demands of our environment?

• How we move through the room affects the mood and atmosphere and hence the experience of the patient and family. Don't rush, move slowly, deliberately.
• Don't focus on trying to 'fix' every single issue – just sit with it.
• We can stay present and focused on loving kindness as Ram Dass teaches us by repeating, 'I am loving kindness, I am loving kindness'. Don't just mindlessly repeat this – be sure to reflect and focus on each action performed with loving kindness.
• Integrate your heart, mind and body in your care. Listen to your intellect, feel what your body is telling you and let it speak through your heart.
• Create and envision the patients room as a sacred space. Be mindful that many of our prior task are carried out in the support and creation of this space.
• Pause before we enter that sacred space to acknowledge that another human being is dying. Pause to breath, honor this moment and patient, enter the room in a 'not knowing or doing' space. This is no matter what your task is – even if a simple 'to do'.
• Do enter the room to be present and available.
• Rather then doing each time you enter, focus more of a felt sense of listening and being.
• Once again, let us add to this list to improve our understanding.

Charlie Garfield brought this up in his April 2013 talk:

Listen from the heart.

Speak from the heart.

Act from the heart.

Summing it Up!

All too often in the emergency environment we become task focused. However, the dying patient provides us with a special and sacred opportunity to really nurture, respect the process and be deeply present. We must remember that we are all in the process of dying, it will be us someday and in this moment we have a unique opportunity to approach this patient and family in a different than usual way.

The challenges we face are how to do this within the demands of our respective workplaces. It is my hope and our goal to integrate both the doing and the 'being'. I hope that our time has been thought provoking and has laid out the beginnings of a road map for you and your patients to take that 'road less traveled by'. I invite and welcome any questions or thoughts that you would like to share.

Counseling Warriors

I have met a lot of vets in my time at the San Francisco VA. I met a 27 year old a few months ago who had signed up at 18 years old with multiple tours in Iraq and Afghanistan.  He was a fire team leader with the 82nd Airborne, lots of action and loss and pain.  He's in school now, making himself into a productive member of society.

As with all 'my' guys I asked about his drinking and drug use.  He is using a lot.  My message to him was that we are here to help no matter what.  My message was that he has a responsibility to the name he wears on his wrist and in his heart to be responsible for what he does, that he must go forth into this nation and world and work toward helping society avoid the wars that cause us to wear the names of dead people on our wrist.

His friend and buddy would not want him to waste his time and life drinking or using.  We were both close to tears on this one.  But here he is at 27 heading toward a career in photojournalism in war zones. We miss the action when we are not there (and I never served in the military but from my ER and Fire experience). 

Remembering Sam


Aloha, my name is David McCullough. It was a death that took me from Hawai'i fourteen years ago and today a celebration of life well lived that returns me home, once again, once again to the people and place I love. There are many of you that have known him longer, more closely and intimately. I have felt so absent, yet still, even now . . . I marvel at the connection to Ohana resonating within my heart.  Sam and Patricia and so many of you make that possible. My eternal aloha and gratitude to you.


I met Sam when we performed in Taming of the Shrew at Diamond Head Theater over 15 years ago. He introduced me to his 'crew' at the Picasso in the Alana Hotel. The Picasso was not a nightclub . . . but it was. It was not a piano bar . . . but it was. It was one of the classiest joints I've ever had occasion to hang and the people made it so. Being welcomed into that circle has been one of the most wonderful experiences of my life – what an honor to be part of Sam's life and earn his trust and love.


So for Sam and I (and many of us) part of life was theater, having a drink or two, talking story and jazz, jazz, jazz. He taught me more about Jazz then I could ever imagine. That love lives on – just as Sam does. So wherever there's a musician or crooner singing a tune, whether under a bridge or beboppin at a jazz joint – Sam is there. Where ever a singer sings 'Spring Can Really Hang You up the Most' or 'Lush Life' I am with Sam . . . all over again. I'm married to a beautiful and very talented singer now and Sam got to meet her. Because of Sam's influence – some of the songs he taught me are the one's my wife performs. It is much of his style and sense of life, expressed through the soul of music that has been transmuted and lives on through all of us.


We all come from different worlds, cultures and times. All inseparably conjoined. I am an emergency room Nurse at the San Francisco VA hospital now but am also a hospice nurse. My father was a veteran and his death took me away from Hawaii nei.  Sam was a vet and our friend and his death reunites so we celebrate his life and how he lived it. There are such things as duty, honor, and commitment and Sam encapsulated all these values and more.  I work with veterans every day and some talk and others do not. Sam was a man's man – at least to me. In my experience he exemplified the archetype of a peaceful warrior through his strength and gentleness.


As many of you know he spent much his life with what I fondly and with great respect refer to as the War Corps. In contrast, Patrica was a Peace Corps Volunteer from 1966 - 1968 and I was a volunteer in Fiji from 1985 – 1987. That is how she and I became friends. In 1996 Jim Hesse and I started Shakespeare on Sundays and I invited Patricia to meet this cool, older and distinguished gentleman. I got busy with the group and of course Patricia introduced herself and the rest, well . . . you know the rest. I am proud, honored and deeply happy at my role in getting two of the most wonderful people I know to hang together.


So that's it. Few, if any of us will remember much of what is said today. These words are not as important as the energy Sam brought to this universe and its affect upon our hearts. I am proud and blessed to have become a better man because of Sam Polson.


Malama pono Sam . . . a hui hou.

Funeral in Hawai'i

I'm back in Honolulu for Sam's funeral. I'm struck by how lonely I am right now.  I also realized  that my ties here are dimming - I know fewer people now. For me it is the people that provide meaning and joy to a place. So I miss what was and naturally wonder at what shall be. 

It is late. 0120 for me but I do have some energy from being back to where I feel at home. One big change is I saw tents on main streets here with homeless people living right on the sidewalk. It's amazing. Not even in San Francisco would they allow that (Years later in reading this I bow to my own ignorance).

Just maybe I could come back. Or maybe at long last I realize I don't have to. Tough as it was being here with a divorce it was also some of the best years of my life. What was - cannot be again and really, I've never been one to live in the past. But this is true - the more past you have - the less future - so naturally it may hold sway. 

I grow tired and soon my thoughts turn nonsensical. 

My Friend - Sam Polson

 

This is in memory of my mentor and friend Sam Polson who died in Honolulu last week after 80 years on this earth. Sam, I've missed you and now I shall miss you more.  We had a lot of nights over jazz, singing, acting and a friendship. I'm driving home now after a long day in the ER and all I can think of is you and Patricia as I listen to the music of Hawai'i Nei and the Jazz you taught me so much about. I see these clouds spilling over the beautiful California coastal hills and I think of you both and am reminded of the islands of home and the people I felt at home with. I feel your spirit Sam and I love you and Patricia no matter the distance and time life inevitably brings. You made me a better person, a better man and I will never forget that and what you taught me. Malama pono Sam Polson, you were a man's man. A hui hou.

David

The view

From our window folly island, S Carolina.

Metta Institute.org Hospice Training.

July 17, 2013
Santa Sabina Retreat Center

Metta Institute (mettainstitute.org) Training: Opening into Mystery (or some such deal!)

Wednesday night - Frank Ostaseski's first session

We had a really great hour lecture / talk / discussion tonight and to round it up we had to play the 'repeating question' game.  Two people ask each other a repeating question with a time limit and in this case five minutes each. At the end of the answer the questioner says 'Thank you'.  No responding is allowed or additional follow up questions. Our three questions were:

1.  What is right about knowing?

2.  Tell me a way you hold on to your knowing?

3.  Who would you be without your knowing (or alternatively - What would our identity be if we were not so vested in what we know)?

So for number one there are the inevitable questions and dissection of the question and that was not allowed.  We had to answer it at face value but could talk about the definition during our turn if we so wished and thought it may be helpful.

So my answer was initially about the easy stuff - knowing encompasses EVERYTHING we 'know'.  Stripped away - we know nothing and become infantilized whether that is like a baby or an old person with dementia or alzheimers.  In our follow up discussion this option was removed from the discussion and the question was asked . . . what other possibilities are there?  Does it free us up in any way?  Is it bad, good, irrelevant, indifferent or what?

What is right about knowing is the power inherent in the act. By our knowing we can contribute and we can also teach or help others. In our knowing - others may now know and hence our own ego inflates - not always bad nor good. In knowing we demonstrate our competency and value to others and society.

My other thought was that knowing what you do NOT know is powerful.  Being able to state that without fear or expectation that you are supposed to know 'everything' gives you power, freedom from fear of being or appearing incompetent.

In short - our knowing is deeply tied to identity.  Strip away what we know and what is left?  Do we cease to be who we are . . . or is there a core to whom we are that is inviolable?  For example - we may believe that some people are innately a certain way in their demeanor.  This remains when all else is stripped away.

Question Two - how do we hold on to our knowing?

I answered - tooth and nail with desperation!  Then there are the physical tricks we use - write things down, record it in some way to memory both flesh and silicon.  But is holding on to our knowing can be a weakness - i.e., I suppose that there is freedom is ridding oneself of the need to know so much, the need to know everything and appear competent.  At least in nursing I've done this.  Pretending in medicine can equal death so you get over that pretty quick most of the time.

For question three - What would we be without our knowing? 

Some answered - 'Free'! One woman said she immediately thought of music being played and not just 'folk music with a guitar'!  She thought of giant magnificent paintings.  Then she and others reflected on how much they are invested in knowing and want people to know that they know so they will be accepted and liked.  It took courage for this to be said as most of us would deny it. This person has a Ph.D. and an M.D.

I think that many people will say they like to know, to be knowledgeable so they can pay the mortgage, buy beer and food and pay the bills.  All valid and true (thank you Paulchen!).  But the larger issue is that our knowing is intimately attached to our identity and sense of who we are in the world.  Maybe, just maybe there are other ways of being in the world, of making a contribution that is NOT tied up in the endless quest for knowing more and more to become increasingly competent and be recognized for that and that ALONE.

We are more than just what we know.  It is only a small part of our totality - if so, what remains?

That is to follow.  As Frank said tonight at our ending meditation . . . we have just begun this inquiry, we are just beginning to ask the question, to lift the lid to ask what is underneath.

Thanks for reading.  It it a silent retreat but my mind was anything but silent after such an intellectually and stimulating discussion.  I wouldn't sleep if I did not get this down so I could 'know' and remember!

D

Daughter Woman

If You Only Knew

If you only knew
How much I love you
And what you mean to me and my aching heart
Seems to overflow
With all that you mean to me now, in the past and future.

As you lie there my daughter
Somewhat battered and worn
Finding life's inroads upon your brow
Knowing at last you're growing up.

And at last I know you'll be alright
That you'll survive and learn
Becoming a woman and citizen
Of a world in need of people like you,
To go forth and heal a battered world.

I never thought I'd have a daughter
Someone like you I could love, worry and get frustrated with so much!
But here we are, holding hands, talking, loving
Doing what fathers and daughters do
And I love you
And now I know what that's all about - life that is.

I miss you Camille … more than you may suspect.
I don't need you're friendship although its welcomed
But I need you, you're occasional hello, banana split,
Coffee time, beer on a hot day …
Because life just speeds up every day and soon it will all pass by
And memories remain.

So if only you knew how much I love you,
You might run screaming from the room!
Some day, years from now and I'll be gone
You'll be an old woman and I hope
You will read these words
To remember this day and our lives we lived
And the love we shared.

My lovely daughter.

David

Written at University of California San Francisco Emergency Room
Room 23
July 1, 2013

Yellow Fevre and Friends at the San Francisco VA Emergency Room

Mark Gonzalez, myself, the bicycle is 'Yellow Fevre', Linda Moustapha and Gus.  I ride almost every day to the San Francisco VA Emergency Room.  Five miles each way and I work with some really wonderful people.  I'll miss them when I leave.  The bicycle was a Kickstarter Project and built by the folks at Mission Bicycle in San Francisco.  It has an 11 speed internally geared Shimano Alfine rear hub, Thomsen seatpost and headset and a Sugino crank.  I really love this bike!

Finger covering part of my foto of lands end in San Francisco a beautiful but chilly day.  Wondering where the ship is going and is it too late for me?

Lands End, San Francisco

As I'm often wont to do I'm here at the Ocean at Lands End on a beautiful blustery day. Thinking about the future with an eye toward the past. It's white capping out there with a stiff offshore wind that drives the boat fast and beats you to pieces should you let it.

I remember getting ready to graduate UCLA and looking up from the UCLA dock at the heavy jets wing their cargo to all ends of our earth. I knew then it would be me someday and felt a thrill up and down my spine.

Now it is years later. I've survived travel, a military coup, marriages and more. I'm married to an incredibly beautiful woman now whom I care for so deeply.

We can live our lives in safety and embrace the stultifying dullness that it entails. I could do so but at what price? Would that I rather take a calculated chance to seize that moment to live and revel in the unknowingness!

This is where I live. Where I can hear the ocean. I walk the paths of my childhood dreams. Over the hills of green and brown I follow the footsteps of my ancestors. The ancient redwoods tower over me and protecting. Winding picket fences, lichen and jade moss covered following the contoured land - the spine of a dragons back protecting its treasure.

Metta Institute.org

From Charlie Garfield:

Listen from the heart
Speak from the heart
Act from the heart

Flower and Wire

View from my window

Metta Institute.org / Creative Collaboration / April 3, 2013

Aloha -

I am attending my third in a series of about 8 retreats / teaching for End of Life practitioners (people involved in hospice or palliative care) at the Santa Sabina Retreat Center in San Rafael, California.  It was a beautiful day and a real treat to drive up here from San Francisco.  San Rafael is beautiful - I would love to buy a house here!  So do many people and this is why it's so expensive.

This third course is about creative collaboration.  We talked for over an hour or two tonight about what are some of the barriers to collaboration at our various workplaces.  Over and over people mentioned many of the same things.  What struck me about the SFVA ER was that we share much of what was mentioned.  For example, people's communication styles (IF they communicate), our own ego's (is it about what they want or what the patient needs?) and much, much more.  Too many to list this late in the evening.

It felt very right to be here again though as I walked in.  We have over fifty people what are taking the full eight courses and all in all it is an expensive (but fair!) proposition.  I am paying for this out of my own pocket and it is over $8000!  But I knew without any doubt after the first few hours last year that it would stretch, challenge and teach me. 

Seeing familiar faces helps.  After all, there is a bond among those who have been around so much death and suffering and yes, joy.  It's a package deal after all. It is not for everyone.  Sometimes it is not for me yet I do it over and over again.  We all get there, some slow, some faster.  It's nice to have someone there who gets it, who can help not only you but the ones you love who are left to live and remember you!

It grows late and I must go.  It is such an honor to work with the people at the ER and especially so with the fine people here at this retreat.  May we all be so blessed.

D

Long time Brah

Missing Hawai'i badly.
The people
Culture
Smells.
Breeze.

Missing it all.

Able to let go
Not so sure.

Need to split myself in two
Integration of da kine

Stuck tween many worlds
Part of them all
Belonging to none
Yet belonging to all

Or at least trying.

D

NYT's article: Ultimately I think

That this world is largely empty of real or true meaning. There is no intellectual underpinning for its existence really c full of sound and fury signifying nothing.

I long to be proved wrong. But I get the fascination and draw of this world. But at the end of our lives I think we always look back and ask if our lives were well lived? Did I matter? Did I help? Did what I do in my life make a difference to others in a positive way?

I know I'm asking those questions more often and with a sense of quiet urgency and largely unconstrained by past concerns that are less and less important.

What I'm pushing for is to make some kind of lasting contribution with meaning. Therein lies the challenge to us all.

Love ya!

D

http://nyti.ms/WKOYe0

NYTimes: Michelle Harper, a Woman of Mystery

Is the ubiquitous, flamboyantly dressed Michelle Harper this generationfs Holly Golightly? Or is she its Sylvia Miles?