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?

Precious the Cockatoo, a patients beloved pet.

Tearing my Right Meniscus & Learning Patience and Pain

As I am confined to less mobility, somewhat housebound it is past time for an entry here.  A few weeks ago I was mountain biking on the bluffs of Gerstle Cove State Park - very close to our family ranch on the East side of Salt Point State park.  I took a very easy, slow speed tip-over / fall onto my left side.  Good enough, no damage done from that.  As I was unclipping and then twisting to get up and out of the ditch I was lying in I heard my right knee pop a bit and had a bit of pain.  Stopped what I was doing, straightened it out and then was able to get up and ride for another hour with no pain.

A few hours later it locked up and the saga began.  Realistically though this was not from my bike tip over for I had pain over a year or more while pivoting and had not been able to sit cross legged for the last few years due to pain (especially noted when I wanted to have a yaqona ceremony).  So the bike just exacerbated a preexisting injury.  I put up with it for a week without an MRI and then with no resolution scheduled the MRI.  Now I love MRI's and almost all imaging technology even though I am untrained it seems such a 'cool' thing to be able to see the inside of a body - especially your own!  That said it is not the spectacular 3 D, cleaned up and super enhanced CGI stuff we get out of Hollywood.

My official diagnosis is a bucket handle tear of the Right Meniscus which for those who do not know is the pad between the bones of your upper and lower leg.  If the damage is bad enough they can take it out.  As they related to me this was one of worst tears they had ever seen but it was repairable with sutures.  I have the arthroscopic images and after orienting myself it was very impressive to see the tear and actual abrasions / channels I had worn into some ligaments.

Dealing with the Aftermath

I chose the word aftermath quite deliberately.  The lead up to and the surgery itself was nothing.  Recovery has been harsh - truly difficult for me and the number one issue has been pain.  Other issues have been greatly lessened mobility, a greatly lessened feeling of independence and the corresponding need to rely on others for assistance.  I find myself continuing to be surprised by my reluctance to not depend on others - I find it difficult to ask for help so I am working on that.

The pain - as an ER nurse (and I am proud of being in the ER so am taking credit for that because not just anyone can work in the ER!) we ask our patients to rate their from 0 - 10.  Zero being no pain, 1-2 is uncomfortable and 10 the worst pain experienced in their life.  You know where I am going with this one don't you!?  Well ladies and gentleman - this was my 10!  It did not hit until later that night after my local block well and truly wore off.  I ended up just weeping - not only from pain but the mental frustration, the unexpectedness of it's severity and the attendant anticipation of more to tome and for some time.

In 'my' ER, I am known as one of the more compassionate and involved staff (not always a good thing depending on the situation).  To the point where I go beyond what other nurses do, when the time is available, to hook patients up with additional resources but also to the point where many of the other RN's give me a hard time about being too nice or understanding or 'soft'.  Some RN's simply are task performers - that is bullshit and I don't want them in 'my' ER.  I want passionate, involved, proactive, caring nurses that can do it all and not just 'get' a difficult IV stick.  Why talk about this now?  Because inevitably every thing I go through in life has the potential to make me a better person but also a better nurse.  This experience is a good one then - as much as I may hate the pain and curse the situation.

The positives are that I now have a better idea of what a 10/10 pain is for me and I have done some good technical learning also.  The negatives are that I have had to resort to Vicodin (only side effect was itching!)  for the pain and my initial use really was high - considering I had never used opiates in the past.  I said NEVER didn't I?  So I used 40 in six days.  Sometimes two an hour.  It was crazy but the pain was almost unbearable at times.  I was doing my best to 'man up' but also not to take that fallacy to the extreme either!

I am just over a week out from arthroscopic surgery.  I follow the usual regimen, RICE (rest, ice, compression, elevation).  Mobility is slightly up and improving.  Vicodin use way down which I am very happy about!  So I continue my ibuprofen and am also using Bromelaine to help with the inflammation.  I am better on the crutches but boy do I miss walking and riding.  The plus side is that I am going to get back into the pool as soon as possible.

I miss my work mates something fierce.  I'll go back the day after Christmas, as non-weight bearing as possible and doing a lot of administrative work.  We have this whole goal of doing a nurse first contact in the ER instead of a registration first contact so I will be pioneering that whole idea and developing some protocol around that. 

That's about it for now.  Even now my pain level is up to about a 4-5 but my tolerance for that pain level has gone up.  I am grateful for that as I am for so much else.  Thanks for reading,

David

Driving from the ridge on Skaggs Springs Road. Beautiful sunset, music and many thoughts. Remembering the past and then remembering how it felt to anticipate the future. Feeling that frisson of lovely optimistic passion run down my spine knowing that I was at the beginning, the beginning of a life and that it was all spread out there before me - waiting,waiting,waiting. I treasured that unknowing and recognized it even then. I still long for the unknown and the attendant excitement.  Ties to our lives and the community are so rewarding but at times I tired of the comforting embrace of all that is so knowable. I live a passionate and rewarding life that has its share of excitement, danger, peace and incredible beauty. I am a fortunate man.  Yet for me there lingers, and always will, that certain sense of much yet to be done, so much still undone. And yes, I embrace, long for it because it is still waiting, waiting, waiting. I will not die without having done so much more then I thought I was capable of. 

I'm waiting at home
Tending the home fires
Banked against the coldness of broken hearts.

I may not be the man you wanted but hope I'm the one you need ……
When cold winters wind blow
the ages of our years upon us
I'll be the one, I will be the one.

So hasten home
Less sleep and the years
Take me beyond your reach
And I'll not know the beating of my heart
Pressed against yours

Nor the touch of your skin and tears
Mixed with
Intermingling with
The endless wash off wave and tide that
Beats the beat of a pulsars heart
At the end of the universe and time

I'll be the one if you'll be the one
We'll circle round interminably you know
The inexorable pull of loves gravity
Pulling us home
Pulling us home
Again and again
pulling us home.

I Wish it Had Been You

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 and 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.


September 2012
Written at a workshop on Palliative care by the Metta Institute.org

Driving South Meyers Grade

Why I love and live where I amc

View from my window

Santa Sabina center, San Rafael, California

Wise Relationships, Palliative Care and Hospice Course

Aloha . . .

From tonight (Wednesday, Sept 12, 2012) to Sunday at 12 I am at the Santa Sabina Retreat Center (also on the web) with the Metta Institute.org on a course or retreat/study in Wise Relationships.  This is more aimed at Wise Relationships in the sense of working with the dying in hospice or palliative care.  But, of course, any kind of work like this benefits in all realms of one's life. 

This post will not be terribly well organized - lots of thoughts running through my head from the last week.  So I shall start with this - tonight Frank Ostaseski talked about the meaning of when people at this retreat clasp their hands together and bow.  Not only to honor of course but to pay homage, to acknowledge and so on and so forth.  But he said that one hand could be thought of as Wisdom and the other, Compassion.

I loved that and I want that to be me.  I fail miserably most of the time but hey, it's practicing right!? Compassionate wisdom and wise compassion . . . yeah baby.

This last Monday was my birthday.  I took the day off.  Partly in preparation for this course but also to process, think about and flush out the prior week which was  a very hard on on the work and personal front.  I drove to the Camp David West Sunday night and spent the night alone . . . but I was not alone.  I watched the stars for the longest time and I was not alone in my heart.  The ridge is a place of eerie beauty but not strange beauty but just so so beautiful.  I awoke the next day and it was one of those days, you know, where every little thing you see and hear is so crisp, present and real that it just leaps out at you begging to be noticed.  Every little thing I saw begged to be just watched and studied.

I was without thought really, not focused, no busy mind but just accepting, observing, being present, full of wonderment, appreciation and love.  But most of all, gratefulness for the opportunity to be alive and lucky enough to have clean water, no one trying to kill me or my family, good health and stability and so much more.  Yeah, those thoughts really did cross my consciousness!

So while I was alone . . . I was not . . . I was at home not only in my home but in my heart.  And all this can be so hard to explain to someone who just may not get it, who may not be in touch with whatever the hell I was in touch with.  But for me it was the ever present realization that I am a part of the larger picture, the web of interconnectedness that binds all of us and all things together.

I did not want to leave . . . to drive in cruel traffic, separate from the wash of ocean on rock, the cry of the hawk, the quiet rush, rush, rush of the Raven's wing over my head wending through Redwood trees hundreds of years older than I.

I struggle even now for the words that will fly straight into your heart.

What I know is that I needed to be there . . . alone or not.  The challenge, among so many, is to be able to reach that special place and realization where ever I am.  So I work and continue to work on that.

I left on Monday.  I stopped at the top of Myers Grade looking South and the view took my breath away.  It was so ungodly beautiful I just broke out in tears - just think - to have lived long enough and seen so much but to be touched to my soul by such beauty.  I am so very lucky.  Of course I did have Jan Garbarek's Officum album on and it was a long hard week (hmmm, lots of those of late but that is not all bad!).

I took Highway One all the way down to San Francisco and despite having lived / traveled over much of the planet it is one of the most beautiful drives or experiences there is. 

So that's quite enough for now I think! There's more to follow - these courses are vital, thought and feeling provoking and most of all provide the tools one needs to do the job in the ER or hospice and life in general.  I signed up for all of the courses - not cheap - but it is an investment in sanity and my ability to help others.  Gladly done . . . with out regret . . . with pride.

Thanks for reading . . . malama pono,

D

Cycle Ride Golden Gate Bridge

Hawaii

Interviewing with Hospice Hawaii of late. Exciting, hopeful, working hard and it feels like a great match.

The view from our window

View from our window, Lucca, Italy

Hotel Celide, Lucca, Italy

View from the Uffizi gallery

The Ponte Vecchio bridge in foreground looking west.

Hope alls well!

A view from our window

La Scala Opera House, Milano, Italy

The Alps on the way to Italy

Loving Nursing but Wanting More? Of course!

I love being a nurse and especially in the ER.  I love to take increasing amounts of responsibility - to the point where now I cannot envision just staying as a nurse.  I like to manager and take responsibility for not only good medicine but managing resources and people in a very challenging environment.  In short . . . I want to do so much more so I can have a greater impact.

My style is inclusive and consultative.  Meaning I don't make unilateral decisions.  I weigh people's opinions, gather information from diverse sources, look for creative 'out of the box' solutions constantly but I not afraid to make the tough call.  If I have done my work responsibly then I know what I am doing is best for the patient, team and ultimately for myself. 

All this being said I have been looking for work in Hawai'i.  Ideally we would like to return to a place I have called home and where we can be together.  I absolutely love my job at the VA and would not mind continuing to work for the VA in Hawai'i but I am also talking with Hospice Hawai'i and I am very impressed with them - would love to work with them too.  As much as I love the ER . . . hospice is dear to my heart as difficult as it can be at times. 

I have not given up my goal of becoming a Nurse Practitioner or Physicians Assistant.  I could join the State Department in that capacity.  But I am not sure that I 'have' to do that to either be happy or fulfilled.  Still, I wish to practice at a higher level - to have the capacity to do more as needed.  I continue to learn so much at the San Francisco VA but am just not sure I am content to stay put in one place.



For now . . . .

Mountain Bike Ride, Sea Cliff in San Francisco