7.5.15
Whats up and a Moral Manifesto (or what the hell's it all about Alfie!?).
I am still working as an RN case manager for the Advanced Illness Management program for Sutter Care at Home part of the incredibly huge and supposedly 'Non Profit' health care system. I love the job in some ways, I love the patients who all have a life expectancy of 12-18 months. I hate the miles I am putting in, I am polluting our air sometimes driving a 125 miles in a day and an average of 100. That is at least three hours in the car a day. Would that be good for any of us? I know not.
So without going into details I know that in the long run this job is not for me. My legacy of patient care is good - I lessen suffering, relieve pain, make people laugh in the most dire of circumstance. I am fulfilled in this way. Yet lurking there, somewhere in the background of heart and mind is a lingering satisfaction and disatisfaction and wondering of what else is there to be lived? And where? And how?
I believe that these are universal questions that we all want, sometimes knowingly, sometimes it may be just a vague unknowing discontent. Similar to that idea of damn it, what the hell is going on here? Why am I here? What IS it all about Alfie (one of my favorite songs so bittersweet in its melancholia)?
Viktor Frankl wrote about this in his seminal work, Man's Search for Meaning (http://www.amazon.com/Mans-Search-Meaning-Viktor-Frankl/dp/080701429X/ref=sr_1_1?ie=UTF8&qid=1431051937&sr=8-1&keywords=victor+frankel). For me the take away was that people search for meaning in purpose, that we need both and they are inseparable. We find our purpose in what has meaning to us. Without either we drift in incomprehension and more of a meaningless existence unremarkable in it's ordinariness. While occasional flashes of meaning and enlightenment may occur, in large part, we tend to live our lives punctuated by the sadness of living a life without purpose. Hence, society, the marketers, the Ad Men and corporations step in to fill the void filling our hearts with the promise of temporary fulfilling desire.
So I have purpose and meaning. Yet I feel I am stuck in some ways in my daily ordinariness. I am so rich by some standards yet I am guilty of that too . . . I consume too much, live in too large a house, get caught up in snagging the latest Iphone or hooking up with a fantastic audiophile system that makes me cry the music coming out of it is so beautiful and soul shaking. I live for those moments.
Yet other moments exist too . . . the simple human experience of shared lives and moments and destinies. I am not quite sure where I am going with this so bear with me a moment . . . think back to your past and what moments meant the most to you, what memories carry the greatest emotional resonance? I submit that lives led in quiet desperation occur everywhere across this planet and that desperation takes differing forms.
I submit to you that we have a duty, nay even more than that, we have moral obligation to find our purpose, our meaning in life. And no, tis not to shop my sweet. We have a duty and moral obligation to make the world a better place, to improve it for others and not just ourselves. We must look beyond our own shallowness and selfish desires as much and as often as we can. This remains a challenge - at least to most of us.
For me it could mean simply downsizing and using less in every way possible. Riding my beloved bicycles more (note the plural use there people?!). For me it would mean traveling more and I do not mean booking a stay in the Hilton while the poor people scrabble for food out of my trash cans and wasted food thrown out of the fat people. Yeah, just a tinge of bitterness there my sweets, just a tinge.
Things are a brewing inside my pea brain. Ready for a change, anxious to move on see the world be of service to more people. I am raging hungry for change and challenge, to race across the plains of this planet like a mad dog howling barking at mother moon crying out of justice and love, majesty and forgiveness, for political justice and righteousness, to crush the invaders and haters under the boot heels of loving kindness and meet them with a steely heart and endless resolve.
There will be more of this later. The only thing that remains is to take the action behind all the blah, blah, blah and more blah.
Thanks for reading. What will you do? What is your purpose and meaning? Don't cop out. Put it on the line and live it. I'm trying. I invite you, all of you.
David
30.4.15
Contemplation
25.7.14
Flight
Flight is a privilege that only a certain number of very fortunate people have been able to experience. It induces a perspective check in my heart . . . for looking down upon this cherished planet and realizing the immensity of it all and yet the intimate smallness that we occupy in the universe - makes me humble.
8.7.14
Thanks Billy Collins
I thought it was a joke I thought it was hilarious thinking of the cute little mice but then in the remains of my house I found Billy Collins poem Carefully chewed into tiny pieces and then reassembled again on the last remaining inside wall of my house.
Clearly my country mice had read Billy Collins poem. And somehow, I knew they thought that would be funny to reenact the famous poem. I no longer have a countryhouse thanks to Billy Collins.
2.7.14
Bourbon Heroin
9.5.14
Star filled night, Scotch, fire and Love
30.4.14
Bicycling
My week days are spent riding my bike, Yellow Fever, to and from work. I average about 11 -12 miles a day based on what route I choose. If I get a fifty miles in a week I am happy but sure would like more. I love to ride in San Francisco because I mainly go through Golden Gate Park. Many times I busy myself scheming how to get longer rides in.
In addition I finally pushed the button and bought a Water Rower and you can check them out at www.waterrower.com
It is a hell of a workout, fun and the sound of the water is one of its chief pleasures. This was unexpected although I had heard of it. More on exercise later.
I do miss swimming but don't want to drive to a pool in a car and drive back. Hate that!
1.4.14
Drugs, Old Age and Poetry in the Rain
My first patient today is in their 50's. Very polite, nice, crying at times so quietly. Heavily addicted to methadone, oxycodone and a host of other substances over the years. First needle in the arm at the age of fifteen. So sitting there talking describing the life to me . . . 'So yeah, I was fifteen and it seems like yesterday and I wish I could really go back in time and tell myself to stop, make that choice not to and live it different. But then, a little bit at a time you find yourself walking along the streets and soon there's no place to live and every single thing you do . . . and it sneaks up on you . . . till you're just a hustler that you've hated your whole life . . .and every single interaction you have is trying to score, to get something up on the next guy, working every angle until finally . . . you're just another addict, there . . . alone, on the streets . . . standing in and staring up at the rain'.
This job breaks my heart more often then not. And I am used to some patients, maybe one percent - trying to hustle me, to lie, cheat and steal their way to enlightenment, the next big score and high. But sometimes they break through in an open and searingly honest plea for help. And then we both laugh, because they and I know there is nothing I can do . . . it is all up to them - I can only help pave the beginning of the path.
Later I get another patient - in their late 70's. Living alone, multiple medical problems of which thankfully drugs and alcohol do not play a role. This person fell out of their bed and woke up later and found he had urinated all over himself. So much upset, sadness and shame came upon him. We are doing our best, as he is, to find out where he can live in a place at a higher level of care so he is not alone. As I wrapped a warm blanket around his all too thin and shaking shoulders he looked up at me, with tears in his eyes and said 'Thank you so much David, I am really sorry to bother you'. And this finally brought tears to my eyes.
It is people like these that bring deep meaning to my life. I recognize my luck and fortune. I am grateful to bear witness and in some small way bring relief, a sense of hope, humor and caring to another human being. Because in the end - none of us should be alone, in a room by ourselves at the end of our life. None of us should be homeless, alone in the streets . . . standing in and staring up at the rain.
5.2.14
4.2.14
'Home' to coffee at Finca Cialitos
26.1.14
When the World Cracks Wide Open
25.1.14
21.1.14
First day - old San Juan, Puerto Rico
26.11.13
9.11.13
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.
3.10.13
My Fathers Jacket
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.
28.9.13
My Metta Institute Presentation
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.
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?
- 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.
Counseling Warriors
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.
21.9.13
Funeral in Hawai'i
16.8.13
My Friend - Sam Polson
David
1.8.13
17.7.13
Metta Institute.org Hospice Training.
Santa Sabina Retreat Center
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.
We are more than just what we know. It is only a small part of our totality - if so, what remains?
1.7.13
Daughter Woman
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
6.6.13
Yellow Fevre and Friends at the San Francisco VA Emergency Room

22.5.13
Lands End, San Francisco
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!








