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

Jiang Yu, China Foreign Ministry Spokeswoman is an Idiot

From the New York Times: 

. . . China’s Foreign Ministry spokeswoman, Jiang Yu, denounced both the self-immolations and the solidarity prayers for them during a regular press briefing in Beijing. “As we know, such splittist activity at the cost of human life is violence and terrorism in disguise,” she told reporters.

Having never been to China nor Tibet I still think she is an absolute idiot.  The whole world knows what China is doing to Tibet - systematic repression and destruction of a culture.  Jiang Yu is a liar and I'd clap her in prison for calling self immolation - 'splittist'.  Maybe we should do to her family what Chinese authorities are doing to Tibet and Tibetan families.

Violence and terrorism?  The US has much of a lock on this of course but justifies it for national security as do most countries.  But China?  Now there is a real scam artist - they may be destined to run the world for awhile as America fades from the scene but to deny that they perpetrate violence and terrorism is just plain stupid.  Is terror and violence perpetrated by the State allowable or preferable to non-State actors?

So China heads down the path of the United States - mass consumption, little regard for the common person, abuse of the environment and liars as leaders.

The winds of change will always be blowing across the planet and I hope I am alive to see China fall along with the US because of the evil that is perpetrated in the name of the State.

Aloha -

It's increasingly evident to me that I do not wish to continue to live in three separate places in a vagabond fashion. I rent a room in San Francisco that I like and the house is owned by a slumlord that does the minimum to keep it up. I hate that part of it, the dirtiness, unkemptness, dark and sad. The plus side is that I park in tohe garage and don't drive the whole week. Yet the place is not mine.

Tonight I drove to my family home on Seaview Ridge. Such a sense of homecoming and peace. Yet I walk in the door and the toilet has a slow leak for a long time o to the floor and the walls are wet from soaking up the (clean) water. So now I have a major reconstruction / remodel on my hands.

Other weekends I must sometimes spend in Sebastopol. So am at neither place I call my own. I really want One Place, a place of ones own as Virginia Wolf wrote.

To to reconcile this separate and disparate state of affairs? Buy a place in San Francisco? Yet my application to Tripler Army Hospital is still extant. My application to the CDC's polio eradication program is going in next week and those are three to four month contracts. I work Monday with the VA's human resources to consider a TDY assignment with the ultimate goal of joining the epidemiology intelligence service - the 'disease hunters'.

David

For now though I am faced with more mundane matters!

Strolling in Rain

Strolling in rain
Misting favourite cashmere dusky red
White Labrador dappled by rain and love
Warm snuffling nose greets inquiry

All's right in my little world in
This precious instant fleeting away
As we pad our way
Through our lives.

David McCullough

Aloha - please read the New York Times article below this blog post for reference! 

Tyler Hicks is one of my favorite and one of the best fotogs out there now known for his incredible images. Somalia is one of the most dangerous places on the planet now. Most, if not all agencies have pulled out now. While stories like these remain the most frustrating to me simply because I can do nothing . . . I also recoil in disgust at our own ritualized response of 'horror' or 'those poor people' while we sit in our comfortable stuffed lives. 

I have no ultimate answer. All I can suggest to any of us is that we do NOT refuse to look at this or other fotos. That we learn to plunge our intellect into the horror and sadness this represents so just maybe, somehow, someday, we can know more and spread the learning to make even a small change. 

Somalia is a failed state in every sense. Somalian warlords tear the country apart for personal and clan gain. The US is doing little to assist, mainly involved in trying to fight 'terrorism' instead of the terror represented by this image.  If it was us, our child or family what would you do? Let's start by spending some time on it. That's all.  There are good people doing great work there at terrible risk. They deserve help and recognition as do the Somalis. 

I woke up early, scanning the New York Times as per my usual and saw this story. Obviously I felt very compelled to share it - part of my own selfish need to expiate my own guilt at the part I play on the world stage.  Not meaning to preach but to learn and increase knowledge and awareness.

Thanks,

David

Famine in Somalia and Tyler Hicks article

A malnourished child at Banadir Hospital in Mogadishu, Somalia. More than 500,000 Somali children are verging on starvation.

Photo by Tyler Hicks

The Faces of Famine
By Tyler Hicks

Famine is sweeping across southern Somalia and sending a stream of desperate people into Mogadishu. Tens of thousands of children are said to be dying there, and there's not enough help to meet the demand for food and medical care. The Shabab, the Islamic militant group with ties to Al-Qaeda, has made delivery of aid to remote areas, and even to the capital Mogadishu, not only difficult but also unreasonably slow, further reinforcing the crisis.

I was recently on assignment to photograph the crisis in Mogadishu. Just a few miles from where our plane landed I was taken to a refugee camp where hundreds of new arrivals, those who walked there with their belongings – and children – on their backs, waited for help and a place to settle. The sight of foreigners, and their hope that help had arrived, created a steady appeal for help. A bundle under a woman's arm revealed an emaciated child, then another in the same state carried by someone else. I motioned to my camera in an attempt to show I was with the news media and couldn't help them with what they needed: food, clean water, medicine, mosquito nets, shelter.

The worst cases were at the crowded hospital. That's where I found the hardest hit, mostly children, some unable to walk or even sit up, others vomiting and all suffering from dysentery. In the hallway every available surface was used for another sick child. I've seen bad conditions in hospitals, but this was one of the worst. Swarms of flies infested the mouths and eyes of children too weak to move. Their parents spent the day swatting the flies away from them and doing whatever else they could to keep them alive. I photographed a father carrying his lifeless daughter, wrapped in cloth, out of the hospital for burial.

Mogadishu is unsafe for foreigners, and journalists rely on local fixers and security to help do our job. Time on the street is very limited, and you're never left in one place for long before moving. This means you're forced to work quickly, even inside the hospital. I found this frustrating, but I reminded myself to trust our guides and allow them to make those decisions.

In early August, The New York Times ran a front-page photograph of a child who was reduced to the frail framework of a starved body. The image showed the child in a fetal position, arms wrapped around the head, almost in a protective gesture. I could see that this image, however disturbing to view, would give proof of how desperate the situation had become.

I enthusiastically support the image chosen for Page 1. The public reaction was overwhelmingly positive, and a reminder of the impact The Times can generate – not only among our readers, but also among other news media organizations and humanitarian aid groups. This is an example of the raw, unfiltered definition of news photography. It doesn't happen every day, and it might not come your way in the course of a year. But sometimes you land on a story, a cause, something that has meaning to you, and the resulting photographs have an impact. They are seen and spur reaction. In a digital age, that's when you're reminded of the impact that a still, motionless photograph can have.

Aloha and finished a long working day in the ER today.  Weighing my decision to apply to Tripler Army Hospital in Honolulu and still finding it the very right thing to do.  I continue to struggle with loving the job I have but hating the cold, grey, foggy, rainy windy toothsome pummeling from the San Francisco weather (better but only in the last two days).  Living in a better place would greatly improve my outlook but moving may entail a longer lease then only to have Hawaii come to fruition.

Love my job and people here.  Love the ranch and people there.  Hate the weather here in the City and the unfriendliness.

So I ponder and wonder.  No hurry to decide as fate and time assist also.

David 

Aloha and our third day back.  Worked a 3:30-1 am shift last night so I am really very tired right now.  Writing this entry from my family ranch on the 'Ridge'.  Back to work Monday to Friday after tomorrow  Another positive thing about Tripler Army Hospital in Honolulu . . . they have 12 hour shifts so you only work seven days out of 14 days!  Yeah baby, I like, I like.

Caught up with John and Peni Gibbs in Kaneohe and it was so wonderful to see them.  While I have many friends here in Californial, I realized this trip that I have many more friends in Hawai'i that I just don't see enough of - more then I do here.

At any rate it is late - interview at Tripler went so well, my hopes are up and time will tell. More on Hawaii later!

D

Lanikai Beach with Jack Attack Dog entering from Left.  I spent many happy hours near this beach in the 90's.  Had relatives who owned a house in Lanikai from the 1930's on.  Not sure when they left - out of touch with them now.  Welden McCullough use to manage a Bank - Bank of Hawaii? and whose family was held hostage at some point.  He was a half brother to my Dad I think.

Aloha and I have been back in Hawai'i for a week now on Kauai and fly to Oahu tomorrow night for about four days. The one thing that is crystal clear to me and is completely resolved in my head is that I am not going to stay in California. I want to return to Hawai'i and in fact did interview for a position on Kauai - informally - but I did talk with some people. I interview at Tripler Army Hospital on this coming Tuesday. I love my job, love the crew I work with at the San Francisco VA but even they know of my love for the Pacific. I feel at home here, relaxed and a feeling of belonging. While it is not my home I know I can make it my home. So many changes.

 The one year anniversary of my mother's death is tomorrow. I plan on renting a longboard and paddling out to the middle of Hanalei Bay with a lei, say a few words in her memory. Something like this: Aloha Kakau, Bula Vinaka mom. I am here to remember your loving spirit and pay homage to the sacrifices and struggles that you endured in your life. To remember the sense of enthusiasm and fun you carried with you almost everywhere you went. I remember the night we spent on the fresh lava beds of Kiluea Volcano on the Big Island of Hawai'i, how late it was and how tired we all were . . . yet you shouldered the burden so well and carried on without complaining. We both knew we had been present at creation and I know how moved you were and excited you were.

Mom - I know we had our differences, disagreements and harsh words. Yet we forgave each other and in the end all was forgiven as you lay dying so well. I felt so sad and I am now moving on, letting that sadness go free and moving on with my life in so many positive ways. I do want to say I am sorry if I failed you in the end with the pain and suffering that you endured - we did our best mom but remain haunted by the possibility that I could have done better or improved in my care of you somehow. I think of that often and it is my greatest wish that you did not suffer. This may be a reflection of my career as an ER nurse and my own deeply personal convictions - but in the same breath I know that to live is to suffer and that it goes hand in hand with joy and life. I apologize if I failed you in any way or if I hurt you.

May the spirit and love that led you to love Hawaii and Fiji and their people bless and honor you my mother. I thank you for giving me life, teaching me how to be a good person and contribute to the world and its people. I thank you also for teaching me how Not to be at times by the virtue of your own attempts and failings at living a good life. May your spirit find comfort and peace, may you exalt in the end of your suffering and in your accomplishments in your brief sojourn on this planet. We will always love you and our father. I will always try to live a good life, to contribute, to do good, to lessen suffering, to teach and learn, to consume less and want less. You and father taught me these things - I do not know how but it is who I am and I know that you were proud of me and worked hard to let me know that. My heart enfolds your spirit my mother, may you be happy and satisfied where ever your spirit is, may you find peace and reward. I miss your presence and I send you my heartfelt love. David