Poem: DO NOT FORGET

Do Not Forget

I have learned to love you more with each breaking day

and I tell you I love you more,

than I did the first year of our lives

we knew together.

now . . . . now that grief binds you tight

in remembrance of those who are dead or dying.

Try not let death seize you in it's embrace

to know that each moment you are alive to grieve

you are also alive to live

I am not here to bind you to me

but only to love you

and my loving embrace

in support of our lives

lived together (not alone).

Death reminds us . . .

make time for the living

let them love you

in the depths of your misery, love and pain

death reminds us that we are all suffering

in loss and love

in love and death,

in birth and living.

Do not forget me . . .

the dead whisper to us

do not forget

do not forget the warm lives and souls that populate your life

do not forget

I am here to support and love

we need each other

we need others

I have learned to love you more with each breaking day

I whisper to you do not forget me

do not forget them

do not forget

do Not forget

Shhh my love . . .

do not forget

to live.

David McCullough

November 21, 2015

Poem Number Six in a Year of Poems

Uncle Mine

My Uncle is mans man

Not my uncle by blood

But more than that me

More than that to me. 

99 now and maybe a hundred soon

He's a betting man on the horses

Born 2/11/16 betting on making a hundred shooting high

Till the Belmont Gates clank open

He'll be in the running. 

He's stood by ailing wife 

As she sank into memoirs hole

Memories burdens laid at our feet

To comfort and adore. 

So off on his journey

With lung cancer to bear

not seen in too long

We all have our own burdens to bear

Nothing of compare

He's part of who I've become

Made by how he has lived and loved

Cared for and by

He is the one

Who's stood by

While others stared

And talked

Faithfulness flowered and grew

Worked and labored

Under love but not lost

My uncle is a mans man

But more than that to me

More than that to me. 

Running his last race

Shedding illusions

Spilling them

Leaves in the sun

A man .… so loved. 

Some Poem in a Year of Sailing

I've long felt the need

For the wind on my face 

Beating to weather

Wind whipped wave and fate

Give me a boat

And a sail to drive her

I'll show you happiness and challenge

A microcosm of life 

Upon a floating point calculation

In an ocean of lakes of liquid

I'd rather be thoughtless

Upon sailing a far reach

Following seas may roughen my passage

But it's where I'd rather be

Time out of mind

It's the sailing life for me my love

Too long left behind

It beckons sirens arrow

Straight to my heart and soul

How much longer must I suffer

These slings and arrows

Before listening to the beating of my heart?

To give in to what feels inevitable

To feel the unleashed power of wind and wave

The lines thrumming in my hand

Vibrating with expectancy and hope …

How long…

Poem Number Five in a Year : Cleanup

Cleanup

I guess, I am thinking, that it is time for more
for more of a continuing goodbye
for I am trying to conclude and rid myself
of the detritus of yes, you guessed it . . .
paper and files and staples and old rubber bands
crackly with age and dissolution.

So I run into and run over the memories of you,
lingering traces of your life and others and mine
inextricably wound up in, muddled and woven
a midst each others.

What shall I keep and disregard?
what paper should I shred, read, not read and scan
scan into its particulate digits and electronic emphemera of
scattered bytes of ones and zeros that make up memories and lives?

so this is not goodbye but a way of remembering
that between the tears and melancholia there remains happiness
that I loved you, you loved me
and that this idea cannot be vanquished

even as the years dilute the things we collect
and they become other people's memories
dear to their hearts and so on and so forth.

I still miss you though.
I still love you.
It is nice to see you again
but I miss your voice
I miss your voice.
I miss your voice.


     David McCullough
     July 11, 2015

Poem Number Four in a Year

Knew this would happen
that I would be late
then I thought I just don't care
any
more
then I have to.

Because there are not Poem Policeman
except in my heart that judge so harshly
so it is a day late
so it is
so it is a day early

quantum chance just spins and spins
in the end and beginning
it is all the same
quarks wink in and out
singing of missing muons

You are late and early in reading this
Poem Number Four in a Year
written on day somewhere between
the beginning and the end
the fourth and fifth day

it is written
that is enough
to make me smile
and shiver.

     David McCullough
     July 11, 2015

Poem Number Three in a Year (Productivity Points)

Productivity Points

I'm sick of productivity points 

The endless bean counting bastards

Assigned me to hell .…

To take sacred care of dying patients

Expecting me to ask…

how can I love?

How can I serve?  

When the only question corporate gods ask is …

Why are your points so low?

Why aren't you seeing more patients?

Go faster, be better, be more efficient. 

This ain't bout love brother 

this ain't about serving sister

It's about bottom line profits in a supposed nonprofit world. 

I want to love and serve

Not be driven by corporate Machiavellian bean counters 

When their family lies dying in my arms should I rush to judgement and say to them that I have no time?

That my points are lacking?

That my corporate overlords are monitoring my implanted chip and movements across the cratered landscape of insurance ruled medicine?

My heart bleeds for their malfeasance and lack of compassion and cold hearted  practicality. I accuse them 

of NOT serving

of NOT knowing how to love

I'll weep for what we have lost and rage against the dying and loss. 

     David McCullough

     July 9, 2015

Poem Number Two in a Year

I wrote a letter to my daughter late last night. 

Late at night my thoughts turned to her and to daughter or son never had. 

Hours spent writing of the love we share

Of hopes and dreams

I want the best for her and whatever that means

But knowing nothing is not much

Or it is every thing. 

We get caught up in the knowing

Sometimes it's too much and leads us to ignorance of another's path. 

But knowledge is power

Freedom from oppressions chains

And I'll preach the power of that till the State executes me for the power of those words.  

All this I tried to say in love so she may listen. 

Knowing in the end that these words on paper or not may echo down the years to the woman she will become. 

Don't live in ignorance. 

Do not ignore history and think you are not OF it. All this. 

All this. 

All this and much more

Of the love we share. 

     David McCullough

     July 8, 2015

Poem Number One in a Year

I have been thinking now
for a year or more that I
must write more poetry
or something creative for god's sake
if not my own
lest I go crazy with noncreativity
sadness
and pain.

my bright idea of writing a poem
once a day
one a day
for a year.

Ah yes I can hear my wife now
muttering in the rafters of her mind
'he will not do this thing, he will just talk of it'
and then my sweet,
my own doubting begins.

Except for tonight
no doubts escape
smashing them flat as they scuttle . . .
and I write.

      David McCullough
      July 7, 2015

Firelit

in firelights glow i sit
surrounded by redwoods over 500 years old
who dwarf me in thought and mind with all they have endured
while immutable testimony resides
they are speechless as I am not

i gaze into these flames
flames real and yet of my heart
and wonder at the hands that formed this burning post
from the redwoods i love and gaze at each day
who formed the iron lock?
still with hammers blow inscribed therein?

who formed their life and loves and what remains?
except the silent testimony of a life lived and a hammer
beating metal that last for a century
buried in wood revealed by fire
fire once so intense metal flowed
love blossomed,
shaped by hands long dead.

I am brought closer to my own past and future
forcing questions upon me of what matters and what last
while answers are uncertain
i ask the questions.
creating a life well lived with love
with community and answers answered
as best they can.

as i gaze into firelights glow
the raging love in my heart
for you, for what was and will be.
I'm tied to the past with fire and love,
Love and fire.
i know not where it leads …. only where i will go.

david mccullough
October, 2014
Camp David West

Whats up and a Moral Manifesto (or what the hell's it all about Alfie!?).

For the moment I am still living in Sebastopol, California in the United States of America.  That said . . . I have always had a restless heart and wandering wondering soul.  That is wehat I call a rich persons problem, understand?  Most of us in the world do not have that luxury - their day taken up by an incredible and unrelenting struggle to survive.  There is no luxury of thought or philosophy - just the struggle.

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

Contemplation

I'm sitting here at Plank Coffee in Cloverdale, California having just left my dying patients beautiful peaceful home where his wife, with so much grace awaits the inevitable. My heart breaks at times at the pain of loss, it's beauty and the sheer living hell and grossness that can come, sometimes, with dying as we move slowly toward what may be next. 

As I move through this oh so gorgeous country, listening to my most loved Hawaiian music anchors me to my own past and winds together with homesickness of my past and memories of the people that have made me and are making me who I am. I'm doing good work these past years, blessed work, at least for me and this choice still resonates with me to this very moment. 

Flight

Flying, to me, has always been about the realization of freedom, a sense of excitement but most of all the thrill of movement and new possibilities of beginnings.  It is a flight above the clouds and induces awe and wonder at the world, it's people and the myriad of possibilities inherent in being human.

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.  

Thanks Billy Collins

I once had my house in the country but it burned down recently. Thanks to Billy Collins, damn him! I put his poem up on my wall to read over and over again, chortling as I read his tail of the mice to grab the match ran through the walls and burned the house down.

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.

Bourbon Heroin

Bourbon and Heroin

Bourbon and Heroin

It's the way I want to go

when I'm a hundred and alone

Eighty or Ninety may be the new young

but ask the old what they think

as they sneer at the youngsters sayings

Don't be a patronizing asshole to me young man

I'd rather be having sex with your beautiful smoking hot wife

than be called a 'cute old man'

screw that into your head and remember it when your'e the old man!

This cute old man has seen a thousand things you have not

Done a million you cannot conceive of

held the hand of a dying child, man and woman

and wept for what was and was not,

what will be and cannot.

So pour me a glass of my finest bourbon

Give me a snort of that smack

crank up some Stones, Gustaven, Miles and Vivaldi

and lets get this done.

Regrets, I've had a few but any life . . . well lived . . .

better have some damn regret,

Without one there is not the other.

Bourbon and heroin

it's the way I want to go

living to be a hundred

if I'm all alone.

I'll have a few friends

who'll join me in those last drinks

and I will love them all forever

and hold them close, so close,

close to my heart.

So pour me one last glass

of that dark and smoky blend

I'll see you on the flip side

of gravity and rainbows end.

    David McCullough

     June 2014

Star filled night, Scotch, fire and Love

I've loved a lot of women in my time. Not a boast or wish or anything at all except a fact.  I'm sitting by a fire, sipping a single malt cask aged 23 year old scotch looking into my past and futures. So reflections come easily with Blackadder scotch, a fire, half moon rising …. Johnny Hartman with his marvelous smooth velvety voice beckoning. What perfection awaits us if only seen. 

So the woman I love, have loved and will love. I'll wish upon that star of yearning to carry me off.  I'll yearn for every true love I've ever had and will have. 

I once loved a woman ( and who hasn't?) that did not love me ( and who hasn't had this?).  Hawai'ian and she captured my longing and the pain of being adrift sans love and softness. What poems I wrote for her!  She asked me ….  Why can't I love more than one?  Who decides?

I've no answers. So I love without thought or reckoning of what may come. 

I think of you night and day, my one and only love, dead but also not yet born. You know I love you but words cannot do justice. 

I've loved a lot of women in my time. But none more than you and I'll always wish you had loved me in return. You'll go through life.  Wishing for the love I have for you…never knowing. But I know you my love and all the foolish things that remind of you on this smokey scotch star filled night . . . sitting by our fire . . . and loving you in the quiet raging solitude of my heart. 

Don't fall in love with a Redhead  - for sure she will break your heart.  Then again I've never been loved before. 

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!

Drugs, Old Age and Poetry in the Rain

If you don't already know I am an ER nurse. Often, patients really touch my heart despite attempts to hide in a secret and protected place. This is one of those times where life and the people in it just crack you wide open.

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.

A gorgeous spider

A most beautiful and amazing spider on Culebra. I'll post a close up later. I have not identified this yet. 

'Home' to coffee at Finca Cialitos

Burrowing into our coffee favorite within the first ten minutes of our return to Old San Juan! Loved Culebra but eaten to death by Memes - in Spanish - sand midges I think. Local coffee, Ecuador hat. 

If you're reading this - just come visit. Don't think. 

When the World Cracks Wide Open

I'll take the world when it cracks wide open

And my mind right along with it

I'll exist there in uncertainty

Certain that it is the only place

Right then and there to be. 

Yeah, at times I wish I knew where

It's all leading other than death

For it's between birth and death

That it gets interesting. 

Two or three years on the island of my mind

Out go the shoots and tendrils of a life

Into the soil of dreams and sometimes harsh reality

Wet and dry, sterile and fecund with the ripeness 

Of endless permutative possibilities

Is it yet I've found a home for my restless heart and mind?

Tis the world I think that I embrace

Too full and rich at times …

Spilling over in tears and blood and love

Engulfing me in joy

Of the woman I've come to love

my family, friends and people I love

The commonality of our struggle 

In living and loving our lives. 

David McCullough

January 26, 2014

Old San Juan, Puerto Rico

Old San Juan, Puerto Rico

This is looking west towards old San Juan from El Morro fort located at the most eastern side. It was originally built by the Spanish and defended for a couple of hundred years until they were overrun and eventually the Americans came and we never called ourselves colonialist that we were and are.

First day - old San Juan, Puerto Rico

Exhausted but so happy to be warm. Found Finca Cialitos - wonderfully local coffee shop that owns their plantation and controls the whole production chain. Very very nice, professional and outrageously good. 

Skill and talent baby. 

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.