Suffering does not occur in a vacuum. It always occurs in relation. The patient who comes in with chest pain and high blood pressure because a beloved relative died of COVID complications in India and they cannot grieve or participate in last ritual rites with family. The patient who expresses grave concern for their son’s safety in returning to work during a pandemic, policing, and protests. The friend who practices medicine in a part of the United States where political division is threatening peace. The Earth still offering oxygen and sustenance despite continued abuse and neglect.

Healing also occurs in relation. It’s hard to heal if there is a sense of disconnection from ancestors, biological and spiritual family/teachers, the land, each other, and ourselves. How do we re-connect, re-awaken, re-member? While healing is a journey and there is no perfect answer, the following practices are offered as possible places to begin the contemplation.

Embodying Kuan Yin

Kuan Yin is the bodhisattva of compassion, the One who listens to the cries of the world. Embodying her feels like a tall order sometimes. How can I listen to others if I can’t hear what’s happening within? Life is overwhelming and overscheduled. How can I unplug from the endless to do and to be list?

I’m learning that Kuan Yin is not only the One who listens to the cries of the world, but also the One who stays till there is ease. There’s a sincere commitment to listening, to staying with the experience for the purpose of understanding. This does not mean that pain disappears, what’s broken is easily fixed, or questions have clear answers. The ease feels like a deep stillness beneath surface waves of experience, a stillness that patiently waits for the waves to dissipate for clarity. As I learn to stay with personally challenging experiences, there is more capacity to be with the suffering in others.

Connecting with the Natural World

1. Find something from the natural world inside or outside of your home. This might be a leaf, a rock, a seashell, a piece of fruit, a grain or rice, a feather, etc.
2. Practice internal mindfulness by noticing what’s present in breath and body with eyes closed for a few minutes. Then slowly open your eyes and practice external mindfulness in relational with this object. How are you different than the object, how are you the same?
3. Then with reverence and humility, listen to what the object has to tell you. What does it have to teach you?

 
Here is poem written on retreat in relation with a seashell:
 
Listening
 
she picked you up from the wet sand
because you looked pretty,
her keepsake from the RV camping
trip off the Mendocino Coast
 
forgetting
you were once the home
of a precious sea-being
just as her body is her home,
 
how she wouldn’t want
to be taken without consent,
how next time she can ask the water
or lift you up to her ear--
 
your mollusk spirit whispering
home is always sacred
no matter how small
or large you are
 
The Five Earth Touchings

Touching the Earth is a practice developed by Thich Nhat Hahn to fill your heart with remembrance of family, spiritual, and land lineage, so blessings of abundance can be offered to those you love, and the process of forgiving those who have hurt you may begin. It is practiced ‘to celebrate the positive and transform what needs to be transformed’.
​
This practice may precipitate unwelcome, unpleasant feelings, especially if you have experienced trauma or other feelings of disconnection. It is offered here as a healing modality to practice in a safe space with others, a trusted teacher or therapist. It is not meant to spiritually bypass what is true for you. Please honor your direct experience.
 
Questions for Inquiry

The following questions can be used for reflective journaling:

1. Think of your country(ies) of origin (ethnic roots). Now think of the country where you reside. Is there anything about the history of the country where you reside that needs to be narrated differently or questioned?
2. How can you be in reciprocal relation with life? What does it mean to set an intention of minimizing harm to other beings, the Earth, yourself?

 
****

Deeply nourished by recent retreats, water is humbly offered to trees in the backyard. It’s a small gesture of gratitude compared to their teachings on grounding, rooting regardless of external or internal climate, on letting go with trust that what’s needed will grow in season.

(Deep bows to Erin Treat, Brian Lesage, Amma Thanasanti and Kaira Jewel Lingo for sharing these teachings, and to their teachers and respective lineages. Suffering does not occur in a vacuum. It always occurs in relation. Healing also occurs in relation.)

​cobalt violet sunrise
over the bay
infusing the heart
with a quiet joy
priming it to meet
the day’s suffering
with peaceful presence
reflecting back hope
when sunrises
are forgotten

I see you Mara, conjuring dreams
of no control and not belonging,
replaying old classics in movie mind
as if they are the whole story.

What if I lay on my back, fully
surrendered to what’s playing
without needing to control content,
breathing into the body’s story?

May I trust the heart’s compassion
to support new stories or resilience-
loving presence a cocoon
nurturing metamorphosis within.
​

On the healing journey, the tendency is to resist pain and prefer a cure. I am no different. If there is an antibiotic that can treat an infection, a cast that can mold broken bones, a treatment that can offer relief, then I will vigorously support it.

And there are some things that don’t have immediate answers, remedies that can’t readily alleviate suffering. For sacroiliac and gluteal muscle discomfort, I’ve tried yoga, Qigong, Ayurveda , homeopathy, acupuncture, medication, chiropractic care, physical therapy, nature therapy, meditation, writing, dream interpretation, talk therapy, and mostly recently art therapy.

After typing out this list, whispers of judgment arise. Maybe if you weren’t complacently sitting around and doing more research for the perfect therapy, your ass wouldn’t hurt so much. Or maybe you aren’t spending enough time with one modality, expecting a miracle and instant gratification.

The whispers are met with smiles. Understanding the yearning for relief from suffering, the heart patiently responds. Dear One, you don’t need to try so hard. Surrender the resistance as best as you can. I will never leave you.

Surrender does not mean abandoning the healing modalities that are helping. It means not placing the burden of expectation on any one modality to produce a definitive answer, a cure.

​As a family physician, it’s a privilege to support a patient’s wellbeing. When there is a reliable treatment for dis-ease, we both appreciate the gifts of modern medicine. It’s harder to work with a diagnosis that is uncertain, it’s treatment even more elusive.

As I learn to cultivate loving presence and stay with this body, may it support healing presence with others.

It’s the transitional state that is often overlooked and dismissed.

What a joy to be on this retreat with Anne Cushman. Thank you for helping me process the perimenopausal transition!

****

A Woman’s Worth

Perimenopause mother tree,
rooted in old beliefs
of a woman’s worth.
Don’t let the foliage,
the fertility fade away
as green leaves still cling
to memories of summer.

Let one brave leaf bleed
from bright yellow
to burnt crimson,
inspiring others to fall
so barren branches
can practice the art
of letting go.

A woman’s worth
is not in the promise
of spring blossoms,
but a willingness to ground
in the truth of her season,
to nurture what is
still growing within.

****

Menses

Menses, I’ll miss you, the way you are a slow trickle in a creek or a rushing river of sloughed off endometrial lining. I’ll miss the pelvic cramping that starts as mild movement on the PMS Richter scale, then slowly crescendos into larger seismic waves.

Do I take an Advil, silencing the uterus, or do I breathe through wave after wave of sensations ripping through the lower belly, allowing the uterus to speak? It doesn’t have to be a boxing match between Western medicine and Eastern philosophy, does it?

I’ll miss the tampons, the Always pads ranging from regular, long, and extra-long/overnight so you don’t stain underwear, pajama pants, or bed sheets. Why was I so ashamed of you?

Though this womb well is almost dry, I will think of you every time I sustain a cut, or care for a bleeding patient. It doesn’t matter where the blood comes from; it’s a sign of life, a heme-rich stain of your wisdom tattooed everywhere I used to look away.

With the pandemic forcing more families to stay at home, the lines between school, work, and home are blurred with unclear boundaries. I’ve talked with patients, extended family, and friends who are struggling to maintain decent communication in closed quarters where most of life is happening these days. The internal aversion is also exacerbated by unhealthy air quality from raging California fires, limiting outdoor activity and escape.

For the first few months of travel limitations and social distancing, I felt that I was doing OK, even celebrating the sweet connections to my family. After an RV trip where we are all in even tighter quarters than at home, rubbing up against each other with every movement, something inside me snapped. Was it perimenopausal mood fluctuations, past patterns finally catching up with me, other causes and conditions? Do the reasons even matter?
 
Patience

Opening to what’s happening in the relational field requires so much patience. I love my family dearly, but I’m not always going to like them, especially when we disagree. The nature of life is change. There is nothing new about this concept. We are not fixed beings, but processes doing our best to acclimate to external forces. And everyone has their own way of adjusting.

Pausing and taking a few deep breaths before speaking or acting can make a difference between clarifying connection or disastrous disconnection. I recently listened to a podcast outlining a four-step approach to communication designed to increase clarity, minimize miscommunication, honor each person’s individuality, and build a shared sense of trust and respect for long-term success. Remembering intentions for healthy relationships, I was grateful to implement the practice a few times in conversation.

Patience is not about getting my way or forcing a certain outcome. It’s gently engaging eye contact, using words as windows instead of weapons, and awareness of body language internally and externally.
 
Presence

Close relationships can often lead to perceived nuclear fallouts when monkey mind is active. It’s so easy to get triggered by past hurt with an overlay of old scenes coloring what’s actually happening. It’s also tempting to stay focused on thoughts like train schedules flashing in the mind, constantly rechecking details for the future in case I miss the train.

How can I trust the present moment as it’s playing out, especially when I’m conditioned to fight, flee or freeze when it’s uncomfortable based on the thoughts and feelings arising? Present moment awareness is all about dropping below the story line, below the cranium to feel the story as sensations in the body, connecting with whatever I am sitting, standing, walking, or lying down on as gravity reminds me to let go of everything but this moment. Beginner’s mind is all about a certain innocence and curiosity for the moment rather than prematurely predicting an ill-fated outcome.

So how do I transform monkey mind to beginner’s mind when conditioning is strong? I keep coming back to the practice of mindfulness or sati, returning again and again to the breath (or other meditation anchor) to remember. I could be lost for seconds, hours, days, even years, and presence is like a breath of benevolence. It doesn’t judge or ask why I left, why I don’t feel safe, why I feel the way I do. It simply opens the door, no questions asked, with an enthusiastic and heartfelt Welcome home! I’ve missed you.
 
Possibilities

2020 is certainly a year of much distress and heartache for many. And I need to remember that this suffering is not new. Our ancestors have faced such trials and tribulations, and so will our children. There is no escape from sickness, aging, and death, or the dissatisfaction that arises in response to it. While grief is a guarantee to all who live, so is gratitude. If everything is in a state of flux, then I must bring a sense of blessing to that change through heart practices like the Brahmaviharas.

Yesterday, I had the opportunity to practice metta with Ayya Anandabodhi. I’ve learned metta as a traditional Burmese practice of silently and systematically repeating phrases of goodwill towards myself, a benefactor, dear friend, neutral person, and difficult person. Ayya Anandabodhi led a guided metta meditation that revealed the radiant, unconditional, boundless qualities of metta. I began by visualizing and lighting a diya inside the heart, breathing into it to fuel the flame of love. With each outbreath, I was invited to send that sacred flame of metta above me, below me, around and everywhere, allowing it to spread in all directions. If specific beings arose as natural recipients, that was fine. If not, that was fine, too. There were no ‘shoulds’, no comparing to past practices, no predictions for the future, just one woman’s heart feeling more expansive and free from conceptualization than ever before. I remembered my own goodness and the capacity to hold distress in loving arms.

When I don’t resonate with a family member, can I also remember their goodness? It helps to reflect on the times when I have felt connected, and all the things I appreciate about them. Relationships are not easy. They are complex and rather messy. They can also be exquisitely tender and redeeming, growing the heart to hold beauty and terror in the same loving space.
​
Writing this does not guarantee safe passage for future encounters. It does provide a template for embodied understanding and growth. I am still learning…

There is a space
where ordinary self
and higher self meet,
between thumb
and forefinger,
touching briefly
to decide
who will win.
 
What if both
are necessary
for the journey?
May the place
where they meet
be a guide
for compassion
and wisdom.
 
The balance is
what leads to peace.


It’s typical for anxiety to arise before I leave for a trip. Did I make a complete list of what to bring? What if I forget something? Will I fit in with the group that is not my usual spiritual family and sense of safety? How will body, mind, and heart behave on the trip without the support of meditation, yoga, and altar props? When I return, will I have space and time to unpack, do laundry, and attend a virtual retreat comfortably before going back to work?

I’ve spent so many years identifying with the ordinary self, engaging in spiritual practice to annihilate her, leaving no trace but a perfectly enlightened higher self. But ordinary self still worries, still feels things, still senses restlessness manifesting as tension in the body.

What if both ordinary and higher self are necessary for the journey? Ordinary self has taught me to deepen the heart’s wellspring of compassion, to connect with others in shared vulnerability, taking turns giving and receiving support. Higher self has taught me patience and the sacred pause before speaking and acting unskillfully, how to embody RAIN, and offer care to what’s needed. Both have taught me to be on the lookout for beauty and bathe in the joy of living, especially in the face of impermanence.

May the place where ordinary self and higher self meet in the Gyan mudra be a guide for compassion and wisdom.

The balance is what leads to peace.

There is a key that I’ve found through these practices, unlocking mysteries, answering questions I’ve had over lifetimes. I’m so afraid to lose this key, guarding it sometimes to the detriment of my relationships with loved ones. What if I forget? What if I’m not perfect in practices, in life? Will I spiral down into the womb of bloody postpartum darkness where thoughts threaten connection and unwanted emotions signal abandonment? Who will love me then? Will I be strong enough alone? Can I remember these practices without the key?

Menstrual cycles are irregular. Moods shift like unpredictable weather patterns. Gripping the key tightly- identities of a meditator, writer, physician, healer, mother, wife, daughter, family member and friend, I don’t want the life I’ve so carefully constructed over the last fourteen years to change. If it does, I only want it to change for the better (whatever that means).

In meditation this morning, I heard the following words. Awareness that this practice is not about perfection or self-improvement, but trusting the heart without expectation. What if I toss the key into the ocean, allow the waves to swallow this house of sand?

Loving awareness is everywhere. It’s time to let go of the key…

(Inspired by “Small Kindness” by Danusha Laméris)


It’s relatively quiet on the hike-
minimal sounds of birds chirping,
lizards scurrying across the path,
footsteps against dry leaves and dirt.
The few hikers I meet have
facial expressions masked.
I can’t tell if they are smiling,
frowning, or the lips are flat-lined.
Out of nowhere comes this silent scream.
When will this all end? 
When can I see your face again?
Like a mother holding the frustrations 
of an impatient child,
I try and open to what’s here-
uncertainty, the wish for things to be different.
All I can do is thank a hiker
for stepping aside so I can pass,
wave to another hiker,
Enjoy your hike.
When I can’t see your face,
words and hand gestures 
will have to be enough.
I still miss the smiles.

It’s noontime. I’ve just finished seeing my last patient of the morning. As I head back to my workstation and pick up my phone, there are some texts from the Dasher who delivered food I ordered from Door Dash. I notice the last few texts are pictures.

There’s a white bag of food with a receipt attached standing against the backdrop of a door with a sign on it, one of the many generic gray doors that lead into buildings 1, 2, and 3 on the Fremont campus. The last text reads, “Your order was dropped off. Please refer to this photo your Dasher provided to see where it was left.”

In a blind fury, I rush outside to try and find the food, completely ignoring the picture’s details, other texts and calls explaining how the Dasher tried to reach me, where and how long he was waiting. I also suddenly develop selective amnesia for the disclaimer Door Dash gives about food being left at the door to protect Dashers from COVID exposure.

Circling the buildings like a hungry hawk ready descend on its prey, I’m not only interested in finding my food, but also the Dasher to instruct him on how to do his job. I call him and arrogantly explain my position as a busy physician seeing patients, how he should have waited, how leaving the bag where he did is completely unacceptable. He agrees to drive back to where he left the bag, and calmly suggests I take a look at the picture and instructions he left while he is on his way.

Ironically, we simultaneously arrive at the same door where he left the food. Except there is no white bag. He doesn’t know what to say. I continue to sing the same song of entitlement and how this is all a big inconvenience for me, oblivious to what he must be thinking or feeling. As he leaves, all I can think of is the lunch hour quickly being compressed into 45 minutes, 40 minutes, how I will have to drive out for food, a missed opportunity to catch up on work.

On my way back up to the office, I run into my medical assistant who tells me that a nurse saw the bag and delivered it to me. Taking a seat at my desk, I take a few bites and reflect back on the time between picking up my phone, seeing the texts and sitting here now.

In my contracted state, I conveniently forgot to slow down, to breathe, to see the larger picture. Sure I was hungry and concerned that the food I purchased was not easily accessible, but I completely dismissed the Dasher’s experience (his attempts to communicate the details of where he left the food, his unfamiliarity with the Fremont campus, possible health concerns, other orders he might be trying to fulfill).

 
****
 

Power and privilege can be dangerous when we see only what we want to see, the 10% of the iceberg that seems obvious to us, when we only hear our version of the story. We don’t realize how accepting our narrative as the only truth can cause unnecessary harm. This is where slowing down, taking a few deep breaths, getting curious, and extending compassion beyond one’s own know-it-all mind, prized body, and small heart helps to include others in the circle of awareness.
 
Power and privilege can also detrimentally impact collaboration and delivery of healthcare. False assumptions and ensuing judgments of a patient, care team member, or any employee of Sutter Health  by race, ethnicity, citizenship, religion, gender identity, sexual orientation, age, weight, socio-economic status, education level, job status, etc. to the point where is impairs their safety and wellbeing, are the damaging results of implicit bias.

How you choose to explore the 90% of the iceberg that’s submerged, the dark cold places shaped by causes and conditions of cultural upbringing, societal influence, etc., is up to you. Where do you wish to inspire meaningful change in your sphere of influence? There are plenty of ways to melt the ignorance and a solid, separate sense of self. This writing is an invitation to find out how you wish to proceed in expanding the circle of awareness.


****


Looking out the office window at the trees, I take in oxygen and release the carbon dioxide confusion I’ve been carrying for the last half hour. Then, I breath in the air of this Dasher’s reality, and breath out a compassionate apology and gratitude for the food in front of me. I pick up my phone to text him.
​
Thank you. The food found its way to me. Forgive me if I looked, sounded angry. Maybe you are new to this facility and want to limit your exposure. Please stay safe. (prayer hands emoji)
 

Bubbles and Butterflies by Shirley Reede

I was grateful for some quiet time to unplug from work - sit, walk, read, write, and engage with the Bikkhunis from Aloka Vihara and poems from the Therigatha on a home retreat for a few days.

 
Tissa ~ Third
 
Why stay here
in your little 
dungeon?
 
If you really
want to be free,
make 
every
thought--
a thought of freedom.
 
Break your chains.
Tear down the walls.
 
Then walk the world--
a free woman.
 
 
In the silence, a life pattern I’ve known about for some time resurfaced for contemplation.
 
I rely on specific outcomes, conditions for happiness.
 
Since the pandemic changed our way of life in March, I’m reflecting on identity, what really matters to me, and how I want to contribute to the wellbeing of others based on my own dance with life.
 
I was filled with ideas of healing hope, gift wrapping them faster than others could open and enjoy them. “Would any physician like peer support, mindfulness training? How about compassionate support? Would any patient like a mindfulness consultation, a tailored mindfulness meditation created just for you? Step right up and sign up for a mindfulness for stress shared medical appointment, or an online six-week meditation and reflective journaling class.”
“Take me out of respiratory clinic! That isn’t where my talent is. As every place is being hit hard economically, medicine is no exception. I’d like to make a living (right livelihood) offering mindfulness as medicine in addition to Western medicine.”
 
Just typing all this out and reading it aloud makes me realize how much energy I’ve directed into willing a certain outcome.  I’ve also strategically tried to plan trips when other vacation plans were cancelled for safety reasons, and constantly check my phone to see if I’m receiving emails or texts that align with my ideal future. What have I missed along the way?
 
There is so much compassion for this heart-mind that dearly loves mindfulness, not just for stress reduction, but for the deep and profound ways the teachings have changed and healed my life. Of course I am passionate about this! I just need to remember that is not the medicine for everyone. Or, the package it comes in, the way that it’s offered may not work for everyone.
 
As much as I enjoy and am committed to Western medicine for its miracles and healing opportunities, it does not always integrate body, mind and spirit the way meditation and writing do. I understand why it feels like a part of my healing energy, my creative spirit stagnates when it doesn’t flow the way I envisioned it would.
 
Life is asking me to be on the lookout for joy and wonder like a toddler delighting in summer bubbles and butterflies. Life is also asking me to get curious, to be patient, to delight in the care received from others and be on the lookout for opportunities to extend care to others. 
 
Having a distinct vision for joy, wonder, and care is not wrong. It’s the attachment for things to be a certain way that causes suffering. It’s the limiting beliefs that cause distress. Anything short or different from The Vision is a failure, not good enough, all my fault.
 
 
Letting Go (inspired by Tissa ~ Third)
 
Why stay here
in your little 
world?
 
If you really
want to be happy,
make 
every
moment,
a moment of care.
 
Open your mind.
Let go of limiting thoughts.
 
Then meet each moment
with curiosity and wonder.
 
 
May we all let go of life patterns that cause suffering. May we let go into life’s mysterious unfolding.
May we be on the lookout for joy, wonder and care in each moment.
 
(Please share information about this class with anyone interested. As I am learning to let go, I can still advertise😉!)