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.

​It’s not going to happen to me. It happens to older people, people with end stage cancer, daredevils who take risks. The tears I’ve been shedding these past few weeks are for other people who have died from COVID-19 complications, others who are affected socially, emotionally, economically, and physically by this pandemic. Not me.

A few days before my birthday, I started to feel pain in the chest wall. A slight tickle in the throat foreshadowed an ominous cough. But without shortness of breath and a fever, I wondered if this was anxiety or the beginnings of a diagnosis the whole world is keen to keep at bay. Were all those tears for others, or were some to help water seeds of understanding for this life?

With years of mindfulness practice and contemplations of impermanence, one would think I’ve considered the possibility of dying. I’m embarrassed to say that this heart-mind lives in a protective bubble of delusion. Even when my aunt, who was like a mother to me died from a poorly differentiated unnamed cancer six years ago, I still didn’t believe it could happen to me.

Till now. This virus has an eerie way threatening everything. A regular day at work in the outpatient setting with business casual clothing is now replaced with scrubs, tennis shoes, and sometimes full HAZMAT ensemble. A casual trip to the grocery store requires gloves, a mask, hand sanitizer, six feet between patrons, and timing to avoid long lines. Walks in the neighborhood on a sunny spring day feel strangely quiet, as if the outside air will kill on contact.  Zoom has become the virtual safe space where it’s all happening.

As physicians, we dance with illness and wellbeing on a regular basis. We even have end of life discussions with particular patients where prolonging life may sacrifice quality of life and personal wishes. But how often do we contemplate our own mortality?

What’s happening locally and globally is tenderizing this heart- mind like never before. There is a visceral (as opposed to cognitive) understanding that I will not live forever. This body may one day become immune to Covid- 19, but it cannot escape death as it’s natural end.

If you knew that your time on earth is limited, who or what would really matter? Would it be the white hairs showing through darker ones on video visits or zoom calls, or a heightened sense of touch from loved ones sheltering at home with you? Would you still answer “fine” to all the questions from colleagues, family and friends on how you are doing, or would you pause and follow the question to see where it leads?

I believe we have a responsibility to contemplate our own mortality, or at least begin to ask the hard questions. Our patients are facing the fear of sickness and death daily, hourly, every second, in every question asked and every look of a brewing storm just below the surface of feigned tranquility.

How do we find a middle way between anxious overwhelm and blatant denial? Perhaps it starts with opening to what is here, one slow breath, one small step at a time, not trying to predict an unknown future or take shelter in a past that no longer exists. When distracted by thoughts of wishing it were different or that you were elsewhere, the gentle invitation is to return to the present moment with as much kindness, and as little judgment as possible, to notice what’s happening inside your body and heart.  If the present moment is too triggering or overwhelming, it’s skillful to open in baby steps with lots of support.

The energy and effort required for this practice are not the same as striving for good grades, extracurricular activities, and letters of recommendation required for college, medical school, and residencies. You don’t get more points for overperforming. It takes a certain humility and courage to let go of labels, ideas, concepts to touch the bare truth.

Mark Nepo writes, “We waste so much energy trying to cover up who we are when beneath every attitude is the want to be loved, and beneath every anger is a wound to be healed and beneath every sadness is the fear that there will not be enough time.

When we hesitate in being direct, we unknowingly slip something on, some added layer of protection that keeps us from feeling the world, and often that thin covering is the beginning of a loneliness which, if not put down, diminishes our chances of joy.

It’s like wearing gloves every time we touch something, and then, forgetting we chose to put them on, we complain that nothing feels quite real. Our challenge each day is not to get dressed to face the world but to unglove ourselves so that the doorknob feels cold and the car handle feels wet and the kiss goodbye feels like the lips of another being, soft and unrepeatable.”
​
As we slowly unglove our hearts from all the protective armoring, may we skillfully connect with ourselves and each other, honoring the grief and gratitude arising along the way.

​Dear Healthcare Workers,

Change is inevitable. With the current pandemic, change at work (and elsewhere) is likely faster than you ever expected. How can you meet these moment to moment changes, acknowledging the thoughts and true feelings underneath them? How can you remember the body that is holding so much right now? Who or what can you count on in challenging times? What does connection, collaboration, and self-care mean to care for others?

If these questions resonate, then perhaps you will find this guided mindfulness meditation for healthcare workers useful.

Thank you for caring!
​

As a front-line family physician, I’m used to offering compassionate care to patients, and listening to the care team at work. I’m used to holding space for meditation and reflective journaling classes, supporting family and friends in ways that feel wholesome.

And sometimes it’s overwhelming. With the recent pandemic, the constant barrage of news, work email updates, protocols constantly changing, and questions, there has been little time to contemplate what’s happening within.

This body is also in greater pain than normal. After several months of physical wellbeing with PT and engaging in movement practices I love (yoga, hiking, walking, Qigong), the body has decided to speak (scream at times). I’m sure it’s contributing to the overwhelm with fear eclipsing the things I usually see and remember.

Over the years, I’ve cultivated a strong lovingkindness and compassion practice to face challenges. But somewhere along the way, I’ve forgotten to pause for fifteen seconds six times a day to really let joy’s sunlight reach all the dark places within me. To help me remember, I joined an Awakening Joy course.

For a few days I was diligent with the practice, opening like a sunflower to moments of gratitude throughout the day. The pain in the sacroiliac joints and gluteal muscles was improving. Yeah, I thought. I’m on the right path!
Then the body screamed. I’m doing the PT daily. I’m trying to take it easy physically. Where am I going wrong??? In a state of despair and overflowing tears, I reached out to people who could help me remember what I was forgetting. The incoming texts/emails of care and support definitely helped me to remember a few things.

1.) I must put my own oxygen mask on first before I can take on the suffering of others. This means meeting my own suffering with compassionate care and asking, What’s needed now? I’m not always in a quite space to listen, so it’s important to take this time when possible, pencil in an appointment for myself, like I did this morning. 

2.) S.O.S.  I heard this acronym through a prerecorded webinar my work offered titled “Managing the Unknown”. When you notice that you are on information overload, and the brain, body and heart cannot take any more, STOP what you are doing. Stop clicking on more news links online, more email. Stop engaging in conversation that is echoing doomsday. Stop immersing yourself in more secondary trauma. OBSERVE the thoughts and feelings within with kindness. If that’s hard, imagine a kind, supportive being/presence with you. Stay here as long as you need to really listen internally. SWITCH to something that is positive and nourishing – a cup of tea, a conversation with a friend, music, a walk, journaling, humor, etc. (I’ve also heard this as  S.T.O.P.: Stop. Take a breath.  Observe thoughts and feelings. Proceed with something nourishing. 

3.) Stay informed so that you have the latest information from the CDC, WHO, your local state, county, and health care professionals AND ask yourself what else you need to hear so that the scales are balanced. It’s easy to listen to statistics, worsening conditions, and conversations around you that accentuate the negative. What do you need to hear that’s positive? Where can you find this? It might be an inspiring quote, book, movie, song, story, prayer, etc. If you are having a hard time looking, ask others! Try this one on:

"My friends, do not lose heart. We were made for these times. Ours is not the task of fixing the entire world all at once, but of stretching out to mend the part of the world that is within our reach. Any small, calm thing that one soul can do to help another soul, to assist some portion of this poor suffering world will help immensely. It is not given to us to know which acts or by whom, will cause the critical mass to tip toward an enduring good. One of the most calming and powerful actions you can do to intervene in a stormy world is to stand up and show your soul.”  
-Clarissa Pinkola Estes, Jungian psychoanalyst, author of Women Who Run with the Wolves. 

4.) Which brings me to my next point. Be a calm presence where you can be. Today I had the opportunity to speak with a relative overseas, a local business owner, and a stranger while shopping for groceries. The questions that used to sound like massive missiles attacking were surprisingly welcome. The conversations included some of what I am sharing here. If staying calm is not possible (it’s not expected, even for me), then can you be generous in other ways? Can you call someone who is currently quarantined, or check on them in other ways that do not place yourself at risk? Do you have an extra toilet roll, hand sanitizer, can of food that you’re saving for The Apocalypse? Do you know of neighbor you can share this with, someone who is restricted financially, physically, or by some other means?  Generosity cultivates abundance of heart and mind, widens survival of the fittest perspective into one of interdependence. Just be sure to wash your hands thoroughly with soap and water for at least 20 seconds, and don’t share if you’re sick.

5.) Impermanent/Imperfect/Impersonal. Physical pain and global pandemics can feel permanent, imperfect, and personal. It sure feels perpetual, messy, and personal to me right now. But if I take a closer look, there are moments when the body isn’t raging, even parts that feel neutral or pleasant. There are times when corona virus is not the main news infecting body, mind, heart, and spirit. It was not the main news when I dropped my daughter off or picked her up from school, on a mini retreat this morning in sitting and walking meditation, while brushing my teeth or taking a shower. 

It can also help to remember that others are affected by what’s happening, just as you are. Knowing that so many lives have been affected, what can you keep doing regularly to maintain some sense of normalcy? (If you or someone you know has been significantly harmed physically, emotionally, financially, etc. please grieve the way that you need to. ‘Normalcy’ may be the last thing you need to hear/read.) Maybe it’s the way you comb your hair, brush your teeth, sip morning coffee or tea, go for a walk/run, meditate, eat, work, hug/kiss healthy family members, sing, dance, or any number of things you normally do (and are still doing:) Though change is inevitable, it’s healthy to maintain contact with who/what is familiar. It can nurture a sense of safety in times like this.
 
 
 
surrender
to a beating heart
an unsettled belly
a hand on each one
just sensing
just breathing
prana providing companionship
through every future unknown
 
 
This post is not written to negate the true feelings that are here: fear, anger, loneliness, despair, etc. It isn’t a spiritual bypass to a happier place untouched by illness or suffering. (If you know of such a place, let me know!). I needed to sit with all the paralyzing thoughts, feelings, and physical manifestations of them. I will likely be sitting with them for some time. Surrendering to a beating heart and unsettled belly, I placed a hand on each one, just sensing, just breathing, prana providing the companionship that was so desperately needed. I know that this simple act is not enough to heal the world, but it is certainly “mending the part of the world that is within my reach” through every future unknown.
 
May these reflections be of benefit to all beings everywhere without exception.