The serene smile on his face softens the limp in his gait, the cane transformed from a resented crutch to welcome companion. Hiking with my own SI joints and gluteal muscles on fire, I’m curious how this fellow hiker (at least two to three decades older) can embody such joy and ease in the midst of an imperfect body.

As we approach one another, I pause to find out.
How do you make this look so easy?

His smile widens, his eyes beam against the backdrop of the sun’s radiance. Flanked on either side by guardian coast live oak and madrone trees, the scent of forest infusing the air between us, I sense that I am in the presence of a mysterious messenger.

I just keep walking till I can walk no more.

****
​
Do you have any meditation and writing classes going on? I’m really struggling with several things.

The tone of her email concerns me, as if she is barely hanging on by a thread, searching for a lifeline to strengthen her tenuous connection to what matters most.

As we begin the mindfulness consult, I can tell she is testing the waters. Will she drown in the revelation of her story, her tears, or will the exchange offer some insight to guide her back to safe harbors?

Nearing the end of our session, she is very clear about what would be helpful in a guided meditation.

In addition to recognizing, allowing, and investigating the uncomfortable thoughts, feelings, and sensations, I need to remember gratitude, joy, and trust my capacity to be with this.

****

I stopped the Ultram, doc. It just caused constipation, and didn’t do anything for my knee pain.

The patient proceeds to share what he is learning after a few sessions of physical therapy. And suddenly, there’s a clarity that could not have come any sooner till now, because the ignorance of separation was always clouding my perception.

Can I watch you walk from this chair to the door and back?

Like an infant curious to explore a new dimension of movement, he rises slowly from the chair without his cane. Placing the right foot forward, he leads with the trusted leg, and pauses. I sense the anticipatory anxiety, the concentration, the yearning to heal as he lifts the left leg and places the left heel on the ground, doing his best not to let the left knee buckle under him.
​
I feel like a proud parent watching her child take those precious, memorable first steps. As if the patient can read my mind, he grins and ambulates to the best of his ability.

Baby steps, doc. Baby steps.

****

The resistance and resentment I’ve carried for years against chronic pain is slowly starting to dissipate. From the hiker, I’m inspired to keep living, keep persevering till I can walk no more. From the mindfulness consult, I’m learning that this heart-mind-body can open to unpleasant circumstances with compassion, patience, and trust, balancing the scale weighed down by difficulties with appreciation and joy for what often gets overlooked. From the patient, I’m motivated to take bold baby steps in the midst of burning pain without needing to be a strenuous hiker or yoga practitioner who can perform all poses perfectly.

Be on the lookout for mysterious messengers in your life. They are what make this life worth living, and the learning never stops…

​In meditation, it's possible to let the limiting sense of self settle, and allow the larger space of self to emerge.
​

​Pain can be a pathway to suffering, or a poetic prescription for healing.

If you could only take a few people, a few things with you on a long trip, who or what would you take? I’m not talking about some exotic trip away from home, but the trip that you live every day from the moment your eyes open to the minute you fall asleep, and the cycle you repeat each day till you breathe your last breath.

What really matters to you? Who or what do you trust to carry you to the destination you seek? Do you travel with rigidity, considering the journey a failure if you don’t land where expected? Or do you course correct with wisdom and still love yourself when you miss the mark?

I’ve contemplated these questions for some time. Blown around by the eight worldly winds: pleasure/pain, gain/loss, success/failure, praise/blame, I’m tired of packing people and things along for the ride that shake things up unnecessarily without purpose.

 
El Capitan

sitting like a mountain
massive in this moment
no thoughts can blow me away

 
So I made a list of what supports faith in the journey, and what hinders it.
​

Supports to Faith:

- meditation (simple healing breath, heart-mind framing each moment in wisdom and care)
-pausing, waiting for what’s shaken up to settle so that speech, action can be more skillful
-Dhamma mentoring, classes, retreats, talks
-spiritual friends who mirror my True Nature
-family and patient challenges reminding me of Bodhisattva vow (on your way enlightenment, will you take us with you?)
-seeing how I’ve met challenging situations before, inspires trust that I can do it again
-Nature, unconditional loving Mother who nurtures calm, beauty, patience, wisdom, understanding, and trust
-writing strengthens the whispers of inner champion who takes inner critics’s concerns and transforms them into healing, wise words
-inspiration from music, movies, reading
-heart connections with family, friends, patients, clients, strangers
-embodied, grounded presence
-deleting Facebook account (cultivating contentment, simplicity over comparing mind, creating space in my calendar, my life)…ok, so I’m back on Facebook, and I need to remember aspiration over expectation
 
 
Hindrances to Faith:
 
-physical, emotional pain
-losing someone or something dear
-when something breaks, looks unappealing, increases aversion
-disagreement, disconnection with those I am close to
-prolonged exposure to bad news
-relying on astrology for good news, things to look forward to
-scattered, thinking presence
-alarm going off in the middle of a disturbing dream
-too many choices, not trusting the future
 
Practicing with these contemplations this month, I’ve discovered a few things. I can cultivate an unconditional love for this body-heart-mind, no matter how it is feeling. Despite a medical system that requires so many competing components for attention, I can connect with patient stories and not just make it to the end of the day disconnected and depleted. The allure of technology does not need to eclipse the possibility of contentment found in each moment.
 
And, I’m still a being doing her best to course correct with wisdom, still learning to love herself when she misses the mark. May the labyrinth of life allow for a natural spiraling in, then circumambulating out, never knowing if the center is reached and still carrying its intention with each step.
 

The cozy configuration of our family nest during the pandemic is about to change. The news of my in laws coming soon to stay with us for a significant length of time rattles the bones, leaves the nervous system unsettled.
 
It’s tempting to spiritually bypass what’s here, to suppress thoughts, feelings and sensations that aren’t congruent with my partner or rebel against cultural tradition. It’s also easy to blame others for misunderstanding my need for space and silence.
 
The Practice is asking for ease, curiosity, patient benevolence, a reliance on certain support systems, and remembrance of beauty, joy, hidden gifts.
 
Ease
 
Sitting in meditation each day is like relaxing back into my favorite chair or cushion, leaning the weight of my body and worries against a giant redwood tree that knows how to root and endure. The breath makes its loyal sweep from head thoughts to heart feelings to gut sensations, gathering them all in its tender embrace, unifying the pieces into one collective, sacred experience.
 
Curiosity
 
From this grounded place, questions about perception are asked without expectation of an exact or perfect answer. What’s happening now? Who am I taking myself to be? How am I relating to others? To space? To time?
 
Patient Benevolence 
 
Once I have attended to my own authentic inner experience in an honest, compassionate way, I can begin to let others in, to get curious and ask about their experience, to sense the multidimensional aspect of relationships and vast space of the Brahmaviharas. Love is not a limited resource trapped inside my own heart. It can flow both ways...towards myself and others. 
 
May I be happy, as well and safe as I can be, peaceful and at ease.
I care about my suffering.
May I know joy.
May I trust in the mysterious unfolding of my life.
 
May you be happy, as well and safe as you can be, peaceful and at ease.
May you care about your suffering.
May you know joy.
May you trust in the mysterious unfolding of your life.
 
 
May we be happy, as well and safe as we can be, peaceful and at ease.
May we care about our suffering.
May we know joy.
May we trust in the mysterious unfolding of our lives.
 
The term ‘patient’ benevolence helps to remind me that there is no fixed timeline for this process, no need to get anywhere, become anyone too quickly if it doesn’t feel like an embodied experience. Rushing the process can cause more harm.
 
Reliance on Certain Support Systems
 
It’s so easy for me to let anxiety and aversion eclipse the whole truth of any given moment. Sometimes I miss sweet family connections, opportunities for beauty and joy.
 
When this happens, the skillful, compassionate, and wise move is to lovingly separate from others so I can connect back with myself to remember. (Sati, the Pali word for mindfulness means ‘to remember’). Through meditation, mindful movement, time in nature, reflection and writing, listening to music and singing, I hear that one clear voice calling out for me to listen. I can also reach out to wise ones who offer safe shelter for the nervous system to settle, the bones to rattle less.
 
I need to take things one breath, one step at a time, slowing down so the contraction of time does not scatter my attention in multiple directions to dissipate and waste energy.
 
Remembrance of Beauty, Joy, Hidden Gifts
 
When there is resistance to unpleasant perception, animal instincts of survival kick in. Can I fight? Can I run away? Can I play dead, sleep, and wake up when it’s safe, when it’s all over? 
 
Is it ever truly all over???
 
 Zen Master Setcho Juken said, “Here in the dragon’s jaws: many exquisite jewels.”
 
For me, the jewels of practice have shined in so many ways—the width of loving-kindness, the depth of compassion, the length of joy unmeasured by circumstance, the groundless ground of equanimity that does not crack in any mind-heart-body quake, seeing all parts of myself reflected in other beings, other animals, the Earth, and vice versa, everything mentioned and not mentioned in these words, the unborn, the unheard, the unseen.
 
*****
 
I am ready to welcome my in-laws, welcome all that arises internally and externally with this shift. I am not the same person I was before. My partner, daughter, mother, and in laws are also not the same. I know it will not be perfect, that I may forget what I have learned, written, practiced and embodied over time.
 
When this happens, how blessed I feel to return to these words, this heart-mind, these intentions to embody The Practice as best as I can like Kali, Durga, Lakshmi, Kwan Yin, Tara, a Dakini, a redwood, willow, oak tree, all phases of the moon, a lotus (including muddy, tangled rhizome roots, long stem, and budding blossom), the uterine journey from menarche to menopause, the elemental forces of Nature...the Divine Feminine in all her many moods and manifestations!

2020 has been a year of many things. I won’t pretend to know what it has been like for you. I have heard from many that they wish to have a different 2021. But what does this mean exactly? Less suffering with no COVID, police brutality, political division, physical, emotional, social, and economic stress? More joy in gathering with others to commemorate the beginning and ending of life (and everything in between), travel, return to school and work, seeing the smiles of others?

I also wish for a different 2021. And I’m paying attention to where I plant seeds of loving intentions- where I’m forcing something to grow/change, where I’m slowly letting go, patiently waiting for something to take root.

On December 24, I received my first COVID vaccine with a mixture of dread and hope. Dread that I’d be one of the few cases who developed a serious adverse reaction.  Hope that this would be a positive step in the fight against COVID. I’m relieved that the only nuisance was a sore arm for a few days, and I’m still diligently tracking symptoms through Vsafe.

I realize that there is still so much uncertainty. Will I build immunity to COVID? How long will the antibodies last? Am I safe to be around patients? Are they safe with me? What does this vaccine mean for us all heading into 2021?

Recognizing the fear and doubt in these questions, I’m aware that these thoughts, emotions and the physical manifestations of uncertainty within are not alone. There is also awe at the timeline and sound scientific data supporting the vaccine’s efficacy, gratitude for meaningful work, incredible colleagues, loving family, health, abundant food, shelter, and so much more.

Most of all, there is a deep bow of reverence to the practices of mindfulness, lovingkindness, compassion, joy, and equanimity with meditation and writing carrying me through some of the darkest times of post-partum depression and anxiety, losing my aunt-mom to cancer, chronic sacro-iliac, gluteal muscle pain, and COVID-19. Though Western medicine and other modalities have been supportive, it is these practices that saved me from sacrificing this heart-mind-body to fear and doubt.

To this end, I’d like to support others in planting loving intentions for 2021. Will you join me here? However you choose to heal and support yourself in 2021, may you remember that love and wisdom are so much larger than fear and doubt. What you plant now affects everyone and everything around you for days, weeks, months, and years to come.

Nisargadatta Maharaj  said, “Wisdom tells me I am nothing. Love tells me I am everything. And between the two my life flows.”

May the idea of a separate self dissolve with the wisdom of shared journeys. May love connect you to all.

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.