​Climbing up the steep hill at Foothills Park,
I reflect on this faint sensation
pushing from the back, pulling forward
without regard for the body’s buy in,
the heart’s sensitivities, the mind
taking over the whole endeavor
as if speed and production are key.
How often do I push patients, pull
at the loose ends of family and friends
to get somewhere, get something done,
the checklist seemingly complete
so I can finally stop and breathe?

I’m so tired of this conditioning,
this need to move at the pace
of a ticking time bomb ready to explode.
What would it mean to find my own rhythm,
heed the call of heart time not measured
in seconds, minutes, hours, even days
but in compassion, curiosity, creativity-
slowing down to create/discover
what it means to move at own pace?

(This was first written a few months after my father died on Wednesday, August 30, 2022. It was submitted to a few publications and rejected each time. Perhaps I need to rest it here, invite it back into my own heart, and not seek anyone's approval but my own. May it offer some healing insights for others...)

It’s 1:45pm on an ordinary Wednesday in August.  A time when children returning home from summer day camps are cooling down with orange or berry flavored popsicles. A time when the sun is lazily strolling through a clear blue sky, too warm and weary to move any faster.

It’s a carefree time for most. But not for my brother.

Papa is sitting on the sofa slightly slumped over, his eighty-one-year-old spine yielding like an old, soft coat hanger to the weight of end-stage congestive heart failure, kidney disease and Parkinson’s. His signature salt and pepper beret hangs low over his forehead, covering his eyes.

After a few friends and relatives leave, my brother assumes he is just resting.

Until he moves closer to tap Papa on the shoulder, and Papa completely keels over like a marionette no longer guided by higher hands.

****
​
On Monday, two days before Papa dies, I receive a phone call from him.

“I miss you.”

His voice is magnetic, drawing me out of the embodied, grounded place I’m trying to reach. I hold the memories of this man’s significance in my life at bay; they are visitors I am not ready to confront. Right now, I’m at the gynecologist’s office waiting in an exam room to discuss treatment options for perimenopause. The appointment was rescheduled after I missed the last one visiting him in the hospital.

“I miss you too, Papa.” The response manages to push its way past the conglomerate rock of emotions stuck in my throat.

Seconds later, Dr. M rushes in like a whirlwind, eyes me on the phone, and backs out of the exam room. Clearly my phone call is more important than her services. I’m not sure I agree.

“Papa, I need to go. I’m at the gynecologist’s office. Call you later.”

Tenderness for my own wellbeing, my own healing process pulls me away from the call. Perimenopause is changing my inner landscape so much, that I feel like a foreigner inhabiting a strange body. But the force of guilt is equally strong. My nervous system is flooded with intense feelings, sacroiliac joints burning from prolonged sitting with Papa at the hospital for several hours and at my brother’s place now that he is home on Hospice.
​
Papa is still dying. After several hospitalizations for congestive heart failure, his heart is more susceptible to fatal arrythmias that can only be managed in an acute setting. As much as Papa wishes to prolong his life, quality of life outside of a hospital with loved ones is most important to him.

My thoughts are interrupted by a soft knock on the door. Dr. M reenters the exam room. I guess I’ve decided to stay. It seems like a logical decision, and my heart yearns for more guidance.

As I’m driving home from the appointment, I try to call Papa back. My sister-in-law answers. “He’s sleeping.”

“I’ll try to call him later.”

*****

I work on Tuesday and Wednesday to see a backlog of patients trying to catch up on two years of delayed medical care since the onset of COVID. They’re still afraid of the virus and all its variants, but cancer, complex pain, and confounding mental illnesses are strong competitors. My heart feels even more fragmented trying to meet everyone’s demands. Am I caring for anyone successfully?

The opportunity to call Papa later never comes. I am not there. I don’t get to say goodbye.

“Well, whose fault is that?”, my inner critic chastises. “You’re SO selfish, always putting your needs before others, even the man who raised you like his own daughter. You left your cousin brother alone to face his death. How could you?”

Another voice tiptoes into the conversation. This one feels like it’s coming from an older, wiser place. It might even be ancestral. “Dear One, it’s true you were not physically there in his last moments. You were consciously caring for so many depleted beings. Can you remember the times you were present to care for Papa in meaningful ways?”

I don’t see Papa again until my brother, sister-in-law, and I dress him in traditional white clothing at the funeral home for the final viewing before cremation. His skin is oddly smooth from the effects of funeral makeup, but it can’t hide the slight tension in his jaw, as if he is still objecting to this unsolicited outcome.

Memories that were once conveniently sequestered can no longer be held back. A shy eighteen-month-old girl arriving with her mother from India after her parents separated, trusting a strange man (her maternal uncle) at the airport to embrace her as one of his very own. Frequent trips to Yosemite and other national parks, weekend trips to Golden Gate Park and Ocean Breach in San Francisco where Papa instilled a deep reverence for the natural world and Gandhi’s principle of compassionate action in me. The time when he drove down from San Francisco to Los Angeles in my gap year between college and medical school, because I had contracted tonsillitis with a nasty secondary allergic reaction to the antibiotic, and I had begged him to come.

Flooded with guilt and grief, I question him silently. “Papa, am I worthy of this rite?”

His demeanor conveys neither judgment nor approval.

*****

The choices we make can restore or haunt us. Sometimes it’s not so black and white. I still see Papa’s face, hear his voice in the pleas of my dying patients.

“Help me!”.

Sometimes I recoil in fear and overwhelm, forgetting how to access the spirit of healing that extends beyond each exam room.

Sometimes I stay with compassionate courage and fierce tenderness, softening the boundaries between who is doctor and patient, who is parent and child.

Most days I’m learning to navigate the shifting landscape of change and loss without a clear road map, assuaging guilt with self-forgiveness, and caring for myself and others in significant ways.

Mindfulness teacher and author Jack Kornfield said, “If your compassion does not include yourself, it is incomplete.” As Papa once told me, even Gandhi needed a day of rest and silence.

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.
 

​Sandbridge, Virginia Beach, United States by Jae Bano

The lipid (cholesterol) and Hbaic (3 month blood sugar average) results are released online by my primary care physician. After a few months of changing the exercise routine due to a chronic piriformis injury, and celebrating Diwali, Thanksgiving, and Christmas with so much food, I know the numbers won’t be good.

Taking a few deep breathes, I click on the lab links. The numbers confirm my apprehension. Shoulders slump, the heart sinks in disappointment.

Judgmental thoughts abound. How could you possibly think hiking and walking would be enough? Can’t you control your food choices and intake? Isn’t it a bit hypocritical to offer advice to patients you can’t even follow yourself? The thoughts threaten to submerge the heart even more in the brewing anger, fear, and sadness conjured by them.

Mindfully aware of the thoughts, feelings, and effects they have on the body, I recognize an old pattern based on past causes and conditions. The lab values feel like health grades, a kind of report card defining my wellbeing. If the numbers are outside of a certain range, then I have failed.

Ouch! This hurts. It’s unpleasant. Does it have to be, or am I adding on extra arrows of suffering that don’t need to prick so sharply?

I don’t like the numbers, but like final semester grades, they don’t define what I’ve learned about physical, emotional, and spiritual wellbeing. I wonder what a wise teacher, loved one, or good friend might say to me in this moment to help me remember kindness.

Sweetheart, this is an invitation to the biggest wellbeing party of your life! How does your body want to move, to dance? What do you want to eat at this party that is not only sweet or savory when swallowed, but will last to support deep loving connections with self and others?

Radiant, the heart emerges with more care, communicating with a curious mind to expand a narrowly focused lens on experience. With a panoramic view, I think of my colleagues and other physicians who balance the wellbeing of patients with their own wellbeing every day, sometimes to their own detriment. Ahh, others experience this, too.

Though I work part-time, have so much support at home, and cannot attribute a change in health status to work alone, I know other physicians suffer from exquisite burnout. Burdened by the overwhelming weight of patient care, demanding electronic medical records that threaten the physician-patient relationship, and never-ending administrative duties that seem to proliferate at an alarming rate, mindlessness can feel like the only easy way out.

According to Diana Winston, Director of Mindful Education at the UCLA Mindful Awareness Research Center (MARC), mindfulness is “paying attention to your present moment experience with openness, curiosity, and a willingness to be with what is.” For years, I worked with definitions like this in meditation, movement practices, silent retreats, and meetings with a mentor. The “paying attention to present moment experience with openness and curiosity” piece was starting to make sense. The mind got it, but the heart still wasn’t convinced.

When I learned about Kristen Neff and Chris Germer’s research and teachings on self-compassion, and began to integrate them into mindful practices, the heart began to trust the combined capacity of heart-mind to communicate with the body, to be in tune with each other and sense when there was an imbalance of thoughts, feelings, and sensations leading to dis-ease. The capacity to stay with these experiences led to internal freedom and joy independent of external circumstances.

To this day, mindful self-compassion gives me the strength to stay with difficult patients and circumstances, to touch intimacy and vulnerability without overwhelm, to celebrate healing with patients in a larger context than ones limited by disease states and problem lists.
 
Clearing
by Martha Postlewaite

Do not try to save
the whole world
or do anything grandiose.
Instead, create
a clearing
in the dense forest
of your life
and wait there
patiently,
until the song
that is your life
falls into your own cupped hands
and you recognize and greet it.
Only then will you know
how to give yourself
to this world
so worth of rescue.
 
May we all create a clearing in the dense forest of our lives. May mindful self-compassion bring back the meaning in medicine.