​Praying to the porcelain god (not knowing if the Andean gods hear me), I am emptied out from both ends. Have the indigenous ways failed, or am I just not ready to receive their healing potential?

My patient, loyal, husband stands by, watching and waiting for what’s needed next. He doesn’t remind be of the Diamox I could have taken the day before arriving to Cusco, Peru to minimize the effects of altitude sickness like he did. He doesn’t judge the muña tea I drank in cupfuls, believing it would be enough.

Instead, he waits and honors my autonomy. Can you stay up for another hour after the nausea, vomiting, and diarrhea have subsided? Then the Diamox has a chance to stay in your system.

****

We exit the Vista Dome train headed for Auguas Calientes at kilometer 104, the beginning of our two-day Inca trail trek. Filled with trepidation and excitement, so many aversive and awe-inspiring thoughts pass through. I wonder which ones will prevail.
​

​

​Within the first few miles of the trek, it’s clear that this is more than a ‘moderate’ hike as advertised. There are many large, steep stone steps to scale, and it is much warmer than expected.

Feeling wobbly in the legs and as if the heart and lungs will explode beyond my rib cage from the altitude and exertion (despite the Diamox I am now taking, and muña mist I am inhaling while doing earth salutations to Pachamama), there is a desperate attempt to grasp at anything that will inspire perseverance.

At first I chant the Metta Sutta, tuning into the heart’s emotional resonances to soothe aversive thoughts and mistrust in the body. I also imagine others beings near and far championing my efforts at various points along the way.

It works for some time. Until judging, comparing mind returns with a vengeance. Everyone is passing you up, Kaveri. You are the caboose in your group. Even older hikers are more fit than you are!

There needs to be more space beyond the thoughts arising in my head and uncomfortable body sensations. 

Becoming more porous to sounds of flowing water, footfalls and voices from other hikers, appreciating the bright colored gossamer wings of various mariposa species against the lush green backdrop of the Andes mountains, wild orchids gracing the path, and precision of ancient Incan ruins in tune with the seasons, there is less of a self to protect. It still requires some soothing.

I try not to look beyond the steps a few feet in front of me. Just this step. Just this breath. It’s easier trust this moment and the next one if I don’t need to manage the whole journey beyond what I can see and handle.

I hear Pachamama’s voice:

Life can be perceived as a punishment when things go wrong, or a blessing of small and large miracles in each moment. Like weather patterns and moods, perceptions often fluctuate between the two.

And that’s ok.

****

A few days after the body and mind have had a chance to rest and recuperate, I am reminded of some images that visited me before leaving for Peru.

In the first image, a figure of love in the form of the fictional panda character, Stillwater sits tall like a mountain. He asks me to sit next to him and look down into the water he is overlooking. What do you see?

At first all I see are dark, murky swirls with some flashes of a being filled with aversive, doubting thoughts.

When Stillwater asks me to look again, I catch glimpses of a beautiful iridescent heart that appears to extend beyond the water, beyond space and time.

In the second image, there is a magical tree that bears fruit in various shapes and colors. Each being grows from a fruit, nourished by a unique umbilical branch from the same mother tree. No two being are exactly the same, and they can shift into another shape or color.

I humbly bow to this tree for its beauty, meaningfulness, and implications for each being to extend into unfathomable beyonds, beyond the shapes and colors that are limited to a still-life painting.

We are dynamic beings, more than our skin, shape and color. We have a rich inheritance, no matter how we perceive our family tree.

May all beings see and sense in soulful ways that inspire healing and adventure.

(This poem was first written after receiving a steroid injection for frozen shoulder in April 2023. It's humbling to a be patient on the receiving end of a doctor's advice...)

Four minutes discussing the risks
and benefits of the procedure,
the doctor’s confidence and my worry
sparring in the silence that follows.
 
Four inches of thin stainless-steel injecting
steroids into my shoulder joint,
thoughts of relief and regaining range
of motion subdued by lancinating pain.
 
A fast baseball pitch and loud pop.
A gunshot wound to the right shoulder.
A bomb detonated close to the upper arm.
Four lives embodied in my own.
 
Four drops slide down my cheeks,
the waterfall of reserves drying out.
What will replenish trust as
therapeutic possibilities dwindle?
 
Four steps into another exam room,
I greet a patient in pain.
Before assessing and assuming,
asking about the story…

(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.

​emptying the space 
of preconception 
new ways of looking
​are possible 


When things change, I get scared. Expending more energy on what class I can attend, what book I should read, or who I should talk to, I forget the invitation to just rest in uncertainty.

There is also tremendous compassion for how hard it is to feel windy thoughts jarring the mind, waves of painful emotions crashing against the shores of a tender heart.

A few days ago I was driving home from work. Heavy winds howled like banshees shaking the small electric car to the core of vulnerability. I thought I was going to die.

Arriving home in one physical piece, but many psycho-spiritual pieces, I tried releasing the visceral threat through words and tears in the arms of my loving, attentive partner.

I still felt broken.

I had no control over so many things: the body changing in perimenopause, friends and colleagues having meaningful plans that did not include me, miscommunication with my mom and teenager, patients and families who were not heeding my recommendations.

Yet, the following images arising in different meditations have offered some  comfort and clues along the way.


1.) An image of mysterious eyes crying colorful streaks of tears that veil the face. Allowing rivulets of difficult emotions to flow through the heart space can be beautiful and meaningful.

2.) An image of a woman placing hands on belly and heart, as if the body were a stringed instrument. Her hands feel the vibrations of sacred music from within, her fingers strumming along to create/discover more.

3.) An image of wind and waves threatening to break a protective structure shaped like a rib cage encasing a multifaceted jeweled heart. Sensations of fear and doubt arising as the jeweled heart smashes against its protective walls. As I grant autonomy to the heart, reverence and trust arise in the process, as well as wisdom and courage to love and be loved.

4.) An image of a mind cluttered with preconceived ideas of past experience. I wonder what it might be like to perceive experience with humility, soft and elastic edges, with the enthusiasm and wonder of a child trusting in benevolence. New ways of looking are possible.


****
​

When things change, I get scared. Sometimes I even want to hold onto this writing, these images…as if they are a talisman to protect me from uncertainty. 

Then I remember the true nature of trust. As self, other, and world change, so will words and images. The deepest letting go is letting go of it all, trusting the next words, the next image, the next stepping stone to appear when it feels impossible to cross the floods. 

​On a walk at Calaveras Big Trees National Park, the park ranger paused to pay homage to two giant sequoias that shared the same trunk. The trunks were originally separate, and fused together after a fire for mutual benefit and survival.

I thought of my mother and daughter, how the umbilical connection was severed between us at birth, how the sacral, sacred burning in my body was a sign.

I reflected on all the beings I have pushed away on this camping trip and beyond, the yearning to share the same base, something tender beyond ideas of a separate self.

In meditation, the image of the conjoined sequoias arose, inspiring metta for my teachers, for me, for my mother and daughter, for all the beings at camp, and beyond. It wasn’t my body-heart-mind responsible for such vivid and vast imagination, but tapping into a larger, loving life force inherent in all things.

Listening to the bell resound at the end of the sit, I was clinging- to the bell, the sequoias, the feeling, fearful that I would walk back into a black and white world where beings scurried frantically around like mice to make meaning.

I will continue to disagree with others and feel the pain of separation. I will also persevere in tenderness, beauty, and Soulmaking.

It’s what I was born to ‘do’, and who i already am.

be gentle, be loving
patient and proud
of the wind and tears
that carved a goddess
from suffering

Kwan Yin’s kindred spirit
is learning to listen
to the cries of the world
and stay till there is ease
as she listens to her own body

the dance of sensations
ok as she is
a caged heart
trusting her wingspan
to fly beyond the bounds
of fear and unmet expectations

she is still exploring
she is still unfinished

Burning gluteal muscles, stabbing shoulders
hives when exposed to heat or stress.
Is it Long COVID or just a coincidence?
I never tested positive, had antibodies before the vaccine.
So easy to give into despair like bleak
landscape after a nuclear explosion,
waiting for something to grow,
to give meaning to this pain.
When the evening news, the internet, work emails
and patient messages all beg for better days,
I turn to gratitude practice for solace.

I’m grateful for physical and osteopathic therapy,
for medications that help ease the pain
when another pandemic surge feels overwhelming.
I’m grateful for family holding me
with humor and household help,
for colleagues and medical staff
as smiling crescent moons
in the darkness of a sobering reality.
I’m grateful for teachers, friends, a practice
inspiring the framing of all phenomena
in beauty, wholeness and healing love.

Covid-19: you think you’re so smart,
the best magic show around with variants
evading immune systems and vaccines.
You can invade, inflame, and injure,
but you cannot insist I believe you.
Let me be a source of healing
first internally then externally--
clear water mirroring a sunrise hope
in others clouded by doubt,
beginning again and again
till their last breath or my own.

dangling from the tip
of a question mark
the sea of fear below me
is only a point

With anxiety, I’ve found a certain pattern of questioning in patients and myself. Why is this happening? How long will it last or when will it end? How can I get rid of it permanently?

These questions come from a tender place. I want to feel safe, to know that others and I will be ok, that it won’t end in disaster. I want some assurance that the perceived earthquakes and large tidal waves will have moments of calm and ease between them, that I won’t always feel crappy physically and/or emotionally.

The stress reaction is useful when my life is in danger (imminent car accident, being held at gunpoint, etc.). Stress hormones like epinephrine and cortisol are released to increase heart rate, blood pressure, sense acuity, nutrient mobility and availability. I need to fight, flee, or freeze because my life depends on it. Chronic low level stress can damage blood vessels, increasing blood pressure, raising the risk of heart attacks and strokes, buildup of fat tissue, weight gain, and contribute to brain changes that may cause anxiety, depression, and addiction.

The root cause of anxiety (and it’s close cousin depression) is believing a thought. Instead of asking, why is this happening, how long will it last, or can I get rid of it permanently, I ask different questions with mindfulness practice. What’s happening now, and how I’m relating to it? I allow thought clouds to pass through the spacious sky of mind, connect with emotions beneath the thoughts, feel earthquakes and tidal waves as physical sensations within the body, remembering compassionate presence and common humanity.

I’ve experiences strange back spasms since June/July of 2020. They attack in the early morning hours, and by the time I wake up, it feels like I’ve done hours of back breaking work. The initial pattern of questioning led to a trial of many different healing modalities. A few were effective, while others looked like a mirage in a dry desert of yearning. None of the solutions were permanent.

Mindfulness is like a best friend when everyone else has left, when life fails to keep its promise of perfection. It’s a happiness independent of external circumstance, very much dependent on internal grounding, spaciousness, warmth and flow.

The practice of mindfulness is not a quick fix. Like other things you may have learned (playing an instrument, learning a new recipe, language, or subject, training the body physically for a sport or marathon) this process takes time. It is not meant to replace medications or counseling therapy, and can complement them well. The remedy must be tailored to each individual’s needs and preferences.

dangling from the tip
of a question mark
the sea of fear below me
is only a point

a wave returning
to the heart’s ocean
mindful compassion
replacing all the old questions

It’s helpful to heal a problem when the answer is simple. When it isn’t, may mindful compassion be part of the cure.

​

“The path unfolds in two dimensions: horizontal and vertical. The horizontal path spreads forward and back across chronos, tic-toc, sequential time: minutes that flow like sand through our fingers. Here and then gone. The vertical path extends as kairos, deep time. The fullness of ripening moments swell and then narrow, like heartbeats, thumping out their fleshy rhythm. Horizontal time propels us. Deep time nourishes and sustains us.”

After reading these words by Pamela Weiss, something shifts inside me. It feels like the missing link, the connection I’ve been looking for to understand the relationship between fear and faith. Fear is a contracted state, a constant push-pull dynamic between what’s here, what’s missing from the past, and what’s needed for the future. Fear is judgmental, blaming anyone who cannot guarantee its safety. And, it is just one breath, one heartbeat away from faith waiting to surround it, to hold it in a steady, tender embrace.

One week ago, I had the joyful privilege of joining Jackie Long and circles of women for yoga on the beach in Half Moon Bay to raise funds in memory of loved ones who passed from cancer. Moving through sun salutations in praise of our star humbly hiding behind clouds, surrendering to sandy earth in child’s pose as vibrations of pounding surf were felt beneath us, it was an exhilarating experience.

Though I was aware of the sacroiliac joints and gluteal muscles previously re-injured by certain yoga poses, I believed it could be different this time. Sacred cause, sacred place, sacred instructor, sacred people, sacred body…there was no need to be scared. It would be different this time.

As the week and my body unfolded from the yoga experience, I began to feel twinges of discomfort. Prior experience, body wisdom, patience, compassion, and determination helped me tend to the pain lovingly with modalities that would promote healing.

Fear has not vanished. There are still whispers of judgment from time to time— the horizontal path conjuring flashbacks of past painful outcomes, predicting future catastrophes, each choice I make flowing like sand through my fingers. Where can I find true refuge? Where can I feel safe?

Today, the sensations are the loudest they have been throughout this week. What does it mean to lovingly embrace fear, to surround it with faith? Faith is expansive. It does not judge, but speaks with wisdom, sensitivity, patience, curiosity. I don’t know what will happen, and I’m with you every step of the way. Loving attention heals no matter what. Like a mighty grandmother oak, faith roots in vertical time, each moment while simultaneously reaching up and out for connection.

rooted in this moment
branches reaching out
cultivating a deeper faith
to surround fear and doubt

​As I learn to take refuge in this abiding faith, may it serve as refuge for others. May I trust what I cannot see, yet feel growing deep within, reaching up and out for connection.