(Listen to audio version here)

(If you would like to listen to the audio version of this talk, click on the link above.)
​
​The picture changes. Have you noticed this? People, places, things I’ve loved and wanted to hold on to are no longer the same. Family pictures that we took when my daughter was a baby are different now. She’s no longer a cute little cherub, but a tall, lanky teenager complete with acne and attitude.

The picture of who I wanted to be as a mother was so radically different than who I actually was. Instead of having my shit together and nursing my daughter lovingly, I looked like I hadn’t slept for days, felt irritable all the time, blamed anyone and anything in my way (especially myself), and couldn’t breastfeed beyond about 6 weeks.

For those of you who have ever been first time parents, you know it’s challenging. Even if you haven’t been a parent, anything you take on that is new and unfamiliar can be difficult: adopting a pet, starting a new job or school, caring for an aging family member, losing a job, moving to a new place, a new medical or psychological diagnosis in you or a loved one, and so on.

But stress, discomfort, dis-ease, is not just about meeting moments of difficulty in life. We all face challenges. What makes certain ones more stressful than others? 

2600 years ago, the Buddha had a word for stress. In Pali, the language spoken by the Buddha in India at the time, the word is dukkha. Just living this human life, we know that pain is inevitable.  But the added stress is optional. There’s a saying that illustrates this point well: pain x resistance = stress. If pain is inevitable, then what adds to the stress?

It’s our resistance to what’s happening moment to moment. The desire to hold on to the way my body used to be in less discomfort and able to do certain yoga poses, the aversion to burning, searing, aching, throbbing sensations in my left gluteal muscles, sacroiliac joint and right shoulder, the delusion that none of this should be happening, that I should be able to fix it, that this experience of pain is unique to Moi and no one else has ever felt this way.

What are you currently holding on to in your life? What are you pushing away? How are you daydreaming or misunderstanding a current situation? It may help to place a hand on your heart or a part of the body that is hurting, breathing into any discomfort with as much tenderness and compassion as you can muster. If that feels awkward, then imagine a comforting presence here with you now, breathing with you, understanding you, loving you just as you are. 

With our body’s, our circumstances, the people and things in our lives ‘forever’ rotating through like a slideshow, what can we come to rely on that is real, that will provide some measure of robust comfort when the picture is always changing? How can mindful awareness frame the experience in curiosity, kindness, and remain intimately connected regardless of whether we like, dislike, or believe what we are seeing?

There’s a song that I love from high school called ‘Pictures of You’ by an 80’s band called The Cure. The lyrics start out:

I've been looking so long at these pictures of you
That I almost believe that they're real
I've been living so long with my pictures of you
That I almost believe that the pictures
Are all I can feel
 
I realize now that expectations I had of myself as a new mother, as a person with this current body, even of my daughter as they are now, are all rooted in past or future stories of what could have been, what should have been.

This moment, right here, right now can be so exquisite, unburdened by past blame or future worry. For me, The Cure for stress is to identify more with the picture frame, and not the changing picture. Easier said than done, right? It’s hard to believe this when there are constant messages and advertising of the perfect picture, the perfect body, the perfect life on Facebook, Instagram, the media and beyond.

Mindfulness practice trains us to notice when we are lost in a story that isn’t true, when emotions feel like weather systems that will last forever and are actually changing all the time, when sensations define who we are and don’t need to be taken so personally. 

Learning to identify more with the picture frame, the frame of mindful loving awareness rather than the picture of changing circumstances takes time. If you are fairly new to mindfulness practice, you may uncover thought patterns and old habits you haven’t seen before. Things can feel worse before they feel better.

Know that you aren’t crazy or doing anything wrong. This is completely normal. In firefighting, the term backdraft is used to describe the sudden introduction of air into a fire that has depleted most of the available oxygen in a room or building. Similarly, when you bring attention to patterns of desire, aversion, and delusion, they can initially feel more intense.

This is when it’s helpful to practice with the support of others- a trusted teacher or therapists, wise, loving spiritual community. I’ve also found it useful to bring a spirit of creativity, adventure, and play to these practices. Like learning to cook a dish, play an instrument, grasp a new language, ride a bike, or train yourself in any unfamiliar skill, it can feel so cumbersome if approached with rigidity or expectations of immediate results. Yuck! Who wants to do that?

And, it takes a certain amount of gentle discipline, curiosity, kindness, patience, trust, determination, care, compassion, joy, beauty, resilience, and forgivingness to keep practicing, at least in my recipe book. Your healing journey may need similar or different ingredients. You won’t know till you try, keep showing up, adding a little more of this, taking out a little bit of that.

After 15 years of practice, I still identify with the picture, and sometimes forget about the picture frame. What’s changing is the capacity of this heart-mind to notice sooner, rather than later what’s needed to frame every experience in some aspect of love. It doesn’t matter how long it takes me. What matters most is my willingness to try. I’d like to share a poem that I think speaks to this "Cure for It All" by Julia Fehrenbacher.
 
This life isn’t what I expected. This practice isn’t what I expected. And it’s inspired such a radical honesty in me to try and see things as they are. Nothing more. Nothing less.  Anything else just doesn’t make sense.

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.

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…

Restlessness, Metta, and True Nature

There’s a restlessness inside me--
checking the phone, the weather
checking for missed emails, calls, texts.
Am I ok as I am?
Are others ok because of me?
When did the external funhouse
mirrors get so distorted?
When did abandonment
become the only story?

May I be patient with anxiety and restlessness,
and trust something precious beyond this.

A few Winecup clarkias stand out
amidst Pacific poison oak.
Beautiful growth is possible anywhere.
The trill of a red-winged blackbird
invites joyful sound meditation.
Magnetic Mama Earth guides footsteps
to avoid stepping on western
whiptails activated by amygdalas.
So I’m not the only one!
A summer breeze blows
the breath inside out.

Am I ok?
​
There is no one left to answer…


No Timeline for Love

I don’t need to fill my heart completely 
before I can show you love.
I just need to see the thorn,
feel the sharp point against softness,
wrap the wound in tenderness
as scar tissue learns to love
in its own healing time.


Soon

These days of cutting okra and long
beans together will soon be over--
hearing knives slice through dark
green flesh at different rhythms,
watching the way your air pods
hang from your ears
as a slight smile crosses your lips,
wondering what you’re listening to
and if you’ll still like that song in college,
or who you will choose to love.

Or the way I turn to you
with partially cut vegetables
that you will chop into smaller pieces
the way your mother did back in India,
breaking down larger pieces of life,
seasoning with spices and cooking slowly
into food the family can easily digest
until arthritic hands can no longer chop
or vision fades into final darkness.
​
Soon all I will have are these words,
and memories of three generations
cutting okra and long beans
side by side by side.
What used to seem so mundane
now feels like sacred ground.
Please help me to be here!
Soon we will all be gone.


Emptiness

emptiness
is fullness
still healing
till she can let go
completely


Receiving
​
everything
is a gift
unwrapped slowly
by your perception

For years I've gone on retreat, escaping family and home to find freedom. Little did I realize that freedom can be found within my own home, that refuge in a Brahmavihara happens wherever, whenever the heart is willing to feel, and surround all experience in its embrace.

Deep gratitude to Brian Lesage and Sangha for this sacred, unique, configuration, to family and friends for being there with food, hugs, kisses, laughter, and conversation when needed, to colleagues for covering my time off from work, and patients for trusting this practice to widen/deepen my understanding of compassionate care.

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.

​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

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…

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😉!)