​rocks polished
with the soft cloth
of loving attention
the gems are emerging
 
Have you ever had one of those days where it feels like you got up on the wrong side of the bed, and you want to go back to sleep?
 
I recently had one of those days.
 
Words were hit like racquet balls in conversation with family members instead of catching them, holding them for a while, and then playfully tossing them back. My low back, sacroiliac joints, and gluteal muscles were starting to complain again, as if I wasn’t taking good care of them. I was hungry and nauseous from the Suprep Bowel Kit solution in preparation for a colonoscopy.
 
Instead of stringing undesirable events together on a continuous chain of aversion, I was surprised by the care that showed up between and around these events.
 
Bathing the body in compassionate breath, I also took a breath for others in similar situations. There was awareness of imperfection, impermanence, and the impersonal nature of it all. I noticed the way my partner and mom would check up on me periodically to see how I was doing. I pictured loved ones saying the exact metta words I needed to hear, wrapping me in a warm blanket of love and understanding.
 
May you polish these rocks of aversion with the soft cloth of loving attention.
 
May you stay in the present moment and notice the care around you.
 
Don’t misunderstand me. I didn’t like any of the confusion in conversations, the physical discomfort, or the unsettling gastrointestinal sensations. (I won’t even go into the bowel details!) If I had gone back to sleep, I would have missed out on the gems emerging with practice, with time.
 
****
 
Waiting in the pre-op room, I answer the nurse’s questions about my medical history, medications taken, and sign all the necessary consent forms. When it’s time to find a vein suitable for IV access, the nurse comments that I’m a ‘hard stick’ (venous access will be difficult due to small, less prominent veins and some degree of dehydration from the bowel prep).
 
Hard stick.
 
The words pierce a hole in the bubble of equinimity I’ve created in preparation for this procedure. Or is it a bubble of resistance?
 
The nurse attempts to find IV access in my right arm, ‘threading’ the needle to reach a vein. When this is unsuccessful, she tries again with my right hand, again ‘threading’ the needle to contact a vein. After the second failed attempt, two more nurses are called in to try.
 
Each nurse takes an upper extremity searching for a suitable vein, a way to pop the bubble of resistance and access vulnerability. I feel like a pin cushion as tears begin to fall for the sharp, lancinating sensations felt in my right arm and hand.
 
I didn’t sign up for this. This wasn’t even on the consent form. This isn’t supposed to happen!!!
 
Allowing the tears to flow, the irritation at the first nurse for poking me twice and all the nurses for asking me repeatedly if I’m ok (do I look ok to you?), and the unpleasant physical sensations to be here just as they are, I’m asked to befriend another round of aversion.
 
Breathing in self-compassion, breathing out compassion for other patients who have felt like pincushions, I notice that there is a little compassion for the nurse as well. I have also asked colleagues for help when faced with certain challenging procedures in patient care.
 
Thank you asking for help when you did.
 
The nurse looks at me with genuine care.
 
Of course. I wasn’t going to stick you again. I usually don’t have trouble with IV access. You were a hard stick.
 
The words don’t feel as sharp as they did before. Rocks polished with the soft cloth of loving attention, the gems are emerging.
 
****
 
It doesn’t matter how many times aversion arises, because it will, again and again. It’s how I relate to it that matters most.

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…

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.

There is a key that I’ve found through these practices, unlocking mysteries, answering questions I’ve had over lifetimes. I’m so afraid to lose this key, guarding it sometimes to the detriment of my relationships with loved ones. What if I forget? What if I’m not perfect in practices, in life? Will I spiral down into the womb of bloody postpartum darkness where thoughts threaten connection and unwanted emotions signal abandonment? Who will love me then? Will I be strong enough alone? Can I remember these practices without the key?

Menstrual cycles are irregular. Moods shift like unpredictable weather patterns. Gripping the key tightly- identities of a meditator, writer, physician, healer, mother, wife, daughter, family member and friend, I don’t want the life I’ve so carefully constructed over the last fourteen years to change. If it does, I only want it to change for the better (whatever that means).

In meditation this morning, I heard the following words. Awareness that this practice is not about perfection or self-improvement, but trusting the heart without expectation. What if I toss the key into the ocean, allow the waves to swallow this house of sand?

Loving awareness is everywhere. It’s time to let go of the key…

(Inspired by “Small Kindness” by Danusha Laméris)


It’s relatively quiet on the hike-
minimal sounds of birds chirping,
lizards scurrying across the path,
footsteps against dry leaves and dirt.
The few hikers I meet have
facial expressions masked.
I can’t tell if they are smiling,
frowning, or the lips are flat-lined.
Out of nowhere comes this silent scream.
When will this all end? 
When can I see your face again?
Like a mother holding the frustrations 
of an impatient child,
I try and open to what’s here-
uncertainty, the wish for things to be different.
All I can do is thank a hiker
for stepping aside so I can pass,
wave to another hiker,
Enjoy your hike.
When I can’t see your face,
words and hand gestures 
will have to be enough.
I still miss the smiles.

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😉!)

I’m surprised by the negative polarization against police officers after the death of George Floyd, and so many others. Don’t get me wrong. There are many overwhelming emotions moving though this heart-mind as they may be for you (anger bordering on rage, unspeakable fear, deep disappointment and hurt to name a few). Unnecessary violence masked in innocence, fueled by ignorance and implicit bias is never a good thing.

I can’t just point my finger at all the cases of police brutality. This may sound crazy, but the folks I find myself practicing Tonglen for first are police officers Derek Chauvin, J. Alexander Kueng, Thomas Lane, Tou Thao, and other officers, as well as George Floyd and others meeting death in savage, inhumane ways. How on earth did these officers think that what they were doing was OK, “equally” protecting the lives of all citizens? How are we as a society (you and I) contributing to macro and micro acts of violence on a smaller scale in the places we hold power?

I want to remember that not all police officers are like those who are getting the greatest publicity right now, that there are those who have deep respect and reverence for African American lives. And, this is also a wake-up call for more training and awareness, not just for the “guilty” officers, but for us all. As you are moved to demonstrate the yang of fierce compassion in whatever way you feel is right, please be a contemplative warrior for meaningful change looking at the 3 fingers pointing back at you when it’s so easy to place blame elsewhere.
​
Here is one way you might consider growing in awareness, making an intentional shift from racial innocence and distress to racial literacy and harmony within community.

The Dakini Speaks
© Jennifer Welwood

My friends, let’s grow up.
Let’s stop pretending we don’t know the deal here.
Or if we truly haven’t noticed, let’s wake up and notice.
Look: Everything that can be lost, will be lost.
It’s simple — how could we have missed it for so long?
Let’s grieve our losses fully, like ripe human beings,
But please, let’s not be so shocked by them.
Let’s not act so betrayed,
As though life had broken her secret promise to us.
Impermanence is life’s only promise to us,
And she keeps it with ruthless impeccability.
To a child she seems cruel, but she is only wild,
And her compassion exquisitely precise:
Brilliantly penetrating, luminous with truth,
She strips away the unreal to show us the real.
This is the true ride — let’s give ourselves to it!
Let’s stop making deals for a safe passage:
There isn’t one anyway, and the cost is too high.
We are not children anymore.
The true human adult gives everything for what cannot be lost.
Let’s dance the wild dance of no hope!
 

 
When I first heard this poem some years ago, it sounded bleak. Dance the wild dance of no hope? With a passion for beauty, creativity, singing, dancing, and music, I simply could not relate. I also couldn’t resolve the spiritual and creative parts of me that sometimes felt as odds with one another. Dhamma retreats that involved sitting, walking meditation, then more sitting and walking mediation for hours and days on end felt dry, as if something were missing. (Maybe this is why I insist on writing, sometimes singing and dancing on silent retreats when no one is looking or listening.)

Now, change and uncertainty have taken center stage. The Dakini speaks, and I am listening. Have I truly missed the deal here? I’m starting to wake up and notice. For me, uncertainty is so unsettling because of my patterns of control. Though I’ve told others this pandemic is not a sprint, but a marathon, I find myself at many imaginary finish lines hoping the race is over.

I want to travel, eat at my favorite restaurants, go on retreat, get together with family and friends, see patients in person, have my hair cut and colored, and not virtually! And I recognize these are minor inconveniences to have, as many others are suffering in real and devastating ways.

So how can I not act so shocked and grieve certain losses fully like a ripe human being? It helps to acknowledge these “losses” with honesty, without spiritually bypassing the true feelings of impatience, anger, sadness, fear, and overwhelm that may be present. The ripeness includes a clear, wise mind asking, “What’s happening now?” and a spacious, compassionate heart asking, “How am I relating to this?”

It’s important for me to remember that this practice is not perfect. Judgements and resistance still arise. All my habitual patterns of control (blaming others, blaming myself, food and retail therapy, meticulously cleaning, strategically planning) are implemented one after the other in the name of protecting the self. And so many things influence the fight-flight-freeze reaction and the tend and befriend response: physical, emotional, economic stability, practice history, etc.

Most days, I find that I am somewhere in between both physiologic processes. A quivering belly, rapid heart rate, and tense muscles are met with earth connection, warm breath, and fluid understanding of not acting so betrayed. Impermanence is life’s only promise, so what COVID-19 is teaching me is not new. I was just in denial.

Just as Toto pulled back the curtain to the great Wizard of Oz revealing an ordinary man, can I strip away the unreal and live with the real, giving myself completely to this one true ride? I’m tired of making deals for a safe passage. If there isn’t one, and the cost is too high, what does it mean to dance the wild dance of no hope? If there is no ground, what can I stand with, stand for?

I don’t have perfect, complete answers to these questions. Like many of you reading this, I’m still sensing my way into ‘answers’, trying to be as patient, honest, compassionate, and open as I can be along the way. Two words, concepts arising in meditation and life practice over the last few days are wholeness and goodness. Despite feeling broken, imperfect, and disconnected at times, I recognize that my purpose as a physician, meditation/movement practitioner, parent, and writer is not to cure everyone, but tap into an energy of healing that happens whenever the heart-mind is truly present and listening. And goodness isn’t a Pollyannish ignorance of the severe and overwhelming destruction caused by this pandemic, but stories of care I’m seeing, experiencing, and hearing about each day.

If impermanence is life’s only promise, then let my response be wholeness, goodness, and care, knowing that it is imperfect. What will your response be?
​
As you sit, stand, walk, and lie down with this ground of uncertainty, what is still true for you? The Buddha said, “Hatred does not cease by hatred, but only by love; this is the eternal rule.” May you connect with what is still true for you. May this guide you, support you, nourish you in the days and weeks to come.

(This post was inspired by Sebene Selassie, Sharon Salzberg, and Vesak.)

​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.