Friday, September 25, 2020

The Ever-Present Presence of the Present




The ever-present

Presence

              of the

Present

              a

Present

              Gifted to those seeking its warm embrace

              Remedy for dis-ease

              Cure for living in worlds

              “Has been”

              “What was”

              “Yet-to-come”

 

The ever-present

Presence

              of the

Present

              Is our natural state

              Known well to little ones and wise elders

              Sought by those in between (if they even care to seek)

             Like all things valuable, it can't be captured by smartphone, thumb drive, DVR


The ever-present

Presence

              of the

Present

              a

Present

              That offers itself to us at this precious moment

              And next hour

              And all of tomorrow

              Fear not as you reach to greet its embrace


Note: This piece brought me back to the second piece in this Writing to Heal blog, a prose piece about the Superpower of Being Present. Feel free to revisit that piece!

Friday, September 18, 2020

Signs of Change

Can things really change?

Can our country find a way to admit systemic racism and then do the hard work to undue it?

Can we begin to live with our Earth, ending our suicidal quest to dominate it?

Will we begin to honor the Indigenous Peoples of this land, reversing their second-class status in a land that is their own?

Well, I can’t honestly answer all of these questions with a positive answer. At least not with confidence.

But I can see some signs that make me hopeful. I want to share two of those with you.

Example 1: U.S. Forest Service

My family thought about places to get away and enjoy a hike. The outdoors seem to be one place where the pandemic loses its grasp over us. Aside from a piece of fabric covering the face’s mid-section, you almost can forget about words like “6 feet apart” and “Zoom”.

With fatherly skill, I quickly steered the conversation toward Wheeler Peak, my selfish choice for our hike. Our tallest mountain in NM at 13,147 feet, I had wanted to climb this for many years. We looked up the hike and found that, at that moment, the trails in that area were closed. Reading further, they were closed due to traditional ceremonies of the Taos Pueblo.


Carson Forest Supervisor, James Duran stated

“It’s important that the Carson National Forest works to support local traditional communities to continue a traditional way of life that makes the culture of Northern New Mexico so rich and truly unique”. We appreciate the public’s patience and willingness to support our local tribal communities in maintaining long standing connections to these mountains during this unique period.” (link here)

YESSSSS!!!!!!!!

Many of us, myself included, may never have associated public lands and the National Park System as anything beyond an attempt to conserve and preserve the natural beauty of our country. But Indigenous communities have a very different history with the creation of such lands.

Just as land was stolen from these people since the arrival of Europeans, conservation efforts simply provided another avenue to trample over these same communities. As Marcus Colchester writes, “National parks, pioneered in the United States, denied indigenous peoples’ rights, evicted them from their homelands, and provoked long-term social conflict. This model of conservation became central to conservation policy worldwide.”

Making the position of the Carson Forest even more important is the context of Taos Pueblo and the U.S. Forest Service. Just a few miles away from Wheeler Peak is Blue Lake, known to the Taos Pueblo as Ba Whyea, a sacred site to that Tribe used for many traditional ceremonies.

In the name of conservation, the U.S. government appropriated Blue Lake and the surrounding area and placed it under the control of the Forest Service. The Equivalent of The Vatican being taken away from Catholics, Mecca confiscated from Muslims. These thefts usually came without consultation with Indigenous communities. The struggle by Taos Pueblo to regain control of Blue Lake similar to Standing Rock in 2016, represented Indigenous struggles for religious freedom and the protection of sacred sites. (After 64 years of protest, appeal, and lobbying by Taos leaders and their supporters, Blue Lake was restored to the Pueblo in 1970.)


So, to see the Forest Service now working as a protector, not a threat to Taos Pueblo is a victory for all of us. To see words acknowledging that traditional ways are what make our land unique is incredible in a land that has largely ignored and “othered” Indigenous ways at best, often working explicitly to eradicate them completely. (“Kill the Indian, Save the Man” policy of the U.S. Boarding Schools, for example).

Example 2: Princeton University



No, I was not about to take my family on a trip to New Jersey. “Kids, jump in the car. We are heading to audit a weekend course at an Ivy League institution.” Not quite.

But September 2nd letter by Princeton’s president Christopher Eisgruber to acknowledge systemic racism caught my eye.

“Racism and the damage it does to people of color nevertheless persist at Princeton as in our society, sometimes by conscious intention but more often through unexamined assumptions and stereotypes, ignorance or insensitivity, and the systemic legacy of past decisions and policies.  Race-based inequities in America’s health care, policing, education, and employment systems affect profoundly the lives of our staff, students, and faculty of color.

Racist assumptions from the past also remain embedded in structures of the University itself.  For example, Princeton inherits from earlier generations at least nine departments and programs organized around European languages and culture, but only a single, relatively small program in African studies.”

YESSSSS!!!!!!!!

Coming from an institution that represents power and privilege, this divergence from the default - finding ways to justify unjust systems that serve to benefit that person/group speaking - is refreshing. It is healing. It is needed.

So, back to those initial questions, I can say that I have some hope that I can be a part of making real change happen. That is the only place any of us can start – acknowledging our own responsibility to pave a different road for our own lives, our own words, our own actions. We can be transformed just like the Forest Service and Princeton University to stand for undoing racism and a new way of treating each of Creator’s beautiful creations, land/air/animals included.

Healing awaits us, my brothers and sisters.


Wednesday, September 9, 2020

Connection

 

We had turned to leave, the ICU machines and monitors beeping their goodbyes.

Working at the University of New Mexico’s Hospital as a family physician, I had come to visit this patient with a colleague who is a physician assistant upon the request of the ICU team.

Our patient, Ms. Armijo, an elderly woman who'd been hospitalized in critical condition after emergency abdominal surgery for abdominal pain called out after us: “You know, the thing I am really worried about is being all alone.”

As we turned around, and I saw Ms. Armijo’s fright amidst her frail, failing body.

I had thought that our lengthy, pathology-driven questioning had covered all of the bases pretty thoroughly. Where do you hurt? How do you hurt? Are the pain meds working for you?

Now, frozen in mid-stride by her question, I realized that we had neglected the most important thing: Connectedness.

COVID had forced our hospital to adopt a no-visitors policy. On every floor, the hand-holding and bedside banter that partners, siblings, neighbors and coworkers normally lavish on hospital patients was replaced by a sickening silence. Even I, a family physician, couldn't visit my own patients who'd been hospitalized or sent to skilled nursing facilities due to COVID.

Imagine yourself in that ICU bed. Scared for your life, feeling so weak that you cannot even lift a spoon to your mouth--and suffering all of this alone, without the comfort of your loved ones at your side.

This was the situation Ms. Armijo was facing. Not only that, she didn't even have her connection to her family and the outside world with her cell phone missing. No wonder she was distraught!

Our team went back to her bedside. This time we did the listening, not the talking.

“I have no idea what happened to my cell phone in all of this,” she started.

“Have you been able to talk with your sister and family?” I asked.

“No, and that’s what I am really worried about. My sister who takes care of me and she must be going crazy not knowing how I am doing. Sitting here, I don’t think they even know if I made it out of surgery alive! If it weren’t for the pandemic, they would be sitting right here by my side.”

I was being taught, the physician as the student, my patient Ms. Armijo as my teacher.

“Thank you for sharing”, was all I could muster.

“This is not a ‘no news is good news’ scenario for them,” she added.

Listening to her speak, both what was spoken and lay in the pauses and expressions, I was not ashamed but more eager to be her student. To me, it felt like a direct, visceral reminder [or some such] that asking Ms. Armijo about her sense of connectedness, or otherwise, was as important as probing into her abdominal pain and lab results. We were being taught that you cannot have full health or healing if you're disconnected from those you love.

I've started to realize that connectedness can actually be considered as yet another vital sign--as important, in its way, as any heart rhythm or puff of breath.

And in these extraordinarily difficult times, loneliness can almost be considered a new medical condition, one affecting close to 100% of our hospitalized patients, one requiring its own treatment plan. This was true, I realized, not only for Ms. Armijo but for all of our hospitalized and nursing facility patients.

The phone was found by her family, discarded in the chaos that led to her ambulance ride to the hospital. Over the next few hours, with painstaking effort, it was delivered to the hospital - passed like a hot potato to the security guard at curbside, then to a nurse courier, past the badge-access checkpoints and, finally, safely into the hands of Ms. Armijo.

Her body still had a long way to go in terms of healing. But she was now connected back into her world, her support system.

Heading to the next patient on our list, we all knew which question we would ask first. It would not be about pain level, appetite, or bowel movements. Those would wait for later. First question would be simply, “How can we help connect you to those you love?”




* This piece was first published July 28th, 2020 by Pulses: Voices from the Heart of Medicine.


Friday, September 4, 2020

Sacred Play and Imaginary Escapes - Thriving in our New Normal

 

“Hope things go back to normal soon.”

That was the text I received from a friend yesterday. It struck me in reading those words that I have stopped thinking or worrying about the end of the pandemic. In those first months, absolutely. Daily thoughts of getting back to normal life.

Now, out of self-preservation and a renewed sense of life’s sacredness, I have turned to making the most of each day, not wasting a moment of living spending time trying to beg normal to reappear.

My response was simply, “Yep! But let’s make the most of each day until then.”

And in that spirit, I want to share two stories that remind us to find joy, creativity, sacred play, even imaginary escape as tools for thriving in our new normal. Enjoy.

The Teacher Has Arrived

Our house is a weird place these days. We don’t own a TV, our children don’t have phones, and we are as close to screen-free as a modern day family could be. But now? Now, we are 5 people zoomed in to our classes and work, zoned out from each other and the world beyond our 48 square inches of screen space. We have a 7th, 4th and 1st grader and all of them have adapted well to this online life.

Our 2 year-old Sihasin has taken in this sudden change, and it is interesting to see her interpretation of this virtual world. “Dad, do you have another meeting?” she will ask the second I open my computer. “Dad, are you going to your office?” anytime she senses that I am about to start a work session. “Office”, as she has figured out, is a very loose term and could apply to garage, porch, kitchen, living room, etc. “Office dress”, as she and her siblings have observed, ranges from tank tops to running shirts to sleepwear to an occasional collared shirt.

Well, Sihasin voiced that she wanted to go to school just like everyone else. She was feeling left out, not having a screen of her own to stare into. So Nizhoni, our oldest devised a plan. On times when she was not in school, she would sneak upstairs, put on a disguise, and become the teacher for Sihasin. Let me explain that “disguise” in this context means simply changing 1-2 things about appearance. I asked Nizhoni if she uses a different voice as teacher, and she gave me a look. “Dad, that really isn’t necessary. I use my normal voice and I still don’t think she knows it is me.”

Action shot of little one at "school" with Ms. B

So, Teacher Nizhoni broadcasts from upstairs to Student Sihasin who we get onto a tablet downstairs. Teacher Nizhoni goes by "Miss B" and gives her choices – “Do you want to do music or dance today?”. Usually, the class is quite short as Student Sihasin loses interest and simply walks away from the screen. No “good bye” or “I have to go now” but just a departure to signal that this class session has ended. Teacher Nizhoni is quite understanding.

Pics of, in order of appearance, Teacher Nizhoni and (Regular) Nizhoni


 

A Breathe of Fresh Air is All We Need

We were a tired group of physicians, immersed in sickness, loneliness, COVIDness as we cared for patients at UNM Hospital. The week had worn us down, taking out our zip and pep and replaced it with “argghhh”. I think someone mentioned something about fresh air in a figurative sense, but I suddenly realized that real fresh air was exactly the antidote. With inertia of hospital work and an indoor existence the entire week working against us, I was able to coax everyone to come outside with me. I had tried multiple times previously in the week to get us outside, failing each time. Intertia and a huge work load will do that. This time, I think the combination of me using my best attempt at an authoritative voice plus the presence of “argghhh” made the group start to warm up to the idea of a few minutes outside.

We found a nice place of shade on a beautiful late May afternoon and suddenly we were transformed. The grass felt so good, so real. The hospital walls now dissolved, we were free in mind and spirit. Free from work. Free from the burden of so much hardship that was our patients’ reality. Free from ourselves. Spontaneously, the crew starting talking about how incredible it felt to be outside. How it surprised them how quickly they felt rejuvenated by shade, breeze, birds, grass and all that now embraced our senses.

The power of fresh air and simple escapes. From “argghhh” to this pic below in a matter of minutes.

 


May you find joy, creativity, sacred play, even imaginary escape as tools for thriving in our new normal. Practice daily. Titrate dose upward if needed. Enjoy the silly moments along the way.

Friday, August 21, 2020

Going to a special place...


This week’s piece is a chance for you to create space for yourself, maybe here at the end of a long week and maybe on a Monday morning when you see this.

You will need a few items for this exercise – do not pass GO if you have not collected the following:   
Ten minutes for yourself
A piece of paper
One of your favorite writing utensils

We are going to start with a meditation, and you can choose to do this either by reading the script below or by listening to the meditation below. Big choice. Go with your gut on this one.

Meditation - audio version


Meditation - written version

Find a nice space, indoor or outdoor and get into a comfortable position, one free of pain.

If possible, find a position where your feet are on the floor, where you are sitting tall, extending each of those vertebrae to their greatest height. Let those vertebrae breathe life into your body!

Once you have the position that feels good, just sit with that for a minute. Start to slow down the mind as the heart and your emotional/spiritual self takes over command of the ship.

Now, in a completely different place than you were a few minutes ago, you are ready for a journey.

Take some nice, slow, deep, rejuvenating breaths.

Air in, deep into the recesses of those lungs, into the abdomen.

Air out, expelling all that does not serve.

Take as much time as you need here, enjoying the state of being, the state of breathing.. This is your time, and no one is rushing you through it.

Smile, and relax those face muscles. Smile at life, smile at the moment, smile at something that has made you smile earlier today. Smile at all of your loved ones.

Now, with eyes gently closing, take yourself to a special place, a place that you have not been able to visit because of the pandemic. Take yourself to that place right now. Smell the fragrances this place brings to mind. Touch the things around you. Listen to the noises of this special place. Feel the energy around you. Sit with this and enjoy being and breathing in this special place for a minute or two.

Let’s invite one person to enjoy this space with you. Maybe a person who, like this special place, you have not been able to see due to the pandemic. Or maybe someone that comes to mind when you think of this special place.

Invite them to join you. If you are at a beach, they are not sitting beside you in the soft sand. If you are hiking a forest or a favorite trail, they walk in stride with you. If you are in a place of prayer or meditation, they are praying/meditating next to you.

Enjoy this person’s warmth and presence, as you both soak in this special moment together.

Take your time here. This is your time and the clock has stopped ticking. Your heart is now the only beat of time present, and it is set to “timeless” mode.

When you are ready, a few more deep, rejuvenating breaths and then open those 2 eyes to join the 3rd eye that is wide open at this point.

Paper and favorite writing utensil in hand, you are now going to write a hand-written letter to that person who joined you in the meditation. You are filled with healing energy and the writing itself is furthering your healing. There is something about writing on paper that reveals ourselves in a way that typing onto a phone or computer simply cannot. As you write, think of how this letter is going to brighten the person’s day. Think of how you are going to deliver it. Write in joy! Deliver the letter within the next week.

Repeat as needed.


After posting this piece, Veronica Hutchison, an amazing mentee of mine, writes the following along with the picture above: "Just listened to your newest Writing to Heal meditation. I found this funky envelope that I made at a "self care" Native Health Initiative event. Perfect for this letter!"

Friday, August 14, 2020

In the dark no more...



As a healer who has been doing my work in the dark, blind in a sense, today was a big day.

The visit was scheduled, not as a phone visit but as my first Zoom visit since the pandemic began 150 days ago. Usually, I see about 30 patients in-person a week. During the 5 months of COVID, I have seen about 30 patients in-person total, with the remainder conducted entirely by phone.

For someone who values that sacred space where the exam room creates a space where all other worries and commitments cease to matter for those 20 minutes, the only commitment being presence, this has been a big change. Put more bluntly – it has been really hard for me. I am sure most of the patients and providers of the world feel similarly.

That sacred space is now replaced by a phone call with interruptions and multi-tasking, my kids often seeking daddy’s attention as I sit in my home office (e.g. living room couch). Not being able to see people in these visits during COVID further dehumanizes the time together.

I signed on, not believing this was happening, but hoping I wasn’t about to hear an alarm clock that would wake me from a pleasant dream.

In a touch-less, 6 feet apart, face-covered-with-masks reality, I was about to get closer to the people I work with as a physician, the people who teach me about healing.

I hoped this would re-create the sacred space I have been so missing.

When the visit started, Ms. Armijo (name changed to protect patient confidentiality) couldn’t get the visual aspect on her tablet to work.

“Geez. I knew this was too good to be true,” I mumbled to myself. I think it was just life’s way of building the suspense, doing what all movie directors and novelists do so well. Make ‘em wait for the good stuff.

Then suddenly she was there, smiling at me. And I was able to smile back. No facemasks to spoil the moment!

I really did not expect the rush of emotions that rushed and gushed in those next moments. 

Here’s a decent recap of them put into words:

Wow!

I can’t believe this! I can see her and she can see me.

When I say, “I am really glad to have the chance to see you for this visit,” I won’t have to make a silly joke about what “see” means anymore.

I knew I was missing something big these last months, but wow, I didn’t realize how much the human connection was lost in these phone call visits.

Warmth. Connection. Healing.

Healing of a great chasm created by 5 months of practicing medicine blindfolded.

Sacred space

Wow!

In that visit, and in the few I have done since then, I take time to ask the person to show me something about their life that I would never get to see, never be able to fully appreciate if the visit was done in a clinic.

Ms. Armijo chose to show me her service dog that has been such a big part of her healing journey. I licked the screen, an appropriate dog greeting. In exchange, I share something on my end – the garden, a picture, etc. Two humans just trying to find real connection in a virtual world.

Appreciate these small moments today, tomorrow and next week. Those moments where the sacred spaces in your life suddenly return. Maybe not in quite the same form as they would have pre-pandemic, but good enough to make your heart skip a beat, for gratitude to grow.

Reminding us all that the sacred spaces are still much closer to us than we think or see when in the dark. May light similarly shine your way today! May your own light be the illumination.





Friday, August 7, 2020

Of Tree Lines and Tolerance

 

We climbed and climbed. Endless “up” it seemed.

Finally, we got to a place with vistas endless. 360 degrees doesn’t quite do it justice.

Christian, my running buddy and a professional trail runner, had brought me to Penitente Peak in the Santa Fe Mountains, 12,200 above sea level.

Our conversation over the first hours of the run had prepared us well for this peak. In fact, we talked about the Islamic tradition that talks about nature’s beauty as the first tier of heaven.

Well, we had arrived in a place that inspired nothing short of otherworldly splendor.

Being an animal not used to such heights, I stared at the bare faces of the mountains at our eye level. Beneath that nakedness, pinons and spruce trees.

I had never climbed high enough to see what the “tree line” really was. I was now here.

I stared for a moment, confused a bit as I saw a clump of trees very much making a wavy line at best. Gone were my notions that the tree line would bring me back to high school geometry, a straight line connecting two points. Gone was my conceptualization of a belt that the mountain would wear around its waist, somewhere around 11,000 feet high.

    

I think Christian saw my look of surprise as I squinted to make sure I was seeing it all correctly.

“What was the tree line’s teaching for me?” I thought as we began our descent.

My mind, and I assume most of ours, wants to see this world in a very straight-line way. Trees either grow or they don’t, with a nice geometry-teacher-approved-line separating the two realities.

Tolerance requires us to see the trees for how they actually are, even if it jars us from a cemented belief not based in reality. Much more messy, akin to a 4 year old with a paintbrush in her hand as opposed to a ruler-drawn line.

Tolerance is a mindset that appreciates and looks for the nuances that make people who they are, seeking to understand their perspective, affirming their humanity and their right to think and behave differently.

It is a heartset that assumes commonality despite outward differences toward things we care about passionately like climate change, racism, or our best choice for president of the country. That commonality becomes the basis for tolerance, listening, and being open to change ourselves.

I did some reading on tree lines. Yes, they can be well-defined, but they are often a gradual transition. Trees grow shorter and more sparsely before gradually decreasing to an area with no trees. And depending on how the sun hits and where the water runs, the tree line likely differs in altitude even within a single mountain. There can even be a double tree line, with bristlecone pine trees growing far above the tree line for pinon and juniper trees on the same face of the same mountain. Add in the effects of latitude and you see that a tree line ranges from 0 ft elevation in areas of Northern Quebec to 17,000 ft in the Andes of Bolivia.

Tree lines are much more dynamic and wavy and unpredictable than we thought, huh?

I am thankful for this first glimpse of a tree line, thankful Christian brought me to such heights.  In seeing it with my own eyes, I find a place for tolerance to replace a rigid notion of what is that I had carried into that run.

Maybe we just came up with a corollary (remember those from geometry??) about seeing the forest for the trees.

It is seeing the tree line for what it is – not a line at all.

It is seeing each other as clumps and groves with our unique way of being, beautiful growths within a 4-year old’s painting, more human and more unified than our politics or media leads us to think.