Commencement ~ The Journey Continues

Last Sunday marked a milestone in my life.  Thirty-two years after my first university commencement, I again crossed the stage; this time collecting a diploma in recognition of my graduate work at the Tufts University School of Medicine's Pain Research, Education and Policy Program. Perhaps because of the years that have passed since I set out in 1979, this commencement was very poignant for me, filling me with gratitude for all those who have guided,  mentored, and walked beside me over the years; my family, friends, patients, clients, students, teachers, colleagues, neighbors and fellow life travelers.

I was honored to be selected to deliver the commencement address for my program, and I share it here with you, my readers.  I welcome your thoughts and comments on your journey.

May 22, 2011
Tufts University School of Medicine 
Pain Research, Education & Policy Program Commencement Address
by Pamela Katz Ressler, M.S., R.N., HN-BC
To the faculty, administration, fellow graduates, and especially to my wonderful family; I am both incredibly honored and extremely humbled to stand before you today. It has been 32 years since I last wore a cap and gown and I am reminded today of that spring day so long ago in Ann Arbor, Michigan. In 1979, the adventure on which I was embarking appeared so clear and direct, much like Homer’s Odysseus as he set off from Troy enroute to Ithaca. But as with Odysseus, we often find our journeys far more complicated than we ever anticipated…meeting not only with trade winds and gentle seas but also with violent storms and towering waves that can batter us and throw us off course. And so it is for the patients we meet each day in healthcare. They, too, are voyagers on their own Homeric journeys, each filled with unique, authentic stories waiting to be told. It is up to us, in healthcare, to elicit, acknowledge, and honor these stories, to bear witness to their individual journeys and to help them navigate through difficult passages. When we first enter the world of healthcare our mission seems clear and direct – we want to quickly fix what we see as broken, to cure what we see as diseased. While this is a noble mindset, we often miss the opportunity to heal when we blindly set out in this direction. What I have learned is that often we cannot cure, no matter how desperately we try, but the potential for healing is always possible. This statement may seem incongruous to what we see as the measurement of medical success. But, as we look broadly at what healing really is… isn’t it all about reducing pain and suffering…about living and dying with dignity, grace, and a sense of purpose? We meet our patients at many points on their journeys and I see our work as assisting them in gathering the necessary tools of healing to find safe passage on their voyages.


During the course of my studies here at Tufts I have discovered many tools of healing. The Pain Research Education and Policy program was not on my navigational charts when I set off in 1979, but I am so grateful that I found my way here. Through my work with inspirational faculty mentors, especially Dr. Bradshaw, Dr. Glickman-Simon and Dr. Carr, as well as Dr. Gualtieri in the Health Communications program, I have explored pain not only as a physical manifestation of injury or disease, but also as a complex pattern of psychosocial and cultural components that contribute to a sense of suffering. Addressing the suffering has a direct impact on reducing the sensation of pain. The Pain Research, Education and Policy Program has allowed me to explore the intersection of modern medicine, technology, ancient healing practices of the body and mind and spirit, and the innate human desire to survive adversity. It has given me a voice in advocacy and scholarship by helping me to articulate the meaning of pain and suffering for individuals and society. For this I will always be grateful. Some of you may be familiar with the poem, Ithaca, by Constantine Covafy. It is a poem that has kept me company on my journey and I would like to offer it to you as a metaphor for this commencement, as each of us sets forth on new journeys and adventures:

When you set out on your journey to Ithaca,
pray that the road is long,
full of adventure, full of knowledge.

The Lestrygonians and the Cyclops,
the angry Poseidon -- do not fear them:
You will never find such as these on your path,
if your thoughts remain lofty, if a fine
emotion touches your spirit and your body.

The Lestrygonians and the Cyclops,
the fierce Poseidon you will never encounter,
if you do not carry them within your soul,
if your soul does not set them up before you.

Pray that the road is long
That the summer mornings are many, when,
with such pleasure, with such joy
you will enter ports seen for the first time;
stop at Phoenician markets,
and purchase fine merchandise,
mother-of-pearl and coral, amber, and ebony,
and sensual perfumes of all kinds,
as many sensual perfumes as you can;
visit many Egyptian cities,
to learn and learn from scholars.

Always keep Ithaca on your mind.
To arrive there is your ultimate goal.
But do not hurry the voyage at all.
It is better to let it last for many years;
and to anchor at the island when you are old,
rich with all you have gained on the way,
not expecting that Ithaca will offer you riches.

Ithaca has given you the beautiful voyage.
Without her you would have never set out on the road.
She has nothing more to give you.

And if you find her poor, Ithaca has not deceived you.
Wise as you have become, with so much experience,
you must already have understood what these Ithacas mean.
And so, as you set sail from this commencement for your Ithaca…I wish you a long and prosperous journey, the privilege of listening to many stories, and the wisdom of healing….Thank you and Bon Voyage.









Pam Ressler's Blog Featured in Grand Rounds

In the medical world "grand rounds" refers to a time-honored ritual in which experienced physicians, interns/residents and medical students come together to present and discuss a patient, condition, or treatment before an audience.  In the blogosphere we have our own multidisciplinary Grand Rounds in which interesting and informative health care blogs are selected to be highlighted and reviewed each week. I am thrilled that my blog was one of the health care blogs selected to be featured in this week's Grand Rounds.  I am humbled to be in such great company! 

Grand Rounds March 1, 2011

Communicating the Experience of Chronic Illness Through Blogging

What does blogging have to do with communicating the experience of illness?  Quite a bit.  I have been exploring the intersection between narrative medicine, coping with illness, and blogging for my research in the Pain Research, Education and Policy Program at Tufts School of Medicine.  Blogging creates a unique and accessible way for individuals who are isolated with chronic illness to be able to express and communicate their experience beyond the medical diagnosis. It provides a way for patients to tell their story and begin to make meaning out of what has happened to them, in real time. 

I recently was interviewed by Helen Osborne, Health Literacy Out Loud, about my research on use of tools of blogging and social media in health care. If you are interested in hearing more about communicating the experience of chronic illness through blogging, I hope you will listen to my podcast with Helen by clicking here.

Kaleidoscopes in Unexpected Places

Kaleidoscope: derived from Ancient Greek; kalos (meaning beauty, beautiful) + eidos (meaning form, shape) + skopeo (meaning to observe, consider, examine)
 



Kaleidoscopes are all about perceiving the world differently; observing beautiful forms in everyday objects or places. I recently learned that they can also be found in the most unexpected places. 

The photo to the right, is one of several in an exhibit entitled, Kaleidoscope by Artists for Humanity; a public installation in Terminal C at Logan International Airport in Boston.  As I waited in the terminal to bid my youngest daughter, Jen, goodbye as she returned to college after winter break; to my left were the TSA screening checkpoints with a long queue of tired and harried-looking passengers and to my right were these stunning kaleidoscopic images of nature and beauty. How many of the people in line turned their heads and saw these photos of serenity amidst the chaos and aggravation of a full body scan? I don't know, but my guess is not many. 

My resolution this year is to look for the extraordinary in the ordinary by taking some time to turn my head and look at the world through the lens of a kaleidoscope...the same world just perceived differently.

Happy New Year...What Are Your Priorities This Year?

"Five hundred twenty-five thousand six hundred minutes...how do measure, measure a year?", asks the opening song from the musical Rent.  Our new year's resolutions often focus on beginning a new year with better time managment skills, more effective prioritization of tasks and in general being more organized with our time.  Does this sound familiar?  If so, I invite you, at this beginning of a brand new year, to take a breath...and then read an email I received today from a colleague at University of Massachusetts/Boston.  It made me stop in my tracks and simply smile at the profound wisdom of a six-year-old:
"Here is a suggestion from my six-year-old daughter on how to start your TO DO list. Two of days ago, I wanted to teach her how to make a plan for the day so I asked her to bring me a notepad to write down what we would like to accomplish. She jumped quickly and brought a note that said “LOVE” and without even waiting for me to ask her anything, she said: “Mommy, I wrote the first item on the agenda” grinning from happiness. “Isn’t LOVE the most important anyway?”, she added.
As I watched her in awe, I noticed a change in my state of mind. “Yes, dear child, LOVE is the most important”, I said to her and thought to myself … “even if nothing else gets accomplished for the day but we share LOVE with each other the day would be quite successful”. We made a schedule for the day and moved on. Every time we were in disagreement we reminded each other “What was the first item on our Agenda?”
Put LOVE first in your daily/weekly/yearly TO DO list and simply enjoy the benefits it will bring to your life."
What incredible insight and what a good suggestion for the first item on the inevitable TO DO list(s) in our lives!  How will you measure your precious five hundred twenty-five thousand six hundred minutes this year? How about in LOVE.

Wishing you LOVE in the new year,
Pam

Wabi Sabi Revisited

In a previous blog post, I discussed Wabi-Sabi, the Japanese aesthetic of finding beauty and wholeness in the imperfection of life. The Stress Resources November newsletter asked readers to send in their reflections of wabi-sabi. Here are a couple of reflections I received:


From Hilary Gould


The Wabi-Sabi Pomegranate
"Each year in December the pomegranates come into season and both Sam and Daniela have loved eating these since being very young. We have one picture of Sam about 4 1/2 years old covered in red berry juice.


My mom told us about a "better" way to open pomegranates she read in a cooking magazine. Slice off the top and bottom, slice the skin in 4 vertical places, then put the whole pomegranate in a bowl of water. When you start to pull apart the fruit, the berries sink, and the unwanted rind and skin float to the top. When you are done, you skim the top and pour the berry-seeds into a colander. Easy! So, when we tried it at home...both girls said..."This is no fun. It's TOO clean. I want to be covered in red juice like when I was little".  I think the girls missed the Wabi-Sabi aspect of the pomegranate experience!"



From Abby Seixas, author of Finding the Deep River Within


"I loved your mention of wabi- sabi in connection with the holidays--YES! I wonder if you'd like to include the exercise in Chapter 7 of my book: Wabi-Sabi Eyes" ~A.S.


Wabi-Sabi Eyes (excerpt from Finding the Deep River Within, pg 131)


"If you have noticed that you have a perfectionist streak, try a little wabi-sabi! What if you aspired to imperfection? Can you see the beauty if a few dirty dishes left in the sink? Your child's unbrushed hair? Robyn Griggs Lawrence says, 'Wabi-sabi reminds us that we are all transient beings on this planet--that our bodies, as well as the material world around us, are in the process of returning to dust. Nature's cycles of growth, decay, and erosion are embodied in frayed edges, rust and liver spots. Through wabi-sabi, we learn to embrace both the glory and the melancholy found in these marks of of passing time.'


Wabi-sabi is a different way of seeing, a good antidote to seeing through the eyes of imperfection. Next time you want to jump up and comb that hair or wash those dishes or straighten those piles, pause for a moment, try seeing it through wabi-sabi eyes."
Thank you to Hilary and Abby for giving us some ways to view the holiday season through wabi-sabi eyes.
Enjoy,
Pam

Engaging with Grace this Thanksgiving


As you gather together with family and friends over the Thanksgiving holiday, what are you going to talk about? I am guessing that the topic end of life choices will not be on the list of conversation starters. But perhaps it can and should be. While none of us knows the exact choices we will need to make for ourselves or a loved one at the end of life, we can open an ongoing conversation about what is important for us, what we value, and what are our wishes. As someone who has had to face end of life choices in both my professional life and in my personal life, beginning the conversation around the dining room table is much more compassionate, and empowering than beginning the dialog in the intensive care unit.

For the past three years, I have been participating in the Engage with Grace Blog Rally at the invitation of Paul Levy, CEO and President of Beth Israel Deaconess Hospital in Boston and am thrilled to see that the number of health care bloggers supporting this effort has grown exponentially each year. As we consider the exciting possibilities of participatory medicine and an increased desire for more shared decision making between health care providers and patients/families, we also must recognize that we need to ask about our loved ones wishes for medical care and intervention; understanding that they may not be identical to our own. Please join me and my family as we Engage with Grace this Thanksgiving with one slide and five questions.

With gratitude,
Pam

Things we are grateful for this year

For three years running now, many of us bloggers have participated in what we’ve called a “blog rally” to promote Engage With Grace – a movement aimed at making sure all of us understand , communicate, and have honored our end-of-life wishes.

The rally is timed to coincide with a weekend when most of us are with the very people with whom we should be having these unbelievably important conversations – our closest friends and family.

At the heart of Engage With Grace are five questions designed to get the conversation about end-of-life started. We’ve included them at the end of this post. They’re not easy questions, but they are important – and believe it or not, most people find they actually enjoy discussing their answers with loved ones. The key is having the conversation before it’s too late.

This past year has done so much to support our mission to get more and more people talking about their end-of-life wishes. We’ve heard stories with happy endings … and stories with endings that could’ve (and should’ve) been better. We’ve stared down political opposition. We’ve supported each other’s efforts. And we’ve helped make this a topic of national importance.

So in the spirit of the upcoming Thanksgiving weekend, we’d like to highlight some things for which we’re grateful:

Thank you to Atul Gawande for writing such a fiercely intelligent and compelling piece on “letting go” – it is a work of art, and a must read.

Thank you to whomever perpetuated the myth of “death panels” for putting a fine point on all the things we don’t stand for, and in the process, shining a light on the right we all have to live our lives with intent – right through to the end.

Thank you to TEDMED for letting us share our story and our vision.

And of course, thank you to everyone who has taken this topic so seriously, and to all who have done so much to spread the word, including sharing The One Slide.

Engage with Grace: One Slide Project

Happy Wabi-Sabi Thanksgiving


In the November Stress Resources Newsletter, I contrasted the Japanese aesthetic of Wabi-Sabi, the beauty of imperfection, to our westernized view of perfection (think Hallmark card, Norman Rockwell illustration, Martha Stewart anything) continually fueling our stress levels during the holiday season. I asked readers to send in their version of what a wabi-sabi holiday in their home looks like. Thanks to my sister, Hilary Katz Gould, from Huntsville, Alabama, for sending along her thoughts....have a wabi-sabi day, little sis.


Wabi-sabi Thanksgiving table at the Gould's

The pumpkin pie will have a crack in the middle, and the crust will not be flaky or gourmet. It will be made by Sam, and her middle school recipe from 7th grade. Store bought crust and easy canned ingredients. It will be tasty though, and we will only have a few more years of Sam's pumpkin pie to enjoy before college sweeps her away.

Daniela's cranberry sauce will consist of a bag of berries, and a cup of sugar, maybe some orange zest... if we happen to have oranges around. It will end up cooling in what ever bowl is around at the time. May even end up in a plastic cup, if that is the easiest for her 11 year old hands to work with.

Derrick's turkey will be stuffed with a loaf of ripped up white bread with paprika, mushrooms and some chopped onions. His mother's recipe from her Hungarian mother.

None of these dishes will be beautiful, or gourmet, or color coordinated. But, years from now, the picture of the imperfection, or wabi-sabi table will bring back wonderful memories of our family Thanksgiving.

Wishing you all a wabi-sabi Thanksgiving...filled with mindful moments and gratitude.

Technology and Resilence


When friends and colleagues hear that I teach mindfulness and resiliency skills AND that I am actively engaged in social media in health care, they often scratch their heads in confusion. Mindfulness and building resiliency are thought to be at odds with our increasingly 24/7 digital society. Let me say, I agree. But resiliency is the ability to bounce back from adversity, and often requires creative solutions to do so. While I see challenges of over saturation with information and a frantic pace of living associated with 24/7 technology, I also see wonderful opportunities for increased connection, communication, as well as decreased isolation especially by vulnerable members of our society. One of the manifestations of increased technology is its ability to narrow the divide between those with chronic illness and those without. Helping to normalize interactions and social connection in ways that were once unimaginable are now possible for the cost of an iPad...and that is resilience!

Click here to read the NY Times article that inspired me to write this post. I would love to hear your thoughts and welcome your comments.

Resilience


This morning, as I walked down my front walk to gather the daily paper in the driveway, I noticed the embodiment of resilience in the most unlikely spot...a lone Stella d'Oro lily blooming brightly and vigoursly amidst the signs of impending winter. Frost painting the grass, the chill of New England autumn in the air, yet this hopeful flower of late spring and summer opens up to the sun, blooming brightly without regard to the season or anticipation of the future. A lesson of resiliency and mindfulness learned this morning from a small flower...I am grateful!

Unlocking Memories


Anyone who has had a family member stricken by Alzheimer's disease knows the feeling of helplessness and hopelessness that arise both within the loved one with Alzeheimer's and those family members watching the person they once knew slowly disappear. As we continue to find ways of extending life, we often neglect extending quality of living in our effort to support the medical treatments. A non-profit organization, ARTZ, has directed its energies toward the goal of extending quality of living by engaging patients with dementia and their family members in activly connecting in the arts, through music, visual arts, and cinema. Unlike short-term memory, often the long-term memories of a painting, an old movie, or a song remain intact and can be source of interaction and connection for a person with Alzheimer's disease and their loved ones. A recent article in the Boston Globe, Memories Unlocked, highlights the local initiatives of ARTZ. I am pleased to support initiatives that recognize supporting and increasing quality of life is as important as supporting and increasing quantity of life.

I welcome your thoughts and comments about this topic.

The Arts of Compassion: Perspectives on Arts and Health


A reminder about an interesting upcoming symposium in the Boston area, on Saturday, October 2, which promises to be a very special gathering of experts, leaders and visionaries in the field of arts and health care. The event is open to the general public and will be followed by a concert by the Longwood Symphony -- an orchestra composed of health care practitioners. Here is a press release about The Arts of Compassion: Perspectives on Arts and Health:

"A year ago, a remarkable group of engaged, curious and committed individuals who share an interest in the role of the arts in health care began to meet to share ideas and inspiration. Each month, the group, including Longwood Symphony Orchestra, gathered to hear a presentation about the remarkable work being done by one of its member organizations.

BACH: Boston Arts Consortium for Health now invites you to join us, to learn more about the remarkable breadth and depth of the field of arts and health care here in the greater Boston community.

Join us as we learn about Whittier Street Health Center's Expressive Arts Therapy program; Artists for Alzheimer's work with people living with Alzheimer's, Longwood Symphony's LSO on Call program, The Healing Empowerment Center, and much more.

During the midday break, participants are invited to learn about integrative medicine from practitioners at the Mobile Clinic from the Integrative Medicine Alliance.

The Arts of Compassion will be held from 9:00am-5:00pm at the David Friend Recital Hall at Berklee College of Music, 921 Boylston Street, Boston. The conference is open to the public, and the registration fee of $35 includes materials and lunch. Online registration for the symposium is available through the Longwood Symphony Orchestra's website

Participants are invited to attend the Longwood Symphony Orchestra's opening season concert at a discounted rate of only $25. The concert is will be held at NEC's Jordan Hall, 30 Gainsborough Street at 8:00 pm. Go to www.longwoodsymphony.org and enter discount code SYMP"

The Many Faces of Reslience

We often think of resilience when we are faced with a diagnosis of a life threatening disease, or perhaps when a natural disaster shakes us to our very core. This is when we hear the term "resilience" used most often by ourselves and the news media. But what about the faces of resilience during these bleak economic times -- the faces of your neighbors and friends who are not facing a devastating diagnosis or an instantaneous natural disaster, but the bleak economic outlook, family stresses or just surviving in tough times? Do you see resilience? That is why I found the article in the Boston Globe entitled: Resilience in Bleak Times so compelling. Look into the eyes of a resilient person and you will find someone who finds and maintains connection to self and to the outside world and finds meaning in giving back while moving forward. What does resilience mean to you?

Stress Reduction on a Parking Ticket?


I did a double take when I heard this story on the news today: the city of Cambridge MA has new parking violation tickets with yoga poses printed on the reverse side. Stress-producing to receive a ticket but stress-relieving to do the yoga poses after receiving a ticket? I will be interested to follow this story and hear reactions as people start receiving the yoga parking tickets. If you are one of the "lucky" ticket holders, please comment on this blog. Click here to read the story.

Arts of Compassion


Mark your calendars! Arts of Compassion: Perspectives on Arts and Health is an upcoming symposium scheduled for Saturday, October 2, 2010 at the Berklee School of Music. The Longwood Symphony will also be performing after the symposium. The symposium is being sponsored by BACH (Boston Arts Consortium for Health). This promises to be a wonderful day of inspiring speakers and moving music!

Summertime Moments

If you surrender completely to the moments as they pass,
you live more richly those moments.
--Anne Morrow Lindbergh




Ah...summertime! I look forward to the slower pace during the months of July and August. It is a wonderful season to regroup, rebalance, and rediscover...read a book just for fun; take a walk at dusk listening to the sounds surrounding you; try an ice cream flavor you have never tasted. What are your favorite ways to surrender completely to the moments as they pass?

Nurses Lead the Way With Health 2.0 Chronic Disease Initiative for Teens


If you have observed teens in the last 10 years, you will know that most teens prefer texting to talking on cell phones. It is this observation that led Visiting Nurse Service of New York to propose an innovative chronic disease management tool for teens with Type 1 diabetes (insulin-dependent diabetes) using aspects of health 2.0 and social media. The pilot program, which will run for two years, supplies each teen with a BlackBerry smartphone with specific interactive diabetes tracking software installed. The teens will be tracking and monitoring their blood sugar and diet information into the BlackBerry and the data will be monitored and analyzed by visiting nurses with the hypothesis that more frequent monitoring by teens with diabetes will lead to better health outcomes and fewer complications of diabetes.

Kudos to the Visiting Nurse Service of New York for embracing a creative use of new technology to provide better disease management to a very wired target market! How do you envision tools of technology and connection being used in healthcare?

Check out a video about the pilot program by clicking here.

Where You are Going...Are You Already There (Here)?


Thanks to my friend, Sue Wood, for reminding me of this wonderful story that was recently posted on the blog, www.bemorewithless.com. I first heard the tale of the Mexican fisherman and the Harvard MBA several years ago, but with each reading I see more and more wisdom in the message of mindfulness and peace in the present moment.

An American investment banker was at the pier of a small coastal Mexican village when a small boat with just one fisherman docked. Inside the small boat were several large yellowfin tuna. The American complimented the Mexican on the quality of his fish and asked how long it took to catch them.

The Mexican replied, “only a little while. The American then asked why didn’t he stay out longer and catch more fish? The Mexican said he had enough to support his family’s immediate needs. The American then asked, “but what do you do with the rest of your time?”

The Mexican fisherman said, “I sleep late, fish a little, play with my children, take siestas with my wife, Maria, stroll into the village each evening where I sip wine, and play guitar with my amigos. I have a full and busy life.” The American scoffed, “I am a Harvard MBA and could help you. You should spend more time fishing and with the proceeds, buy a bigger boat. With the proceeds from the bigger boat, you could buy several boats, eventually you would have a fleet of fishing boats. Instead of selling your catch to a middleman you would sell directly to the processor, eventually opening your own cannery. You would control the product, processing, and distribution. You would need to leave this small coastal fishing village and move to Mexico City, then LA and eventually New York City, where you will run your expanding enterprise.”

The Mexican fisherman asked, “But, how long will this all take?”

To which the American replied, “15 – 20 years.”

“But what then?” Asked the Mexican.

The American laughed and said, “That’s the best part. When the time is right you would announce an IPO and sell your company stock to the public and become very rich, you would make millions!”

“Millions – then what?”

The American said, “Then you would retire. Move to a small coastal fishing village where you would sleep late, fish a little, play with your kids, take siestas with your wife, stroll to the village in the evenings where you could sip wine and play your guitar with your amigos.”

Season of Change

As the season of commencement, a time of change and new beginnings is upon us, this poem by Rainer Maria Rilke struck me as a quiet breath of wisdom into the stress of changes in our lives.

The Sonnets to Orpheus, Part Two, XII

Want the change. Be inspired by the flame
where everything shines as it disappears.
The artist, when sketching, loves nothing so much
as the curve of the body as it turns away.

What locks itself in sameness has congealed.
Is it safer to be gray and numb?
What turns hard becomes rigid
and is easily shattered.

Pour yourself out like a fountain.
Flow into the knowledge that what you are seeking
finishes often at the start, and, with ending, begins.

Every happiness is the child of a separation
it did not think it could survive. And Daphne, becoming a laurel,
dares you to become the wind.


~ Rainer Maria Rilke ~

Vicki Kennedy's Reflections on Compassionate Care


I had the pleasure of hearing Vicki Kennedy, the wife of the late Senator Ted Kennedy, give a very moving speech at the 8th annual Celebration of Women in Healthcare hosted by the Kenneth Schwartz Center on May 26. Mrs. Kennedy spoke eloquently, but more importantly authentically from her heart, when she reflected on her caregiving journey and the healing power of compassionate communication between providers and patients. Click here to read an article about the event.