My Weekly Culinary Adventure in Mindfulness

Those of you who have followed my blog for some time know that I participate in a CSA or "community supported agriculture" each year -- our CSA is the lovely, First Root Farm on Lexington Rd in Concord, MA.  For me it is the best of all worlds, my family gets to eat fresh, local vegetables each week and we support a local farm in our town at the same time.  We also share in the farm's bounty or losses each year (like last year when the eagerly anticipated tomato harvest was disappointingly sparse). 

Today was "opening day" for First Root Farm and I was thrilled to pick up our share of fresh picked arugula, radishes, chard, lettuce, kohlrabi, and garlic scapes.  Each week is an exercise in mindfulness...I never know until I pick up my share at 4 PM what we will eat for dinner that night.  But the beauty of this in-the-moment meal planning is that whatever I find at our farm pickup each week is always interesting, colorful and surprisingly delicious -- even if I don't quite know what to do with it.


Thanks, Laura, Nina, and Ariel, our First Root Farmers, for making our Thursdays mindful culinary adventures!

Cambridge Film Screening of The Dhamma Brothers

There will be a film screening of the award winning documentary, The Dhamma Brothers, on Monday, May 21 at 7:30 PM at the Brattle Theater in Cambridge, MA.  The film makers, director and producer will be present at this screening.

If you haven't seen this amazing film, do yourself a huge favor and make sure to view it.  This film will open your mind and heart to the practice of mindfulness in a most unlikely place, a maximum security prison in Alabama.

Hope to see you at the Brattle Theater on May 21 at 7:30 PM

Real Nurse (RN) Contest...Win a CD or Starbucks Gift Card

Did you know that registered nurses make up the largest sector of the health care professions?  We are 3.1 million strong and according to national surveys, nursing has remained the most trusted profession for the past decade. On a humorous note, it has also been reported that nurses drink the most coffee of any profession. 

During the week of May 6-12, Stress Resources is joining the American Nurses Association in celebrating Nurses: Advocating, Leading, Caring, as part of National Nurses Week 2012. The purpose of the week long celebration is to raise awareness of the value of nursing and help educate the public about the role nurses play in meeting the health care needs of the American people.

  

In honor of 2012 National Nurses Week, Stress Resources is holding a Real Nurse (RN) contest for all nurses (current and retired) and nursing students.   

"I KNEW I WAS A REAL NURSE WHEN......" 

Prizes:

1st Opening the Door to Meditation CD ($19.94 value)

2nd Starbucks Gift Card ($10 value)

To participate simply email your answer to the following: "I knew I was a REAL NURSE when...." Your answers can be funny or serious. Deadline is midnight, May 12.  I will select two winners from all entries submitted and include answers (without names) in the June Stress Resources newsletter and on this blog.  Email me at Pam Ressler (pressler@stressresources.com) Make sure you include your name, what nursing school/university you attend(ed), and your address

Get A Life: A Commencement Address by Anna Quindlen

I have just returned from my youngest daughter's college commencement ceremony. As you can imagine, I am overflowing with pride and joy for Jen as she enters this new phase in her life.  I also recalled my own undergraduate commencement over three decades ago.  I have absolutely no recollection of who the speaker was or what wonderful words of wisdom he/she imparted to us freshly minted college grads embarking on our adult lives in 1979. Their words fell on deaf ears, I was too interested in hurrying on to the next step in my plan and moving into adulthood.  Perhaps that is why I enjoy reading exceptional commencement addresses now -- to read the words of inspiration through a different life lens; one with a bit less impatience and perhaps a bit more perspective on the joys and sorrows of being human.  I am not sure what my 21 year old self would have thought of Anna Quindlen's commencement address to Villanova graduates in 2000, but I hope she would have been even half as inspired as I am now.

"I have no specialized field of interest or expertise, which puts me at a disadvantage, talking to you today. I'm a novelist. My work is human nature. Real life is all I know. Don't ever confuse the two, your life and your work. The second is only part of the first.

Don't ever forget what a friend once wrote Senator Paul Tsongas when the senator decided not to run for reelection because he'd been diagnosed with cancer: "No man ever said on his deathbed I wish I had spent more time in the office." Don't ever forget the words my father sent me on a postcard last year: "If you win the rat race, you're still a rat." Or what John Lennon wrote before he was gunned down in the driveway of the Dakota: "Life is what happens while you are busy making other plans."

You walk out of here this afternoon with only one thing that no one else has. There will be hundreds of people out there with your same degree; there will be thousands of people doing what you want to do for a living. But you will be the only person alive who has sole custody of your life. Your particular life. Your entire life. Not just your life at a desk, or your life on a bus, or in a car, or at the computer. Not just the life of your minds, but the life of your heart. Not just your bank account, but your soul.

People don't talk about the soul very much anymore. It's so much easier to write a resume than to craft a spirit. But a resume is a cold comfort on a winter night, or when you're sad, or broke, or lonely, or when you've gotten back the test results and they're not so good.

Here is my resume: I am a good mother to three children. I have tried never to let my profession stand in the way of being a good parent. I no longer consider myself the center of the universe. I show up. I listen, I try to laugh. I am a good friend to my husband. I have tried to make marriage vows mean what they say. I show up. I listen. I try to laugh. I am a good friend to my friends, and they to me. Without them, there would be nothing to say to you today, because I would be a cardboard cutout. But call them on the phone, and I meet them for lunch. I show up. I listen. I try to laugh.

I would be rotten, or at best mediocre at my job, if those other things were not true. You cannot be really first rate at your work if your work is all you are.

So here is what I wanted to tell you today:

Get a life. A real life, not a manic pursuit of the next promotion, the bigger paycheck, the larger house. Do you think you'd care so very much about those things if you blew an aneurysm one afternoon, or found a lump in your breast? Get a life in which you notice the smell of salt water pushing itself on a breeze over Seaside Heights, a life in which you stop and watch how a red-tailed hawk circles over the water gap or the way a baby scowls with concentration when she tries to pick up a cheerio with her thumb and first finger.

Get a life in which you are not alone. Find people you love, and who love you. And remember that love is not leisure, it is work. Each time you look at your diploma, remember that you are still a student, still learning how to best treasure your connection to others. Pick up the phone. Send an e-mail. Write a letter. Kiss your Mom. Hug your Dad. Get a life in which you are generous.

Look around at the azaleas in the suburban neighborhood where you grew up; look at a full moon hanging silver in a black, black sky on a cold night.

And realize that life is the best thing ever, and that you have no business taking it for granted. Care so deeply about its goodness that you want to spread it around. Once in a while take money you would have spent on beers and give it to charity. Work in a soup kitchen. Be a big brother or sister.

All of you want to do well. But if you do not do good, too, then doing well will never be enough. It is so easy to waste our lives: our days, our hours, our minutes. It is so easy to take for granted the color of the azaleas, the sheen of the limestone on Fifth Avenue, the color of our kid's eyes, the way the melody in a symphony rises and falls and disappears and rises again. It is so easy to exist instead of live. I learned to live many years ago.

Something really, really bad happened to me, something that changed my life in ways that, if I had my druthers, it would never have been changed at all. And what I learned from it is what, today, seems to be the hardest lesson of all. I learned to love the journey, not the destination. I learned that it is not a dress rehearsal, and that today is the only guarantee you get. I learned to look at all the good in the world and to try to give some of it back because I believed in it completely and utterly. And I tried to do that, in part, by telling others what I had learned. By telling them this:

Consider the lilies of the field. Look at the fuzz on a baby's ear. Read in the backyard with the sun on your face. Learn to be happy. And think of life as a terminal illness because if you do you will live it with joy and passion, as it ought to be lived.

Well, you can learn all those things, out there, if you get a life, a full life, a professional life, yes, but another life, too, a life of love and laughs and a connection to other human beings. Just keep your eyes and ears open. Here you could learn in the classroom. There the classroom is everywhere. The exam comes at the very end. No man ever said on his deathbed I wish I had spent more time at the office. I found one of my best teachers on the boardwalk at Coney Island maybe 15 years ago. It was December, and I was doing a story about how the homeless survive in the winter months.

He and I sat on the edge of the wooden supports, dangling our feet over the side, and he told me about his schedule; panhandling the boulevard when the summer crowds were gone, sleeping in a church when the temperature went below freezing, hiding from the police amidst the Tilt a Whirl and the Cyclone and some of the other seasonal rides. But he told me that most of the time he stayed on the boardwalk, facing the water, just the way we were sitting now even when it got cold and he had to wear his newspapers after he read them.

And I asked him why. Why didn't he go to one of the shelters? Why didn't he check himself into the hospital for detox? And he just stared out at the ocean and said, "Look at the view, young lady. Look at the view."

And every day, in some little way, I try to do what he said. I try to look at the view. And that's the last thing I have to tell you today, words of wisdom from a man with not a dime in his pocket, no place to go, nowhere to be. Look at the view. You'll never be disappointed." ~ Anna Quindlen (2000 Villanova Commencement Address)

Spring Haiku

How can we not be mindful during spring????  A haiku quickly formed in my mind as I noticed the exquisite display of blossoms this week...

Spring Haiku


Clear pink plum blossoms
Outside my office window
Awakening spring

What is your seasonal haiku?  Please share a haiku with me on my blog (a haiku is a seventeen syllable poem of three lines, first line 5 syllables, second line 7 syllables, third line 5 syllables)

Pam Talks Pain

What a title...did it capture your attention?  I had a great time guest hosting with Tufts Pain Research, Education and Policy Program the weekly WEGO Health Health Activists' Tweetchat on March 13.  I am passionate about bringing more visibility to the invisible epidemic of chronic pain.  It is time we recognized that chronic pain (pain lasting more than 3 months) is not just a symptom but should be thought of as a disease entity that needs complex and multidisciplinary treatment.  Thanks again to the WEGO Health folks who do an amazing job amplifying the voices of health activists and advocates locally and globally.

#HAchat Recap: The Invisible Epidemic: Pam Ressler Talks Pain

by Caitlin

130 million people in the US are chronically ill, and 116 million of these people suffer from chronic pain.  With so many suffering, it’s amazing that chronic pain is something rarely talked about and a constant source of tension between those who suffer from pain and their healthcare providers (HCP).  Why don’t people talk about chronic pain? Why is there stigma against those who suffer from chronic pain? As HealClick pointed out, no one has ever questioned the “stomach ache”, so how can HCPs doubt “unbearable pain”?

This week’s chat was hosted by Pam Ressler (pamressler), a current faculty member of the Pain Research, Education, and Policy (PREP) program at Tufts University, registered nurse, social media enthusiast and pain research advocate.  Wendy Williams (TuftsPREPpain), Associate director of the Tufts Prep program also joined in on the conversation.

Perceptions of Pain
pamressler: Huge problem…pain is invisible! It’s not something you can put under a microscope or cover with a bandage, and this is the biggest reason it’s so hard for physicians and HCPs to understand, it’s something that they can’t exactly put their finger on.  Many doctors seem to be under the impression that chronically ill patients “just want to swim in opiates” as TiffanyAndLupus put it, and they label these chronically ill patients as drug-seeking.  They are also hesitant to treat pain because they don’t want to get labeled as “dealers” of pain medication.  Then it’s the fact that there are different types of pain.  julianna12369: “There seems to be a breakdown when it comes to visits to hcp’s for chronic vs acute pain.” Co-morbidities can also stay a doctor’s hand when writing a prescription:  julianna12369: “There is a lot of stigma. As soon as someone sees I am #bipolar and I have #lupus, that’s it for taking much of my pain seriously.”  In this way, suffering from multiple conditions may undermine a patient’s “pain credibility” with their doctor. 

ArthritisAshley #HAchat I have anxiety & rheum arthritis, chiari, celiac, palindromic rheumatism, DIL, POTS, thyroid issues but anxiety is all many docs see -#HAchat
hockeygrl1:  i wish my dr would listen more. She attributes pain to #frbro & gives me antidepressants, sometimes i need more #hachat
kimmieCollas @hockeygrl1 & some of us can’t TAKE antidepressants (manic episodes & other nasty effects #HAchat

And even if you find a doctor who understands your pain, ER trips can lead to accusations of drug seeking behavior.  In the end pain has a bad reputation amongst both patients and caregivers. For patients, it’s a life altering inconvenience.  For HCPs:  ArthritisAshley:  “I hate that chronic pain disorders are associated with hypochondrism, pill-popping etc.”
But it’s not just about the pain. It’s about how others perceive your pain and how you perceive yourself.  It’s one thing to not have your doctor believe in the severity of your pain, but what if members of your own family were in doubt? hockeygrl1 “I agree on the family worried about pain medications. My daughter mentioned that she thought I refilled mine too soon. not true”.  What about all of the things that result from chronic pain, such as fatigue or depression? How do you treat these symptoms without throwing anti-depressants at the problem? Susanmees: “docs need to ask what else is happening in someones life, not just physical pain, mental &stress issues too”.

Thinking outside the doctor’s office
The chromatically ill and those suffering from chronic pain seem to be some of the biggest advocates of alternative therapies, even when doctors are not: kimmieCollas “most of the MDs I’ve talked to abt integrative therapies say there’s no proof – I say if it helps, I don’t care if there’s proof .”  Here are some therapies our Health Activists have tried:

@pamressler: We need to expand our tool box for chronic pain…meditation, yoga, tai chi all can play a role #hachat
@FabulousandSick: I totally agree. We also need to add diet changes to our tool box.. #HAchat
TiffanyAndLupus T1: This month I have been learning meditation and taking a chronic pain yoga class. BOTH are helping to relieve my pain! #HAchat -
bitogoth Finally started meeting with a therapist to address anxiety/stress aggravating chronic pain, and nice versa #HAchat
PainCHAS massage therapy is smart conservative solution. also should not forget about psychology
bitogoth Heat, hydro and electrotherapy all help for me, but not always accessible (hydro) #HAchat -

Writing your own pain scale
Just as different therapies work for different people, pain is different for everyone.  We often talk about how each patient is unique and that no one deals with their condition in the same way, reacts to medication the same way, or has the same needs in terms of their treatment or care. The same goes for pain, which is another reason pain is so hard for doctors to treat.  julianna12369 “I would like pain scale thrown out. I want my hcp to know that years in pain make my 5 diff then that 5″.  But how is a doctor supposed to treat that?   How does he or she know that your 5 is worse than someone else’s?  ArthritisAshley “My pain & symptoms are always in flux. I could be fine one minute & immobilized the next”.
bitogoth suggested defining your own pain scale:  “I wrote my own scale for my doc- very specific. Has helped much in communicating pain”.  It will lead to a better conversation with your doctor about your pain, and also help your doctor decide on the best course of treatment.  You should also define your expectations with your doctor. While it’s important to strive for a pain-free life, it seems that most of our Health Activists found this to be unrealistic:  julianna12369 “I don’t expect to have ZERO pain, I think that’s unrealistic. Healthy people have SOME pain. Just manage pain.”  As always, communicate your needs to your doctor and come up with a plan to address them. Like patients in any other condition, the chronically ill and those suffering from pain are just expecting for their doctor to listen and respect them: julianna12369: “so my expectation of my HCP is to listen, believe, communicate, and try. And for me as a patient, the same.” TiffanyAndLupus “I would like my Drs to know I am coming to them for help; because I don’t have answers.”
Finally two pieces of wisdom to carry you through the week.  Last week we heard from an HCP that doctors hear empowered groups more than empowered individuals, so don’t forget: TiffanyAndLupus Alone we are one; together we are strong. @HealClick: 130 million total chronically ill… The epidemic no one knows about.
And though we doubt you need a reminder of why it’s important to talk to your doctor about your pain: ArthritisAshley – “I had a doctor tell me it was “all in my head.” It was but NOT how he meant it – I had Chiari malformation & needed brain surgery.”

Do you have other alternative ways to deal with pain?  Additional tips for communicating with your HCP about pain?  Feel free to send additional ideas to editorial@wegohealth.com!
Make sure to join us next week for more on Health Activism and Healthcare Professionals!

Are We Truly Measuring Patient Satisfaction?

I was struck by an op-ed piece I read recently in the New York Times. The author, Theresa Brown, RN, in her piece entitled Hospitals Aren't Hotels, opines that we set unrealistic goals in medical treatment when  patient satisfaction scores are the primary measure of success. Is patient satisfaction  always correlated with more expensive or aggressive treatment?  Perhaps we need to redefine satisfaction? Can we shift our model of care from a "doing for" model to a "being with" model and still achieve patient satisfaction? Do we, as Theresa Brown suggests, always need to first hurt in order to heal?

 Lots of food for thought here...would love to hear your comments!

The Other Side of the Exam Table

This week I found my self on the "other side" of the exam table as a patient confronted with a medical decision. Two weeks ago, one innocent misstep left me with a tender and slightly swollen left foot. Being the watchful waiting type, I iced, elevated, and medicated with ibuprofen. Since the foot still seemed tender and swollen after 10 days, I sought out medical advice (besides my own). An x-ray showed a stress fracture of the 2nd and 3rd metatarsals (bones on the top of my foot). I was referred out to an orthopedic surgeon for follow up. 

Now this is where I think the story gets interesting and how it relates to how health care and the decisions we make each day that impact these costs. Upon consultation with the orthopedist, it was suggested that I also have an MRI to further visualize the foot.  In the past, I would have immediately scheduled an MRI but now with a high-deductible health care insurance policy, I paused and began an initially uncomfortable discussion with my health care provider of the cost/benefit ratio of having an MRI at this time, postponing it or forgoing it completely.  I asked if the information gathered by an MRI would change the proposed treatment of the injury which had been visualized by x-ray.  When I learned that the answer was no -- that the initial treatment would be the same, I respectfully declined having an MRI at this time.  Knowing that an MRI would cost me in the neighborhood of $1000+, and this would come out of my pocket due to my deductible, certainly influenced initiating the conversation I had with my provider. Would I have made this same decision if I did not know the financial cost of an MRI or if I would not be directly impacted by the cost?  I honestly don't know, but it became apparent to me that we need to educate ourselves, providers and patients, as to the cost of health care choices with  transparency and discussion.  We have all been removed from the true costs of health care, advanced diagnostic tools and pharmaceuticals by our current health care model. What else do we "buy" with total disregard to cost? I can't think of any other product or service.  I am a staunch advocate for universal health care; excellent health care should be a right in any civilized society -- but I am also an advocate of transparency of costs so we can have thoughtful, informed discussions regarding appropriate health care choices in terms of risks, benefits and costs with our providers.  If we know the financial costs of certain procedures or diagnostic tools  as well as potential benefits will that change our behavior as health consumers or our recommendations as health care providers?  

I am mulling over these questions in my mind and would love to hear your thoughts. By the way, my decision was to forgo the MRI at this time, to wear an Aircast boot, use crutches for two weeks and then reassess with my orthopedist the need for further diagnostic workup.  This is what participatory medicine is all about.

The Rituals of Healing

Do you notice the rituals of healing in the same way as you notice the rituals of religion? It is interesting to think that rituals play a large role in the healthcare system, and perhaps in our ultimate healing. What do you consider the rituals of healthcare? Perhaps the white coat and stethoscope? The physical exam?  Receiving of a prescription for a medicine?  I have been reflecting on what we consider rituals related to the healing process as I have read and watched some interesting remarks on this subject from two leading sources on this topic.

Dr. Ted Kaptchuk, the director of Harvard's Program in Placebo Studies and Therapeutic Encounters, was recently interviewed in the New Yorker magazine about his quest to understand the placebo effect and how it influences quantifiable measures of health.  Could our belief about whether a treatment is effective or our level of trust in routine rituals of healthcare, such as placing a stethoscope on the chest, physiologically change our ability to heal? 

Dr. Abraham Verghese, author and physician, ponders whether we, as a society, are in danger of losing the art of medicine as we have increased access to technology to support the science of medicine. In his recent TED talk,  Dr. Verghese argues that while it is important to have modern tools of medicine, which are enabled by science and technology, the art of medicine is essential as well.  For it is the art of medicine that allows for the human connection between patient and healer to emerge and the rituals of healing to be sustained.

What are your thoughts?

Wisdom Where You Least Expect It

I don't know about you, but I am beginning to feel myself being pushed, jostled and dragged along with the frenzied masses this holiday season.  Try as I might to step back, take a breath and be mindful, I am amazed at the cacophony of  "shoulds" and "to-do's" that seem to continuously play in my mind at this time of year.

So there I was today, at the post office, picking up mailing boxes for the presents that "should" have gone out on Monday but were still sitting in my car on Friday, when I reached into the pocket of my coat to pull out my car keys and noticed the keys were caught on a sewn-in tag in the pocket.  The coat is not a new,  it is one that I have worn each winter for the past two years, so I was surprised to find that there was a tag in this pocket, and even more surprised to look down and read the words on the tag...

Hmm, simple and direct words of wisdom, and all I really need to remember on this journey we call life..."Stay Warm. Keep Dry."  I smiled for the rest of the day at the wisdom that has quietly resided in my pocket for two years without me noticing...a wonderful reminder for me to be open to finding gifts where I least expect them, even in familiar places.

Season of Kindness

With the uber excess of the holiday season, it is easy to forget the gift that we each already possess, is renewable and transferable, doesn't need to be wrapped, always fits and doesn't cost a dime...the gift of kindness and compassion.  In the Buddhist tradition, this quality of loving kindness or compassion is called metta and is meant to be cultivated and nurtured both in ourselves and extended outward to include all living beings in the world. Self compassion is often the most difficult to nurture, but essential to be able to acknowledge and share your metta with the others.  During this season of giving, why not  save yourself a trip to the mall and consider giving the gift of kindness, compassion and presence?

Kindness
by Naomi Shahib Nye 

Before you know what kindness really is
you must lose things,
feel the future dissolve in a moment
like salt in a weakened broth.
What you held in your hand,
what you counted and carefully saved,
all this must go so you know
how desolate the landscape can be
between the regions of kindness.
How you ride and ride
thinking the bus will never stop,
the passengers eating maize and chicken
will stare out the window forever.

Before you learn the tender gravity of kindness,
you must travel where the Indian in a white poncho
lies dead by the side of the road.
You must see how this could be you,
how he too was someone
who journeyed through the night with plans
and the simple breath that kept him alive.

Before you know kindness as the deepest thing inside,
you must know sorrow as the other deepest thing. 
You must wake up with sorrow.
You must speak to it till your voice
catches the thread of all sorrows
and you see the size of the cloth.

Then it is only kindness that makes sense anymore,
only kindness that ties your shoes
and sends you out into the day to mail letters and 
purchase bread,
only kindness that raises its head
from the crowd of the world to say
it is I you have been looking for,
and then goes with you every where
like a shadow or a friend.

Engage with Grace this Thanksgiving

For the past few years I have joined in the annual Thanksgiving blog rally, Engage with Grace: One Slide Project. This year, however, Engage with Grace holds special meaning and remembrance for me.  

On November 21, our community of Concord, Massachusetts lost an incredible teacher and mentor, David Prifti.  David, a gifted artist who taught photography at Concord-Carlisle High School, had the unique quality of connecting with each student to make them feel like they were the most amazing, talented kid in the world.  But more than that, David taught his students how to navigate life with grace, dignity, hope and humor.  

During the past two and a half years, as David lived with the diagnosis of pancreatic cancer, he allowed us all to become his students as he shared his journey through his widely read blog, Prifti News. Last month he shared with his blog readers his decision to enter hospice care and determine as best he could that the end of his life would be filled with the same beauty, grace and gentleness that had always been central to his life. One of the many gifts that David left with us is the recognition of the importance of communicating with others, expressing our wishes for the end of life.  

And so, this Thanksgiving, I dedicate my participation in Engage with Grace to David Prifti, in gratitude for teaching us all the meaning of grace, hope and peace.  

May your Thanksgiving be filled with mindful moments and shared conversations with those you love.
Pam


Engage with Grace 2011: Occupy With Grace

Once again, this Thanksgiving we are grateful to all the people who keep this mission alive day after day: to ensure that each and every one of us understands, communicates, and has honored their end of life wishes.

Seems almost more fitting than usual this year – the year of making change happen. 2011 gave us the Arab Spring – people on the ground using social media to organize a real political revolution. And now – love it or hate it – it’s the Occupy Wall Street movement that’s got people talking.

Smart people (like our good friend Susannah Fox) have made the point that unlike those political and economic movements, our mission isn’t an issue we need to raise our fists about…it’s an issue we have the luxury of being able to hold hands about.
It’s a mission that’s driven by all the personal stories we’ve heard of people who’ve seen their loved ones suffer unnecessarily at the end of their lives.
It’s driven by that ripping-off-the-band-aid feeling of relief you get when you’ve finally broached the subject of end of life wishes with your family, free from the burden of just not knowing what they’d want for themselves, and knowing you could advocate for these wishes if your loved one weren’t able to speak up for themselves.
And it’s driven by knowing that this is a conversation that needs to happen early, and often. One of the greatest gifts you can give the ones you love is making sure you’re all on the same page. In the words of the amazing Atul Gawande – you only die once! Die the way you want. Make sure your loved ones get that same gift. And there is a way to engage in this topic with grace…

Here are the five questions – read them, consider them, answer them (you can securely save your answers the Engage with Grace site, www.engagewithgrace.org), share your answers with your loved ones. It doesn’t matter what your answers are, it just matters that you know them for yourself, and for your loved ones. And they for you.

We all know the power of a group that decides to assemble. In fact, we recently spent an amazing couple days with the members of the Coalition to Transform Advanced Care -- or C-TAC – working together to channel so much of the extraordinary work that organizations are already doing to improve the quality of care for our country’s sickest and most vulnerable.

Noted journalist Eleanor Clift gave an amazing talk – finding a way to weave humor and joy into her telling of the story she shared in this Health Affairs article. She elegantly sums up (as only she can) the reason that we have this blog rally ever y year:

“For too many physicians, that conversation is hard to have, and families, too, are reluctant to initiate a discussion about what Mom or Dad might want until they’re in a crisis, which isn’t the best time to make these kinds of decisions. Ideally, that conversation should begin at the kitchen table with family members, rather than in a doctor’s office.”

It’s a conversation you need to have wherever and whenever you can – and the more people you can rope into it, the better!! Make this conversation a part of your Thanksgiving weekend – there will be a right moment – you just might not realize how right it was until you begin the conversation.

This is a time to be inspired, informed…to tackle our challenges in real, substantive, and scalable ways. Participating in this blog rally is just one small – yet huge – way that we can each keep that fire burning in our bellies, long after the turkey dinner is gone.

Wishing you and yours a happy and healthy holiday season. Let’s Engage with Grace together.

Choosing to Keep the Heart Open

Grief is universal.  As human beings we are fortunate that we can feel the emotion of love so strongly, but tightly bound to this intense love is the incredible grief we feel when one we love dies.  Some of you may know that my son, Nick, died of a rare form of cancer in 2001 when he was just 14 years old.  I was both humbled and honored when I was recently asked to deliver a speech at the 20th annual Pediatric Memorial Service at Massachusetts General Hospital to honor the children who had died and the parents, siblings, relatives, friends, and healthcare providers who they left behind.  A large part of my professional life is spent as a public speaker, so I am comfortable expressing myself before a large audience.  However, as you can imagine, this speech didn't come easily to me. As I worked on what I wanted to say to the audience gathered at Massachusetts General Hospital, it became clear that perhaps these words needed to travel further, so I am posting them here, in my blog, in hopes that someone who may find comfort in them will find them here.  It is with compassion, peace and hope that I offer these words to each of you ~ Pam

  

Sunday, November 6, 2011 ~ Massachusetts General Hospital, Boston, MA

"The only whole heart is a broken one...it lets the light in" ~Rabbi David Wolpe

There are few choices afforded to us in how to survive the loss of a child.  Well meaning friends, relatives and professionals may advise us "not to let this tragedy define who we are", but I will have to respectfully disagree with this advice.  The tragedy of losing a child is a life changing event like no other: We are confronted with not only the loss of one we deeply love, but with the loss of our future as we had envisioned.  We are shaken to the very core of our existence and essence. Yes, this event will define us for the rest of our lives whether we want it to or not.

When our loss is new, it is unfamiliar and terrifying in its intensity.  I vividly remember waking up the morning after Nick died and being absolutely amazed and incredulous that the sun had the audacity to rise, that the school bus continued on its scheduled route down my street, that  people went to the grocery store, commuted to work and  that the mail was delivered...the outside world continued to function as if nothing had occurred.  It was a surreal scene.  Because for me it was as if a nuclear bomb had been detonated.  The world as I had known it had been destroyed with the death of my son.  My world now was defined as a new normal even though I wished desperately for the old normal to return. 

Rabbi and author, David Wolpe, aptly describes the feeling of new loss in this way  "When we experience a loss, a hole opens up inside of us. It is almost as if the loss itself plows right through us, leaving us gasping for air" and we bleed profusely through this opening. During the early days, months and years after our loss, we focus on how to slow down this  hemorrhage, this continuous emptying of grief.  But then something begins to change, very, very slowly; the immediate agony subsides. Around the edges of that opening, things begin to heal and scar tissue begins to form.  This is the point at which we can choose how the tragedy of our loss will continue to define our lives...we can choose  to allow the scar tissue to continue to form and thicken, closing the hole within us -- hardening us to the world with the unfairness and unjustness of our loss; or we can choose to allow the hole to remain open, allowing not only the stream of grief to flow out but permitting light, hope and meaning to enter.  I have chosen to allow the hole within me to remain open and this is one of the gifts my son has given me. 

Rabbi Wolpe suggests that "The only whole heart is a broken one, it lets the light shine in."  Allowing the hole to remain open, has allowed me to be a more compassionate person to others and myself, perhaps a bit less judgmental and more empathetic than I was in my old normal.  Keeping the hole open has made it easier for me to prioritize what really matters and not what I think should matter -- it now OK to say no to mundane tasks and yes to things that feed my soul.  I do not fear many things now -- after all the worst has happened to me, so what do I have to be fearful of now?  And most important, by keeping the hole open, continuing to allow the grief out and the light in, I am able to hold Nick and the meaning of his life close.  

So, perhaps I have what the professionals call a "maladaptive coping strategy", but I embrace the notion that yes, I have let this tragedy define me in a way I never imaged would be possible; by allowing my heart to remain broken, and open, it is, in my new normal, whole once more.

I wish each of you peace, hope, and healing on your journeys.

The Familiar Becomes the Unfamiliar and the Unfamiliar Becomes the Familiar

We have been closing up the family cottage for the winter this week.  The familiar now somehow unfamiliar or perhaps is it the unfamiliar now somehow familiar?  The sounds of summer have receded; replaced by the sounds of autumn; the sounds of silence.  But it is more than sounds that make the familiar unfamiliar...it is all the senses converging that creates this new place within the familiar space.  The lake now quiet and smooth as glass, pine cones dropping from tall pines nudged off their branches by industrious squirrels, leaves turning to crimson and gold and fluttering downward on the breeze, the air somehow different.  Perhaps it is the pungent scent of mulching leaves, the mist that remains on the surface of the lake late into the morning, the blackness of the earth, or the hint of smoke from a fireplace that reminds me that nothing remains the same, that we are always in flux...even in the most familiar of surroundings.  Season to season, year to year, the familiar becomes the unfamiliar and the unfamiliar becomes the familiar.

Remembering September 11: Reflections on Hope, Renewal, and Resilience

The Well of Grief

Those who will not slip beneath 

the still surface of the well of grief

turning downward through its black water

to the place we cannot breathe

will never know the source from which we drink,

the secret water, cold and clear, nor find in the darkness glimmering

the small round coins
thrown away by those who wished for something else.

~By David Whyte from Close to Home

 

Do you remember when September 11 was just another day on the calendar? "September 11", or simply "9-11", has become a universally recognized phrase meaning a moment when, collectively, our lives in the United States changed forever. As the 10th anniversary of September 11, 2001 approaches, we are reminded of the cataclysmic events of that day, and the utter astonishment and disbelief that something like this could happen to "us".  While this was a collective moment, each of us individually will have our own private, personal "9-11's" in our lives.  Perhaps our personal 9-11's will come as a dreaded diagnosis, a late night phone call, an accident, a devastating natural disaster, an unspeakable hurt or loss. There will be no journalists covering our 9-11's, no awards for heroism, nor museums built, but that doesn't make our personal 9-11's any less devastating or life-altering. While we cannot prepare for what our personal 9-11's will look like, we can find ways to build resiliency; first by acknowledging the grief and loss that occurs when our life is knocked off its axis and then by diving deep to find ways to cope, make meaning, find purpose, and renewed hope in our "new normal".  I have been touched by reading some of the stories of resiliency this week, stories of those who have used these past ten years to rebuild lives in ways that look very different than the lives planned and imagined prior to September 11, 2001. This is the work of renewal, resiliency, and hope; to find something glimmering in the darkness, as David Whyte suggests in "The Well of Grief".  We cannot control the outcome of an event, a 9-11 in our lives, but we can control the experience by creating a renewed sense of purpose, meaning and hope in our lives as we adapt to our new normal.  

In Praise of the August Tomato

Hallelujah! Tomatoes...red, yellow and green zebra...my weekly pickup at First Root Farm, our local CSA (community supported agriculture) farm in Concord, MA, yielded a rainbow of August tomatoes today. This has been a hard year for our finicky tomato friends, too cold, too hot, too wet, too dry, falling victim to fungi and hornworms; so these August jewels seemed even more precious as I carried them home.  Each year I am reminded that freshly picked August tomatoes, still warm from the sun, taste like nothing else in the world.  I sliced the tomatoes, tossed them gently with fresh mozzarella, basil, olive oil and a touch of freshly ground black pepper. The epitome of a mindful moment; all five senses heightened.  I am again reminded that life is delicious.

Mindful Moments

"Two roads diverged in a wood, and I -- I took the one less traveled by, and that has made all the difference."  ~Robert Frost

What road did you travel this summer? Did you make time to diverge from the usual to find the extraordinary in the ordinary? Mindfulness is about stepping off the well traveled road every once in a while to notice life as it unfolds in the present moment and not in the rearview mirror.  I am grateful for these moments, which cannot be planned or anticipated but simply appear when one slows down to the speed of life. 

A few glimpses of my summer mindful moments are represented in the pictures below. I invite each of you to share reflections of your summer mindful moments, moments when the ordinary became the extraordinary, through photos, poems, or prose with my blogging community.  Please email me your submissions and I will share them in future blog posts.

Lake Michigan Sunset

Treating Chronic Pain as a Disease and Not a Symptom

Viewing chronic pain as a disease and not a symptom of some underlying condition is a notion that is gaining traction in the medical field.  Melanie Thernstrom, a chronic pain sufferer and journalist has written a wonderful book: The Pain Chronicles, which highlights the experience and complexity of living with chronic pain.  Read more about chronic pain as a disease and not a symptom in this recent New York Times article: Giving Chronic Pain a Medical Platform of Its Own by Tara Parker-Pope

More Good News About Meditation

The news about meditation just keeps getting better!  In a recent study by UCLA neuroimaging researchers suggest that people who meditate have stronger connections between brain regions and show less age-related brain atrophy. The benefit of having stronger brain connections is the rapid relay of the electrical signals in the brain which typically decreases with age.

Eileen Luders, a visiting assistant professor at the UCLA Laboratory of Neuro Imaging, led a team of investigators in the study using a new type of brain imaging (DTI) which provides insight into the structural connectivity of the brain. The study found that the differences between the meditators and the control group were not only in one area of the brain but involved networks that include most regions of the brain, and structures such as the limbic system and brain stem.
"Our results suggest that long-term meditators have white-matter fibers that are either more numerous, more dense or more insulated throughout the brain," Luders said. "We also found that the normal age-related decline of white-matter tissue is considerably reduced in active meditation practitioners."

To read more about this study, click here for the UCLA press release

Mindfulness in the Form of Peas

Mindfulness comes in many forms and for me, today, it came in the form of peas. Let me explain. This is the first year that my family and I have been involved in a CSA, or Community Supported Agriculture, thanks to our friends Cindy and Jim. I am not and have never been a vegetable gardener; the produce aisle at my local grocery and an occasional farmer's market have always been fine with me. So, I was a bit concerned that our foray into weekly vegetable pickups from the CSA would be just another thing to add to an already very full to-do list; but I was mistaken.

My weekly pickups have instilled more mindfulness in my Thursdays. I don't know what types of veggies we will be having for dinner until I actually pick them up. Without the pre-planning and future thinking of making lists of specific ingredients for an intended recipe, I have become accustomed to the surprise of picking up whatever has been harvested that day and enjoying the adventure of the present moment by combining often disparate ingredients into something simple but often delicious.

I have become mindful of the complex flavors of the multiple varieties of greens, have experienced the curiously intense flavor of freshly harvested fennel, and gained a new appreciation for the labor involved in picking and shelling enough peas to feed a family. Today as I ventured out to pick some fresh peas off the vines at First Root Farm, I recognized this new form of summer mindfulness meditation in my life; stopping in the middle of a busy day with many pressing deadlines and simply choosing and picking ripe, plump peas for the dinner table; no way to hurry up the process, just simply going with the rhythm of nature with a curious and open mind. I am not sure what next week's bounty will be, but these peas look incredible in this moment.