5 Cents: The Doctor is In

Generations of Mothers – Mother’s Day 2013

2013-05-11T14:41:00.001-07:00

This week my youngest brother and his son arrived from Florida. They were here primarily to visit my 86 year old mother, who recently declared “I’m not getting any younger” and demanded that my brother and, separately, my sister, come visit and spend time alone with her. Steven picked up Jono and his son Charlie from the airport and brought them to our house, and my mother arrived about an hour later via her helper. As she carefully descended the few stairs inside the front gate, she kept looking up to see her son’s face as he waited for her. Her eyes were shining. She is very little, even shorter with age, and my brother is tall. He carefully bent over to hug and kiss her, his son standing just behind him, and I could feel her overwhelming joy in the moment of reunion, mother and son.

Last year, at the end of June, my son returned after spending 10 months in Israel (The Summer of Impending Loss, He’s Gone). The day of his return, my husband, our daughter, and I went to the airport and waited in the baggage area. I kept looking for him… and then I spotted him. The first to reach him, I was the first to encircle him with my arms and be held by his stronger ones. During that long hug, I surprised myself crying for joy, for the breathtaking feeling of a mother reunited with her son.

Just days ago, as I watched my mother reunite with her son, I remembered. And then I also remembered all the years when I was the one visiting my mother, happy to see her, but also happy when I left to return to my own life, not quite understanding her towering joy when I arrived, or her plummeting sadness after I was gone. Now, in one moment of awareness, I became joined to my mother.

Our son is coming home from college on the east coast in just one week. I can hardly wait. He has decided to transfer to college here and live with us at least for the next year. I now realize what an incredible gift of time we are about to receive. I think about our daughter, a junior in high school, and wonder what it will feel like when she, too, leaves to go to college, and how I will miss her even as I encourage her to start out on her own journey. Before I know it, they will both be visitors when they come home.

On this day of honor to mothers everywhere, let us celebrate our unity as mothers, or as children of mothers, or as grandchildren of mothers. Let us remember that each mother’s child is as precious, unique, and beloved as our own children. May all children and mothers experience the joy of happy reunions.

Growing Life

2013-05-08T10:28:00.000-07:00

I have had a “dry spell” in my writing – a time when my metaphoric pen ran out of ink, and I couldn’t replenish it. My ideas were all focused on family needs and transitions, my counseling practice, and more recently, learning the personally and professionally exciting field of neuroplasticity, how the brain changes itself, and how that can be applied to eliminating persistent pain.

Now my thoughts and desires turn, again, to the traditional preoccupations of spring. I am planting my garden, choosing plant starts and seeds, following the sun through the day to see where it lingers most, and planning where each plant will (hopefully!) be able to grow and produce its vegetables, fruit, or flowers.

With any physical enterprise, I usually need help. Heavy digging of our clay soil and pulling of weeds, clearing underbrush, and taking out deeply rooted unproductive or dead plants, is not safe for my precariously balanced physical structure. I am fortunate indeed to have my husband Steven, who is willing to partner with me in this endeavor. This year he is recovering from a knee replacement, and so we also asked our neighbor’s gardener to do some of the heaviest work for us.

Now it is my turn. I buy soil amendment and plants and seeds, direct the placing of compost, and finally get my turn to put my hands into the soil itself. I love to do the lighter digging of prepared soil, plant the seeds and starts, and water them. It’s fun to figure out what needs to climb up a cage or which vine will need a support to twirl around as it grows, then find the ones I used last year or the year before, and use them again. I pulled the wisteria back where it shaded my vegetable bed in the front of the house, and tied it onto the fence rail so the tomato and beans I planted would get more sun.

As I work in my garden, I am growing hope. Each plant and seed contains the potential to become large, lush, beautiful, and delicious. I am growing nourishment, of the body and the spirit. I am growing pleasure, mine as I engage all my senses to see, touch, smell the plants, hear the spray as I water them, and ultimately taste the fruits of our labor. Pleasure is shared with my family as we watch the growth, anticipate the wonderful food we will make and share further with our friends, and the beautiful flowers we will enjoy all summer long.

Weather is unpredictable. There are times of rain and times of dryness. I hardly noticed that my writing was drying up, but when I did, I prayed for rain. And then I waited…

Somehow I didn’t notice that even in the dry time, seeds were forming and dropping into the dark, conserving their energy and potential to grow, and getting ready.

Examining Our Lives

2012-09-25T08:46:00.000-07:00

This is the time of year when, in the Jewish tradition, our lives are examined. We bring the previous year to mind in order to find its truth. What is the truth about myself? Were my words and actions what I meant them to be last year at Rosh Hashanah and Yom Kippur, when I made resolutions for the New Year? Were there times my words were not as kind and compassionate, as patient as I wanted them to be (ask my teenage daughter!)? Could I have done more for the community, for the earth, for my mother?

Questions such as these are always answered in the affirmative. We could always do more, do better. No archer, not even Robin Hood, can hit the center of the target every time.

The truth, however, is greater, and also requires other questions. Did my words make a difference for another person? What were my deeds that supported others and made the world a better place? What did I say or do that nobody else in the world could have done? How did I keep the promise that I made to myself last year?

Sometimes it is very hard to acknowledge the truth of misdeeds, and make amends. We do so in order to “clean the slate” and make ourselves ready to do better in the coming year. However, it can be even more challenging to acknowledge the truth of our good deeds, and thus accept ourselves as complete human beings.

Every culture has its own system of social rules. In ours, politeness dictates that we do not focus on our accomplishments or good deeds. When we speak of them, we don’t want others to think that we are “bragging.” We are taught that the highest form of giving is that which is anonymous. Similarly, it is expected that we will do the right thing without the expectation of praise; however, our mistakes are routinely criticized. In time, this is internalized, and we hardly notice our successes, while criticizing ourselves, sometimes repeatedly, for our mistakes.

And yet, it is the knowledge of ourselves as good people which allows us to understand when we have missed the mark and gone astray. In some way, the more we are aware of the times we have gone out of our way to help, the times we have made a difference, of when we have acted in accordance with our own ethical principles, we create a conscious pattern of good deeds.

So how has this last year been for you? How did you “hit the mark”? Can you remember when your words made a difference to another person, when your actions helped someone, when you did something to make the world better? Is it possible for you to accept your truth, and from the wholeness of self-knowledge, make choices for the coming year?

Focused on the wholeness of our beings, we awaken to another year, rededicating ourselves to strengthen the pattern that we create out of compassion, kindness and love, commitment to social justice, and our intention to make the world a better place for all life.

Shana tova – have a happy and healthy new year.

Magic

2012-06-28T18:53:00.000-07:00

“Star light, star bright,

First star I see tonight,

I wish I may, I wish I might

Have the wish I wish tonight.”

Tonight I wished upon a star, the first that caught my eye when I looked up into the night sky. I recited the verse, long cached in the storage closet of memory, with the ease of repetition, and felt a sense of relief. The worry that had prompted this particular wish was alleviated, at least for now.

We wish on stars, on pennies thrown into fountains, ponds, or wells, on eyelashes blown by our breath from a forefinger. We wish on birthday candles as we blow them out, on breaking the “wishbone”, on rainbows. These are some of the wishing traditions I grew up with, and there are so many different wishing traditions around the world.

We also create our own wishing traditions. When we were children staying with our grandparents in Nogales, Arizona, my sister and I would walk down the 2 hills to school or the library, and as we walked back up the hills, near the top there was a tree stump. We named it the “wishing stump” and always took a minute to take turns standing on the stump to make a wish, before continuing home. One of my friends has named and calls on the “parking goddess” to find a parking place, and I have developed my own version of the “parking goddess” ritual – I think it helps!

Wishing rituals are often outside traditional religions, though there are certainly wishing traditions within religions. In my religion, Judaism, there is a ritual of placing pieces of paper with wishes written on them into chinks in the Western Wall in Jerusalem.

We read all kinds of fairy tales in which wishes play a central part. Sometimes three wishes are granted. Sometimes the wrong wish is hastily made, and sends the story in a different direction. Powerful fairies grant wishes to a newborn baby, as in “Sleeping Beauty”. The central longing in “The Wizard of Oz”, one of my favorites as a child, is the wish to go home.

As modern scientific adults, we often think of wishes as childish and unproductive. However, in actively wishing, we exercise a powerful tool that utilizes practices which are known to benefit physical and mental health. Hope and positive thinking have been studied and found to increase a sense of well-being and alleviate stress. Even the simple act of making a wish helps us to feel more in control, calmer, and without as much anxiety, more able to access creative problem-solving.

Furthermore, we are using imagery, which can positively affect the immune system and many other physiologic processes. The words we say actually can cause the body to activate release of transmitter chemicals and hormones, either harmful or healing, depending on what is said. Consider being in the kitchen, accidentally cutting your arm, calling out, and then someone comes to help you. If that person says “oh my God, I’ve never seen so much blood,” the sympathetic nervous system releases adrenaline, the “fight or flight” hormone, which can cause elevated blood pressure and heart rate, thus possibly increasing the bleeding. If that person says “I’m here to help, the worst is over, relax and let me see your arm,” the chemicals that are released are likely to be parasympathetic, which lower blood pressure and heart rate, which is likely to make it easier to stop bleeding.

Finally, there’s magic. All human cultures have some longing for magic – a way of using personal power to affect what is around you. We live with the reality of events which we cannot control. Perhaps wishing on a star is much more than a ritual of childhood. Perhaps the ability to do so is actually one of the heroic qualities that sustain us. When we really, really wish with all our strength, when we can imagine the future we want so much, and find a ritual into which we can channel our love and longing and hope and dreams, we internalize that hope and find a way to articulate our dreams. At the same time, by speaking the truth of our desires, by acknowledging them, we can unlock the creative thought process that will help us find a way to change or find peace with our lives.

Ray Bradbury

2012-06-21T18:53:00.000-07:00

Ray Bradbury died June 5, 2012, at the age of 91 years. I found out a few days later, in the morning, a snippet of the Times in my email, my thoughts immediately overtaken, remembering stories of windswept landscapes on Mars, and dark warm nights illuminated by fireflies.

Ray Bradbury was an icon to me -a writer whom I read from childhood to the present, whose stories contained elements of science fiction, fantasy, and poetry, who used deceptively simple clear images to portray complex ideas. He had been a friend of my father, Leonard Rosenman, who was a composer, and my mother, Adele Bracker Rosenman Essman. He once inscribed a copy of "Switch on the Night" (about a child who is afraid of the dark): "To Danielle and Gabrielle, who I am sure will never need this book, from a very old man named Ray Bradbury." (Gabrielle thinks he was about 30 years old at the time.) That copy of the book is long lost - but I read a newer copy to my children.

By happenstance, my family was visiting Los Angeles during the week-long celebration of Ray’s 90^th birthday. Gabrielle & Peter, my sister and her partner, took us to two wonderful events during that week. We saw the initial performance of a play he had written, and a screening of the movie, Fahrenheit 451, and I was privileged to speak to him for the first time since I was a child. My son and daughter were able to hear him speak about being a writer. He recommended that anyone who wants to be a writer should write a story every week. He himself wrote every day.

Ray Bradbury wrote about magic in everyday life and the intersection of everyday life with magic, especially the fantastical experience of children. Of course, we didn't call it magic when we were children, and he doesn't call it magic either. The New York Times said that he did not use the "technical jargon" that was prevalent in the science fiction of the day, and this helped his writing reach a broader audience. His writing used the evocative language of the imagination, and reading his stories felt like the images from his words on the page reached directly to me, and activated my own imagination, so that I could see, hear, feel, smell the landscapes and characters in his books.

Imagination is the quintessential human quality, and a longing for magic lives in the deepest part of our souls. Like Ray Bradbury, we may not call it “magic”, yet we find ourselves reaching out with a sense of wonder for that which is mystical, evanescent, transcendental, spirit, essence, God. We find ourselves asking the great questions about the meaning of life: what is the place of humans in existence, who inhabits the next galaxy, what happens after this life is over, and who switches on the night.

So I do not say to Ray Bradbury, “Rest in peace,” but rather, “Rest in wonder.”

A Change of Plan

2012-04-14T22:43:00.000-07:00

Recently I learned that my friend Hester had been suddenly diagnosed with Stage 4 cancer. She had been focused on daily living, her long road stretching out to the horizon, attending to friends, creativity, work, and related pleasures and struggles. Within days, her life abruptly made a hairpin turn into a new path, narrow and poorly lit, and short. One week after I spoke to her, she died.

It is at these times that the veil, which protects us from certain knowledge of our impermanence, draws back and we glimpse the evanescence of all life. This happens rarely for most of us, and we usually focus our attention on the events and circumstances of our lives as if we will always be living, here on this Earth. Younger people, especially, tend to feel personally immortal, even when they know people who have died. At a certain age, that veil becomes thinner, and somewhat frayed. We have family and friends who have life-threatening illness, or who have died. The numbers increase with our own age. It becomes easier to imagine “that could be me.”

Still, the veil is there, even if thinner, and those moments when we recognize the brevity of life disappear back under the veil.

How do we live life fully, completely, inhabiting each moment we are granted? In those moments when the veil is drawn aside, can we still live in the present? Is it possible to do so despite knowledge of what awaits us at the end? Or is the veil necessary, like blinders, to keep us focused in the present? Is this a universal phenomenon, or just a product of our own culture, which keeps illness and death at a distance, and encourages everyone to hold on to the appearance of youth?

Certainly there are other cultures in which illness and death are regarded as part of life in a different way from our own, in which people are cared for at home among family of all ages. Also, there are places where death comes more frequently to people at a younger age, because of infectious diseases, hunger, and war. In these circumstances, there may be very little left of the protective veil.

Though the many religions and spiritual traditions of our world offer guidance, ultimately we each find our own way to co-exist with these questions. Like many of us, I spend most of my time focused on the details rather than the overview. I attend to my family, do my exercises, see my patients, care for our pets, plan and cook dinners, go out with my husband, my attention directed to the events carefully listed, by color and category, on my phone calendar.

These last two weeks, however, my veil has thinned, and I know that, as I go through my day of details, my life, too, could change suddenly and irrevocably. This awareness brings so much discomfort that I immediately turn away into mindfulness practice, name it “anxiety,” and return my attention, not to my breath, but back to the specifics of daily life.

Still, I find my mind meandering at odd times, wondering about meaning. What are humans here for? Why does each life seems so expansive, and yet so brief? When people die, how can they suddenly not be here? What am I here for?

I sometimes see time stretching in a line from the past to the future, or not in a line at all, with everything happening, in some way, simultaneously, and all life connected into a vast web. In some way, everyone who was ever here, is still here. In some way, it is life itself that is the meaning.

Physicians Have a Natural Role as Advocates

2012-01-27T21:45:00.000-08:00

This is an article I wrote that was published on Kevin Pho's blog: KevinMD.com

As physicians, we are often called upon to be advocates for our patients. Sometimes they have no other person to turn to. At those times, in particular, we evaluate their health in the context of relationship, family, and workplace. Having practiced family medicine for so many years, and now in counseling medicine, I have had the responsibility of advocating for my patients with their health insurance companies, within their families, and with their employers. I take this responsibility very seriously. more

New Year’s Resolution

2012-01-25T13:57:00.000-08:00

Tradition asks us to use the onset of the New Year as a time to make resolutions for changing our behavior for the better in the coming year. In fact, making – and breaking – those resolutions is the topic for conversation and news articles every year at this time.

I actually get this opportunity twice a year: January 1, with everyone else, and in the fall during the Jewish holidays of Rosh Hashanah and Yom Kippur, with others of the greater tribe. One would think that I would get used to it, perhaps even good at it – that somehow my resolutions, like the bare root trees of winter, would ground themselves in the fertile soil, and grow strong and leafy, signaling my success to everyone.

Instead, I find myself revisiting the same basic resolutions twice a year (at least!), though the context and details may vary slightly.

So, again, it’s January, and I plan, over this next year, to take better care of myself and to put myself and my own needs, first. Just writing that I will “put myself first” makes me so uncomfortable that I feel compelled to add, “most – or more- of the time.” Then, feeling that I have chickened out, I go back to the stronger statement, and say “yes, I will put myself first.”

Why is this so hard for me that I must resolve, over and over again, to make these particular changes in my life? The concept is not foreign to me; as a physician, I advise my patients not only to take care of themselves first, but how to do it. With this advice, I have told my favorite parable (“Reflections”), familiar to all who travel by airplane, where, at the beginning of each flight, the flight attendant tells the passengers “In the unlikely event that the cabin should lose pressure, and the oxygen masks are released, put on your own mask first, before you help others who need assistance.”

What would it mean for me to put myself first? Certainly, it means prioritizing behaviors and activities which make me strong and diminish pain, decrease stress and make me happy. These include exercise, regular rest, meditation, creative expression, and attentive scheduling. In reality, I actually do these things, but not consistently and not enough.

So it is ironic that I have counseled innumerable people, my patients, through these same lifestyle changes. The results are varied - often people make at least some changes, but sometimes they don’t. Perhaps most of them, similar to my own experience, do take on practices that help them focus on their own health, but can too easily get derailed by the needs of others.

Our personalities, experience, and training influence the direction of attention. Some of us tend to turn our attention first to those around us who are in need. As a woman, a mother, and a physician, my natural predisposition to notice and attend to those in need became more compelling. It is what I tend to do first. It becomes automatic.

The antidote to automaticity is mindfulness. When we notice our thoughts and feelings as they occur, we can recognize that we have options, and choose what to do in that moment. In choosing, we do not react automatically, but thoughtfully. If I plan to go to the gym and exercise, but before I leave my daughter tells me her computer isn’t working and I need to fix it so she can do her homework, my automatic response would be to try to fix the computer because her homework seems more important than my workout. But if I stop and examine my options, I realize that this is the only time today I could go to the gym, that my exercise is very important, that she could clean her room first, or hand-write her work for now, and that I can easily look at the computer when I return, while I rest after exercise.

We don’t usually think about heroes as making choices to care for themselves. Heroes traditionally care for others at the expense of themselves. Yet when we examine the qualities of heroism, we find courage, steadfastness, and the ability to make split-second choices which save lives. The hero does what is right, regardless of the expectations of others.

Sometimes we find the qualities of heroism inside ourselves, and apply them to situations which do not seem like the stuff of legends. Still, they are the same qualities, which we use on a micro-scale every day. With them, we do things to save our own lives, a little bit at a time. In the Jewish tradition, the person who saves one life saves the world.

The Longest Night - Finding Light

2011-12-26T10:34:00.000-08:00

It’s dark – the darkest time of year. Short days and long nights, however cold or warm the climate, evoke the search for light. Many of our traditional holidays at this time of year have imagery of bringing and sustaining light out of the darkness. My own tradition of Judaism builds the light, increasing candle by candle, over 8 nights.

Our DNA fears the dark, prehistoric dangers remembered in the primitive brain. We light fires and candles at this time of year as an anodyne for fear. Imagine our distant ancestors wondering if the sun would really return. Even now, our children often need a nightlight so they can go to sleep.

When we are ill, or in pain, or depressed, or things are not going well, it feels sometimes like being surrounded by the dark - not a warm friendly dark, but rather the dark of winter, cold and bleak. At those times, without even knowing it, we crave the sun’s light – hours of it.

Imagine that inside you, in a safe place, is your own life-giving sun, containing light and warmth. Imagine its rays carrying healing light through every fiber of your being, floating gently, exactly where you want it to be. This lovely sunlight wraps around you, inside and out, completely relaxing you, reminding you of your own well-being, and wholeness. Finding the light inside you can transform the dark of the year into a soft dark, a velvet dark, the dark of being tucked into your own bed by someone you love, and snuggled under the covers. With your own light inside, you are always safe, and all is well.

I wish everyone a New Year filled with good health, happiness, and joy, and always, peace.

Vaccines, preventable disease, and the nature of risk

2011-12-23T14:39:00.000-08:00

This is an article I wrote that was published on Kevin Pho's blog: KevinMD.com

Two nights ago, I was watching, with my family, an old episode of Dr. Quinn, Medicine Woman, in which a young woman is bitten by a rabid wolf, develops rabies, and dies. That same night, I read a post on Facebook decrying the dangers of immunizations, with a link to an online “news” article blaming immunizations for everything from spreading cancer to HIV.

My mother, as a girl, was bitten by a rabid dog. More...

Kinship

2011-11-26T19:09:00.001-08:00

This year we celebrated Thanksgiving with a family dinner at our home, bringing together family from both sides and various parts of the country. This morning I woke up reflecting on families and how we think about them.

Most physicians majored in science as undergraduates in college. I majored in anthropology. A generalist even then, without even the hint of medical school on the horizon, I was drawn to the study of humans, especially within the social and cultural matrix. This gave me license to also take any courses that interested me, which I happily did, including literature, psychology, sociology, the arts, language, and a variety of student-initiated courses through a pioneering and activist program called the Center for Participant Education (CPE), where I was part of the student staff.

In anthropology, we studied kinship, drawing elaborate diagrams of personal connection. It was important to understand that in different cultures, the meaning of family is also different, that the mother's brother might have a role in one culture which the father has in another.

I think that I have always perceived all humanity as connected in a vast web, ultimately kin, though the details at the edges vary in ways that can define separation and difference.

My family has its own definitions. I’m the oldest of three, with a sister 2 years younger and a brother 7 years younger. My parents divorced when I was young. My mother Adele’s family was enormous and present in my life. People traveled across the country to attend weddings, Bar/Bat Mitzvah celebrations, other important life events, and funerals. My father Leonard’s family was distant; his parents were people from whom he escaped as soon as he could, and who, after the divorce, weren’t there at all. Somehow we also lost touch with the rest of his family, though many years later, there was a marvelous reconnection with his brother’s family and his aunt and uncle and cousin. My mother remarried to Phillip when I was 15, and I suddenly had 2 stepbrothers, and there were five siblings instead of three.` My father remarried once, giving me 2 stepsisters, then again, then again, finally giving me a wonderful “wicked stepmother” Judie, and turning me into a “wicked stepdaughter.” My mother and Judie became close, supporting each other through each husband's last illness, and still calling each other "my wife-in-law."

When my mother remarried, she invented a new kinship category that described the relatives of her husband’s first wife, who had died. They became “our third family relatives.” She continued to use that descriptor, without explanation, into the present, as if everyone knows the meaning of this kinship term. My mother also fostered many teens, who came to her for respite and an accepting environment. This included some nieces and nephews as well as friends of friends of her own teens. These latter sometimes became permanent family members, especially Bayla, who we always considered to be another sister.

When I married Steven, not only did we now have each other’s family as our own, we also took on all the official and non-official family that each of us had accrued. Thus, his brother, Charles, became mine, but also his brother-in-law Calvin from his first marriage, became my brother-in-law as well.

There have always been different ways that we have the children that we raise. However they come to us, they are our children, the foundation of our families. We give birth to them, we adopt them, we foster them, we are drawn to each other as adults and adopt each other. Their children are our grandchildren. We also foster, adopt, and choose each other as grandparents and grandchildren.

Often, we become such close friends, that the relationship transcends even friendship and becomes family. This has happened to me, to my husband, to our children, and to so many others.

What is really important, it seems to me, is to acknowledge and cherish our families; however they come to be our fathers, mothers, children, grandparents, sisters, brothers. And then to do so for their fathers, mothers, children, grandparents, sisters, brothers. And moving on and outward through every connection and every generation, until we know without a doubt that we are all indeed part of the same family, connected irrevocably, our fortunes and fates linked forever.

Giving Thanks – Opening to Hope - Making Peace

2011-11-23T11:30:00.001-08:00

My teens remind me that this holiday of Thanksgiving has a checkered past. Its origin reminds us of when the generosity of one people was met with oppression by the other. Yet the tradition of giving thanks for a successful harvest, and later, gratitude for making it through a variety of difficult times, is a long one and is shared by many people of different cultures.

What keeps us going in difficult and challenging times? We are certainly living in such a time now, with widespread economic hardship and disparity. Is there something essential that we can access under any circumstances that gives us strength and brings us peace?

The practice of gratitude allows us to find the beauty in our lives, acknowledge the love we give and receive, and experience ourselves as grounded and balanced. It is not the same thing as being in denial of adversity. It does not preclude realistic analysis of the situation, or take away from tough decision-making and planning. Rather, it helps us appreciate and understand what we have, which is necessary to illuminate our view of the path ahead.

So for me, Thanksgiving is an opportunity for gratitude practice within the context of the greater community. It’s important to know its checkered past, to do everything in our power to transform a history of oppression into appreciation and gratitude for diverse cultures and peoples. And, of course, we celebrate with a great feast of thanks for the delicious harvest.

Two years ago, my son was a junior in high school and studying in Israel for the fall semester. He was about to travel with his group to Poland to study the Holocaust. The parents were asked to write letters which would be given to the students while they were there, for support during a difficult time, while they visited the death camps. I wanted to write something for him about hope, and started writing a poem, but it morphed itself into a poem about bread and peace. I think the two are strongly related, for we must have hope to be able to envision a world in peace.

Recipe for Peace: Bread of the Earth

Take a very large bowl

And put the world into it.

Stir carefully while adding:

-1 measure of pure warm rain

-a double measure of the milk of human kindness

-1 teaspoon of wildflower honey

Sprinkle with your hands full of the leavening of humor.

While it starts to rise

Go away and leave it alone.

Use the time to lie in the sun

With your ancient Labrador retriever,

Arm resting on her lumpy softness,

Her breath whistling in your ear.

After all, DOG IS MY COPILOT.

After she gets too hot, check the bowl.

The bubbles are proof that it will all come together.

Time to add more ingredients, this time by feel:

-seeds of change – be sure to put in enough

-breezes of hope fanned by millions of wings

-a mixture of human endeavor soaked in spirits

-some squeaky wheels liberally greased

-a few salty tears to bring out the flavor

Knead it with compassionate hands,

All the hands around the table,

Each sliding off the others

As the dough is stretched and compressed,

Formed, shaped, irrevocably changed by every touch.

While you are kneading, sing –

Find the notes that bring

The work and the workers together into harmony.

Then – you will know when – rest the dough.

Cover with good intentions.

Use this time to learn someone else’s language,

Talk to a stranger,

Or wonder who lives in outer space.

The time has come.

Now the dough can be brought

Into alignment with the stars,

Shaped into the peace that will perfectly fit

The pan it was meant to inhabit.

Slipping the pan into a crucible

Of uncounted starfire, you wait.

The scent is tantalizing –

It is what you have always longed for,

Yet do not know.

Finally, it is here, in your own kitchen.

And you sit with all the others,

Feeling the purr of your warm cat

Extending her vibration from your lap

Out to the universe,

While inside is Peace.

Danielle Rosenman

c. November 11, 2009

Occupy Hope

2011-11-06T20:35:00.000-08:00

This week Occupy Oakland, in solidarity with the Occupy Wall Street movement, sponsored a General Strike, which culminated in a 2 mile march to the Port of Oakland. I was not there. All that I am, forged in the heat of the protest marches and demonstrations against the Vietnam war, in favor of ethnic studies classes at U.C. Berkeley, in support of the people’s right to the use of land, sent my heart and my husband out to march. My body, constrained by chronic back pain and more recently chronic foot pain, was unable to be there.

Invisible disability is more common than anyone knows. There are so many of us who look just like everyone else, but who live with limitations of physical, mental, emotional, or intellectual function.

Our nation, and indeed the world, is impaired by dysfunction that has been increasing, under the surface of awareness, for a long time. As a society, we have been living with invisible disability. Just as the individual’s unseen disability is so difficult for others to recognize, most people simply have not noticed the magnitude of the dysfunction in social institutions, or its affect even on the people that they know.

Now the dysfunction, the disability, in our nation has become so widespread that it has broken the surface, and everyone can see it. No longer invisible, it affects 99% of the people, and it can be experienced personally with all the senses, and not just seen as affecting someone else. We and our friends are burdened with financial difficulties, worried about caring for our aging parents and getting our youth through college without leaving them crippled with debt. We and our acquaintances are struggling to keep our homes, or have lost them, or never had a chance of owning them. We and our families have lost our savings, or lost our jobs, or can’t get a job. We all know single parents who can’t afford childcare or someone who retired after a full work life who must now try to find a job to pay the bills. Around us, schools and universities and libraries and community centers and services for the aged, ill, and disabled are being closed, unfunded, unstaffed. And, as my disability is something I cannot ignore, that of our society also must be addressed by us all.

If we are to engage with these issues, it helps to understand more about ability and disability. The World Health Organization International Classification of Functioning, Disability and Health (ICF) has updated the discussion of ability and disability. It defines “disability” as “an umbrella term for impairments, activity limitations and participation restrictions.” The ICF emphasizes that anyone can experience disability, which thus becomes a “universal human experience.”

Even more important, the meaning of a disability depends on the context of a given environment. The environment can make a difference between the “level of capacity” and the “level of performance.” If my environment is my home or my office, where I can sit on my reclining chair, I have less back pain, and my “performance,” or what I can actually do, is close to my “capacity”, or what I can do under ideal conditions. On the other hand, if my environment is marching in a demonstration in the streets, my “performance” is less than my “capacity,” and I will have to stop in just a few blocks and go home.

The importance of these definitions is the concept that changing the environment can completely change the meaning of the disability. The word “ability” can be defined as “the power to act.” The previous, or medical, model is to try to fix the disability. As a physician myself, it is always very tempting to put energy and resources into fixing the problem. However, as an experienced physician, I know that this is not enough, and that the results are often limited. The new model is to bring the person with the disability into balance with the environment, by changing the environment.

Now we are in the realm of healing. As physicians, we support healing, which derives from the word for wholeness. As such, we are obligated to attend to the whole person within the whole partnership/family, within the whole community. It is attention to the wholeness of our community, in the broadest sense, which inspires the Occupy movement.

What else does the Occupy movement have to do with healing? I’m not referring to the fact that so many people in this country have limited or no access to medical care, that the chief cause of bankruptcy is medical bills, that people die because they do not have health insurance (I personally have 2 friends whose death certificates should have included the diagnosis “due to lack of health insurance”). I’m not discussing the lack of preventive medical care, which drives up unnecessary health care costs on top of the enormous human costs of illness. I’m not even talking about the differential between the 1% and the 99%, and how the worth of a life and of health is measured in money.

The Occupy movement, grassroots assemblies across the whole country, is composed of a true representation of the 99%, different ages, genders, races, ethnicity, religions, work histories, interests, and ideas. These assemblies promote wholeness, coming together for group consensus decision-making, helping each other with the activities of daily living of a society (housing, food, etc.), and focusing on healing the dysfunction of society as a whole. It is a movement that rejects special interests, has no leaders, and has a single issue:

people together making change, resisting greed, corruption, and the hoarding of resources by the 1%. They are changing the environment in the process of trying to fix the problem.

This movement is our hope. Any physician can tell you that we must have hope to go on, even in the most desperate circumstances. When we have hope, we can tolerate the most difficult treatments, smile despite the pain, and plan for the future, to make a better world for our children’s children’s children.

Living with Invisible Disability - 1

2011-10-30T19:05:00.000-07:00

Isn’t it more interesting to skip around the details of our life stories, to tell the part that seems important right now, without the need for strict chronological order?

Today’s story is about invisible disability, mine, but perhaps it could be similar to

yours.

The short version begins many years ago with a car accident, two months after I got married. We were going to Macy’s to exchange gifts. Another driver turned her car left without stopping or looking, and hit our car in the intersection. I was left with neck and back pain, eventually taking time off work because it kept getting worse, returning to work, and continuing to work, with more or less pain, for many years as a family practice physician. Eventually, over a period of years, the pain in my low back kept worsening, until finally, I couldn’t work as a family physician any more. After a while, I created a transition into a different kind of practice, in which I can use a reclining chair to sit more comfortably, and offer counseling to those who see me, usually people who live with illness, stress, or medical conditions. I feel incredibly fortunate and grateful that I can still use my experience as a family doctor and also my personal experience as a patient.

There are so many of us who have an invisible disability, something that disrupts our lives and causes discomfort or pain, that nobody can tell is there. Sometimes people who are very close to us, family and friends, don’t “get it.” They hear us talk, they know the facts, we tell them the things we can no longer do, but it just doesn’t seem real. Seeing is believing. I have talked with a number of people about how painful that can be, experienced it as well.

We find support from those who see us truly and completely, often our partners who live with us and help us, and from each other.

What qualities does it take to make a good life with a disability, invisible or visible? How do those qualities relate to our search for the hero? Where can we find our inner courage, fortitude, and perseverance, and how can we accept ourselves on the days those qualities seem out of reach? Is a sense of humor heroic?

I’d appreciate your comments…

Ay Chihuahua!

2011-10-21T18:19:00.000-07:00

Meet Laverne. She’s a nine year old Chihuahua, and she is now ours. Yes, my horizons have expanded beyond Labradors despite every expectation of my own or, for that matter, that of anyone I know.

I am well known to be a dog person, and have been all my life, moving from the Collie of my childhood (Lad) to my first Labrador (Chaos), born from my friend’s dog and not quite the right color for a Lab. My next Labrador, Samba, was well-bred and gentle, and by then I knew that if you are to be a dog breeder, you must be very responsible to improve the breed as much as possible. Samba was the perfect mother, and I kept her daughter Cuica, and then Cuica’s granddaughter Clave. Though I really wanted to get a puppy when Clave was 10, because of my chronic back disability, I couldn’t do all the bending and picking up that comes with a puppy, so it didn’t happen. After Clave died, we turned to Rescue, and we adopted our next Labrador, our chocolate, Grace.

Cats came into my life when our daughter was 2. We adopted 2 Abyssinian sisters, Penny and Poppy. Our daughter, Clave, and the 2 cats were all the same age. Penny died some years ago, but Poppy is going strong and is about to turn 16. Two years ago our daughter asked for a kitten for her upcoming birthday, so Mimsy came into our home. So I am a dog and cat person.

However, I have never been a Chihuahua person. I couldn’t even imagine it. So how does a “big dog” person end up with a Chihuahua?

Understanding this transition requires knowing something about our daughter, like Poppy, almost 16 years old. She is passionate about animals, all of them. She believes with all her heart in animal Rescue. As part of her high school, she has been working as an intern at the local animal shelter, and this summer, as I wrote previously in The Summer of Impending Loss, has fostered a kitten (so far not adopted). At the shelter, she was attracted to a small dog in the shelter with her sister. The two Chihuahuas were named by the shelter “Laverne” and “Shirley”, after the TV show. Now, Laverne was being fostered and our daughter asked if we could adopt her. She presented us with a careful and well-written set of arguments why this would be good for her and for our family. We agreed to meet the dog. She was brought over to our house by her foster, who turned out to be an old friend of mine, and someone our daughter knows from the shelter. We were unexpectedly charmed by this very tiny dog who has her own dignity and is calm and affectionate, and not at all yappy.

So that is how we are now a family with a Chihuahua. I feel as though my acceptance muscles have been stretched wider than her 5 lb. frame accounts for. My friend who fostered her told me that she adopts dogs from the shelter that would have difficulty finding homes because they are old or blind or both. I admire my friend and my daughter for their open hearts, their love of animals and willingness to take them into their (our!) homes, and the hard work that this entails.

In thinking about the qualities of heroes, I wonder about love. We are impelled to many acts of courage and selflessness by love. Animal Rescue is driven by love, but it takes many other qualities to rescue and care for animals. It requires that we set our own needs aside to care for the needs of others who are different from ourselves, that we find the special inner vision which allows us to see each life as significant, and most of all, reverence for and fostering of life itself.

He’s Gone

2011-10-17T16:02:00.000-07:00

This was written right after our son left for his gap year in Israel, at the end of August.

My son is gone, having offered himself, arms stretching up to be caught by the enormous silver bird which will fly him to Israel. His room is more than empty, it is void. He considerately put all his things in the closet and drawers. There is nothing on the walls, and only my old copy, loaned to him last year, of “The Folksinger’s Guitar Guide” on the shelves. I appreciated his consideration until the moment when I opened the door, stared at the blank walls, and felt the pain of loss shoot into my gut and twist, thinking “oh no, I made a terrible mistake – I should have had him keep his things out so it would still look like his room.”

Anticipation of pain is not anything like feeling the pain. Expecting to feel sad, I was surprised to feel devastated. Telling myself that he’s alive and well, happy and excited, that I’m lucky in these and so many ways, didn’t help.

So many of my friends - my family - have already sent their young men and women off to college, to travel, to work, to live close-by, to live across the world. Their support and their wisdom wrapped around me, holding me through the first few days which have been the hardest.

There are books and movies and poetry and songs about young people starting their journeys into the future. We don’t hear so much about the journeys of their parents, left behind to face a road that changed while they weren’t looking, suddenly facing a different direction with no signposts or maps.

Now I am half on that different road, with one gone and the other here. And I am looking in a different way at parents who have traveled this road before me. With children, everything is, in some way, related to their presence. When they have gone, and we are without them, the empty spaces in our homes reflect those in our lives and hearts. Eventually, after years of focus on getting our children to the next step, and the next after that, we begin to think about our own future.

Joseph Campbell has written extensively on the mythic journey of the Hero, through a series of stages from the “call to adventure” through trials and important meetings with guides, to a supreme ordeal that changes the Hero forever, ultimately leading to return with inner powers and rewards. When our young people set out on their own, they, too, experience a “call to adventure” which leads them into the lives they ultimately make for themselves.

This stage of the journey for parents is also impelled by a “call to adventure,” but the “call” does not come to us. As the ones left behind, how do we move beyond loss to envision a different direction for our lives? What qualities can we find inside ourselves that help us to choose a direction and start moving? How is the hero inside the parent different from that of the youth?

The Summer of Impending Loss

2011-10-16T15:26:00.000-07:00

As the weather warmed this week in October, I was thinking again about the summer. This was written 8/27/11, a few days before our son left home for a gap year in Israel.

This has been the last summer our son was going to be with us, before leaving the family to go to a gap year in Israel and follow his life. At the same time, our daughter fostered a kitten all summer long, destined to leave her for another home. Every moment of this summer has been bittersweet, knowing that things would change forever at its end. It has also been full, with many long deep talks, and with four of us hanging out around the dinner table until late, enjoying each others’ company. Just as I stand this morning in my bathroom eking out the last drops of hair gel to save every bit, I know that these last 3 days with my son are totally precious; I can’t ever buy any more of these moments, and the ones in the future will never be the same. My daughter and I are united in the anticipation of loss. My husband turns away from it as much as possible to support us all. He spends time with our son watching “Die Hard with a Vengeance.” They plan to bake challah together the last day. For our son it has been the summer of anticipation of a different kind, that of freedom, adventure, exploration, adulthood. He can hardly wait to go, and his imagination explodes with fireworks of possibilities.

For those of us who remain here, in the family home, we are already drawing closer to each other, getting used to plans that are for three instead of four. We have redistricted the lines of responsibilities. We remind him to leave his room clean and spare, so it can be used for…something. We watch him look at everything with the eyes of one who is leaving, we watch him with eyes of the ones who are left.

I remember leaving my mother, my family, to go to college. I could hardly wait. The short distance from the San Fernando Valley of Los Angeles to Berkeley seemed so satisfyingly far away. The unknown was sweet and enticing.

Many years later my mother told me how she made herself wait until I was on the airplane before she cried.

Now my mother lives ten minutes away. She will be with us when my son has gone, coming over for Shabbat meals on Friday nights, asking what we have heard from him. I will turn on my computer to show her his blog from Israel. We will all talk on Skype, but he will not be here to make me feel small against his chest when he hugs me goodnight.

Continuing the Path: Highways and Byways

2011-10-11T13:38:00.000-07:00

Do you remember when girls were overtly discouraged from choosing careers in science? I never thought it was happening to me. I just thought I was bad at science - struggling with poor grades in high school chemistry (completely forgetting I had just completed biology with the highest grade in the class!). And if I couldn’t “do science”, I couldn’t be a doctor. How many of you had an experience like that?

How many of you, as I did, returned many years later to something that you loved, or perhaps went on a different path completely? Many of us discovered eventually that we could do science, or whatever it was we had been told we were no good at. What was it for you? For me, I was shocked, when, after graduating from U.C. Berkeley in anthropology, and then living for a year in an anarchist collective (getting work typing manuscripts for professors), I figured out that I wanted to be a doctor, after all. Two years of pre-med science and four years of medical school later, I was deliriously happy to graduate from medical school. I was a doctor.

I’d appreciate comments with your experiences…

Reflections

2011-10-09T11:41:00.000-07:00

There are times when we stop doing and focus on being. We spend time with ourselves looking inward instead of outward. For physicians this is unlike most of our lives, in which attention, focused primarily on the needs of others, drives us in an often hectic schedule in which any reflection must be fitted into other activities.

Thus we have short times for thinking when we are driving, as we walk from one room to another, as we eat lunch, or in the moments of blessed peace in the bathroom. When we do think, it is still likely about others, about our work as detectives in figuring out just what is wrong and how can we fix it. Sometimes we wonder if we are doing the right thing, or if there is anything else we can do, or if we have made a mistake. Sometimes we agonize over a mistake.

Physicians are trained, sometimes severely, to not think about ourselves. In training, we learn to turn away from our own needs for sleep, food, exercise, emotional support, and time for reflection. We are supposed to be available to work long hours (the number of hours is now regulated, which was not the case when I was in training) no matter what we personally feel. In one extreme example, when I was an intern, the senior resident on call took care of the emergency room in the small community hospital, and the back-up physician was a faculty member who was on call to come in to the hospital when he was needed. One night when I was on call, I went into the resident lounge and saw the senior resident sitting on the sofa with an IV in his arm and a bag of fluid dripping into his vein. He was ill with a stomach virus and was so dehydrated that he needed the IV fluid to be able to stand up. I was shocked and asked why he was doing that, and was told that the particular faculty physician (who felt that residents should work under any circumstances) refused to come in to the hospital, and had told him to use IV fluids and go back to work. The senior resident felt that he had no choice but to do what he was told and kept working. In this way, we acquire the habit of putting our own needs last.

We learn that to serve others, we do not think about ourselves and turn our lives to “doing.” We are tremendously busy; it takes a lot of everything we have to care for our patients. And yet we have so much to think about. When we do stop, and be with ourselves, it takes time to move the focus in, to sit with our breathing and feel the boundaries that delineate who is “me”.

When I stop to think of myself as body-mind-spirit-together, to consider “me”, I create and reinforce a pattern of self-care that spreads out to nurture the wholeness in those around me, including my patients. I believe that when we can see the wholeness in people, and let them see that we see them, they are strengthened and can more readily find their own wholeness. Here is where healing begins.

Another way to think about this is the airplane analogy (one of my favorites - it may come up again). Every time you get on an airplane, you are told that in an emergency, if oxygen masks are released, you are supposed to put your own mask on first, before helping the person next to you.

Many traditions help people stop their usual activity and go inward to care for their wholeness, sometimes during particular holidays, others suggesting more frequent practices. Many people find times for reflection that are unrelated to any traditional practice, and can range from quiet time going fishing, running, doing music or arts or crafts, cooking, or sitting in the sun. I find quiet time for myself in music, meditation, and increasingly, in writing.

In my tradition, this is the Jewish New Year, Rosh Hashanah, the day the world was born, and the Days of Awe, Yom Kippur, in which we stop everything to be with ourselves. This is the time of reflection, when each of us asks ourselves “How did I do last year? Where did I stay on track? Where did I miss the path? What do I need to do in order to find the trail and start again? Where am I going?” And as a physician, “How can I be aligned with the path of service and still care completely for myself?”

And so I am reflecting also on the qualities of heroism, and what we do when we focus our attention inside. The physician is considered a hero for saving lives. But most of us don’t save lives in that dramatic way every day. I wonder if this process is part of what allows us to continue to persevere, to move through our lives with courage, to act from selflessness that actually is based on self-knowledge of our own wholeness.

In Which I Decide to Become a Doctor

2011-09-19T19:15:00.000-07:00

I was 10 years old when I decided that I wanted to be a doctor when I grew up. That was the year when Lucy, from the cartoon “Peanuts”, set herself up to give advice for 5 cents, noting: “The Doctor is IN”. That was also the year when my favorite TV show, “Robin Hood” (with the romantic Richard Greene in the title role), went off the air. It was two years before my mother came down with rheumatic fever and was in bed for a whole year, during which time I helped care for her, and her doctor, who made house calls, taught me to give injections into an orange.

I can’t remember just what it was that prompted me to write in my diary that day, “I will be a doctor when I grow up!” I wanted to help people and take care of them. Nurtured by my hero who “robbed from the rich to give to the poor,” I developed a strong sense of social justice even as a child. A Jewish upbringing and education impelled into my very bones the sense that giving to those in need is not charity, but justice. Living in the shadow of the Holocaust, we knew that during our parents’ lives, six million of our people, along with so many others, were senselessly destroyed, wiping out a whole culture. As a child, I was determined to fight for my life and the lives of others, and never to submit passively to anyone’s destruction. Aware of oppression, my sense of commitment grew as I did, that I would stand on the side of life and liberation, and make a difference with my life and work.

So my path toward doctorhood seemed clear and obvious. I never considered bumps and obstacles that waited around the bend in the road.

What Does it Mean to be a Hero?

2011-09-19T19:11:00.001-07:00

I have found myself thinking a lot about heroes. Who is really heroic? Are heroes born that way, with a Destiny looming ahead? Is heroism a rare thing, the subject of poetry, books, movies, and headline news? Or can anyone become a hero, and if so, how does it happen? Above all, what does it mean to be a hero?

We have seen, in books and film, the Greek hero, often related to gods, who takes on impossible tasks and mythic journeys. Dictionary definitions focus on courage, bravery, selflessness, and valor. They mention sacrifice, fortitude, steadfastness, dedication. Today we think of people like firefighters, warriors, Martin Luther King, Mahatma Gandhi, Mother Theresa. Our kids think of superheroes, like Batman and Spiderman, and anime and manga characters who are larger than life.

Sometimes in the news there is a story about an ordinary person who does something heroic, like rushing into a burning building to rescue those inside. Other stories feature people who, risking their own lives, stop assaults or gunmen. The events of the 9/11 attack and destruction are full of stories of “ordinary” people who heroically moved into danger, risking their own lives to save others.

Turning our attention to the neighborhood or schoolyard, we can see another hero; the person who stands up to bullies or interrupts an unkind or demeaning remark. There are so many people whose quieter courage leads them to confront poverty, oppression, cruelty, injustice, war, intolerance, and apathy, people who are unknown to most of us, who are never in the news.

The hero that interests me the most is the one that can be found inside most of us, if we really look. This hero has all the qualities, including courage, sacrifice, fortitude, dedication, selflessness. The mythic tasks are on a smaller scale, but no less daunting. The journey lasts a lifetime, and there are usually many obstacles, some labyrinths, a monster or two, and numerous bends and twists in the road. It requires everything we’ve got, sometimes including divine intervention, and the reward for each task completed is the next task.

This hero is a parent, a teacher, a construction worker, a doctor. She is an artist, a lawyer, an engineer, a plumber. He is a nurse, a salesman, a musician, an animal control officer. This hero struggles with illness, raising children, saving the environment; with disability, fatigue, discrimination, paying the rent; with surviving abuse, homelessness, and caring for elders. This hero is you and me.