A Smiling Buddha

She sits
like a smiling Buddha.

Brittle diabetes
renal failure,
and malignant hypertension.

She is blind
and last year
the surgeons removed her left leg
due to the ravages
of diabetes.

Still
she sits like
a smiling Buddha.

I ask how she feels,
how she is

Her response:
"Very well, thank you. And you?"

She sits like
a smiling Buddha,
the picture of equanimity.

Her husband flutters
to her side
like a loving butterfly
alighted on her arthritic shoulder.

"How long have you been married?"

"Thirty-seven wonderful years"
is her smiling reply.

"There's our wedding picture
on the wall."

She points.

"You are beautiful," I say.

"We were," she replies.

"Oh, but you still are!" I insist.

She smiles
like a Buddha
in gratitude.

I have seen loving equanimity
and acceptance
in her
unseeing eyes.

She sits
like a smiling Buddha,
the world at her
feet.

Mindfulness Journal: Meditation

Meditation is like watching a riot in my mind. Random thoughts, errant voices, snippets of music---it all rushes into the vacuum created when I close my eyes. At times, a minute or more will go by before I realize I've been sucked into a morass of thought and problem-solving. Then, I have to shake myself loose and start again.

Shunryu Suzuki said that meditation is not about turning off your thoughts. You must simply let the thoughts enter through the front door and exit through the back door without serving them tea. Well, my wholly undisciplined mind not only offers them tea, there's usually breakfast as well. No wonder they stick around.

Yes, there's a riot in my mind, and I guess if I just keep sitting, it will eventually slow to dull roar.

Problems

"When reflecting on our problems, we should include ourselves."

---Shunryu Suzuki

Alone

"What a lovely home you have here," I say as I walk in the front door.

"Thanks. People always say that when they come here." He seems like any other suburban middle-aged man. We sit in the living room.

"So, what's happening today?" I ask as I open his lock box and arrange his morning and evening medications.

"I don't know. Maybe I'll make some calls. Maybe I won't. I don't have a car right now so I don't know what to do today."

"Well, it's a beautiful day out there. Would you consider getting some sun, checking out the flowers and the trees, and getting some fresh air? I see on your care plan that you're supposed to try to go outside every day."

"Yeah, I could do that, I guess. I hadn't thought of that. I'm pretty lonely, too. I've been depressed."

"I think I know what you mean," I reply. (What I want to say is that I've been very depressed myself, but "therapeutic use of self" does not seem appropriate in this situation. There are times like these when I want to explain how depression also frequently has its grip on me, and reaching out---both to people and to Nature---is often my greatest survival strategy.)

"How about this?" I begin. "Make some calls to at least one friend and one member of your family this morning. Then make sure you get outside for a walk once this morning and once this afternoon. Getting out of the house can be really helpful, even if only for a few minutes. The sun feels so good."

"OK. I can do that. Thanks for the suggestion. Should I take these meds now?" He seems confused.

"Yeah. Take these now and take the evening meds with dinner. And I'll leave your meds for Sunday on the table since there won't be a nurse coming tomorrow."

"Oh, that's right," he replies. "Sundays are hard because nobody comes over. It can seem like a long day, especially when I don't have a car and it's so far to town."

"Well, remember we talked about making those calls today? Maybe there's someone who can come see you tomorrow, especially if they know your car is broken down."

"Hey, that's right. Why didn't I think of that? I'll make those calls as soon as you leave." A smile passes across his face, then disappears. By the time we reach the door, he's smiling again.

"Thanks so much for the visit," he says, shaking my hand warmly. "I feel a little better now."

"So, you'll do some good things for yourself today?" I ask in parting.

"Oh, yes. Absolutely. You can bet on it."

I get in the car and put the key in the ignition. Looking in the rear-view mirror, I see that he has walked over to the garden and is leaning on the fence, looking out towards the hills. The sun is bright and there are a few horses in the fields beyond his house.

My prescription for him was no different than what I tell myself, and in the face of depression and the sense of isolation that often accompanies it, there's no telling how effective those interventions will be. When it comes to the mystery of our minds and the solitude we each experience within our minds, no one can offer an explanation that will wholly satisfy us.

Some of us are blessed with an inner equanimity free of depression and isolation from others. Some of us---myself included---struggle with the demons of depression and other mental afflictions that bog us down and cloud our thinking. Depression can short-circuit decision-making and cause us to pull away from those we love just when we need them most.

And what about my admonition to my patient to call friends and family and get outside in the sun? It was like I was talking to myself.

Desire and Happiness

Whatever joy there is in this world
All comes from desiring others to be happy,
And whatever suffering there is in this world
All comes from desiring myself to be happy.

SHANTIDEVA

Rural Health Care: A Few Thoughts

Having just interviewed for a position with a home health agency whose territory covers a large swath of rural countryside, I am appreciating the challenges and difficulties of delivering care in such a setting. Whereas the city---where I currently provide home health care---finds patients in an area of high population density and relatively close geographic proximity, serving patients who live in mostly single family homes in far-flung sections of the countryside is an entirely different story.

When considering such matters, I recall how Dr. Paul Farmer, the founder of Partners in Health (recently featured on "60 Minutes"), created teams of trained lay outreach workers to bring care to patients living in rural isolation.

Native American reservations face great challenges when it comes to the delivery of home health care. The Center for Rural Health at the University of North Dakota School of Medicine use their resources to drive policy and develop care models vis-a-vis rural health and the delivery of medical care in rural areas.

Even the Health Resources and Services Administration of the U.S. Department of Health and Human Services has an Office of Rural Health Policy that strives to improve rural health care around the country.

It is now an accepted fact that physicians are leaving primary care and family practice in droves as specialization becomes the ultimate goal. More and more medical students choose specialties other than primary care as the cost of medical school skyrockets and the subsequent debt after graduation becomes even more astronomical.

While much is written about a nursing shortage which is feared to be worsening by the day, a physician shortage--especially of primary care physicians---is also taking hold, and one can easily extrapolate that any nurse or physician shortage is bound to have a devastating effect on rural health around the country. Many articles recount how doctors are in high demand, and strategies to lure health care workers to rural areas are discussed in stories and reports from Australia, Norway, and elsewhere.

Rural health is a subject which has never captured my imagination, yet today's interview and a few clicks of the mouse were enough to make me dig just a little deeper. While strategies and policies to offset the growing national shortage of nurses and doctors are developed and implemented, those living in rural areas are sure to be hoping that they don't get left in the proverbial dust.

Definition and Redefinition

Working a few hours at the community health center in the city yesterday was a good reminder of the things I do and don't like about my current career trajectory. Spending a half-day helping out in my old office also solidified those stark reminders of why I eschewed full-time work four months ago.

Quietly observing my colleagues, I watched as everyone seemed to be running around in circles of frustration and habituated action. Paperwork flew as harried notes were written and typed, prescriptions proffered and recommendations made. Med refills, telephone calls, follow-ups, appointments and prescriptions devour the minutes of everyone's day, and I certainly did not see many happy faces in the course of my work day.

Driving home, I remarked to my wife Mary how I do indeed miss intellectually stimulating interactions with my favorite doctors, and I also do sincerely miss some of the personal connections that I had with a few very special patients. Still, that life now seems to be fading further, and I practice letting go over and over again when I pass through the office or the health center as a per diem nurse. It is a deeply personal process, and my own self-definition is still very much in flux.

As I try to define who I am professionally in the world---nurse, healer, writer, blogger, consultant---I'm struck by how those definitions themselves feel limiting. My identity as a nurse is still quite firmly front and center, and "writer" now feels more real than ever. But there is more to me than those two words, and this mid-life period of redefinition (but not "crisis", mind you!) is a rich time of seeking and asking. As for the answers, they are slow in coming, and the more I grasp for them, the further away they seem to recede.

During the Dream.....

Always recognize the dreamlike qualities of life and reduce attachment and aversion. Practice good-heartedness toward all beings. Be loving and compassionate, no matter what others do to you. What they will do will not matter so much when you see it as a dream. The trick is to have positive intention during the dream. This is the essential point. This is true spirituality.

CHAKDUD TULKU RINPOCHE

National Nurse's Week

In recognition of National Nurses' Week (officially May 6th to May 12th), I want to take a moment to honor the approximately 2.9 million registered nurses who provide skilled and compassionate care to millions of Americans day in and day out. Nurses are an essential component of the healthcare system, and this week is simply an opportunity for recognition of a body of individuals whose work is essential to the health and well-being of so many.

Expanding that notion, I would also like to recognize nurses worldwide, my professional brethren with whom I am connected through our mutual dedication to service and nursing care. All too often, we focus too keenly on our own community or country, losing sight of those in lands beyond our borders. Nurses and other healthcare workers labor each day in refugee camps, on battlefields, at the site of natural disasters, and on the streets of cities the world over.

Many blessings to my fellow nurses, and to anyone and everyone who has ever taken a moment to help another sentient being. May we all be free from suffering.

Mindfulness Journal: Notes on the Mind

My mind—an undisciplined animal running amok---brings me little comfort. I need to lose my mind. I need to be set loose from my mind. I need to realize that I am not my mind. Not my mind? Lose my mind? Or perhaps loosen my mind?

I feel sad that my mind has its way with me so much of the time. It roams freely—perhaps too freely---dragging me violently along, the way a child will pull a puppy down the sidewalk against its will.

Sitting for five or ten minutes at a time is enough to give me pause, to realize the wild untamed nature of my mind.

I need a retreat.