Monday, April 30, 2007

Article on Multiple Chemical Sensitivity

Dear Reader,

Please follow this link to a fairly comprehensive article which I recently published on Nurse Linkup vis-a-vis Multiple Chemical Sensitivity (MCS).

As a nurse with MCS, I feel it is my duty and responsibility to educate other nurses and healthcare professionals about MCS, and to advocate for the accomodation of patients with MCS and related illnesses when they encounter the healthcare system. Although the article is specifically targeting nurses, it is very readable by the lay public. As far as I know, Nurse Linkup does not require membership or a log-in process in order for non-members to read articles. If you have any problem accessing the article, please email me (nursekeith@gmail.com) and I will happily email the article to you forthwith.

Sunday, April 29, 2007

Darfur Die-In Report

The Darfur Die-In, Rally and March on the Boston Common today was an inspiring and powerful event, with moving speakers and an enthusiastic crowd of several thousand. As always, yet another sociopolitical movement is to a large extent powered by students---both high school and university---who use their burgeoning social and global awareness to focus their energy where it is needed the most. This is truly cause for hope.

As I have related in a previous post, the non-profit healthcare company for whom I work offers a 401(k) through Fidelity, a company which is the largest holder of stock in PetroChina. Chinese petroleum companies are the economic fuel for the Darfur conflict, purchasing the oil which the Sudanese government sells on the world market to finance its campaign of genocide. The task at hand is to convince my company to divest from Fidelity completely and offer us a socially responsible investment alternative. Failing that, I will convince as many of my colleagues as possible to pull their money from the 401(k) plan, despite the personal financial loss which that will entail. We all choose our battles in life quite carefully, and this is a fight which calls my name.

If you have not done so already, please visit this link to read about Fidelity's economic link to the Sudanese genocide, sign the petition to call for Fidelity's divestment from PetroChina and Sinopec, and consider calling Fidelity yourself to voice your demands. Whether you are a share-holder or not, you are certainly a share-holder in the human race, and our Sudanese brothers and sisters are being raped, slaughtered, or rendered homeless by the atrocities perpetrated by the Sudanese government and militias.

Having called Fidelity and registered your displeasure, you may want to research whether your state or province has already divested from Sudan. Fourteen states within the US have done so, as have dozens of colleges and universities, including Harvard. Consider whether your local institutions of higher learning have understood the implications of where they invest their money. Finally, consider examining your own mutual fund investments, understand where your money is going and who is benefiting from your savings, and to what end those funds are being utilized. Socially responsible investing is possible, and groups like Domini and Calvert have already paved the way in that regard.

The first genocide of the 21st century could be the last. Putting our money where our mouth is must be a crucial step on the road to peace in Darfur.

Saturday, April 28, 2007

Darfur Die-In and Rally: Boston, April 29th

If you live anywhere in the vicinity of New England, please consider coming to the Boston Common tomorrow---Sunday, April 29th---for a Die-In, Rally, and March for Divestment as part of the Global Days for Darfur campaign. The event's specific website can be accessed here or here.

We will be traveling some hours to Boston to in order to participate. If you are unable to do so or live in another region of the country, please check here for events near you. If you live outside the United States, please use your favorite Internet search engine to find events in your area.

The Darfur tragedy is the first genocide of the 21st century. Let's make it the last, ever.

Friday, April 27, 2007

A Birthday Story

I recently paid a visit to an elderly woman for whom I served as a visiting nurse some years ago. We are still friendly and I check in on her from time to time.

Sitting on the side of her bed, I learned that her 74th birthday was only days away. I wished her well and I was somewhat surprised by her response.

"I hope that this will be my final birthday."

"Your final birthday?" I placed my hand on hers.

"Yes. I hope Jesus will take me. I'm ready to go. It's been a hard life." She crossed herself and fingered her rosary that never leaves her thin and fragile neck.

Of course, I could have responded like many people would, especially those for whom death is a failure, a sign of weakness. But instead I chose to meet her where she was.

"If that's what you truly want, I'll hope that for you, as well. But I would really miss you."

She grabbed my hand and pulled me close to her. Then we sat in silence, looking at the shrine in her room: the Virgin Mary, several crucifixes, a incongruous plastic dog and toy car, and other Catholic items of worship and devotion.

"Do you feel you've had a good life?" I asked.

"No," she replied. "It has been a life of misery, suffering, and hard work. Now, I'm too sick to even enjoy my years of rest." She folded her hands in her lap in resignation.

"Don't you enjoy your children and grandchildren?"

"Not really,"she replied. "I'm just in too much pain. I'm ready to go. I've almost died a few times but He always sends me back. I've had enough."

We hug goodbye. I kiss her on the cheek and playfully touch the end of her nose with my index finger. She smiles and girlishly wrinkles her nose and eyes. I note to myself that she will turn 74 this week, the same age as my vibrant and healthy mother. Oh, the ravages of poverty and deprivation on the human body and spirit!

Getting into my car and returning to the clinic, I'm glad that I didn't try to talk her out of her feelings or deny her desire to "finish up" and move on. At her age, after all she has been through, she deserves to welcome death if she so desires. Is it geriatric depression? Likely so. Is it treatable with antidepressants? Possibly. Should she be treated? It is debatable on many levels, and she would probably decline treatment anyway. A tough sell, at best.

So, happy birthday to my little friend, even as she hopes for an end to the succession of the years. Perhaps her wish will come true, or perhaps her Jesus has other plans. At any rate, when she finally gets to meet her maker, I'll rejoice for her and send her blessings on that joyous journey home. Until then, may her days be brightened by the small things which can mean so much: a smile, a kind word, a caring touch, a shoulder upon which to rest her weary head.

Thursday, April 26, 2007

Darfur, Money, and My Conscience

Here is the text of an email which I sent out to all of my coworkers and colleagues today, including our non-profit corporation's CEO and CFO:


Dear All,

It has come to my attention that Fidelity, the company through whom we are all investing in our IRA’s, is heavily invested in two Chinese companies----PetroChina and Sinopec---which are directly feeding the economic forces causing the genocide in Darfur, Sudan. For those of you not familiar with the Darfur situation, here is a brief snippet:

  • Sudan and its government-sponsored Janjaweed militia have committed pervasive violations of human rights in Darfur, Sudan, since early 2003, earning the designation of the first genocide of the 21st century.
  • The atrocities taking place in Darfur, Sudan, have been identified as genocide by unanimous declaration of Congress in July 2004, by two Secretaries of State, and by the President of the United States.
  • The genocide in Darfur has resulted in the deaths of hundreds of thousands and the displacement of millions of Darfurians, and is continuing to claim victims.
  • There is a well-established link between the oil industry in Sudan and the revenue of the Government of Sudan which overwhelmingly goes to increased arms and funding of the genocide in Darfur.
  • Fidelity, through its mutual funds, not only has been a major investor in two of the largest oil companies operating in Sudan, PetroChina (through its parent CNPC) and Sinopec (aka China Petroleum), but it has been significantly increasing its holdings in these tainted companies.
  • Fidelity is the largest holder of PetroChina on the New York Stock Exchange. Counting Fidelity's holdings around the world, Fidelity owns 5% of the outstanding shares of PetroChina, worth $1.3 billion, as of their February 14, 2007 SEC filing.
  • PetroChina's closely related parent, CNPC, is Sudan's largest partner in the oil industry there. We hold PetroChina accountable, just as we would CNPC, since the "separation between these two companies is largely cosmetic" and they "should not be rewarded" for creating distinctions on paper to obscure their connections to the genocide.
  • US law prohibits American companies from doing business in Sudan, yet Americans are legally able to invest in foreign companies operating in Sudan. Over the last two years, many large investors, including US colleges and states pension funds, have made the responsible decision to divest from PetroChina and Sinopec.

I have spoken with Fidelity representatives, and they report that no official statement has been made by Fidelity as to whether the company will divest from companies which fuel the genocide. In fact, Fidelity’s holdings are increasing as other companies divest from Sinopec and PetroChina.

For myself, I have a rollover IRA which is invested in the Domini Social Equity Fund, a socially responsible mutual fund which does not invest in companies with poor records vis-a-vis human rights, workers rights, environmental practices, the military-industrial complex, etc. However, Fidelity still earns money on my investments with Domini, something with which I am increasingly uncomfortable. However, my bi-weekly deposits of money from my paycheck do indeed go into a Fidelity Freedom account, and this is even more unfortunate.

So, in a perfect world, Fidelity would divest from PetroChina and Sinopec and we could all leave our money where it is without another thought. I doubt that will happen. In the next perfect world, our company would change plans (or offer another choice) and we could all have the option of leaving Fidelity. In the worst scenario for me, I will stop my voluntary contributions, withdraw my money from Fidelity, and open my own IRA, therefore losing the benefit of employer contributions. I assume that the last choice may be the one I will be forced to make.

If anyone would like more information or would like to follow up with me, please let me know. At the very least, I urge everyone to visit this link to read about Fidelity’s involvement and sign the petition to Fidelity. On Sunday, Mary and I and our son will travel to be at a massive demonstration on the Boston Common (partly organized by my niece, a student at Tufts) against the genocide in Darfur, followed by a march to the Fidelity offices downtown.

Thanks for your attention to this email which turned out to be longer than anticipated, and see me if you would like any more information.

Keith

Troublemaker-in-Residence

Wednesday, April 25, 2007

The Never-Ending Story

"What usually keeps you from taking your HIV meds?" the doctor asks. We sit looking at her.

"When I start using drugs again," she says, unblinking, holding my gaze.

"And how can we figure out when it's time to try again? Do you feel like you might be getting ready to give it another chance?" The doctor and I exchange glances.

"Oh yes, I'm ready. If you want to try, I want to do it. I know it's important."

I know she's sincere, but we've been here so many times. Once, she almost died from liver failure from her meds, a negative side effect of adherence. Another time she had toxoplasmosis (a brain infection) so bad she had a seizure, and that was because she wasn't taking her meds. Talk about a double-edged sword.

The doctor gives her the rest of the spiel. "You understand that without the prophylactic meds, you could get very sick or die from an opportunistic infection. If we can get you back on HIV medication, those infections are no longer a worry. But you have to stay clean and on the meds."

She's a very sweet person, and we've worked together for six years. I think we really admire one another. I've brought her kids Christmas presents. I bought her an alarm clock so that she would wake up in time to get her kids up for school since they were truant more than 100 days last year. I think she sold the alarm clock. She also sold her grown daughter's TV and DVD collection.

The doctor asks some more questions.

"Do you have a partner, spouse, or husband?"

"Yes, my husband."

"Does he know your diagnosis of HIV?"

"Of course, yes."

"Do you use condoms when you have sex?"

"No, never. He doesn't like them." She looks gravely at the doctor.

I chime in. "So, even though he knows he's at great risk of infection with HIV, he won't protect himself?"

"We've been together so long---more than twenty years. That's the way he is."

"Has he been tested?" the doctor asks.

"He won't," she says. "He doesn't even go to the doctor."

We end the interview and send her to the lab for the bloodwork. Sitting down with the doctor who is a second-year resident doing his Infectious Disease rotation, we begin discussing the case with his preceptor, an Infectious Disease Fellow at the hospital.

The preceptor says, "Haven't I heard this story a thousand times before? Cocaine, unprotected sex, avoidable opportunistic infections, virus out of control?"

"Probably ten thousand times," I say. "It's the never-ending story."

And so it goes.

Tuesday, April 24, 2007

Impermanence

To contemplate impermanence on its own is not enough: You have to work with it in your life. Let’s try an experiment. Pick up a coin. Imagine that it represents the object at which you are grasping. Hold it tightly clutched in your fist and extend your arm, with the palm of your hand facing the ground. Now if you let go or relax your grip, you will lose what you are clinging to. That’s why you hold on.

But there’s another possibility: You can let go and yet keep hold of it. With your arm still outstretched, turn your hand over so that it faces the sky. Release your hand and the coin still rests on your open palm. You let go. And the coin is still yours, even with all this space around it.

So there is a way in which we can accept impermanence and still relish life, at one and the same time, without grasping.

---Sogyal Rinpoche

Monday, April 23, 2007

Telephone Triage

A few choice snippets from some recent telephone triage. No judgment. Just reportage....

"I'm moving to another apartment and I think I threw away my Oxycontin. Can I get another prescription?"

"It feels like a ball in my esophagus."

"I was at the ER 'til four this morning because my daughter was sick. Now I can't breathe and my back hurts. What should I do?"

"That spot on my leg? It's really red and swollen and it hurts when I walk."

"I just can't do this anymore. I do everything alone. I have no friends since I quit drinking. I just wanna die."

"Yeah, I had intercourse with this woman that I'm falling in love with, and she doesn't know I'm HIV positive. Then I had this discharge from my penis but it went away. Should I worry about that?"

"I'm really stressed. I got this job, and taking care of my brother on top of that, plus the gas company cut us off three days ago. But at least my divorce is final."

"I feel so sick. I'm throwing up, my back hurts, I can't pee, I have diarrhea, and my head hurts so bad. Plus I'm all alone. Can you bring my meds over?"

"Keith, I just don't know what to do."

Sunday, April 22, 2007

Transcendent Moments

Last night, Mary and I went to a very interesting venue---an art gallery in an old granite bank---to hear a jazz sextet visiting from The Manhattan School of Music. It was truly a transcendent evening of music. The compositions and performances were rich, textured, and just challenging enough to keep me on the edge of my seat and listening actively and attentively, but with enough melody to hang onto and stay grounded. The moments of atonality and dissonance were very much balanced with moments of resplendent melodic beauty.

The ultimate moment of the evening came about half-way through the performance. I moved my chair quite close to Mary's, and we sat quietly listening together, each in our own worlds, but certainly joined in the same sensual experience of listening to the music and watching the musicians, one of whom we have known since he was a little boy. At a certain point, we leaned our heads together, our index fingers meeting quite subtly as our hands rested on Mary's right leg. I turned my face into her hair and simply rested there. The familiarity of her physical proximity and warmth, coupled with our simultaneous but separate enthrallment with the music, was a moment of such beauty and subtle intimacy. Those few minutes were truly a golden moment for me out of our eighteen years together. It was a demonstration of the simple but powerful oneness that can be experienced by two people who have been together long enough to be so energetically united. There were no words, nothing to convey, apart from the pressure of two fingers touching, the closeness of one another's aura, and that feeling that someone you love is present with you, along for the ride, and taking in the exact same experience in her own unique way.

Transcendent is the right word to describe that experience. And gratitude is what is felt so deeply for having lived it.

Saturday, April 21, 2007

Cultural Richness and Gratitude

Saturday afternoon, the sun slowly receding behind white clouds after a day of brilliant sunshine. Our Tibetan neighbors are having a gathering/party at their home. Prayer flags wave over their yard as the kids play basketball in the driveway.

Suddenly, the basketballs cease their bouncing as traditional Tibetan drumming, dancing and singing commences right in their driveway, some of the crowd seated in the open two-car garage. We can just make out the dancing figures through the trees, their house being about one-hundred yards from ours.

Depending on the wind, we can often smell the traditional sweet grass being burned during the prayer services often held outdoors in this quite suburban setting.

With a considerable number of resettled Tibetans in our area, this type of scene is quite normal and very welcome, bringing diversity (that overly used American word) and a sense of something other than bland, white middle-class America. Similarly, where my brother and his family live in New Jersey, Asian Americans and East Indian Americans abound, bringing the quality of food, intellectual promise, and culture to a whole new level.

Lacking such cultural richness in my own life, I am moved and curious at how these families manage to maintain their unique cultures amidst the tumult and relative crassness of American life. Their tenacity in holding onto their cultural roots and practices seems so much stronger than the relative assimilation of my Eastern European Jewish ancestors. While I acknowledge that I could have tried to retain my family's ancient culture myself, by the time I was old enough to consider doing so, I was already two generations removed from any such practice. And so it goes. I am always impressed when young people from other cultures choose to participate and continue traditional practices and languages even as they adapt to life in America. Their lives are only enriched by such an effort, and the rewards are myriad, I'm certain.

Having such a sweet celebration take place so close to our home is a reminder that we live in a society of rich multiplicity, and for that I express my appreciation and gratitude.

Friday, April 20, 2007

Passing the Gauntlet

Oh, Friday afternoon it was, and I waited with impatience for that clock to strike five pm. As that blessed minute hand reached twelve and the workday ended, so too ended my responsibility to answer calls and pages, to attend to further requests. With the tentacles of need being cut and the encumbrance of accountability relaxed, the stethoscope was stowed in the bag, the notes were filed, the charts returned to their proper place, and the report submitted to the nurse whose job it will be to answer urgent calls all weekend. It is certainly a satisfying gauntlet to pass!

While they may float through my mind over the next few days, I can rest in the fact that I have done my best and they can fend for themselves. The one with the abscessed injection site, the poorly controlled hypertensive, the woman who can't urinate, the other who's been vomiting---they have access to a phone, to an ER, to their own powers of self-care. I relax my grip, unwind the wound up brain, put the nurse-mind to sleep (or at least temporary suspended animation).

Now is the time for focus on the self, my own needs, my own desires, the needed rest of body and soul. A deep breath from which to drink deeply.

Thursday, April 19, 2007

Me, My Pain, and a Hangover

Remember those silly t-shirts that said, "My parents traveled to (name of city) and all I got was this lousy t-shirt"? Well, my body and brain are saying a similar thing to me this morning: "Our resident mind decided we needed a muscle relaxant last night and all we got was this lousy hangover".

My back was killing me last night, even after a Neuromuscular Therapy appointment, an hour on the TENS unit, and a little more bodywork by Mary in the evening. So, I took a muscle relaxant to decrease the muscle spasms in my lower and mid back, and hoped that I perhaps might sleep through the night, something I haven't done for weeks now. Sadly, I still awoke at 2am, did yoga for twenty minutes, subsequently removing myself to the downstairs bedroom for the remainder of the night. Did I sleep? Yes, with continued discomfort, and awoke with a brain filled with stuperous cotton candy, awful cotton mouth, and a body ready for nothing but lethargy. I had to laugh, knowing that today would be a 12-hour workday, with per diem home visits from 7:30 to 9:00am, regular job from 9 to 5, and evening clinic from 5 to 8pm. Amphetamines, anyone?

That said, my day today has been spent assuaging the pain of others, obtaining narcotic scripts for chronic pain, giving attention to others' aches, pains, and complaints. Sometimes, based upon my relationship with a patient, I might decide to share with them my own struggles with chronic pain if I feel that my personal disclosure would be of some benefit. More often than not, though, I realize that I, as a working professional, have access to many other treatment choices (ie: massage, neuromuscular therapy, acupuncture, a gym with a pool), and thus the disclosing of my own struggle could, in fact, elicit envy in my patient rather than my intended purpose of commonality. Therapeutic use of self is a tender beast.

Speaking of tender beasts, my back twinges and aches now as I type. Non-steriodal anti-inflammatories (NSAIDs) like Tylenol, Motrin, and Aleve do nothing. Massage seems only to scratch the surface now. Trigger-point injections did almost nothing, and a spinal injection yielded less than two weeks of moderate relief. Where to turn? My patients take narcotics for chronic pain: Oxycontin, oxycodone, Fentanyl, Percocet, Vicodin. I'm just not willing to go there. So, here we are, me and my pain. Oh yeah, and the hangover, too.

Over time, pain becomes part of the physical and psychological landscape, like the feeling you have being in your own skin, or the familiar brush of one's arm against one's side. Pain becomes an appendage, something that's just there, like an extra limb growing in the wrong place. It becomes difficult to even imagine what it was like to not have this pain. Was there even a time when it wasn't there?

So, when my patients complain of pain and ask for meds, I serve them as best I can, knowing full well that those meds may mask the pain to some extent, but the underlying pathology---if one can be discerned at all---often remains a mystery. Even those with correctable pathologies---a herniated disc, for example---may find little or no relief after spinal surgery, the pain sometimes even worse than before their operation. Sadly, there are many cases where the cure indeed seems worse than the disease. And then it's too late.

For now, I grin and bear it, laugh if I can, and try to make friends with this ache that just never seems to go away. If you, dear Reader, suffer from a similar chronic and recalcitrant affliction, welcome to an enormous club. Membership is free, of course, but the price you will pay is dear.

Wednesday, April 18, 2007

Socks

Just this morning, one of my colleagues (a PhD-level Clinical Psychologist) said, “I think a person’s well-being is generally influenced by whether or not they’re wearing the right socks.”

What influences your day and determines its trajectory?

Tuesday, April 17, 2007

Thirty-Three

Thirty-three dead. Precious lives were lost, the violence fueled by handguns so easily acquired. The parents of most college students around the country feel less secure today, less certain, less trusting.

Lives are shattered around the world each day: in Iraq, Palestine, Israel, Colombia, Mexico. Today it's our turn to once again acknowledge that suffering, loss and death are universal and know no borders.

May all beings be free from suffering. May all beings be at peace. May those who mourn find comfort.

Monday, April 16, 2007

Nurse, Heal Thyself

Please surf over to Nurse LinkUp to read my latest blog post on that site regarding nurses and their proclivity to eschew timely and healthy self-care.

My first article on Nurse LinkUp (on Multiple Chemical Sensitivity) is due to be published soon. Stay tuned.

Sunday, April 15, 2007

Laughter Yoga---Let it Begin!

It's done. We inaugurated our local Laughter Yoga Social Club with a small group of friends here in our home this afternoon. As the rain and snow soaked the New England ground outside, we were warm and cozy in our (currently tenantless) basement apartment, laughing and giggling together, ending with a wonderful meditation led by Mary. It was a truly empowering and liberating experience to actually lead a successful session of Laughter Yoga for the first time since our leadership training.

Many smiles and laughs later, blood pressure lowered and internal organs massaged, participants and leaders alike finished the session healthier and happier than when they started. After our session, watching videos of Laughter Yoga in India on YouTube---in parks, in factories, in prisons---it's apparent that we've really discovered a simple and powerful tool which can be brought to many people so very easily. The vision---laughter in hospitals, schools, nursing homes, prisons, businesses---seems so unassuming, yet the potential impact is truly beyond measure.

Saturday, April 14, 2007

Golden Moments

A tool as powerful as the mind seems so readily hijacked by random thoughts and emotions. When one turns one's focus from the present moment, turning the gaze towards the past or future, an emotional derailment is all too easily experienced. So many spiritual teachings consistently guide us to remember that lingering over the past or future---either in regret or in fear---will most likely lead to suffering.

For example, if one is precluded from eating a particular food due to a newly discovered allergy or sensitivity (like a particular nurse I know all too well), feelings of lack result. Such mental concentration on what is lacking strongly derails the mind from enjoying the present moment, detracting from real-life experience as the thoughts focus on something that is actually an illusion. A losing proposition all around.

Remaining aware of the current moment is paramount, something which the poorly controlled mind will labor to hijack, often with great success. I write these words entirely for myself, for I am guilty of missing out on the present moment so very often.

But here we are again, and that golden moment is back to savor. Am I up to the task?

Thursday, April 12, 2007

Thinking Blogger Awards

Several weeks ago, I was honored to be tagged for the Thinking Blogger Award by both Nurse Ratched and N=1 over at Universal Health. Continuing this "meme" has been on my back-burner, so to speak, and I am finally taking the time to fulfill my commitment to continue the tradition.

The participation rules are simple:

1. If, and only if, you get tagged, write a post with links to 5 blogs that make you think,
2. Link to the original post which gave birth to the awards so that people can easily find the exact origin of the meme,
3. Optional: Proudly display the 'Thinking Blogger Award' with a link to the post that you wrote (here is an alternative silver version if gold doesn't fit your blog).

(Due to my negligible skills with html, I cannot figure out how to display the award, but at least I know I received it and can tell you about it in words.)

Now, for the real work at hand: choosing my five honorees. While Nurse Ratched charged her honorees with choosing five blogs in the nursing/medical blogosphere, I am choosing to abide by the original rules which does not designate a specific category of blogs from which one must choose. While this is a difficult choice to make, my five choices are:

1. Death Maiden: while Death Maiden has not been posting recently, her blog is a veritable treasure trove of thoughtful musings on life and death.

2. Graceful Presence: a blog reflecting Buddhist thought and wisdom from a personal perspective. Simply lovely.

3. The Happystance Project: Tony Plant's UK-based blog promoting his outstanding work and outlook vis-a-vis the spreading of happiness for carers and caregivers worldwide.

4. Adventures with Multiple Chemical Sensitivity---Tales of the Masked Avenger: the Masked Avenger is my hero. She confronts MCS head on---with no apologies---and paves the way for all of us who live with MCS and related conditions. Give that woman a gold star (and a chemical-free world)!

5. Donor Cycle: TC over at Donor Cycle writes about her life as a Transplant Coordinator, an often thankless job which saves lives most every day. She is a hero in my eyes, and worthy of recognition for her work in what some may consider a subterranean sector of healthcare.

Those are my choices, folks, a diverse grouping which encompasses healthcare, Buddhism, chemical sensitivity, and the proliferation of happiness among caregivers. Please pay them a visit, and decide for yourself if these writers set your mind to work.

Blessings.

Wednesday, April 11, 2007

Laughter, Depression, and Healing

Having completed training to be a Certified Laughter Yoga Leader, it is now my conscious intention to use laughter as a means for healing. While it would be easy to simply focus my intention on others, the admonition of "Healer, heal thyself" calls to me loud and clear. Actually, it veritably screams for my attention.

The myth and legend of "the wounded healer" has a long history, and I admit that for some years I have operated frequently on this level. When one is moved to dedicate one's life to the healing and well-being of others, I believe that one's overall effectiveness in that endeavor is directly proportional to the amount of self-healing and actualization which one can manifest along the way. Intending to bring laughter, joy, or healing to others, one's own demons must concurrently be grappled with (and perhaps occasionally subdued).

Healing is a life-long process. Wrestling demons to the ground is one thing, but what is to be done with said demons once they are prone? My long-time companion of depression has played the role of monkey on my proverbial back, sheltering friend, escape, crutch, affliction, and unwanted appendage. Descending as a fog, a screen through which the world is filtered, depression is like a miasma of suffering and darkness that blankets one's world like an ashen snowfall. The world becomes muted, cloaked in gray, bereft of joy. Can this companion be left behind or cast aside like so much unwanted baggage?

I sincerely believe in the physiological basis of mental illness while simultaneously seeing such illness also as a manifestation of spiritual distress and psychic disturbance. Walking this line of Western and Eastern thought, I move professionally in the world of mainstream medicine, take antidepressants (which I credit for saving my life), and also subscribe to modes of healing viewed askance by the majority of medical providers. Thus, based on those diverse belief systems to which I subscribe, I view my own depression as a chemical/physiological illness which I can heal and recover from through both traditional and unorthodox methods. In my personal recipe book of healing, the more methods the merrier.

With a desire to continue to provide opportunities for healing for those with whom I work and play, it is wholly apparent that continuing to sweep out my own corners and clean my own house is not only recommended, it's a vital necessity. Walking one's talk is not only a figure of speech, it is also a way of life manifest in one's daily actions. I am in the process of recommitting to my own healing and personal growth, knowing that my effectiveness in the world as a healer and nurse is intrinsically tied to my own success on the home front.

Monday, April 09, 2007

Laughter Yoga, Part II

After a full day of Laughter Yoga Teacher Training with Dr. Madan Kataria, the originator and founder of Laughter Yoga, Mary and I are both feeling transformed and uplifted by our experience.

On March 13th, 1995, Dr. Kataria founded the first Laughter Club in a public park in Mumbai (Bombay), India with four other participants. Deciding to laugh therapeutically together on a regular basis, the five soon grew to fifty in a matter of days. Eventually, they ran out of jokes and funny stories and were somewhat stumped as to how to proceed. It was decided (and subsequently demonstrated) that anyone can laugh at any time for no reason with the correct instruction and guidance. It was at this time that Laughter Yoga was born, now comprising some 5000 Laughter Clubs in 55 countries.

Combining laughter exercises, simple physical movements, childlike playfulness, and Yogic breathing exercises, Laughter Yoga utilizes the scientifically documented fact that the body cannot tell the difference between forced laughter or genuine laughter, thus either form of laughter will bring about the same beneficial physiological effects and oxygenation. Therefore, if you can't laugh without provocation, you can "fake it until you make it" and still gain all the benefits which laughter can bring, including increased oxygenation, increased release of endorphins and other beneficial neurotransmitters, as well as more rapid clearing of the stress hormones cortisol and epinephrine.

Our experience today of unfettered laughter with like-minded strangers in the most bland of physical environments---without jokes, humorous stories, or other rational provocation for our laughter---is a direct example of how a roomful of people who have only just met can form a bond of playful joyfulness in a matter of minutes, further cementing that unity over the course of a day. With the added value of spiritual teachings, yogic breathing and free-spirited play, the day was truly unlike any other I have ever experienced in a workshop context (and I have participated in numerous personal growth workshops over the years, including Inner Child work, anger/shadow work, couples' weekends, men's workshops, and spiritual retreats.)

A key learning point for me today was the concept that there is a distinct difference between joy and happiness. Happiness is seen as a concept of mind, based mostly upon the perception of having/acquiring/living that which we have decided is our desire. Joy, rather, is simply the ability to be in the moment, more a concept of the heart and creative powers than of the rational mind. Knowing and experiencing that difference is one of my greatest challenges in life, now brought even more into my conscious awareness. Having lived with depression my whole adult life, the decision to consciously make that distinction can turn years of thinking about depression on its head. Am I ready for such a concept in my personal cosmology?

Only one day's work/play has convinced me that the power of such simple tools---laughter, breathing, and playfulness---is both profound and truly accessible to anyone. Under Dr. Kataria's strict instructions, we are not allowed to charge money for any services or trainings unless we offer an ongoing Laughter Yoga Club in our area at no charge to the general public. We are already scheming how we will accomplish this, and I look forward to future reports as to our progress.

Til then, may laughter bless your day.

Sunday, April 08, 2007

Easter Sunday, Niagara Falls

We are ensconced in snowy Niagara Falls on Easter Sunday, with one day to rest and relax before our Laughter Yoga training begins. Most places are closed for the holiday---even the local Starbucks----so the day is free and open to exploration and, most of all, doing nothing (or next to nothing, that is). Having left our original hotel after one night due to inadequate facilities and strong chemical smells throughout the hotel and rooms, we immediately packed our bags this morning and found a much more agreeable locale where we can feel comfortable, with no obvious triggers for our Multiple Chemical Sensitivity (MCS).

Last night, we went to great extremes in order to be relatively safe in our noxious hotel room: cramming towels into the space at the bottom of the door to block out the strong chemical stink of the hallway which leaked through the cracks around the door; sleeping with a window open to the 25-degree (fresh) air; and sealing the bathroom shut since it stank of cigarettes, the stale odor of which was pouring in from the broken "exhaust" fan. Luckily, Mary slept with sheets and pillow cases brought from home, sparing her the often bothersome facial rashes which she experiences from hotel bedding. Oh, the places we go!

Traveling with MCS is a significant challenge. Hotels are ubiquitously cleaned with harsh chemicals, fragranced products, and deodorizers. Sheets, towels and bedding are washed in scented detergents, dried with fragranced dryer strips, and sometimes sprayed with flower essences in fancier establishments. Add to this picture residues of recent guests, cigarette smoke, carpet shampoos, new carpeting, recent painting or renovations, and a host of other products or activities, and the person with even mild MCS can face a traveling nightmare. Last night was no exception, but after a very long drive and arriving at 11pm, looking for another hotel when exhausted (and irritable with chemical poisoning) seemed even worse than spending one night in our reserved room. That said, since we had called in advance to request a room free of chemicals and the use of cleaners for 24 hours prior to our arrival, the hotel manager was kind enough to not charge us for our stay, making the transition elsewhere less painful indeed.

Being Easter Sunday, we are experiencing our own rebirth this morning, rising out of the nocturnal ashes of our petrochemically intoxicating stay at the first hotel. As a middle-aged (who, me?) man of Jewish descent who was raised in an excessively secular home (where Christmas and Easter were celebrated as mainstream cultural extravaganzas of candy, tinsel, Santa Claus, eggs, and bunny rabbits), Easter has little personal meaning for me in and of itself. With only marginal ties to the pagan community, I understand the meanings of rebirth, the equinoxes and solstices and such, but I am, by and large, a man without a religion or culture. Sad as this may seem to some, it is my personal creation, and my church, as it were, tends to be that most expansive and welcoming of churches---the "Church Without Walls", Nature herself. So on this Easter Sunday, we will go take a look at the icy, snowy and windblown falls of Niagara, and send our wishes for cleansing, rebirth and new beginnings, sending outmoded ways of being and thinking careening down the cascading waters.

Saturday, April 07, 2007

Laughter Yoga

We are off to Niagara Falls for a two-day training/conference on Laughter Yoga, founded by Dr. Madan Kataria and Madhuri Kataria of Mumbai, India. Known as a "global movement for health, joy, and world peace", Laughter Yoga uses yogic breathing (pranayama) and other simple but effective methods to assist practitioners in eliciting spontaneous and healing laughter, thus benefiting from the well-documented physiological and psychological benefits of laughter. Popularized by Norman Cousins with his book Anatomy of an Illness, Mr. Cousins demonstrated the healing power of laughter, leading to numerous studies of the beneficial effects of laughter as a form of medicine and healing.

With wireless internet access at our hotel, I hope to post several times during our stay to keep you, dear Reader, informed of our experience.

Til then, keep laughing.

Friday, April 06, 2007

Vulnerable

Vulnerable. They are a "vulnerable population" and that is why we serve them. Why are they vulnerable, you ask? They are poor. They are mostly people of color. Many of them do not speak English, or speak very little. They suffer inordinately from chronic illness. What illnesses? HIV/AIDS, addiction, Hepatitis B and C, tuberculosis, asthma, diabetes, hypertension, gastrointestinal illnesses, autoimmune disorders, chronic pain, mental illness.

The vulnerable often live on the fringes of society. They live in public housing projects plagued by poor sanitation, roach infestation, vermin, poor maintenance, shoddy and outdated construction. High-rise apartment buildings with only one elevator which consistently breaks down are the norm. Poor security is de rigeur. Litter and trash are ubiquitous. Drugs and guns flow in the streets. Violence is accepted as a part of life. Apathy can be contagious.

When one feels disenfranchised by the society, one learns to value one's environment and surroundings less. One also may begin to value even one's self less, as well. Elders are abandoned to poverty. Children are left behind by a school system in shambles. Agencies serving the poor become corrupt at the core, bleeding the funds away from their intended recipients, filling instead the bellies of the prosperous. Young men are carted off to jail by the score, while their pregnant young girlfriends quit school and lose their drive to succeed and escape the cycle.

We see it every day. We wrestle with it. We cajole our patients into action, into self-determination and responsibility, health and self-care. Well-being. Being well. We want them to be well. To be more than well.

They are vulnerable, and we seek to empower and protect them. To heal them. To help them heal themselves. The healing is done not only on a personal level. Healing takes community, partnership, a certain level of "buy-in" by a critical mass of the population. Many hands make light work, and we consistently reach out for hands wherever they are proffered. We join hands across this troubled city and seek any path which may lead towards elevation and growth, upward movement, empowerment, healing.

Vulnerable. Yes, they are vulnerable. And we reach out our hands. Again. And again.

Thursday, April 05, 2007

The Widening Circle of Compassion

Visualize someone to whom you feel very close, particularly someone who is suffering and in pain. As you breathe in, imagine you take in all their suffering and pain with compassion, and as you breathe out, send your warmth, healing, love, joy, and happiness streaming out to them.

Now, gradually widen the circle of your compassion to embrace first other people to whom you also feel very close, then to those about whom you feel indifferent, then to those whom you dislike or have difficulty with, then even to those whom you feel are actively monstrous and cruel. Allow your compassion to become universal, and to enfold in its embrace all sentient beings, and all beings, in fact, without any exception.

---Sogyal Rinpoche

Wednesday, April 04, 2007

Nurse Pre-Vacation Syndrome

Diagnosis: Nurse Pre-Vacation Syndrome (NPVS)

Etiology: Co-dependence, inadequate toilet training

Signs and Symptoms:

*Delusions that one's patients will probably die if you leave them in the care of others

*Possibly realistic fears that paperwork and charts on your desk will mate and multiply in your absence

*Memories of previous vacations in which said vacation was spent recovering physically and emotionally from the amount of preparation needed in order to take a vacation in the first place

*Resentment of co-workers who are not about to go on vacation

*Feeling like this will be the last vacation you will ever take "because taking a vacation is too much work"

*Already planning what you will do when you return to work

*Inordinate amount of time spent on Mapquest

*Distractedly gazing out the window

*Telling your co-workers that they can call you on your cell-phone with questions about difficult patients while you're away

*Lottery fantasies

Treatment/Goals:

1) More frequent vacations (practice makes perfect)

2) Re-read Codependent No More

3) Leave cell-phone at home "accidentally"

4) Take even more vacations

5) Quit your job

6) Read Codependent No More again


Prognosis:
Especially good if you adhere to treatment goal #1.

Tuesday, April 03, 2007

Link Up Blog Post

As I have mentioned before, I am beginning to provide content---both blog posts and articles---to the new nursing website, Nurse LinkUp. This will never preclude regular posts to Digital Doorway, but I will occasionally point you, dear Reader, to my posts at that site.

In that regard, please click here for a blog post on nurses and the media, and tune in again tomorrow for another installment here on Digital Doorway.

Monday, April 02, 2007

"To Sleep, Perchance to Dream......"

We send an inordinate number of our patients for clinical sleep studies, and many of them return with diagnoses of Obstructive Sleep Apnea, Restless Legs Syndrome, and occasionally more esoteric scientific labels of "disordered sleep". It is widely understood that individuals with morbid obesity often suffer from apnea---periods during sleep wherein respiration will temporarily cease---and a considerable cohort of our patients spend their nights tethered to machines which enable them to breathe normally during those hours set aside for nocturnal rest which most of us take for granted.

It came to my attention today that some cutting-edge and forward thinking diagnostic sleep centers are beginning to offer sleep studies in hotel rooms rather than the relatively sterile sleep labs generally located in hospitals and medical centers across the country.

Many of us have difficulty sleeping in strange places and foreign beds. If we knew we had a sleep disorder and were sent to a sleep center for diagnosis, why would we necessarily be comfortable enough in a laboratory to fall into a sleep pattern which mimics that which the technician would like to monitor and assess? Thus, a new marketing niche for sleep centers and hotels is born.

In Chicago and Cleveland, these hotel-hospital alliances seem to be thriving, and patients apparently appreciate the more cozy and private environments which can create sleep experiences more closely aligned with a patient's natural sleeping state.

So, is this type of "boutique" healthcare only for a select segment of the population? Who would be offered such a service? Who would be denied? Who would never be told it existed?

For those readers who already are acquainted with this writer's sociopolitical stance vis-a-vis the provision of equal healthcare for low-income populations, you will not be surprised that this trend of medical care does indeed raise a few red flags for me in a certain contextual framework.

Working with low-income Latinos on Medicaid in the inner city, I immediately wonder how many of our patients---if, of course, they met clinical criteria---would even be offered such a service. Our patients---most of whom have never been able to afford a single night in the most moderate of hotels---live in public housing, have little access to transportation, and certainly live as some of the poorest in the country, most well below the official level of poverty.

Consider for a moment the following scenario: Medicaid and, say, Blue Cross/Blue Shield will both agree to pay for a diagnostic stay in either the traditional hospital sleep lab or the hotel version. A provider in a sleep disorder clinic has a university professor with narcolepsy in exam room #1, and a disabled Latino woman with obstructive sleep apnea in exam room #2. Given that each patient meets clinical criteria for a stay in the new Marriott-based sleep center, and each insurance will reimburse at the same rate, which patient will be offered the opportunity for a night at the hotel-based clinic, and which will be relegated to the cinder-block sleep room at the hospital? It's a no-brainer, really, and my trusty "Healthcare Inequality Detector" (patent pending) reaches the red zone of the meter in no time.

Call me cynical, folks, but I have seen enough in the last ten years to know that our patients will often----but not always---be sent to the back of the healthcare bus, so to speak. I don't always mean to be a burster of bubbles (or do I?), but when I see a new specialty being offered that potentially smacks of elitism or classism, I somehow feel the need to point out the potentially inherent disparities which may be encountered therein. As I explore the new offerings of such services in our region (which are now beginning to manifest), this will be one aspect of such care that will certainly fall under my scrutiny (and that of my aforementioned Healthcare Inequality Meter).

So, in your wanderings and peregrinations, dear Reader, keep an eye out for such disparities, empower patients to receive the care they need, and champion the notion that even the poor deserve a good night's sleep at the Raddison (especially if Medicaid is paying the bill).

Sunday, April 01, 2007

Sunday

A Sunday drive in the country
to visit a friend
who lives and works at a Buddhist retreat center

Conversation
canine company
exchanging of ideas and experiences

Hot herbal tea
nuts and dried fruit
fresh water

Simple
relaxing
unpremeditated

Real.