Pam Ressler, R.N.

The Rituals of Healing

2012-01-14T22:28:00.000-05:00

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

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

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

What are your thoughts?

Wisdom Where You Least Expect It

2011-12-16T23:23:00.000-05:00

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

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

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

Season of Kindness

2011-12-04T15:27:00.000-05:00

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

Kindness
by Naomi Shahib Nye

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

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

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

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

Engage with Grace this Thanksgiving

2011-11-23T16:17:00.003-05:00

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

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

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

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

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

Engage with Grace 2011: Occupy With Grace

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

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

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

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

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

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

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

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

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

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

Choosing to Keep the Heart Open

2011-11-08T16:40:00.002-05:00

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

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

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

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

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

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

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

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

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

The Familiar Becomes the Unfamiliar and the Unfamiliar Becomes the Familiar

2011-09-27T23:30:00.001-04:00

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

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

2011-09-05T16:43:00.001-04:00

The Well of Grief

Those who will not slip beneath

the still surface of the well of grief

turning downward through its black water

to the place we cannot breathe

will never know the source from which we drink,

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

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

~By David Whyte from Close to Home

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

In Praise of the August Tomato

2011-08-18T21:04:00.003-04:00

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

Mindful Moments

2011-08-13T20:53:00.002-04:00

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

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

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

Lake Michigan Sunset

Treating Chronic Pain as a Disease and Not a Symptom

2011-07-19T15:13:00.001-04:00

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

More Good News About Meditation

2011-07-15T17:10:00.000-04:00

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

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

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

Mindfulness in the Form of Peas

2011-07-07T22:51:00.000-04:00

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

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

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

Commencement ~ The Journey Continues

2011-05-23T21:40:00.005-04:00

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

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

May 22, 2011

Tufts University School of Medicine

Pain Research, Education & Policy Program Commencement Address

by Pamela Katz Ressler, M.S., R.N., HN-BC

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

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

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

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

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

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

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

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

And if you find her poor, Ithaca has not deceived you.
Wise as you have become, with so much experience,
you must already have understood what these Ithacas mean.

And so, as you set sail from this commencement for your Ithaca…I wish you a long and prosperous journey, the privilege of listening to many stories, and the wisdom of healing….Thank you and Bon Voyage.

Pam Ressler's Blog Featured in Grand Rounds

2011-03-01T20:28:00.000-05:00

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

Grand Rounds March 1, 2011

Communicating the Experience of Chronic Illness Through Blogging

2011-02-21T22:24:00.000-05:00

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

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

Grow Your Brain

2011-02-02T16:18:00.001-05:00

It appears that the western world has just discovered the benefits of mindfulness! For the last several of weeks my email inbox has been happily flooded with links to various articles singing the praises of mindfulness meditation training...I love this!!! But what, you may ask, has fueled this sudden interest in mindfulness, and its ancient roots in eastern meditation practices? Neuroimaging. Yes, evidence-based biomedical research has finally caught up to our observational, and albeit anecdotal, research that has long suggested a positive psychosocial and physical benefit to mindfulness training.

A new study, based on MRI scans of participants' brains pre and post an 8-week Mindfulness Based Stress Reduction Program (MBSR) revealed structural changes, an increase of 1-3%, in the grey matter of the brain. These changes were most significant in the areas responsible for learning, memory and emotional regulation. Earlier studies have suggested an increase in brain activity/function in areas of the brain associated with positive emotion, optimism and focus. Very powerful evidence that we have much more control than we imagine in growing and changing our brain and emotions. Here is a link to an article which appeared this week, "Brain Gain" by Deborah Kotz in the Boston Globe

What are your experiences with mindfulness? Do you need a refresher or are you interested in learning mindfulness skills? I invite you to take a look at my website, Stress Resources, for ways to grow your brain and integrate mindfulness into your life. I look forward to hearing from you and growing our brains together.

Kaleidoscopes in Unexpected Places

2011-01-10T23:38:00.000-05:00

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

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

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

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

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

2011-01-01T23:22:00.002-05:00

"Five hundred twenty-five thousand six hundred minutes...how do measure, measure a year?", asks the opening song from the musical Rent. Our new year's resolutions often focus on beginning a new year with better time managment skills, more effective prioritization of tasks and in general being more organized with our time. Does this sound familiar? If so, I invite you, at this beginning of a brand new year, to take a breath...and then read an email I received today from a colleague at University of Massachusetts/Boston. It made me stop in my tracks and simply smile at the profound wisdom of a six-year-old:

"Here is a suggestion from my six-year-old daughter on how to start your TO DO list. Two of days ago, I wanted to teach her how to make a plan for the day so I asked her to bring me a notepad to write down what we would like to accomplish. She jumped quickly and brought a note that said “LOVE” and without even waiting for me to ask her anything, she said: “Mommy, I wrote the first item on the agenda” grinning from happiness. “Isn’t LOVE the most important anyway?”, she added.

As I watched her in awe, I noticed a change in my state of mind. “Yes, dear child, LOVE is the most important”, I said to her and thought to myself … “even if nothing else gets accomplished for the day but we share LOVE with each other the day would be quite successful”. We made a schedule for the day and moved on. Every time we were in disagreement we reminded each other “What was the first item on our Agenda?”

Put LOVE first in your daily/weekly/yearly TO DO list and simply enjoy the benefits it will bring to your life."

What incredible insight and what a good suggestion for the first item on the inevitable TO DO list(s) in our lives! How will you measure your precious five hundred twenty-five thousand six hundred minutes this year? How about in LOVE.

Wishing you LOVE in the new year,
Pam

Wabi Sabi Revisited

2010-12-06T10:45:00.004-05:00

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

From Hilary Gould

The Wabi-Sabi Pomegranate

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

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

From Abby Seixas, author of Finding the Deep River Within

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

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

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

Wabi-sabi is a different way of seeing, a good antidote to seeing through the eyes of imperfection. Next time you want to jump up and comb that hair or wash those dishes or straighten those piles, pause for a moment, try seeing it through wabi-sabi eyes."

Thank you to Hilary and Abby for giving us some ways to view the holiday season through wabi-sabi eyes.
Enjoy,
Pam

Engaging with Grace this Thanksgiving

2010-11-24T14:47:00.007-05:00

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

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

With gratitude,
Pam

Things we are grateful for this year

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

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

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

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

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

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

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

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

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

Engage with Grace: One Slide Project

Happy Wabi-Sabi Thanksgiving

2010-11-24T11:39:00.007-05:00

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

Wabi-sabi Thanksgiving table at the Gould's

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

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

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

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

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

Technology and Resilence

2010-11-03T14:56:00.007-04:00

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

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

Resilience

2010-10-13T09:13:00.004-04:00

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

Unlocking Memories

2010-10-12T10:11:00.006-04:00

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

I welcome your thoughts and comments about this topic.

The Arts of Compassion: Perspectives on Arts and Health

2010-09-23T11:47:00.005-04:00

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

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

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

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

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

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

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

The Many Faces of Reslience

2010-09-22T09:06:00.007-04:00

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

Stress Reduction on a Parking Ticket?

2010-09-21T19:48:00.007-04:00

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

Arts of Compassion

2010-09-10T11:54:00.002-04:00

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

Summertime Moments

2010-07-06T22:32:00.004-04:00

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

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

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

2010-06-22T13:50:00.006-04:00

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

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

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

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

2010-05-30T23:00:00.010-04:00

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

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

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

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

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

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

“But what then?” Asked the Mexican.

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

“Millions – then what?”

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

Season of Change

2010-05-28T13:33:00.004-04:00

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

The Sonnets to Orpheus, Part Two, XII

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

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

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

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

~ Rainer Maria Rilke ~

Vicki Kennedy's Reflections on Compassionate Care

2010-05-26T21:29:00.008-04:00

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

Catching Tadpoles

2010-04-05T21:26:00.003-04:00

"Spring has returned. The Earth is like a child that knows poems."
Rainer Maria Rilke quotes (1875-1926)

As I gaze out onto my office parking lot in Concord, Massachusetts, I see an amazing sight...a young boy and girl crouching low to the ground on the edge of the sidewalk that leads into my office building.

On closer observation, I see a net attached to a long pole in the young boy's outstretched hands. They are fishing for tadpoles in the flooded parking lot! With the historic level of flooding the Northeast has withstood over the past weeks, the ensuing hassles with closed roads, canceled train service between Boston and New York, rivers overflowing, dams breaking, pumping out of basements, loss of property and water damage to valuables; this sight in the parking lot...two small figures patiently fishing, eagerly anticipating their catch, made me stop and smile.

Time after time, I am reminded of the choices we make in viewing the world. Do we see a flooded parking lot with no where to park, or do we see an opportunity to fish for tadpoles in the sunshine? One situation, two very different experiences.

May you catch many tadpoles this month,
Pam

Love after Love

2010-02-15T07:03:00.012-05:00

February is a month of the heart...both our physical heart evidenced by very important public health campaigns such as the Go Red for Women initiative by the American Heart Association; as well as the metaphorical heart...the heart of love and compassion. Often we think of love as simply the commercial accoutrements of Valentine's Day with roses and chocolates, but can we think of it as much more? How do we create a culture of compassion and empathy for ourselves and others? Now that the Hallmark day of love has passed, I thought I would share this poem by Derek Walcott that touches upon the very difficult task of compassion for self. I have included an audio clip of Jon Kabat-Zinn reading the poem....enjoy!

What does the poem mean to you? How have you included compassion for self into your day to day life? I would love to hear your thoughts and comments!

Love After Love

by Derek Walcott

The time will come
when, with elation,
you will greet yourself arriving
at your own door, in your own mirror,
and each will smile at the other's welcome,

and say, sit here. Eat.
You will love again the stranger who was your self.
Give wine. Give bread. Give back your heart
to itself, to the stranger who has loved you

all your life, whom you ignored
for another, who knows you by heart.
Take down the love letters from the bookshelf,

the photographs, the desperate notes,
peel your own image from the mirror.
Sit. Feast on your life.

Request for Research Help from Health Bloggers

2010-01-23T21:43:00.006-05:00

Do you or does someone you know blog about their chronic illness? Lisa Gualtieri, PhD and I are interested in the motivation of why people choose to start and maintain a health blog for a research survey we are conducting. Can you help us out by answering the questions below or forwarding them on to health bloggers you may know? We appreciate any help you can provide us! Feel free to send emails directly to us at: pressler@stressresources.com or lisa@acm.org or post your answers in the comment section below.

We are researching why people choose to start and maintain a blog about a health condistion and would appreciate your answers to these questions:

When and why did you start your blog?

What do you see at the primary reason(s) you continue blogging?

How often do you typically post?

What types of feedback do you receive? How many comments do you typically get to each post?

Do you know how many unique visitors you have during a particular time period (say 2009)?

Do you do anything to promote your blog or attract new readers?

Do you use your real name in your blog?

Do you read other blogs by people with health issues and, if so, which and why?

Have you shown your blog to your doctor or other healthcare professional?

It's All About Connection

2009-12-07T09:49:00.011-05:00

Each year The Kenneth Schwartz Center selects a Compassionate Caregiver who embodies the qualities of empathy, compassion, caring and presence in their work and life. This year's winner is Dr. Amy Ship, a primary care physician at Beth Israel Deaconess Medical Center in Boston. I was particularly moved by Dr. Ship's acceptance speech, where she explains that it is all about connection...connecting through presence, through compassion, through understanding as both the care-giver and care-receiver. “The longer I’ve practiced medicine, the more I’ve come to realize that we are all, as the years go on, ‘survivors,’” she said. “For some it is cancer, but for others it is diabetes, or seizures, or kidney failure, or all of the above. Others are survivors of loss – loss of a limb, loss of sight, loss of autonomy, loss of hope, loss of a loved one. And I have learned that many of us – like me – carry with us some secret sorrow – a loss or challenge that is not noticeable. Connecting with patients means looking for what is not immediately visible, listening for the hole in another’s heart.”

I encourage you to view Dr. Ship's speech by clicking here and see and hear what connection in healthcare is all about! Congratulations, Dr. Amy Ship, truly a compassionate caregiver.

Engage With Grace: The One Slide Project

2009-11-25T16:09:00.005-05:00

I was honored to again be asked to participate in this year's Engage With Grace blog rally by my friend, Paul Levy, President and CEO of Beth Israel Deaconess Medicial Center in Boston. Thanksgiving is traditionally a time to gather with friends and family...and a perfect time to ask, listen, and learn about loved ones' hopes and desires if they could not speak for themselves. So between the football games, the turkey, and the pumpkin pie...take some time to begin a conversation by sharing Engage with Grace with the important people in your life.

Wishing you and your family a happy and healthy Thanksgiving,
Pam

"Last Thanksgiving weekend, many of us bloggers participated in the first documented “blog rally” to promote Engage With Grace – a movement aimed at having all of us understand and communicate our end-of-life wishes.

It was a great success, with over 100 bloggers in the healthcare space and beyond participating and spreading the word. Plus, it was timed to coincide with a weekend when most of us are with the very people with whom we should be having these tough conversations – our closest friends and family.

Our original mission – to get more and more people talking about their end of life wishes – hasn’t changed. But it’s been quite a year – so we thought this holiday, we’d try something different.

A bit of levity.

At the heart of Engage With Grace are five questions designed to get the conversation started. We’ve included them at the end of this post. They’re not easy questions, but they are important.
To help ease us into these tough questions, and in the spirit of the season, we thought we’d start with five parallel questions that ARE pretty easy to answer:

Silly? Maybe. But it underscores how having a template like this – just five questions in plain, simple language – can deflate some of the complexity, formality and even misnomers that have sometimes surrounded the end-of-life discussion.

So with that, we’ve included the five questions from Engage With Grace below. Think about them, document them, share them.

Over the past year there’s been a lot of discussion around end of life. And we’ve been fortunate to hear a lot of the more uplifting stories, as folks have used these five questions to initiate the conversation.

One man shared how surprised he was to learn that his wife’s preferences were not what he expected. Befitting this holiday, The One Slide now stands sentry on their fridge.

Wishing you and yours a holiday that’s fulfilling in all the right ways. "

To learn more please go to http://www.blogger.com/www.engagewithgrace.org. This post was written by Alexandra Drane and the Engage With Grace team.

Musical House Calls

2009-10-18T17:38:00.007-04:00

The Longwood Symphony, an orchestra made up of physicians, medical researchers and health care providers, broke with their tradition of playing a large concert and instead took their music to their audience -- their patients. Dr. Lisa Wong, pediatrician and president of the Longwood Symphony Orchestra stated,“To launch this year, instead of having a concert in Jordan Hall, where we usually play for 800 to 1,000 audience members, we thought we’d bring it to the patients". This year the healer musicians were broken into several groups that spread out over Boston, visiting health centers, hospitals and elder care centers in an initiative called LSO on Call: Health and Harmony in the City. They reached a similar number of audience members yesterday, playing for a total of about 800 in nearly two dozen small concerts.

To read more about this great group of healing musicians, click here for the Boston Globe article.

My Summer Labyrinth Quest

2009-09-05T13:13:00.011-04:00

I am fascinated with labyrinths and their use in meditation and health. On my summer travels I explored a number of labyrinths in the Midwest that I found on the worldwide labyrinth locator. Each of these five labyrinths are unique but are similar in their ability to allow the user to stop, take a breath, observe and proceed. Please share photos of your favorite labyrinths by emailing them to me and I will post them here. Enjoy!

Ellsworth Labyrinth Garden, Ellsworth Michigan
11 circuit, Medieval/Santa Rosa labyrinth. Constructed in 2004 by members of the community of Ellsworth. It is located on the banks of Lake Ellsworth and surrounded by perennial gardens. mosaic stepping stones line the outer edges of the labyrinth made by community members representing their hopes and wishes. (http://mi.imagemakers.com/labyrinth.html)

Sacred Sparks, East Jordan Michigan

Linda and Jerry Aydlott have lovingly constructed this classical labyrinth on the land behind their gallery and store in Northern Michigan. Labyrinth, goddess garden and rustic fairy walk at the back of their property are all open to visitors to explore. The labyrinth is a 7-circuit design, 50 feet in diameter and was constructed from field stones in 1998. (http://sacredsparks.com/)

Raven Hill Discovery Center, East Jordan Michigan

Constructed from field stones, this rustic classical labyrinth graces the front entrance to Raven Hill Discovery Center. It was constructed in 2004 and is 35 feet in diameter(http://ravenhilldiscoverycenter.org/)

Nelson's Herbs, Edwardsburg Michigan

Imagine a labyrinth constructed of over 560 lavender plants...that is what I experienced at Nelson's Herbs. A fragrant meditative walk. Originally built in 2004, it is 60 feet in diameter in the medieval/Santa Rosa style. (nelsonsherbs@aol.com)

Saint Mary's College, Notre Dame Indiana

Located near the entrance to Saint Mary's College, this is a 7-circuit classical design constructed with black river rocks with circular pavers to line the path. Twin finger labyrinths are near the entrance allowing you to "walk the labyrinth" with your hands. (http://saintmarys.edu/)

Finding Meaning in the Face of Mortality

2009-07-16T21:38:00.003-04:00

I recently read an interesting article in the Wall Street Journal by Melissa Beck: A New View, After Diagnosis, highlighting a program on "meaning-making" at Memorial Sloan-Kettering for advanced stage cancer patients. The program is based on the seminal work of Viktor Frankl, Man's Search for Meaning, in which he suggests that people can endure any suffering if they know their life has meaning. Dr. William Breithart, who developed the program known as meaning-centered psychotherapy, explains that through the program participants are guided to "reconnect with many sources of meaning in life -- love, work, history, family relationships, and teaches them that when cancer produces an obstacle in one, they can find in one, they can find meaning in another". Results of a pilot study comparing "meaning-making" groups compared to traditional cancer support groups were encouraging in respect to decreased anxiety and increased spiritual well-being.

You don't need to have cancer to benefit from the exercise of reflecting on what is most meaningful in your life. We are generally too mindless and busy to notice! But it is never too late to stop, take a breath, and reflect on what we love.

Empathy vs Emotional Reasoning

2009-07-08T21:41:00.006-04:00

Is there a difference between empathy and emotional reasoning? Michael LaFerney, PhD, PMHCNS-BC, believes that healthcare professionals often confuse the two, and this can often hinder or derail patient-provider communication. In the current edition of Advance for Nurses, Dr. LaFerney defines empathy "as the ability to understand another person's circumstances, point of view, thoughts and feelings." He goes on to explain that, "Empathy involves communication. Trying to understand what another person is experiencing without communication leads to interpretation without meaning. It becomes a mechanism of internal thought processes rather than an understanding of another's point of view or feelings." Dr. LaFerney describes emotional reasoning as "mind reading" on the part of the healthcare professional; unconsciously inferring one's own feelings, anxiety, or needs to the patient. Emotional reasoning is a lot faster for harried physicians and nurses than empathetic communication, because it does not require slowing down and taking time to truly listen to the patient. But as Dr. LaFerney points out it often leads to misdiagnosis and disconnection from the patient's needs, fears, or desires. The bottom line is MORE COMMUNICATION LEADS TO QUALITY HEALTHCARE.

What are your thoughts on empathy vs. emotional reasoning?

Medicine in the Age of Twitter

2009-06-15T20:06:00.003-04:00

Dr. Pauline Chen poses an interesting question in her NY Times article, Medicine in the Age of Twitter: Does online social media help or hinder patient-provider communication? If you haven't heard about Twitter, it is a new social media platform that allows users to communicate via short, 140 characters or less, "tweets" to other users. I am intrigued about the possibilities of connection, but am wary of the lack of human touch. What do you think?

Letting the Patient Call the Shots

2009-06-04T17:47:00.008-04:00

Today's New York Times has an interesting article written by Dr. Pauline Chen exploring what we, in the healthcare system, really mean by "patient centered care". Does the definition of patient centered care shift if we are in the role of patient or healthcare professional? In the article, Letting the Patient Call the Shots, Dr. Donald Berwick, president of the Institute for Healthcare Improvement in Cambridge, Massachusetts, suggests that, “ We would all be far better off if we professionals recalibrated our work such that we behaved with patients and families not as hosts in the care system, but as guests in their lives.” Radical changes in our healthcare system will need to occur to allow this to happen, are we ready for such changes? What do you think?

Perfectly Happy?

2009-05-10T11:53:00.001-04:00

Cognitive scientists who have conducted research on happiness have found that we are not very good at predicting what will make us happy. Ironically, chronic pain, constant noise can decrease our happiness dramatically and winning the lottery or achieving a life long wish often do not substantially increase our overall happiness. A recent Boston Globe article, Perfectly Happy, explores "happiness research" and its role in guiding priorities for social and health policy.

What do you think?

Quality of Life

2009-05-06T20:17:00.002-04:00

Thank you to those of you who alerted me to a wonderful documentary series which aired on WBUR in Boston last week. It is beautifully written and produced, an informative view of the dilemma over end of life care in this country. The title of the documentary is Quality of Death, End of Life Care in America: Inside-Out. As I listened to the documentary I felt a more appropriate title might be Quality of Life instead of Quality of Death because even as patients, families and healthcare providers prepare for death, life continues. Perhaps our emphasis on what we DON'T want done at the end of life overshadows what we DO want done? I read an interesting article recently that proposed changing the terminology of D.N.R. (Do Not Resuscitate) to A.N.D. (Allow Natural Death). Is there is a difference in your mind between these two statements, or do you feel it is only semantics? This is difficult topic to wrestle with but one that is growing in prominence in the health care world as we confront a rapidly aging population as well as staggering healthcare costs.

Healing Music in the Neonatal Intensive Care Unit

2009-03-30T22:25:00.007-04:00

Sometimes healing comes through low-tech interventions in high-tech medical environments. That thought resonated with me when I came across an article in the McAllen Chronicle, describing the work of Dr. Anatoliy Ilizarov, the medical director of the Neonatal Intensive Care Unit (NICU) at Mission Regional Medical Center in Mission, Texas. As you can imagine, stress is rampant in a NICU, for staff, families and the tiny, fragile patients. Dr. Ilizarov, a trained classical pianist, began streaming music into the NICU to help reduce stress, and discovered that the premature infants began to gain weight faster, and began to feed earlier. Staff and families felt more relaxed as well. Dr. Ilizarov theorizes that the beat of the music, between 60-80 beats per minute, mimics the mother's heartbeat while the infant is in the womb. I was struck by the simple beauty of this intervention, a doctor who is a pianist using his gifts of art and science to heal gently. Good work, Dr. Ilizarov!

Stress So Bad It Hurts

2009-03-17T12:09:00.006-04:00

An article caught my eye in today's Wall Street Journal..."Stress So Bad It Hurts -- Really" by Melinda Beck. The article presents a patient's perspective on being told that chronic physical pain is caused by stress and it is "all in your head". Without further explanation, the patient feels indignant and angry that the health care provider does not believe their pain is "real". The medical community is slowly becoming more comfortable with the notion that psychological stress can exacerbate and even produce physical pain in individuals. Yet, we currently do not have a health care system that is set up to be multidisciplinary in response to chronic pain. There are initiatives going on around the country that begin to address multidisciplinary ways of dealing with complex pain issues. I am currently involved in graduate work at Tufts University School of Medicine's Pain Research, Education and Policy Program, the only one of its kind in the United States. As an initiative to share information and dialogue about pain management, we have started a blog (http://www.go.tufts.edu/pain) on the complex subject of pain research, education and policy and would welcome your voice. I hope that as President Obama considers health care reform, we as health care providers and consumers take on a vocal role of advocating for a multidisciplinary approach to true "health" care and not procedure oriented "illness" care. Only when we begin to acknowledge the innate connection between the body, mind and spirit will we truly begin to understand the complexities of the human body.

I would love to hear your thoughts!

Wellness Care Moves onto the Radar

2009-02-25T15:12:00.003-05:00

The Institute of Medicine has taken a step in the right direction by beginning to advocate for putting integrative medicine on Congress's radar this year. With a new focus on health care dollars and economic use of limited funds, it only makes sense to begin to look outside standard disease based care and at more integrative models of good health care. "Health is more than the absence of disease", said Dr. Ralph Snyderman who is heading up a three day meeting of the Institute of Medicine on the topic of wellness and integrative care.

Kudos to the Institute of Medicine for beginning to view the many aspects of quality, health care as more than just a disease based model. Read the Boston Globe article "Doctors Move Wellness Care onto the Radar" on this topic.

I would love to hear your ideas about how we can create a new model for quality health care in our country.

Become a CMO...Chief Motivating Officer

2009-01-26T08:00:00.000-05:00

Motivate Like a CEO...I love the title of the book that came across my desk recently, written by my colleague Suzanne Bates, but I was a bit skeptical as how this book would be relevant to folks outside of the corner office. However, as soon as I began to read Motivate Like a CEO, I realized that Suzanne's message is universal to anyone who needs to communicate and motivate a team to be more effective, productive, and creative. Communicating a strong sense of purpose, connection and shared goals creates an environment for inviting change and growth; qualities necessary in education, health care, business, politics, and life. For those in health care, think of how helpful it would be to be a more effective motivator and communicator with patients and families; helping to change behavior and lifestyle. For those in education, imagine the positive impact of inspiring students to work toward common goals. The opportunities to use these strategies are numerous and extend much farther than the traditional corner office. Motivate Like a CEO is clearly written and filled with strategies for becoming a CMO...Chief Motivating Officer. A must read for any leader or potential leader!

On Monday, January 26, Suzanne Bates and a number of experts and authors in the fields of business, communication, consulting, stress management, health care, and education will come together to offer special bonus gifts to those of you who purchase Motivate Like a CEO on that day. Stress Resources is pleased to be the stress management firm selected to offer a valuable bonus to book purchasers. What a great way to add an invaluable book, Motivate Like a CEO, to your business library, and also take advantage of a myriad of complimentary bonus gifts from noted experts. To find out more about this one day offer, click here: http://www.bates-communications.com/motivate-bonusoffer.php

Let's Get to Work

2009-01-20T15:47:00.008-05:00

Today I joined with millions of others from around the block and around the world to witness an amazing moment of hope; of picking ourselves back up, dusting ourselves off, and beginning again the remaking of America. President Obama has set before us this challenge...will we accept it? I know I am up for the opportunity to help redefine our collective vision. Will you join me in making a difference? My good friend and colleague Dr. Harvey Zarren, president of the Integrative Medicine Alliance beautifully articulated what so many of us felt today. With Harvey's permission, I share with you his words:

"Know that now a torch has been passed, turning away from fear and into
hope, turning away from coercion and into invitation, turning away from
insulation and into brotherhood, and turning away from the oppression of
privilege and into the responsibility and possibility of
humankind.

The question is raised and the challenge has been
offered: can we, each of us, starting within ourselves and then in all our
relationships and all our positions, can we carry that vision forward with
courage and curiosity, persistence and humility, love and the conviction of all
possibilities?

Let's continue working at the new vision with all
the capabilities and all the energy that we possess and of which we can
conceive."

Thank you, President Obama, thank you, Harvey...now, let's get to work!

New Year...New Possibilities

2009-01-10T20:59:00.002-05:00

"Now let us welcome the New Year,
Full of things that have never been."
Rainer Maria Rilke

Welcome to the new year, a year of new possibilities. Thank you to Pat T., who reminded me of the above quotation as the old year passed and the new year was born. As we in the north bundle ourselves under many outer layers, perhaps this can also be a time of examining the inner layers of our lives and exploring this new place of opportunity, of freshness, that exists in 2009. Inertia is easy, unfolding into new ways of being is challenging...I wish you a new year of challenging exploration!

E Pluribus Unum

2008-12-26T21:49:00.005-05:00

As is our annual tradition in our Concord, Massachusetts neighborhood...we gathered together, assembled and lit 1200 candles to glow into the winter night. As each family lit the candles in front of their house, the individual small flickering flames joined together in the cold winter darkness as one cohesive glow illuminating the neighborhood. This tradition seemed especially appropriate and poignant this year, as we, together, face challenges and new beginnings in our country and world...e pluribus unum...out of many, one.

The Hero's Journey

2008-12-12T17:58:00.004-05:00

We are all on a hero's journey...a metaphor for our lives. At the recent Massachusetts Conference for Women, I became acquainted with a beautiful poem, Ithaca by Constantine Cavafy, which conveys the hero's journey in prose. How often are we only on a quest for Ithaca, the Holy Grail, Nirvana...you get the picture...goal driven without respect to the wisdom we gain along the way? May your journey be long and adventurous on your way to your Ithaca.

Ithaca (by Constantine Cavafy)

When you set out on your journey to Ithaca,

pray that the road is long,
full of adventure, full of knowledge.

The Lestrygonians and the Cyclops,

the angry Poseidon -- do not fear them:

You will never find such as these on your path,

if your thoughts remain lofty, if a fine

emotion touches your spirit and your body.

The Lestrygonians and the Cyclops,

the fierce Poseidon you will never encounter,

if you do not carry them within your soul,

if your soul does not set them up before you.

Pray that the road is long.

That the summer mornings are many,

when,with such pleasure, with such joy

you will enter ports seen for the first time;

stop at Phoenician markets,

and purchase fine merchandise,

mother-of-pearl and coral, amber, and ebony,

and sensual perfumes of all kinds,

as many sensual perfumes as you can;

visit many Egyptian cities,

to learn and learn from scholars.

Always keep Ithaca on your mind.

To arrive there is your ultimate goal.

But do not hurry the voyage at all.

It is better to let it last for many years;

and to anchor at the island when you are old,

rich with all you have gained on the way,

not expecting that Ithaca will offer you riches.

Ithaca has given you the beautiful voyage.

Without her you would have never set out on the road.

She has nothing more to give you.

And if you find her poor, Ithaca has not deceived you.

Wise as you have become, with so much experience,
you must already have understood what these Ithacas mean.

Click here to hear Sean Connery read Ithaca with video and musical imagery

I would love to hear your comments on how this poem speaks to you and your hero's journey.

Massachusetts Conference for Women

2008-12-11T20:58:00.008-05:00

I was honored to be one of nearly 5,000 women filling the halls of the Boston Convention Center today for the fourth annual Massachusetts Conference for Women, featuring more than 85 speakers, including headliners Lesley Stahl of CBS 60 Minutes, columnist Liz Smith (who, by the way, is 85 years old and still going strong), publisher Joni Evans, columnist Judith Martin (Miss Manners) speaking about their new joint venture, wowOwow.com, Holly Robinson Peete and Marianne Williamson. The Conference’s theme, “The Next Chapter of You,” was highlighted throughout the day encouraging attendees to invest in themselves and give back to their communities.

Jessie M. Gaeta, M.D. was honored with the Conference’s Be the Change Award. The award recognizes a woman who rises above and beyond in the realm of service by shining light on an unmet need in her community. Dr. Gaeta dedicates her life to caring for the homeless. As a practicing internist at Boston University Medical Center and Boston Health Care for the Homeless Program, she treats homeless patients on the streets and in shelters. Dr. Gaeta also leads policy advocacy at the Massachusetts Housing and Shelter Alliance. By raising awareness of the public health implications of homelessness and the cost-effectiveness of a Housing First approach, she has successfully influenced lawmakers to create social change through the institution of new approaches to ending homelessness.

Click here for photos of the 2008 Massachusetts Conference for Women

I attended some amazing breakout sessions with speakers, Ariane deBonvoisin, Abby Seixas, and Marilyn Paul, whose strategies of change, self-care and organization of the inner and outer aspects of our lives expanded on Marianne Williamson's keynote statement: "The only antidote to the chaos is a deeper way of living".

The fifth annual Massachusetts Conference for Women is slated for Dec. 10, 2008 at the Boston Convention & Exhibition Center. I am planning on attending again, and would love to have some of you join me!

Did you attend the conference this year? I would love to hear your comments...what were the take home messages that resonated with you?

Engage with Grace

2008-11-26T12:45:00.007-05:00

Thanksgiving is a time we traditionally gather together with family and friends to express our gratitude for being able to share food and companionship with one another. It can also be a wonderful opportunity to share with loved ones our most personal wishes for what we hold important to us at the end of life if we were unable to speak for ourselves. I was pleased to be invited to play a part in spreading the word on the Engage with Grace: One Slide Project by Paul Levy, CEO and president of Beth Israel Deaconess Medical Center in Boston. The goal is to begin this important conversation with loved ones before the need arises, so you can best carry out their wishes and choices if they cannot speak for themselves. From Nov 26-Nov 30, health bloggers across the globe will be sending out the same message to their readers, hoping that we can help you find the words to begin this compassionate conversation with your friends and family.

We make choices throughout our lives - where we want to live, what types of activities will fill our days, with whom we spend our time. These choices are often a balance between our desires and our means, but at the end of the day, they are decisions made with intent. But when it comes to how we want to be treated at the end our lives, often we don't express our intent or tell our loved ones about it.

This has real consequences. 73% of Americans would prefer to die at home, but up to 50% die in hospital. More than 80% of Californians say their loved ones “know exactly” or have a “good idea” of what their wishes would be if they were in a persistent coma, but only 50% say they've talked to them about their preferences.

But our end of life experiences are about a lot more than statistics. They’re about all of us. So the first thing we need to do is start talking.

Engage With Grace: The One Slide Project was designed with one simple goal: to help get the conversation about end of life experience started. The idea is simple: Create a tool to help get people talking. One Slide, with just five questions on it. Five questions designed to help get us talking with each other, with our loved ones, about our preferences. And we’re asking people to share this One Slide – wherever and whenever they can…at a presentation, at dinner, at their book club. Just One Slide, just five questions.

Lets start a global discussion that, until now, most of us haven’t had.

Here is what we are asking you: Download The One Slide and share it at any opportunity – with colleagues, family, friends. Think of the slide as currency and donate just two minutes whenever you can. Commit to being able to answer these five questions about end of life experience for yourself, and for your loved ones. Then commit to helping others do the same. Get this conversation started.

Let's start a viral movement driven by the change we as individuals can effect...and the incredibly positive impact we could have collectively. Help ensure that all of us - and the people we care for - can end our lives in the same purposeful way we live them.

Just One Slide, just one goal. Think of the enormous difference we can make together.

(To learn more please go to www.engagewithgrace.org. This post was written by Alexandra Drane and the Engage With Grace team)

Happy Thanksgiving and may your Thanksgiving table be filled with companionship, compassion and conversation.

Putting the Patient First

2008-11-20T15:58:00.016-05:00

As much as I believe we currently have a very broken system of health care in this country that is in urgent need of healing; when I see an organization that is doing right by the patient and families it serves, I readily applaud their success. Such is the case with Beth Israel Deaconess Medical Center (BIDMC) in Boston. While not part of the mega-Partners Healthcare group in the Boston area, they have been an institution at the fore of patient centered care, being one of the first hospitals in the country to institute primary care nursing over 30 years ago. I regularly follow the blog written by the CEO of BIDMC, Paul Levy. Through his blog, Running a Hospital, he has added transparency, humanness and compassion to the commonly hidden world of hospital administration. He has also helped to create a culture of cooperation and patient centered care among hospital staff that is truly remarkable. This culture of cooperation is evident by the following letter from a patient Paul Levy posted on his blog:

"As far as I'm concerned, you can take all those posted quality metrics and throw them out the window when you get a letter like this one that I received from a patient:

BIDMC is a special place. The nursing care deflates your stress about being
in the hospital. The doctor's talent makes you believe you have the best
possible care. The atmosphere makes you feel that people like their jobs and
feel invested in them, so you feel that everybody is paying attention, whether
they are cleaners, food service, transport, department heads, trustees.I
especially noticed the employees' investment in their jobs. (NURSE: "Doctor, I
noticed you are testing Ms. X for TB. If we believe she might have TB, should we
institute those protocols now?" TRANSPORT: "The nurses are really busy. I'll
reconnect your oxygen so you can go back to bed and I'll tell them that I did."
NURSE: Let's not wait for the bed to be changed. I want it to be dry for you
when you have these fevers." She changed the bed and me three times that
night.)Symbol of cooperation regardless of rank or function: Nobody left my room
without taking my meal tray with them.

Posted by Paul Levy at 11/20/2008 10:28:00 AM"

Wow!!!!! All I can say is kudos to Paul Levy and the staff at BIDMC for creating and maintaining a culture of cooperation and compassion and showing us that it is possible.

Road to Hope

2008-11-07T17:16:00.006-05:00

"Hope is like a road in the country; there was never a road, but when many
people walk on it, the road comes into existence." Lin Yutang 1895-1976

As I came across this quote, I immediately thought of the monumental election on November 4 in which we have just participated. With any change there can be natural resistance and fear of the unknown, but this can also be coupled with unexpected opportunity. No matter if you aligned yourself "Blue" or "Red" during the past year, let us come together in this historic time and build a road of hope together, by walking side by side until the road comes into existence. I wish you hope, healing and gratitude during this month of Thanksgiving.

Saying OM instead of Ahh in NYC

2008-10-30T12:26:00.003-04:00

Kudos to fashion designer Donna Karan for putting her money where her mouth is by donating $850,000 for the initiation of a pilot program on integrative therapies at the Beth Israel Medical Center in New York City. The program, highlighted in today's New York Times ,will include yoga, reflexology and aromatherapy as integral parts of a patient's treatment plan, if they wish. I am a firm believer that we can enhance our healing process if we are given options and choices in creating our own care plan, including the best that modern medicine and traditional healing practices have to offer. What a wonderful resource to have a myriad of options available to the patients at Beth Israel. I wish the pilot program much success!

Opportunity Within Crisis

2008-10-09T08:11:00.005-04:00

barn's burnt down;
now I can see the moon

~ Masahide

I came across this poignant haiku this morning. Mizuta Masahide was a samurai in the Zeze domain of Ohmi Province. In 1688 Masahide's house was burnt down, prompting him to write his most famous haiku. The haiku seems very current and relevant to our challenging present times. Can we also see the opportunity within the crisis?

There Is More To Life Than Increasing Its Speed

2008-10-08T11:31:00.003-04:00

"There is more to life than increasing its speed"
Mohandas Gandhi (1869-1948)

Challenging times call for challenging the way we view life. Our natural instinct, when we perceive danger and crisis, is to speed up, try to escape, run away or attack...this works well if you are confronting an aggressive wild animal, but not so well if your "wild animal" looks like economic uncertainty, 24-7 technology, or lack of job security. As counterintuitive as it may seem, research supports mindfully slowing down in times of crisis to decrease the harmful physical effects of stress, increase mental focus and productivity and to regain a sense of internal equilibrium. While we cannot always change external forces in our lives, we can focus on skills to build our resiliency, slowing down, taking a breath, and challenging ourselves to create new ways of viewing life.

What are your thoughts about building resiliency during challenging times?

Lack of Empathy or Scared of Mortality?

2008-09-23T20:17:00.009-04:00

An article in today's Boston Globe caught my eye....a small study conducted at the Veterans Affairs Hospital in Houston assessed verbal interactions between patients diagnosed with lung cancer and their physicians.

Here is an example of one of the verbal interactions:

During an appointment with his doctor, a man diagnosed with lung cancer sounded dispirited when talking about what cigarettes had done to him:

"I was always told I had a good strong heart and lungs. But the lungs couldn't withstand all those cigarettes...asbestos and pollution and secondhand smoke and all those other things, I guess", the man told his doctor.

"Do you have glaucoma?", the doctor responded, abruptly changing the subject."

In the study analysis researchers identified 384 times during these interactions when patients mentioned concerns, worries and emotions concerning their mortality and deadly diagnosis...their doctors responded with empathy only 39 times or approximately 10% of the time! Wow...how very sad for both the patients and the physicians, that they each missed an opportunity to make a human connection. However, when I thought about the study, was it really a lack of empathy on the physicians' part or were the physicians simply scared and unsure of what to do and say to a patient with a terminal diagnosis? Perhaps acknowledging and honoring the human emotions that exist for both the patient and the health care practitioner is the first step to providing competent and compassionate health care.

What do you think?

Let Me Down Easy....What is Grace?

2008-09-17T21:43:00.009-04:00

What is grace?...That is the overarching theme and question that resonates in Anna Deavere Smith's new one woman dramatic work Let Me Down Easy: a play in evolution currently being performed through October 11 at the American Repertory Theatre (Loeb Drama Center Harvard Square) in Cambridge, MA. I had the incredible experience of being in the audience on September 16 to witness and share in the journey Anna leads us through during the two hour performance. Through the stories and voices as varied as Ann Richards, former governor of Texas to Matthieu Ricard, a Buddhist Monk; from Jean Damascene Uwikijie, a Hutu prisoner in Rwanda to Dr. Phil Pizzo, Dean of Stanford Medical School; we are confronted with looking at ways in which our bodies and souls are both resilient and vulnerable. A sense of wonder, beauty, stamina, fear, grief and courage shine through all the vignettes...a snapshot into simply being human. "The only whole heart is a broken one, it lets the light in..."says the voice of Rabbi David Wolpe in Let Me Down Easy. Perhaps this is the essence of grace, to open oneself to the frailty and resilience of the human spirit with compassion and awe. What does grace mean to you? I would love to hear from you!

September....NEW YEAR

2008-09-01T22:06:00.005-04:00

"The purpose of life is to live it, to taste experience
to the utmost, to reach out eagerly and without fear for newer and richer experience."
Eleanor Roosevelt--diplomat & reformer (1884 - 1962)

For me, the beginning of September feels like "the new year". Perhaps this is a vestige from my school days when the anticipation of new notebooks, sharpened pencils and the carefully selected first day of school outfit loomed large in my life. I love the way September days seem bright with promise, even though nothing except the calendar page has changed. Do you also feel this way? Why not embrace this month of September as an eager learner again? As lifelong learners we can learn to observe the fear that accompanies any change, while also relishing in the fact that we are never too old to challenge ourselves with new ideas, dreams and goals. I invite you to take this opportunity to sharpen a new pencil or two, take out a fresh piece of notebook paper, and write down at least one new thing you will try during this "new year" that you have never tried before...I promise there will be no pop quizzes or graded exams this time around!

Enjoy the anticipation,
Pam

Graduations and Commencements

2008-06-13T10:49:00.007-04:00

Graduation...

Commencement...

a time of taking measure and of new beginnings.

As you may have guessed, endings and beginnings are on my mind this month as my youngest child graduates from high school and prepares to start college in the fall. As parents, we measure each of the milestones we witnessed, marking each as "graduations" or intervals in our children's lives and our own. Now is the time for "commencement", a new beginning; stepping, running or leaping into the unknown and trusting the trajectory! May we all have the courage to let go and fly....

"Your children are not your children.

They are the sons and daughters of Life's longing for itself.

They come through you but not from you,

And though they are with you, yet they belong not to you.

You may give them your love but not your thoughts.

For they have their own thoughts.

You may house their bodies but not their souls,

For their souls dwell in the house of tomorrow, which you cannot visit, not even in your dreams.

You may strive to be like them, but seek not to make them like you.

For life goes not backward nor tarries with yesterday.

You are the bows from which your children as living arrows are sent forth.

The archer sees the mark upon the path of the infinite,

and He bends you with His might that His arrows may go swift and far.

Let your bending in the archer's hand be for gladness;

For even as he loves the arrow that flies, so He loves also the bow that is stable."

--Kahlil Gibran

May this be a season for your own commencement,
Pam

Happy Holidays

2007-12-27T10:05:00.000-05:00

As I write this post, I am still glowing from the sight of 1200 luminaria lining the snowbanks and illuminating the night sky of our neighborhood on December 24. It is a tradition we have had in our little section of Concord, Massachusetts since 2001...and reminds us of community, hope and peace.

What struck me this year is how such simple and seemingly insignificant ingredients alone...a white paper lunch bag, a utility candle and some sand...can create such an amazing sight together. Perhaps from the simple luminary is a message for 2008....while each of us has a burning flame within us, imagine what an amazing light we can create together. May 2008 be filled with light, peace, and community for us all.

Many thanks to Rich Stevenson for these photos.

Happy Thanksgiving

2007-11-21T09:22:00.000-05:00

Happy Thanksgiving...wishing you all a season of gratitude. A wonderful little book, Arriving at Your Own Door: 108 Lessons of Mindfulness by Jon Kabat-Zinn, happened to land on my desk this week. As I opened to the first page, a poem by Derek Walcott jumped out at me....reminding me once again of the gratitude I feel daily for the gift of life, love and mindfulness. May you arrive at your own door this Thanksgiving. With gratitude, I share with you Derek Walcott's poem:

The time will come
when with elation,
you will greet yourself
arriving
at your own door, in your own mirror,
and each will smile at the other's
welcome.
and say, sit here. Eat.
You will love again the stranger who was your
self.
Give wine. Give bread. Give back
your heart
to itself, to the stranger who has loved
you
all your life, whom you
ignored
for another, who knows you by
heart.
Take down the love letters from the
bookshelf.
the photographs, the desperate
notes,
peel your own image from the
mirror.
Sit. Feast on your life.
Derek Walcott, "Love after Love"

Integrative Therapies in Treatment of Chronic Pain

2007-11-12T11:20:00.000-05:00

As many of you know, I have a clinical interest in integrative therapies in healthcare treatment. An interesting segment on chronic pain and its treatment aired on the 11/09/07 Today Show. Click here to view the video. Chronic pain is a huge issue in terms of quality of life, worker productivity, and overall health and wellbeing in the U.S. today. It is estimated that over 50 million people in the U.S. suffer from chronic pain conditions. Like many other maladies, chronic pain usually is not curable, but is treatable. We need to open our minds to integrating age old wisdom together with high tech medicine to acheive the best possbile outcomes.

We are "LIVE"

2007-11-11T13:10:00.001-05:00

"LIVE"...What a curious way to describe getting a blog and website up and running! But, it is a wonderful way to kick off my new blog which I hope will inspire you to explore, learn and share insights and challenges on sustaining and building resiliency in our lives...work, home and health. I look forward to sharing some of my thoughts, news, and links with you. Let me know you are out there by commenting!