A KABBALISTIC MEDITATION

As an inconsistent meditator I re-called the following one which has renewed my practice. I was introduced to it  by a young Hasidic scholar, Rabbi Stern who prefaced  the meditation by relating it to the ephemeral nature of existence.

” Why”, the sages asked, “does man not breathe like a tree?”  That would certainly be easier for us.  Plants passively exchange gases with the atmosphere.  Why is our existence literally measured from breath to breath?

“Ah” the rabbis replied, “that’s an easy one.  It is so that man does not take life for granted.  So that they recall that each breath is a gift from God and accept it graciously and with humility.”

Quite simply,  we breath in with the conscious awareness that God is intentionally gifting us with this one particular breath.  It is a gift we should accept with cosmic gratitude and joy.  Since we are not in control we can let go of our pretenses. When we exhale the universe is accepting our gift with no guarantee of continued life.  We simply wait without expectation for the next breath. When it comes we can peacefully and humbly accept it with the awareness that it could be our last.  When our minds contemplate this basic notion of existence from breath to breath, all other concerns and fears seem unimportant.

 We can surrender to the mystery of existence and release our mind’s  pre-occupied by inconsequential annoyances, obsessions, frustrations and worrying about possible future catastrophes. 

It is a simple but beautiful method to pay attention to the present moment, to practice nonattachment to thoughts, emotions and fears. It is a powerful tool to release everything and just be.

“BEDSIDE MANNER”– DOES MATTER

I have always believed that interpersonal relations are powerfully influenced by how you say something as much as what you say.

You can disagree with someone while not challenging them aggressively or impugning their character or intelligence.  You can politely ask a question or do so with an implied threat.  Human beings have evolved amazingly powerful ways of signaling each other their intentions through body language, tone and quality of voice, facial expressions, physical proximity, etc.  You can intrude on another’s space and time or respectfully request their attention.

 This truth plays itself out with tremendous clinical implications in the patient-doctor relationship.  When patients are ill they often feel their autonomy and personal power has been compromised.  Physicians should respect their vulnerability and interact with them with an empathic and compassionate awareness.

 How physicians relate to patients has often been referred to as their “bedside manner”.  Just today, while making rounds at JFK medical center, I entered a patient’s room for the first time.  As usual I am conscious of doing so slowly, observing how they appear in bed, saying “hello” and introducing myself by name.  I smile as well.

 Mrs. “Jones” seemed to welcome me into her space.  I proceeded to describe my connection to my medical partners who she had seen previously.  This offered her a context in which to place me. 

She smiled and quickly proceeded to describe her interactions with another physician “Metta”.  She did not refer to him as “doctor Metta” and stated that she felt he had been particularly unprofessional with her.  She described how he acted when they first met.    Apparently he did not introduce himself to her and addressed the nurse who was present at the time rather aggressively.  She perceived him as abrupt in his speech and demanding of her time.  He proceeded to ask her questions but it was clearly “too late”—-she responded “you should already know the answer to that one!” 

 Dr “Metta” may have been in a bad mood.  Or he might be unaware of how his approach to patients is detrimental to his interaction with them.   He may be an excellent clinician with a deep grasp of medical knowledge.  But Mrs. Jones will not see him again. However, because of his inability to relate to this patient, his professional abilities are rendered null and void. 

First impressions do count in any human to human interaction.  Now my questions to Mrs. Jones might have been just as basic as Metta’s.  Perhaps she could have interpreted them as redundant as well.  Perhaps she could have questioned why I didn’t already know these facts.  But she didn’t.  I connected with her first as a human being and secondarily as a patient.  I demonstrated respect for her “space” as well as subconsciously asking permission to speak to her and examine her.  Her granting me that audience empowered her.  That relationship between us allowed the process to continue. 

Whether or not I can offer her healing wisdom remains to be seen.  At least the opportunity to do so has been created.  So “bedside manner”…..does matter.

BIOMEDICAL ETHICS — A “Hot Mess” but Essential

I am into week 8 of my Bioethics course at Cardozo Law School in NYC.  It is sponsored by my medical school alma mater, Albert Einstein College of Medicine as well as Montefiore Hospital and Medical Center where I did my Internal Medicine residency.

Fascinating, challenging, confounding, powerful, essential—these are but a few of  the descriptive terms I can quickly come up with. 

The class is an interesting mix of physicians, lawyers, social workers, psychologists and others interested in the complex are of biomedical ethics.  So far we have touched on areas related to the autonomy of patients, the doctor-patient relationship, the nature of “informed consent”, the right to refuse treatment, withdrawal of life support and who has the authority to make these decisions, reform at the end of life with more to come. 

The reading assignments are challenging  as well.  Some are written by philosophers/ethicists, others by physicians, still others are case law studies written by lawyers and judges with important decisions which become valuable precedents.  

Several of the students are actively involved in hospital-based bioethics committees.  They are called in to do real world consultations on patients with a host of complex issues.  The only way they can function is as a team composed of members from a variety of backgrounds.  The recommendations can be some form of a  consensus.  It is far from an easily achieved.

Various factors must be accounted for–the wishes of the patient if they are known, emotional family members who are themselves uncertain and conflicted about what decisions should be reached.  And what about family members who are seeking the quick demise of their relative for personal gain?

There are personal religious issues and beliefs to be dealt with as well as the attending physician’s religious/ethical belief systems.  There are the issues of abortion, of who makes decisions for minor children, or terribly disabled newborns that should or should not be allowed to die.

  One powerfully charged example is the issue of discontinuation of life support for a patient at the end of life.  What are the details of each particular case?  There is no place for standard protocols or formats to mandate what should be done for any one individual situation. 

What about the distinction between removing someone from a respirator and stopping hydration and nutrition?  Instinctively people make a distinction.  Yet legal precedent moving all the way to the Supreme Court in the Cruzan decision have declared that legally (and ethically) there is no difference.  Both are considered artificial life support.  Yet families often find it much more difficult to stop hydration and feedings.  There are too many cultural and emotional links to feeding and being fed.  Love and feeding are inextricably linked in the deepest recesses of our  psyches. 

And yet we as a society and our health care system as it exists must absolutely be capable of assisting families, physicians, hospital systems etc. reach difficult if not painful decisions.  Resources are not only limited but we cannot afford to misuse them, to literally waste them when they are inappropriately expended. 

This is where bioethics fits in.  It is completely immersed in the  “hot mess” of life, health and death.  But we ignore these issues at our own peril. 

I am interested in learning more about them.  It is an integral part of my own metaphysical journey.