the beginning …

willI’ve started this blog, as I wish to tell a story.  It’s a very personal story, & as a rather extreme introvert, I struggle with that, as well as with the concern that it may appear to be self indulgent.  This is a story about me, at least at its surface; tho as Avalokita observed, all Five Skandhas are empty; I as self am empty of individual existence; this is a story of interbeing, as it turns out, my best beloved, the interbeing of all of us, told through the only vehicle I have available, empty as that may be; but that will come out only in the telling.

So sitting at this keyboard, at which I was once so proficient, now with one finger of my right hand tapping the keys, where to begin?  Well, as Lewis Carroll and J.R.R. Tolkien have suggested, the Beginning might be a very good place.

I was born at Deaconess hospital in Milwaukee Wisconsin, in the wee hours of the morning on March  22nd, 1951; a year of the Rabbit; square in Pisces acc. to Vedic astrology, but directly on the Aries/Pisces cusp acc. to Western astrology, born breech, so I suppose Pisces from the waist down & Aries from the waist up, with Aquarius rising over Lake Michigan.  Mars & Mercury in Aries, Moon in Virgo with north node in Pisces, here’s the rest of the chart for those so inclined.

will-natal-chart

I suppose the astrologers among you could skip most of the rest below & jump right to the conclusion of this story, but then you’d miss the journey, & as the real story is about Here & Back Again, that’d be a bit sad.

I was fortunate to be born into a hopeful & loving family.

My father was perhaps The Most Devoted man to walk the planet, unconditional in his love & regard of all.  My mother was loving, but enculturated to dispense love more conditionally; this may have impacted variously on my siblings, but with my Mars & Mercury in Aries I seemed to play ahead of conditional judgement.  We were – 4 of us – named expectantly for royalty, George Edward, William Frederick, Diana Elizabeth, Margaret.  My William attributed variously to William I, Conquerer, and to Kaiser Wilhelm (I, the senior, with whom I share my birthdate).  & these were the standards we were silently expected to live up to – and did live up to, in my mother’s eyes.  I recall her rage when the town put up a sign on the avenue in front of our house, announcing “Slow children at play;” not HER children, certainly.

We grew up in rural / becoming suburban Wisconsin, North of Milwaukee, nearby to Lake Michigan, & I spent most of my youth outdoors.  On the first day of 1st grade we were to announce to the class what we wanted to be when we grew up, I asserted that I wanted to be an ornithologist, the word sacrificed to 4 missing front teeth.  My teacher – I think Miss Anthropy – told me I didn’t know what that word meant, & I quietly left the classroom, defiantly, taking my Peterson’s Guide with me, subsequently to attend school only until 11 a.m. for most of my grade school years.  My mother, a music teacher working from home,  enabled my resistance much to the chagrin of a series of elementary-school teachers, by providing me with a blank musical staff book, with access to the 2 upright pianos in our living room, & suggested I record the songs of birds in musical notation.  I still have the staff book, with chickadee-dee-dee, scarlet tanager, indigo bunting, Baltimore oriel, eastern bluebird, a variety of sparrows & warblers, the dreaded whip-poor-will (tho I rolled as “Bill” until my college years).  There were lots of places to play, watch birds, fish, collect rocks, in the fields & edges of dairy farms, woods, abandoned limestone quarries, & the shore of the Big Lake (Michigan).  The marvelous Milwaukee museum was a favorite special treat, & I likely provided entertainment to the curators of geology & paleontology with my finds of freshwater muscle pearls & digging-finds of buried chicken bones.

So perhaps I’m getting a bit lost in misinterpreting “the beginning.”  A dear friend of many years ago, Alyson Miller, teaching elementary grades in Amherst Maine, up the Airline road from where I was living in Old Town, observed that “kids these days,” with digital watches & clocks, didn’t realize that time goes around in circles.  Thank you for that, dear Alyson.  Not sure that time goes around in circles, but it certainly is not linear either – so where is “the beginning,” Best Beloved, if events in time – as events in space – are intermeshed & truly interdependent?

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from starfish reproductive physiology to family medicine

It was a cold & windy day.

I was onboard the Argentine-registered Islas Orcadas, heading North across the Drake passage, between the South Orkney Islands & the Falklands.

and we Knew we were going to Die.

We’d spent the previous 3 days drifting engineless, winds blowing us toward an enormous looming iceberg, but we failed to die then.  My life had passed before my eyes, principally highlighting every dessert I’d ever turned down, having consumed my stash of Argentina’s best chocolate over the previous 3 months at sea.

But today we were in 60+-foot seas, green water flowing over the deck when we hit the trough of a wave, the ship listing 60 degrees to starboard on the wave crests (she was built to heel to 90 degrees, but that would require an extreme act of faith).

John Konecki (a true coyote if there ever was one, God rest his soul) & I climbed the ice-mast, a hollow tube, to the small ice-pack-navigation station at its top, 60 feet above deck, and were cantilevered out over the sea as the ship listed over each windy crest.  Great view of the wildly-blown sea birds!  But we Knew we were gonna die, so WTF?

& I decided I wanted to go to medical school.  Right then & there, cantilevered out over the raging South Atlantic.  Perhaps it hadn’t occurred to me seriously before then, as it was so in line with my mother’s expectations?  So I’d followed my heart, & was studying marine biology, on a trawler in the antarctic – a venture which had taken me from Wisconsin & Michigan to California to Maine.

But cantilevered out over the Drake Passage, it suddenly came together, seemingly a perfect merging of my left brain intellectual striving for scientific knowledge, and my right brain, Zen-educated leadings to salve the suffering of all sentient beings.  A recipe for Right Livelihood.

So, Best Beloved, you might have figured that we survived, I made it back Buenos Aries, and eventually home to Maine, in one piece, or there might not be this story to tell.  Lots of intervening adventures, returning to Buenos Aries the day prior to the 1976 coup, but those are not for here.  & Those of you who know me know I Did go to medical school (the University of Vermont), & did go on to practice medicine.  Lots of Good times & lots of stories between my last installment & this one, & more again following the Drake Passage passage.  But to relate those here would be bowing to a linear interpretation of time.  And Time, I’ve learned, is neither linear, nor does it go around in circles.

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The Fall, from this side

There are two stories to tell, which are both distinct and non-distinct from one another, both occurring simultaneously, one in this world and one elsewhere;   Half of my consciousness was firmly in this world, intellectually & perceptually intact.  So that story first, if only to get it out of the way.

Friday September 12 2014 was a heavy day.

Gravity waves from colliding black holes were yet to be detected, but it was 348 years since Newton’s apple (only 21 years since Apple’s Newton, Ron) & gravity was very real that day.  It’d already done a number on my friends Ron & Elizabeth, coming over the coast range on their motorcycle, & if you know that story, oh my …  But they’re tough cookies, and doing well these days.

Mary had left early for a trip backpacking with friends on Mt. Jefferson in the Oregon Cascades, I was home alone with the puppers.

I’d been feeling a bit odd, hard to describe, but started falling on the kitchen floor, my left side giving out, landing always on my left hip, left shoulder & left lateral knee.  After a few of those I was left pretty sore, & decided it might be best to just stay down.  It was a pleasant day, so the back doors were open for the doggies (a friend once described doors as things with dogs on the wrong side of).  My pups – Maggie, a 6-month-old Golden Retriever, and Rosie, a 7 year-old Golden/Bernese Mountain Dog cross – cuddled with me sweetly on the floor; Maggie as a warm cozy bolster for my back, Rosie as my soft & warm pillow.

I was blessed (?) with anosognosia; a big word that is not a thing-in-itself (as no such exist, as we will see, Blessed One), but basically means in medical lexicon “doesn’t have a clue” – no awareness of one’s neurologic deficits; a phenomenon recognized by the neurologist Joseph Babinski in 1914, and a common characteristic, it ends up, of strokes in the region of the brain in which I had my hemorrhage.  So I lay on the floor for 30 hours, I found later; didn’t seem that much time had passed, but time is neither linear nor does it go around in circles.  With my sweet doggies as companions, occasionally trotting outside to pee & chase away the squirrels marauding my grapevines; but mostly cuddling devotedly.  Remarkably, No fear, which still surprises me a bit.  Perhaps a blessing of the phenomenon of anosognosia.  The downside, of course, was no motivation to crawl to the phone, nor to holler to my caring & attentive neighbors for help.

At one point I decided I really needed to pee, tried pulling myself up on the nearby dog crate, crashed & banged my throat on the edge & collided with the floor on that same now excruciatingly tender left hip.  So ended up peeing in a dog bowl, to the infinite amazement of my furry companions.  Then tipped the bowl (my left hand clumsy).  Later, several well-meaning Naturopathic students sent me YouTube videos describing “stroke as a spiritual experience”.  Well more of that as we go along, but at the time, I had trouble accepting that lying on the floor, half paralyzed, in a pool of my own urine, might be a ritual belonging to any religion I’d choose to embrace.  Though I suppose it might beat out crucifixion.

Toward afternoon on the 13th, my son Ben came over to harvest the last of the season’s tomatoes (to my friends in Maine, yes – we actually get ripe tomatoes out here from July to September, with killing frosts waiting often ’till late November).  He hollered in through the open back doors & I hollered back “take all you want.”  I must’ve sounded strange (my speech was rather Parkinsonian, I leaned later, coming out in a rush & flat of affect), & coming from an odd angle, me on the floor, so he came in with his basket of tomatoes, set them down, & said “uh, dad, shouldn’t you be in the hospital?”  Now the thought had struck me, as they have bed-pans there, and little bottle-urinals, & sweet nurses who tuck you in ask “are you comfortable dear?”  But I countered that I Know what they do in those places to folks going through stuff like this, done enough of that to others in my day, & didn’t want a piece of that; I was envisioning cranial angiography.  He called my other son to come by (we’re blessed with two capable & caring sons living within a few blocks) & I tried to negotiate watching how things played out over an hour or two before doing anything rash.  They carried me into bed, got me a glass of milk & a dose of Arnica 30C “for the bruised hip” & surreptitiously phoned for an ambulance.

The ambulance ride is a bit of a blur – My attention, I think, was struggling with which “reality” to remain with.  I recall the neighbor twins, Arley & Boone, standing with my granddaughter Brigit, on the huge broad-leaf maple stump in their front yard, entranced by the ambulance & accompanying firetruck.  The caring & competent ambulance crew, an EMT telling me “you’re having a stroke,” me responding “I think you might be right” & his response “I know I’m right.”  The lights & siren as we headed off.  The ride was short, I recall the painful large-bore IV stick (artfully performed) in my right arm, and the strangely painless backup IV in the left arm, that side apparently devoid of feeling; the joan-of-arc-coe-circleJoan-of-Arc monument in the traffic circle on 39th & Gleason & I think that was a moment of Return to this world, realizing Joan had endured far worse & would have chastised me for cowardliness in the moment.  I have no recollection of the emergency room, but believe the triage there was brief before the hum of the CT & ride up to the ICU.  My CT was displayed on a wall-mounted monitor in my ICU room, and I was able to read it while waiting for the neurologist & neurosurgeon to arrive.  A cotton-ball-sized opacity showing white with fluffy margins, much like a cotton ball really, in the region of my right basal ganglia, with bleeding into the 3rd ventricle; surrounded by a pale halo, edema surrounding the hemorrhage, with compression of the lateral and 3rd ventricles and just a hint of a midline shift.

Didn’t need the attending to tell me that looked bad.  Likely a 25% chance of short-term survival, & very likely a cabbage-like state were I “fortunate” enough to pull through.  Fear for the first time – worry really, about the impact of my certain disabilities on my dear Mary, tho  I got a chuckle reflecting on how artfully she deals with cabbage in the kitchen.  A repeat CT early the following morning, I discover at that time intended for neurosurgical preparations; the halo of edema & swelling resulting in compression of the ventricles & midline shift had resolved, & the neurosurgeon was cheated out of a mortgage payment.  A thanks to my boys for their inadvertent cleverness with the Arnica for that.

There’s more to the this-world story that follows, but that needs to wait for what was happening over on the other side, ‘cause, in this world at least, time appears to be linear and sometimes appears to run around in circles.

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The Fall, from the Other Side

So this is the more difficult piece to write –

For a long time I felt awkward to share it, ‘cause it seems like it might have been a rather privileged experience, perhaps something not to really be shared with others – not knowing how many have been able to bring such stories back to this world – yet how to reconcile the sense that this was a story for “me,” when The Story is ultimately about interbeing & the illusionary nature of having an independent existence.

And then there’s the issue of trying to describe something to others who might not have a shared basis of experience; tho that may be merely presumptuous,  and perhaps the dimensions of experience we might need to share for the significant story here are varied.

& then my overdeveloped left brain has tried to play with this, to understand it intellectually, iatromechanically, as an intellectual brain trained in conventional western medicine might attempt to do.  Was this a dream, a hallucination of a dying brain?  I’ve had a very rich dreamlife, and afterwards, some dream images can persist & feel like “real” experiences; but in the whole, afterwards, these are easy to recognize as dreams.  I had an amazingly compelling hallucination once, hypothermic while canoeing in a blustery snowstorm in northern Minnesota in late September many years ago, & still feel I can understand loon song from that experience; but again I can readily recognize that in retrospect to have been hypothermic delirium.  This experience was very unlike those.  This was no less illusional than my daily life, my waking samsara.  I was there, my consciousness divided between a this-world presence and this walk between worlds, I suppose what the Tibetans describe as the ‘chi kha’i bar do, the transition of the moment of death, at least the death of a much missed 10% of my brain.

There was falling – of course repeatedly on the hard kitchen floor, in the bathroom; the toilet & between toilet & wall, in the pantry, & on the dog crate catching my throat, with bruised left hip, side of knee & elbow on those bony places; I eventually decided to just stay fallen, cuddled with the dogs (Rosie as sweet warm fluffy pillow, Maggie lying pressing back to me, guarding, a soft & cozy bolster); but also falling into a deep bottomless abyss; if I need to find a shared image, imagine the depths of Khazad-dûm.  A deep, fathomless abyss. I’d landed (on my left hip) on a smooth sloping rock ledge off to one side, sloping down off to the abyss again to my left; behind & to my right was a tunnel, a stone arch opening, very dark.  I think that was The Passage, heavily Veiled; there was only a very faint glow of light to “go into”, but a strong sense of invitation; I was too sore to move.   A bit of clear starlight from what appeared to be a single star far above, reflecting off black rock. Below was black, fathomless depth. The tunnel felt like the way out, & I felt compelled to try; but clawing at my back was – well, a clawing at my back – “unfinished/unreconciled stuff” – & I felt the clear sense that entering the stone arch to the tunnel had to be done in peace. Turning back to the clawing, I heard strains of song – my “other” consciousness had gratefully received my boys’ arrival & rescue from the kitchen floor, tried to bargain for another hour of waiting, dealt with the arrival of the paramedics , the ambulance ride past the Joan of Arc monument at Coe Circle on 39th & Gleason, ER, radiology visit for CT, & arrival in ICU, & was now (time was very confused; neither linear nor going about in circles) lying in the ICU bed gazing at my CT image on my ICU room monitor, waiting for the neurologist to come by & read it.  In This World,  I was totally intellect – my emotive mind was elsewhere – bright white cottonball lesion deep behind my right eyeball, in from the posterior temple, above the wing of the sphenoid, the size of a – well, a cotton ball, a hemorrhage in the region of the right basal ganglia; whispy white trails into the 3rd ventricle (Not Good, nothing to tamponade that bleeding & closer to essential “housekeeping” functions); a thick pale grey halo about the cottonball (edematous swelling surrounding the bleed); the central suture & midline structures shifted prominently to the left of midline (Not Good at All) (good radiology training ;^)).  My intact cognitive brain registered a 77% short-term (hours) mortality risk, with vegetal status for the 23%. Gonna be a cabbage at best for my sweet Mary & my lovely boys (I did get a dark chuckle noting how resourceful Mary is with cabbages, a little butter or olive oil, onion, caraway seed, vinegar, maybe some apple, she can totally make it rock ;^)). Feeling so happy to witness the boys’ competence & compassion, we’ve done a fine job with them, sad that my part in that job is ending, wishing I could tell them how (proud? – not quite the enormity of the word I need) I am of them, not knowing how to say good-bye, hoping that can be dignified & not drooling with a half-paralyzed tongue. Granddaughter Brigit still standing on the neighbors’ old front-yard Maple stump with neighbor twins Arlie & Boone watching me loaded into the ambulance, Mary not here, still hiking in the alpine meadows of Mt. Jefferson, but even if she were, I’m so far away; back down in the abyss, strains of Ripple playing from the nurse’s station, over & over as the Grateful Dead are known for.  it seemed like hours or days, timeless; perceiving a bizarre sense of irony in the Grateful Dead’s presence in this space.  I felt No fear – “Isolation” might describe my feelings, but even that concept is our invention to highlight our reality of connection, this was pure no-connection, a walk in a totally far-off place.  Not wilderness, wilderness is defined by our presence in contrast, and I love wilderness, I feel comfortable there; this was wilderness’ wilderness.  The feeling of Damien Rice’s Cold Water is precise (I heard him sing this, feeling it deep in my spine, at the Roxy in Prague), Empedocle’s Air Element distilled & pure.  My wonderful boys were there at bedside, Ben & Caleb, I was loving their devoted presence, reminding me so of their grandfather, but most of me was far, far away, across time and space.

Back to the abyss, trying to come to some peace with the clawing, which now felt enormous, eclipsing even the depths of the abyss in its insistence for my attention, I was witness to overlapping filmstrips of my life “passing before my eyes” – like my dad’s old 16mm movie filmstrips overlapping diagonally – some passages so swift I couldn’t really make them out, others (both painful & blissful segments) in painful or blissful slow motion. The blissful segments all were about connection, about holding & being held.    Wanting to replay & getting to replay some of these, wishing I could just stop the replay of others.  Maybe by rolling off the ledge?  But that’d be the end of the blissful segments as well and I so, so wanted to keep those.  Superficially, recollections of my life – tho I now appreciate as my Karma, revealed.

At some point I discovered, just to the left of the opening of the stone arched tunnel (so out of the span of my easy awareness; Left Neglect is so difficult to describe, I will make an attempt in a subsequent post) an upward sloping ramp, narrow sidewalk-wide, about the width of my forearm’s span, spiraling far up the sides of the cylindrical abyss above.  I started up toward the music, my way lit by the starlight from above, and it became clear that the starlight was issuing from the hands of a  long-estranged very dear old friend; this becomes now deeply personal, to be shared with that dear soul, as I have, but not here.  Perilous, as working up the spiral, the abyss was to my left, the side of my paralysis, perceptual “neglect,” (not understood at that point, more on this later) and the side of my (later labeled) “listing to port”.  Not sure if I walked or crawled; I recall both.  The voice of my light-giver joined the singing, chanting it seemed in aelvish, and my steps lightened, the painful segments of my Karmic visions feeling eclipsed.

An eternity (really, tho the Dead were still playing, but then, they are known for that) “later” I crawled the last of the winding spiral into my ICU bed, abysmally uncomfortable, but more padded than the ledge or the kitchen floor, and my “separated”  consciousnesses (both empty of independent existence, as Avolokita so deftly observed) merged.  A warmed blanket helped, felt heavenly really (that nurse was a “Wendy” – my old friends from Vermont days will understand that), and Mary was there now at bedside, so sweetly, so strong for me, having bravely driven 3 hours since receiving news from our sons, (she says “what else could I do?”) also offered a warmed blanket; my emotive mind was fully worn out, all I could greet her with were “the facts,” the technical description of my “event”, hoping that pure intellectual knowledge might be reassuring.  As a “cabbage,” I was living in my head, in the relatively intact left side of my head ;^).

The illusion – magnified in the revelations of my Karma in bardo – was one of intense isolation, which is possible only within the delusion of having an independent existence; contrasting with the revealing of interbeing of us all, my “self,” my loving partner & devoted family, my dear most beloved friend of so long ago (although, do you see, Best Beloved, Time is not linear, nor does it go around in circles) bearing starlight in her hands, the sweet nurse with the warmed blankets, the cotton fields where the cotton for those blankets grew, the many-generational sufferings & joys & labors of the workers in those cotton fields, the clouds above those fields bearing rain serving the growth of the cotton; the sauce Ben made from those late-season tomatoes nourished by another falling of that same rain falling in a distant, but strangely non-distant region of the world …

Now some guys might have “gotten it” by merely reading the Prajñāpāramitāhṛdaya, as I first had so many years ago, and for some it may have required as much as a sprained ankle.  For this fella it took a 2cm hemorrhage in the right basal ganglia, stroke as a spiritual experience indeed.

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Left Neglect

One of the strangest and most disruptive neurologic sequelae of my stroke, was “left neglect.”   So difficult to attempt to describe, let me begin with the rather dry, intellectualized description in the WikiPedia:

Hemispatial neglect, also called hemiagnosia, hemineglect, unilateral neglect, spatial neglect, contralateral neglect, unilateral visual inattention, hemi-inattention, neglect syndrome or contralateral hemispatialagnosia (ooh, I like that term, as it is nearly as incomprehensible as the phenomenon itself) is a neuropsychological condition in which, after damage to one hemisphere of the brain is sustained, a deficit in attention to and awareness of one side of space is observed. It is defined by the inability of a person to process and perceive stimuli on one side of the body or environment, where that inability is not due to a lack of sensation.

Now the subjective description:

Lacking yet a name for this, and appreciating only that “a lot of shit was going down” (was this an expression of anosognosia,  or is it merely the basic nature of subjective experience?); I could see my neighbor twins Arlie & Boone standing on the huge maple stump in their front yard as I was carried to the ambulance; I somehow knew my granddaughter Brigit was with them as well, but could not see her (she was apparently standing on the same stump, my son/her father later told me), and as I was strongly aware, but to the street side (my left) – not in my left visual field, but in the left of “what was going on”.

The WikiPedia article goes on to describe this:

An important question in studies of neglect has been: “left of what?” That is to say, what frame of reference does a subject adopt when neglecting the left half of his or her visual, auditory, or tactile field? The answer has proven complex.

In ambulance, I was oriented head forward, on the driver’s side of the vehicle, & had a view out a side window on my right, so was able to see Joan of Arc in the middle of the Coe Circle traffic circle at 39th & Gleason; I recall being impressed that an ambulance with lights & siren is definitely the vehicle of choice in a traffic circle, and recall the rallying I felt to this life from Joan perched valiantly on her gilded horse.  The paramedics were evidently on my left in the rear of the ambulance, & I discovered later I had a large-bore IV in my left arm; painless at insertion, as I lacked any sensation in that arm, and unaware of any fuss in placing it, as that apparently all took place in that strangely inaccessible left world.  The narrow winding pathway out of bardo first appeared to my left as I lay on the ledge in those depths, I was late in discovering it & likely only did so on reviewing my “options,” the abyss from that perspective still more to my left, so placing the pathway, tho still to my left, in the accessible right world.  On climbing out the narrowness of this ledge-pathway might have been terrifying, especially with my tendency to veer to / fall to the left (later discovered in consistent wheel-chair collisions with walls & objects in that mysterious left world); my inability to appreciate the precipitous drop-off to my left, with awareness only of the vertical & sometimes overhanging wall to my right, and the right-world half of the path before me, might have made this feasible.

Mary, & my boys during their stay, were at the right bedrail; later I was to use the left side of the bed for transfers to the amazing butt-grabber (a fantastic wheeled device for plucking me out of bed & transferring me to the shower room, radiology, the PT department &c. in my early days), but this remained a mysterious & inaccessible world.

Much later – 17 months following my “incident” – after my left neglect had miraculously resolved (that story later), I read – at the suggestion of a friend – Lisa Genova’s excellent novel Left Neglected, featuring a protagonist dealing with this phenomenon.  Much of the description rang true for me, especially with my experiences in the earliest days, and I could identify with many of the strategies the protagonist had used to cope with, and attempt to overcome, this phenomenon.  This novel, and the WikiPedia article, go a long way in describing hemispatialagnosia, and I’d highly recommend them both to someone wishing to understand these intellectually.  I do so wish that had included my care team.  Not to fault anyone – I received good care, by & large, for the issues that were facing me in the moment.  & likely was not in good position to recognize & integrate the assistance I’d require later, in moving forward.  Perhaps, within the limitations of the medical model, the assistance I was given to cope with & manage this, was cutting-edge.  My speech & language therapists emphasized scanning far to the left, to bring text into the center of my visual field.  Physical therapy worked with scanning far to both sides while walking, while emphasizing balance with my gaze diverted from direct-ahead; and I began to be able to avoid walking into the walls that are so often placed in that mysterious left world, & to protect the regularly injured toes of my left foot from forceful collisions with the legs of the bed, &c.; this now several months later, after returning home.

Incidentally, regarding returning home – I discovered some secrets to happiness – having two sons, one a carpenter (new, sturdy rails on the front porch steps, one on the right, going up, and the other on the right, going down,  new, sturdy banister down the cellar stairs, handrails in the bathroom) & one a chef (self-explanatory, esp. as my new most wonderful family doc was to focus on diet & exercise as the key elements of long-term risk-management); and Sisters – Mary’s lovely sister Nancy, now living stateside after many years an ex-pat & previously a Skype presence in our lives, moved in for several weeks & spared Mary from the day-in-day-out of tending to & motivating me.

The breakthrough with left neglect began happening 10 months after my “incident.”  Mary found, & encouraged me to see, a craniosacral therapist (Valerie Vala, LMT).  The initial visits were very nice for general energy, mood, &c., but I vividly recall at one early visit suddenly being aware that the light in the room was issuing from a large window to the left of the massage table as I lay on it; and discovering a small wind chime hanging outside that window, in that bizarre left world.  Following subsequent visits in the fall of 2015, I recall on my walk south to the bus stop for my short ride home, the colored leaves of the trees across the street in that left world.  The access to that left world never lasted very long, an hour or a few hours, & I reconciled myself to brief glimpses of it, focusing on coping with its inaccessibility.

On a vacation in Maine (have I suggested that I have an inexplicable heart-connection to Maine, oh Best Beloved?), devoid of such brief glimpses, I recall sitting for dinner at Moody’s Diner (an occasional break from my obsessively healthy diet is necessary, for pie, as it is well-known that one can die from depression).  There was a table of folks “from away” about 20 feet ahead, & slightly off to the left; I could “see” them technically, particularly those in the right-hand side of their booth, but could not incorporate their presence into my actions or general awareness.  They were rather animated & loud, as “folks from away” often tend to be; and it was very difficult for me to relax & eat my pie with all the cacophony going about in that inexplicable left world.  I ended up putting my pie in a box, to focus on trying to relax & enjoy the companionship of my extended family (who, lovingly trying to understand & accommodate my hemispatialagnosia, were all seated in the right world portion of our booth; I was able to appreciate & relate to the right-world half of each of them, as well as to the right-world half of all the pieces of pie on the table pie, tho without recognizing that their left-world “halves” were being neglected); & ate my pie later, along with some of a beautiful loon-decorated wild blueberry pie I’d made back at the cottage.  Pie therapy, underrated at best.

With brief access to the Left World following craniosacral sessions, esp. following attention to my sphenoid, the final breakthrough occurred with a long-distance Reiki session.  Lotsa detail that feels a bit too personal to share here, re the who & how, and perhaps that was integral in the magic; but I was able to feel & see the Sender, over my left(!) shoulder, chanting what I later learned to be the Reiki principles in Japanese; at the end of the session I opened my eyes to an integration of the Left and Right Worlds and have maintained that integration ever since.

A couple months later, still revelling in my newfound ability to participate in that strange Left world, we were celebrating my granddaughter’s birthday in a video arcade – an environment close to hell in my best of days.  With video games making sudden noises & displays randomly about the room, 3 huge-screen TVs blasting out different channels, I was able to maintain a presence & actually interact with kids & friends.  Fortunately across the street is the Tao of Tea, where the wait staff has a collective pulse of 40, & Mary & I were able to recover there with a placid dinner & a Shiboridashi of Jingmai Bai Cha.

I realized – after all had resolved – that, lacking one of the basic functions the right basal ganglia play, of retaining a visual/spacial “map” of the Left World, anything occurring there had been strikingly instantaneously novel – like someone jumping out suddenly from behind one’s back – a constant string of surprises leaping out from that strangely inaccessible world.

Much to be shared about Left/Right, brain lateralization, Dominant/Nondominant, intellectual/feeling, Giving/Receiving; and perhaps this is the Central Story; for another time.

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Rocks

I’ve mentioned my early childhood leanings to ornithology; still there, tho not as a profession.  I kept my sanity (well …) on board ship on my antarctic adventures by getting up early for bird censuses – albatross, shearwaters, storm petrels, penguins, …

But this was balanced by other fascinations with the natural world.  A pet raccoon, snapping turtles, flushing pheasants from the hedgerows about home, fish in the river, small streams & abandoned gravel quarries, & the Big Lake.  And rocks.

Not sure how it actually started, but I had 3 shelves in my basement bedroom, 8 or 9 feet long, organized for my collection.  Perhaps first with Lake Michigan beach pebbles, but eventually my participation in family vacations was built around what might be added to my collection.  Lead ore from a visit to Galena Illinois, quartz geodes from road cuts in Southern Indiana, Amethyst & beach agates from the north shore of  Lake Superior.

A vivid memory was a gift from my “uncle” Jim Lindenthal, my dad’s best friend & work colleague, who would riffle through the feldspars they imported for clays for electronic ceramics at the work they shared, and bring me rare treasures; the prize a thumb-sized perfect crystal of golden-yellow beryl, heliodor, from a feldspar quarry in Maine; my first connection to Maine, later my home for 26 years.

My dad was of the sort to build it yourself; at one point, his own airplane, in our basement; why buy something if you can build it yourself for twice the price?  Tho he was good at scavenging & actually keeping cost to a minimum.  One year for Christmas he built (we built together, he was great at that) a lapidary machine – for slicing, grinding, finishing & polishing stones.  We frequented rock & mineral shows for inspiration, and to add to my collection.  Onyxes, tiger eyes, green aventurine, agates, to add to my local finds of Lake Michigan Beach & Kettle-Moraine glacial drift stones.

4th grade was a pivotal year for me.  Following a string of Miss Anthropies as elementary school teachers, I scored Miss Stewart.  I clearly recall the day, in class, bored with the material & staring out the window, a small piece of black jade in my lap I had laboriously shaped from a sawn slab into an even elipse and sanded into a cabochon with successively fine sandpapers, now working it to a satin finish with a rouge cloth, apparently fidgeting with my hand in lap in the classroom.  I’m sure not knowing what all this hand-in-lap activity might portend, my teacher asked to see my hands.  Terrified my treasure would be confiscated, I showed her gingerly, & she exclaimed “beautiful!  Do you like rocks?  What is it?” (examining it closely)  She brought in some of her collection the next day, & so began my first full-day, and first devoted, participation in school.  I Loved fourth grade, nearly enough to attend school most days.

Owyhee jasper mala

Owyhee jasper mala

I titled this post “rocks,” but perhaps it should be titled, like all of these posts, “connection.”  Dad, “uncle” Jim, Miss Stewart, golden beryl, black jade, these rocks at the time a fascination with the natural world & admired for their immediate physical beauty.  Since my walk on the edge, the intimacy of that relationship has grown, & I’m finding in them a connection to those slower rhythms of life and an integration with Connection, interbeing with Others.

Whether born from eggs, from the womb, from moisture, or spontaneously; whether they have form or do not have form; whether they are aware or unaware, whether they are not aware or not unaware  …

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Life 0f the Spirit …

My mother was raised Methodist, my father Episcopalian.  I think I’ve got that right, as background it’s close enough.  I was raised in a Wisconsin farm town transitioning to suburbia, with Germans & Polish as the dominant ethnic groups, in which there lived basically two apparent species; Catholics & Lutherans.  Lutherans did not eat fish on Fridays, tho there may have been other distinctions of significance.  There were some Methodists across town, a rather silent species it seems, somewhat aligned with the Lutherans; we occasionally attended for hymn-singing at holidays.

A life of the spirit was important to my parents, but passive participation in the existing structures was not; & so, with a few other families, we started a “church.”  It began, I recall, in  rented space in the basement of the town hall; during the Cuban missile crisis this broke down, as the air raid siren was atop the building, too often interfering with proceedings; so we began meeting in each others’ houses; I mostly recall ours, and especially the Forests’, with a large enclosed porch & large windows, on a beautiful wooded lot overlooking the Milwaukee River, across the river from our part of town.

The involved parents took turns officiating the service and providing for the children; many years later, when I discovered Quakers, I had the sudden realization that this is what we had been all this time.

After many years the collective families finally raised the funds to purchase a lot & build a church, incorporating it as Presbyterian (“governed by the elders”) & to hire a full-time minister, a respectable Dutch-Reformed gentleman.  Pews & lectern, families in the pews, folks hired for youth education, a grand project in the eyes of many, but for me, the essential nature of spiritual community became lost in the shuffle. I realize some folks desired a formal “tended to” church, and this met their needs, not fitting in to the existing denominational structures in the community; but for me, the life of the spirit had been in the act of co-creation, the communion of souls.  The final coup to “religion” for me was the reluctance of my church leaders to offer guidance during my Vietnam War years leadings to pursue conscientious objector status with the local draft board.

I attended Michigan State University in East Lansing Michigan, and became active in a few groups organizing protests of the war.  Most were lost in Protest, & I perceived the psychic violence in that protest to be parallel to the violence of the war, not in body count or physical hardship certainly, but in psychic burden.  There were a few rather pithy older women involved, however, who seemed to possess a foundation, a clear understanding of why war (& not just this war) was objectionable; or rather, more meaningfully, why peaceful alternatives to war were preferable.  They had few words, and between the drawing of my introversion, and the intrigue of mystery, I was pulled in to the Society of Friends (Quakers), rediscovering the nature of spiritual community that had been planted as seeds in my youth.  The Student Mobilization Committee lost its appeal on my realizing that the real work was internal and local, and Tolstoy, Hermann Hesse, Ram Dass, a Penguin edition of the Bhagavad Gita, eastern teachings embedded in the evolving 1960s beat community, and Friends traditions and Practice became my focus.

My parents struggled a bit with my “political” leanings (tho perhaps more with my hair & beard), both having served in the military in WWII, but have I mentioned that my dad was unconditional in his Love & Regard for all?  Dad had served as an unarmed (for lack of ammunition) combatant in then-Czechoslovakia (more on that connection later), and witnessed many of the the horrors of that war, I grew up with his beautiful pen-&-ink sketches of the countryside about Cheb & Pilsn about the house; and in truth my personal peace testimony derived more from him than from any other source.  The Quaker Peace Testimony derives from a perception of “that of God” in everyone, our essential interbeing, a concept I believe my father truly understood, & that I inherited from him (Margot, Diana, would you agree?).

Mary & I were married in a Quaker ceremony, under the care of Midcoast Friends Meeting, in a log lodge at Tanglewood Camp in Lincolnville, Maine.  The marriage certificate – a large illuminated document signed by all in attendance, friends, family, and one still-mysterious stranger, hangs on the wall above our bed.  It’s worked for 33 years, and shows no signs of failing despite our recent hardships.

It is difficult for me to frame my involvement in Buddhism as “religion;”  I prefer to call it “practice,” but perhaps that’s more the result of western attitudes about “religion” than it is about the essential nature of Buddhism.  I think my first introduction was Hermann Hesse’s Siddhartha, followed by the writings of Gary Snyder, wanderings from there into the poetry of Basho, Issa, Dogen, and on from readings, to the practice of Sōtō Zen, principally inspired by my teacher, Shunryū Suzuki-Roshi, at the Tassajara Zen Mountain Center.  My Sangha is my Friends (Quaker) community, which I’ve participated in these past 15 years inconsistently due to my introversion colliding with an extrovert’s daily job, rendering Sunday mornings often a precious time for seclusion; my personal practice is Sōtō Zen / Mahayana Buddhist practice with some wanderings into Tibetan Mahayana tradition.

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Sitting in the morning, with dogs

Sitting in the morning, with dogs

Breathing in, breathing out
Maggie brings a sock, drops it, slobbery kiss, my nose, my eye
samsara can be very sweet

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Sitting in the morning, with dogs, part 2

Sitting in the morning, with dogs, part 2

Rosie panting in my face
“heh-heh-heh-heh”
Dog breath in, Dogbreath out
the Great Bernese mantra

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Sitting in the morning with dogs, part 3

Sitting in the morning with dogs, part 3

Rosie’s tail in my face
swish left cheek
swish right cheek
lessons in duality

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Sitting in the Morning, with Dogs – part 4

Rosie finds a tennis ball, goes brings it,
drops it in my lap, bows
nasally dog-songs
hrrnn? hrrnn? hrrnn? hrrnn?
in my face
more insistent, even than my discursive thoughts

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Sitting in the morning with dogs, part 5

Sitting in the morning with dogs, part 5

Rosie lying
Quietly
Her Tail in my lap,
her soft back warm against my knee & shin
the gentle rhythm of her breathing
two? one?
this illusion of duality

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Sitting in the morning without dogs

Sitting in the morning without dogs

(written after 2 weeks “away,” on vacation in Maine, the puppers still 3,000 miles from the ocean)

Without tennis balls or tail in face
My own breath breathing in, breathing out
This illusion of separation
Reinforced by 3,000 miles

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Sitting in the Morning, Once Again with Dogs

rosie-stickSitting in the Morning, Once Again with Dogs

(on returning home after 3 weeks away)

Rosie stretched
her warm soft back against my right shin & knee
gets up, wanders
as does my mind
comes back with a stick

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The Fall, another attempt to describe

I’ve been reading my 19.October Post (The Fall,from the Other Side) and realizing I might have done a decent job describing my sensory impressions at the “time,” but not so much the Experience of that walk on the Edge.  In truth the Experience took quite a while for me to begin to recognize, really coming to me only following an amazing long-distance Reiki session some 16 months later, when the hands that provided light in that Dark Place came back into my life on this side, as a treasured friend & sender of Reiki.  Even now, I struggle at describing this profound experience in a way that does not feel merely mundane or trite; hence my initial reluctance to attempt a description.

I can describe the experience, as I have, as lying alone on a rock slab in a dark abyss, with images of my life passing before my eyes; tho the Experience was something rather beyond this, neither enveloped in that description nor differing from that description (to borrow the language of the Diamond Sutra, which is why we can use that description).

The Experience was one of abject isolation, aloneness, separation; lying alone on a rock slab in that forsaken “place,” the painful filmstrip segments of my life speaking of separation; against the backdrop, to which my immediate awareness was numbed, of interbeing – interbeing (with) my loving & devoted wife/partner, driving in shock & grief 3 hours to sit at my bedside, (with) my devoted and capable sons, (with) my loving 4-legged companions on the kitchen floor, (with) a most dear long-estranged friend who somehow had the ability to walk into that timeless place between worlds to light my way (no, Best-Beloved, that was most definitely  Not a mere hallucination or dream image), while the blissful filmstrip segments illustrated moments of loving connection.  The preposition “with” in parentheses above, as subject and object are One, rendering the preposition either unnecessary or wholly necessary & implied; tho we may Perceive Subject and Object as distinct, Object is by its very nature “with” Subject.

The delusion of isolation is only possible within the illusion of an independent existence; if “I” do not have independent existence, if “self” is an illusion, but exists only in interbeing “with,” how can “I” possibly find “myself” alone, isolated, separated?

mappa-mundiI often refer to the 4-element construct of Empedocles when teaching the nature of health & disease.  With Mars & Mercury in Aries, Empedocles’ Fire element has been huge in my life; directly above the horizon, a life focussed on doing, determined, confident, a Mind-centered life.  In bardo, the Experience was pure Air element, cold, alone; seeming opposites, yet the thread that runs through as truth between both is the illusion of an Independent Existence.  The core nature of my Karma.

Such a blessing to be guided out, back to this world, with that recognition.  Next time through, I’ll try to be more aware, I might hope a sprained ankle will be sufficient reminder.

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Ankylosing Spondylitis

My diagnosis was informal, tho strikingly definitive.  I was walking down the hallway on a general medical ward in my 2nd year of medical school, followed closely by an attending rheumatologist (John Bland, M.D.), for whom I later developed enormous respect as a compassionate & capable clinician & teacher, and his entourage of residents, fellows and students – like a cluster of ducklings about their mentor.  “Classic gait” are the words I recall hearing from behind me – referring I now understand  to the lack of motion in my fused sacroiliac joints, the lack of any gluteal activity, and over-involvement of my quadratus lumborum & hamstrings in normal stride, adeptly observed by this master of his art as I was merely going about my rounds ahead of him.  Incidentally, John was Quaker, a graduate of Earlham College (such a woven web!).  I paused and permitted a quick demonstration of Schober’s test – a measuring tape on my back, documenting loss of flexion in the lumbar spine on attempted touching of my toes.  I already knew all too well that my fingertips would not make it past mid-shin; at age 18, 12 years prior, my toes had begun tapping the highbar on stalders, and I could no longer burry my face in my shins on a piked front.  A torn meniscus in my knee and the consequent deconditioning had terminated any further gymnastics aspirations, and my yoga practice had become discouraging and taken a backseat as my flexibility deteriorated.  I suppose it was actually a bit comforting to have a named “condition” to explain my fall from physical capability, rather than consider this to be the result of sloth and lack of dedicated effort.  Further medical workup might have been interesting intellectually, and might have precipitated aggressive medical “management,” with its attended risks as well as benefits; the rheumatologist of my hallway encounter actually discouraged this, using it as a teaching moment to appropriately inform his entourage that history & physical examination are primary in assessment, necessary & often sufficient for diagnosis, prognosis & development of a plan of action; for this, he displayed some photos of the eventualities of succumbing to the disease, and emphasized attention to posture, maintenance of what flexibility I still had, and continued physical activity.  I was a long-distance runner at this point, and had always enjoyed hiking in the mountains & running with my dogs, and these became the mainstays of my treatment.  My rheumatologist, 64 at the time and nowheres near to retiring, was an avid Nordic skier, who had taken up marathon running after a heart attack sustained in a ski race at 59; he was a strong proponent of physical activity in the management of rheumatic diseases, and of health in general, and served as an encouraging mentor, both personally & professionally.  He finally succumbed at age 80, teaching & practicing into his final days.

Ankylosing spondylitis is an autoimmune inflammatory disease, involving inflammation & bony fusion of the articular tissues & ligaments of the axial skeleton, most particularly of the sacroiliac joints, the lumbar & cervical spine, & the sternoclavicular joints.  A common marker is a genetic variant in one of the human leukocyte antigens, known as HLA B27, a variant commonly seen in Native American populations; I have a minor heritage of Seneca,  expressed principally in the shape of my nose, my cheekbones (tho obscured since 1969 by beard and better seen in my sisters), a high instep that has made the fit of hiking and ski boots a challenge, and this autoimmune disease.  I’m not aware of any history of it in my family; however my father was identified as being a valuable tissue donor, having the HLA B27 tissue type, when he provided skin from the sole of his foot to my youngest sister for cleft palate repair, and he frequently donated skin for other such children during my childhood years.

Back & neck pain began to be an issue, episodically, in my early- to mid-30s, likely staved off by my level of activity, efforts to maintain decent posture, practice of Tai Chi picked up for purposes of sanity during my medical residency, and dedication to Bob Anderson’s wonderful book Stretching, which was a Bible in the days of my medical training.  Eventually this evolved from inconvenient stiffness into daily pain.

I became a walking weather station.  I’d been taught, in my medical training, that aggravation of rheumatic disease by weather changes was a myth, but I was a living contradiction to that supposed wisdom.  I could reliably predict oncoming storms 4-6 hours prior to any meteorological signs.  This was a valuable superpower on our family canoe trips every autumn in Maine, but became a mere annoyance following our move to the Pacific Northwest.  Here all one needs for weather prediction is a calendar; in Portland (Oregon), it’s common knowledge that if one cannot see Wy’east (Mt. Hood) in the winter (September-April), that’s because it’s raining; if one can see Wy’east between September & April, that’s because it’s about to rain.

Back pain was severely aggravated following my stroke, while in hospital.  I supposed at first that may have been the result of repeated falls on the fateful day, or perhaps due to inactivity during those early days of confinement to a hospital bed; but with increasing discomfort even as I began to be able to move again, and as the falls of that day became more distant, 10 minutes of online research revealed a tidbit missed by my treating neurologists, who ignored an easily-found observation in their one-sided concern re controlling my blood pressure; Lisinopril, a commonly-used blood pressure medication known as an “ACE inhibitor” (“ACE” = “angiotensin converting enzyme”), exerts its principle physiologic effect by inhibiting the degradation of bradykinin, a significant mediator of inflammation and inflammatory pain; and was severely exacerbating the pain of my disease, as well as the systemic inflammatory disease itself.

Another 30 minutes of research on my laptop using the hospital’s internet connection, revealed that the inflammation of ankylosing spondylitis is not limited strictly to connective tissues of the axial skeleton; there is frequent inflammatory involvement of the endothelial tissues of the cranial arteries as well, and stroke risk is significantly higher in affected folks, due to compromise of the cranial arterial walls.

My blood pressure had been modestly elevated before the stroke.  In ambulance it was quite high, likely as a result of the stroke and perhaps of my traumatic experiences of that day.  Keeping it down was important – but with a medication that might contribute to further weakening of already compromised arterial walls?  One of my mentors in medical school – Larry Weed – told us that medications had no side effects – they may have effects we desire, along with effects we do not desire, but these latter are best not considered to be “on the side” – they are as real, and their presence as predictable, as are the desired effects.  The severe exacerbation of my back pain was not a “side-effect” of a medication, but a very real effect of a medication selected myopically for its desirable effects on blood pressure.

I’d been all-too-aware, as a practicing physician, of how medicine has become fragmented among specialties, with a shortsighted simple-systems-based iatromechanical philosophy suggesting simple linear close-order causal relationships to be sufficient to guide understanding & treatment.  I was now swimming in that great misunderstanding in a very personal way.  Several months later I began to experience Lisinopril’s common “dry cough,” and progressed to sounding like Rod Stewart without the talent or the manager; another effect of this medication.  Struggling with other undesirable effects of other blood pressure medications, and lacking a suitable alternative, I’d remained on this one; fortunately my wife Mary found me a wonderful family doctor, Miles Hassell M.D., who specializes in long-term risk reduction; whose primary interventions consist of a Mediterranean diet and physical exercise; & with those on board I was able to exchange my medication with a low dose of an alternate & get me off the offending agent.

My back pain settled down quite a bit, back to a more manageable pre-stroke level of 6-8 on a 10-point pain scale.

I managed homeopathically with Rhododendron chrysanthemum, the Siberian “snow-rose,” or Bellis perennis, as indicated by the symptoms of the acute flare (dear friends in the homeopathic community, a differential of those remedies in this context would make an interesting study, and we might do that together elsewhere), on an as-needed basis for acute exacerbations; and the bowel nosode Morgan Pure for long-term management.  Along with some excellent craniosacral work.

& then, on February 1st 2016, 16 months following my stroke, a Miracle Occurred.  

I woke at 5 a.m., 3 hours before my normal waking time, feeling amazingly good, with the clear sensation of hands working my low back, the tired & sore paraspinals & quadratus lumborum, down deep into the very sore & tender iliosacral angles, all these structures relaxing & without pain for the first time in many years.  Odd, as I was lying on my back at the time, and this continued without interruption when I rolled onto my side, & when I got up for a short walk out to the kitchen.  I immediately recognized those hands, there was no mistaking them,  they belonged to a dear friend living 3,000 miles distant whom I’d not seen for 22 years, and then only briefly since our parting 36 years prior, who had recently had the bravery to reconnect via the small miracle of email.  We’d studied bodywork together in my first year of medical school, Swedish & deep tissue massage & Polarity, practiced on each other frequently, I’d know those hands anywhere.  Hadn’t allowed anyone else to work my back in the intervening 36 years.  The hands that lit my path out of bardo.  I wrote, asked if she’d been sending Reiki, she responded that she’d “only” been holding open a loving space.  2 days later she sent me a long-distance Reiki session.  Lots to relate there, another time; but for here, in that session, soothing warmth deep in my pelvis, deep along the anterior iliosacral ligaments, and full comfort in that region, long a settling place for the pain of the world. 

I’ve been fully pain-free since, now 9 months.  SI joints & lumbar & cervical spine have un-fused & returned to full ranges of motion, something rather unheard of in the medical record.

bellisLast April, walking in a city park near home, I was able to reach down, standing, with unbent knees, beyond touching my toes, to pluck some Bellis growing in the grass; this flower I’d previously used to manage my pain, which I’d had to gather on all 4s, no longer needed for that purpose, now “merely” to be admired.

As a licensed medical doctor, I’m not legally permitted to claim cure of an “incurable” disease.  So need “officially” to call this a remarkable long-term remission, tho my heart knows fully otherwise.

On relating this to my current physiatrist, she smiled, held up her cellphone & suggested, “I don’t know how this thing works; but I use it every day.”

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Malas

Many years ago I had the rare pleasure of meeting a genuine friend, in Farokh Master, of Mumbay India and the World.  Those of you who share my homeopathic community likely know Farokh as a brilliant homeopath and teacher of homeopathy, as well as a man with a heart the size of India.  Tho those descriptions may be serious understatements.  I met Farokh in Belgium, and later cemented our friendship in Munich and Greece, where I learned more from him while riding on the back of a motor-scooter, in Greek traffic on twisty island-coast roads than I have from the entirety of homeopathic teachers I’ve had the privilege of meeting over the years.

4 years ago – easy to date, as on our return trip through the airport in Delhi, we were greeted by an enthusiastic gentleman with a lovely Punjabi mustache, on inspecting our U.S. passports giving us 2 vigorous thumbs up, “Obama!”  – our first news of the results of the 2012 election – I attended a homeopathic conference hosted by Farokh, Dr. Barbara (Nath-Wiser) & Spero Latchis, at the Tara Center, in the village of Sidhbari, Kagra district of Himachal-Pradesh, northern India.  The conference itself was amazing, as any of you who know Farokh might imagine.  India met & far surpassed all expectations.

Our flight from Delhi to Dharamshala was cancelled, due to bankruptcy of the regional airline, introducing us quickly to another culture’s understanding of making other plans, gifting us with a night in a Buddhist guest house in Delhi and a 2-day taxi ride via Chandigarh to Sidhbari with amazing food en route.  A friend has described Indian taxi rides as “good opportunities for mantra practice,” and I can wholeheartedly concur.

Many many fond experiences of India & Indian culture; one inspiring aspect for me was devotion, evident in so many ways.  About Sidhbari, at the nearby Norbulingka Institute & in  nearby Dharamshala & McLeod Ganj, one could not walk far without hearing devotional practice, by Buddhist monks, & by laypersons, both in temples & about their daily routines, most commonly to Chenrezig (Avalokiteshvara), or to Green Tara, often accompanied by the fingering of mala beads.

Now prayer beads or rosaries in the Western tradition were a familiar item for me, along with the western prayers accompanying their use, esp. by the Roman Catholic friends of my youth; but sometimes a familiar phenomenon seen in a foreign culture can bring new meaning or appreciation.  I’d been introduced to Japa practice in a Tibetan Buddhist sangha during my medical residency years, and understood – intellectually at least – the practice, and the fundamental distinction between Buddhist “diety” practice and Western diety worship; in imaging the “diety” before oneself, imaging oneself as the “diety,” and dissolving the illusion of duality or separation.  Witnessing this in practice, as a part of daily life, was quite a different experience.

Curious about the role of the often-seen malas, I found myself perusing some in the gift shop at the Norbulingka Institute for the preservation of Tibetan Culture, a short walk from my lodgings at the Tara Center in Sidhbari; and noted pleasantly that these were commonly made of stones, those things of love from my youth, with which I’d always had an inexplicable connection.  We splurged on a few to bring home, along with some Pashminas, a turquoise & coral-encrusted teapot, and a gorgeous hammered brass singing bowl.

Following some initial miracles with long-distance Reiki (we’ll get around to that, Best Beloved), and with my firewall of skepticism generally broken both from that & from my earlier walk on the edge, my Reiki practitioner suggested some stones to benefit my throat chakra, Vishuddha; I had some appropriate Lapis, aquamarine (a birthstone, and long a favorite following that related lovely golden beryl crystal of my childhood), and blue lace agate; and discovered another essential connection with stones, looking at these friends whether aware or unaware, whether not aware or not unaware, with newfound blue-aventurine-malaappreciation.  Vishuddha is not all that has been in need of healing, and I began collecting stones in the form of beads, and constructing malas of these for use in devotional practice, as well as for wearing for connection to their elemental existence, constructing these in mindful practice, exercising Vishuddha both vocally & silently in mantra practice in their assembly.  Long drawn to Avalokiteshvara & to Tara, & to expressions of the heart, anahata, stones in green & pink took center stage for me; green & pink “Morganite” beryl, Unakite, jaspers, bloodstones, rose quartz, green Prehnite & aventurine, green kyanite.

Following a backpacking trip into the Obsidian area on the west slope of South Sister, an extinct stratovolcano in the Oregon Cascades (a particularly invigorating trip), waking there at night to witness thousands of rain-moistened chunks of obsidian sparkling in my headlamp & realizing I’d been sleeping over tons of this in a highly renewing night’s sleep, I began incorporating stones supporting the lower chakras – obsidian, black onyxes & agates, deep red garnets, carnelian, blue kyanite, blue & blue/gold tiger eye, some gorgeous dark brown, nearly black petrified wood.

Each one has become my favorite, and Mary gets a chuckle at what my brain appears to have become as I show her the latest & exclaim “I just Love this one!”

I suppose it’s possible to view these as  material attachments, and there is admittedly an appeal in this samsara to the material aspects of existence; my discovery however is principally one of connection, of interbeing with these things whether they be aware or unaware, whether not aware or not unaware; interbeing  through these rock-expressions with the lovely Miss Stewart of 4th grade presence, with my father, my “uncle” Jim, with Avalokita & Tara, with my brave & beatific Reiki practitioner, a very dear old friend now re-encountered; with this Earth beneath my feet and the slow pace of geologic time, which is neither linear, nor does it go around in circles.

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So somewhere in there I became a homeopath …

My training in conventional family medicine was thorough, captivating & ultimately disappointing.  I had many wonderful mentors along the way – Larry & Laura Weed; Christopher Smith, a small town doc in rural northern Maine; John Bland; the venerable Lou Rosin (who came out of retirement from 40 years in rural family practice to direct my residency program); Shelly Burchmann, a semi-retired anaethsesiologist who directed the hospice & chronic pain programs at my residency; John Linn (obstetrics); Lynn Vice PhD (a clinical psychologist working within my residency program); fellow family practice resident Drew Palin, a former professional football player gone over to rugby who attended each Monday with his nose in a new place; too many others to mention, including a number of valuable teachers whom I resented at the time & only came to fully appreciate later.  

I began my practice career post residency in Bethel Maine, a gorgeous town in Oxford County nestled in the Mahoussic Mountains, on the Androscoggin River, Mary giving birth there to our two sons, at home.  As a solo practitioner taking on an abandoned practice 30 miles from the nearest other medical practice, I quickly experienced the difficulties of handling the demands of practitioner availability.  I’d been trained in the philosophy of “biopsychosocial medicine” – a catch-term in the family practice community 0f the ‘60s-‘80s – suggesting the need to integrate an appreciation of patients’ psychosocial needs with the narrowly-focused medical diagnosis in understanding illness and in designing effective therapeutics.  In practice this too-often translated into copious chart notes accompanying the inevitable pharmacologic prescription, with psychosocial information principally guiding the decision to provide pharmaceuticals from the clinic’s sample stock rather than write an expensive prescription.  With one of the towns I served hosting a paper factory, I had a dream one night of writing chart notes on the sheet of paper issuing from a 6-foot-diameter reel of paper at the plant, spinning off as rapidly as I could scribble, a Sisyphean task.

Bethel is the nearest town to a popular ski area near to the Maine/New Hampshire border, so in addition to local clients, in winters I served a population of folks “from away,” often tending to lacerations, sprained ankles & minor & major ski injuries outside of normal practice hours, frequently missing dinners & bedtimes with my wife & young children.  With the attendant tasks of managing a practice & raising a growing family, I found myself under considerable stress, and my body responded with an outbreak of shingles.

I was bathing the boys one evening, & experiencing some considerable pain in my thoracic back.  With my history of mechanical back pain I assumed this was merely one more mechanical pain expression a bit higher up my back, and the warm bathwater seemed rather appealing (unusual for me – homeopathic colleagues, follow along & organize/analize the emerging totality).  I climbed in & cranked up the hot water, ‘till the boys & I looked rather like lobsters ready for the table; Mary ran in & rescued the boys from the steamy cauldron, & I cranked the heat up a little more.  That night I had dreams of splitting wood for the wood stove for the winter, the unsplit pile growing larger with each swing of the maul.

The next morning the first vesicles appeared, arching around my left chest from mid-back to sternum, dusky red with pain radiating in the same pattern, & my academic mind quickly leapt to the diagnosis.

I spent much of the morning, between patient visits, staring at a sample bottle of acyclovir, the conventional treatment for acute shingles, but could not bring myself to take it, having recently read Jurassic Park & having newfound respect for messing with DNA.  I called a colleague, a conventional doc I worked with who had recently been studying homeopathic medicine who had offered to extend treatment to me anytime should need arise; & told him I did not believe in his witchcraft, but was feeling desperate.

The visit involved a drive to Portsmouth New Hampshire.  He saw me for nearly two hours, asking questions that dived deeply into that “biopsychosocial” model, barely touching on the kinds of queries that would be the focus of conventional medical attention.  He seemed to be most intrigued by the story of the evening bath, the nature of my splitting wood dream, and my growing dissatisfaction with conventional rural family practice, once my vocational “north star.”  He did look at the shingles eruption, with his attention focussed on the precise color of the surrounding skin, and the size and clustering of the vesicles, details that conventional approaches would consider to be without significance.

His treatment was a single poppy-seed-sized pellet of the homeopathic remedy Rhus toxicodendron (Toxicodendron radicans, the eastern poison ivy), at the 10M potency, an astronomic dilution of the actual substance.

I figured “whatever,” the time was not fully wasted, he was pleasant to hang out with, the drive was lovely & it sure beat another day of Sisyphean charting.  Ignoring his caveat to avoid eating for a few hours, I stopped at a dock-side eatery for fried clams on the way home.

Back home, I woke later that night to the absence of pain; the sudden cessation of the intense feeling of being chainsawed in half through the left chest.  Following a glorious rest for the remainder of the night, I found the vesicular rash healing at my morning shower.

A few days later the saga extended somewhat.  I continued to do well, but my sons broke out with chickenpox, acquired most certainly in the tub from varicella virus I’d shed into the bathwater.  We were driving through Waterville on an errand & stopped at a natural foods store for lunch kibbies, & along with the yogurts & bread, Mary picked out Maesi Panos’ book Homeopathic Medicine At Home along with a few vials of remedies she’d mentioned in the context of chickenpox.  She set me to work reading & organizing the boys’ symptoms, and some Antimonium tartaricum in 12C potency brought speedy relief, sufficient to take them to the local beach a few days later without precipitating an epidemic among fellow bathers.

Mary purchased a few more books for me, along with a 50-vial kit of remedies for homecare purposes.

A few weeks later a letter arrived in the mail, advertising a year-long course in homeopathy in Boston for medical professionals, meeting on weekends once monthly.  The narrative described many primary care physicians becoming disillusioned with conventional practice, & I wondered who’d been looking over my shoulder.  Mary asked if I might be interested, I said it looked interesting, & she replied “well good – ‘cause I just transferred money out of our savings and enrolled you.”   Bless her.

After a few months of the course, and investment in a few more books for my personal library, I began  using homeopathy cautiously in a few perplexing cases, with invariably good results.  I often joke that God & Hahnemann conspire in sending us easy cases early in our careers, to hook us on this wonderful approach to healing.

As time rolled on, it was common for me, describing proposed conventional treatment options to a client, to have them ask me “doc, if I were Family, what would you recommend?”  I’d respond honestly along the lines of “I’ve been working with this old approach to healing that’s a bit outside what I was taught in my conventional medical training,” & quite commonly they’d respond, “well, I’d go with what you’d do for your family.”  So I was soon thrust into nearly full-time homeopathic practice, pushing my envelope of learning.  I was delighted to immerse myself into an approach to healing in which that “biopsychosocial” model translated directly into a treatment plan, rather than sit on the side in common deference to a simple myopic iatromechanical model of illness & treatment.  The previously Sisyphean task of obtaining a comprehensive history now obtained a fully useful meaning.

At this point, I’d left the clinic in Bethel and was practicing in the field of occupational medicine and chronic pain management, with a few general family practice clients, down on the coast in South Freeport Maine.

At one point I found myself torn, feeling like the old Olive Oyl of the Popeye comics, between the worlds of conventional and homeopathic medicine, feeling that the task of maintaining and further developing skills in both simultaneously was insurmountable.  There were many fine, competent & compassionate conventional family physicians in my community, but nary a homeopath.  In order to be able to devote myself squarely to the practice of homeopathy, I picked up and relocated to the lovely town of Blue Hill, on a coastal peninsula at the junction of midcoast & downeast Maine, an area well-served conventionally, with a large alternative community hungry for a homeopathic practitioner as well as a more traditional community including folks inevitably not sufficiently served by even well-executed & compassionately-delivered conventional medicine.

I smile reflecting on the first office space I came close to renting in Blue Hill; with a large semi-circular window overlooking the rocky Blue Hill harbor, it is unlikely I could have attended to any serious work; I ended up reserving the spectacular ocean views for my homes, initially in Sedgwick & subsequently in Brooksville.  Very fond memories of raising my family in these communities.  Leaving Maine was difficult for us, I recall the old Quaker lady story of Hester, returning from visiting her son who’d moved to Portland Oregon, telling her friend Mable, “it was a pleasant visit, but the weather was some awful.” Mable’s response, “Well, Hester, what did you expect, 3,000 miles from the ocean?”

I maintained an active practice devoted to homeopathic family medicine in Blue Hill from 1993 through 2001, traveling to teach part-time at a weekend-attendance homeopathy school in New York City, at some state society meetings in Pennsylvania & Ohio, and at the National Center for Homeopathy’s annual conference; and began some international teaching in Belgium , Bulgaria, and the Czech Republic,  when I was invited in 2001 to direct the homeopathy program at the National College of Naturopathic (Natural) Medicine in Portland Oregon, which brought me to my current home,  3,000 miles from the ocean.

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Loons

I’d mentioned that my stroke-time Bardo experience was distinct from both dream and hallucination, and felt it might be worthwhile to recount an hallucination.  Unlike many of my generation, this was not the result of ingested substances, but rather the result of severe hypothermia, while canoeing in the north country fair, where, as Bob reminds us, the winds hit heavy on the borderline (where snowflakes storm, when the rivers freeze and summer ends).

Near the end of my first year of Residency (St. Mary’s hospital in Milwaukee Wisconsin, a lovely spot across from Lake Park on beautiful Lake Michigan), my “created” North Star was dimming (how does one discover a north star in the southern hemisphere?) prior to the discovery of a “true” discovered one (an every 3rd night call schedule, plus added OB call by election, and questioning my adequacy despite a very affirming/supportive faculty & peer group & patient population providing evidence to the contrary, all contributing to my questioning).  I took a 3-week vacation on my own, rented a small solo Blackhawk solo canoe, and drove up to the Minnesota/west Ontario boundary waters, feeling the need for time in the wilderness to regroup.  I’d researched what turned out to be a lovely loop trip through lakes & river systems & short portages.  

The first day is so vivid – working up a small stream blocked every 50 or so yards by beaver dams, getting out to wade wet & slide the canoe over the dams to tails slapping, herons working the shallows.  Scattered clouds, but high 60s in late September, soft breezes, gorgeous.  That night camped on an island in a nice-sized lake, slept open in a string hammock, the aurora the most amazing I’ve ever seen it, huge dancing curtains of light; tried to stay awake to catch it all, but weariness of the day won out.  Woke in the morning to a moose checking out my camp (or v/v ?).

The weather turned the next day, to 3 days of a cool, humid drizzling rain, as I worked my way along a small, slow river.  The last of those evenings, damp & cold, I cooked dinner in the drizzle to river otters playing in the river about my camp.  Next morning, having dried my bilge-soaked heavy wool socks over my camp stove, I entered a large lake, in a stump-filled bay, several of the “stumps” being the antlers of partly-submerged pond-weed-eating moose.  As I paddled out in my little canoe (did I say it was very skinny?) into the lake proper, the weather turned once more; I was headed into a stiff headwind, the lake tossed up in large oncoming waves, the cloud cover dropped, and snow started flying in a dense blizzard.  Visibility was a bit beyond the bow of my little canoe, I could only paddle quartering upwind & brace in my skinny boat (a very capable little boat, working near my limits as a paddler).  I started to get really cold (did I tell you it’d been cold & drizzling for 3 days?).  Couldn’t stop paddling/bracing to put on another fleece layer under life vest & raincoat, so I kept on keeping on, knowing the lake was studded with islands & I’d likely be able to take shelter on one.  No such luck.  Knew I was in trouble when I stopped shivering – enough clearness of cognition left in hypothermia to remember that.  

loonA loon popped up directly off my right bow.

If you’re unfortunate to be unfamiliar with loons, their song is hauntingly beautiful, one of the rare treats of the north country.  Often described as hauntingly melancholy, their song is in truth one of connectedness, of finding one another over Great Distances.  We tease, on canoe trips, of never seeing just one loon – & if you think you see only One, it’s just a matter of missing out on all the others.

Now I’d been singing to the loons to allay fear; I’d previously learned loon song from the loons up on Cold Stream Pond near Enfield Maine.

This loon popped up right there, about 3’ off my starboard bow, paddling along with me, me singing away in loon song trying hard to not be terrified of the weather.  She looked at me with her big garnet eye, started giving me crap about my “Maine accent”.  In Minnesotan, hey, youbetcha.  I still recall it, can hear it singing back timeless, like yesterday only clearer, & in that moment, a clear understanding of loon song as a language, in Minnesotan accent hey.

Ended up telling me (in Minnesotan loon accent, did I mention?) to follow it, steered me after some immeasurable time had passed into a quiet bay, the haze lifted & I saw it was the sheltered bay of a lovely small island.  I dragged my canoe up the beach, stumbled around trying to figure out if you pitched your tent & hung your food from bears, or hung your tent & pitched your food.  One of those. Finally got that figured out satisfactorily  & crawled into my (dry, warm) sleeping bag in my tent, pitched, not hung, ate a sandwich I’d made ahead that morning (best PB&J ever), and dozed off.  Forgot to bid farewell to my loon friend, she disappeared into the enveloping evening darkness, the cold, wind, snow, waves & water her familiar home, her down sleeping bag waterproofed & ever-present, her song blending with many others into a soothing lullaby.

At end of trip, counting up my days, ends up I slept through 2 nights & days that night.  Finally woke warm & cozy to clear sunny weather in the 60s with a stiff wind from the northwest.  The rest of the trip was glorious, past cliffs with ancient petroglyphs, the final portage about a mile with the rented featherweight canoe and my small pack down a wide sunny forest path with falling golden leaves before a ride down the beaver-dam stream guarded by blue heron sentinels, to my waiting truck & drive home.

Restored, North Star clear & calling to me on resuming my training.

It still feels I can “break through” & understand loon song, even today.
I suspect they’re really a race of aelves somehow.

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Writers of my Life Story

Some of my favorite writers – as one might guess, from my awkward borrowing of their devices & elements –
are:  (this list could go on & on – how could I omit Bob Dylan, Leonard Cohen, John Gorka, …)

Rudyard Kipling; First English-language writer to receive the Nobel Prize in Literature, so I suppose paving the way for Bob.  Despite his (Rudyard’s, not Bob’s) deplorable role as an agent of British Imperialism, he evidenced a sweet childlike fascination with the world, evidenced in his works.  I keep my long-tattered childhood copy of his “Just So Stories,” best-beloved, and still marvel at how the elephant got his trunk, how the rhinoceros got his wrinkles, the sing-song of old man kangaroo, and more.  On seeing my first-ever mongoose in the brush at the edge of a forest trail above McLeod Ganj, who else might come to immediate mind but the ever-valiant Rikki-Tikki-Tavi (Nagaina was nowhere to be seen).

Anne Lamott, of whom I’ve read far too little; ditto seeing the world through the fresh eyes of childhood, blessed with Shoshin, but also through the seasoned eyes of wisdom born of the duhkha of this Saṃsāra; along with the beauty of devotion, something I’ve needed to glean from the traditions of cultures other than my own.  A bit of a bell-buoy at times when I’ve needed Help.  Thanks, Wow!

John Lennon, of course, for those of my generation.  Faint glimpses of the now painted-over original portrait on the wall in the Menší Město pražské, below the castle close to the Vltava; the December 8 1980 dance party, on that fateful night, in our old house on the River Road in Underhill Vermont, conceived by the incomparable Wendy James (then Mozeika)  & MC’d by Zeideco Mo, my dear friend formerly known as Phil Mozeika.  The floor joists just barely held up.

Life is what happens to you when you’re making other plans; though the night is cloudy, There is still a light that shines on me.  Shine until tomorrow, let it be.  I get by with a little help from my friends; but that’s the whole theme of this blog.  

Thank you for holding my hand; 
when I touch you I feel happy inside; It’s such a feelin’ that my love I can’t hide I can’t hide I can’t hide.  Woooo!!!

J.R.R. Tolkein, who basically wrote my life-story as a fantasy staged in Middle-Earth.  Like many of us I suppose, I have aspired at times to be a wizard, and am sometimes cast as one by well-meaning friends & students I’ve mentored; but note that Tolkien was far less impressed by wizards, than by the lowly hobbit, who “had no magic, other than the ordinary kind …”  My life has been blessed by such friendships as those that accompanied Bilbo & Frodo on their wanderings, and now we come back to John Lennon.  I’ve “gotten by” with a (lot of) help from my friends, a cast that might easily be envisioned as personifications of Galadriel, Éowyn (as my sweet and amazingly strong partner these past 35 years), Boromir, many Samwise Gamgees, Pippins & Merrys, perhaps a few Gandalfs (I suspect that you all know who you are, tho many of those Galdolfs & a few fellow hobbits have left this realm).  Very sweetly, no Orcs.  A few would-be Sarumans along the way, none of whom wielded much real power, hungry ghosts as they are.

Jackson Browne
among many lyrics that accompanied the maturation of my limbic system through the ‘70s, his beautiful “For a Dancer.”  Now Jackson’s story of that poem is his own intensely personal story to tell; but my interbeing with his immortalized dancer is intimate, in the reflection and impact of these lyrics in my life:  (apologies for omissions & reconstruction of his lyrics out of order, but then again, time is far other than linear)

Keep a fire burning in your eye
Pay attention to the open sky
You never know what will be coming down

Perhaps a better world is drawing near
And just as easily, it could all disappear
Along with whatever meaning you might have found
Don’t let the uncertainty turn you around
(The world keeps turning around and around)

Just do the steps that you’ve been shown
By everyone you’ve ever known
Until the dance becomes your very own

No matter how close to yours another’s steps have grown
In the end there is one dance you’ll do alone

Though I would add one observation:  to borrow the language of the Diamond Sutra, there is no “alone.”  Which is why we call it alone.

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Biofeedback

One of my excursions in the practice of medicine was into applied psychophysiology & biofeedback.  It began in residency – I was a bearded, Birkenstock-wearing resident who declined to wear a tie with my mandatory white jacket, encouraged to pursue a biopsychosocial model in appreciating health, disease & healing, but the psychosocial seemed too often to be missing in the treatment plans adopted by my attending physicians.  Native in a few of my mentors – the venerable Lou Rosin, my residency director, come out of retirement after 40 years of family practice in remotely rural Bayfield Wisconsin, and Shelly Burchmann, another refugee of retirement, an anaesthesiologist who ironically had dealt with unconscious patients most of his career, but now focussing on chronic pain and hospice, two areas where the psychosocial issues are both clearly evident & centrally important.  I supplemented my experience in the hospital & outpatient clinics with readings challenging Cartesian mind-body duality, from the literature evolving over the ‘70s’’80s.

I began working with progressive relaxation with some of my patients.  So a story of that.

I was called one day by the labor & delivery floor – the labor & delivery nurse calling asked our family practice outpatient clinic receptionist for “that odd bearded resident that does all that strange stuff.”  A woman admitted in premature labor was having difficulty sleeping, what with the hospital environment & all the interventions going on (including a terbutaline drip, essentially an IV infusion of an adrenalin analog, go figure).  I walked over with a cassette recorder, talked her through & recorded a progressive relaxation session, and left the tape, with a brief note of instruction for use, on the bedside table of my soundly-sleeping client.  No more news of that client, until visiting back in Milwaukee 3 years later.  I walked into the local drug store (Oriental Drugs) late one evening; the pharmacist spotted me, & hollered, “hey, doc Taylor!”  & a fellow stepped out of an isle, said “are you doctor Will Taylor?”  I nodded, he asked, “you got any more of those tapes, like you made for my wife?”  Ends up it worked well for her sleep & they now had a lively 3-year-old, he’d used the tape to help with anxiety related to stress at work, they’d given it to a friend to help a daughter with an eating disorder, & it went a few more rounds with others, but was now worn out.  I got his address & mailed a few new tapes, who knows how many lives they’ve affected.

Best story though was a few years later, at a first visit with a fellow with anxiety & obsessive-compulsive issues, I offered a made-in-advance “sampler” tape, with a series of relaxation sessions – progressive relaxation, autogenics, & several different guided imagery sessions I’d recorded.  He came back 3 weeks later enthusiastic, saying it had changed his life.  Curious about which strategy he found most effective, I asked him which track her preferred.  He looked at me oddly, not understanding.  I repeated, asking if it was the “relax your toes & work up you legs to the ankles, shins, knees &c.” track, or the one that talked about the waves in the ocean, or …  & he responded, “no, there weren’t any words.” Thinking he must’ve been playing side B of the cassette, on which I’d dubbed some soothing instrumental music, I asked if he enjoyed the music, & he responded, puzzled, “no, no music either, it’s just a gentle “shh-shh-shh”.  I’d “cured” this fellow with a blank tape, offering him “merely” 10 minutes/day of “doing nothing.”

Anyway, back to residency.  We had a clinical psychologist working with our program, Lynn Vice, a cognitive-behavioral therapist and exceptional human being.  Lynn’s tasks were several; teaching us how to talk with patients, training “interviewing skills,” teaching us brief counseling strategies, anchoring the psychosocial aspects of our biopsychosocial model of family practice training; and very importantly helping us learn how to care for ourselves as physicians, a well as discern our individual paths in the profession.  I worked with Lynn to refine my skills at teaching clients relaxation strategies, and one day – before my northwoods loon encounter – she sat me down & told me I needed to practice these myself, to fully appreciate and be truly effective with them.  Also so I wouldn’t die during residency.

Lynn had some biofeedback equipment – a couple of old J&J modules – that she loaned me to experiment with, & my mars- & mercury-governed gadgety mind had a blast with them.  Measuring & providing real-time feedback of finger temperature (peripheral vascular tone) with a thermistor, & skin conductance; a function of moisture in the skin, hence of autonomic regulation of the skin’s sweat glands.  I began attending workshops, the annual convention of the Association for Applied Psychophysiology & Biofeedback, and met some mentors & colleagues – notably Jeffrey Cram, Stephen Stern.  My main focus, in line with interests developing over the same time period in chronic pain management, was in surface EMG (muscle activity) monitoring & biofeedback, particularly in use; using dynamic surface EMG recording during movement to document & provide feedback re muscle activity & balance, to document & augment the work of Vladimir Janda on myofascial dysfunction,  overlapping with my studies with Janet Travel in myofascial pain.  I had the privilege of contributing to the early development of this field of work, collaborating with my good friend Jeffrey Cram, who lived at the Ananda spiritual community near Nevada City California, using surface EMG recording in the early detection, prevention, and treatment of occupational “repetitive use” syndromes.  During the mid-1980s I was the primary teacher of surface EMG biofeedback for the Stens corporation, a biofeedback equipment distributer, training & support organization for practitioners, headed by Stephen Sterns.

In addition to this more mechanical use of EMG biofeedback, I was intrigued by psychophysiologic applications in training autonomic balance and general relaxation.  Eric Peper, then of San Francisco State University, was a close colleague working with respiratory biofeedback in the management of asthma, chronic obstructive pulmonary disease, panic & anxiety disorders, and general physchophysiologic health.  One of the rare functions of the body that falls under both autonomic & direct voluntary control, respiration (actually ventilation, the activities of the body governing the movement of air into / out of the lungs) seemed to underlie one’s ability to control such diverse measurable psychophysiologic variables as peripheral temperature (peripheral vascular tone), pulse volume & rate, skin conductance, & resting tone of the principal muscles of emotional expression, variables we could easily measure & provide as direct feedback to the patient in psychophysiologic training.  In providing biofeedback of these variables to patients in training, it was most often the rate & pattern of breathing that we were employing to gain regulation.

Biofeedback of breathing pattern itself was awkward in the day.  In addition to the most expensive instrument available, the patient’s hands, one on belly & one on chest, I employed a device with two lengths of surgical tubing, one encircling the chest, the other the belly; each containing a powdered resistance material, such that electrical resistance varied with stretch of the tubes; this could then be displayed on a light bar initially, & later on a computer screen as computer integration of our equipment was developed, displaying the rate & rhythm of ventilatory efforts, and the relative contributions of diaphragmatic and thoracic breathing.  Eric dabbled with the incentive inspirometers used in hospital following surgery, to provide feedback on the actual volume of air moved in respiratory effort, to train slow deep breathing.  It was often easier though to provide feedback of some resulting physiologic variable, such as finger temperature, using a thermistor taped to the finger, or pulse rate & volume, using a photoplethismographic sensor clipped to a finger or earlobe, all reflecting peripheral vascular tone; or skin conductance, reflecting autonomic regulation of the skin’s sweat glands, passing a tiny current between electrodes affixed to two fingers; or surface EMG recording the electrical activity of muscles of importance in emotional expression, such as the occipitofrontalis, with recording electrodes on the forehead; the masseters, recording jaw tension; or the upper portions of the trapezei between neck & shoulders, bearing the weight of the world on the shoulders.  All of these reflecting balance between “fight or flight” sympathetic and “rest & digest” parasympathetic nervous activity, and most easily modified by the individual by attending to respiratory rate, depth, & pattern.  

Heart rate variability stepped forward as another measurable reflection of autonomic balance in the early ‘90s.  With computerized processing of harvested psychophysiologic information, it became possible to easily monitor the beat-to-beat variability of heart rate, measured with a photoplethysmographic sensor clipped to a finger or earlobe.  Heart rate is initiated intrinsically in the myocytes of the sinoatrial node and is influenced by a complex variety of factors, but rests in a delicate balance between the stimulatory effects of the sympathetic nervous system, mediated by sympathetic innervation and circulating catecholamines; and the calming effects of the parasympathetic nervous system, mediated by the vagal (tenth cranial) nerve.  In normal functioning, this results in a rhythmic variability of beat-to-beat heart rate, reflected in the easily monitored peripheral pulse.  The degree of variability, and more significantly the regular rhythmic nature of the variability of heart rate, provide a reflection of the degree of autonomic balance, the balance between the stimulating, alerting, “fight or flight” activities of the sympathetic nervous system, and the “rest & digest” activities of parasympathetic activity, both vital, but vital in balance, to the normal healthy functioning of the organism.  With the advent of relatively inexpensive handheld devices for signal processing and display, sensors & software have become available to permit heart-rate variability biofeedback not only on desktop & laptop computers, but on smartphones & tablet devices as well.  I’ve been using the HeartMath sensors & software on my Macintosh computers for several years, and more recently on my iPhone & iPad (currently this is available for OS X, Windows, iOS and Android devices).

I’ve employed biofeedback in my medical practice professionally for over 30 years, and utilized it for personal health casually over that time, but never imagined I’d be requiring it as an essential aspect of health management personally.

My stroke knocked out the right basal ganglia of my brain, an area controlling, among other things, extrapyramidal motor neurons involved in the inhibition of primitive spinal reflexes, including those reflexes that permitted our arboreal ancestors to cling to the branches of trees; so for my left arm, resulting in uninhibited spasms in clench/grasp of the hand, flexion at the elbow, and internal rotation / abduction at the shoulder.

2 years following the “event,” following an extended period of DIY attempts at therapy (my initial therapies focussing on walking were marvelous; but the clinic I worked with initially divided me at the waist between Physical therapy (lower extremities) and occupational therapy (upper limbs), I finally located a gifted physical therapist (Ruth Holloran, DPT, at Progressive Rehabilitation Associates in Portland OR) who recognized this for what it is, who had the training & skills to begin to address it.  While designing an exercise program for me, she noted that these were the exercises demonstrated by EMG studies to be effective in restoring functional muscle balance in the shoulder;  guess who had performed those studies?

I also was struggling with autonomic arousal, with frequent episodes of psychophysiologic tension, manifesting as increased heart rate, elevated blood pressure, cognitive confusion or “brain fog,” and feelings of tension throughout my body quite unfamiliar to me, and unresponsive to the strategies I had learned over time.  I’ve practiced zazen – sitting samatha meditation – for over 40 years, and (unwisely) fallen away from regular daily practice, as its integration into daily life seemed automatic.  Now samatha practice is something quite other than, but is still in part dependent on, the calming of psychophysiologic arousal of the body, but through this practice, I’d become rather adept at maintaining a healthy autonomic balance.  Sadly the damaged region of my brain, the right basal ganglia, involve the central operations of the autonomic nervous system.  That skill was gone, as was my left hand’s memory of this keyboard, in the death of a small but important portion of my brain.  Fortunately the functions of the brain are not “hard-wired” into particular regions, but following damage may be taken up by functioning neuronal networks exercised to take over.  The trick is in training new neural networks to adopt the “lost” functions.

I don’t wish to use this platform to advocate for individual “products,” but do wish to speak of Truly Useful Gadgets when that seems appropriate.  In order to exercise functional breathing patterns to restore autonomic balance, I’ve played with a few novel biofeedback devices.  Utilizing an iPhone’s built-in motion sensors, the iOS APPs BioBelly and Lull (along with a few similar) work with a phone tucked into one’s waistband or lain on the belly when supine, and provide  auditory feedback of abdominal breathing rate & rhythm based on abdominal respiratory excursions; visual feedback in real time is not available due to the phone’s location in one’s waistband.  

SpireGoing this several better, Spire provides a small independent sensor/feedback unit that clips into one’s waistband, that pairs with an iOS or Android device via bluetooth, with an APP for processing & display of breathing rate, rhythm, and algorithm-processed interpretive data; real-time feedback is provided by visual display of the respiratory rhythm, and a simple game-like interface, with a library of included recorded scripts or “boosts” walking one through guided practices.  The device also serves to log breathing patterns, and categorizes these as “streaks” of calm (slow, regular), focussed (more rapid, regular), and tense (rapid, irregular) breathing; also logging activity, steps taken, and estimated caloric expenditure in activity; the device also provides notifications, both via text notifications on the paired device and vibration of the sensor on one’s belly, for feedback proximate to stretches (“streaks” of calm, relaxed, & tense breathing, reminding one of one’s breathing status as it’s worn throughout the day.

My unit is relatively new to me, but my experience in using it these past few weeks, is that it serves as an excellent device for respiratory pattern biofeedback, both for discrete practice sessions, and while engaged in activities about the day, in order to generalize one’s self-regulation into daily life, as well as a device for logging and retrospectively examining one’s breathing patterns, and hence autonomic balance, over the course of daily activity.

The ability to achieve calm functional respiration has returned easily for me, with only a little practice; its generalization into the normal activities of daily life has proven more difficult, and this is really where the Spire device &  APP have come into full usefulness.  The device on  and APP open now on my phone, displaying my respiratory rhythm as I type this, I’m able to observe & maintain a smooth regular rhythm of 12 breaths per minute (a “focus streak”); with real-time visual feedback, and with alerts to my phone when I veer from this pattern; not the “calm” 6-8 breaths per minute I can easily achieve in a focussed relaxation session, but far better that the highly irregular 17-20 breaths per minute I tend to fall into when inattentive.  The goal, of course, of biofeedback is to become independent of the device, of external feedback, to utilize the provided external feedback to develop & cultivate internal cues of awareness.

The logging function has also proven useful.  Including synchronization with my phone’s calendar, photos, health kit and location awareness, I can retrospectively identify those situations that prove most challenging as well as most conducive to autonomic balance, offering the opportunity to modify those activities as they recur, or build in self-management pacing or other strategies.

Overall, an elegant (pleasingly ingenious and simple) instrument, built for an ingenious & complex organism.

 

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