Time Is

Yesterday, June 12th, was the one month anniversary of my transplant. My recovery is progressing well, and in fact my doctors, nurses and coordinators all tell me that my progress is nothing short of spectacular, something I am not ashamed to admit that I love to hear.

And yet, it is not quite as fast as I would like.  I wish I were back to normal already, or better than normal, as I was told would be the case. I’m tired of being tired, sick of being cold (I feel cold all the time), and everything else that has come with this recovery. Even though they say what I am experiencing is typical and to be expected . . . I’m impatient for the healing process to be over and done with.

I know it’s the wrong attitude. I should just let go and let time heal.

Recently I read where a Buddhist teacher or blogger said time does not heal. Unfortunately, I don’t remember who it was, nor did I bother to read the article and discover the context in which that statement was offered. Now, some reason it’s stuck in my mind, and taking the statement as it is, literally, I couldn’t disagree more.

It is important to pay careful attention to the timeless reality of now, but it is equally as important to understand the passage of time, the cycles of time. As always, the first and best Buddhist solution is to find the chu-do, the middle way.

To deny time or simply remain in the mindfulness of now is as bad as living in the past, or living only for the future. Time brings change, and since the Buddha taught everything is transient, we should have faith that change can be our friend, our ally, if we choose to let go and flow with it.

We should also try to understand the cycles of time and just where certain situations stand and where they intersect with other situations, forces, and qualities, in the complex pattern of life.

In my situation, allowing time to heal forces me to work on my practice of patience, which I’ve noted more than once is not my particular forte in life. Being patient with healing, being patient with my medical team, with myself . . . for me, it’s a struggle, but I am armed in this fight with confidence, for as Shantideva wrote, “Even while I remain in this world of suffering, through the practice of patience, I shall have beauty and good health and long life, and even the extensive joy of a universal king!”

Allowing time to heal our wounds is about having confidence about acceptance, something we probably don’t think about too often, so I’ll say it again . . . have confidence about, with, and in acceptance.  It is good to accept things, to trust in the virtue of letting go, being patient . . . after all, it’s really just that old wu-wei, the natural way of things . . . it’s understanding that time does heal . . . that all things change with time and acceptance is not rushing change or being unduly concerned about time . . . you see, for some people . . . for those who love . . . who really love . . . time is . . .

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Preparing for The New Normal

It is early in the morning of my 11th day at the hospital. I was scheduled for release today but I had arranged to have some work done at home during my absence and it involved glazing the bathtub and kitchen sink, a process that produces toxic fumes, so my place will not be fit for human consumption until Saturday morning. The chief surgeon here feels that I am doing so well, and they have invested so much in my surgery and recovery, that it would be a shame to jeopardize it in any way, so rather than risk I might go into the apartment too early, they are keeping me a couple days longer.

Prioritizing allocation of liver transplants is based on The Model for End-Stage Liver Disease, or MELD, a complicated system that even the doctors involved in liver transplantation do not completely understand. By late April, my Meld score was high enough that I started receiving offers for livers. Several times, I got phone calls that a liver was available but the primary candidate might be too sick for the surgery, so I should stand by as a backup. The week before my actual transplant, the situation looked favorable enough that they brought me in, gave me a room, and I waited all day while the transplant surgeon went to New Mexico to inspect the liver. None of these worked out.

Finally, Sunday the 11th, another call. Stand by, no eating or drinking, and this time, I was the primary.  There was little question that I was well enough for the surgery. Well, I hoped I was well enough, there was a small bit of doubt on my part. In any case, around 8am Monday morning, a final call. This is it. The liver is good. It’s yours. Get here as quick as you can.

My second cousin, a young filmmaker, picked me up and stayed by my side during the several hours’ long prep for surgery. It is all a blur to me now. I remember it was around 1:30PM when the anesthesiologist, said, “I’m going to get you drunk, now.” The next thing I knew it was sometime Tuesday and I had a new liver.

One reason why I am doing so well is that, as I indicated, I was relatively healthy prior to surgery. Most recipients are very sick by the time they get a liver. They been through interferon treatments, or perhaps have battled ascites, the distended abdomen swollen with fluids. Liver cancer put me on the fast track. I got extra MELD points for cancer. Now as I write this, I realize that I have crossed over another threshold: I am a cancer survivor. I no longer have cancer.

There isn’t much to do here. Read, wait for breakfast lunch dinner, wait for someone to come in and interact with you and relieve a few minutes of your boredom, even if in doing so they prod or poke or otherwise inflict some pain upon you.  And watch TV. In my case, it’s more a vain search to find something worth watching. Unfortunately, the channel selection is limited and what most Americans find interesting on television, I have no use for whatsoever.

But here I am. Alive. And although it is such a cliché, with a new life. Biding a few more days, rejuvenating, growing stronger, preparing to embark on the new normal, one centered around taking medicine designed to suppress my immune system. It’s exciting in many ways, for now that the heavy lifting is over, I am much more confident to face what lies ahead. That confidence was always there, I just wasn’t always able to touch it. I know it will be hard. I know there will be setbacks, possible rejections, and possible future hospitalizations. And with that knowledge, I see it is really just a another phase of the old normal, the same old life, the ceaseless struggle against suffering, the path that goes on forever to the endless further.

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Meditation, Mantra, and Minis

The Benson-Henry Institute (BHI) at Massachusetts General Hospital is a leader in the clinical practice of mind-body medicine.  It’s Director Emeritus is Dr. Herbert Benson, whose primary focus has been on stress reduction. In the 1970’s, he developed a technique based on Transcendental Meditation (TM) that he calls “The Relaxation Response.”

Transcendental Meditation and Mindfulness meditation are the two forms of meditation used most often in clinical settings.  Both TM and contemporary Mindfulness are often criticized for being “meditation lite,” watered-down versions of traditional meditation.  While it is important to note that 85% of all diseases is stress related, from a Buddhist perspective relaxation and stress reduction are only the short-range goals of meditation.  The long-range goal is transcendence over suffering, moving from unwholesome states of mind to wholesome ones, and the development of penetrating wisdom.  The Buddhist focus is on the complete transformation of the individual.

At the BHI, patients are encouraged to do “minis.”  These are mini-meditations, short periods of meditation usually 5 minutes or less, a quick fix to reduce stress in a short amount of time.

“Minis” can also be reciting mantras.  Ellen Slawsby, Ph.D., the director of pain services at BHI, says that mantras use “something inborn, an internal mechanisms to elicit your own endorphins or endogenous morphine.”  Indeed, studies have shown that reciting a mantra does release endorphins.  Mantras provide other benefits as well, all similar to those associated with mindfulness meditation:  they relieve stress; move energy throughout the body, regulate heart rate and chemicals in our brains; enhance positive brainwaves; increase immune functions; and help lower blood pressure.

Slawsby claims that “As little as 30 seconds of using a mantra can dampen unpleasant sensations.”  Sure, for maybe 30 seconds. The mantras used at places like BHI are often short phrases, maybe two to four words.  Aggie Casey, director of BHI’s Cardiac Wellness Program, says “They may quietly to themselves repeat the words ‘I am’ as they breathe in and then ‘at peace’ as they breathe out.”  Such phrases are hardly mantras, though.  They are more like short affirmations.

Healing Buddha Mantra: “Thus: Om Healer, Healer, Great Master of Healing Supreme, Joyfully Going Beyond, So Be It!”
Healing Buddha Mantra: “Thus: Om Healer, Healer, Great Master of Healing Supreme, Joyfully Going Beyond, So Be It!”

It is difficult to come up with a precise definition for mantra, but traditionally, a mantra contains one or more ‘bija’ (seed) syllables that may or may not have some literal meaning.  Roger Corless in The Vision of Buddhism explains that, “A mantra may contain words, or sounds that has a specific meaning; but meaning is not its essential feature.”

Originally, mantras were considered “sacred words” possessing magic power.  However, Ryuichi Abe* says, “[It] is possible to understand mantra as a linguistic device for deepening one’s thought, and, more specifically, an instrument for enlightenment.”  If approached in the right way, mantra is a meditative discipline.

There are certainly positive short-term benefits to the relaxation and stress reduction focus of contemporary meditation.  Yet these methods are much more effective, and transformative, when practiced from a deeper level, with a real commitment of time and perseverance.  Now there were always be those who will never be interested in committing to the full path.  For them, short periods of “mindfulness” are enough.  Yet, I can’t help but wonder if the contemporary approach to meditation and mantra doesn’t have the effect of detouring those who might decide to go further.  As well, I question how repeating a short affirmation for a small period of time can cut through the delusions of self and fundamental ignorance, which Buddhism teaches is the root cause of all disease and all suffering.

Today on a number of ABC programs, Nightline commentator Dan Harris promoted his new book about meditation 10 Percent Happier. On World News Tonight, he said it only takes five minutes. “Everyone’s got five minutes.” Only 10 percent happier? “That’s pretty good.” Well, it’s better than nothing. But I am afraid that these sort of presentations mislead people into thinking that is it easy, and when they find out it isn’t then they will give up, as many do, or form a negative association with meditation. The other extreme are those who oversell the benefits of meditation, giving people the impression that it will solve all their problems. That is equally as dangerous and irresponsible.

Meditation is hard. When we engage in meditation or mantra practice, difficulties will come up. That is a good thing, for without difficulties there can be no real progress. When we talk about overcoming or transcending suffering, we don’t mean that sufferings ever go away. But rather, we view suffering differently, and that change of perspective facilitates our transformation.  Thich Nhat Hanh writes in the Miracle of Mindfulness, “Feeling, whether of compassion or irritation, should be welcomed, recognized, and treated on an absolutely equal basis; because both are ourselves.”  The same holds true for suffering, and so the transformation we speak of involves establishing a state of inner well-being that the suffering part of ourselves cannot overwhelm.

Just as meditation is hard, life is hard. People have always looked for quick and easy solutions to life’s problems, but the plain fact is that the solutions can be as complex as the problems themselves.  Five-minute mini-mantras or even twenty minutes of mindfulness does not compare to the hours of practice these methods truly demand, and I feel, depreciates their full potential.

Suffering and illness are directly related to the unstable nature of the mind. Chaotic and stressful thought patterns disturb the flow of life force in the channels and nerves, resulting in physiological disequilibrium.”

David Crow, In Search of the Medicine Buddha

Steady periods of prolonged meditation or chanting, or both, are especially powerful tools for restoring balance and leading the mind back to a state of equilibrium.  Rome was not built in a day.  Inner transformation and durable wellness cannot be achieved in five minutes.

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* Ryuichi Abe, The Weaving of Mantra: Kukai and the Construction of Esoteric Buddhist Discourse, Columbia University Press, 2000

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Healing and the Emptiness of Karma

In any discussion about the Buddhist perspective on healing, one of the first things we have to contend with is the doctrine of karma. This is a troubling notion for some modern Buddhists who are inclined to doubt karma (and rebirth) because there is insufficient evidence of their validity. I have doubts myself about these two concepts, yet I have never been willing to dismiss them outright. One thing I’ve learned over the years is that there is little in Buddhism that is not useful on some level.

Sickness is one of the four sufferings taught by the Buddha (along with birth, old age and death). Raoul Birnbaum, in Healing and Restoring, explains the traditional view of how karma relates to sickness:

Most fundamentally, disease relates to either a direct or indirect result of karma, either retribution for specific acts or the ultimate effect of longstanding patterns of thoughts, words and deeds. Since the mind drives the speech and actions that generate karma, it is the mind especially that is seen as root of disease.”

Karma has long been seen as a form of metaphysical payback. If you’re not “good,” then something really “bad” is going to happen. Your karma will get you. Karma became a tool to coerce people to adopt socially acceptable behavior. There is a flip side. Good deeds will reap future positive situations. The amount of merit (punya) a person accrues can result in good karma: a good rebirth, or in this life, good health and freedom from disease. Basically we have been presented with a scenario where a sword of Damocles is hanging over our head and a carrot dangles from a stick in front of our face.

Now, our old friend Nagarjuna had some problems with this. He understood that karma referred to “action” and not to a law of causality, and that all action is volition and volitional. Karma is not the result or effect of action. For karma to be “a law of cause and effect,” it would have to be of the nature of permanence (nityata):

If karma were a fixed thing [i.e. enduring] because of its self-nature, then its ripening would always remain.

Nagarjuna, Fundamental Verses on the Middle Way 17:25

The questions Nagarjuna dealt with in Verses, included whether or not the ripening or effects of karma were imperishable and inevitable, and if perhaps the effects existed prior to the full ripening.  As I understand it, Nagarjuna felt these questions suggested that karma exists from its own side, that it has self-nature. However, that cannot be the case, for all phenomena whether material or immaterial are devoid of any inherent self-nature or essence, and are impermanent.  Things are not “fixed.”  They are sunya – empty.

David J. Kalupahana (who passed away Jan. 15) writes in Nagarjuna The Philosophy of the Middle Way,

Even though there is no continuity of karma (and in this case, borrowing), that is, it does not continue in any subtle or substantial way, the responsibility for that karma cannot be denied once that karma is performed . . .

The simple notion of human responsibility is what is upheld here, not the metaphysical notion of the fruit or result that lies hidden and gradually attains maturity . . .”

I am simplifying Nagarjuna’s explanation a bit, and yet it is simple. He did not reject cause and effect, for actions do have consequences.  However, he does reject the notion that karma is some self-existing force, a Law of the Universe.  It seems to me that a sense of responsibility is the all-important take-away from the doctrine of karma.

Few people in this modern age have any use for the notion of responsibility. As soon as it is suggested that individuals should assume responsibility for what happens to them, one is accused of blaming the victim, etc. That’s missing the point. It is foolish not to take responsibility for one’s own actions, just as it is equally unwise to say that every consequence in life is a result of karma.

We can’t say the cause for every suffering exists within the life of the individual, or that effects are always the result of some past action. But, without a doubt, suffering exists within, and taking responsibility for the suffering can influence the future.

The first step in healing, then, is to “own” the suffering.  We take full responsibility not only for the suffering but also for the healing process. This requires a willingness to break free from past negative patterns in thought, word and deed that can impede healing. It also involves compassion or love for oneself and for others.

The English word ‘heal’ is connected the word ‘hale’, which is related to ‘whole.’ To heal is to be whole. ‘Whole’ also means, “that which has also survived” and “keeping the original sense” and “to heal.”

In Buddhism, wholeness ultimately means to be awakened.  Awakening implies wisdom, but also surviving or transcending suffering, and discovering one’s original nature.  In this way, the path to awakening is also the path to healing.

Listening to and understanding our inner sufferings will resolve most of the problems we encounter. In order to heal others, we first need to heal ourselves. And to heal ourselves, we need to know how to deal with ourselves. If we know how to go back to ourselves, listen and heal, we can change. But most of us don’t know how to listen to ourselves and understand the sufferings.”

Thich Nhat Hanh, “Stop and Heal,” Jamsil Indoor Stadium, Seoul Korea, May 2013

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Healing

For years now, I have studied and experimented with various Buddhist and Taoist healing modalities, to the extent that I became a certified chi energy healer/teacher.  But until recently, I was rather complacent about integrating them into my regular practice. Now I’ve reached a point where employing these methods seems imperative to me.

Doctors can treat the physical elements of a problem, but often it is up to the patient to tend to the spiritual and psychological aspects.  That is precisely the emphasis of Eastern healing practices.  If, in the process of using these techniques for healing self and others, one can also positively affect physical aspects, so much the better.

From the Buddhist perspective, all practice is a healing practice, aimed at cleaning the poisons of greed, anger and ignorance from our system, curing delusions, and dispelling the disease of suffering.  The historical Shakyamuni Buddha has often been called the “Great Physician” because his dharma is a medicine capable of healing all beings in both body and mind.

In the late Indian Mahayana period, the concepts of “inner” (dealing with the mind) and “outer” practices were formulated, incorporating concepts borrowed from traditional Indian spirituality, such as the chakras.  In China, Buddhism adopted many Taoist ideas, including theories on the flow of chi energy.  And when Buddhism was transmitted to Tibet, “outer” practice developed into the Four Tantras (Gyudzhi) which became the foundation of the Tibetan medical system.

It’s tempting for Westerners with our logical, rational modern minds to dismiss Eastern healing methods as ‘hocus-pocus’ or magical thinking.  I think it is simply a matter of a different approach.

I first learned about Tibetan Medicine in 1984 when I read John F. Avedon’s In Exile From The Land of Snows, which to this day remains the definitive account on the Chinese conquest of Tibet and its aftermath.  Over the course of the book, Avedon recounts a number of healing stories that seem utterly fantastic and unbelievable.  He also devotes a chapter of the book to Tibetan Medicine along with a detailed profile of Dr. Yeshi Donden, who served as the Dalai Lama’s personal physician for two decades and re-established the famed Tibetan Medical Center.  Since this book was published, Dr. Donlen (Dhonlen) has become well-known for his treatment of many renowned patients.

Because the approach of Tibetan Medicine is so dissimilar from the way medicine is practiced in the West, Dr. Donlen’s methods are still difficult for Western doctors to comprehend.  What appears to be almost entirely intuitive at first glance is actually based on the development of acute powers of observation.  In Exile, Avedon quotes Dr. Richard Selzer, who was an assistant professor of surgery at Yale University and had occasion to watch Dr. Donlen at work,

I went to observe Dr. Dhonden with some healthy skepticism.  I was surprised and elated by what I found.  It was as if he was a human electrocardiogram machine interpreting the component parts of the pulse. We have nothing like it in the West.  It’s a dimension of medicine that we have not yet realized.”

Avedon also quotes Dr. Herbert Benson, who led a team of Harvard researchers to the Tibetan Medical Center in India in 1982,

Western scientific documentation of Tibetan claims is nonexistent.  It would be nice, through, to discover the worth of what they have developed over thousands of years.  If their claims are only partly true they would be worthy of investigation.  Therefore, can we really afford to ignore this?”

This same question is relevant to the whole of Eastern healing philosophy and methods.  While the efficacy of these solutions have not been fully studied and documented in the West, they have been practiced for several thousand years, and since we cannot afford to ignore them, it is incumbent upon us to keep an open mind.

Many of my upcoming posts will deal with the subject of healing, and I will discuss some of the methods I’ve learned.  Today’s post serves as an introduction.

In this world, all breathing creatures, all beings – whether human beings, animals, whatever – are exposed to different forms of suffering.  In the Tibetan system we believe that whether we are physically healthy or not, basically all of us are sick.  Even though disease might not be manifest, it is present in dormant form.  This fact makes the scope of disease difficult to fathom.”

Dr. Yeshi Donden, Health Through Balance

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