how to learn a new language

 

I feel as though I've had to learn two new languages in the past few weeks just to get through the books I was reading. "The Mind Illuminated" by John Yates, PhD (aka "Culadasa") introduced me to terms like extrospective awareness, grades of piti, metacognitive introspective awareness, samatha, and shared receptivity, concepts involved in deepening the meditative state. The author was kind enough to include an extensive glossary at the end of his book so I didn't have to flip back through hundreds of pages to refresh my memory when definitions escaped me.

"To have another language is

to possess a second soul."

~Charlemagne~

The other book, "Being You" by Anil Seth, about the science of consciousness, dealt with concepts like sensory prediction errors, metacognition, free energy, posterior probabilities, and Bayesian inference... no glossary included, thank you very much.

These subjects are difficult enough to understand and apply without introducing a foreign language. So why did I bother to struggle through them?

"Our passion for learning...

is our tool for survival."

~Carl Sagan~

Simply put, I am curious, with a passion, about the neurophysiology of the brain, especially the nature and manifestations of consciousness. Not only the origin of thought, but the mysteries of perception, volition, memory, and imagination, as well as higher states of consciousness, all of which segue into my interest in meditation. This is perfectly consistent with the curiosity that propelled me into the study of medicine in the first place: how the heart works, how babies are made, how a broken bone heals...ad infinitum. There are so many languages to learn.

"A different language is

a different vision of life."

~~Federico Fellini~

You don't have to attempt anything as bewildering as consciousness studies or deep meditation to understand this. You might be curious and impassioned about other things. NASCAR racing, for example, or climate change, or cooking...something you are driven to learn about. How hard are you willing to work at it? Are you willing to learn a new vocabulary in order to succeed at it? 

If you're lucky, you may not have to learn a new language to pursue your passion in life. But, if you don't mind learning one new language, why not shoot for five? You might consider starting out with something like "The Five Love Languages" by Gary Chapman. I learned a lot from him, and I understood every word.

"The capacity to learn is a gift;

The ability to learn is a skill;

The willingness to learn is a choice."

~Brian Herbert~

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three big ifs

The last time I saw my primary care physician, I was handed a clipboard and instructed to answer page after page of questions...as always. The questions included updates to my demographics, my insurance information, my family medical history, and a "health risk assessment" that included questions about lifestyle (exercise, diet, smoking, and alcohol/drug use), about my mood and stress levels, current and previous health conditions, dementia screening, recent falls, and my ability to perform daily activities such as feeding myself, dressing, and bathing. It's annoying to fill out the same questionnaires year after year because it's time consuming and redundant...but it makes sense from a health maintenance perspective. This line of questioning helps the physician identify problems that predict poor health outcomes. It provides information he can use to institute preventive strategies, as well as timely interventions to correct or compensate for developing problems.

"A facility that asks you to fill out

a health screening form is a sign of one

that really cares about its members."

~Kathi Davis~

This, however, only works if the patient is honest with his answers (ie. how much he really drinks, or how many times she really has fallen). It only helps if the health care provider takes the time to review his patient's answers, and who has time for that? And, it only benefits the patient if he is willing to follow his provider's recommendations. THREE BIG IFs.

I know this because I'm a physician, and at times, I'm a patient.

As a physician, I learned not to ask my teenaged patients if they were sexually active because the answer was always, "No"...lest the truth get back to Mom and Dad. Instead, I asked how many sexual partners they'd had. Two...twelve...twenty? You'd be surprised.

Likewise, when (if) my PCP asked me whether I felt anxious or depressed, I might have said "No"...because I wasn't comfortable sharing it with him, and I was pretty sure he had neither the time nor the expertise to help me, so why bother?

Meaning we miss a lot of important information when we explore a patient's medical history...

"There is no greater agony than

bearing an untold story inside of you."

~Maya Angelou~

...not to mention their backstory. 

Let's say your patient has breast cancer. She is forty-four years old, the same age her mother was when she was diagnosed. But her mother died following surgery and a full course of radiation and chemotherapy. This is what scares her. She jumps to the conclusion that this is her fate as well, despite the fact that her mother's cancer was far more advanced when it was detected. Despite the fact that treatment has improved in the twenty years since her mother's diagnosis. The patient's initial reaction to her diagnosis may be to give up right then and there...her unnamed, invisible, and unspoken thoughts, feelings, and emotions left unchecked.

"Your body hears everything

your mind says."

~Naomi Judd~

Or, perhaps the patient is a middle-aged man who schedules a ten minute appointment with you so he can get something for his heartburn. But he isn't simply experiencing indigestion. He has angina, and it's getting worse. He has convinced himself that it's just his stomach because the thought of a heart attack scares him. His brother had one last year, and ended up with a pacemaker and a defibrillator. His ten minute appointment ends up requiring an EKG and blood work, and it stretches into a forty-five minute dialogue about unstable angina and the need for hospitalization. He tries to laugh it off, but beneath his cavalier manner, he fears for his life. His family. His business. All of it unspoken, invisible, unacknowledged.

"A physician is obligated to consider

more than a diseased organ,

more than even the whole man.

He must view the man in his world."

~Harvey Cushing~

Clues to the unspoken forces at work in the patient's life include refusal of or noncompliance with treatment. Denial, anger, impatience, or resistance. Reticence. Despair. 

As health care providers, we must handle these patients with care. We need to ask about their fears, expectations, and perceptions. We have to take the time to speak about what we intuit to be unspoken or unacknowledged. To take the time and make the effort to uncover the truth.

If you are the patient and your story is too scary, or shameful, or complicated to put into words, let your provider know you are struggling. The words will come to you when you have a dedicated listener. He needs to know.

"Anything will give up its secrets

if you love it enough."

~George Washington Carver~

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the difference between practicing medicine and narrative medicine

RMNP

It's one thing to be able to put a name to your illness. To say, "I have cancer," or "I'm in heart failure," or "I have arthritis." It's another thing to describe all the ways it affects you. All the ways it makes you feel...physically, psychologically, and emotionally. This defines the difference between medicine and narrative medicine.

"Science tells you when and how you are ill;

your particular culture, or subculture tells you

when and how you are sick."

~Ken Wilbur~

It isn't enough to know that you have a disease. You want to know why you have it. You want to attach some sort of meaning to this illness. What did you do to deserve it? What can you expect? How will it affect the people in your life? These issues describe your sickness, and they have everything to do with the culture that surrounds you and the stories it tells. Those stories reach into your family, your environment, your experience, your expectations, and your longings.

"There's a phenomenology of being sick,

one that depends on temperament, personal history,

and the culture we live in."

~ Siri Hustvedt~

Oh, you have lung cancer? Why did you smoke? Why didn't you quit? Who will miss you when you're gone?

You have diabetes? What did you expect? Your mother and father were both diabetic...and overweight, just like you.

Cancer? When no one else in your family ever had it? That's so sad.

The culture you live in can create an entire narrative around your illness.

"Patients tell stories to describe illness.

Doctors tell stories to understand it. 

Science tells its own story to explain diseases."

~Siddhartha Mukherjee~

In some cases, your narrative is fueled by speculation, judgement, ignorance, and blame. Not a healing thought among them. The patient's pain is intensified by guilt. Weakness is compounded by shame. Fear morphs into despair. The patient feels sicker and sicker.

In other cases, illness is met with concern, compassion, and care. 

Your confused or agitated grandmother is treated patiently and gently. The abject beggar is bathed, clothed, and fed. The smoker with lung cancer, the obese diabetic, and the middle-aged banker with the STI are all cared for without speculation, judgement, or antipathy.

The stage is set for healing.

When we are ill, the diagnosis is just that: the name we give the disease. The sickness is the story that surrounds it.

"It is more important to know

what sort of person has a disease

than to know what sort of disease a person has."

~Hippoctares~

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our collective narrative

Okay, I admit it. Yes, I am working on a memoir. It's an illness narrative that I share with my brother. It explores the wildly disparate outcomes of our hospitalization as young children with the same illness (rheumatic fever), at the same time, in the same place.



Buffalo Children's Hospital today

 

I could write about other aspects of my life in medicine. I could tell you what motivated me to go into medicine in the first place, and the chance encounter that clinched my decision. I could tell you about my most difficult cases as well as the amazing recoveries I've witnessed. I could write about my struggle to balance my professional life with my family life. But that's not the medical narrative you need to hear. That's all about me. 

 

"Healing yourself

is connected with healing others."

~Yoko Ono~

 

You need to know if my story reflects your story and how our narratives are connected. Not because we had the same illness, underwent the same treatment, or achieved the same outcome, but whether we share the same lingering aftermath of the experience. 

 

"People start to heal

the moment they feel heard."

~Cheryl Richardson~

 

Think about how illness shaped your life, affected your relationships, and influenced your moods. Did it leave you with fear? Anger? Shame? Or did you emerge healed? Grateful? Strong? What did illness teach you? What can you teach me?

 

Your story is uniquely yours, but it is, in fact, connected to everyone else's story on an emotional, psychological, and even spiritual level. Your voice makes our collective narrative deeper, stronger, and wiser.

 

"Tell your story

because your story will heal you

and it will heal someone else."

~Iyanla Vanzant~

jan

 

submersed

 

If you are a health care provider or a caretaker you may have attended a patient who was dying. I sat with my mother for fourteen hours the day she died, hoping my voice...my simple presence...would bring her some comfort that day. Perhaps it allayed her fear, eased her sorrow, or brought her some sense of peace. I do not recall her suffering. She did not appear to be short of breath. She never cried out in pain. And then...with her last breath...she was gone.

"Tomorrow I will be gone.

I will be a flower or a leaf...

I will be very happy."

~Thich Nhat Hanh~

Thich Nhat Hanh taught us we fear death because we believe that in the end, our life amounts to nothing. We are filled with fear of annihilation. I disagree. I believe we fear death because we fear the suffering we will endure...and cause our loved ones...during the process. Regardless of what we believe comes afterward.

*

I spent last week with a couple of my grandchildren. I never tuned in to the news or commentary I usually follow so I was not aware of the unfolding drama aboard the Submersible Titan until it became clear that the men on board were running out of oxygen, helplessly facing suffocation even as massive rescue efforts were underway

Imagine what that must be like.

If you hold your breath long enough, your body will crave oxygen. Thankfully, your nervous system is wired to override your efforts. You will eventually take that needed breath. Gasp! But what if there were no oxygen in the air you inhaled? You would suffer, desperate for relief until you passed out. Until you died. 

I couldn't shake off the horror of the fate of the five men on board the Titan. The slow suffocation. The certainty they would die. Watching as the others succumbed one by one.

"All beings tremble before violence.

All love life.

All fear death.

See yourself in others. 

Then, whom can you hurt?"

~Buddha~

Hanh taught that the most important task we face in life is to make peace with death. To accept the fact that everything is impermanent. To fully embrace what we believe follows. This is something we must all reconcile for ourselves. It has to be something that makes sense to each of us personally, because no one knows what comes after death. Some believe it is never ending peace and joy in Heaven. Hopefully, not an eternity spent in Hell. Others believe in rebirth, giving us time to learn the lessons and embrace the sacred practices we missed or rejected the first time around. I prefer the idea of a green burial, and the re-animation of my DNA in an apple tree, a flower, or a ladybug. Embracing the possibility of a meaningful and joyful afterlife is a great help. 

I also take comfort from accounts of the near-death experiences of people who have, for example, survived cardiac arrest. The white light. The visions of angels and glimpses of heaven. The utter absence of pain and suffering that make some who survive wish they hadn't. Suggesting that the moment of death is both painless and transcendent.

Yesterday we learned of the violent implosion that destroyed the Titan and took its five passengers to their deaths. Now I'm trying to process that...

"In the depths of your hopes and desires

lies your silent knowledge of the beyond;

And like seeds dreaming beneath the snow

your heart dreams of spring.

Trust the dreams, for in them is hidden

the gate to eternity."

~Kahlil Gibran~

jan

why we wander and where we go

Rocky Mountain National Park

June 2023

~Andrea Gashinski~

There is no question that writing, or storytelling in any of its iterations for that matter, has the power to heal. Hence, my interest in narrative medicine. Most of us would also agree that music has the ability to affect our mood. That art can bring us to awe.

But what about time spent in nature? In the wilderness? In solitude?

"Morning has broken like the first morning."

~Cat Stevens~

\

"I am at home among the trees."

~JRR Tolkien~

"Still waters run deep."

~various attributions~

"Nature is my religion. The earth is my temple."

~Nidhi Bhatt~

"Of all the paths you take in life,

make sure a few of them are dirt."

~John Muir~

As Tolkien put it:

"Not all who wander are lost."

Some of us wander because we are suffering. Some are healing. Others are grieving. Some of us are in search of peace. Others, courage. Still others, wisdom. Even joy. 

If you sometimes feel lost...and don't we all at times?...remember to:

"Keep close to nature's heart...

break clear away once in a while and

 climb a mountain or spend a week in the woods.

Wash your spirit clean."

~John Muir~

You'll feel better.

jan

 

"the mind illuminated"

 

I'll be off the grid, so to speak, for the next week or so...heading out to Estes, Colorado to explore the park with a few of my favorite people. This is the reward I promised my new right knee if she kept up with her PT and proved she could hike a bit without complaining about it. She's eager to see if she measures up, and so am I. Of course, there are some activities we will have to pass on, like rock climbing and white water rafting...

...meaning I will need a couple of good books to enjoy poolside while the younger generation puts their lives at risk.

"Books are a uniquely

portable magic."

~Stephen King~

Most people I know like to read a good mystery or thriller, a romance, or fantasy when they are on vacation. Not me, though. I disappeared down the consciousness studies hole again a few weeks ago, chasing a few references from the book I was loving, "Science, Being, & Becoming: The Spiritual Lives of Scientists" by Paul J. Mills, Ph.D. 

Among the titles that attracted me were "Physics of Consciousness" at 304 pages, "Song of the Cell" at 496 pgs., "The Science of Consciousness" at 514 pgs., and, on a lighter note, "Braiding Sweetgrass" at 408 pgs., and "The Immense World" at 464 pgs....none of which I wanted to haul all the way cross country. (I know, I know...I should have a Kindle, and I do have one, somewhere...).

"I like big books

and I cannot lie."

~attribution unknown~

So I turned to Amazon and came up with two short, light-weight paperbacks I thought would suffice: "When the Trees Say Nothing" by Thomas Merton, and "The Confession Club" by my favorite novelist, Elizabeth Berg. That order went in before I landed on this:

The problem is I couldn't resist opening it, and now I can't put it down. The good news is it comes in at 430 pages so I won't be able to finish it before I leave. The bad news is it weighs in at 2 lbs., and I'm definitely hauling it to Colorado!

This is the most detailed, reader-friendly instruction in meditation I have come across yet, no offense to Pema Chodron, Jack Kornfield, or Sharon Salzburg, among other great teachers. 

If you are curious about the practice of meditation and its benefits, this book is a practical and inclusive guide. If you are skeptical about what you have been taught or have read about meditation, the author, in addition to his credentials as a Buddhist meditation master, is also a neuroscientist. He understands both sides of the equation. If, like me, you have a regular meditation practice but you want to take it to the next level, this book will show you the way. If you're ready to give up because nothing seems to be happening or you find the practice difficult, don't walk away just yet. Again and again, the author touches on an issue that resonates with me, and I've been meditating regularly for years. He goes into obstacles to effective meditation, the sense of failure we all experience as beginners, and the reasons we fail to progress. Then, step by step, he shows us the way forward. 

Meditation is good for you, and for the world. You don't have to take my word for it though. Discover it for yourself.

"Believe nothing

no matter where you read it or

who has said it,

not even if I have said it,

unless it agrees with your own reason

and your own logic."

~Siddhartha Gautama~ 

(The Buddha)

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