The Tao of Old Age, Sickness, and Death

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good afternoon everyone
i was thinking home what better encouragement and feeling on talk on the body than to have one of the migraines that i've been dealing with for the last few years be present with me right now know that will help me be a little bit more real about what i'm talking with you about i think
it seems that over the last few weeks we're beginning to weave fabric with a certain themes to this practice period and one of the themes i feel most strongly is the theme of faith
i think it underlines our study of life and and under is what's underneath the on that his mind her present will be hearing more about at some point and it was really what under his underneath the talk i am about to care which is about the trump
and confidence to live our lives no matter what the circumstances are and that's really my definition of on faith from a buddhist perspective
this is the second way seeking line car for the she so and i liked her a standard speaking somewhat about what i've learned by the practice of medicine for the last twenty five years and particularly of the last decade where i've taken care of primarily older people
the like a lot of us in this room and holder and for the last two years my focus has been primarily on feeling of care and hospice medicine
after the title of this talk is the down of old age sickness and death dow having its two meanings the one and being incomplete or oneness with your activity with no separation for between you and the person and the material in the activity in the to doing
and the other meeting being just the ordinary get up in the morning make your lunch go to school and ten class like family was telling us the battle for each other saturday it's just that part of living our lives
and it's another way of taking the j thread of our lives and threading the golden needle to so the fabric
no i administered by because i tend to fall in the safe side of things for the absolute side of things fairly readily i wanted to be sure to grounded in reality of thousand and body in the reality of what it means faith one's death and with fears
and ah reluctance says the dreams that people have as they look at that moment by reading to you dylan thomas's good night do not go gently into that night
do not go gentle into that goodnight old age should burn and rave at close of day rage rage against the dying of the lived the wise men at the end know dark is right because their words had forked no lightning they do not function
well into that goodnight
good man the last wave by crying how bright their frailties might have danced to the green bay rage rage against the dying of right while then who caught and sang with son implied and learn too late they grieved it on his way to not feel joy
gentle into that good night
great man near death who see the blinding site blind eyes could place like new years and vk rage rage against the dying of the light and you my father there on the same height
curse bless me now if your fears tears i pray do not go gentle into that good night rage rage against the dying of white

the themes for my life
have been about loss and longing to reconnect i think maybe in some ways that's true for many of us here
for which were if that takes us took me over forty years to resolve a resolution that happened finally one day as i was walking in the magic of abba q in the southwest and suddenly realized that i didn't have to live my
feeling loneliness and believing that that would always be so and in those moments that disappeared forever
in that way
the loan the longing that we have i think belonging maybe everyone in this room has had to reconnect and find themselves old and from life you know as i really like looking at words dictionary and the longing includes with feeling longing for so
something that can not quite pieces of fills and i thought well this word has read joseph because there is that piece that once you really find your way you've had some experience that you know that you'll always be incomplete because somehow you'll always be separate
yearnings at other word i like as because it has a wistfulness to as it has an emotional undertone which is funny for a familiar and as a great word because it comes from the german which means greed or hunger how much it was our how
many of us are hungry for that wholeness to have that last somehow filled
and it also comes from the greek which means to urge are encouraged for you caressed
she is about grace and rejoicing
so ah i really have come to understand that that's what my workers as a physician just like it has been as a person
as my stories have calmed down and unable to find my presence within love i am able to tap into that joyful place
in medicine about twenty years ago we may quite a big deal of the medical narrative this was a revelation to doctors that it was important to understand the story patients told themselves about their illnesses that leads to modern doctors that was to understand what those stories are to know what the place of the illness was
was in the in people's lives how they related to it and how to transform it as such
and the stories are good to a point
they stop serving if they continue to codify an idea of what someone is and so with healing in that is to find the way to thread the eye of the needle with the story to find the wholeness to smooth away to take away the the obscure
creations for that person's health because there's always held inside a person
medical care has a lot of problems i was trained very well to find the problem was the disease was the illness if someone doesn't feel well there's something there that must be fixed through something wrong and out of place the site where kaiser says with all agree and have even preventative meds
austin is about preventing particular diseases if not about scene was already right and whole and hood and bringing that forth and that really is i think the work ah to do particularly when people are aging sick and dying because you
not gonna fix it but you can heal it was a very different things
no that
buddha talked about how lucky it is how fortunate is to be born with a human body that we need to have a human life in order to practice we need to have the human life because we have a consciousness we can no reason we can understand cause and
fact in a way that animals and tiles and pebbles on camps
i think it's also true because we have a body ah because we have a physical body
the longer i take care and people the more i realize that the most precious possession any of us has your fortune can go in the stock market your house can burn down your marriage can fall apart but as long as you have your health in your body you can continue on in your life
you feel whole and yourself but when your body is threatened you really don't know who you are who want to do
i remember being for it and i was fairly spit in those days and i have always been had always been there i go again far and ah looking at myself in the mirror one day and wondering how despite how physically active i was i have sunk
how developed folgers and
in places i had never had before who was this person for first
and in a certain way no different than how i felt how my mother felt my mother had been at the end of her life ill and in intensive care and and skilled nursing for six months than at the end of it in the last days of her life she walked
with her little walk through my proud strong
straight ahead fair-minded mother and saw herself in the full length mirror i'm not sure that she's seen that image since she had gotten sick and she said was her dry manhattan immigrants sense of the universe who's that
both half meaning it and half laughing at ourselves for cleaning us
and i think over and over again as we age we come up against them how many of my patients who said to me when i've never been a diabetic
but i've never take you to take for medicaid some new medications for my wrist has never heard before
oh this party is changed what you mean it's changed
you know and even now having had this last seven years a great deal of difficulty with this particular body
having receiver for
carrying a diagnosis of something that's like lucas having arthritis and fatigue that really limit me
and having developed sensitivities to things that are used to be enjoyable
i still have a twenty five year old's mind and i think well you know next week i'll be able to get up and ride my bike fifty miles like i just did
a decade ago
i think maybe this is the common experience of harder and sheriff's to the fact that the body is changed for the mind and spirit and idea of who we are hasn't
it's like you don't really get another life you know sometimes i wake up and i still think will tomorrow i'll have that life i thought i always wanted the marriage for four years and a three kids from love
how fun it will provide is rather like being on a river rock freshly fried where you get on and if you wanna get off with the end you have to keep going in the same direction there's no going back again
so i'm not having a body is about being real it's about being real about what you really can and what she can't do in this most reasonable
try to get it get a sense of how much time
we're faster not do that and saying one of the wonderful things about being ill and having limitations as that you realize that you have limitations and that your body really is the one that calls the shots so during a time for when i had a terrible episode of psychiatric and
for work for hours and basically flat on my back from rest of the time there was enormous relief knowing that that's all i could do the go go go energetic get everything done always have a list that i could multitask on person had to go someplace else because i was invented watching the
prison raindrop go across my bedroom as the day went on and that actually was really wonderful to be real about what i could and couldn't do and for those of you who've had pain for has conditions that are fatiguing you know that if you try to push against their all you get is more miss
during and so the first thing about having a body in aging is that you have to be real about what's happening your body always wins
an anime
no playwright whose name i don't know he's from the last century who talks about what it's like to have an aging body and with a great deal of encouragement he says you know there are three kinds of beginner's mind but for our purposes maybe we can call it ordinary mine for dinner
arie mind is where he just deal with what's in front of you because that's really all there is to do and you can't treat yourself anymore his fellow choice about doing other things
so in in his explanation the first kind of beginners or ordinary minds the very first time you do something is completely new when you have no idea how you're doing it
the second time was when you're doing something artistic when you're playing jazz or creating and then and said
the activity just comes out you have no idea what it's going to be maybe a good sand hawk has like that when i don't know
oh and the last is when you're old he says because when you're old you don't know what your body is going to do you just have to get up into each thing one at a time so like we just have a cup of tea or we just wash our ball he just get up and my gonna make it to the bathroom today are now
not am i going to be able to stand today or not and i've been invaluable to prepare my meal today for not how am i gonna do it on what will not look like i've never done it this way before because my body has never been this way before and so it's when our live creative endeavor

seems to have been my my way
we've been drawn to work and he doesn't dying and i think maybe i won't say a whole lot about this because i knew him with her run out of times thinner than i think for a couple of other things i want to say that the very first experience i ever had a for her having an older man a doctor nervous
retirement a community doctor and when you are going to the hospital for the first time in you're all excited about learning you really don't want the old community got to be the one who's initiating new you want to have left smart the brilliant some universities on after the view that that he took me dr john show
as suit and grey hair took me to the best side of a man who was about to die of lung disease and we stood there with them he put me forward we stood there with them as he breathed his last breaths
and there's something so real about just being with that person his wife passed from him so real and so so complete that i knew that i was in the right place
dogan says and i'm sorry if this is too heavy but it
really calls to me and joe the fanciful on birth and death called shoji
our surgeon likes to translate at birth and death but souza another translation which is life and death that i think is probably is more relevant to what i'm saying the opening lines of shoji are since there is buddha in life and death there is no life and death
it is also said since there is no gouda within life and death we are not diluted by life and death
so what that means to me
his that since there is buddha and life and death put as everywhere everything is good and nature
there is nothing we have to worry about our ideas about for than that we don't have to worry about them there is no life and death it's all good off
since there is no buddha within life and death meaning buddha is not outside of life and death life and death are completely buddha where not diluted by life and death meaning we can see life and death for what they really are when we're alive with
purely alive we're not dead when we're alive were purely and totally ourselves whether our body behaves the way we think it should when we were twenty five or whether it behaves an old and for getting an unreliable wedding like with do when we have a flair of arthritis or one where
eighty and we're we're just slowing down
we're totally alive and one were dead says something else again you can think of of dogs analogies and the ginger cohen of firewood is firewood and it does not become an ash again as does not become a fire with for each her own the screen thing and i think
we get into trouble
when we think about time in a continuous way we think oh i'm still what i was when i was twenty five now that i'm fifty three but actually right now i'm just fifty three and i'm just here with a migraine and a flair of arthritis sitting here in front of you have
having this conversation i'm not twenty five and i'm not a tooth you know it's justice here right now
thank you
and ah

i have a real fear of things that die
have two more stories to say in an open up the questions ever real fear little things dying life your pet fish floating on the tackler of the ball for your pet parakeet or funereal pointing them dead at the bottom of the cage and something that i've always been a vs to
so sunday i was on my way to the farmers' market for my little community ritual and i get out the front gate and the nanda pulls me back to bring my attention to a dense sparrow or dead shipping skirt on the line right there in the front of my a walkway and i'm a horror and a versa
oh my god then god forbid of wanna see it and i think well as priesthood not so good of nida leave this poor little sparrow in the middle the sidewalk
and so i have one found fro and
a trial and i carefully picked him up and took him over to our front yard where we have accused the guard from a i this chanting for him and i noticed this the wonderful feathers the viewer of call for chipping sparrow is beautiful with the rust colored head and with gray
yea and wide and flat patterns on his winning and it's perfect black eye am and for carrington forming its peak in the riches on his outstretched little legs and ah it was just that was this form that had been averted was no longer
a averred
it was threat it was ash of the firewood and i could see it that way and feel complete ease and appreciation
i have had many experiences with patience as they've been dying and there's one i'd like to share i'm sure mr on i know mr william young would be really delighted to have his name mentioned here
and ah he knew that this was a part of my life and liked bath very much about our relationship
when i met him about five years ago he was already very ill and frail you've been on dialysis for many years and ah he didn't like being so ill and he was rather afraid of death even when seem like he was closed many times mr young was an extremely generous
man is quite safe from his day if he used and he had liver disease left over from having had a substance habits when he had been younger and yet he lived a life of real openness with people he used to have a restaurant and he cooked for people
i'm and made food for the homeless people in the community when he owned the restaurant when he became quite ill and lived on a small amount of disability you take as little walker was flu that he prepare and taken across the street and and down the road to the laundromat that was near him and leave it for the homeless people he knew stay there
he was the kind of person who had come out of the clinic and everyone would say oh how wonderful it was that he was here today we really like him so much
over the last months of his life as end-stage renal disease does his body couldn't keep up with the metabolic demands that it has the dialysis does not a perfect fix and he was beginning to melt away his muscle mass and strength in his body's ability to
and he reluctantly agreed that going back to the hospital didn't do anything for him and going to the emergency room wouldn't do anything for his chest pain and so we made a decision not to send him back to those places
an off
but he wanted to stay on dialysis because he didn't want to give off my life he loved as much he loved life so much he was so completely alive and himself
even as he was dwindling away
and he was just so beautiful
and on the day before his eyes that down with them and we chatted for a while and he said to me
you know i'm not going to die i'm not ready to die yet i'm not gonna die don't give up for me and i said no i won't i know you're not knowing that he repeated within a few hours why we're death i won't say he was completely alive
and he lived from me alive and i think that's really fast the health within our ancient is to continue to be who we are to feel
that fright longing to be ourselves no matter what's going on and to be present to in whatever way he can and so this image of the field
a learn flat thread and
the needle
an arm
hung assures
i'm blanking on the name of the other book we're reading but there he talks about it as the j from the j lu meaning our life than the workings of our lives and the gold thread the gold thread that we take these moments are conditions and we seeing their whole lives in the presence
and we read that golden favour of life
start with that thank you for listening and and i welcome any comments questions shared experiences that you may have
how should i wait as much better thank you for some words are still a little bit scary

summary of house
he ran for was completely alive i hope various reminded me of
something that happened with one of my a predator piracy was stay here
her life
please watch her house to filled with for the artwork and at home he said to me afterward i seen know how green to be with her leisure was dying as well
there isn't any wrong
for say or how to that wasn't problem
she's not very
after better off her
hospice patients
he said we're dying
color over well
right in the way

this is very well said as the same thing is when you're given a diagnosis of a difficult life threatening illness who don't become the cancer you don't become the lupus you are still thoroughly who are you just have this other thing that you deal with in your life and so even though
there's something going on where you think you can see the end of your life you're still thoroughly alive and when for those of us who have family members and friends and people that were with is so important to remember and with ourselves stay while i stay alive for every last second of it
this is off
this they think is what dylan thomas is warning us away from when he says do not fortunately into good night
i'm getting a clunk
for thank you very much for your attention will have more time to talk practice periods still heating up