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Life on the Ground Floor – Winner of Hilary Weston Writers’ Trust Prize for Non-Fiction

Hilary Weston Writers’ Trust award winners announced at Toronto gala

“James Maskalyk, left, was awarded the $60,000 Hilary Weston Writers’ Trust Prize for Nonfiction for Life on the Ground Floor: Letters from the Edge of Emergency Medicine. David Chariandy, centre, received the $50,000 Rogers Writers’ Trust Fiction Prize for Brother. Sharon Bala received the $10,000 Writers’ Trust/McClelland & Stewart Journey Prize for Butter Tea at Starbucks.

STORY HERE.

 

The Subtle Art of Giving a Fuck

C.E.C. Newsletter #140  

“I’m not telling you to make the world better, because I don’t think that progress is necessarily part of the package. I’m just telling you to live in it. Not just to endure it, not just to suffer it, not just to pass through it, but to live in it. To look at it. To try to get the picture. To live recklessly. To take chances. To make your own work and take pride in it. To seize the moment. And if you ask me why you should bother to do that, I could tell you that the grave’s a fine and private place, but none I think do there embrace. Nor do they sing there, or write, or argue, or see the tidal bore on the Amazon, or touch their children. And that’s what there is to do and get it while you can and good luck at it.”  – Joan Didion

Action.

He lays in a hospital bed, blue gown pulled down from one shoulder by a tangle of cardiac leads.  On the monitor behind him, the electricity in his heart flutters, then spills into a dozen different directions.   Alarms hoot.  A nurse runs into the room, then another, then me.

“Do you notice that? In your chest?” I ask, feeling for a pulse in his wrist.

“No,” he says, glancing behind him.  “What?”

The advice given to writers is to start in the middle.  It’s a good instruction, because it maps onto a reader’s experience of living.  At rare times, it seems like a perfect grace, our place as witness at the centre of it all.  Most of the time, it doesn’t feel that way, at least not to me. I’m often puzzling over how I ended up where I am, untangling events that led me there, feelings about them that colour the present. If not that, then I’m asking questions.  What should I do now?  Does it even matter? Is it worth giving even one fuck?

It is.  Maybe even all the fucks.  Every small act is tied to the other, and can create conditions for our continued freedom, or stand in its way.  In that way, nothing matters more, so we’re big on action at the CEC.  You know that, though.  It forms one of the pillars that girds us.  Meditate.  Get clear. Celebrate.  Find love.  Activate.  Let it move us where we most need to go.

Sounds easy.  It’s not.  It takes practice to give a fuck.  It needs strong, healthy relationships with others, so we get the feedback we need to be sure our aim is true.  It takes courage, requires that we deepen in both humility and trust of ourselves, so we can receive those messages without feeling we did something wrong.  It takes effort, because we must bring our full attention, our true mindfulness, to bear again and again, so the wisdom of our lived experience can find its way into the world through skillful means and do the work it most wants to do: repair the tender, hurting parts first in ourselves, then in others.

As Shunryu Suzuki said, “there is no such thing as enlightenment, only enlightened activity”. The insights we’ve gleaned on the cushion, or in play and exploration, find traction as they latch onto all parts of our day.  This month, we are going to work through our Mondays with the intention of applying what we know in larger and larger circles.  We’ll start first with ourselves, heaping on radical acts of kindness and self-compassion that make up the forever-work of getting out of our own way.  We’ll move slowly outward, to see how we can use our practice to show up in relationship, with another person, to our community.  We’ll explore how these connections not only sustain us and shape us, give us the feedback we need to grow, but move smoothly into larger themes of activism and humanitarianism, as a natural extension of the love we have for what holds us together.  Last, we are going to touch the cosmic, the dance that we are a part of, witting or not, willing or not, each cell a glimmering reminder of the Big Activity that is unfolding through you and your beautiful beating electric hearts, again and again and again.

Monday Night Explorations for October 2017

Start time 7:25pm; address is 967 College, just past Dovercourt at Octopus Garden Yoga.
Cost: $10-20 Sliding Scale

CEC_Meditate

DATE: Oct 2
TEACHER: James Maskalyk
THEME: Explorer, know thyself.
MEDITATION:  It’s not where you’re from…
INTERACTIVE:  …it’s where you’re at.

James: This week, to start off this wild, widening adventure, we are going to cast the lens towards ourselves in fine detail, to see what we are carrying into the room and onto the cushion, so we can better understand the ground from which we act.  In the interactive, we are going to dust off a few CEC favorite  practices in action, so we can tune our awareness to a body and mind in motion.  Then we are going to use these as turning points for a discussion on the difference between action, and reaction.

CEC_Meditate

DATE: October 9
TEACHER: Kevin Lacroix
THEME: Gratitude – special Thanksgiving edition!
MEDITATION: Nurture Positive
INTERACTIVE: When Life Gives You Lemons, Say Thank You.

Kevin: “Thanksgiving” in French is “Action De Grâce” (Look at that! Action – October’s theme – is built right in! This stuff practically writes itself). Literally translated back to English, Action de Grâce means “Action of Grace”. Tonight we explore the possibility of becoming skillful and mighty action figures of Thanks-giving as we meditate on gratitude, and invite the many meanings and expressions of grace (divine assistance; kindness; ease) to the proverbial Thanksgiving dinner table.

CEC_Meditate

DATE: October 16
TEACHER: Jeff Warren
THEME: Being There for Others
MEDITATION: This is Me with Good Boundaries
INTERACTIVE: This is Me Swamped and Bleeding Sideways Into Your Eyeball

Jeff: I know what being there for others means: it means secretly imagining I am personally responsible for the happiness of each person I meet and making sure to get helplessly entangled in their psychic dramas so I can get overwhelmed and leave them confused and worse off than they were before. Or at least, that’s how I used to do it, when I wasn’t drunk. Then I learned about b-o-u-n-d-a-r-i-e-s. Apparently they have these in some countries. This Monday, we practice healthy action in relationship – ie, how to NOT merge into a flabby sea of oneness.

CEC_Meditate

DATE: October 23
TEACHER: Erin Oke
THEME: The Great Unknown
MEDITATION: Don’t Know Mind
INTERACTIVE: Making a Difference

Erin:  From the nightmare of colonialism to condescending “development” projects to every bad relationship you’ve ever had, so much damage in this world has been wrought by the mentality of “I know better, I can fix you.”. Cultivating the “don’t know mind” helps us listen more carefully and open to possibilities hanging out beyond the rigid assumptions of how we think things should be. Tonight we’ll meditate on all that we don’t know, try to ease into a warm bath (or cold shower!) of uncertainty. Then we’ll explore what it feels like to make a difference, and have a difference be made to us.

CEC_Meditate

DATE: October 30
TEACHER: Jeff Warren
THEME: Why Are We Here, Anyway?
MEDITATION: Cosmic Lovefest
INTERACTIVE: Bombshell Bodisattvas

Jeff: Wow, lots of caveats around action this month, I guess we are a tender bunch – learning about self-care, about boundaries, about humility. But let’s not let our humanist realism trump our contemplative hearts, because, as everybody knows, love and service are still the only real games in town. Is there a place for this kind of idealism in our mangled modern world? What might it look like, and how can we help each other come to it in our own ways? The night before Halloween, we spook the hipsters with the only thing they truly fear: earnestness. Bring on the loving kindness!

 

 

G is for Ground.

(excerpted from my 2017 book “Life on the Ground Floor”)

I’ve been cutting down my shifts in the last few years so I can spend more time on Ethiopia. I work about ten a month now. It’s just enough to keep my skills up. Fewer, and my fingers fumble.

When I graduated, I did twice as many. During those months, being in the ER was simpler than it has been since. My flow was natural, my hands steady, and my patients’ faces grew as indistinct as the date or time. It was the hours outside of work that started to hurt. It is easy to ignore your own worries when there is a never-ending list of worse ones placed in front of you. My rela­tionship failed. Friends fell away. Beauty too. I felt fine.

I wasn’t. Fatigue caught up with me and I slowed down for a minute, looked around, wondered where everyone was.

If we in ER gather in community, it is to talk about how to resuscitate a baby, to poke needles into fake plas­tic necks, or to practise for poison-gas subway attacks. We don’t practise joy, how to stay well in the face of all the sickness.

Doctor, Nurse, heal thyself.

Or not. Those who work in the ER burn out faster than any other type of physician. I’m not sure if it’s the shifts or the long, steady glimpse of humans on their worst day.

I think most of us would say that it’s not the sickest that affect us, that it is the minutes in contact with them when we feel most well used. In a macabre way, we hope for the next person to have something really wrong with them, but it is more rare than you’d imagine to see a criti­cal patient in Toronto, even in the trauma room, someone whose system needs the order the alphabet can bring.

Most of the work here is in minor. ERs are open all hours, and since the service is free, people often come in early, instead of an hour too late. Sometimes there is nothing wrong with their bodies at all. There are so many measures in place to keep people well, or to catch them before they get too sick, I can go weeks without intubat­ing someone. Worried minds, though, latch onto subtle sensations that magnify with attention, and lacking con­text, they line up to be reassured. The two populations, the sick and the worried, mix together, and separating them keeps us up all night.

Suffering souls, though, there is no shortage of them. They circle this place.

Some sleep right outside, on sidewalk grates, wrapped in blankets, waiting. One is splayed in the clothes he lives in, face pressed against the metal grille in a deep, drunk sleep. Every few minutes, a subway passes below the grates, and a rush of warm air flutters his shirt like a flag.

Businesswomen spin in and out of an office tower’s revolving doors. They cross the street, eyes dancing between their phones and streetcar ruts, pretending not to notice the figure on the ground. Shoppers with bags from the Eaton Centre dangling from their arms lean into the road looking for taxis, jump out of the way of rushing cars.

A guy across the street notices the body. He glances at it, then at the hospital, makes a calculation that there must be no better street grate in the city, and moves on. Others step over him, as if he was downtown city furniture.

Within a few blocks of my ER, there are a dozen shel­ters for abused women and the homeless. There are health clinics for indigenous people, gay men and women, refu­gees, detox centres, beds for kids who’ve run away from home. On my way to work I pass them, pierced, dyed, smoking. Sometimes I’ll see them in the ER, shyly pulling away a bandage from the cuts they made on their arms.

Seaton House, a men’s shelter just up the street, holds more than five hundred. It has an infirmary for the old and the sick, a special floor where the most craven alco­holics are given brandy every hour, so they don’t die on those grates. A patient told me that the floors are patrolled by gangs, and if you’ve a bag, they will pin your arms from behind and rifle through it, taking what pills or dol­lars there are.

“They call it Satan House.”

He was new to Toronto, to big cities even. He sat on our bed, his bag empty and eyes wide.

“I can’t go back there. Drugs. Bugs. Fights. Can I stay here? Just one night?”

Sorry, man. Here’s a list of other shelters, a central access number, a sandwich, a prescription for the medicines you lost, a number for our social worker who can help you fill it, a bus token, a bandage for your foot. But I’m sorry, this ain’t no hotel.

He held his backpack tight, under the sheets, shook his head, no fucking way. Security hoisted him from the bed, a guard on each arm, walked him down the hallway, out the door, into the night.

We give out clean needles, single-use vitamin C sachets so people can dissolve crack or black tar heroin in its acid instead of sharing lemon juice and scarring their veins. Some people come in just for sandwiches, or to use the phone. Others, to sit in a chair.

One of my colleagues rolled a man in a wheelchair out into a storm. The man had been pretending he couldn’t walk, but when Jeff’s back was turned, he would stand, grab hand sanitizer from the wall, and drink it down. He’d been doing it for hours before someone noticed. After Jeff pushed the man out, he sat back down at the desk in minor, began angrily filling out the man’s chart, paused, then slammed his pen down and, furious, snowflakes melting on his scrubs, wheeled the man back in. Our trust gets broken and broken and broken and broken, but underneath it is an even deeper caring.

A few years ago, I heard an overhead page—“Dr. Maskalyk to triage”—and I walked out, to help decide which way to direct a stretcher I’d guessed, and instead saw a bailiff who touched me with an affidavit, dropped it, furled, on the ground.

“Sorry,” the registration clerk said to me, bashfully. “I thought he was a friend.”

I picked up the rolled paper. A lawsuit. It named many doctors. I couldn’t remember the complainant.

I got his chart from medical records. It didn’t cue me. I’d met him once, two years before. I could remember the night. So busy, running from minor to major every few min­utes. I have a vague memory of his back, but not his face.

The chart was mostly empty. “Flank pain” was his complaint, and I scratched in only a few physical findings. In the margin was a note from the nurse: “Verbal order, Maskalyk, morphine 5 mg IV.” You get calls like that all the time, from a worried nurse, asking for pain relief for someone writhing in a stretcher. Sure, sure, I would have said, after I asked a few questions, 5 milligrams.

In the years that had passed, I had touched a hundred backs, seen many people in pain. This man was fine. There was no bad outcome. He had CT scans, MRIs, all negative. His charge to me was that I contributed to his opiate addiction. He named every doctor who had crossed his path.

The case dragged on for years. My lawyers kept tell­ing me that it would go no further, but it kept limping. Every few months, another letter, until whoever was helping that man exhausted what money he had and the case was dropped.

Some of my colleagues haven’t been so lucky. Some­times that person with back pain that sounded the same as the hundred before in fact has a hemorrhage, or an infection, and becomes paralyzed. I received an angry letter from a family doctor who said I was incompetent for not x-raying the leg of a young woman he had sent to the ER. She hadn’t fallen, hadn’t endured an injury. I examined her leg. No swelling, no chance of a break. Not blue, good pulse. No emergency as far as I could tell. Does it hurt when you do this? Stop doing that, I said, every doctor’s favourite piece of advice. Rest it, see if it gets better. It didn’t. The bone had a tumour in it.

Shoulder pain in a drunk man, sleeping it off in the hallway. This time, I got an x-ray. Negative. The pain persisted. I CAT-scanned his neck. Broken. The pain was from a pinched nerve. He hadn’t complained of neck pain, couldn’t remember falling. But I didn’t feel along his neck until much later. I should have. I didn’t even put a collar on before I sent him to scan. A screaming radi­ologist called me in minor. “What the hell are you doing sending him up alone?”

First shift, after I graduated. A pharmacy student with severe asthma. Often, patients with chronic disease know what they need. Adrenalin, intramuscular, he said, requesting our most powerful drug. I found a nurse, told her what I wanted, stepped away to write on his chart, turned back to see the colour drain from her face, watched him fall back onto the bed. How did you give that adrenalin? I shouted, my finger already on his neck. Intravenous, she said, knowing her mistake, that in a living person, it must never go straight into the blood, that it is too much for a beating heart to take.

Shit, I said, lacing my fingers together before ham­mering down on his chest.

He lived. I told him what had happened, then my chief and the nursing supervisor. The patient understood, probably better than anyone in the world. At least my asthma’s gone, he said, wincing as he tried to sit up.

I could go on. No matter how careful I try to be, I make mistakes. The next one is just waiting.

We are taught all kinds of things as we work our way down the alphabet. To spot a hurt person, to remain sus­picious, to learn from our errors. It can be difficult to rest from the worry.

“You will fucking too see this patient,” I said to a resident who refused to assess a woman with AIDS who couldn’t stop vomiting long enough to take her pills and had nowhere to go. “Because it’s your fucking job, that’s why.” Anger shook me.

“You stupid jew cunt!” a patient yells at my colleague.

“Handshandshands!” a security guard shouts as the man they are watching undress pulls a knife.

“I have hep C, and if any of you come close, I’ll spit in your eye!” another man, scratched and bruised, screams, five cops holding him down. He was released from prison a day before, having served twenty for murder. In his hours of freedom, he beat another man nearly to death. “Come here,” he says, looking at a nurse behind me. “I dare you.”

I’ll sue you. I’ll stab you. I’ll come back with a gun and kill all of you. You’re a shitty doctor. You’re an ugly nurse. You’re an idiot. Goof. I want a second opinion. I want to kill myself.

Dying person, dead person. Sick person. Lying person. Faking. Manipulative. Poisoned. Raped. Dead. Screaming. Crying. Writhing in pain. Hopeless. Afraid. Confused. Alone.

Wow, must be stressful, people say.

You get used to it, we answer.

Ground floor, downtown, ground down. Suffering can be contagious, and no matter the job you do, it just keeps coming back.

Your world view skews. If you don’t make an effort to balance it, the ER becomes your new normal. Like a home, you turn to it for what you need. Your colleagues seem like the normal ones, because they can joke while a man, shot dead, lies behind them.

Daddy, a colleague’s daughter said, all you do is work, sleep, and drink. A nurse told me after a string of five days in a row, she took a bottle of wine to bed, and cried.

It’s hard to make it ten years here. Some don’t make it two. It’s worse for the nurses. They spend more time at the bedside, unobserved, unprotected. They watch people die over hours, asking, “Am I going to make it?” again and again. I get asked once. “We’ll do what we can,” I say, and move on.

The ones that last are changed. The shifts, the swearing, the shouts of pain, the anxiety and sadness and anger pour­ing from strangers. Miss a decimal place and someone’s dead. Drug seekers lie to your face so they can flip pills on the street, and you grow suspicious of those in real pain. The addicts and alcoholics who circle this place, lost and dying, whom you can’t help and no one else wants. A security guard had his nose broken one week. A nurse, a chunk of hair ripped from her head. She waited until it stopped bleeding, then finished her shift. I haven’t seen her since.

We work when we are sick, masks over our faces so we’re not contagious. I broke my arm, and didn’t miss a day. We have a silent agreement to not ask for help. Sick­ness becomes weakness, weakness a sickness.

It’s rare to connect with the people I treat. The ones I do best for wake up in the ICU, in a sedative haze, not sure what happened or whom to thank. We deliver more dead babies than live ones. No one shouts, “Mazel tov! It’s appendicitis!”

We don’t develop relationships with patients, claim that we prefer it that way. We dive deep, straight, unapologetically, unsentimentally, into a person’s worst fears, ask them about sex, drugs, who’s hurting them, why they’re hurting themselves. We look in their eyes, watch them cry, put needles into their veins until they’re plump with water, dab blood from their cervixes, know their bodies more intimately than they ever will. When the new shift comes in, we go home and try to live in ours.

I sat in my first suit, tugging at the cuffs, and told the doctors across the table, ones who were deciding whether they would let me into their emergency training program, that I thrived on the type of challenges the ER presented. I didn’t mind odd hours and had healthy habits to make up for tough nights. They nodded, satisfied, and I walked out, past a half-dozen nervous young men and women, their answers the same as mine.

We get ground down anyhow. The pace, we’ll say, images of mangled limbs we take with us wherever we go. It’s hard to leave, even if you know you should. It feels good to be surrounded by those who know what you do, to whom you don’t have to explain.

Some of us make it through. Some drink. Some smoke. The ones who last best, laugh. Even about the black things. Especially about the black things. Without the absurd, there is only tragedy.

A woman, twenty, fell down twenty stairs. One eye was swollen shut. She wouldn’t answer to her name or open her other eye. She pushed at the nurse’s hands that tried to help her, again and again, sought to climb out of bed. I sedated her until she was still, and did a CAT scan of her brain. The scan showed bruising, blood in the grey matter where there should be none, a slick of it pooling inside her skull, squeezing her brain tighter and tighter. I called the neurosurgeon, a German, and explained what I saw.

“So she needs the OR,” I said over the phone.

“Is she . . . pretty?” he said in a heavy accent, chew­ing, swallowing.

“I don’t know . . . I guess so.”

“Zen we must to do everysing,” he said, and hung up the phone.

A few hours later, nurses and I recalled the conversa­tion as we switched back and forth for CPR. We laughed, above an old woman’s still heart, caught ourselves, turned our eyes back to our work, and fell into smiles.

You can see those who are edging out. When we’re unable to meet the sadness, or to laugh about it, cynicism takes hold. Even worse, anger. We curse nurses on other floors for being too slow. We criticize our colleagues’ decisions, their flow, their bad day, forgetting that they, like us, are just trying to make it through a shift, a week, a month, a life, surrounded by all the pain.

Last, we curse our patients. This is a final sign. Touch­ing many people, but being touched by none of them, they close like a flower that no longer sees the sun. It’s as if every person takes away from you something you need.

Not her again, a nurse says under his breath, as a volunteer places a chart of a regular on the desk, as if this wasn’t the point of the place, as if this didn’t happen twenty times a day.

People think that to make it through, we become inured, develop some kind of barrier, beyond emotion. It doesn’t work like that. You can offer an illusion of indif­ference, even tell yourself that you’ve got it handled, but all that tough stuff makes it in just the same. What shuts down is the part that turns it around.

There’s too much to do, a next patient to see, and if you’re never told how important it is to work on anger and fear as it comes up, you put it off, and the frustration diffuses into all aspects of your being, its origins almost invisible. You can get so behind, you abandon the proj­ect. Then, on that fateful day, when you have a chance to do something right for someone you don’t know, or cut a corner, you say to yourself, “Fuck it.”

The end has come. Time to quit.

People do. Plenty. I’ll see them in the hall after many months, when I used to see them every day. Miss us? I’ll ask. Yeah, they say, I do, some of them wistful. But I just couldn’t do it anymore. It wasn’t good for me.

What they mean is, instead of just the worries follow­ing them home, some numbness did too. Joy started to seem for fools, because while there are many things we will never know, what we do know for certain is that one day, a bullet meant for someone else will whip through our body, our foot will turn on a dog’s toy on the second stair and we will fall, or a cough will tickle our chest then sputter a tablespoon of blood, and in an instant we know what it means.

It’s here.

the stuff of life.

 

pouring through us, and over us, then, for a moment, we’re flowing with it, then we’re lost.

a man died today.  men die every day, women too, but this one we were almost there for.  he lost vital signs on the ambulance stretcher a few minutes before his body arrived.

i told his mom.  people don’t expect to hear that kind of news, not once a child gets old enough to take care of himself, but there it was.

the bottom of her heart fell open, and the grief painted over me, the nurse, filled that small room until it was heard to breathe. i left to take care of a few pieces of unfinished business, having learned something of the language of sadness, how certain people want to be alone with it for a minute, or didn’t mind if i declared myself as one as long as i came back.

i did some paper work, called the coroner, returned to the quiet room and sat beside her, waited.  after a few minutes, she looked up.

i told her about my strange job, the view it offered, hovering near the end.  i told her that most often, the last minutes seem so quiet.  the mind quells, then the body.  when you watch them, you get the taste of a peace we know when returning to a true home.  she held my gaze for a second, tears shaking in her eyes, nodded, turned back to her hands.

i didn’t say it because i thought she needed to hear it.  i said it because it is the truth, and in those minutes, it counts.  like it does in all of them.

after she left, i gathered with the nurses who were there when he arrived.  we didn’t talk about what went right, or what we might do better next time, just what had come up.  i said i felt a sadness that was going to stick around for a while. i’m glad we tried, someone said.  we all nodded.

we’ve started talking about these kind of things at work.  it’s good.  i’m discovering that it helps to have company more than i knew, not just with the difficult things that can seem yours alone, but in the many joys that seem part of this difficult, worthwhile work, that all humans share, how to live, how to love, how to let go.

A Field Guide to Paying Attention.

C.E.C. Newsletter #137

“The power to concentrate was the most important thing. Living without this power would be like opening one’s eyes without seeing anything.”

― Haruki Murakami

 

 

 

 

 

Evidence suggests our minds wander from the scene in front of us, into waking dreams about half the time.  It’s impossible to say, categorically, whether one is better than the other, but it seems, when asked, people reported that rather than such flights giving pleasure, they left them wanting more. Turns out we might never be so contented as when we’re alive to what’s unfolding before us, when the stuff of our self touches fully the present, and the real possibilities no dream can ever quite hold.

It’s a nearly inevitable drift, being called away from our chosen focus.  As William James described, even with a simple form of attention, concentrating on a dot on the wall for instance, one of two things eventually happens: 1) the dot grows indistinct or 2) our mind gets called elsewhere.  Ask yourself successive questions about it, though, how big, what colour, how far, and you can hold your attention for a comparatively long time.  This is what genius does, he says.

I’m not sure how it feels to be a genius, but I am getting used to what it feels like to be me, and even when a medical student is relaying to me important details about a patient he has just seen, if I don’t choose to concentrate, I can nod at appropriate times, and accomplish an admirable list of mental tasks without listening to a single word.  Paying attention requires not just a decision, but a particular effort.  In this March month, we are going to explore these facets, the intention, the effort, and the successive questions that follow.  What does it feel like?  Where is it pointing?  What riches does it bear?

The historical buddha, when he was just a boy called Siddhartha, around 9 years of age, felt the pull of concentration one day, underneath a crab apple tree.  While watching the spring scene before him, ministrations of the laity, a farmer toiling with an ox in the field, he was, for a moment, completely absorbed into the scene.  It passed, and he was once again alone on the hill.  Freedom, he thought, lies in that direction. He stood, dusted his legs, and stepped into the sun.

While such full arrival may happen spontaneously, it is also something that can be encouraged by practice.  If we call our minds towards the present, they land there more often, maybe even stay long enough to explore the textures of this infinitely evolving moment and the increasingly subtle world from which possibility blooms.

Join me and our doughty explorers this month as we lay out a field guide to paying attention.  We’ve polished and sharpened cartographic tools, calibrated sextants, and each March Monday, 730 pm sharp, set out towards that unchartable, impossibly slippery, X-marks-the-now through which everything rushes. Avi’s bringing extra life vests.  I think Kevin made some snacks. Well….that got your attention.
See you on the cushion.

Dr James

2016 was everything.

lots to say about this bouncing baby year, but you know, even more to do. sincere wishes of love, but an even truer commitment to show you what i mean. i think that’s the biggest change for me, and while the movement towards it may have been incremental, even unseen, it feels irrevocable for the first time. i know that who i am in the world never mattered, only how i am in it, that it is in love, and kindness, and patience that i will find the freedom to grow forever, and when confronted with injustice or hatred, i must not turn nor retreat from it, but hold the tender ground it is trying to claim and hide from sight.

this past year i learned that the heart does not speak in english, but in nearly imperceptible tugs from an infinite array of strings that travel through all things that have ever lived and ones not yet born, and in those soft pulls, a collected wisdom about how to live, as sure as the one that gathers bodies in their beautiful shapes.

while tempted to go on, i would ruin the promise of brevity held in the first sentence, and i am loathe to ask your reading time now, when i am going to demand it in april when my book comes out. i know. exciting times. you’ll come to the launch in toronto, the after-party, then the one in ethiopia. they’ll be even better with you there.

in the last days of 2016, i kept recalling a quote i read in dag hammerskjold’s book, markings, but it is not his. he attributes it to thomas aquinas, and though i may not have it perfect in my memory, it is something like, “why do you search for rest? you are here to work.”

lots of it ahead. glad to have your company. in it’s spirit, last night i came home from the ER, and put together a mix of songs that kept me warm this last year. different than previous ones, i didn’t favour the album, nor tracks that were only from 2016. why? spotify. still, all of these songs were new to me, and might be to you too.

i’m off to myanmar/burma in a couple of days, and am switching off this mad machineworld that has me so captivated in favour of the subtle one. i’ll see you sometime in february, and be glad. be well. love. j.

for those who dig spotify, the unmixed version is here:
https://open.spotify.com/…/…/playlist/2MtwsNxZ8iHxUEuJLglRH1

trump slump.

need to go. that’s it. so, as we should have done all along, we organize, just better, facilitate healing where there is pain, in ourselves and between each other like it was our main job, because it always has been.

it’s a deeply hopeful time. we have been given a great gift, and those who only lament this morning don’t know how intelligent, committed, aware and loving the Americans I know are. my sense is that, for the first time, they are all going to dig in. hard. I bet that over the next four years, more if necessary, they will show the world, and all those who suffer unjust and cruel leaders, what true revolution looks like, what true healing is.

we’re with you. promise. your challenges are ours too, are beyond borders, always have been, and we’re sorry for those of us who infer by pretending we’ve solved the ones you’ve highlighted, that we’ve been able to rest from them. we haven’t; we’ve only succeeded in hiding them better.

no more. we’ll join you about being honest, embracing who we truly are with love and courage, even the parts we wish weren’t there, and see that the rift in the USA is the same as the one in ourselves, the separation from our fellow wo/man and their great struggle to thrive and be happy, from the wounded, struggling earth, from our true gentle nature, clouded by fear.

so, no, I don’t think the next years are going to be the worst. I think they’re going to be the fucking best. it’s like someone you love telling you again and again about a problem you have, but because you aren’t fully honest about your complicity, you don’t recognize your true power to transform it, but on the day you do, like a bolt from the sky, illusion falls away, and in its place: the ground from which real change emerges, but is never delivered.

so we good. the work has always been there, but never this clear. you Americans don’t need to flee here to canada; we’ll come there, in great numbers if necessary, and once we solve your shit, THEN you come here, and help us work on ours.

I mean, what’s the worst case scenario? we become soldiers of fortune, living on jerky, traveling by night, and performing random acts of mass kindness and bitching halloween parties in places that need them most? it will be like the last four years, just…more.  we’ll be spending more time doing what we do best, living our values, just harder, betting it all on love, just more often, and giving our own healing the attention it needs so we know the direction.

it is difficult on the eve of such great work to say “congratulations”, because some of it will be grim, and started amidst a profound sadness that has always been there, just below the surface, about the deep pain we hold so close from generations of trauma, that we haven’t let ourselves fully feel. beyond it, though, that brand new place we’ve always imagined but none of us has yet to see. donald trump will make America great again, but not in the way he imagines.

glad we get to do this together. I can think of no better group of people to stand in the breach of the many hurt places we now see, and bring them together. so let’s do that, and then party about it. hard. see you there.

How to Bow.

                                       

August Newsletter:

CEC #126 - How to bow

“Between stimulus and response, there is a space.
-Viktor Frankl

We are born with few tools, but there are some. Our eyes register light. We can cry. We even have a few reflexes. These responses to stimuli are so automatic and reliable in every human, that should we not reproduce them, it can signal something wrong with our ability to interact with the world.

Touch an infant’s cheek, and her mouth twitches to that side, prepared to latch. Startle her, or simulate a brief fall, and her arms open wide, then close, and often, she cries. There are a few others. In most children, with time, these early ones fade, though in some rare people, traces remain. If you stroke Jeff’s cheek, for instance, his leg beats up and down like a rabbit’s and he weeps. Try it.

Others appear. Before an infant has even stood, the parachute reflex emerges, her arms automatically extending as if to catch a fall. Teenagers across the world, at the precise age of 14, reflexively roll their eyes as soon as their parent’s utter a word in public.

Maybe we’re talking about habit now, an action not riven into a neural pathway as part of a nervous system’s normal development, but one for which, over time, with practice, the turnaround has become so fast, it can nearly seem the same.

Nearly. As Frankl says above, there is often a space, even if disappearingly small. For reflexes, not as much. The distance is proportional smaller. Many of them, like the one a doctor taps from the tendon of your knee, do not even travel to your brain, just loop from stimulus to response right in your spinal cord. Most other complex inputs, though,the ones to which our response leads to the patterns of behaviour that form a life, there is processing in our awareness, even if subtle, even if lightning quick.

There was a time, once, when such stimuli lead to longer consideration. Should I try this cigarette? Wow. It made me cough. Should I try another? Oh, I’ve received a message on my phone. Is now the right time to check it? How does this thing work again? With time, and practice, smokesmokesmoke. Checkcheckcheck.

Thinkthinkthink.

I work in the emergency department. As soon as I open the curtain, I receive many inputs. Does this person’s clothes tell me they sleep on the street? That’s a great risk for many things. Is that a facial droop? My mind races with questions, I can almost fail to recognize properly the worried soul shivering in the hospital sheets.

So I try to slow down. It’s hard, and I often don’t, but it’s best when I do.  If I can, sit down.  I try, at least once, to put my pen away, and not write. And nearly every time, I  take their wrist, feel their pulse.

Bump. Bump. Bump.

Wow.

It pays to slow down.  If I’m not careful, I can be hurried along then frenetic then overwhelmed, frenetic, hurried along. The space disappears.

We can claim it. That’s what this month is about. Slowing down, making ritual from habit. We’ll do it sitting. We’ll do it noticing the subtle tug of a stimulus, the twitch of our response. Perhaps, we’ll even notice the space, get a glimmer that if we pay attention it grows, and  to the freedom it holds, to ourselves and to others, we will learn how to bow.

Dr J.
Director of Science and Special Events
The Consciousness Explorers Club

Monday Night Explorations for Aug 2016

Start time 7:25pm; address is 967 College, just past Dovercourt at Octopus Garden Yoga.

CEC_Meditate

DATE: Aug 1
TEACHER: Dr James
THEME: From habit to ritual
MEDITATION: Hold it now…..hit it
INTERACTIVE: Slow and low, that is the tempo.

Everybody catch the boogaloo flu. Actually, don’t. It’s incurable. Before you know it, you’ll be up and down the avenue, breathless af. During this non-Beastie Boy themed session, we are going to tune into automaticity, not the easy response that comes from a natural place, but it’s evil cousin, the habit, the entrained neural pattern that activates our behavior before we have had time to decide whether it serves us. For the sit, we focus on subtle activations, for the interactive, we identify a space in our life where habit has crept in over intention, and next week, see what space ritual has in slowing us down, making us alive to our power.

CEC_Meditate

DATE : Aug 8
TEACHER: Avi Craimer
THEME: Meaning and symbol
MEDITATION: Ritual intention setting
INTERACTIVE: Transform your life with symbolic action

We automatically respond to the meanings of things on both a conscious and an unconscious level. Ritual is a way to take control of and leverage this innate meaning responsiveness. In tonight’s meditation we’ll use a simple opening ritual to enhance our meditative concentration. In the second half, Avi will lead us in a creative process to discover and design symbolic actions to transform stuck patterns in our lives.

CEC_Meditate

DATE: Aug 15
TEACHER: Dr James
THEME: How to bow
MEDITATION: Full surrender.
INTERACTIVE: How low can you go

The world is a beautiful place, but it is a hard one too. Despite our attempts to know it, it outpaces both our hopes and imaginations. The search can leave us feeling alone, irritated, confused. A question emerges, as possible antidote: are you bowing deeply enough? To the mystery, to the person passing you in the subway turnstile fighting the same big questions, to yourself, as jewelled as any other facet of this net. This week, we sit, and let go. And let go. And let go. Perhaps we find, even with all that letting go, somehow, we are still, somehow held. Then, we bow.

CEC_MeditateDATE: Aug 22
TEACHER: Jeff Warren
THEME: The Practice of Perspective
MEDITATION: Layers of Our Discontent
INTERACTIVE: The Art of Moving Out

This week, we explore perspective from two directions: in sitting practice, where we’ll tease out some of the understated and not-so understated ways we find our moments lacking (and in the seeing, a subtle freeing), and, for part two, a wonderful art practice designed to take us out of ourselves into some of the insightful and often healing perspectives that surround us.

CEC_MeditateDATE: August 29
TEACHER: Erin Oke
THEME: Liminality
MEDITATION: Opening to possibilities
INTERACTIVE: Labyrinth walking

The middle stage of ritual, begun but not yet complete, is called liminality. Rife with ambiguity, confusion and possibilities, it’s a rich time for discovery. We’ll meditate in that middle space, opening to the compelling nature of our ever-changing experience. Then we’ll take our interactive practice on the road to a local park and walk a labyrinth, a contemplative journey embodying those liminal twists and turns. How we’ll emerge from these rituals – transformed, solidified or something else entirely – is anyone’s guess. We can go for ice cream afterwards and discuss!

happy new day.

2015 sounds like the beginning by James Maskalyk on Mixcloud

i’ll keep this short, as it has been a long night in the ER. how many vodka sodas can a teenager drink on new year’s? i don’t have an exact answer, but not as many as he thinks he can.

the hospital is a living thing, i can tell you that, and the ER is its mouth. it eats sick people, or spits them out. i saw a man sleeping outside, shivering from the cold, a woman with a broken hip, one who was losing her baby. i ate my dinner listening to a neurosurgery resident discuss with his staff doctor the list of patients he had seen in the evening. brainstem tumour. infected cervical spine. cancer breaking through a vertebrae.

this has been one big, bad ass year. there has been no other that presented the same challenges, not the way these ones rolled out. in many ways, it was the hardest in a long while, and at the same time, the most honest. i feel more ready than i ever have been for the intense work that stretches from it.

i wonder if that’s true of us together. my teacher, shinzen (may grace and good fortune bless him), has a theory about fermi’s paradox, why if we live in such an infinite universe, we have received no message from another intelligent civilization. we could be the first. we could be all alone. maybe a message, on its way to us for millennia, is still hurtling through cold space, or we received it before we could understand. there are others, but shinzen suggests that instead of looking to the stars, or to mars, for freedom, maybe consciousness develops to a stage where we realize every answer to any question that matters is embedded in us, every single secret. there are other civilizations, sure, and they have heard our signals or ones like it, and at first it excited them, and they hurried to respond, but as they heard more, realized that other places were also looking for peace while still fighting, love while hating, they slowly saw their own green place, the civilizations rising and falling beneath their feet, their children born again and again, and they knew that if they raced away towards other oceans they would just dirty them too, so they stopped building machines, and let their listening equipment rust and for the first time knew their home.

i’m fond of this theory. certainly, as good as any other. in some ways, I think we are on some kind of trajectory that may recognize that the answers we need are not how to get to Mars but how to live our small life more deeply as it is now.

grateful for all of you who have shared this rare time with me. you have filled my heart time and again.

here is some music for you. love. j.

***

try to make a mix every year, around this time, that shows my fondness for both music, and the album. nearly all of these are from bands who put out great records in 2015. it was one of the best years i can remember, and hard to choose only a few. and, as i intimate below, hard not to make every song on this record a courtney barrett one. love.

***
Solo – Max Richter – This guy is my favorite contemporary composer for two reasons. One, he makes really beautiful concept albums, like his latest, 8 hours long, that is designed to play out as we sleep, then welcome us to the world. Two, he is the only contemporary composer I know, while also making me feel I don’t need to look much farther.

Coco Blues – Mbongwana Star – I remember a friend of mine who worked in DRC, where MStar are from, telling me that when he went out to listen to music, the band just played the whole night, no stopping for applause, or to demarcate the end of a number. It was all one long song. I’ve wanted to go there since, and one day, I will. And until then, this.

Oulhin Asnin – Terakaft – Oulhin Asnin means, “My heart suffers”, and the desert blues of Mali have never been bluer, as all Libya’s guns worked their way into souks, then villages, into the desert where the Tuareg people have sang their songs for a thousand years.

Broken Necks – Eskimeaux – Pretty music from brooklyn wrapping its arms around you.

California – Grimes – She is officially le sheet. Produced this poperfect record, sang on it, did the art, finely tuned ear to the ground all the way through.

Brown Skin Girl – Leon Bridges – I listened to this record more than any other. I can’t understand why every band isn’t this band.

Dust Bunnies – Kurt Vile – to all those times you had a headache like a ShopVac coughing dust bunnies, and for those times you just wanted someone funny and smart to be singing to you.

Washed-up Rock Star Factory Blues – Corb Lund – Alright, I’m from Alberta, and you might think I’m choosing this song ’cause i like the plains or pretending i do, or dudes from there too, and in some ways you’re right, but in most ways your wrong. I’m choosing it ’cause when I was in Edmonton, this guy was the lead singer of the heaviest band around, called the Smalls. If you were on the verge of understanding what he was saying over the ratatatat of the drum and the heavy guitar, someone would put their boot in your eye and now he’s singing johnny paycheck and probably always was. https://www.youtube.com/watch?v=SFBA_Vn309I&list=PL1C8FEA6105D79FF6&index=2

An illustration of Loneliness – Courtney Barret – This is the record of the year. No shit. She is my new favorite band, and every song on her album rules. I don’t have much else to say.

La Loose – Waxahatchee – love and loss never sounded sweet as they do coming from alabama and just from the name, i think i’ll fish this river (then put em back)

River – Ibeyi – twin sisters, born in cuba, raised in france, singing in yoruba, a nigerian language. percussion is spare and crisp throughout, and you’re just like, “God sounds good” no comma.

Demon – Shamir – genderqueer future soul music from the heart of las vegas and why not.

Mmm – Harleigh Blu – how can a song that sounds so sweet be so so sad.

Want Something Done – Oddisee – I lament the loss of the boombap , not just because the vocal refrains these days are so lazy, but because there isn’t enough space to say anything much deeper than “uhhhh”. Anyway, this guy keeps it nice.

i – Kendrick Lamar – but no one nice than this guy.

Dub Storm – Fats Comet – second craziest song i heard.

Cruel Sport – Blank Mass – this is, actually, the craziest song i’ve ever heard. it is a long player, worth listening to in it’s entirety. i mean, if you’re a cyborg looking to have a good time.

Love – 77 Karat Gold – soul music from Tokyo, what in the 2015 more than that?

When life is in your hands

 

(this piece originally appeared in PenguinRandomhouse’s Hazlitt magazine.)

I knew what had happened, though I wasn’t there. She was tossed from her motorcycle, turned in the air and fell, her helmeted head bearing her body’s weight. The landing snapped her neck at its weakest point. When I saw her in the trauma room, her eyes roved, trying to find mine, but not a flicker of movement anywhere else in her body.

I looked at the CT scan minutes later, which showed fragments of bone, a route her spinal cord could not stretch through. It was cut completely.

I leaned over her face, met her eyes, told her what I saw. Would she be able to move again? No, I said, never again. She asked more questions, then fell silent. I was called away. An hour later, a nurse told me she was asking for me again. I returned to her room.

“Doc,” she said, her voice serious and clear. “Can I ask you to kill me?”

“Oh, darling. You can’t. I can’t. I know why you’re asking, but … I can’t. I’m sorry.”

I work on the other side, I wanted to tell her, of a fine and indelible line. My work is to cultivate vitality, help it find a freedom to go as far as it naturally can so it can manifest its full expression. All my work studying disease has been at ameliorating it—how to mitigate the effects of trauma on the body, not deliver it.

After Carter, a recent Supreme Court of Canada decision, it is no longer a crime for doctors to help end their patients’ lives if those patients are capable, give informed consent, and suffer intolerable pain as a result of a medical condition. Now, many doctors are wondering if we will be drawn into new territory: helping people die who otherwise would live.

If a person comes into my ER threatening or having attempted suicide, I do two things. First, I tell them I’m glad they are here, even if they aren’t. Second, I take away their ability to make any more decisions about their care. It’s a powerful privilege, and one we treat with gravitas. Killing yourself is something you can only do once.

As you read this, patients and families in emergency rooms and intensive care units around the country are making decisions about death and the futility of treatment. These discussions involve physicians helping them to understand an illness’s trajectory, and how low the likelihood might be of treatment leading to a true recovery. It is a shared recognition that death is near. Working to prolong a life at all costs would be a denial of our intimate understanding of the process we are all part of, and the responsibility of physicians to our patients: to create an opportunity for them to thrive, and when that isn’t possible, guide them and their families through the letting go.

We don’t often handle this last transition well. We have let people think that dying is a problem that needs to be fixed—something best done in a hospital, out of sight, instead of something as beautiful and necessary as a birth. Our reluctance to embrace this difficult problem more publicly makes me wonder if doctors are the right people for the even bigger job that may soon be asked of us. I have my own opinions, but there are no medical mission statements that define a life worth living, or teach you how to determine when one no longer is.

This lack of public dialogue is surprising, because privately, nearly all of the doctors and nurses I know have had discussions with people close to them about the care they want at the end of their lives. My parents and wife know mine: If I can’t make the decision, and it seems I will never again show love, nor breathe on my own, let me go. For me, denial of treatment in this instance is an act of grace, not just for the person who is dying, but as an expression of the deeply natural process that we are part of.

The Supreme Court has cleared a way for other endings. If, in the future, I decide that I am in too much pain to live any longer, someone can hasten my death—though to this point, there is no guidance from federal or provincial governments as to how far this help might go. It could be a lethal prescription for those of sound mind who truly don’t want to live, so they can achieve their goal with as little pain as possible. Or it might include a doctor standing at the bedside, administering a drug with an intention to kill someone who, despite their pain, might survive for days, even years.

It would require a change in the mindset of most physicians. If a person comes into my ER threatening or having attempted suicide, I do two things. First, I tell them I’m glad they are here, even if they aren’t. Second, I take away their ability to make any more decisions about their care. It’s a powerful privilege, and one we treat with gravitas. Killing yourself is something you can only do once.

My aunt had a disease called scleroderma, a rare condition that can cause your skin to tighten until the bones come through the ends of your fingers, make your lips so small you can no longer eat. When her hands could no longer work well enough to cut food into pieces tiny enough for her mouth, she let others do it. It was a humble act for a proud woman. Until the end, she was strong and beautiful. Her dying taught me something about how to live.

A person’s right to choose for themselves how to live their life or die their death is, in the end, theirs alone, and seeking the best ways to do it should not be a crime. There are people who are well informed, supported, and emotionally skilled who endure unrelenting physical torment from which they seek release, and will decide to take their lives. My worry is that if we don’t strive to make it possible for people to find freedom even in the face of age, pain, and sickness, choosing to die risks becoming an illusion of choice itself.

I am not new to dying. I’ve seen it happen to adults and infants, suddenly and slowly. It is my impression that in the last minutes and hours of a person’s life, there is little pain. Most people die in peace. But there are things I can’t know. I do not know agony, or the true helplessness of my body passing beyond my control. I can glimpse that in these cases, assisted suicide, or even euthanasia, can be seen not just as an act of mercy, but one of true kindness. If Canada does allow for physician-assisted suicide, it must not be because of our reluctance to address pain—be it physical, social, or spiritual—nor to confront the societal aversion towards age and disability. If we hasten to neither of these things, the Supreme Court’s decision—made to preserve autonomy and prevent people from taking their lives prematurely—may not bear its promise.

I still see the woman with the broken neck in the emergency department. She returns because she got pneumonia from not being able to breathe deeply, or an ulcer in her back from lying in bed. If she remembers me, she doesn’t mention it. We give her antibiotics, at her request, and bandage her wounds. She has not asked me again if I could help her die. It could be because, until recently, it was a crime. Or it could be that she found something to live for.