A Buddhist in Basildon Hospital (2)

Since I last posted William Ruddle has contacted me to arrange a meeting with him which occured ten days ago, in his office.

He told me that he had not received my letter as he had been away from work with an illness, and he was very concerned that I might have felt that he didn't care. He apologised for the delay in responding. I believed him and his explanation dissipated my concerns, which I acknowledged were unfounded and, I admit, unworthy. He was entitled to an apology from me, I thought, so I made one.

We talked generally about chaplaincy issues and Mr Ruddle shared some interesting information about local Trust policy and practice as it affected his ministry at Basildon, and that of his team. I hope I shall have an opportunity in future for further conversations with this priest, and to develop something of a collaborative relationship.

In line with my tendency to let posts stand I shan't delete the earlier entry I made, which does me little credit, but I hope that this puts the matter into perspective, and will restore any confidence in Mr Ruddle and his ministry at Basildon that I might have damaged.

A Buddhist in Basildon Hospital

Basildon Hospital is currently in the news, slammed by the Care Quality Commission (CQC) following a recent unannounced inspection. I don't think there's a hospital in the country where an inspector wouldn't turn up a grubby curtain, a dusty bit of clinical kit, or a commode which - if you turned it upside down between normal commode-based operations - had a bit of something nasty stuck to an overlooked surface.

There was a time when novice student-nurses spent most of their working hours in the sluice-room, restoring filth-encrusted bits of sanitary hardware to pristine condition for another twelve-hourly cycle of careless degradation by sputum, urine, faeces, vomitus, purulent and bloodstained fluxes of all colours, consistencies and odours; and in various volumes, usually copious. Novices were hardly allowed to go near a patient during this three months of stomach-churning apprenticeship. Not until they had proved themselves in the sluice-room were they allowed to shake down a thermometer, or take a pulse.

Those days have long gone the way of seamed stockings, starched cuffs, cuban heels and the six-day week. But I digress.

I have a double stake in Basildon Hospital. I worked there as a nurse - a Senior Nursing Officer - from 1981 until 1988, so I'm very well acquainted with its layout, although it has otherwise changed out of almost all recognition, and I recognise no-one there now, nor am I recognised myself. I have been an in-patient on a couple of occasions, most recently last month where I was admitted as an emergency, fortunately one that was quickly and efficiently managed, so that I am now at home.

My own experience of the hospital was generally favourable, and the medical staff were courteous, conscientious and 'involving'. Every doctor I met (there were several) treated me as an adult, as an equal, so that I could engage collaboratively and felt safe. I was struck by the way medical management was systematised, and followed logical and (presumably) evidence-based protocols. Of course it helped that I am a nurse, and could ask the right questions. I was rather disappointed with the standard of nursing care, but that's something I may return to, in greater detail, another time.

There was a point during my recent spell in hospital where I needed advice from someone, on a matter that was not clinical (so that I didn't want to burden the nurses) but personal and practical. To be honest, I thought I might die. I had developed signs and symptoms very quickly, and they suggested a rapidly progressing brain disorder. Within eight hours I lost the ability to stand or walk, although I was rational, calm and relatively untroubled. I asked for a notebook and began to write notes that I thought might help my wife and family to wind up my affairs - about my bank account, pensions, work and so forth. To help me gather my thoughts I asked to see a member of the chaplaincy team.

Although I had 'registered' as a Buddhist on admission, no-one had mentioned it afterwards, and I told the nursing staff that I was happy to see anyone from chaplaincy, if they could spare the time. After an interval the nurse-in-charge told me that no-opne was available to see me until the following Monday (this was on Saturday afternoon). I was a little surprised, but not put out in any way. I know chaplains sometimes work 'on the front line' of sudden death and bereavement, so was willing to wait my turn.

As it happened, after an urgent brain scan it was decided that I was safe to discharge, if I could manage at home, to return after a few days for follow-up and further tests. I came home, relieved, to begin my recovery (which continues).

When I returned to the hospital a few days later I delivered a short hand-written note to the hospital reception desk, addressed to the head chaplain, enclosing a copy of RAFT which explained the basis of Buddhist spiritual care, and the Ananda Network. I asked if the chaplaincy would consider an offer from me of voluntary service to Buddhist patients, at their explicit request, and I offered to make myself available for any discussion or examination that might be proper. I mentioned that I am an existing Buddhist chaplain at an Essex hospital, and gave the name of the Lead Chaplain who was willing to give information about me on request.

Two weeks later I had received no ackowledgement or response. I therefore wrote another courteous letter of enquiry addressed to the Lead Chaplain, Rev William Ruddle, by name. I acknowledged that my original letter might have gone astray, or that a reply might have crossed in the post. I asked if I might have a response. If my suggestion was redundant, I asked if I might be reassured by being told what the current provision for Buddhist patients might be.

Two weeks later I have still had no response, so today I have lodged a formal complaint with the Trust's Patient Advisory and Liaison Service. I know that Buddhists don't take things personally, and I am not making this a personal issue; but I think something seems to be seriously wrong at Basildon Hospital, and I would like to be reassured that it is not as I suspect. If it is, I see it as a duty on me to help to put it right, not just at Basildon, but more widely across the NHS, if the need to do so exists.

Therefore my intention is, if necessary, to use the Freedom of Information Act (2000) to obtain comprehensive information from the Trust about the provision of chaplaincy services to people of various 'minority' faiths (including but not exclusively Buddhists) who are patients, relatives, friends or staff members at Basildon Hospital. We shall see how carefully the needs of seriously ill, dying or bereaved Buddhists, or their carers (amongst diverse others), have been considered under the religious ministry of Mr Ruddle, as I believe it is his duty as a public servant, and where - if at all - he needs to apply himself promptly to a remedy, if he is capable of doing so, and competent enough.

The Information Act is but one recourse I shall have to sorting this situation out. I have several others in mind. If you have any ideas, please let me know.

If you yourself are interested in supporting this initiative of mine, please let me know, so that we can put our heads together strategically, and make common cause of this important issue. I shall report further on what happens in due course. I have been promised a prompt response from PALS, and I think they mean what they say.

What's the point? (2) Climate Change

I do rather enjoy this image of the Apocalypse. Is it saying to you what it seems to be saying to me? I thought so.......



Since my last blog I've been following a discussion within the Network of Buddhist Organisations (NBO) about climate change. Mike Masheder, a physicist and member of the Western Chan Fellowship, wrote persuasively and with authority about the crisis the world's inhabitants face, and the issues facing the Copenhagen Climate Change Summit that meets on 7 December.

Copenhagen - a successor to the Kyoto Agreement - aims to thrash out a solution to the climate change problem which, linked to the imminent end of fossil fuels, really signals "the end of civilisation as we know it", and possibly the end of humankind, if not the end of all forms of life on this planet.

Mike's post elicited the following response from Ken Jones, socially-engaged Buddhist, and it is so typically trenchant and compelling, as well as so characteristically a call to action within a framework of dharmic common sense, that it bowled me over. Ken writes:

"First, am I corrrect in supposing that, in the view of most scientific experts, our climate change crisis cannot be significantly affected by human agency, when compared with the workings of cosmic forces to the same end? In short, we are really in the grip of the Divine Artificer, and whatever may be achieved at Copenhagen wont make much difference ? And the Climate Change Camps may as well pack up and go home?"

"Although I consider myself as tolerably well informed, I haven't anywhere else come across this social and ecological bomb shell, and neither, evidently has the rest of the world -- Left, Right or Centre. Secondly, is it also being argued that ecological sustainability is a myth? That, even with a serious attempt to achieve significant energy efficiency, maybe even to develop (safe???) nuclear power extensively, and somehow progressively to move beyond quantitative material growth, we shall still be doomed once fossil fuel reserves are exhausted?"

"If these arguments are substantially sound, then SO FAR AS CLIMATE CHANGE IS CONCERNED, socially engaged Buddhists should switch their commitment from social change exclusively to the more ancient Dharmic task of enabling the manyfolk to EXPERIENCE ecological misfortune with equanimity, since they cannot DO anything significant about it OUT THERE?"

I couldn't agree more with the apocalyptic and incalculably wise old git. This is surely what we should be doing, the best way we know how, and starting with ourselves. It doesn't have to be a battle with ourselves, we can start by cultivating a teeny-weeny bit of tolerance for frustration and discomfort, and - as experience shows - a little bit of investment yields a harvest of fulfilment; the work virtually does itself if we have confidence in, and attention to, the natural tendency for self-healing that is our birthright. As for how we may enable the manyfolk to do for themselves as we do for ourselves, I can only enjoin you to

"Be present, bear witness, befriend"

What's the point?

The Tibetan syllable "hung" (see below)

I discovered this story in Wake Up To Your Life (WUTYL) by Ken McLeod:

According to the Tibetan tradition, Avalokiteshvara ( also called Lokeshvara, Kwan Yin), the bodhisattva of awakened compassion, received the awakening-being vow from Buddha Amitabha. Avalokiteshvara vowed that he would work for the benefit of beings without limit and, to convey the depth of his aspiration, he resolved that should he ever succumb to despair his head would burst into a thousand pieces.

For time beyond reckoning, Avalokiteshvara worked to free beings from the cycle of existence. He worked for eons and eons and finally took a break to see how he was doing. To his dismay he saw more beings suffering in cyclical existence than when he had begun. "What's the point?", he groaned, and his head burst into a thousand pieces.

Buddha Amitabha appeared before him and reminded him of his vow. Avalokiteshvara resolved to work again to help beings, but this time without any expectation or idea of accompanying anything. Through the power of Amitabha's inspiration the thousand pieces of Avalokiteshvara's head became a thousand arms, each with an eye in the palm.

To formulate a new vow of awakening mind, Avalokiteshvara looked over the world of beings and saw three things: beings were suffering from poverty, reactive emotions had grown stronger, and being needed help fast. Now truly present, Avalokiteshvara experienced the suffering of the world for what it was. Direct awareness took the form of a syllable in his heart, a blue-black hung, the syllable of pristine awareness.

The syllable hung transformed into the Fast-Acting Protector, the six-armed form of Mahakala, the embodiment of the wrathful energy of compassion. The Protector represents how the clarity of compassion, free from subject-object dualism, cuts through all confusion and works for the welfare of all.

I like this story for its crazy 'over-the-top' symbolism of exploding heads and forests of eye-waving arms, all in the interests of suffering humanity. I also relish Avalokiteshvara's taking an evaluative break to audit his performance - a very Twenty-First Century thing to be doing. One can almost see him, sweating into the monogrammed ("AV") leather seat of his Porsche soft-top as he punches data into his blackberry, pulling at an uncorked magnum of Veuve Cliquot, and groaning: "What's the ****ing point?"

Perhaps allegories like this were written to resonate with people's everyday experience, to illuminate it, and to show us that we are not alone. In the story the hero Avalokiteshvara reached "rock bottom", the pit of despair, a place of darkness from which there was no way out. He was, as so many people say nowadays when stark reality impinges on fantasy, "shattered". Despair is, for many, the point at which we wake up, 'see the light', 'turn round in the seat of consciousness', 'find salvation'. For alcoholics, it's the First Step.

I've been in that place and so, I dare say, have most of you who read this. At such a time all our elaborately-constructed edifices of thought and opinion about what we are, who we are, and what we think we ought to do, all crumble to nothing, leaving nothing for us to do except what lies in front of us, directly, nakedly. This is the moment of awakened compassion, a moment of pristine immediacy. Christina Feldman describes it like this: "We are all beginners in the art of compassion". And our first act of compassion is, as it must be, for ourselves.

A few weeks back I met Claire Breeze, a disciple of Joan Halifax Roshi. Claire is currently undertaking chaplaincy training with Upaya Institute and Zen Centre in the US, and we arranged to meet at Jamyang in South London for a chat about the Trust and her chaplaincy work. It was while talking with Claire that I realised how parched and arid my practice has become, and how much in need of spiritual refreshment I am. Claire teased me gently for my slightly curmudgeonly take on things, but we found we have much in common, and her account of Joan Halifax's influence and orientation inspired me and lifted me up. Claire told me later that our meeting had inspired her, too: "Something small and simple. I am going to make an offering in my local area to simply be with people who are chronically ill or reaching end of life. Nothing complicated or highly sophisticated, just simple sitting, bearing witness and befriending."

How wonderful this is. How perfectly and simply Claire's offering captures the essence of the Ananda Network's mission of "being present, bearing witness, and befriending" - a statement that bears resemblance (dare I suggest) to the hung syllable that lay in the heart of Avalokiteshvara as he experienced the suffering of the world, and embodied that wrathful energy to overcome it.

For several years now I have despaired at the inadequacy of my chairmanship of the Buddhist Hospice Trust, at how ineffectual have been my efforts to 'modernise' or 'renew' it, to understand how it might work to bring succour to people in need, to recruit new support, to mobilise and encourage energies in others. As the poet W B Yeats wrote in 'Things Fall Apart', "The best lack all conviction, while the worst/Are full of passionate intensity". I sometimes feel these words might be my epitaph!

Enough beating myself up. I am spurred on by the tale above, and by Ray Wills's gentle mantra, "Do what you can, perfection isn't on offer".

To be continued soon....

Dying Matters Coalition

Token picture of old chap looking serene and knowing and, in all probability, totally unaware that his picture has been hijacked by the Dying Matters Coalition to advertise its campaign. I take that back unreservedly.

We got our "Membership Certificate" in the post today, a token of our having signed up with the National Council for Palliative Care's campaign to 'promote public awareness and debate on issues of death dying and bereavement' earlier this year. Four Trust supporters went to the first annual members' Forum on 13 May this year. I think we sent more delegates than any other of the 100 organisations who were in on the launch of the "Dying Matters" coalition, as it is now called. The organiser even told me off for sending so many, but do I care?

As I've tried to point out in recent months and years, there's a big push in place from Government to improve End-of-Life Care, and especially to respect the wishes of the big majority of people who would prefer to die at home than otherwise, given the option, and being assured of a reasonable level of care at home to make dying comfortable, dignified, pain-free and with the dying person "in charge". In other words, with the sort of care one would normally expect to get in a hospice, but bearing in mind that less than 5% of dying people actually get hospice care, most of them children with life-limiting illnesses or (a few) terminal cancer patients.

It's impossible not to be cynical about Government motives for wanting people to 'choose' to die at home: it's obviously a lot cheaper than dying in a hospice, and it saves blocking a hospital bed that might be needed for someone on a waiting list. Die-at-home is clearly a bean-counter's dream. But there's also good evidence that people do want to die at home, given the provisos mentioned. Nonetheless, the "Dying Matters - Let's Talk About it" campaign needs to be seen in that light, as a marketing device to raise awareness of the "options" available, and - possibly - to nudge people towards a cheaper end-of-life solution than currently exists.

As a Buddhist I've no quarrel with any strategy that brings the inevitability of death into sharper focus, especially if that focus embraces the way we live our lives while we've still got lives to live, and encourages us to live them more fully. That's the moment-by-moment challenge facing each of us, and the essence of the Buddhist way, it seems to me.

I'm rather sceptical, though, about this preoccupation with the "Good Death" - it's a concern that has too high a salience with many western Buddhists. Surely if we can get living right, and have more day-to-day concern for the Good Life - not the fantasy Good Life of big houses, expensive cars and endless youth courtesy of the plastic surgeon's scalpel - the good death follows on naturally? Or did I miss something in the Buddha's teachings?

The next step? The "Dying Matters" campaign proposes three things we can do as an 'organisation' to help raise public awareness and build a strong "cross-sector coalition". Here they are:

1. Tell other organisations you work closely with the Dying Matters Coalition and encourage them to join too. If you want to join as an individual (remember, you will get a Certificate!), go to http://www.dyingmatters.org/ or phone Freephone 08000 21 44 66

2. Support the Dying Matters National Awareness Week (15th-21st March 2010) and plan an activity or event to raise awareness.

3. Let the Coalition know what you are currently doing to raise awareness of death, dying and bereavement and share your examples of good practice with the Coalition.

If you've any ideas about how to do these things, let us know.

As for myself, well, I put myself about on behalf of the Trust by 'blogging', by going out to give talks to Buddhist groups here and there, by putting in time at meetings or conferences, by occasionally running workshops like the one I offered recently at the Mind-Spirit conference in Chelmsford Cathedral, and by writing articles and letters (not all of them get published, but some do). And I try to keep myself "in shape" as best I can as a Buddhist practitioner, though my practice is as idiosyncratic and unruly as I bet yours is. If I offend you, I apologise (fingers crossed).

Holistic Health - The Spiritual Dimension

I picked this leaflet up recently during a hospital chaplaincy visit to St Tiggywinkle's, and I thought it was worth tossing in to the discussions some of us in the 'Buddhist community' are having about the Buddhist chaplaincy role: what chaplains do, how to measure the outcomes, how to benchmark the performance specifications, and all the other important aspects of the developing work.

I thought this was remarkably cogent and fitted in very well with the modern approach to health-care and spirituality being promoted within the NHS.

St TIGGYWINKLE'S NHS UNIVERSITY FOUNDATION TRUST HOSPITALS

DEPARTMENT OF MEANING, PURPOSE AND HOPE (formerly SPIRITUAL AND PASTORAL CARE formerly "Hospital Chaplaincy")

NOTICE TO PATIENTS

The procedure you will undergo is designed to explore meaning, purpose and hope, and our technicians are specially trained and experienced in it. These guidelines will help you to cooperate in the procedure and get the most benefit from it.

When in the cubicle, please remove any scepticism you are wearing and leave it in the tray under the couch. IMPORTANT: If you are carrying any scientific materialism please deposit it in the red bucket in the corner and replace the lid firmly.

Lie on the couch and make yourself comfortable and credulous. A technician will be with you soon.

The procedure isn't painful, but some patients experience a warm 'connected' feeling, and there may be a little discomfort during the installation of new meaning. This usually passes off quickly.

When the exploration is complete you may have a slightly renewed purpose, so it is all right to have a cup of tea and a light meal (not provided) in the Tiggywinkle Terrace Restaurant and BrunchBar.

Further explorations may be needed. If so, the technician will advise you, and make a further appointment.

We welcome your feedback, comments and suggestions. There is a form for this purpose on the way out. You don't need to give your name, but to help us provide a culturally and socially equitable service we do request that you answer the questions on gender, age, ethnicity, sexual preferences and whether you have read Professor Dawkin's book, "The God Delusion". All of it? Really?

Please remember to collect your scepticism etc before you leave the cubicle. St Tiggywinkle's accepts no responsibility for any loss or damage to your incredulity as a result of this exploration.

The procedure could also affect your hoping mechanisms: you may notice hoping that we have a nice day; so thank you, and the same to you. See you later!

Open wide.....

Another long gap between posts, but someone wrote recently to comment on my last one, and that jolted me out of my (sort of) stupor, and prompted me to blog again. Something else prompted me: I've had a dental abscess for about a month, treated reluctantly by my GP ("That's a job for your dentist"), but it didn't get better so I visited my local dentist this morning to see what he thought about it.

The dental practice has been rebranded, so it's now called the Smile Centre, with smiling designer-clad young women and a new waiting room with plasma TV. Somewhat nervously, I asked to see the price list. I had about £100 in my pocket, having just picked up my reirement pension at the Post Office. I suspected the bill might be more than I was carrying, and my bank account is bare. Some of the treatments on the "Smile" part of the menu were startling, running into four figures...

Emergency treatment £85, planned extraction £50. These items seemed like the clinical equivalent of starters on a restaurant menu, prawn cocktail or something spread on tiny squares of toast. I feared treating my septic upper jaw would cost the equivalent of lobster thermidor or something stuffed with truffles, but the dentist took pity on me when I asked him to tell me if I could afford treatment, and I got away with paying him £65.

I had to have two goes at getting numbed-up, because infection interferes with the take-up of local anaesthetic (he said), and his first attempt at removing my miserable molar stump was pretty painful. At the second attempt, and after drilling, pulling and pushing, the bad tooth yielded in three sulky pieces.

I identified quite strongly with that tooth. It had inhabited the cavern of my mouth for, I estimate, about 68 years, and had crunched through a mountain of comestibles over nearly seven decades. I can understand its reluctance to give way to sudden tugs and hostile wrenches from a stranger, and I wonder if I shall show as much reluctance and obstinacy when the time comes for me to give up my hold on life? Shall I, like the molar, cling hopelessly on? Well, I admit, until now, I've preferred to think of myself as - if not a shining example of good grace at the end - at least not as a frightful, fearful, curmudgeon, snarling and/or pleading for a bit longer.

This rather new owning up to not being ready for death is welcome and timely. I have built up an enormous repertoire of vain opinions and over-valued ideas over the years, including well-aired ideas on death, and only very rarely have I been challenged about them by people who know me. There have been a few honourable exceptions, people who have called a spade a bloody hypocrite. You know who you are and I salute you with belated thanks. First for having the guts to tell me what I needed to hear, and second for not writing me off as a totally lost cause.

Don't misunderstand me, I'm not about to throw all my opinions overboard, not quite, and not just yet. But something has dawned on me, a new state of mind provisionally labelled "maybe you don't know as much as you thought you did"; I feel a bit lighter and free-er, less tethered to certainty, and in the end it didn't hurt much, and it didn't cost more than I could afford.

Bardo

Bardo, gap, interval, hiatus - call it what one will, it's been a long one since I last wrote anything on this blog. During the interval I've asked myself many times if I should return to it, and found no convincing answer. Lots of questions about who it's for and what it's for and who's writing it. No clear answers, unless the interval itself supplies one, and the fact that I've resumed.

The image opposite is Bardo, 2001 with grateful acknowledgement to Jeff Irwin Photography 2008

I've written elsewhere about the tentative but (to me) unmistakable impetus that is gathering in the affairs of the Trust. I spoke with Stephen Hendry today and we corresponded by email about the spirit of renewal that is abroad, and which he has instigated with the support and encouragement of Willemien and Lisa Sheehy, two relatively new and relatively young Trust supporters, with my own support (and my own direct involvement), and without dissent from other Trustees.

Stephen and I are meeting on 27th February for a 'brain-storming' meeting, and we hope Lisa will be able to join us. When Stephen proposed this meeting I told him laughingly that I felt I needed a strong wind to blow through my mind. I intended this as a light-hearted comment, but even as I thought about it more, Stephen had himself picked up on the analogy and responded in an email, "Let's be guided by the wind. I like that. The wind allegedly saved the Japanese from invasion by the Koreans. The Great Wind, Dai-Kami. Great to be guided by the wind".

I found myself suddenly very moved by his words. Tears pricked at my eyes. Moved to respect for whatever wisdom, perhaps unwittingly, had been expressed in the words we had chosen, or had been open to; about the project we, but mainly the "Young Ones", are tentatively and hopefully embarking on. A project I am very, very unlikely to see fulfilled. Yet a project that fills me, unaccountably, with hope. We call it (for the sake of a title) Conscious Living, Conscious Dying or CLCD for short. It is, perhaps, a 're-branding' of the concept of Hospice in the Heart; yet it is pregnant with renewal and, I think, a kind of enlightenment. And of enlightenment it is wisely said that it is never what we conceive of, reach after, or expect. How could it be so?

This afternoon we received a message from a trainee GP in East Anglia, "glad to have found us!" - how marvellous. She sent an enthusiastic offer of tacit support and encouragement. Amongst other things she comments on the strictures imposed on medical people by the General Medical Council, the doctors' regulatory and disciplinary body, about spiritual matters. These must be kept strictly boundaried in dealings with patients, so that personal religious beliefs never intrude on or affect the professional relationship (I paraphrase).

I respond that I also think it's important that we act mindfully in our relations with those we serve, so any such rules should be interpreted as a guide to the wise and a law to the foolish. I'm rather sceptical about talk of the 'spiritual dimension' that is creeping in to the language of health-care.

Assumptions about the universal acceptibility of a 'spiritual dimension' to be addressed by care-staff (e.g. through on-admission assessment of "spiritual needs") are bound to end in tears, I think. There are lots on conscientious non-believers in the 'spiritual dimension' out there waiting to feel justifiably aggrieved, and file legitimate complaints. More aggro from NHS 'customers' we don't need! But I know I'm swimming or wading against a strong tide of contrary opinion here, especially amongst chaplains (I am one).