The Nest in the Stream: Lessons from Nature on Being with Pain
March 5, 2018 / By Stephen at Parallax
The Nest in the Stream: Lessons from Nature on Being with Pain by Michael Kearney, MD was released on February 27th, 2018.
Here’s an excerpt:
As I go into Ben’s hospital room, it is dark; the window blinds are closed. Ben has advanced cancer of the bowel. He is thirty years old and not doing well. He will finish his latest round of chemotherapy this afternoon and then he will go home. He has lost ten pounds in the past two weeks, even though he says he has been eating fairly well. I ask him how he is doing. He says his colostomy has not worked since yesterday morning and that his belly feels tight. He looks tired and I can tell from how he is moving about in his bed that he is in pain.
Just nine months ago, Ben was diagnosed with locally invasive rectal cancer. I was asked to see him as the physician with the palliative care team in the hospital. We had been consulted by Ben’s oncologist to try to help him with his pain and to offer emotional support to him and his family as they struggled to cope with his new and serious diagnosis.
When I met Ben and his mother for the first time, Ben was in a room on the oncology floor. I entered his room and found him lying on his side; his rectal pain was so bad that he could not lie flat. I recall how he looked on that first visit—his bright brown eyes, his young bearded face, and the intricate, colorful tattoos on both his arms—and I remember how his mother, Juanita, was sitting at his bedside, her face full of sadness and concern. Ben appeared so strong and well. What had struck me most was his vibrancy, his openness, his gentle directness. He had welcomed my involvement in his care. I had felt happy to meet him.
Unfortunately, since then, things had gone badly for Ben. Despite surgery and first- and second-line chemotherapy, his tumor had recurred and spread throughout his pelvis. He went to Los Angeles for a second surgical opinion and was told that no further surgery was possible. He had had multiple readmissions to the hospital since then for chemotherapy and symptom control.
This current admission had been to start third-line chemotherapy, but afterward his discharge was delayed until now because of severe pelvic pain and other symptoms, which have only recently started to settle down. Ben is due to go home this evening to his grandparents’ house. He had moved in to look after them prior to being diagnosed with cancer. His grandfather was very ill himself with end-stage heart disease and had recently been enrolled in hospice care. His grandmother had kidney failure and was on dialysis.
Ben had often spoken to me about his granddad. They are very close. He told me that when he had first received his cancer diagnosis, his grandfather had prayed that he could take on Ben’s suffering for him.
A little while ago, Ben’s nurse had told me that she had just heard that his granddad’s condition had deteriorated. She did not know if he was aware that his grandfather was close to death. This could affect his discharge plan.
I ask Ben if he has had news from home. He says no. I tell him I had heard that his granddad is not doing so well and that I wanted him to be aware of this so he will not be surprised when he gets home.
“I’ll cheer him up,” Ben replies. “Last time when I got home and he saw me, it cheered him up.”
“You will, Ben,” I say with as much conviction as I can muster. “You will cheer him up.” I say goodbye to Ben for now and tell him that the nurse with our community palliative care program will call him tomorrow to make sure he’s doing OK. I tell him that I look forward to seeing him when he comes back in two weeks for his next round of chemo.
Despite all his difficulties, Ben has big plans for the future. Recently, he told me that even though he had had a job with a delivery company before becoming ill, his real passion is working with wood. For a few moments, his face lit up as he described different types of timber and shared his plans to open a wood shop with a friend when he is well again. He has not given up hope. He so wants to get well and carry on with being a thirty-year-old.
I have been working with patients like Ben for as long as I have been a doctor. While it can be challenging to control pain such as his, there is always something to do—a dose adjustment here, a new medication there, another line of treatment to explore—and I am grateful for the advances in hospitals in pain management and interdisciplinary teamwork that have made such a difference for patients like Ben. Finding medical answers is not the problem. The real challenge is something deeper, something more subtle, pervasive, and intractable: those elements of human anguish that lurk within and around and beyond the physical pain, the nonphysical dimensions of pain that do not have an easy fix. That is what I have seen for some days now in the dark rings under Ben’s eyes and in his flat expression as he lies in his dim-lit, shuttered room. My medical training had done nothing to prepare me for such distress.
I think of Ben as I am driving home. I notice a hollowness at the center of my chest and realize I am feeling saddened and impotent. I care deeply about him and wish I could do more to help. I feel frustrated with the Western model of medicine, which has so little to offer here despite its great achievements and its self-confidence to the point of arrogance. Despite some temporary successes along the way, at some more fundamental level I know that we, his team of clinicians, are failing Ben. Yes, we have eased his pain, but he wants more than this. He wants his health back. He wants his youth back. He wants his life back. Although no one has said so directly, it’s looking increasingly unlikely that we are going to be able to achieve this for him.
But there is another kind of failure and a deeper disappointment here. Despite being surrounded by people who care about him, I sense that Ben feels utterly alone in his suffering. And while his emotional solitude is probably in part a voluntary withdrawal, compounded by the traumatic effects of treatment and the pain of his disease, I suspect that it is mostly because of the uncertainty and grief he is living with. I am acutely aware that what is needed here is not a scalpel or another pill. I long, as one human being to another, to reach out to Ben in his isolation.
When I arrive home, our family dogs, Lenka, an English springer spaniel, and Lucy, a Chihuahua-mix, give me their usual enthusiastic welcome. I take them for their evening walk along the quiet tree-lined roads close to where we live. It’s a hot September afternoon. As the dogs sniff around, I linger in the shade and listen to the bird song. I notice a white-breasted nuthatch and watch as he walks along the underside of an oak branch, all the while hunting for insects in the fissures of the bark.
When I get back to the house, I feed the dogs. I look at today’s text messages from my daughters and the pictures of the day’s activities of my little grandson. I send off a brief reply and begin to get my things together for the Native American sweat lodge I am planning to attend this evening.
I have been attending these ceremonies for more than ten years now. They have become a spiritual lifeline for me and are something I look forward to each week. This way of prayer has become my “church,” not in the sense of a religious belief system, but as an Earth-based practice that feeds my spiritual hunger in ways that my root tradition of Roman Catholicism no longer does.
I eat a quick supper and leave a note for my wife, Radhule, who is still at work. I get into my car and begin the one-hour drive south, hoping I won’t be delayed by the rush-hour traffic.
As I arrive, I notice that the willow-frame structure of the lodge has already been dressed with canvas tarps, old blankets, and comforters. People are gathering around the fire. Wolf Wahpepah, the water pourer of the sweat lodge and its spiritual leader, is sitting on the ground to the north of the lodge, calling any newcomers to join him. His wife, Lisa, stands nearby, talking to a friend.
For more than twenty years they have made these ways of prayer available to whomever comes their way.
I approach the fireplace and look around to see who is there. There are men and women, young and old, Natives and non-Natives. Some are sitting alone, while others are standing side-by-side facing the fire as they chat. A young couple have brought their little baby and are introducing her to everyone. A group of newcomers are now sitting with Wolf in a circle on the ground. He is talking to them quietly about this way of prayer and telling them what to expect in the ceremony. My awkwardness soon fades, and I quickly feel at home in this diverse and welcoming gathering.
I go to take some tobacco to strengthen our prayers from the stone bowl on the ground. I hold the tobacco to my heart and close my eyes as I think about what I want to pray for this evening. I sit down and look at the sacred fire, blazing logs surrounding the “stone people,” the lava stones that are at the heart of the ceremony. I notice that I am full of my concern for Ben. For a moment, I see his gaunt young face. There’s a crack between two burning pieces of wood through which I glimpse a glowing, orange-red rock. I step forward and give my tobacco offering to the flames.
Wolf has stood up now and is calling us together. “Relatives, the fire-keeper informs me that the stones are ready. It’s time to change into your sweat clothes, take a final drink of water if you want to, and then let’s crawl inside.”
As I approach the lodge, the fire-keeper is by the door holding some burning white sage. The sage smoke purifies the individual and the area around them. I fan the smoke towards my face and chest, get down on the ground on my hands and knees, and crawl to the opening of the lodge where I touch my forehead to the earth. As I do so, I say the greeting, “For all my relations!” Wolf replies,
“Welcome, relative!” I crawl inside and move, clockwise, “sun-wise,” into the dark.
“Bring us the stones!” Wolf says as Lisa leads us in a song to welcome the lava stones, “the grandfathers,” who arrive one at a time, glowing red. The doorman uses deer antlers to catch each stone and carefully place it in the fire pit at the center of the lodge. All the while, we are singing a song that welcomes the stone people as friends. One at a time, Lisa drops sacred herbs on the stones. As the fragrant smoke rises, someone close to the stone pit reaches for a handful of smoke and rubs it into his hair.
Wolf calls for the water and the fire-keeper passes in a bucket, full to the brim. Wolf touches the base of the bucket to the stones and says, “Water is life,” then he rests it on the ground, takes the ladle in his hand, and turns toward the stones. He gives thanks to the Creator for these ways of prayer and for our very lives this day. He sings and prays as he pours water on the stones and the lodge begins to fill with “the breath of the stone people.” He talks to us about these grandfathers, “the oldest living beings on the planet.” He says that the natural state of the stones is gray, which is how they were when they were found on the desert floor, but that this is not their “original state.” Their original state is glowing red, which is how they are when they are born. In the fire they once again burn red and bright. Wolf says that our spirits also have that same quality of brightness when we come into the world but that living in the world and being subject to negativity, over time, can dim our spirit.
“This negativity is not ours,” he tells us. “Ours is that original bright spirit. By building the fire, we help the grandfathers to return to their original state. Then, when they come into the lodge, they remember what we did for them and they return the favor. They bring us back to our original state. This is why the sweat lodge is called a ‘purification ceremony,’ because it washes off that negativity.”
As we sit in the break between the first and second of the four parts or rounds of the ceremony, sounds of hissing and bubbling come up from the stone pit. Wolf talks about how the first people prayed in this way before they had conversational language or song. “The original songs in the lodge were the natural sounds of the ceremony that the medicines make, a language that our minds don’t understand but our hearts and spirits do. Being in here is not primarily about what words we use. It’s about allowing our spirits to mingle with all the helping spirits of the lodge. It’s about remembering how to pray.” After a pause, he adds, “Prayer is not about what we say or do. Prayer is a state of being. Whenever we’re in the state of being that is prayer, everything we say or do is prayer.”
Wolf calls for more stones and, as they are brought in, he invites people to offer a prayer, if they would like to do so. A young woman talks about how she is having a hard time with panic attacks and prays for help. She signals that she is finished with her prayer by saying the word, “Aho!” Others quietly echo, “Aho!” in understanding and support.
I think of Ben. I see that he is dying, even though I hope he is not. Ben doesn’t want to die, yet I sense, at some level, he realizes what is happening, and this is fueling a deeper pain: the pain that I have not been able to reach. I feel so powerless. I wish I could do more.
The sweat is pouring down my body now and dripping from my hands. I let it carry all that I am feeling for Ben in its flow. As if he heard me, Wolf says, “We can bring our pain to the stone people and offer it to them. Like the water we pour, we can let our pain go to the stones. Just as the sweat flows from our bodies, we allow our pain to fall on the Earth. The Earth doesn’t judge our offering as positive or negative, good or bad; it doesn’t put a value on it. Mother Earth just receives whatever we offer her as energy. She takes that energy back into her body and transforms it into pure life force….” As I listen to Wolf’s words, something in me quiets, listens, remembers. I sense that I am receiving a teaching I already know, yet am searching for. I make a silent prayer for Ben, for his deepest healing, whatever happens, and I pray for his family.
Wolf hands Lisa the drum and asks her to lead us in song. He continues to pour the water as the drumbeat begins. The heat intensifies to a point where my face is stinging. My feet are now a puddle of mud. I feel cramped and uncomfortable and my neck is strained from bending beneath the willow beam that’s pressing against the back of my head. I try to wriggle into a more comfortable position in the tiny space without bothering my neighbors. Then Lisa begins to sing. I recognize the song and I join in. I give myself completely to the singing. As I do, I notice that a quality of spaciousness and stillness has come into my awareness. I am singing with all my heart and I am silently watching myself singing with all my heart. The song ends and Wolf says, “All together!” With one voice we call out, “For all my relations!” The firekeeper, hearing this as a signal, raises the flap and allows cool air inside.
The fourth and final round begins with Lisa singing a song of gratitude. As I join in, I suddenly understand something I once heard her say about the transformative power of the sweat lodge ceremony. She had talked about the “energy transfer” that happens between “the sacreds” in the ceremony—the stones, the water, the songs, the prayers—and us human “two-leggeds.” I flash back to how I had been feeling when I got here this evening. I had arrived full of the stresses of my day at work and worries about Ben, feeling tense and shut down.
Now we are approaching the end of the ceremony. The stones that were red at the start of this round have turned gray, having been cooled by the water poured on them. As I watch this, I am aware of what feels like a glow at the center of my chest. Where there had been heaviness, there is now lightness and warmth, and a sense of being in the right place.
As the final song finishes, Wolf talks to us about what will happen next. He says, “In a few moments we’ll crawl outside. I encourage you to stay in silence for a little while as you offer each other a drink of water. Act as you would after waking up from a powerful medicine dream.” He finishes by saying, “In crawling in here tonight, we crawled into the womb of Mother Earth. Now, as we crawl out, we do so as brothers and sisters.”
Together we cry out, “For all my relations!”
The Nest in the Stream: Lessons from Nature on Being with Pain by Michael Kearney, MD is now available.