Reflections on a Coral Tree: My Palliative Fellowship Year

Summer

In June, when I arrived at the start of my Fellowship year, our coral tree had a thick outer canopy of fresh new green leaves. Late Spring/Early Summer, the season of new beginnings … a very auspicious time of year to begin my training in a medicine that would change my life. It reflected back to me my own Spring. I felt fresh, open, tender, very green, and full of excitement for the potential I might discover within myself along the journey upon which I was about to embark. I had just completed my residency in Internal Medicine, which had quietly shaped me into someone I barely recognized. I knew my calling was medicine, but somewhere along the way during my residency, I lost the heart center of my work. I had been hoping that Palliative Medicine would nurture the reawakening of my heart.

Interestingly, in Eastern medicine, the organ system of the Summer is the Heart, “The Emperor,” where the Shen resides. The Shen is often translated as the Mind. The emotion of the Heart is joy and excitement. I was filled with joy and excitement as my Mind and Heart were being reintroduced to each other in the context of our beautiful work in Palliative Medicine.

As the summer progressed, our coral tree flourished and it's leafy display matured and intensified, showing the world what a magnificent coral tree is capable of, for all to see. Summer is the most Yang of the seasons. Yang is the exterior, the surface, the observable. It is the bright flame, consuming the stored fuel from winter. It is action and doing. I quickly felt rich with new knowledge and my confidence was growing. My focus was on outward performance, prescribing the right medications, knowing the correct actions to take. I was surprised at what I was capable of in terms of quickly managing symptoms. This was an expansive time.

Fall

Then Fall came, the leaves of our coral tree turning brown and falling away. Its life force no longer directed to the exterior. It was the beginning of the season of contracting, consolidating, and quietly going inward.

The organ system of the Fall is the Lungs and the emotion of the Lungs is grieving. My focus shifted to a deeper awareness of the eminence grief that our patients and their families were experiencing. All living beings are connected. I dropped the outer layer that had shielded me well throughout my residency from my patients' emotional suffering. I became more authentically present, less preoccupied with fixing a symptom, and instead, connecting with their vibration of grieving. I consciously slowed down, practiced being comfortable with silence, sitting at the bedside of patients who did not have visitors, being a co-witness to their journey, matching our breathing cycles, wishing them safe passage. Learning the value of non-doing, of holding the sacred space.

Winter

In the season of Winter, our unadorned coral tree revealed it's previously hidden amazing core strength, it's broad trunk that itself was composed of multiple broad trunk-sized branches arising quickly from it's base, as well as it's extensive powerful system of roots. Our coral tree's solid foundation was now visible.

The organ system of Winter is the Kidney, which serves as the origin of qi or life force for all the other organs; it is the foundation. The emotion of the Kidneys is willpower and courage. Winter is the most Yin season of the year. It is the deep, the interior, the quiet, the stillness, the time for replenishment. It is a time for reflection and consolidation.

OPEN IN VIEWER

The Winter months for me were a time of quietly applying myself to the work. Long days, studying up until the time to sleep, trying to get enough sleep, allowing the fates to direct me, being open and guided to my next lesson, bearing witness to people's lives and deaths. A family member who needs support. A pain crisis during the night. A patient who silently passes from dementia as his wife lies next to him in bed, holding him. Seeing spiritual pain that medications cannot reach. A gentleman with extraordinary dignity as a tumor takes over his face and neck. The sweet, bright-eyed 90-year-old Emma, who greeted me each morning with “I am still here.” Yes. Another asking with anguish, “Why haven't I died yet?” I don't know.

During this Winter season, like the revelation of the amazing foundation of our coral tree, I saw the amazing foundation of our Hospice, which those before me had created. A few core people at its center that had nurtured this organization over the years, which grew to support hundreds if not thousands of employees and volunteers all with the same extraordinary vision, the same root, in the service of thousands more. I grew to appreciate my place in this tree of life of our Hospice, and the magnitude of the lives we have collectively touched.

As one stands up close, it can appear as a tangled chaos of branches. Some of the branches straight, some twisted and uneven, taking sharp-angled turns, a testimony to life itself, sometimes predictable, sometimes not, but together, not only surviving, but flourishing with elegance. Then, standing back to admire the whole, the grandness is apparent.

Throughout the Winter, in the course of my busy and sometimes sleep-deprived days, I applied myself to whatever was right in front of me, often going for long stretches without looking up. Occasionally, however, I would step away from the details of my day, and get a glimpse of the whole, often prompted through a friend, curious about my work, asking me to tell her what it is I do. This would suddenly propel me to a wide-angle view, in which I could fully appreciate the beautiful work my team members and I were doing, the enormous gratitude of the patients and their families, the extraordinary privilege it is to be so intimately in peoples lives at such tender moments in their journeys.

Spring

In the Spring, our coral tree did something I had never seen before…Its leafless branches still bare from Winter sprouted the most vivid, bright red flowers, striking against the deep blue cloudless sky. All Winter our tree had been silently preparing for this display in celebration of its inner tropical nature. The flower stems spread out from the ends of bare, unadorned leafless branches. In spite of having no scent, the flowers attract countless life forms, including birds, bees, and human beings. As it turns out, this flower has been an inspiration of artists around the world.

One day this Spring. I was in a local hospital, having a quiet conversation with a patient. I had been asked to see her by her primary admitting team, who said she was in denial about her newly diagnosed advanced-stage cancer, and in all likelihood had only weeks to live. Her daughter was at the bedside. We had a lovely conversation for about an hour. After we had finished, I walked toward the door, and a nurse, who had been standing behind the drawn curtain next to the patient's bed, met me at the door and said, “I was listening to you as you spoke with the patient. What you said was so beautiful.” I had not been aware that she had been in the room with us, and was very touched by the sweetness of her words. My Winter of subtle, quiet, inner cultivation had blossomed, to my surprise, into a beautiful outward display, a wonderful culmination of this year's lessons.

The Spring is a time of new beginning. The organ system of the Spring is the Liver, “The General,” which is a powerhouse responsible for the smooth flow of qi and blood. The emotion of the Liver is impatience if its mandate for smooth flow is interrupted or blocked. I can feel the push of a new beginning as my Fellowship year is coming to an end. And I must admit to feeling some impatience to get on to the next new phase. However, as our coral tree grabs my attention with its extraordinary flowers, I am reminded to pause, to be present, to not be in such a hurry, and to savor the beauty that is right in front of me. I am witness to the reunion of my Mind and Heart through Palliative Medicine, which fills me with an overwhelming gratitude. I see the beauty of this year in the faces of my amazing coworkers, each of whom are like the beautiful flowers of our coral tree. Their kindness, sense of humor, patience, generosity, hugs, guidance, and wisdom have nurtured me this whole year. I am like a small seedpod at the base of one of the bright red flower petals, a seed that my Hospice teammates have all had a wonderful hand in creating.

I have completed the full cycle of one year of Fellowship training. When I reflect back over this year and the changes that have occurred, I have a peaceful sense of completion. At the same time I am once again at the beginning of a new cycle, a new Spring, full of great potential. The seeds of what I have learned, experienced, and witnessed this past year will be the foundation for new growth, for teaching the next generation of learners, and for the loving care of future patients and their families.