Mark Sherman

“There are two realities. The one unfolding right now all around you… and the stories you have about it.

We mostly live within our stories.. Our beliefs and narratives about ourselves, each other and the world are the lens through which we see life, and largely determine how we think, speak and act.  Whilst some stories have the potential to unite us in culture and tradition, drawing us ever closer to a place of belonging, stories can also be equally powerful in their capacity to divide us from ourselves, each other and the natural world around us. 

There is a tension rising in modern society between the dopamine-fueled draws of materialism, overbusyness and politics of power; and a pull towards practices of inner transformation such as meditation, yoga, and psychedelics.  One is outward, brash and founded upon beliefs of fear, impoverishment and individualism. The other is quiet, inward-focused, and rests upon a recognition of our innate wholeness.

Whilst war, hatred and a staggering violence again each other and our natural world, seem to be proliferating,  so is there a growing interest and research into mindfulness and meditation, psychedelic-assisted therapies and the wisdom traditions of the world.  This tension has never been more apparent than at this moment we are living in — a period characterized by increasing wealth, longevity, and technological advance and, simultaneously, a rising prevalence of anxiety, depression, substance use and deep divisions within community and between nations. 

Our stories are influenced through experience with the world around us, and the presence — or lack thereof — of an intimate connection to the world within us.   If our outer existence is not balanced and informed by an intimate cultivation of inner knowing then we are bound to live at the reactive discretion of our physiology. When faced with threat — to our physical, emotional, or psychological safety — our bodies are wired to react with fight, flight or freeze.  Our heart rate and breathing increase, digestion and immunity slow, and our brain becomes reactive and hypervigilent. Fear is the predominant emotion when faced with threat. The challenge is that this threat does not need to be real in order to evoke this reactive state.  The perceived story of  transgression against our character will lead to the same physiologic fight reaction as would an actual physical threat to our life.  The entrenched narrative of tragedy and uncertainty will elicit a dissociative flight or freeze reaction no different than when faced with actual tragedy. 

When we are bereft of the grounding stories inherent in our cultural and religious traditions we become increasingly susceptible to the prevailing stories from popular culture — stories today that are manufactured by commercial and political interest, and then inoculated to the masses through social media, news outlets and AI algorithms.  Rather than stories of belonging, identity and relationship arising from traditions passed on from generation to generation over millenia, we are sold narratives of fear, separation and inadequacy, born within marketing agencies, board rooms, and political parties. 

Peace is this moment without judgement or story. It is not dependent upon life unfolding according to our preferences or plans, but rather is a deep recognition of the miracle unfolding within, and all around us, right here and right now.  This peace, joy, and healing, arise from the humble remembrance that each person, experience, and emotion has its place — every thing belongs. 

Contemplative wisdom traditions have developed practices, over thousands of years, such as prayer, meditation, mindful movement and ecstatic song and dance in order to cultivate this realization of our true nature.  Many of these traditions frame this realization as a ‘waking up’  from the slumber of our stories of separation and fear.  These human practices of awakening ground us in this precious moment, loosening our attachment to our stories, and cultivating a perspective of Truth amidst, and beyond, the play of ideas.

The great German mystic, Meister Eckart, once said that there is ‘no such thing as a spiritual path‘.  John O’Donahue added to this proposition by stating that if there is one, ‘it is but a quarter of an inch long’. Awakening to Truth is available right here and right now.  It does not require joining a monastery, a pilgrimage to a sacred mountain nor a renunciation of your belongings.  It simply asks you to slow down enough to step outside of your narratives, and immerse yourself in the miracle of this moment.  The draw of psychedelics, meditation and mystic traditions is rising within our popular culture now because we need them more than ever.  Now is the time to wake up. 

We try so hard… to accomplish, to solve, to fix, to belong.  Sometimes our effort is wise and meaningful.  And sometimes this exertion comes from a place of fear, and we end up micromanaging our lives in a way that denies the grace and mystery of it all.

Our human condition invites each of us towards a balance of effort and surrender.  Creativity is a wonderful example of this balance.  All acts of creation — whether writing, music, painting, problem-solving, planting a garden or devising a business plan — require a careful interplay of deliberate action and an acceptance of the emergent quality or life.  Mary Oliver, in her Poetry Handbook advises the would-be poet:

“Writing a poem is a kind of love affair between the heart and the conscious mind. They make appointments with each other, and keep them, and something begins to happen. Or, they make appointments with each other but are casual and fail to keep them: count on it, nothing happens. “

I love the way that Mary Oliver speaks of the relationality of our mind and heart – like a dance of human and divine; of reason and mystery.  There is a trust that is cultivated in this love affair.  We honour this trust by showing up. This is the effort.

And yet this relationship asks, as well, that we be willing to listen to the heart, whether these whispers are unnerving, vulnerable or bizarre.  We must allow this whispered wisdom to move through us, informing our thoughts, speech and behaviors. This is the surrender.

When we become trapped beneath the weight of our busyness, or mired within the mundane muck of our doings and shoulds,  it is often because we have misplaced this trust — or faith —  in that which moves through us and all around us, but is not us at all.  We forget how to let go.  Margaret Atwood has often spoken of the importance of non-self in the creative process.  When asked about her book, Negotiating with the Dead, she asserted, “You will never meet the person who wrote this”.  And as Rick Rubin, Grammy Award winning music producer and author of the exquisite book The Creative Act: A Way of Being writes, “Ultimately, the act of self expression isn’t really about you”.

This rings true in my own creative expression as well.  The poetry or writing that I produce is never really ‘mine’, but rather something that moves through me – a creative wellspring that I can tap into.  In my teaching roles, there are times when something novel, resonant or edifying arises from my lips, within the container of a retreat, workshop or course.  When I allow myself to be a vessel, then these words can become a gift and an inspiration… to myself and, hopefully, to others.  When my intellect or ego become excessively involved, however, then the concepts or words begin to feel like sunlight filtered through murky water — the light simply doesn’t get through.  My role is to get out of the way.

Healing is also a creative act that moves through us, but is not entirely us.  Healing requires this very same fine balance of effort and surrender.  If I am ill, it is important that I get some rest, drink fluids, and take the medicine that may quicken my recovery.   This is the effort.  However, I must also trust this body, and remember that healing is ever an innate movement towards wholeness.  This is the surrender.  It is this humility that allows me to understand what may be getting in the way of this movement, and what can facilitate this flow?

When Medicine is at its best, this is what we are so privileged to do as healers. Our role is to meet our patient with all of the skill, knowledge, experience, and compassion we have. This is the effort.  And then we must let it go. We must have trust in the person we are in relationship with; in the medicine we are choosing; and in the healing process itself.  Despite all of our technology and pharmacopeia, we do not do the healing. As healers we simply facilitate, and participate in, this mysterious and sacred propensity towards life and a balance of health.  As Voltaire quipped, “The art of medicine consists of amusing the patient while nature cures the disease”

There is a balance of effort and surrender in meditation.   Our effort lies in showing up to our practice, to our retreat, to our community…   But there is, as well, so much surrender.  Similar to Mary Oliver’s advice to a poet, meditation is also a love affair of head and heart.  It is a courtship of trust.  Meditation reacquaints us with ourselves, and invites us to remember how to listen deeply to that which arises within the stillness of practice.  When the noise and busyness begin to settle we can once again fall in love with ourself as we are; with this moment as it is; and with this world as it is.   Meditation is an effort of compassion, and a surrender into Love.  

To see a World in a grain of sand
And a Heaven in a wildflower
Hold Infinity in the palm of your hand
And Eternity in an hour.
                                            William Blake

Ours is a world ever more impoverished from that which is sacred.  In these neon times we falsely ascribe meaning and value to the fragile promises of material wealth, eternal youth and an ethic of overbusyness that have become the popular narrative of our epoch, and the very measure of our worth and personhood.

The consequences of such a culture are evident throughout society.  Never before have we faced such an epidemic of mental and spiritual suffering.  The prevalence of disorders such as attention deficit, depression, chronic pain, burnout, anxiety, addiction and discontent are the inevitable result of being disconnected from the sacred in ourselves, in each other and in the natural world in which we live.

Sacred has been defined as that which is “worthy of awe, respect and dedication”.  It is our connection to the transcendent, beyond the limits of our material world. It is the realm of Spirit. Since the dawn of human existence, our ancestors have found solace and sanctuary in relationship to that which is sacred. Ceremony and song; dance and prayer; art and story have been the foundations of human cultures throughout the world, honouring the mystery of the Divine, and rooting ourselves in belonging.  From animist cultures to polytheistic, and monotheistic, religions, our faith traditions have pervaded society with ceremony, community and a clear ethic of being, imbuing the sacred into all aspects of life. WIth the secularization of society we have lost the signposts, but not the hunger, for a relationship to Spirit. Without such a connection to this basic human need our inherent challenges, sufferings and frailties become bereft of meaning, and we drift upon the turbulent waters of existence without anchor or sail.

Indigenous cultures across the globe maintain this connection to sacred in their awareness of Creator in every aspect of life and being. Amidst the blessings and hardships of day-to-day existence lies a deep recognition of meaning and grace that is the foundation of indigenous culture and identity.  The stories, traditional knowledge and healing arts of indigenous peoples have arisen from an intimate relationship and respect for the natural world . The poignant phrase, “All My Relations”, often used by North American indigenous peoples,  breathes this humble understanding of connection and interdependence with animals, trees, plants, insects, sun, moon and all of life — recounting a story of kinship and connection.

In the book, Doors of Perception, Aldous Huxley describes, in eloquent detail, his own personal psychedelic experience under the influence of mescaline in May 1953.  Entrenched within the eternal moment of his sensory awareness, Huxley becomes enraptured by the form and nature of a chair, a painting and a flower, writing, at length, of the depths of beauty and interconnection within each object — the suchness of each thing which contains all things. He famously wrote, “If the doors of perception were cleansed, everything would appear to man as it is,… infinite.”.  

Rediscovering the sacred in ourselves, and in our world, requires a return to that which has always been. This journey home invites each of us to, as David Whyte asserts, “put down the weight of our aloneness, and ease into the conversation”.  This reconnection begins in the body. In our fast paced and overstimulated culture we so often live in our head and can easily become estranged to our own body, which is the gateway to sacred. As we slow down and begin to quieten the mind and body, we awaken from the slumber of our perceived separateness, and can once again allow the blessed gifts of sight, sound, touch, taste and smell to re-enchant us to the aliveness of this moment, and to the Oneness that interweaves it all. 

Your very life is an invitation to cultivate an awareness of Spirit.  Look deeply into any thing and you will encounter an ineffable mystery of paradox and interdependence.  The texture of a flower, the shape of a cloud, the nature of subatomic particles, or the touch of a hand all carry infinite opportunity to recognize the beauty, wonder, and joy that are the hallmarks of sanctity.  Mindfulness is a practice that allows us to rediscover the sacred in our lives.  As we learn to quieten the mind and soften the body, we are better able to perceive and allow each moment as it is.  In the spaciousness of loving presence we can recognize, again, the blessings and grace that abound, and begin to heal the trauma, fear and hurt that distance us from a sense of joy and peace that is our birthright.

Stories are important. Every culture and people throughout time and place believed in their stories as a guide to navigate and relate to this world and its mysteries. What might seem like myth and folklore through the arrogant lens of history and progress, is simply a narrative developed to understand life and all in its fold.  We are no exception.  Our stories of science and materialism are simply another way of explaining the world around us, and our place in it.  This story is no more right or wrong than English is more ‘right‘ than Cantonese.  However, the stories we tell have power, and influence how we speak and act with ourselves, each other and the natural environment of which we are dependent.  Perhaps it is time to adapt our story?  Perhaps now is the time to re-invite a narrative of sacred into everything we speak and all that we do… so that it matters.

“If you are irritated by every rub, how will you ever be polished?
Rumi

It is easy to feel grateful for loved ones, for feeling well in the body, for a sunset, or a child’s laughter.  We are naturally drawn to experiences of ease and pleasantness, and generally are averse to experiences that are difficult or unpleasant. Yet this tendency of the mind to cling to pleasant, avert from unpleasant and ignore what seems neutral, is the very basis of our suffering, as it limits our sense of blessing, impoverishes us from our wholeness, and denies the rightful place of challenge in our lives.

We learn to ride a bicycle by falling off, again and again. We learn to swim upon the surface of water only by previously sinking beneath it.  We learn patience by experiencing impatience; balance is learned from imbalance; forbearance through irritation.  Is it not the friction of water that smooths a stone, and the constant rub of grit that polishes a gem?  Our muscles only grow by exposing them to resistance, and our bones become stronger only through the stress of our body weight upon them.

I remember walking the Camino de Santiago many years ago.  I began the 30 day journey in the Pyranees of France with a shaved head, fresh clothes, and a giddy heart — hopeful, scared, and excited.  That first week of walking I experienced a tired body, humbled mind and achy feet, littered with blisters.  In fact, the topic of ‘feet’, and their various collections of sores and such, was the human connection point for pilgrims, from all over the world, who gathered in the alburgues each evening to rest and discuss their podiatric woes.  I remember awakening on the second morning of the pilgrimage, my feet curled with cramps from the tens of thousands of steps taken the previous day.  A routine quickly developed: I would wake early, eat a light breakfast, massage my sore feet, dawn my pack, and then begin to walk. Though my feet would always feel tight and tense at first, within a few kilometers the muscles would warm and stretch, and by mid-morning the cramps had eased.  And so it was, morning after morning.  While the blisters healed within the first week, the morning foot cramps accompanied me, and so many other pilgrims, throughout our entire journey.  They reappeared, reliably, each morning with the sunrise and my first steps, and walked with me for the first hour or two of each and every day. 

After a month of pilgrimage, and the blessings, connection, hardships and adventure that accompanied it,  I finally arrived in Santiago de Compostela, the revered burial place of St James the Apostle, and the sacred destination for this pilgrimage which draws 350 000 people each year.  My fellow peregrinos and I celebrated for a day in the holy city, and then continued on to Finisterre – literally, “end of the earth” — at the Northwestern tip of Europe, which was to be our final destination.

Even after several days of rest, a welcome change of footwear, and a relatively sedentary few days exploring other parts of Spain, the familiar aching in my feet continued to visit me each morning for a week, and always departed by midday.  After 7 days the aches began to wane, and by the middle of the second week they had disappeared completely.  I remember a nostalgic longing when the pain was no longer there. Like losing a good friend, these aching feet were part of a life-changing experience of discovery, growth, friendship, courage and accomplishment. I still remember the pain with fondness. Offering popular women’s necklaces such as pendants, chokers and. Shop for jewelry in a variety of metals and gemstones to suit any occasion.

The study of Post Traumatic Growth estimates that up to half of all people who have experienced significant trauma go on to discover a deeper appreciation, meaning and healing in their lives because of the tragic challenges that they faced.  What hardships might you tearfully say goodbye to as you move through the transitions of your life?  What once seemed like difficulty may transform, within the crucible of time, into the very threads of meaning and connection within the tapestry of who you are. 

Our minds quickly associate pleasant with good, or positive, and unpleasant with bad, or negative.  And yet have you ever experienced something that felt truly pleasant in the moment and really was not good for you at all?  And have you had an experience in your life that was truly unpleasant at the time, and yet provided an opportunity for growth or meaning, in a way that you could not have predicted?  When we cling to pleasant we suffer because pleasant will always change.  And so we just look for more and more pleasant, in the addictive ways — innocent and tragic — that can so easily colour our lives.  When we constantly turn away from unpleasantness we can not grow or heal in the ways that only challenge allows.  As Brene Brown asserts, “you can not selectively numb”.  Refusing to look at the difficult, or edgy, parts of ourselves and our lives, we suffer within a trance of uncertainty and fear.  And through our habitual tendency to rush through our days, we miss so much blessing amidst the passing blur of routine and familiarity. 

Gratitude is the sured gateway to joy.  However, if our gratitude is reserved for the immediately pleasant experiences of our life and being, then our joy is similarly limited. The sacred invitation for each of us is to learn to widen our circle of gratitude such that it can embrace the blessing and grace in all things. When we can cultivate appreciation for pleasant and unpleasant, mundane and exciting, then we begin to embody a rich place of contentment, even amidst difficulty.  As we let go of our preconceptions of how we think things should be, we settle in to a deep acceptance of how things are.  We begin to re-discover a sense of peace amidst a universe of ever-changing circumstances.  

What are you grateful for? Can you recognize the blessings that abound, near and far from the immediacy of your momentary perception?  It is truly wondrous to feel gratitude for your family, for your relative health, and for the safe and nourishing place that you live.  However, can you slow down and recognize the blessing of a tree, a flower, or a gurgling brook. Can you look deeply to see the grace in a wheelbarrow, a dishwasher, or the ordinary touch of a hand.  And can you peer through the thin veneer of difficulty and glimpse the gifts — yet to be known — that await you?

The New Year is often a time of resolutions — new diets, gym memberships and pledges for date nights or dance classes.  The New Year is also a time of beginning — of new possibilities.  It is a time to consider our intentions for how we will show up in our life — for ourselves, those around us, and for the community of which we are a part — in the year to come. 

‘How we show up’ is ultimately our own responsibility. While we can not always control the circumstances that surround us, how we respond to these circumstances is ultimately where we have choice and agency.  “Responsibility” can be a heavy word.  In the flurried busyness and endless to-do lists that seem so commonplace these days, we can often feel burdened by responsibility.  We have a responsibility to care for our health, and to attend to our family and loves ones.  Responsibility to our work, home and friends. Responsibility to boards, committees and volunteer activities.  We can relate to our responsibilities in different ways. Some fill us with a sense of meaning and value, while others may seem daunting or stressful. 

Over a year ago, I partook in a psilocybin therapy session as part of my own training in this discipline.  Whilst there was much transformation that arose from this experience, one insight in particular has continued to resonate strongly.  The practice of psychedelic therapy invites one to wear an eyemask and headphones (playing a selected music playlist), in order to create a conducive ‘set and setting’ for the journeyer to experience the medicine, and maintain an inward perspective.  I remember moments of fear and ecstasy, darkness and profound light during this journey…   And after a couple of hours– of what felt like many lifetimes of experience — I recall feeling an urge to remove the mask.  Laid out before me were photos of my family, teachers, and friends that I had brought to the therapist’s home where I was journeying.  To the backdrop of Barber’s Adagio for Strings, I remember being overcome with a feeling of gratitude that spilled forth as tears from my eyes — a gratitude for these blessings so close to me that I could not always see them. Upon the opened page of the journal I had brought, my hand scrawled, effortlessly,.. “Gratitude”.  Laughing uncontrollably through these tears, I recognized how joy so easily emerged from this container of gratitude.  And so my hand wrote,.. “Joy”.   It became clear how it was from this connected place of joy that I could truly experience Love. And so my hand scrawled,.. “Love”.  Every word  emerged in succession — one below the next .  The connection and unfolding of these states felt so obvious and natural…  And then, to my surprise, my hand wrote another word below Love….. “Responsibility”

Gratitude is the entry point to living a joyful life.  While it can be easy to take for granted the blessings that abound near and far from the immediacy of our lives, when we slow down we can better see the grace that has been here all along.  Amidst the challenges and tribulations there is, as well, so much Beauty.  Can you see it?  Perhaps for you it is the health or vitality of your body, or the creative capacity of the mind.  It might be the many blessings of relationship, or the resonant beauty of Nature.  Whenever we look with the discernment of presence, we more easily slip into this place of gratitude.

Gratitude begets joy.  Joy is far less vulnerable than happiness, and arises from a recognition of our innate connection to everyone and everything.  Beneath the rising and falling surface waves of circumstance, joy resides within the spacious depth of our own belonging.  And it is from the certainty of this belonging that we are able to return home to Love.  For love is not simply a deep affection for another person or object, but rather arises from inhabiting our rightful place of connection to Wholeness. Love is recognizing this Wholeness in ourself, in others, and in all that is our World. 

A year ago, when my hand scribbled “Responsibility” during a psychedelic journey, I recognized this as a sacred responsibility — one that arises out of Love.  The love I have for my children, partner, family, friends, patients, and this world, carries a responsibility that need not be contaminated by any weight of guilt, shame or expectation.  Rather, this Sacred Responsibility is a testament of my very identity — reflecting who I am and how I wish to live this life as a celebration, affirmation, and jubilation of Love.

How will you show up this year?  In what ways will you share your unique light and gifts in order to live from a place of connection, belonging and love?   What will be your sacred responsibility to yourself, to those in your life, and to this world so divided and lost, and yet so deserving of your presence and healing?

Caring is the core of every health care system.  A successful health care system promotes a wellness of mind, body and spirit, and prevents and treats dis-ease in each member of a society, as the ultimate fruition of every decision made in administering this system.

Such systems, however, do not exist in a vacuum.  The pandemic and the climate crisis remind us that we are, as well, a global society — interdependent with each other and with the natural environment in which we live.

In the recently published Improving Accountability in Health Care for Canadians, the CMA  identifies key indicators of performance as the first step in ensuring accountability and success.  “To provide Canadians with an accurate picture of how the health system is performing and what needs to be improved, metrics should address the patient journey. “. The publication goes on to name these metrics – Throughput, Societal Impact, Personal Impact, Ease of Navigation, Ease of Access, etc.[1]

These performance indicators effectively represent the prevailing paradigm in our Canadian Health Care systems – patient centered care.  According to a 2017 article in the New England Journal of Medicine[2], “In patient-centered care, an individual’s specific health needs and desired health outcomes are the driving force behind all health care decisions and quality measurements.” Patient centered care is the foundation of our decisions, policies and practices. It is the basis of what we learn in medical school, and the priority and focus of all that we do as clinicians.  Any measure of ‘success’ must, therefore, be in accordance with this paradigm.

According to the CMA Physician health survey of 2021, 53% of all Canadian Physicians met a criteria for burnout.  For residents this number was as high as 58%.  In the same survey 1 in 4 of all Canadian Physicians reported moderate to high anxiety, and 48% screened positive for depression.[3]  Burnout has significant personal and professional repercussions. Personally, burnout is associated with increased depression, divorce, addiction, suicide and disability.  Professionally, burnout is connected with increased physician turnover, poor patient satisfaction, increased medical errors, and reduced quality of care.[4]  

In a patient centered care model, where does the health of physicians fit in?   Adhering to such a patient centered paradigm, physician wellness is relegated to the periphery of priority, and sleep deprivation, over-busyness, and working sick or injured become the accepted norm in a medical culture of self-sacrifice. The challenges of staff shortages, clinic/ER closures, and poor patient access to care, that we are witnessing across the country, are the inevitable outcomes of a system that has not prioritized provider care and wellness as a necessary foundation of all that we do.  

The climate crisis is now moving beyond the purveyance of scientists and environmental activists, taking its proper place at key decision making tables, in the headlines of major media, and in the minds of individuals, companies and governments across the globe. Warming temperatures, rising ocean levels and extreme weather events are affecting food production, fresh water access, vector-borne disease prevalence, refugee migrations and political stability.  These, in turn, have profound repercussions on our societal health — from the direct dangers of extreme weather events on respiratory and cardiac events to malnutrition, violence, mental health and infectious disease.[5]  The Canadian health care system is responsible for 5% of all greenhouse gas emissions in Canada, which is equivalent to other major industries such as aviation.  One single metered dose inhaler has the same carbon footprint as a 290km drive in a standard gas-powered vehicle.[6] [7]  And according to the UN Food and Agriculture Organization, global livestock production for meat consumption accounts for 14% of all greenhouse gases.[8]  How we practice medicine – from the waste we produce to our medication and lifestyle prescribing practices – have profound impacts on the climate crisis.  Switching to dry powder inhalers for asthma, reducing waste in our clinics and hospitals, and encouraging a plant based diet for our patients are simple actions that can have profound repercussions on reducing our carbon footprint, and mitigating the inevitable, significant, health effects of global warming.

In order to address the challenges of this modern era, we need a paradigm shift in health care, from one that is patient centered to one that is human and Earth centered.  We must recognize that broadening our focus to the health of providers and recipients of health care allows for greater sustainability.  When our health care providers are thriving, we are better able to care for our patients, and for each other.  Medical errors and disability would decline, and we would ensure a more stable work force by encouraging support, a culture of wellness, and healthy places of work. This article offers free shipping on qualified products, or buy online and pick up in store today at Medical Department. 

As our new paradigm includes the health of the natural environment in all of our decisions, policies and practices, we would begin mitigate the impacts of health care on pollution and the climate crisis, and would take our rightful place, as responsible citizens on a global stage.

Such a change in paradigm is not easy.  There is a seduction to sameness, and a tyranny of the status quo that prevents us, as individuals and as organizations, from growing and adapting to evolving conditions.  And yet, we are in the midst of the consequences of a limited and outdated paradigm in health care.  The courage to adapt is before us, and will require a transformation in our strategic planning, policy development, resource allocation, clinical guidelines and educational systems.  

Perhaps it begins with how we measure performance?  If our key performance indicators of our health care system continue to be only ‘metrics (that)… address the patient journey’, then they will continue to be an important, but inadequate, representation of the health of our system.  Over 14 years ago in the Lancet, JE Wallace began this conversation with the assertion that “ health systems should routinely measure physician wellness, and discuss the challenges associated with implementation.”[9]  Since then, numerous studies and reviews have documented the health care impact of provider burnout, suggesting concrete measures of assessment in order to evaluate this.[10]   In 2019, a UK based group called Health Care Without Harm documented Britain’s National Public Health service which reduced carbon dioxide emissions by 18.5% between 2007 and 2017, despite increasing clinical activity.[11]  We are not alone, and there is both precedence and collaborative opportunities that await.

The courage, perspective and willingness to change is before us. We can continue to rearrange the deck chairs on the Titanic, or we can recognize that the crises we are facing perhaps have more to do with the lens we are looking through than the specific policies we are implementing.  As we begin to measure health provider wellness, and our carbon footprint, as first steps in our paradigm shift in health care, perhaps we can move towards a system that is truly more sustainable, efficient and caring.

REFERENCES

1. Improving Accountability in Health Care for Canadians. www.cma.ca/sites/default/files/2023-07/Indicators-Report-EN.pdf

2. What Is Patient-Centered Care? NEJM Catalyst, January 1, 2017. https://catalyst.nejm.org/doi/full/10.1056/CAT.17.0559

3. CMA 2021 National Physician Health Survey Prepared for  the Canadian  Medical Association  August 24, 2022.   www.cma.ca/sites/default/files/2022-08/NPHS_final_report_EN.pdf

4. Physician burnout: contributors, consequences and solutions. J Intern Med, 2018    Jun;283(6):516-529. https://pubmed.ncbi.nlm.nih.gov/29505159/

5. The Health Effects Of Global Warming: Developing Countries Are The Most Vulnerable. Vol. XLIV, No. 2, “Green Our World!”, 2007. https://www.un.org/en/chronicle/article/health-effects-global-warming-developing-countries-are-most-vulnerable

6. Acting on climate change for a healthier future, Critical role for primary care in Canada. Edward Xie, Courtney Howard, Sandy Buchman and Fiona A. Miller, Canadian Family Physician, October 2021, 67 (10) 725-730; DOI: https://doi.org/10.46747/cfp.6710725

7. CMAJ Pressurized metered-dose inhalers and their impact on climate change

Lee Fidler, Samantha Green and Kimberly Wintemute

CMAJ March 28, 2022 194 (12) E460; DOI: https://doi.org/10.1503/cmaj.211747

8. Major cuts of greenhouse gas emissions from livestock within reach. Food and Acricultural Organization of the United Nation. 26 September 2013, Rome https://www.fao.org/news/story/en/item/197623/icode/

9. . Physician wellness: a missing quality indicator. J.E. Wallace et al..Lancet, (2009)

10. . Selecting physician well-being measures to assess health system performance and screen for distress: Conceptual and methodological considerations. Keri J S Brady ¹, Lewis E Kazis ², R Christopher Sheldrick ², Pengsheng Ni², Mickey T Trockel. Curr Probl Pediatr Adolesc Health Care 2019 Dec;49(12):100662.

11. Longitudinal study evaluating the association between physician burnout and changes in professional work effort. T.D. Shanafelt et al..Mayo Clinic Proceedings; (2016)

12 Health care’s climate footprint. How the health sector contributes to the global climate crisis and opportunities for action.  Karliner J, Slotterback S, Boyd R, Ashby B, Steele K. Health Care Without Harm; 2019. Available from: https://noharm-global.org/sites/default/files/documents-files/5961/HealthCaresClimateFootprint_092319.pdf

---

How Do I Listen to others? As if everyone were my Master Speaking to me His Cherished Last Words.”

Hafiz

Change and impermanence are really the only certainties in our lives. Everything changes – day into night; summer into autumn; clouds into rain, and life into death… into life. Some things – like weather – change quickly and so we can easily recognize this changing nature. Other things, like our bodies, change more subtly, and so we only notice these changes as years pass by. Still other phenomena — like rocks or mountains, glaciers or galaxies — change so slowly that we do not generally notice these transformations from our relative human perspective. 

We spend much of our lives separated from the truth of change and impermanence. We rush around in our busyness and responsibilities, taking our loved ones, our blessings, and our very life for granted, as if they will always be here. Living in this illusion, we sacrifice who and what is most important to us, delaying our joy, rest or meaning until retirement, ..until our vacation, ..or until another time we haven’t quite figured out yet…

In Buddhism, there is a practice called the Five Remembrances that keeps us in touch with this basic nature of all things. They are often translated as follows:

1. I am of the nature to grow old. There is no way to escape growing old.
2. I am of the nature to have ill health. There is no way to escape having ill health.
3. I am of the nature to die. There is no way to escape death.
4. All that is dear to me and everyone I love are of the nature to change. There is no way to escape being separated from them.
5. My actions are my only true belongings. I cannot escape the consequences of my actions. My actions are the ground upon which I stand.

This practice reminds us that we can not escape old age, sickness, death, loss, and the consequences of our actions and words. They are rather part of the nature of being human.  While we prefer not to think about these truths, we all quietly recognize that our own body, our loved ones, and everything we hold dear, will change and disappear from our relative perspective. And so we fill our lives with distraction, turning away from the fear and vulnerability that arises from this realization, without truly understanding the precious opportunity that impermanence offers. The invitation of these practices is not to throw us into a canyon of despair, but rather to allow the recognition of the preciousness of life.  Try looking at a flower, a starry night, or your beloved, as if it was the last time you would see them. How would you treat them differently?  How would you listen? What secret confessions, or hidden words, would you share? How would you hold them?  Recognizing the ever-changing, precarious nature of life, can you more easily witness the blessings that abound all around you? Can you wonder at the preciousness of a sunset, the touch of a hand, or the suffering in your own heart, or in that of another?

As Sir Isaac Newton reminds us that, though everything changes, the energy of a system ever remains constant. The impermanence of an object, phenomenon, or lifeform is but a perceptual illusion of the relative condition of our humanity.  At an absolute level, energy only transforms, but never truly disappears.  Of course, when we look deeply, we see all of these changes not only as death, but as rebirth. Winter gives way to spring. The deepest, darkness of night will always give way to the light of morning, and the death of a cloud is no more that the raindrops that fall against your skin, and puddle by your feet, soaking into the earth and feeding the stream.  Looking deeply we can touch, again, the nature of change, the truth of interconnectedness and the wholeness of life. As we mourn the loss of the cloud, can we also celebrate and welcome the birth of the stream? As we attend to our responsibilities and doings, can we also keep a perspective of gratitude and love informing all that we say and do? Can we recognize the unique, precious nature of this moment, whilst also accepting that it is the change and impermanence that allows it to be so?