 Well, I'm sorry that the tyranny of the clock is the suffering of all its own And we'll try to pick up where you left off and there was your I think you were really hit in the stride there Well, we do have time to take questions 45 minutes for questions. So I invite y'all to approach microphone and And if you have any thoughts or questions ideas notions Comments, but let me just kick off the questions then So Remus, you were talking about like the metamind dealing with suffering this the mind almost amplifying suffering by focusing on the suffering and that a person might be able to transcend the suffering if they're able to Distance themselves from that by applying meaning to the suffering and recall the story of About American GIs and in World War two taking heavy casualties and wounded and and Some of the many of the GIs passing up on the morphine so that Because they felt that a fellow GI may need it more that they that they That they had brothers in arms who were in worse shapes than them and they were Individually facing what one might consider extreme suffering, but it turned it into Meer pain, I guess you might be able to say So is that what is that where you're kind of? Is that where am I kind of going down the right road and discussing what you're thinking? you brought up even Looking at the pain Situation yeah, I mean I mean I would wonder about the definition of suffering in regards to pain Yes, is suffering extreme pain or is suffering Pain in the absence of hope suffering Basically is the You know doka that I was speaking of earlier So it's not necessarily just extreme physical or mental pain, but it's the basic this basic sense of like you know this satisfaction or uneasiness or You know disturbed the state whether it's physically or physical or mental But yes, that sense of extreme pain If we can make friends with that pain, let's say a strong physical pain Of course it sounds almost cavalier to say that well here We are in perfect comfort sitting here, but to do that and while you're in the midst of dealing with Some extreme Circumstances cancer end-of-life In conditions, it's very difficult Yes, it's not easy. That's for sure, but I think of course with the help of I'm not saying we shouldn't take any kind of medical care we must have a Professional care along with that if we can work with our mind a little bit or for pain and working with making friends with the pain As much as we can that actually makes a big difference Whether you want to bring pain into your Side and make it a friend or you want to treat it as an enemy until you die Right. It's going to be there anyway. Yeah, so we have questions. Go ahead Let's see how we're doing with the audio sure that now it's on now it's on it's harder, but we can Because you were nice and you asked me nicely well now I've taken over the audience I'm sorry. I have to do it this way now because you asked me nicely I'm going to let you have some blood and he relaxed his arm and The syringe filled with blood and I was 19 years old and looked at him and thought How did he do that? What is the mind that happened so I got the blood I have spent my entire career as a Psychotherapist and as a nurse and as a theologian Trying to figure out how he did that and we're coming to understand the body mind So I have a question and an observation based on that That story why don't you? How do the three of you approach? The body mind in this in this suffering when we touch one another The purpose of suffering the meaning of suffering How do you from this the perspective that each of you hold? What is our mind in such a way that it transforms or shapes the body and transforms the illness the pain the suffering Go for it Well, you know doctors are pretty concrete about pain Doctors are concrete about pain because It's such an important element in our diagnosis of illness There are lots of kinds of pain and Many of the different many of the kinds of pain Point to a certain type of illness in the body So physicians are asked a lot of questions about pain How does it start what brings it on what makes it worse? What relieves it? Is it positional? I mean we have a lot of questions about pain physical pain That does not get to your question of how The pain is actually perceived By the patient and what it also may mean to the patient in my Exposition I try to differentiate between pain and suffering because pain if it is caused by Some organic illness That I'm trying to diagnose and treat If I get the right make the right diagnosis Usually there's a way for me to treat the pain, but suffering is much more in The mind than it is in the body and Physicians are often not as alert to suffering as to pain Because suffering we caught week requires knowing a Lot more about the patient Then we tend to want to find out today in our very Technologically oriented system of medical care suffering is much more difficult to treat But once we know our patients and ask questions that are not necessarily medical questions but philosophical questions questions of self and Selfhood sometimes we can get to the basis of suffering and when we do When we deal with suffering directly and we give of ourselves and our time I have often Know I've often noted that if I deal with suffering. I can also deal with pain much easier much more easily You know when you go to the hospital There's a chart on the wall sometimes pains looked at very linear There's a little happy faces a little happen They get sadder and sadder and sadder Further right you go and one on the further right is like this. Oh my disguise in bad shape But there's there's no other There's no cross It's linear. There's no others nice dimension dimension of the state of actuality of self or anything like that You know, so how does the doctor? Approach that well, I guess you're directing the question to me But I would I would say I would say you know in an acute situation Someone's in the hospital very often. They're admitted because they're in pain It's our job To diagnose the cause of that pain and do our best to deal with That's the acute situation Let's say you find that the that the patient's pain abdominal pain is not something simple It's not appendicitis you call a surgeon and the patient's better in 24 hours and goes home Say you find like in one of the cases I presented or two of the cases that the patient has a serious medical problem And you evaluate that medical problem, and then you might have bad news for that patient You may have actually done something to relieve the patient's pain and temporarily But the patient is left with a serious medical problem. That's going to change Change change life of that patient Forevermore Happy faces Don't Deal with that Right you deal with that over time By getting to know your patient being able to speak honestly and forthrightly with the patient It's only then that you That you begin to plumb these other dimensions of That patient and how he or she is dealing with the illness with the news with the diagnosis with the difficult therapy that may lie ahead but that is The hard part of our job the easy part Is figuring out what's wrong? the hard part is Dealing with the patient the patient's family After the pain has been diagnosed ameliorated you're often left With the with the situation in which order to relieve suffering you must plumb your patients Dimensionality and It's hard to do it takes an emotional investment Some doctors are naturals others are not it can be taught It can be modeled But it has to be something that is reinforced throughout career and You know, they don't call it. They don't say it's the practice of medicine for nothing takes practice. It's a continual practice but I believe that Many many of my colleagues most of my colleagues With time to understand to make this distinction between pain and suffering Well, I I mean I think Dr. Winick was absolutely correct the only note that I would add is that pain is absolutely essential We couldn't live without pain. You know, in other words, the worst thing that could happen to us is if we were Totally in a hundred percent free of pain Because as dr. Winick pointed out unless you are in pain physical pain on some level There's no way of knowing what's the matter with and so that signals Something that's happening to you that should be remedied The real the problem of pain it seems to me is a where it's chronic and it's sort of continuous and continuous and continuous and continuous and We we don't have an easy way of dealing with it and secondly Where it's basically unbearable because the alternative of saying, okay, we can handle the pain But we handle the pain at the cost of you're losing really consciousness or being totally drug And so the real problem is how does that pain fit into a person's sense of the loss of self? in other words when one really feels that their self is being threatened the sense of who they are the Capacity to relate to others the capacity to fulfill the roles that they were used to and these are no longer Possible then you go from simple pain to perhaps what we would call suffering But I would say in my experience the worst kind of pain is not physical That's what I tried to say in my remark is where a person is overwhelmed with guilt or grief or feeling that they've missed their opportunity to do what they have to do in their life that now It's too late You see it's this this is this is profound suffering and we're how do you deal with that? It's not just a matter of saying, you know Well, I have to look at it on the bright side and have these happy faces. I have to confront Myself I have to confront the worst within me and then I have to say how do I remedy that now? Here's where I think religion can play a role and I think that this is an important thing for us to look into But apropos of your question the thing that's interesting with respect to mind body We just don't know the answer to that question For example, how do we explain hypnosis? How do we explain? I've seen situations where a person is hypnotized and they don't bleed They're caught, but they don't bleed Well, how do you explain? Well, how do you explain with the fact that a person under hypnosis can do things that normally they're incapable? I would say you would bet your life you couldn't do that then on the hypnosis You find yourself able to do that to lift things that you never dreamt you could and so forth We just don't really know the powers of the mind and we don't really understand the relationship between mind and body Now, I think the mistake is to have a kind of a reductionism and this is the sadness if you are basically within the context of a medical context where you're constantly looking for a physical cause for everything or a physical basis for everything and you don't allow an Alternative kind of a mind or a soul or something like that that becomes a problem one of the great in my opinion tragedies of psychiatry is that psychiatry today is basically organically oriented. Well, okay Let's let's see. What's the best medicine for this particular? We're not actually saying what is this illness this depression this anxiety? How does that fit into a person's self-understanding with respect to what that life means to them? That's the Okay, more questions Hi, my name is Annette and I'm from San Antonio I guess my question I'm going to start with the question and then explain the question is As panelists as what you present for me is very empowering very clear and very missing in My experience of the health care system here in our Western society I just recently a couple of months ago had broken my arm and had went through the whole process and I noticed there were a lot of questions that were lacking in my care and and I Had to you know, I was grateful for my own personal travels with Spirituality and religion I was raised Christian but later in life I chose Buddhism as a study and The practice of Tong Len meditation has been the greatest way for myself to transform my suffering Because it's about taking in the suffering and getting it that my heart has the capacity to hold that and So I find myself like any other human being getting caught up in my own Personal pain whether it be mental emotional or physical I'm like everybody else. I take it personal. I want it to go away But when I take that in and get it that I'm not the only one in this very moment who's suffering It diminishes my pain. It never fails. I also walk in circles of other groups of people where our whole Philosophy is that the way we help ourselves is by helping others and I get to see that anytime I get out of myself I'm helping somebody else. It diminishes my pain now when I experienced my experience with You know having the break having the surgery and then going into physical therapy. I found that it was all very linear There were no nobody ever asked. What body did I bring into this injury? They only talked about the specific injury itself and And what course of action we were going to go through to Rehabilitate that injury But I have a body that I brought into that injury So I had you know, whatever complications come with that body as well, and I just found it very frustrating And found myself actually pulling out from that physical therapy to create my own physical therapy Which my insurance won't pay for But there's a missing there. This is you know I was felt very enriched by what you all had to share and I'd like to know you know like How many students how many physicians are in this audience listening to this and how's this being presented? to the students who are learning to become doctors and And how's this being presented in the hospital so that this change is being made that that people are being asked You know, what what is your what is your understanding of what's going on here? What does this mean to you? because I just I just found it very disheartening when I went through that experience and And I know that I was grateful for what I had that I could use for myself To support myself through that process. So that's my question. What is being done? to present this To students and physicians who are out there touching people on all levels. So thank you Well, I'd like to say that your experience is unusual, but it is not and I think that our our fragmented medical system now Unfortunately is disappointing in a lot of ways to a lot of patients and that is something that I think that we have to work on as as a medical institution as medical educators As individual physicians as as as medical professionals not just physicians, but nurses and therapists of every yoke is that we do tend to concentrate on the on the parts and not the whole person I do want to say one quick thing that that has bearing on your question, but also the other question, you know that It is slow mindfulness mindfulness is is making its way into the medical literature There is there are people that write about mindfulness and meditation as a way to help pain to deal with post-traumatic stress disorder Cancer Particularly in the nature of pain and suffering. So I think that that that Physicians are becoming aware that mindfulness Meditation are things that can help It's certainly not in the mainstream, but there's certainly getting to be a literature in that regard and And and I think that it behooves all of us who are medical professionals to to Learn about this because we can't help patients by thinking about some of these issues Yes, not much but I Have attended meeting at the John Hopkins medical University in DC area on pain management through mindfulness and Meditation practice mainly targeted for Children who are suffering from terminal disease and so I think like Like you just mentioned I think This kind of things taking place in some part of the I think medical health care communities But that's all I have to add. I don't know the details. What's going on? So let's go over here, sir If I may the title of our meeting is religious and secular approaches To suffering and healing I rise to point out that we haven't talked about secular The issue It for me is that our knowledge that we bring From medicine I am a physician To the arena is basically secular It is independent of Religion if you will As many other things our footnote Galileo if you will But the great spirituality and religions of the world did not address do not address the terrible complexity of CAT scans MRIs the human genome and pathology slides and I would submit That the nexus of this thing is to Translate the secular knowledge that we have to an individual patient Mrs. Jones you have a severe case of intima hyperplasia. I'm going to bet that there's not a lot of Mrs. Jones is that understand that If we can translate that to your blood vessel wall seem to be thickened and may cause a problem for you If we do not address that issue such as a stroke Now mrs. Jones might understand but part of our issue is to take this Tremendous amount of secular knowledge and focus it on one patient and One set of healing circumstances as we go through the process That's correct. That's absolutely excellent point Yes, sir Hi, my name is Javier Barranco. I'm a senior pre-med student at UTSA and I have two questions for for mr. Ryan poacher Sorry if I pronounce it. Yes. Yes. That's okay. It's not my first language. That's good. Yeah, okay, so You stated in your presentation that Change causes pain Right, so suffering suffering. Yeah change costs suffering So does that mean that if a person is undergoing disease Like an illness or something like that the process of healing as well. Does that cause suffering? and And and my other question is that Viewing your your approach from my from a biologist point point of view All the universe, I mean or all the universe isn't constant change So does that mean that we are in a constant suffering and thus the state of not being in suffering does not exist Like are we always suffering Yes Well, first of all The basic Teaching that I was presenting from the Buddhist point of view is that Whatever is in the nature of change, which means a constant In the process of constant deterioration right like our body it doesn't get younger Right, it gets older each second, right? It's changing. So that kind of change, right? It's kind of deteriorating. It's changing. You know, even when we go through a medical treatment to get better We're still not getting younger Right, even we have a new lips and And so forth, but we're still the same age or getting older. And so that kind of constant change You know this kind of what we call impermanence, right is basically bringing us some element of suffering like I think our Pen's friend here Dr. Winaker is it made a wonderful distinction between pain and suffering, right? So it's like the suffering part that we're talking about the mental pain or mental suffering And secondly, yes, definitely there's a state where we can be free from suffering definitely we can achieve that Through let's say, you know In when we can really see How we can work with our mind, right? How we can work with our mind and if our mind can rest in peace calmness and and reach this level of resting or You know making friends with any situation, right? Then you can be happy in any situation, right? It's That's possible Thank you Yes, sir, I I have I could see a lot of questions, but I'm just gonna stay with one I I'm going to talk about myself and our students when I'm going to talk about myself about my problem I have an eight year old Stoke And I want to I want to if I could get somebody to talk about I've been trying to get over it But I still got eight years old, you know, and I want you to talk about that that that's all Well a little bit more I was I like What they say about God. I'm a 58 Year old. I'm 68 But I've been rich since I was 10 years old I'm a man of God. I'm not a preacher. I'm a man of God so That's what I What I like to tell you I respect those men over there because they're talking about God And if you let God take over whatever it is eight years old I think It will happen. I'll get I'll get better, but Like they were talking about pain He's talking about you think You the rain will go away It'll go away. I've never had any rain Eight eight years with this stroke and I never had any pain But I I do have a stroke I can do almost anything I used to do except The names they they I don't remember them And a lot of things I don't remember That's that's something that goes on. I guess I I don't know where it is. So it's up to you All right. Thank you Appreciate your contribution. Okay. Thank you very much You think Okay, well it's a story of perseverance. Yes, and it's it's good for us all to hear stories such as that Yes, ma'am I'd like to I'd like to ask From our religious leaders in the case of Terminal illness with terminal patients. Um, what are your the religions that you know the answers for? How long do you think the dear religions allow patients to suffer before you say enough is enough I know you can't pull the plug. We can't legally pull the plug, but at what point do you stop Going to all costs to continue the patient's life and let up on medications that are life-saving and just go to Palliative care You know, what is your religion's opinion on that? She asked for the religious I was asking the doctor to answer that question Well, let me put it in a more general sense. I think that All too often in my experience and we were discussing this before the presentations We find people dying in intensive care units And I don't think that's an appropriate place to die And I had my own experience of a situation where a younger person was in an automobile accident It wasn't someone I knew I was visiting someone in the hospital But they wouldn't allow this individual from To go into intensive care from the emergency unit because the intensive care was full It turns out that this young man died and two days later one of the people in the intensive care unit also died And there was really no real reason why that person couldn't have been transferred And put into a normal room And what I would call intensive comfort care I think it's very hard. There were always instances where individuals and dr. Winnaker Himself gave the example of his mother before really for all intents and purposes one would say look She really is in such bad shape that So I think the several things one has to keep in mind the first thing is Does that person really is that person fighting for their life? In other words Is there a real Intense desire to continue to live Secondly is the prognosis one that That would indicate there is a possibility of of real Cure let's say or at least some modicum of a of a normal life Then you have all these advanced directors and you have what is in aphasia course. What is that? What is that called? No, no, no, there's an actual There's a way in which you actually fill out Where you look at the the background you look at the whole variety of factors that would contribute To whether that person even should enter into Intensive care or not There's a whole range of of protocols that would in a sense lead one to make that kind of conclusion So I would say that in general My inclination would be not to keep the intensive care unit as a place where people die But is this the jewish? I'm asking what the jewish law is. Is there a jewish law on this? Well, I mean, you know jewish law and jewish practice are two separate things the jew I know that I According to jewish law one person real you should really strive according to the jewish You should strive to keep a person alive Unless death is really imminent than by imminent I mean in the next day or so the next hour or so But in practice that simply isn't the case in practice People would say that if there's really no chance whatsoever Of of any kind of recovery Then what you like my own teacher hans jonas? Has himself written extensively on this saying you should just Literally stop all life supports and let the patient die But to continue artificial artificial Procedures, I would say even from a jewish point of view. There's no reason in the world To keep a person from a halakic point of view artificially alive Yes, it's only if you take everything away and then see what happens So there's a distinction between keeping alive artificially and just allowing nature to take its course And here I would be on the side of those who say that nature takes its course when there's no real reason to continue the treatment Well, I have to sit do you want to say something? Go ahead Well from the the buddhist point of view I think Generally, I think Many of the points I think what rabbi just mentioned I think we agreed there and I think With this principle is it's really up to the individual If the individual who is sick and in Such care, you know, they should be the primary Decider and they should decide, you know In the in the in the case where they can make this decision then the whoever's Responsible Should make the decision there, but the the key point here is we believe in What like a natural process, you know, not like artificial Life and so I think what just rabbi mentioned about You know, if there's a real intention that person want to be on such support Number one and the number two is if there's a really hope that it can bring some, you know positive results to bring back some sort of life and so forth and so I think Yeah, generally Individual decision. That's why I think it's important not to forget to write you well Thank you I just want to say it's one thing to talk about jewish law And buddhist principles But in america, it's a very this this issue that you bring up is incredibly complex ethical Issue with lots of legal ramifications You know our our our guiding principle is autonomy What the patient or a legally designated surrogate decision maker have decided To do in a patient At end of life or with great suffering And we need that information. That's why it's so important that we have that we that we That medical professionals push for Pretty explicit advanced directives Now there are three states in america where you you can if you're a competent individual And you are have a terminal illness Uh Go to your physician and talk about physician assisted suicide when the time comes That's only three states. I think this is a movement that's growing But it's complicated They're they're they're they're ethical And legal as well as moral issues here And I think it probably goes beyond the scope of this discussion to get into that more tonight This is the last question. I'm sorry. Yes, ma'am Hi um Rinpoche my question is actually inspired by what you were saying about Using the mind as a way to transcend pain and suffering Can you say that I pardon can you say that again? I can yes I said my question is inspired by what you were saying about using the mind as a way to transcend pain and suffering um, I had a brief experience of working on palliative care unit and um Working the idea there was to Bring comfort to the people just bring them their food and things like that But also the idea that they were saying on that ward was that you can still die healed But there was one Person that stood out to me a lot And uh, she had Alzheimer's and she was on her deathbed and she was alone And she was fearful and my grandmother went through the same thing So I'm wondering when you don't have the ability to use your mind as a tool um And if anyone else can comment on that as well, what um What can someone do when they're just watching somebody In a lot of mental pain and probably physical and Like Alzheimer's Alzheimer's dementia Yeah Advanced schizophrenia things like that. Yes, actually I was staying with a friend in London many years ago And one of their friends Just passed away from you know back Alzheimer's disease And so he was telling me that Only thing she could remember it was the end of The stage Was songs You know they can remember songs because songs are memory that stored in a different part of brain or something like that. I'm not really Expert on that but and so I think that was really nice. He said they sang songs All the time that was really wonderful. She could remember the whole song And so I think it would be nice to sing You know In that situation for example singing some nice, you know cheerful songs Or if that person is a religious then nice to sing whatever religious hymns or You know praises that you sing and so forth Or if you're a Buddhist, you know singing some kind of You know those are weird Buddhist songs And stuff like that And I think that's one thing and the other thing is I always tell My friends that you know what I feel Is most beneficial and important is not really Bringing any kind of complex religious concepts or ideas to this person That we are trying to help but to create really a genuine space of love and peace You know a a condition A home so to speak Of love kindness and peace And so if we can bring them that support You know from our physical and mental efforts Then I think that's the best support that we can give You know genuine love a space of love Kindness a house of love and kindness a house of Genuine peace you know tranquility Now I have to second that my father Had a long struggle with Alzheimer's disease and that's really the subject of my book My family dealt with him over a period of seven or eight years as he declined And we we tried to honor Whatever remained of his personality of his memories And we did things like play music sing My brother would say You know he would always He thought he had a good visit with my father if he could make him laugh in some way or other and so And so I think that um Taking care of a patient with it with an advancing dementia and being a Loving caring a patient caregiver Is a difficult task But it can be done You'll need professional help along the way But what the Rinpoche Brought to the discussion is Is quite um Is quite true and lasting Can I just say one thing? Yes, sir. I just want to say that it's very important When a doctor treats a patient Or has any contact to see that the other has an inner self That it's always a subject to object subject subject Relationship and not a subject to object relationship And I think that's the point that you were making in other words when Leviticus says love your neighbor For he is like you and how is he like you? Because there is an inwardness to that other person And you have a sense of your inwardness and you have to connect not just to the object But also to the subject that it's a soul to soul relationship And you see that even if a person has Alzheimer's or severe severely debilitated or You know and really limited and I think once we keep remembering that all the time So it's not just an object that I do tests on and that I treat But a subject who has feelings and has a soul I think that's really the important thing And I think that also goes when we're not all doctors or medical caregivers here But we all are going to be touched by the subject In very deep personal ways. I know so many things That were mentioned tonight brought back a lot of memories about me and the loss of my mother and my father And I know that We'll all be able to take something away from this discussion We're all healers in one way or another and and take what you said about Not looking at the object going further even at my own mother and my own father when they're on their deathbeds it was seeing them differently and and of the relationship is differently and And seeing them stripped down as a as an individual And relating to them in a different way as they Made their exit But we do have more in store for you this evening. Thank you so much for our panelists for being with us this evening We want to give them a round of applause Ladies and gentlemen before you break I want to point out just make a couple of points, you know throughout history All of humanity in every culture Share in common. I think at least two experiences and one is that tradition of breaking bread together in order to form community and also The need that we all have to find meaning in our suffering By sharing it with others and I hope that this Conversation that we are about to embark on is something that you will join us for Four things one sit with people. You do not know please Two please participate actively in the discussion And maintain an attitude of respectful Curiosity so that you might come to appreciate the perspective of a person who has a different perspective from your own And finally remember that the table hosts each table will have one or two facilitators Are really there to facilitate conversations And not to answer questions Please join me in thanking our distinguished guests