Tuesday, August 25, 2015

Two months out . . .

My expectation was that by the two month mark the challenges from the surgery would all be a thing of the past.  Well, it's not so.  Whenever I sit or lie down and then get up my body goes through a period of adjustment that includes discomfort (a sense of soreness in the hip) and an awareness that my right hip is still not strong or completely stable.  Once up and on it for a while things seem to balance out and I'm able to do the things I need to do, albeit slowly.  This is disappointing as I'd so hoped that recovery was more of a straight line upward.  My surgeon, Dr. Hartford who pronounced me "good" left me with the reminder that: "There will be good days and there will be bad days."  Hmmmm . . .

Sounds a lot like ordinary life, doesn't it.  I don't know why I imagined that it would simply get better and better every day.  And by day 100 I'd ride off into the sunset.  Pipe dreams.

Well, perhaps it is in the big picture.  My Physical Therapist, Dottie, at Seton Coastside reported that I'm getting stronger and better each time she sees me.  Guess I'm just impatient.

Since the last post there have been two milestones:  I've taken a trip to Seattle to visit my sister in law, Cheryl and brother Gary and I've returned to my ladies gym, Curves to do my morning workout.  I guess this really is progress.  What has been happening is that I continue to adjust my view to be a longer one.  "Well by Christmas I'll be moving normally."  Used to be "in a month"  or "two months" . . . the time expectation keeps on expanding.  The advice I really need to give myself is "Just take it one day at a time.  Do what needs to be done, and be thankful for all that your body is doing to support you day by day.  And, Ron, of course, is my constant support.

Thursday, August 6, 2015

Uneven road

Expectations play such a big role in our lives.  Each time I've posted I've reported progress, new milestones, etc.  These last two weeks have been filled with firsts.  I'm now cleared to drive, so I'm back behind the wheel, which is very nice.  Last weekend after visiting a California Genealogical Society class with Ron we drove up to Calistoga where I took part in a wonderful weekend celebration for teachers.  The Light Awards were given to California teachers with projects designed to increase teaching effectiveness and creativity.  I was a key presenter and another first was that I gave a 90 minute "on my feet" workshop in improvisation for a lively group of educators.  It felt great to be working, thinking, doing my teaching thing.  Each moment I seemed to feel stronger and more confident about how my hip was supporting me.  Another first was going into the Indian Hot Springs mineral pool.  This was the first time I'd been given permission to immerse the wound.  It was all good, and it surely seemed like a turning point in the forward progress of the healing.

On Monday I decided on a walking program to strengthen things. I'd go onto the Coastal trail and walk in a steady manner for twenty minutes.  The next day I'd add two minutes to the walk and so on till I got to 30 good strong walking minutes.  On the day I began this Ron was walking with me and pointed out: "Did you know that you are limping?"  And, as I observed myself more closely I could see that I was.  It wasn't a clean, balanced walk.  I began to feel weak in the right leg and needed to stop several times to rest.  This was clearly a setback from the strength I'd felt over the weekend.  Again yesterday on the same timed walk it felt weak. I thought I noticed a tiny clicking sound as the hip moved.  Maybe I was imagining things.  And then in the evening I observed that the wound, which had formerly been completely healed in appearance now showed some signs of pinkness as if slightly inflamed.  Hmmmm . . . what's going on?

Instead of a simple steady upward progress it seems I may have a detour.  I so want to get strong and fit but today it's hard.  I'm contacting my medical team to see if this setback warrants seeing a physician or if it's just part of the way healing works.  Expectations . . . wanting things to be other than they are.  It's fascinating that our minds like to measure Reality against some image in our minds.  Oh let us celebrate things as they are.

Thursday, July 23, 2015

One month and counting . . .

I have graduated from having "in home" Physical Therapy to doing outpatient PT.  We were lucky to get approval by Medicare to use the Seton Coastside hospital just a mile from our house.  Ron kindly took me for my first appointment with Katrina on Wednesday.  At least half of my hour appointment was taken up with various kinds of paperwork and diagnostic queries.  The amount of paperwork involved in even the most trivial of healthcare interventions staggers the mind.  Seton Coastside is an old fashioned hospital.  It does have a computer, a very old computer ( I've been going there for at least ten years for a cross section of services:  Emergency Room, Mammogram, X-rays, Physical Therapy . . . et al.) But this old computer doesn't recognize or remember me.  Sad really.

No matter how many times I arrive there I spend the first half hour signing forms and giving data to the nice lady who sits at an aging terminal typing in my personal information. They always make photocopies of my insurance and Medicare cards and my ID drivers license. I wonder where it all goes?  I've given it all literally dozens of times at this facility, but each new visit seems pristine in terms of data to be gathered.  Some day all of these data entries  will catch up with each other and will be put somewhere that is retrievable.

All reports are that I'm doing well.  I'm able to even walk around my house without a cane . . . 
 S  L  O  W  L  Y, mind you.  There is something quite wonderful about the kind of deliberateness required to move and do ordinary things.  And, on the other hand, it is also really frustrating not to have a full range of motion and to need a minute or two when I stand to get my legs under me properly.  I've been having a number of mini-meltdowns because I'm expecting all of this to go faster than it is.  Katrina, when asked, said that the full recovery from hip replacement surgery is really a full year's event.  Surely lots of progress will be made before 12 months has past, but the whole thing is a much longer process than I really had in mind.  And, sometimes it just aches.  It's not horrible, but it does get my attention.  Ron keeps reminding me that "I'm making progress . . . really I am."

We went to downtown Half Moon Bay for a walk and a Chai Latte.  After fifteen minutes walking I long to be sitting down.  Hmmmm . . . it's all part of the process, I guess.  I'm afraid this blog isn't very interesting.  But, my purpose is just to put it all down.  The good, the bad and the ordinary.

I have been doing some pleasing art.  I'll post something to add color to this otherwise dreary entry. 

Friday, July 17, 2015

Moving right along . . . entering the fourth week

My new best friend is my cane.  Moving into the fourth week of recovery from my surgery I am able to set aside the walker and accomplish most functions with the aide of a cane.  I had the choice of getting one with purple kittens and flowers, but opted for something more sedate, fashionable bronze.  A friend mentioned that using a cane provides "gravitas."  Nice.  I've been accused of many things, but gravitas will be a new one, if indeed the cane gives me a sense of dignity.  We will see.

Today is 25 days since the surgery was performed.  I'm feeling overall well-ish.  I continue to move V E R Y    S L O W L Y.   I can't lift much and the kinds of motions needed to make the bed are still a bit out of range.  But, I'm happy to report (and Ron concurs) that I'm fully functional in the kitchen and can bake cookies as well as mac and cheese.  We have been eating well, and grocery shopping is particularly fun since the smooth surface of grocery store floors makes moving easy.  In fact using the shopping card substitutes for the walker or cane.  Sweet.

Today I've been reading Bernie Roth's  (one of the founders of Stanford's d-school) new book,  THE ACHIEVEMENT HABIT.   It is full of practical advice about how to get things done, change perspective and get out of your own way.  I enjoy reading a book that respects the reader's time and offers more than platitudes.  Good reading. I recommend it.

Tuesday, July 7, 2015

Celebrate slowness . . .

Have you ever seen a video of a sloth moving?  It's wonderful to watch.  Every movement is careful and deliberate and exceedingly SLOW . . .   I had not known this simple biological fact.  Sloths move slowly.  These days I am a sloth.  Since I am able to do almost everything with my walker at this stage most friends consider I may be healed.  Well, I'm not.  Although it's true I am mending it is truly at a sloth's pace. There is nothing I can do in "ordinary time" or rhythm.  I am learning that the world moves at a clip.  My underwater speed may seem charming to those watching me negotiate a curb with the walker.  When I stand at the refrigerator and take out jars and vegetables I can count the number of tiny moves it takes to go from left to right.
And, while I have some tiny progress by the day, I am not getting faster.

Sometimes this makes me very heavy and sad.  Akin Salawu sent me a marvelous Buddhist tale:
Chinese Bamboo Tree

I like the story of the Chinese bamboo tree: You take a little seed, plant it, water it, and fertilize it for a whole year, and nothing happens. 
The second year you water it and fertilize it, and nothing happens. 
The third year you water it and fertilize it, and nothing happens. How discouraging this becomes! 
The fifth year you continue to water and fertilize the seed and then---take note. Sometime during the fifth year, the Chinese bamboo tree sprouts and grows NINETY FEET IN SIX WEEKS! 
Life is much akin to the growing process of the Chinese bamboo tree. 
It is often discouraging. We seemingly do things right, and nothing happens. But for those who do things right and are not discouraged and are persistent, things will happen. Finally we begin to receive the rewards. 
I am now receiving the rewards of seeds that were planted 5 years ago. You are as well. Are you getting the results you want? If not, begin today to sow the seeds of what you want 5 years from now. 
Remember, if you keep doing what you've always done, you'll get the results you've always gotten. 

By Dan Miller 

Monday, July 6, 2015

Second Week

Today is exactly two weeks from the surgery.  It's going well.  This morning my Physical Therapist came and gave me a lesson in walking with the cane.  It still feels a little advanced for now, but I can imagine in a few weeks that the cane will seem sufficient.  I'm cautious and the walker seems secure and workable.  Every day now I've gone outside for a bit of a walk uphill in my neighborhood.  Rehab isn't dramatic or exciting.  It's a kind of serious plodding along patiently.  

I've gotten some notes from friends who are concerned that I am "putting up a brave face" that everything is fine, when it would be better to share the difficulty.  Well, in truth, there is difficulty but it all seems part of the journey.  I don't expect to feel "normal" for a long time.  And, I don't need to.  What I'm feeling and doing is fine just as it is.  The new slower pace of living provides an opportunity to focus on the details of life.  There is a kind of pleasure in this.

No need to rush around and do anything.  I have enjoyed being able to cook and prepare food standing in my nice kitchen.  Life is good. And, I'm glad I had this surgery done when I did.  Each part of the experience is interesting in its own way.  Thank you to everyone sending good wishes.  

Tuesday, June 30, 2015

Progress . . . One week along

I am surrounded by flowers.  These were all gifts from family.  Thank you Jason, Karen and Joan.  Color helps me heal, I think.  The surgery is literally one week past.   And with the help of my physical therapists, Laura and Sally, I am functioning well.  I use a walker whenever I move from place to place.  I'm able to do all of the essential things on my own now.  It's all slow and considered.  I can even manage stairs . . . carefully.  And, today, thanks to an invitation from our dear basketball seat mates, Gary and Carmen, I went out to lunch!  I was able to get down to the car and then go to Sam's Chowder House for a nice meal.  

Ron has been so kind in doing a thousand things I normally do: the laundry, all of the cleanup, making tea and bringing it, carrying objects like this laptop from room to room as needed.  He is my rock in taking care of physical things.  This morning he changed the bed linens and refreshed the room.  I am grateful.  Tomorrow I see my Doctor's assistant and have my first post op checkup.  Here is a photo of Ron putting a heating pad on my ankle in the shape of a teddybear.  

Friday, June 26, 2015

Day Five: Lots of Blessings

Marriage Equality Ruling
My own recovery is not what is on my mind today.  This is an historic day when the Supreme Court did the right thing in affirming people's right to marry.  Rainbows are everywhere and there is so much happiness that at last some force in our government is doing the right thing.  I've changed my Facebook cover page to use a rainbow heart card I made a while back.  In addition to this momentous announcement I watched our President, Barak Obama give the eulogy at the Church in South Carolina.  At the end he sang Amazing Grace.  This is one fine moment in American history.  Quite a day.

I've promised updates on how I'm doing with my rehabilitation from total replacement hip surgery.  Yesterday had some challenges, and as Susan Landor reminded me "recovery is not a straight line."  The question I wanted answered by those who had gone before me was "how much pain is there?'  
Well, I'd like to speak about that for a moment.  Pain is a funny thing.  It comes in many colors and from different directions.  Anyone who knows me knows that I'm an eternal optimist.  But this journey does have some pain.  Of course.  I'm not trying to be brave or anything, but I'm trying to chose to use the strong meds responsibly so that I don't bring on the complications that arise from all the narcotic use.  I have a pile of pills that I can take "as needed" for pain, for nausea, for itching, for constipation, etc.   And, pain isn't necessarily acute physical anguish . . . it's more likely to be nagging, tired, weak and sore body parts.  I am moving around the house doing ordinary things.  But it is really hard.  Really slow.  I despair of when I'll be able to move with less drag, pain and such.  While it is something of a miracle to be functioning fully, albeit at snail pace just four days from surgery, it is still tough sometimes.  

Some of these first few days have been scary and discouraging.  While I have everything I need, I fall into fears about some of the serious complications that can come up.  All of the mountains of information that the hospital sends me home with is full of disclaimers about things that can go wrong after surgery.  So, the slightest symptom and it's easy for my mind to go there.  Post surgery is full of anxiety producing moments and generic fear of the unknown.  And, another hard thing is that I have to ask Ron to do so much.  I can't lift anything and I even need his help getting in and out of bed.  He is so willing to help.  I just have to learn how to accept it gracefully.

Today was a big milestone.   I was able today to wash my hair.  Woo hoo!  After nearly a week of hospital ickiness and sweaty neck, etc my hair felt really greasy and unpleasant.  I'm not allowed to take a shower until Sunday, I think it is, but today I realized that I could stand over my kitchen sink and using the hose wash my hair.  Voila!  Fluffy hair.  Divine.

Life's little pleasures.  

I am especially thankful for some good advice for an old and dear Stanford student, Akin S.  He reminded me:  "But often we are so busy convincing everyone around us that we're fine that we circumvent the necessary journey. So this is a gentle reminder that its okay & WONDERFUL to experience your recovery as a human & not worry about putting on a brave face."
heart emoticon

Thursday, June 25, 2015

Day four HOME!

Well, this whole experience has been remarkable.  As I type this now on Thursday morning, 10:30am I am at home.  I am dressed.  I have had breakfast.  I am sitting at my computer in the office.  I walked myself into this room and sat myself down with the aide of a walker.  My pain level is low and I'm not right now on the strong pain meds, but have them if needed.

So, I would say my condition is stable and good.  I am fragile and a bit weak and everything is very slow.  My meds list reads like a full pharmacy.  I have a total of 22 meds.  I need a spread sheet to keep count of what and when I take all of these.  Many of them are "as needed" in case I start to itch or become nauseous or something else unpleasant or if the pain gets worse.

The real job now is the retraining of my body and musculature to use the alignment of the new bionic hip.  They say it has a lovely ceramic ball joint, a plastic piece and then a titanium spike of some sort.  What happens is that the bones somehow accept this and grow around it if all goes well.  What is important in the next months is to always be mindful so that I don't fall or extend the leg in someway that disjoints it.  This will be a good exercise in focus, attention, slowing down and doing things deliberately rather than automatically.

I've got wonderful help.  Ron is a champion caregiver and was up twice last night.  I still need help getting in or out of bed.  My right leg isn't strong enough to lift it easily.

I begin Physical Therapy at home today with someone named Laura who is coming to the house to begin my training.  I've had two days of PT in the hospital with great therapists.  Thanks Lisa and Jauiming!

Overall its a positive picture, but I'd be lying if I said it's trivial.  I'm not going to innumerate the problems, but it does seem they are under control right now.  My plan is to do a post daily to give some details.

Frankly this may not be a thrilling blog to read, but I'm doing it both for my own records and for anyone who wants the nitty gritty of how it is going.  It might be helpful to someone else who has this surgery in the future.  Whenever I've told someone "I'm having a hip replacement . . . they know of at least two other people who are also having it done or have had it."  Seems like a rite of passage when you get old enough.

I am very grateful to the nurses, aides, room cleaners, pharmacists and doctors and their assistants who are watching out for me.  And thanks to all my friends who have been sending cheering messages.

Tuesday, June 23, 2015

Second day June 22nd

It's going really well. Surgery was by the numbers. Dr Hartford said it was all good. No problems. I was euphoric when I awoke in recovery likely due to all the medications. I I actually got a good nights sleep albeit in between the every two hour nurses intervention.  Over all it's just great.  I have stood up and taken two steps last night.  Today the physical therapist hopefully gets me walking.

Well my only challenge for the present is managing lightheadednes and potential for fainting.  I seem to be strong enough to walk with the walker but my dizziness prevents me from doing very much.  It's likely caused by my strong pain medicine. They are now assessing the"cocktail ."  Hopefully we can get beyond this glitch with consciousness. .  I may need to be here for four days.  We will see.  

Overall it has been a smooth journey.  I am grateful for the the 30 different people who have entered my room with the purpose of helping me and the hundreds more backstage who serve.
Hospital is great I have a huge room with a view.  Really have not had much pain to deal with.

I'm amazed at how easy it's been so far.  I seem to be in highly competent hands.  It's all good.  I'll have a road to face as I learn to walk with the new hip. I'm motivated to do the work. It's been great having so much love and support. Hip hip hooray for a new hip. 
It will be a while but I'll get there.

Monday, June 22, 2015

Surgery day

Surgery Day Hooray.  Hip hip hooray!!!

We were up at 4:00am to meet our 5:30am date to check in the hospital. And by the time we arrived at Sequoia the sun was giving the world a lovely morning glow.  

Everything has gone perfectly. Being the first case of the day all were fresh, on their mark and doing thoughtful work.  So,far there has been 15 different people who have been taking care of me. I've got their names. 

The post-op experience was ethereal.  I felt elated as I emerged from the anesthesia.  I was soon tranferred to my attractive corner suite in the Hip ward.  Room 3112.  They even gave me a "gift bag with lip balm, toothbrush eyeshades, lotion and lots of fun stuff. 

The anesthesia is wearing off now.  I had a liquid lunch and then my Physical therapist came to do exercises.  I was able to sit on the side of the bed and stand using the walker. I did take two steps but then I got lightheaded and a bit nauseous.  So we didn't yet take that walk down the hall. 

A very neat thing was that they have a line draining any internal blood that may have been lost.  Once they collected a bagful they added it to my IV and gave me back my own blood.  Amazing. 

Now I'm doing well. The challenge will be balancing the pain and side effects in order to begin to walk.  I know you are all cheering me on.  I remember "The path is made by walking." That will be my job.  But likely not till tomorrow.  
 The Internet is buggy so I may not be able to post as often as I would like 
Love to everyone and a big shout out and thanks to Ron. 
Hip hip Hooray. 

Saturday, June 20, 2015

Surgery time scheduled

In my pre-op meeting with the hospital on Friday I've been informed that I'm number one on the surgery dancecard on Monday morning.  This means a 7:30am start for the operation and I'm to be at the hospital to check in at 5:30am. I'm pleased about this as I won't have a lot of time to hang around to worry.  Almost before I'm awake that day they will have me asleep to be ready for the surgery. 

 For those of you reading who know something about this I'm scheduled to have an anterior hip procedure.   Rumor has it that this is less invasive and that healing can go faster since some muscles don't get cut. I've spent part of the weekend getting ready making etegami thank you cards to give to nurses and folks who help.  
I am grateful in advance for all the years of medical knowledge that accompanies me on my adventure.  Thanks to those who studied such procedures and those who know about pain and infection and what to do to combat these.  What a world we live in.  

Wednesday, June 17, 2015

Facing a new adventure

On Monday, June 22, 2015 at Sequoia Hospital in Redwood City, CA I will be beginning an adventure.  I am having major surgery:  a total right hip replacement.  My doctor is Dr. James M Hartford, the handsome and (I'm counting on) gifted surgeon who will perform the operation.  I've been struggling with nagging osteoarthritis for half a decade.   What this has meant is that I've slowed down considerably because walking long distances or hiking has become difficult.  The handwriting has been on the wall that unless I do something this pattern of physical diminution will continue. So finally this winter I decided to go forward with the surgery that I am hoping will give me a new lease on life.  I have been encouraged by the well wishes of friends some of whom have had the operation and for whom it has made a big positive difference.  (Kathy Rowland, you are my role model!)

I've always been mobile and active.  While I'm not a runner or a distance walker I've moved around the planet at a healthy speed.  I like being in motion, going places and doing things.  Increasingly as my hip has become less reliable I've become more cautious and conservative about doing much of anything that requires lots of walking or movement.  I'm all for slowing down, but I just don't want to throw in the towel for traveling and having adventures. My friends know that my husband Ron is a serious runner and very active guy.  I'd like to be able to keep up with him as the years go forward.  So, I'm about to step into a new world of surgery and hospitals and rehab and all that.  It appears to have a lot of unknowns.

While I have a lot of confidence in our medical system I'd be lying if I didn't mention that I'm a little scared about it all.  I've already been to a class that explains all the things I won't be able to do for quite some time after the surgery.  Chief among these is bending over to pick up something.  I know this sounds crazy, but I'm having trouble imagining a life without picking things off the floor.  I do have two of the "picker-upper" thingies to carry around with me.  I've been counting and on the average I bend over to pick something up two to three times an hour.  Perhaps this will be a time to learn how to drop fewer things.

I also don't know how I'm going to handle pain.  I've been blessed that I've not had much physical pain in my life.  And, I know that I will be given whatever pain medications are  prescribed for this sort of thing.  It's something of a mystery to me how my body/mind is going to react. I imagine scenarios, but the truth is I'll just have to wait and see.  I don't think of myself as "tough" when it comes to handling pain and discomfort, but reality is not the same as imagining.  I will just have to discover what comes next.

On the very big plus side I have wonderful Ron who is promising to take care of me when I come home from the hospital to rehabilitate here. He has such a kind and gentle nature and seems willing to take on a lot.  I gather there will also be Physical Therapists who will come to the house to help teach me how to exercise and get the body to heal and become strong.  I'll have a walker and cane and all manner of aides to assist me.

I also know that I have lots of loving family and friends who are cheering me on and sending good vibes and prayers and food!  (Thanks Cheryl who sent literally 40 pounds of dinner meals for the coming month.  I am thrilled to have three freezers full of healthy food. An awesome, creative gift.)

I am considering writing this blog as a record of what's going on during the month or so that I am recovering. I'll try to post as often as I can.  Writing is a good way to process an experience.  And, since I won't be out and about perhaps having a daily writing assignment will be a good thing.

So, if any of you are interested in how it's going check this blog page from time to time.  It's likely I'll do an occasional update on Facebook, but I don't want to turn social media into a pity party.  Most of you know that I'm eternally optimistic.  I'll be hoping this mental trait serves me as I take this new journey.  And, I plan to do art and writing to keep me out of trouble.

Here are some recent painting on silk I've done. Color always makes me happy.

Sunday, April 19, 2015

What would I do with 37 days?

Notice that this is a repost from seven years ago

August 5, 2008

About two weeks ago I was looking out over the Welsh countryside at this vista of the rolling hills, dotted with sheep and little lambies. I painted it in my journal to remember the view from my window. If I knew I had only 37 days to live I think that I would keep on painting and recording my wonder. I’d look at moths as well as roses, at our queen -sized bed with all its pillows and puffy quilts. And, I’d look more slowly at everything in my house and yard.

I don’t want to go anywhere other than where am I now. I love this house, this room where I am typing looking out on a picture window that is engulfed by the pine tree we planted twelve years ago. It is one of the happiest trees I’ve ever seen.

Everyday life is my miracle, my magic, my dream come true. So, I would savor it, including whatever aches and pains or potboilers I’ll run into over these fine gifted days.

The one thing I would add is to write a letter every day for the next 37.  Each letter would be a thank you and love note to someone who has made my life what it is: a blessing beyond measure. I am in the process of making the list of the 37 people who will receive the letters.  I’ll start with my husband, Ronald Whitney Madson as #1 and then on day 37 I’ll write him another letter, so he’ll get "the last words" of Petrushka.  In between I’ll look for and identify those folks living or dead to whom I need to give my thanks and/or apologies. It’s pretty clear that 37 days isn’t exactly enough time to do this completely. So, heck I really do have to start this now so that if for any reason I get lucky and get to hang around beyond the day XXXVII, then well, I’ll be able to keep on going and maybe catch up on the full list.
So, a letter a day . . . and a bit of time to paint or draw something. And, all the rest, I’ll just improvise my ordinary life. I will taste the warmth of Earl Grey tea, the salty sweetness of tomato soup with Gorgonzola cheese, the savory delight of pasta with pesto and peas, and I’ll pull that homemade cherry pie out of the freezer. I will hold hands with Ron a lot. I’ll keep an eye out for things I own that I know friends would love and write little notes saying, "this scarf is for Dalla" and "this book of poetry for Trudy," and "these silk paints for my sister, Kathleen."

There is nothing lacking in my life. There is nothing lacking in my life. I have had joy beyond joy and a field of blessings. So, 37 more days of this paradise will be a lot, thank you.

-Patricia Ryan Madson
August 5, 2008


Tuesday, April 14, 2015

Reality's Work

Reality's Work

Patricia Ryan Madson
                                                     Effort is good fortune. Shoma Morita

                  Masatake (Shoma) Morita was a very bright, extremely sensitive but sickly youth prone to insomnia and gastroenteric disturbances. He was studying psychiatry at the university and was accustomed to receiving a regular stipend for tuition, medical, and living expenses from his father. At one point the regular checks stopped arriving. His father had come upon financial difficulties and was forced to cut off his subsidy. Morita was extremely upset and felt betrayed by his family.
                  He decided to get back at his father for this treatment. To show off his "miserable state" he would cut off all medication (since he now couldn't afford it) and overexert himself. Or, as the story goes, he decided to "study himself to death." This would surely teach his parents the error of their ways in abandoning him financially.
                  But instead of dying the young Morita thrived. In fact, his physical symptoms all but disappeared as he applied himself to study full time. Not only did he appear to "get well" but his efforts produced spectacular academic marks! His own effort had inadvertently led to the relief of his suffering and the discovery of what he would come to describe as "the healing power of work." It laid the foundation for Morita's understanding of the relation of effort to mental health and became the basis of Morita Psychotherapy.
                  Morita Psychotherapy in combination with another Japanese form, Naikan "Reflection," are the foundations for an American Buddhist-based practice known as Constructive Living. Both Morita and Naikan have their origins in Buddhist thought.
                  The term "Constructive Living" was coined and developed by the American psychologist and anthropologist, Dr. David K. Reynolds. Reynolds creation of this paradigm was a result of decades of direct experience in Japan and a lifetime of study in Eastern thought and practice. He has written prolifically in English and Japanese on these themes in both the popular and scholarly presses. He is the acknowledged authority on Japanese Psychotherapies in the United States. But his creative work in developing the clear language of the Constructive Living model is perhaps his most valuable contribution. By taking the essential teachings of the Zen inspired Morita model and the Jodo Shinshu inspired Naikan model, Reynolds has developed a simple prescription for living. The language is straightforward and secular. Its advice easy to understand and humbling to practice.
                  1. Pay attention to reality.
                  2. Notice what you are receiving and what you are giving.
                  3. Know your purpose.
                  4. Accept your feelings.
                  5. Do what needs to be done.

Pay attention to reality.

                  I begin by noticing reality, things as they are. This is the practical exercise of paying attention. I notice that the screen of my computer is blue. The letters are pink. There is a hum from the printer and the computer itself. This hum is the sound of this machine working to support my efforts now. Attention for me now includes noticing the time, 9:35 a.m., as well as my thoughts (currently doubting if this paragraph could possibly be of use to anyone--and while doubting, continuing to type). Remembering Natalie Goldberg's wise advice to writers: "keep your hands moving".

Notice what you are receiving and what you are giving.
                  The second principle informs my attention. It creates a particular lens through which I look. I am asked to notice what supports me, what I am receiving in this moment or have been receiving at other points in time. This lens cultivates the notion of interdependence, of noticing all the efforts that sustain me. Now I am receiving light from the sun, light from a desk lamp (which I observe is being used unnecessarily and so I turn it off). I am receiving help from the computer which records my thoughts, allows me to rearrange sentences, checks my spelling and finally permits me to make a copy to send to my editor. The printer receives this information and creates pieces of paper which hold these words and permit their passage to you the reader. In literally hundreds of thousands of specific ways I am being supported at this very moment. The clock functions--ticking--giving me information about time

Know your purpose.
                  Observing reality, noting all I am receiving, my purpose emerges. As I write this now, I reflect on that purpose. I have an immediate purpose: to write for one hour this morning. To this end I "keep my hands moving." My purpose in writing is to spread information about Constructive Living in the hope that this practical advice may serve to relieve unnecessary suffering. This purpose seems to spring from an inner sense or desire I have to give something back to the world.

Accept your feelings.

                  So, knowing my purpose, I accept my feelings. Right now I am feeling antsy, wanting to get out of the house, wanting to jump up and make a cup of tea, wanting to be doing something physical other than sitting here with my hands moving over the keys. I am feeling insecure about this essay, doubting the form I am using now to write these personal immediate illustrations of how I use Constructive Living. There is no need to "fix" these feelings. I do not need to gain confidence as a writer in order to write. I do not "need" to jump up and make a cup of tea (although sometimes that is exactly what does need doing). I don't need to do anything at all with these sensations. I feel them, of course. They are my feelings. I accept them as part of me now. I do need to write, however.

Do what needs to be done.

                  And so I act. Now, this means the action of writing. I sit at the computer. I keep my hands moving. Writing happens; through me. For me this is right livelihood: Doing what needs to be done. "What needs to be done" and "What I want to do" may coincide. However, my personal desires are not driving the inquiry. My personal needs are a subset of what needs to be done overall. Sometimes "my" needs lead, sometimes they follow. In reality there is no distinction. I return my attention again and again to reality to learn what needs to be done. And then I do it. In most cases "what needs to be done" is crystal clear, right in front of me. It is simply that I am not yet doing it. Constructive Living reminds me that I do not need to "get motivated," "gain confidence," "get psyched," or "get ready." I do need to act. It is in the doing itself that meaning is often revealed.
                  Both right livelihood and Constructive Living imply a principled standard. Everything we do has a consequence. No matter how small, there is no action that does not impact others in very practical ways. In Constructive Living the lens of Naikan (noticing what I receive and give) helps to replace the customary ego-centered perspective with a broader more holistic view. This may discourage self-interest as the sole motivating factor. What needs to be done is never an abstraction, never theoretical. It is always specific, concrete. My awareness of interdependence can clarify and inform my actions. What needs to be done is always a more inclusive question than simply what I need to do now.
                  Constructive Living would view the question of right livelihood from the vantage point of purpose. Right livelihood occurs when work is purposeful. So if my purpose in life is "to benefit others and not to injure" then anything and everything I do which serves that end can be considered as right livelihood. My work as a Drama teacher, my work on neighborhood committees, sweeping the street, volunteer work, making lunches for my husband, composing this article, washing dishes--indeed, whatever reality brings me that my mind tells me needs to be done qualifies.
                  If I accept that right livelihood is "doing what needs to be done," then the question arises: "How do I know what is right for me to be doing?" This question assumes that there may be some work that is not> right for me to be doing. Further, it assumes that there may be some particular work that is right for me.            
                  Reynolds has a quotation neatly typed and posted near the computer in his home office in Coos Bay, Oregon. It reads: "There is Reality's work that only you can do." If you ponder this for a few moments, it will be clear that this phrase contains at least two perspectives. From one perspective, everything I do derives from and returns to Reality. It's inescapable. The other perspective implies "specialness." Only I can do certain jobs. Another way of putting this is that there are some jobs, some kinds of jobs, which seem uniquely suited to my aptitude, abilities, and interests. How do I find them?
                  Constructive Living suggests two strategies: 1) Examine your purpose(s) and 2) Pay attention to what Reality has placed in front of you.
                  The question of purpose is best studied in the clear light of Naikan reflection. To practice Naikan means to examine the self in relation to others by asking three questions: What did I receive from them? What did I return to them? What trouble and bother did I cause them? I begin the inquiry by recalling my earliest memories of my mother and father. As I sincerely reflect on these questions, I begin to discover the details of the thousands of meals that I was fed, the specific clothing bought for me, the rides I was given, the lessons, the times my mother sat by my bedside when I was sick. The specific answers to these questions provide me with a ledger. Naikan examination shows me that, even by my own standards, I have been receiving more than I have given back to others. These findings often bring about a personal realization of my debt to the world. I cannot find right livelihood by thinking only of myself.
                  The person in search of his purpose who is asking the question, "What would I really like to do?" isn't yet asking the instructive question. Starting with such a feeling based question is missing the mark. The question implies a loop between the questioner, the specific job, and that job's "ability" to please the doer. Further, it appears to promise that if I get the "right job," it will make me happy and I will after that be doing "work that I like." While this may appear reasonable, it makes my "happiness" the measure of my success.
                  Realistically, I know that I cannot "be happy" all the time. My feelings come and go, changing often like the weather. If I go in search of work that "excites me" I am likely to be disappointed at least some of the time. Even the most stimulating work contains tasks that must be done whatever my motivation. Reality doesn't bring work that is always pleasant to do. While it is unrealistic to seek work that will always make me happy, it is possible to seek and find work that consistently supports some purpose of mine.
                  For example, my purpose may be to make the world a more beautiful place. To that end, I may choose any number of jobs that focus my time and talents on creating aesthetic environments. I can serve that purpose, not only when I go to work as a graphic designer, but also in the way I set the breakfast table for my children. I can serve that purpose by picking up trash in the park or in my neighborhood. I may serve that purpose as well, when I refrain from rough language or gossip. Or my purpose may be to help relieve unnecessary suffering in the world. To that end, my choice to refrain from an unkind word to a colleague forwards that purpose no less than my job as a nurse or social worker. So the answer to the question of purpose precedes and informs all that follows in the search for my true work.
                  When Morita saw a patient who complained about his job, wishing to quit, he had a stock response. Before counseling or allowing the patient to quit Morita asked him to examine his purpose. If, indeed, his purpose could not be served in this particular job then that was considered a sufficient reason to change. If it was possible to serve his purpose within the current job setting then Morita would insist the client remain in the job and apply himself with greater attention and diligence. Morita saw that satisfaction in work came not so much from finding the "perfect job," but rather from "doing the job in front of you perfectly"--that is, with full attention.
                  As I grow to appreciate all that I have been given in my life a natural desire to return something emerges. Out of this desire comes my purpose and from this my work. It is clear also that right livelihood comes both from my own purpose and from Reality's purpose, achieved through my hands.

Reprinted from MINDFULNESS AND MEANINGFUL WORK, Parallax Press, 1994, edited by Claude Whitmyyer