Healing the Healers: Tibetan Medicine Wisdom for Healthcare Professionals in COVID-19 Times

Excellent. Well, welcome everybody. Thank you, Sean, for the, for the help. We want to welcome you to Healing the Healers. A presentation sponsored by the Division of Palliative Care of the University of California, San Francisco, with— I'm going to have to look at the list. We have quite a few co-sponsors. I just want to acknowledge the Osher Center for Integrative Medicine at UCSF, the UCSF Psychooncology Group, the UCSF Spiritual Care Group, the UCSF Integrative Psychiatry Interest Group, the Earl E. Bakken Center for Spirituality and Healing from the University of Minnesota, Global Health Research Foundation from Los Altos, California, the Institute for Holistic Health Studies at San Francisco State University, the Kunde Institute in Daly City, Center for Tibetan Medicine and Tibetan Wellness, and Tibet House US, in New York City. We're so happy to have you all here. We're just incredibly pleased to have the variety of speakers that we have today, and you've all read about that, and that's probably why you signed up. I'm going to just briefly mention from the University of Minnesota, Dr. Tenzin Namdul, who has some interesting research I'm not going to mention, he's going to mention. We have here Yangdron Khalsang, who is the Tibetan Medicine Director at the Kunde Institute in Delhi City. And she and I this morning were on another Zoom session at 7:00 AM because it was 10:00 PM in Amdo, Tibet. And we had a live Zoom session. With 5 noted Tibetan Buddhist medicine people running a wonderful medical institute in Tibetan medicine that Yangdrön, I'm sure, will be mentioning more about. We have Geshe Lobsang, who works with the a couple of things. One is he brings meditation and mindfulness into jails. He's been doing that, I think, for about 7 years. And he also works through the Kunde Institute with Dr. Cao Zheng. And he will be doing some meditations with us throughout this program. So we're going to have an opportunity to learn up here and to learn from our hearts. We also have Jennifer Daubenmire, Dr. Daubenmire, who is a wonderful researcher into mindfulness and so many other things that are of interest, I think, to all of the whole audience. And again, I'm not going to go over credentials of all these people. They, uh, it's all written out for you. Michael Raybould is with us. He's the— my leader at UCSF for about 13 years. I've been a member of his symptom management service. It's an outpatient palliative care group that was very innovative when he began it 13, 14 years ago. And when I attend the meetings weekly on a Wednesday morning with doctors and nurses and social workers, and chaplains and many other people, maybe 25 people who work in palliative care. It is the best meeting I've ever attended in my professional career because even though we talk about people who have died, and it might be a 38-year-old nurse who's talking about a 38-year-old patient of hers who died, who has 3 children, there are obviously many heartfelt expressions as we talk about those who have died. At the end of the meeting, we leave with one gratitude going around. Everybody says something they feel grateful for, and you feel refreshed. And I hope that even though today we're going to be speaking about very painful, challenging suffering that the world is going through right now, with COVID-19, that we'll have an opportunity to also have moments of humor and laughter, which is— it kills viruses, I'm convinced. I'm going to do an NIH study. I hope it's true, but I know it makes me feel better. And we are intending for all of us to be uplifted by this opportunity to share today some of the things that we're calling the wisdom from Tibetan medicine. So I think that's enough for me to begin with. And let's see, I think it would be wonderful, and it will be wonderful, if Lobsang, you will be leading us now.

Hello, tashi delek everybody. So I'm going to lead meditation today, and this particular meditation practice I designed for healthcare professionals. And so this is called Transforming Challenges into Inner Growth. So it is very brief, it's very short, but it's very powerful and perfect for American. It's a very short one, but if you have your time, you can expand it as much as you can. So my part is today going to be have 3 different parts as a usual ritual practice at the beginning as a writing style, like at the beginning, opening, and body, and concluding. Same thing like the beginning And then I have a main practice and then closing practice. Okay, so now I call here transforming challenges into inner growth. So this is very, very particular practice by the great practitioner who always been waiting for it. Whenever they encounter with such a challenging situation, they always try to put them into their inner growth, spiritual growth. So now, for the healthcare professionals, especially this particular time, in— of course in general, especially this particular time, you are facing a lot of challenges. And if you can, this is the best chance, or best chance for you to have an inner growth, and your especially spiritual practice if you're a practitioner. Okay, so now we are going to have mind setting first. I call it settling the mind. So definitely you just had a lunch and must be already settling your mind. So in Tibetan proverb, we have a saying If you don't stir muddy water, it will stay clear. If we don't alter the mind, it will find its own peace. Chu mayon na tang, sem ma du na de in Tibetan. So let us bring attention to the breath. Or your body sensation if you're not comfortable for the breathing. So just normal breath, no need to have a deep breath right now. So just normal breath and just try to settle your mind. Whatever busy life plan you had, just leave this set aside. So once your mind is settled, so now appreciate yourself that you're able to make today. This conference, imagine how many people, they have no opportunity to have such a wonderful conference, which always talk about Love and Compassion. But even though someone has the time, someone has this approach, programs, but they cannot make the time. Probably you may aware many of your colleagues, they really want to, they are unable to find time. So that's why you should appreciate yourself that you are able to make a time today. Let's gently open your eyes and take a deep breath in. Exhale. All right, thank you.

Okay, thank you. I feel refreshed and a wonderful start to our time together and We're now going to hear a presentation. I, I would like to say just a little bit more about Dr. Daubenmire. Received her doctorate at the University of California, Berkeley. Did postdoctoral research at the University of California, San Francisco in health psychology. Was assistant professor in Department of Medicine at the Osher Center for Integrative medicine at UCSF. In the past 15 years, she studied the impact of Eastern mind-body healing practices, including meditation and yoga, on psychological practices, including meditation, and health outcomes among individuals with obesity, type 2 diabetes, heart disease, and prostate cancer. She's done more in, uh, this time than probably 5 or 6 researchers. She's conducted NIH-funded randomized controlled trials to examine the impact of meditation and mindful eating practices on eating behavior and metabolic health. In 2015, she was awarded a US Fulbright Senior Research Scholar Award to study Tibetan medicine and Buddhist perspectives of the mind-body relationship in Dharamsala, India. She currently teaches a course on traditional Tibetan healing methods at San Francisco State University. and I'm just so pleased to have had this opportunity to get to know you, Jennifer, and looking forward to your presentation.

Thank you.

Hi everyone. It's really nice to be here, and I wanted to thank you, David, for organizing this event at UCSF in conjunction with Yongjun, who's initial idea it was. And it's a joy to be here with people at UCSF and the wider community. I spent a long time at UCSF and now I'm at San Francisco State. I've been practicing and studying the meditation traditions and philosophy of Tibetan Buddhism for about 20 years now, and so it's really quite an honor for me to be able to share with you a little bit of the wisdom that I've been learning through my teachers through the ages. So I will share my screen right now. Hopefully you can see that okay. And we were originally planning this talk a few months ago before COVID-19 hit on a similar theme of healing the healers. And we were really interested in addressing this issue of physician stress and burnout among our healthcare providers. Little did we know that a pandemic was coming our way, and so we quickly pivoted to change the content of what we had planned to address what's going on now for people. And so I just wanted to start out by saying that, you know, I've been really just amazed and in awe to see the response of our healthcare providers during this crisis. The amount of the courage and the commitment and the compassion that I've seen throughout the UCSF community and other medical centers around the country has just been really heart-moving for me, especially when I consider that, you know, initially what I was reflecting on is the current stress epidemic that our healthcare system is facing with patients and doctors, where studies are showing considerable burnout among our physicians and also among our nurses. And patients themselves are stressed. It's estimated that 60 to 80% of doctors' visits are stress-related. And so we have this incredible burden in our healthcare system. And we know that burnout affects the quality of care of the patients. And so it's an important issue that we want to address. And with that said, I just want to also echo what Lobsang was saying about using difficult situations to grow. And I feel like it's been so amazing to see just the healthcare providers rising to this occasion. So in response to this issue of stress and burnout among our healthcare providers has been the development of compassion training programs across medical centers across the United States. And interestingly, a lot of this has been inspired by By Tibetan Buddhism and at the encouragement of His Holiness the Dalai Lama, who is a spiritual leader for the people of Tibet. And he, in his meetings with scientists throughout the decades, he has been learning, studying neuroscientists with, with top researchers and psychologists as well, and has noticed that that we're very good at identifying negative states of mental health, anxiety and depression and stress and post-traumatic stress disorder, et cetera. But we don't have such a rich understanding of positive qualities of well-being and prosocial behavior. And so he encouraged scientists, you know, why don't you study compassion? And scientists said, Oh, okay. So there's been these efforts at Emory University, Stanford University, and now UC San Diego of developing compassion training programs, which are really rooted in the Tibetan tradition, in the Buddhist tradition. And the medical system of Tibet is really grounded in Buddhist philosophy. So they go hand in hand in a lot of ways. And there's been increasing evidence to show that these programs are helpful in increasing compassion among our healthcare providers. Late last year, there was a grant, a $100 million grant offered by Denny Sanford to the University of California at San Diego to begin to do systematic research on the neurobiology of compassion to reduce physician burnout. So the university is really seeing this as a crucial need and a need to address, for us to address.

Let's see.

So I wanted to talk a few minutes about what we mean by compassion. This is a term that hasn't had a lot of clarity in years past, and it would get conflated with other concepts such as empathy or sympathy. And so research has been done to begin to understand these subtle differences. And so I'm using a definition by Thupten Jinpa, who is a translator of His Holiness the Dalai Lama and created one of these compassion Cultivating Compassion programs, and he, along with others, defined compassion along these three dimensions. So the first is having awareness of another person's suffering or need, so being able to pay attention to what's happening to those around us. It could be nonverbal facial expressions, it It could be somebody saying something and having the presence to really listen to them. So this is a cognitive aspect of compassion. And then the second aspect is feeling emotionally moved, feeling a resonance with the emotion that the other person is feeling. And the third component is a motivational component where we have the intention and the wish to act and to alleviate that suffering, to change the situation in some way. And so this concept of compassion is contrasted with empathy, and in the healthcare professions we often hear of a concern that physicians or nurses are developing compassion fatigue. They're at risk for this, especially now during COVID-19 times. And empathic distress, where we actually feel overwhelmed and distressed at another person's suffering. And so there's been some research to try to disentangle this empathy from compassion, and this has been done by Tanya Singer and her colleagues in, in Germany. And she's done some interesting neuroscience research to find that when people are trained in empathy, which is to feel the emotional resonance of another, but not necessarily to act on that wish to alleviate their suffering, that when they're shown pictures of people suffering in an MRI scanner, parts of the brain are activated that are related to pain regions in the brain. In contrast, when people are given training in compassion, in the wish to alleviate that suffering, it's actually associated with brain regions that are connected to pleasure— oops, excuse me— to pleasure and to a sense of social connection or positive emotions. And so I think we all have had that feeling when we have helped someone in the past, and it just feels good. It just feels good to help someone, and it's a way of connecting and extending ourselves. And so research is starting to bear that out. And so His Holiness the Dalai Lama who was awarded the Nobel Peace Prize in 1989, often says that compassion and tolerance are necessities these days. They're not luxuries or soft skills that we can choose to adopt if we want, but they're essential for our collective humanity, for our collective survival. And we can all reflect on the numerous parents or teachers and mentors, community members that have played a role in the development of our own lives. And so contrary to this notion of compassion fatigue, of being overwhelmed, His Holiness argues that actually compassion can be boundless. It can be limitless. And so in the Tibetan Buddhist community, oftentimes there will be a vow where people will take this vow to benefit others even at the cost of their own well-being. And so this is His Holiness's favorite prayer here. So I— these 4 lines that he said that gives him encouragement and hope through his life. And it's written, or it was created by Shantideva, who was an 8th century scholar in Buddhism in India. And so I'll say it aloud, and if you'd like to explore what this is like, you can say it aloud with me or read along to explore this boundless quality of compassion. As long as space abides, as long as the world remains, just so long may I be there resolving all beings' pain. So it's thought that we all have this potential within us, and it's innate to us in some ways, as mothers caring for their young, but it's also a trainable skill. Our brains are changeable elastic, we can learn. And so these training programs are about actually developing these qualities in ourselves. And I wanted to highlight a few components or themes of these practices in these programs. And the first one is, interestingly, it's this idea of receiving compassion, that in order for us to give compassion, it's helpful for us to be able to recall experiences of having received it ourselves and to have been touched by it in some way. And so there'll be meditations about recalling instances of, of having received compassion or imagining receiving compassion from someone who we believe supports us and cares for us. This second aspect is self-compassion, and this actually arose in the Western scientific literature. It's not so explicit in the Tibetan tradition. It's assumed, actually, but in the West we suffer from a lot of self-criticism, a sense of low self-worth that's often tied to our performance and what we achieve, but it's not something that's considered intrinsic to our being. And so it's actually something difficult that we struggle with. And in these compassion training programs, a considerable effort is spent around self-compassion. And Kristin Neff, who's developed this work and this concept, has it defined in terms of 3 aspects, where we are being kind to ourselves and kind of letting go of the self-critical judgmental talk that we can often say to ourselves in our minds, kind of subconsciously sometimes, and that we also are honest with ourselves and what we're genuinely feeling in the moment when we're going through something, not trying to suppress our emotions if they're painful, and letting them be present. And the third aspect is realizing that we're not alone, that other people are going through something similar as well somewhere on the planet, that this is kind of a shared emotional experience. Then of course the last aspect is extending compassion to others. And this can begin with the close loved ones and then extend it out further to colleagues, acquaintances, even strangers, and then ultimately even people who we necessarily don't like, or if we think they did something wrong. And so that's the invitation for the boundless aspect of compassion. And in order to develop these qualities, these Tibetan training programs often refer to some philosophical perspectives. And to, to respond to our kind of our rational self-interested state of mind, showing how compassion is actually logical for our own self-interest as well. And so these teachings begin with the recognition of that we are all the same fundamentally in joy and sorrow. We all desire happiness. We all desire to be free of suffering. Our circumstances differ. Our privileges differ, but ultimately at its heart we all share these same emotions. And so we're interchangeable that way, we're the same that way. So there's a sense of not needing to prefer someone else over another person because we're equal. And surely, you know, the COVID-19 virus has shown us that we're all equally vulnerable in, in terms of being exposed. And affected. And so the second concept is interdependence, that we are all connected together. We don't live in isolation, and we're actually dependent on others for our own well-being, and that can give rise to a sense of gratitude and a wish to reciprocate. So I wanted to give some real-life examples of what this is looking like, because I feel that people are displaying these naturally, these insights from the Tibetan tradition. So here is a nurse from China near the epicenter, and she was writing early on about her experience where she analyzes the blood samples to test blood for COVID-19. And it was the Chinese New Year, and she was on vacation going was going to go off to her family to celebrate the New Year. And she decided to stay back. She told her mother and her daughter to go ahead, and she was going to stay and volunteer to analyze these blood samples. And she says in her own words that this virus brings us all together. It unites us. So something in her was feeling part of a larger community and felt that call to respond. And as another example, I wanted to give— I was reading about the UCF— UCSF scientists are working very hard to discover how the virus works and potential treatments for us. And there were some discussions about how these scientists were really amazed at the quick level of collaboration that was happening between labs and internationally, that the scientists were coming together and overcoming the barriers like never before. And it was this potentially new era of a collaborative science that was emerging. So here's another example of compassion in action. This is a doctor, Nadia Alam, who posted on her Instagram account that she had been starving, thirsty, tired, working 7 hours straight, wearing all her PPE. And there was this older man with poor lung function who had been alone for a few days. He couldn't see his family, and they wanted to put him on the ventilator. He had signed up for it, and then at the last minute he says, "I don't want to die on a machine. I want to see the blue sky." And so she just dropped everything, all her plans, and just sat with him and held his hand, and they just watched the sky together. And she said that this just kind of broke her heart doing it. So here she is, you know, being very human in her role as a doctor and responding very compassionately. And here's another story of another doctor, Dr. Hella Akbarnia, who met with this patient a few days before he went on a ventilator, and then met him after he survived and was coming off of it, and he went to go find him, and he said to him, you know, you told me you trusted us to get you to this other side, and it looks like you're doing fine. And so the patient looked at him and started to cry and said, I remember your eyes. And then the doctor started to cry. And he said that, "This patient's strength, his kindness, his calming words meant to me everything. And at that moment, my heart rate finally started to slow down, like the first time since the epidemic had begun." So it was this beautiful moment of giving attention to each other, looking at each other in the eyes, and feeling a connection that was mutually beneficial for both of them. So this is an opportunity for healthcare providers to, to remind that we can also receive from our patients as well, and that we're all human together. Okay, so I wanted to turn now to a little data research, the scientist in me, and perhaps the scientist or researcher in you who likes facts. So this is an interesting study that was done and initiated by a medical student, Sydney Tan, at Brown University, who was interested in looking for solutions to physician burnout and stress by looking to the experiences of Tibetans in the Tibetan medical school in Dharamsala, India, and how they cope with stress. So I just wanted to share one general finding here where they were administered a coping survey, and they found that the Tibetan students were reporting more religious coping, acceptance, and positive growth compared to the American medical students. And as you can see, the religious coping was quite low for the US students. It was about as low as using substance use and denial for coping, whereas it was quite high for the Tibetans, and also these themes of acceptance and positive growth. And so I found that really interesting and wanted to share some interpretations of this, drawing on the philosophy of the Tibetan tradition in terms of these. In terms of acceptance, Accepting impermanence is a big theme in the, in the Tibetan tradition in order to cope with the suffering that arises when we get what we don't want and don't get what we do want, generally speaking. And so this is an article that was written in the New York Times by a palliative care doctor. So Janita Puri, who was feeling the grief and the sadness of losing many patients, and it was starting to weigh on her. She was taking home the sadness and was starting to get burned out. And then she came across a Tibetan Buddhist event where these monks were making a sand mandala. And some of you may have seen this before, and there's a photo here. These are very intricate, detailed, beautiful paintings that are created with little grains of sand kind of being scraped into with these little instruments here. And it takes, you know, days of round-the-clock work to create something this detailed and complex. And when she saw that, she assumed that this that sand painting was going to be preserved and hung somewhere. And so when she learned that it wasn't, she saw the monks, once they finished, part of the ritual then is to wipe away and basically destroy all that they had created over the past week. And she was shocked to see this. And she, wasn't shocked just to see that, but also to see the contentment with which the monks were doing this. It was the same level of calmness and contentment in which they had created this in the first place. And so that really struck her as a teaching on how to begin to let go of those things that we can't control, or those things that we wish were permanent in some way, but aren't. And so she quotes Thích Nhất Hạnh, who is a Buddhist Vietnamese monk, who says that impermanence does not necessarily lead to suffering. What makes us suffer is wanting things to be permanent when they are not. The last point I wanted to raise is this idea of transforming poison into medicine that Lobsang was mentioning. The Tibetans love peacock feathers. They're often in paintings or in rituals. And it's believed that the peacock eats the most poisonous plants in the forest and the leaves that other birds and animals won't eat. And in so doing, it makes their plumes beautiful and makes them radiant and shine. And so this is a metaphor for the philosophy of the Tibetans is to actually use all the negative situations and emotions of our life, not to reject them, but to use them, embrace them, become friends with them, see them as allies in transforming ourselves. And so there's a compassion practice called tong len, which Lobsang may lead us through that exemplifies this idea of using what's painful in our lives as a way to develop compassion and wisdom. The Tibetans also really like the lotus flower. The lotus flower is this beautiful flower that grows up out of the muck of a, of a pond. And so here this quote says, "The lotus flower blooms most beautifully from from the deepest and thickest mud. And so the compassion and wisdom arises from the suffering of our own lives. It's not to be rejected. And I wanted to give you a little flavor of what spiritual practice looks like in the Tibetan tradition, and this is an image of Green Tara, and she is a female Buddha of compassion. And here she is, she's sitting on a lotus flower that's arising out of a pond. So she's an example of someone who has transformed all of her suffering into compassion and wisdom. And she is now in a place where she can serve and benefit others. It's this— one of the myths about her life is that she was born from a teardrop of the Buddha of compassion, Chenrezig. Upon seeing the continual suffering of the world. So a very tender, that very tender part of us that's very moved in seeing the suffering of others. And green is a symbol of the wind, which is very swift, quick energy. And so she has one leg kind of tucked up, sitting, when she's resting in wisdom, and the other leg is ready to kind of jump off her lotus seat and serve others. So she is this union of wisdom which understands impermanence, but she is also actively engaged in the world in helping beings who are suffering. And this is a practice that His Holiness the Dalai Lama has recommended for people who practice in this tradition to do. And it's thought that these deities are in part a reflection of our own inner potential. And so it's a, like a, kind of like a reflection of what's possible, of what's already in us. And this is her mantra here: Om Tara Tutare Ture Soha. So that's all I have to say. So I wanted to thank you so much for listening, and really a special thank you to all of the healthcare providers out there and all of you who are supporting each other in one way or another. Thank you.

Jennifer, thank you so much. That was just beautiful. This is Mike Rabo speaking, and I've been— I'm going to be monitoring the chat function, so if people have questions, please do put them there, and we'll try and get to as many of them as possible. There was one super simple but super super meaningful question that came up during your words as you talked about compassion including the wish to alleviate suffering. The question was, what if there is no way to help? And obviously that's— that may be a full lifetime's worth of thinking about it, but I'd love, as we're moving on to our next section, if you might try and address that question. In the setting of compassion, what if there is no way to help?

Yeah, thank you. That is a really wonderful question, and that is what we are faced with often. And one of the analogies for compassion is— a traditional analogy is a mother who has no arms and has lost her child. Her child has fallen into a rushing river. Is being swept away, and that mother cannot rescue her child. And that is the feeling of compassion. And so oftentimes we might not be able to physically do something. Nevertheless, we still aspire, we still set our intention to be a benefit. And in particular, the Tonglen meditation practice that we'll be doing is a way— is often a great solution to this problem when we feel very helpless and there's nothing we can do. We can do this practice of actually imagining their suffering and kind of taking it in and into ourselves, or removing it from them and breathing out a sense of relief or hope of what they need. So we can still work with it at the level of our minds, even if we can't physically do anything.

Thank you so much, Jennifer, and thank you for this presentation. Each of our speakers could speak for hours.

Sorry.

And, but we're trying to stay so you'll have time left for your Sunday. That's part of self-care because this is a free program and even the CE units were free. And that was because of the support, generosity, and wonderful care that Spiritual Competency Resource Center, which you can look up, you'll be getting it in your emails, they have contributed to this program the 2 CE credits for psychologists, nurses, and everybody like that. Not for physicians, but many other people. And David Lukoff, who's the director and founder of that program, is a wonderful friend, and he's watching right now. So I wanted to say thank you again, David, for doing this for free. I want to say a little bit about Lobsang, very briefly. He's going to speak and do a meditation for us. And then Yangdrön, Dr. Kyle Zhang, will be talking from the perspective of being a Tibetan medicine person trained in Lhasa and now in— had for many years here in the United States. And then we get to Dr. Tenzin Namdul from the University of Minnesota, who's going to talk about his amazing research. And then we'll do a few other things. So Geshe Lobsang studied Tibetan medicine at the International Academy for Tibetan Traditional Medicine and has been practicing at Kunde Institute's clinic in Daily City. He teaches courses in Buddhism, meditation, and the arts of compassion and travels regularly— with a short break at the present moment— throughout the United States, Taiwan, India, Russia, and Europe. He will share techniques and perspectives on the development of compassion and self-care for healthcare providers. So I am so pleased to now turn it over to Lobsang.

All right, so now this is my second part. So second part is setting intention. So now it's become like actual, uh, your practice. So as I mentioned earlier, it is— I designed it like a simple kind of ritual. So it's very important to have such this kind of like ritual things for your daily life. So because when you have a ritual, it become like ritual makes you become like more structure, creates a structure. So at the beginning you set your intention. So if you ask me, do I do it? Yes, I do it. It depends upon how much time you have, so it doesn't matter the time. So I usually do As long as I can. If I don't have time, I just sit in the car for like 1 minute before I get in the clinic, or before I go to the prison to talk. So now here, setting intention is very, very important. So setting intention, it is like musicians. They're tuning the instruments before they go to the stage in front of thousands of people. So it is for you, it is more like turning a day for your, as your healthcare professional in a clinic, in the hospital sessions. So, so this is the very, very important to having your intention setting. So we are going to meditate for like very short period of time, so I become more chatting, chattering because it is a guided meditation. And also it is time-limited, so I am guiding you and meditating at the same time, so it is going to be recorded. And when you listen again, you can pause the video and then you can meditate as long as you can. So sorry for become more chattering for this time. So we are setting our intention first. So our intention should be, "May I able to spend this particular time, this particular time to more beneficial," if you setting your intention in the beginning. Imagine or have a thought, set intention that, "May I become more beneficial to my patients today." Having a pure intention, it is like having a clean source of the river. So no matter How much polluted in the middle, you still have a chance to have a clear water, because source of the river is still clean. So same thing, even you cannot hold the same intention throughout the day, throughout the practice, you still have a power. Once you have intention to serving others, especially unconditional loving care to others, So now first we are going to have a receiving compassion, loving, from your teachers, from your mentors, from your colleagues, of course your friend or family members. You can imagine their face, or just have a simple thought in your mind. So sometimes people feel like receiving compassion is more like selfish, which is not. You need the compassion in order to give others. For example, when you're flying in the plane, they always advise to put on your face mask yourself before helping your child. So if you don't have enough oxygen, If you're almost suffocated, there's no way you can help others. So same thing, if you don't have a compassion, if you don't have enough loving, caring, it is hard to compassion to others. Even though you do give, you may feel exhausted. And Thai. So now let us move to giving compassion to others. And this is the particular prayer to setting your intention and compassion, loving kindness practice. So I'm going to read this at loud, and you can— or you can just whisper. May all sentient beings have happiness and its causes. This is the how you feel practicing a loving kindness practice. And compassion: May all sentient beings be free from suffering and its causes. Here sentient beings refers to every single being, even including mosquitoes and cockroaches. And spider as well. If you don't have that kind of like mind capacity, you get reduced to only human beings or other animals. So if you practice, if you give a service in a hospital to the patient with a loving and compassionate feeling, Compassion, it energizes you. It opens up your heart. It makes more room in your heart to hold more patients or people. I met many physicians and healthcare providers. They said, "I really love my patients and try to help, but I'm very exhausted when I come back to home at the end of the day." So probably you may need to slightly change your mindset. So sometimes people are very confused between compassion and empathy. So empathy, sometimes the emotion for others. Suffering exhausts you more. And contrary, the compassion practice energizes you. It empowers you. Let's gradually move the compassion practice to others to self-compassion. As Jennifer said earlier, so Americans, they're more harsh to themselves and hard to have self-compassion. So we deserve loving care, we deserve compassion. You should be treating yourself as you would treat your good friends and family members. You are the source of happiness to others. Once you are happy, you become more healthy, and you can help your patient more efficiently. Research found that self-compassion is more beneficial to our psychological well-being. Than self-strings, because self-compassion is associated with emotional resilience and having less narcissism and less anger. So be compassionate for yourself. It makes you more happy, and you can make other people more happy. So now let's move to a particular Buddhist practice that, as Jennifer mentioned earlier, example is a green Tara this time, because His Holiness the Dalai Lama advised Tibetan and his followers to recite green Tara mantra during this particular healthcare crisis, COVID-19 crisis. So Green Tara is very powerful female deity. This is the deity of compassion and is wealth deity for wealth and protector and infertility as well. So wealth is a spiritual wealth and material wealth. She is good for both. And then of course protection. So it protects from your— it protects from your fear and insecurity. As a Buddhist practice, I'm going to say this mantra.

Out loud.

And if you recite after me, it become like you are receiving a transmission from me, which is the traditional Buddhist way, having an unbroken lineage transmission. So I have received this transmission from many great masters, including His Holiness the Dalai Lama. So mantra says like that. I'm going to, um, making homage first and then say mantras. Om Tare Tuttare Turi Soha. Om tare tutare ture soha. End of the third time, you should visualize the green Tara and imagine that you receive this powerful mantra transmission from the great masters. You can imagine and visualize Holiness of Dalai Lama or other spiritual masters that you have. Om Tare, tu tare, ture soha. Om dadadadada. Om tare, tu tare, ture soha. Khyawadhi yenyu dodapamo dramo ryujindro vachidya moliyabate salagpa sho. So now once you are well protected from saying the Green Tara mantra, so now you can do a tonglen practice. Tonglen practice is is the practice that you— you're giving and taking practice, which is more active compassion. So imagine or visualize that blue light that I show you here around your heart chakra. If you're sitting next to your patient, Visualize their sufferings and the problem they are going through, and you just take all the sufferings to your— the light blue, which is Medicine Buddha's color, and then transform them into happiness and joy and send back to the— your patient. You can repeat that over again, again, or you can do this very slow process. Depends upon your time. So, if you— once you have said this Green Tara Mantras, so you, you are well protected. It doesn't mean like, you know, Green Tara mantra directly kills the virus. Having Green Tara mantra, imagine the Green Tara deity, it gives you security. Once you feel secure, you feel more comfortable, you are more happy. So that produces a lot of good hormones like oxytocin, dopamine, and so on. And that once you're happy and healthy, that builds up your immune system, that protect from your sickness. So now this is the self-empowerment. I'm going to say this in— read this in English first. May all type of medical wisdom develop perfectly within me and benefit all the sentient beings like the sun and the moon. May everything I speak become beneficial and wise. May all service I provide become medicine. May all I give be beneficial. And may my teacher and mentors bestow blessing on me. I say this every morning before I see the patient, as I mentioned earlier. It's part of my mind-setting practice. And this is from Yuthok, Ningthik. So end of the— I'm reading in Tibetan again. And end of my Tibetan chanting prayer, you can visualize. Your mentors and your teachers receiving, giving you the blessings. [SPEAKING CHINESE] Thank you.

Hmm.

Thank you so much, Lobsang. We're now going to— and I will say just a little bit about my friend, Mempa, Dr. Kao Zang, Yangdrön to her friends and patients and everybody who knows her, was born in Tibet and was first introduced to Tibetan medicine as a young child by her uncle who served as chief physician to the integrative unit of the Tibetan Medical Hospital in Lhasa. She was later fortunate to work under the supervision at the Tibetan Medical Hospitals in Lhasa and Chengdu. Memba Yangdron earned her Tibetan medicine degree from the Tibetan Medical University in Lhasa. She's been practicing for over 20 years Tibetan medicine and teaches throughout the United States, Canada, and Europe. And what I know her from is first meeting her at Yangdron. You may remember when Thupten Jinpa, the Dalai Lama's main translator and editor came, and we had him speak at UCSF several years ago, and you came for that. That's the first time I believe I met you, and so happy to hear that you're going to present for us today some information that's more on the philosophical side of Tibetan Buddhism that might be applicable and helpful to all of us as caregivers. So, Dr. Cao Zhang.

Thank you. Yes, I'm here. Can you see me? Yes. Yes. Okay, so thank you very much. Let me put this one a little bit away. So maybe I'd like to invite everyone to stretch your arms out, maybe on the side, because we've been sitting our and 15 minutes, so I had a little stretch. All right, so first of all, I would like to thank David to put this wonderful webinars, and including Jennifer, and all of us work together really well. Um, thank you for UCSF co-sponsor and become our major sponsor for our event. So before that, I'd like to invite you a small map to take you to Tibet today on the Zoom, on the, in the Zoom, right? Taking the Zoom, we're going to fly to Tibet. So Tibet is like, I'm not sure how many of you know, But it's right in between Himalayas and a big country, India and China. We're stuck in right in between. So if you don't remember where Tibet still is, so you can think about Tibet is like the sandwich bun between India and China. So we're the central part. As it is located, so the Tibetan Culture, language, and medicine all has influence from neighborhood countries, although it carries its own indigenous and traditional medicine and culture. And this is one of the best photos that I— map I found, which also shows the rivers where it supplies to So I'm using this one to present to everyone. Okay, so as I mentioned that we got the influence from east and west part of Tibet, then Buddhism obviously is one of the major thing that influenced in Tibetan culture since between 6th to 8th centuries. So on this slide, on the right side, there's the Blue Buddha, which represents the Medicine Buddha, which highly regarded as the physician of not only for physical health but also for mental health. So I would say psychiatrist and MDs, physical doctor, as a physician. And on the left side is one of the statues of the regular Buddha. So those two are the main influence in Tibetan culture. So this is how we grow up, and I will share with you more. So this is the Potala Palace, right in the center of the Lhasa, where I grow— I was born and where I grow up. So here is two statues here. It's a One of the famous kings of Songtsen Gampo and his wife from China. It's called Wöntrong Gungdru. So the reason why I'm bringing Songtsen Gampo's photo here, or statue here, is because he became one of the famous and unified Tibetan culture and made empowered Tibetan culture. So at that time, or after him with his descent, Tibetan, we had a first integrative conference back in early 8th century. The king invited physicians, scholars to Tibet from China, Kashmir, Persia, Dogo, Dogo, Nepal, and India to integrate all the indigenous medicine into Tibetan medicine. Since this indigenous medicine integrated into the traditional and indigenous Tibetan medicine and has been developed in its own region and its own unique medical system, which known as Sowa Ripa, and I will mention that. So up to now, I like to show you this beautiful slides. It's a— we call medicine mandala. What does that mean is almost like a land of medicine Buddha. So if you can eye spot one point where you can see the blue Buddha right in the center of this beautiful palace, and surrounding the medicine Buddha in the east, west, north, south, all surrounded with the different layers of different types of plants, herbs, minerals. So they all provide healing in different properties, but I'm not going to focus on this, but I'd like to give you 10 seconds to take a look at it on this particular pankas or medicinal tankas, what we call, or visual illustrations. Okay, so now I'm going to move on next slide. So this particular photo that we have here, and you probably have seen that on our flyer, is one of the famous Tibetan doctor called Yuto Yundek Wangpo, and he is the main person that put regulations for Tibetan medicine and put us— build a school on Tibetan medicine and also made quite a disciplined ethics and conduct for doctors. So which is shown, I put that chapter in here. So in Tibetan medicine itself, it's called, in Tibetan it's called "Gyu Shi," and translation is "Four Medical Tantras." And this one is explained in the second section. It's called "Explanation." Explanation Tantra, which is on the chapter 31. So if anybody wants to refer back, so this is the source. So we all use one book ever since then for Tibetan medicine education. So speaking of the doctor, I want to explain a few things here. The word The word in Tibetan, doctor, I checked in a couple of dictionaries and they all explains either as a medicine man or as a healing of the different healing arts, providing different healing arts in the past. But we don't use those connotation as much now. But in Tibetan, we call Men. As a medicine. Menpa means the medicine man, and men itself means to benefit and to heal, or another way you say it's benefiting or healing. So when you put the pa word there, we call menpa is the doctor. It means the person who offers the benefits or actively benefiting and healing others. Again, medicine men. So we use this word actively into daily practice for doctor's name, although there are 3 or 4 or even more different terms for doctor, but this is one of the common names in Tibetan. So now speaking of the principles of doctor's ethics. So what I want to share this one. Yesterday I went through the chapters to explain to you about this ethics, but it's not that— how to say— I couldn't present as interactive to sharing my own stories, so I went back to flip over with a different way to share, because I have some wonderful story to share. So I put a compassion through action, and this is my journey to become a member or doctor under compassionate teachers or mentors. So one of the story I want to share with you when I was a B2 in elementary school, probably 7 to 10 years old. And I had seen two doctors. And one of them I would call Dr. A and Dr. B. The Dr. A is someone everybody in the community would love to go to see her. And she's so compassionate when she does injection needles on the muscles. Never have a pain. And when she talks, she's really gentle. She's so good at patient. So including me as a 7-year-old, I would love to go to see her instead of other people, the other doctor, which is the Dr. B. So she's someone that nobody in the community like to see her unless she's there. Nobody's there, then they have to see her. And she didn't talk really nicely, and she wasn't as gentle as Dr. A. And I didn't know why, but I did not want to know why they're acting like that. But I, my mentally, I acted with somehow I love to play as being doctor when I was little. So I always go along with Dr. A's action, and I loved her so much. That I was playing as a different roles, I would be playing as her. Then I just found out in last couple years through my mom said, actually the Dr. A is not doctor, she's a trained nurse. And Dr. B, she's the medically trained doctor. So there's some gaps between the Dr. A and Dr. B. To me, the Dr. A, the nurse doctor is She has a great compassion, truly carrying the compassion in her practice into her daily life. So I somehow followed her as much as I could. And so story 2 is about my aunt. She still practices in Tibet, and she's very famous, and she's not as trained as Hai Ling. She used to be barefoot doctors, and she got trainings, but she has the most generous heart, and she's so good at a patient. Every single person loved her. So I got a— she wrote, read my bio. I had another uncle Dr. Chen, who also was one of my mentors when I was in school. And he was also a wonderful person and great with the patients. So all their images stayed with me so much. In addition to them, I had a third person as a patient who turned to be one of the mothers of my friend. Friend, and she told me one last thing right before I graduate. She said, "Young Jun, when you graduate, don't be too happy. I need to tell you one thing before you get on your practice. As a patient, we love to see the most compassionate and most gentle doctor. Even if you are giving us the best medicine, If you are not compassionate to me, if you are not carrying kindness to us, and if you just pass the medicine, just say take this, and without explaining, without asking so much information about her condition, she said we take the medicine home, but we most likely we won't take it. So this is a great education for me too. I take that take advice seriously. So those are the things that I have learned from my neighborhood, how to say, my mentors. And the number 4, I'm going to share later. I have a few slides. Education, compassionate education through culturally and socially. So we have some saying how we grow up. So I put that in there. And then of course the last one and the most important one, one of the most important one is my root teacher from Tibetan Medical School. His name is Khenpo Torotsonam. And this is a fully trained Tibetan doctor and he not only on Tibetan medicine but on all the doctorings in Tibetan culture and religion, he's an expert. So one of the pictures I want to share with you on the right side where he was holding on the lady's forehead, actually at that time he's blind already. He was blind for the last 8 or 10 years, but he still sees, he still saw so many patients daily basis, and what he would do is Instead of checking pulse, he would check the forehead and the ears, and he can prescribe perfect medicine for the person. And he's such a compassionate person, because he wouldn't, he wouldn't waste any time. Every time, every day when he needs to teach, but in between, Lunchtime, we have a 2-hour lunchtime at that time, as still is, and evening we have about 3 hours, we finish by 6. Then those older teachers spend so much extra time with the students, they train so many students. Like one of the doctor, we had a meeting this morning, Dr. Gunjo Yau-sen is the PhD who came to give us a presentation this morning, is one of his teach students many years ago. So he would eat quickly, then he would train the students, because students all come from different areas. And as well as he would teach students, he memorized all the contents. He knows where the— where are everything is in the line, in the pages, in which books. And one My own story is in 2000, I went back to get some training with him. I stayed there in Beijing. At that time, he was in Beijing, so I stayed there for a month. And so, you know, he wouldn't— of course, he wouldn't ask for tuition, so I offered some tuition myself because that's our U.S., how to say that, You know, we need to pay anyway for getting education. So he sent the money back to me. He said, "Go to save the money, go to see your mom. And I know you can do more things for your patient, but I'm so glad you are here. You came all the way back from Tibet, from U.S. to study with me." But this is just one example. He feeds students, he feeds all his whoever comes from a distance to stay with him. They study with him, then they go home. They shelter with him. Anyway, this is one of the compassionate through action example that I want to share. And then back to the culturally education, socially. So we always being told when we were little means if you lose something, if you're not losing something, but if you didn't get something, but if the other person gain and you don't get upset, you always say if you make other people happy, it is equally same as practice of compassion or kindness. So this is a one phrase that I grew up with. And second one, we always say, right, without being a monk or a nun, if you become the doctor, you are equally practicing the compassion and kindness. So we say, "Memba tien, the truth of the Chinese." So like this, I always been told like this, and those are my memories from when I was growing up. Even if in Tibet we had a lot of religions being taken out from our curriculum, is they upgraded into different level, but we still had those wonderful teachers and from social— socially and culturally being and training the younger generations like this. So this is the mentality how I grow up. And now going back to Yuto Yundev Gombustayn, who is the photo that I had earlier. So he's the main person who set up the physician's qualification. So it talks about qualities of doctor, nature, definition, classification, functions, and reward. And in terms of quality, we talk about intelligence, Compassion is one of the major things. Commitment, dexterity, diligent, ethics. So I'm going to focus on the first two today. So being intelligent in Tibetan is called tangpo lola denpa ti lo chi lo den los tsesung denpe. So there's three qualities. Basically, broad-mindedness, open-minded. So search for every possible things to help patients. I'm coming back for this. Number 2 is a mental stability. Number 3 is a discerned and wise mind. So I'm coming back to the intelligence as an open-minded or broad-mindedness. So what I see at this point was as being trained doctors or nurses or International, in our medical education, I think we're still not broadened enough to help patients. The reason why I'm saying this is right now we're going through the COVID-19 situation and a pandemic, and now the frontline doctors are only the Western doctors. And Eastern doctors like a Chinese doctor, Tibetan medicine doctor, and also Ayurveda doctor, they do not get any chance, or nobody reviewing their— what they can offer to current situations. So one of the reasons we're doing this many seminars, I have done 3 or 4 seminars in English to present the COVID-19 what Tibetan can— what Tibetan medicine can offer to this point. So, I think we are intelligent enough to be in the intellectual part, because we're going really good, try to do research, to finding out vaccinations, and finding or making, even having the car makers to make ventilators. But we're not broad— broadened enough to see the old traditions, what old tradition or traditional medicine can offer to this, how we can integrate into this case to help COVID-19. So this is my one suggestion or thoughts that I want to just put here. Although in Eastern medicine do not have those randomized controlled research. All those medicines have been practiced in the field for thousands and thousands of years. They are open lab. So I hope we can use different glance to take a look at this, see how we Eastern and Western medicine can work together to open that, to pave that new road as an integrative care for the COVID-19 pandemic to save patients' lives. So speaking of compassion, so in order to do compassion, so this is one of the major things that we get training in Tibetan medicine. So through that chapter, Chapter 31, is called Chazin member. So it will have all the description of how you practice, what are the preliminary practices, actual practice, engagement. There's a step-by-step path set up. So as Geshe Lobsang mentioned, the cham tsik, or loving and kindness, compassion and empathy is one of the major training we get. So I was just want to share one of two shocks that my, as my cultural shock. When I came to US and I heard people need to get trained in compassion in later age, I was so astonished that why as people need to be trained, retrained like this? Why wouldn't they be trained when they were little? So that was my first question. And second thing is I'm even more astonished is healthcare provider had no training on compassion in general. However, nowadays, at least those doctors in the frontline, they're using their compassion to help patients. But on the other hand, we need to have a compassionate care and compassionate trainings in schools, like a curriculum, bi-curriculum, so it would be making a huge difference. So the third thing what I want to mention is that in order to practice compassion, then there's 6 mental applications, 2 applications to to be maintained, 3 obligations to be understood. So those are everything is described in that chapter. But how do you do that? How do you cultivate this? What are the methods? So you're actually using your 3 drawer method. It's a body, mind, speech. So those are— you're practicing everything through this mind and body and a speech. So verbally you'll say excluding words. You don't say harsh words. Bodily, you provide care. For instance, we provide the oxygen mask, or you provide food. At this point, we are coming out together to— one of the things we've been offering is free care of webinars. The reason is we want to generate or donate as much information to the public as much as we can, so frontline healthcare providers, they can use some of the information. Then they can empower the patient, and they can be also feeling less stressed. So this prayer is one of my also powerful prayer for me, but it's most for Tibetan doctors. This one is already read by Geshe Lobsang La, but I still want to read one more time. And may all types of medicine wisdom develop perfectly with me and benefit to all sentient beings like the sun and the moon. May everything I speak Because, Omnisense, may all formula I prescribe be the medicines. May all I give be beneficial, including the telehealth or telemedicine. Bestow to me the conventional and unconventional blessing. So in Tibetan word of the men, the medicine here we talked about earlier, right? It's called mint. So it's not necessarily only limited to the drugs that we take. Anything that's beneficial, being positive, it is considered as a medicine. So including now, a lot of us cannot work out and we cannot see the patient directly, but we can see them through the telehealth and telemedicine. So this is why I included there. So now let's see. I have a question here. Is it possible for us to get trained with a compassionate mind and heart? Yes, good news. We have this classical 9 Tibetan steps or phases mindful training maps. So take a look at this. Beautiful thangkas. Or actually, this is a sand mandala. This is a different type of mandala that Jennifer mentioned earlier. They built different types of mandala, but this is actually different. It has a— the name of this one is called Mindful Training Map. It is actually built by Geshe Lobsang. Last year, right around this time at Bernal Heights Library in San Francisco. We had that exhibit for 2 months or 1 month, I forgot. Then speaking of the impermanent, it took him about 10 hours to do this, to get this fixed. So everyone wants it, so we fulfilled their wishes for 2 months, then we destroyed at the end. So I want to show you one thing here. So this is the Bernal Heights Library in San Francisco. This is the place where he actually just do the graphics, and he did like— he said like this for 10 hours, only had a 10-minute bathroom breaks. But in order to build the other sand mandala, it would take much more time. Just for this one took him by himself and his daughter did help during the day. But took him like, I said 10, but actually it's like 12 hours. Now I'm coming back to this mandala. So on this one it has animals, elephant, monkey, and a layperson.

What do you think, Tenzin? Would you like to begin?

Oh yeah, most certainly. Yeah, and we can leave some time for Yongjun to finish at the end.

Good. Let me just say that I'm so happy to have met you through this process. I've known the other speakers, but I'm happy to let people know that you have a book coming out, A Path Tibetan Medicine and You: A Path to Well-Being that you did, and you were a Fulbright Hayes Scholar. Your research is on death and dying conceptually, and you have an anthropological background, so we're eager to hear your presentation. Thank you.

Thank you, thank you, David. So in the interest of time, I would I'd just like to jump into my presentation, but before I start my presentation, I really quickly want to thank everyone who put together this really wonderful webinar. I first had contact with Yonton Kelsang, and then suddenly Jennifer, David, and Lobsang all came together to put this together. I'm really happy that I'm here, and thanks for having me here. Just to quickly give you a brief background from where I'm coming from and what I'm aiming to put on the table. I'm a Tibetan medical physician and trained in anthropology. And my research focuses on attitudes toward death and dying and how they inform and shape care for dying people. And this research that I am really excited to share with you is focused on looking at death and dying and how care is provided for terminal patients through the lens of Tibetan medicine and Buddhist culture, Tibetan Buddhist culture. And I conducted the study in southern India among Tibetan refugee communities. And I'm really happy that I'm able to do this here today because all the former speakers Jennifer Lobsang and Yangton really set the stage for me. So I'm really happy about that. So let me, let me tell you all that what I intend to do today is to focus on a few key themes or points here which came out of my research. First, I want to really focus on the conceptual framework of Tibetan Buddhist cultural attitude towards death and dying. And that's why I have the first point I will very kind of briefly touch upon, is how in this particular cultural setting death is viewed or employed as an avenue to self-investigate and to facilitate a morally ethical behavior, and how they're able to do that. And then I'm going to lead you all to the care for the dying and how in Tibetan Buddhist culture the way they care for terminal patients really highlights or make the intersection of Tibetan medicine and Buddhist philosophy and psychology very visible, acutely visible. And on top of that, I will talk, talk a little bit about how, what kind of contribution the Tibetan doctors they make in complementing the already structured framework in Tibetan Buddhist culture, which is like they bring in a very interesting creative Tibetan medical theory of personalized care based on what Tibetan call rang shin. Rang shin is inherent constitutional nature. And eventually I will touch upon very briefly on death rituals, they are one of the key components in the way they care for dying people or the terminal patients. And I especially want to emphasize here that in, in current situation where things are acutely becoming more and more uncertain or unfamiliar, the ritual in what I've seen in this population setting is very much focused on helping familiarize the dying person or the deceased person to make them familiar with unfamiliar world. So let's begin with these cultural models that undergirds the death and dying understanding in this population setting. I quickly want to share this image with you. Perhaps maybe some of you might have seen this image before, but this is an image that really changed my trajectory of Tibetan medicine practice and my academic pursuits. Because in September 2008, I encountered this particular death which I had very little information about, despite the fact that I was brought up in this very cultural ambience or cultural setting. I read— so this monk, a senior practitioner at that time was in the state of Tibetan meditation called "togdam." And if you are not aware of the word or term "togdam," togdam in Tibetan literally means having control over your consciousness. But not just the consciousness, but a very subtle or extremely subtle consciousness. And the senior monk here in the image, he stayed in that meditation which happens after the clinical death. So he was already diagnosed as having no any brain or cardiac pulmonary function in his system, so he was declared clinically dead, but he stayed in Tukdam meditation for another 18 days. And I had an opportunity to be there as a member of the field investigator for collaboration research between Tibetan Medical Institute where I was working at that time with the UW Medicine in the US. And so that completely blew me away because I started to realize during my time over there in southern India, that was in September and October, it was extremely hot and I went there with really a certain level of skepticism and I was there and I Each day passes and I started to realize this is the kind of death that not only informs and shapes the way the cultural member view and understand death, but it also enforces, it also validates, it also inspires people to aspire to experience an idol, or not only experience but enact an idol living in the dead. So that was really interesting for me in terms of it really gave me a deep level of aspiration that I want to know more about this. And so in 2009, I decided to move to the US to go back to school and eventually got into a graduate program. And hence, at that time when I had to work on my research proposal, I really wanted to focus my study on that. And how I can incorporate that with looking at how we can care for terminal patients, dying people. In 2014, I was doing my pilot study in the same place, and so I went back to Tibetan settlement in South India. And this image is the mummified body of the Tibetan senior practitioner who went into tukdam in 2008, and it was especially instructed and guided by His Holiness the Dalai Lama at the time. In 2014, I was able to have an audience and took the picture. 2017, fast forward, I was in the same region certainly to conduct my doctoral research, and it was really a sort of wonderful coincidence, or same to be this moment for me when I, just 2 days before I was to leave the Tibetan monastery down there, I was informed by one of my informants, my good friend, saying that the young incarnate lama who has been identified as reincarnated lama of the Rinpoche, or the senior practitioner who passed away 10 or 9 years ago, would be enthroning. So they have an enthronement ceremony. So I was able to go and be part of that enthronement. Enthrallment ceremony. And the following summer, I went back to collect some of my follow-up data, and I had this really wonderful opportunity to go and see him. And I had a few question and answer sessions that he wanted to engage, he wanted to know something about, because since he had been told that I was one of the investigators for his predecessor when he stayed in Phuoc Tam, so we engaged in very joyful conversation, which we don't have time for now to share all this conversation. But again, I want to give you guys a kind of a context of the background, how the information or the understanding about death and dying is informed in this particular cultural setting. And one of the things that we can see here, the, the pattern that we see here, is the continuation of life, rebirth or reincarnation. And again, in following slides, I want to also emphasize that it doesn't necessarily have to be that way, because how we, how we can replicate that, how we can situate that in a society where they don't necessarily believe in reincarnation or rebirth, and/or in a secular setting. So when I went back to do my doctoral research, certainly I I didn't just aim to look at Buddhist practitioners, both the monastic as well as the lay community, how they engage in Tukdam meditation. Because not always that people would end up staying in that particular meditation. So I really wanted to look at the broader cultural influence or impact on the way they think about death and dying, where they die, and how they care for terminal patients. And I realized that it's, it's, it's very intimately connected to rest of the community members. And so it's very culturally orchestrated process where you see— where I saw the collaboration between Tibetan doctors and Buddhist practitioners and family members. And one of the things that we are witnessing in today's situation is really like at home here in the US as well as across across the world. People are dying because of COVID-19 without really much of that social process. Many people are dying alone, or the frontliners, the doctors and nurses, they have to really fill in. And either the doctor has to make a decision of life and death, or the nurses have to fill in to, to substitute for family members members. They are the ones who actually are there by the, by the deathbed and trying to provide the process, the social processes which are so critical. One thing that I mentioned earlier very briefly is about the way they view death and dying. And for me it was really intriguing because again, as I said before, despite the fact that I came from the same community, it It really surprises me to meet each of those different informants that spent almost 2 years living there in the monastery complex. And they look at death and dying really more as a medium to self-investigate themselves. And in doing so, they really conceived that, or stages of dying, as a paradigm of not only cultivating compassion, but what comes out of it. And which they always tell me, they would use a very specific term which I have been following. They use the term called "ning tok." And I have used it interchangeably with resilience. And so "ning tok" literally means "heart and power." "Ning" means heart and "tok" means power. So it's the heart power or the courage. So for them, the, the, the bi-directional relationship between the way they can employ the understanding of death and dying, not only in investigating their moral behavior but also in developing a spiritual, uh, spiritual development or develop their spiritual understanding of themselves as well as others. And for instance, If we can look at this image, we have two images here. Both of the images that you would see that the deceased person had stayed, have stayed in the state of Tukdam, which I alluded to before. And most of the time the students would be using the space and time at that moment not only to engage in meditation but also to recite a very specific text. And so in one of the images here you could see a very senior Tibetan Buddhist teacher, Tai Situ Rinpoche, reciting a text next to the senior practitioner who stayed in Tuktam. The other one, who was one of my key informants, his teacher passed away and the teacher stayed in 11 days of Tuktam practice. And so one question that I ask over and over again doing my research, not only doing my doctoral research, but also right from the moment when I was exposed to this particular way of experiencing dying was why they would do that, why they would invest their whole life, what, in trying to be in a situation or a condition that they can engage in this particular meditation. And they would tell me almost all the time unanimously that to meditate on tongyi. And I want to issue a caveat here that when I use the term like emptiness here, certainly I think most of you would understand that there is a much more deeper and wider meaning of emptiness. But for someone who is uninitiated or who haven't really been exposed much to some of the Buddhist Buddhism that has been translated into English. Tongyi in Tibetan literally means the state of nothingness or the empty. But this certainly doesn't mean that nothing exists. And those informants would constantly inform me that when they talk about tongyi, they are really referring to the fact that things exist, but they don't exist in itself. They don't have an independent identity or existence. They are dependent on everything that is in their surroundings, which includes people, different species, and then the environment. And so that's— so the way I tried to design this flowchart is really to give you all a sense of how they actually structure their understanding of death and dying, and then they use that model in their daily practice. Not only in the face of death or dying, death and dying, but also in the face of any kind of life sufferings or crisis. Now, being able to be in the state of meditation like Thukdam is really to transcend beyond the sensory consciousness, which the Tibetans would say is the or the coarse consciousness. So sensory consciousness that we usually are— which usually are based on our five sensory organs. So we see and hear and smell and the tactile sensory of experiencing something on our skin or taste. Those are all kind of dissolved. And when they are in the state of tokdam, they really are at the extremely subtle consciousness as I alluded to do before. When they're in that and they focus or contemplate on the philosophy or the understanding of emptiness, they're able to have this really profound realization of how everything is related or dependent upon each other. And they would tell me that once someone would have that profound understanding, it would, it would automatically develop or generate a deep sense of compassion and loving kindness, which will lead to living a life of morality and integrity. And so it's not, it's not something like you will be told by someone that being compassionate in nature is really happy, really healthy, and you you will be happy, and then you try to bring that up because you need to convince yourself that how effective and how helpful is not only for you but also for others. And so in that state of mind, in the population that I studied, for them it really helps them. Since I mentioned earlier that this community, or the members of community, have a deep sense of belief in continuation of life, or the rebirth, that really helps them to have the confidence in their life because they have already prepared themselves for one of the most difficult things in their life, which is to be prepared for the next life. But then it's not really— it's always a work in progress, they were told. So it's a constant or the continuous process of preparing themselves, and once they have that realization they could generate that state of joy and peace in the face of dying or even in any different life challenging situations. Now I want to show this other aspect. What could be significance of contemplating on a philosophical concept like interdependent— interdependence, meaning interdependent nature? And again, the same thing. Being able to be in a state of mind or consciousness where your focus, where your attention is not disrupted. And so they— how you can do that is really more about on a regular basis of training your mind. And then once you have that sense and then you focus on the understanding of interdependent nature, you can generate or cultivate the sense of loving kindness and compassion, which, which would facilitate a life of morality and integrity. And this is one of the things I want to emphasize here, is with that sense of mind or consciousness or state of being, if you will, could generate a state of mind where one could find joy and peace. Irrespective of whatever situation one finds herself in. And so for, for me, one of the key findings, even though it might sound very obvious, but for me, the more people I spoke to doing my research, I realized that many people don't necessarily realize that how they actually have been so much influenced and informed by their cultural values and beliefs. But most of the senior practitioners that I spoke to, they are very— they are able to be extremely detailed in terms of how they're going to set their mind, train their mind, when they are in the midst of life challenges or when they're facing their death. And so they will tell me that the critical part of being able to tackle with or address a situation which is very challenging is being First, being acutely focused and attentive. Now, being focused and attentive itself might not necessarily help because you might be focused on something which could be negatively impacting your mind and therefore your decision and your behavior. But that focus and attention— attentive mind should be on the virtuous mind, the mind that I elaborated on earlier. Elaborated on earlier about the mind of being the state of joy and peace. And once they are able to have that, then one could develop the sense of heart power, or the nyin gyok, which I said before. And for me, it was interesting in terms of looking at how that would complement the Tibetan medical doctors' engagement with terminal patients. Patients. And of course, most of us know, and especially the other former speakers alluded to all those key information, I don't really have to spend too much time on that. But two key things here are the ways of knowing, how in Tibetan medicine we, we attempt to understand the health, well-being, disease, the mode of treating, looking at different aspects of human well-being. Well-being, those all are very much grounded on Four Noble Truths and the fundamental concepts of— And then the other thing which I thought was really key doing my research was the way the Tibetan medicine emphasized the importance of mind or consciousness and how mind is being associated with the root cause of everything. Whether we look at the physical or the psychological aspects. Especially in the case of caring for terminal patients or someone who are actively dying, the hope and purpose very much get intertwined with a person's consciousness of mind. And so therefore I have this particular image or the animated version of how actually we can look at that, what Tibetan doctors believe bring on the table is they will come with their way of making sure that what each person need, what each patient's needs are. And so they would use the very unique theory of looking at identifying the individual's nature. And in so doing, one of the One of the things which I found really interesting was how they can help the Tibetan doctors and therefore the family members, because they're constantly collaborating and working together. It's like how you can understand both the physical and mental propensity of the dying person, and which could be really helpful for engaging in a very open and honest conversation. And this is the Constitutional Self-Assessment Tool that we came out with after doing research here at the University of Minnesota a few years ago. And both the self-assessment tool and the lifestyle guidance tool is available on the center's website for free, so anyone can get access to that and work on not only for the self-care, but also for caring for their patients. And finally, the ritual aspect is, I thought, which is really key to the way they care for dying person or terminal patients, but also for the family members. So really what it does, I found that it provides a common ground for for all these different collaborators informed by common cultural values and beliefs, because they always tend to have a certain level of conflict or tension when they're caring for, especially in the face of difficult times, they have to engage in certain conversation which might be quite challenging for them too. And so that's what I found is really helpful. And the other thing is It provides a collective goal despite the conflict among, as I said before, cultural actors, and sense of normalcy and predictability. And it's even more acutely needed in today's time where everything is so unpredictable. And then the sense of order rather than chaos. And finally, it helps in providing the ways or means to stabilize a sense of self. When we are experiencing that many people are actually losing their personal agency, being completely inundated by information and all these other conspiracy theories that we are exposed to now. And so that's one of my key informants who helped dying person or deceased person by reading the Tibetan Book of the Dead text to them. He told me that the text— and I asked him like, why you would read this text to them not only when they're dying but also when they're already dead? He told me lots of other things, but one of the key things he told me was the text which he— you all see he was reading— the text written in simple prose explains the physical and mental changes, experiences, feelings and merits of being mindful of this phenomenon. And finally, I want to leave you with this quote. One of my key informants, as well as a very well-loved teacher at the Tibetan Buddhist monastery where I did my research, when I asked him how he wished to die, he told me, "When my death comes, I wish to die like a child falling asleep." in a mother's lap with joy, love, and trust. Thank you.

Thank you, Tenzin. That was so illuminative of the kind of work that you've dedicated your life to and how it will be helpful to so many people. We're now going to have the pleasure— only, we're going to end right at 3:30. We have about 15 minutes for Dr. Mike Rabot, head of so many things at UCSF, but I met him at the symptom management service, and palliative care has been his passion in medicine. And Michael, you've been thinking of all of this, and you live in the real world with your colleagues who are facing especially issues with the epidemic and worries of their own health. So anything you would like to share with us, we'd love to hear.

Well, thank you so much, David, and thank you to all the people who have spoken and, and of course all of you who have joined. And I, I certainly have just a couple of reflections from my perspective as a Western doctor to add to this discussion. And I know I'm glad that this is perhaps for some of us just the beginning of the conversation. I think my, I think my perspective as a Western doctor hearing these comments makes me think a lot about the identity that I and many many physicians, many people in many roles in society and in our communities these days are having, which is a relooking or questioning at what our role actually is and what we really do. It's been a very painful process, I think, for many people who have been labeled by society, quote unquote, as nonessential, and other people grocery store owners and doctors and nurses who've been labeled as essential. And I think this really gets to a question of identity and who we are and what we think we're doing and how we can contribute and how we sit— are situated within society in the community. And I think there's both pain, I think there's potential empowerment that can come from identity. And one of the things that Western medicine certainly has to learn is to be able to hold a broader identity for healthcare workers, and in particular for physicians, where I think this is most manifest, the idea that our role is somehow to fix things, as opposed to bear witness to things, or to recognize things, or to provide compassion in the setting of suffering that's going on. And so in some ways, a session like this is really helpful to— for a Western doc like me to pay attention to what I think I'm doing, what I'm trying to do, what my purpose is. And in some ways, I think that that's a little bit of a microcosm of this whole experience of learning other ways of seeing dying, of seeing suffering, of seeing illness, of seeing COVID from different perspectives, where there's been a real fundamental reorganization or disappearance of the boundaries, traditional Western boundaries, between being a between a patient and a healthcare worker, between a patient and a doctor. There's been a breakdown of boundaries between personal and professional, where most of us on the Zoom call are sitting in our living rooms or our bedrooms or our kitchens doing something sort of professional but sort of personal too. And I certainly am finding that in my own work. Where when I— I spend a lot of time taking care of patients with cancer, and when I get on a Zoom clinical meeting with a patient with cancer intending to talk about their cancer, even though it's COVID, they still have cancer that they're dealing with, which is a big deal. And they often are insistent to find out how I am and to find out how my family is. And really helps me recognize my relationship to them as something different than someone who's fix— gonna fix and someone who's going to be fixed. That we're really actually, and this is a word that came from this session today, we're really interconnected and that we're both gaining from that. And so In the setting of all this loss, I don't at all presume to sort of try and pivot over to what the silver linings are, but the process through this tragedy for some of us, I think, can really be about how much we have to gain by listening to others, by being present with others, certainly by learning about other cultures and other religions and other philosophies, because I suspect that many of us these days, depending— no matter what our belief is, what our religion is, what our culture is, I think are realizing the limits of our culture, the limits of our thinking, the limits of our rituals, and that we need to do more to learn about how to be part of a much larger community with lots of ideas, lots of traditions that we can benefit from, and really find the truths that so many of us might have to share with each other. I'm gonna stop there and appreciate the chance to host such beautiful, beautiful thoughts, ideas, and people.

Thank you all.

Thank you, Michael. That will be your goodbye, and it was beautiful to help orient us. What I'd like to suggest now because all of you out there have had a chance to get to know little bits and pieces of the speakers. So I'm inviting everyone following Mike now to just say a sentence of goodbye. Some people say "no coming, no going," but maybe what you would like each of our speakers to say briefly to our audience so we can end closer to 3:30. And I'll finish with a very short Dalai Lama story. So Jennifer— Jennifer had some wonderful intentions, which we will type up and put on the resource list that you'll be sent later. But Jennifer, you might want to say what you'd like to say.

Thank you, David. And thank you, Tenzin-la. And thank you, Mike. Your words were very moving, Mike. Thank you so much for sharing your inside view of what it's like for you to be going through this crisis and having our roles and boundaries kind of dissolve and be called into question. And having the courage to think about new ways of being that honor our mutual humanity. I think that's just really beautiful and it's very humbling for us all. So hopefully we can start to figure that out together as a community. And I just want to thank everyone for staying with us. All through today, and wishing you wellness and wholeness through this process, and we'll go through it together. So thank you.

Thank you, Jennifer. And Tenzin, would you like to say something to our assembled people?

Yes, certainly. Thank you, David, for this opportunity, and I really want to emphasize again all the hours that you all have spent in putting this together. I'm really not only so joyful right now, but I also really feel that how, how fortunate I am to be part of this. And you all put this together, have been working on this for last how many weeks, I don't even remember. But the UCSF Palliative Care Division, Kunde Institute, and then all all the individual effort that comes into play here, and then of course Mike coming in and helping us to guide us in many different ways how we want to make this as helpful as we can for people who would be joining us. This is such a special experience for me. And again, and on top of that, I want to say that for me to be able to share whatever little bit of work I did for my own research is so helpful in terms of processing what I have learned a little bit and what I have attempted to present to my community. And today, listening to all of the speakers and for me to be able to present this, it really helps to bring that— to make that bridge stronger, so to speak. And also for me to, you know, being able to verbalize most of the work that I was— have been thinking about for all this time, to really to process it further and to, to help myself to get a better, better grip of what I've learned over the course of last few years. So I really want to thank everyone involved in this webinar and everyone who joined us today. So thank you very much.

Thank you. And Yang Dron? Or a love song?

I'm going to do the closing meditation, right? So I'll just do it at the end of that.

Okay.

We just have a couple of minutes and I don't know if Yangdran got back on.

Yes, I'm here.

Oh good. You want to just say goodbye to our group?

Yes.

Yeah, I'm so sorry that we lost each other. For the last 5 to 7 minutes. So I promise to make the presentation available for everyone. So one last thing I want to mention is thank you very much to put this event together, and I hope we can do again in the future to bring more. And do your grateful moment and meditation. At least twice a day, take as a medication. Do the meditation as a medication twice a day, 2 minutes each time, AM and PM. Thank you.

Thank you, Yangdrön. Quick story: the Dalai Lama, my favorite story. In 1984, he was interviewed by a woman journalist in Dharamsala, and he was telling her the terrible sorrow, sadness beyond what anyone can imagine, of the difficulty and pain that his country had gone through and was going through. And she saw in his eyes the depth of sorrow, sadness, tears. Then he looked out the window at a tree, and when he looked back at her, she said, he was transformed. And he said, "Life is so very colorful, isn't it?" And being in the present moment is a wonderful place for us right now, here. And we get to finish with a wonderful meditation love song.

Okay, so now it's continued from the previous meditation. So now end of the usual meditation is dedication meditation. So now here is the dedication ceremony. So since you are offering a service to the patient, so it is part of your generosity, okay? So at the end of the generosity, there is a prayer or dedication every single time you offer your service to others, especially for the healthcare professionals. Professionals, they're your really crucial service. So this is the prayer saying like this. It is a traditional prayer. I slightly altered this wording here in order to fit to the particular for the healthcare professional. Through the power of this vast act of generosity and service, may I spontaneously gain loving wisdom from for benefit of all patients and members of community. For all those who are not helped in the past, through this act of my service, may they all be healed. So this is the prayer service. Like this, I'm going to say this in the Tibetan. While I'm saying, you may able to meditate. Jinpa Yeje Ye Wadiyidu Druvidu Doranjo Sangye De, Ose Gyawanamye Marjuve Kivu Tsunam Jinpe Dru Yoroche. So now this is the prayer from the Medicine Buddha prayer. May all who are sick and ill quickly be free from their sickness. Whatever disease there are in the world, may they never occur again. So, I'm going to say this again in Tibetan, this prayer, as a— and chanting, so you can meditate upon the word that I'm showing here right now. And here, never occur again could be any disease, and especially particularly for the pandemic disease right now, Virus. So once you've done all this, your service and practice, you should appreciate yourself that you're able to do this service, and then dedication. So this last 1.5, 2.5 hours, we definitely accumulated a lot a lot of positive karmas if you are Buddhist. And not— if you are not Buddhist, you accumulated a lot of good energies to serve others. So, all of the positive karmas and energies we dedicated to have a happiness and peace in the world, and especially for the patient that you are serving in the hospital settings. And then if you are Buddhist, your primary goal for the spiritual practice is in order to achieve enlightenment. So you dedicate all your practice and good karmas to achieve enlightenment, to benefit of all living beings. So dedication practice in Buddhism is more like a depositing your money in the term, term which is achieve enlightenment. If you're not Buddhist, you may have any other higher goals. You can dedicate all your positive karmas, energies for that your goal to benefit all living beings. And thank you very much for everybody, and thank you very much for David and everybody who organized this event. So I'm really deeply moved by this such event, and wonderful my friends here. And thank you again, and hope we can have such event again in sometime in the future. So thank you very much, everybody.

And go out and see the sky, but don't go very far. Stay safe, be well, and thank you all for joining us, and thank you for encouraging this kind of a presentation. Thank you.

Thank you.

Thank you. Thank you again.

Thank you. Thank you, everyone. Thank you. Thank you for all the comments in the chat.

Thank you.

Thank you.

Thank you. Thanks very much. Thank you, everyone.

Thank you.