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Relax, Let Go

Dear friends, I wrote this poem in veneration of Thich Nhat Hanh, whose inspirational writing and poetry has helped me live more peacefully with mental health issues. I am very new to Buddhism, but I feel a deep connection. I hope this poem conveys the peace and calm within the teachings, and conscious breathing for

Relax, Let Go

Dear friends, I wrote this poem in veneration of Thich Nhat Hanh, whose inspirational writing and poetry has helped me live more peacefully with mental health issues. I am very new to Buddhism, but I feel a deep connection. I hope this poem conveys the peace and calm within the teachings, and conscious breathing for

Is Work Love Made Visible?

I have been so touched by the posts many of you have shared on my Facebook page or my website about a time when you were small and recognized that the needs of a living thing mattered to you. Every one of them is a love story. As children we had the capacity to simply love life even in some of its humblest forms… an earthworm… a duckling… even an ant, but as adults we often hide our love or even experience it as something else.

How many times are our actions actually motivated by love without our ever knowing it, even when our love is profound and part of who we essentially are? It is easy to recognize romantic love, parental love, fraternal love, the love of country and the love of friends. But how about those of us who love with our minds, studying for years in order to be there with the knowledge to help strangers or those of us who persevere despite daily difficulties because of a deep love of life.

When I was first diagnosed with Crohn’s disease at the age of 15, I was enraged. My illness separated me from other people my own age. The fun they had and the things they did together required a physical strength that was far beyond my capacity. For the next several years I was a deeply angry person, hating all the well people, isolated and envious and resentful.

When I was 21, I was excluded from the opportunity to spend a summer with my classmates offering help to people in a remote village in Central America. When I discovered that I would not be selected to go because of my physical vulnerability, I was flooded with rage. In the midst of the most intense feelings, I suddenly had a very strange thought. This anger is not true. It’s really your love of life turned inside out. I was stunned. I had believed my anger for years. Yet somehow I was able to see that intense as it was, it was not real and it had never been real. What was real is that I loved life passionately and deeply. I had not known this. The anger had gotten in the way. My love of life was exactly as intense and constant as my rage had been but it was different. It connected me to the world around me rather than shutting me out of it. In the blink of an eye I realized I could find ways to live from this passionate and loving place, my own ways. I was not going to Costa Rica, but this could not stop me from finding ways to love life. The rage that had been my constant companion was gone and it never came back.

There are other places in my life where love has disguised itself as something else. Like the practice of medicine. It’s taken me many years to recognize that medicine is a form of love. The ancients knew that love and not expertise was the foundation of medicine but we, seduced by science, have almost forgotten this.

According to Cicero, The Temples of Aesculapius, the world’s first major health center, was built around a statue of Venus, the Goddess of Love. As a young doctor this was so completely outside of my daily experience that after reading it I put it out of my mind and forgot it. It has taken years to recognize this as the deepest truth about the work of all health professionals. Many of us may still believe that loving our patients is unprofessional or weak or even shameful. We have allowed our science to separate us from our truth.

Love is a part of our Lineage. In the 14th century, Maimonides — asking for the wisdom and strength to practice the medical arts — said: Inspire me with love for all of thy creatures. May I see in all who suffer only the fellow human being.

For several generations now we have not been trained to be fellow human beings. We have been trained to be experts. But perhaps now is the time to escape the limitations of our training and remember the source of our strength. For all of its scientific and technological power, this work we do is not a work of Science. Science is only our most recent set of tools. This work is a work of Service and Service is a special kind of love.

The Healer’s Art, the course I developed for first year medical students, is now taught at 90 medical schools across the country and around the world. For the past few years the students who take this course at UCSF where I still teach it have designed a T-shirt for their class. It says THE HEALER’S ART: BECAUSE MEDICINE IS AN ACT OF LOVE. The thought of all these beautiful young people wandering the halls of one of the most respected research-oriented medical schools in the world in these shirts gives me a deep sense of belonging.

One of the deans at a Medical school in the Eastern United States commented that after teaching the Healer’s Art, he had noticed a shift in his own relationship to medicine. “For me this course is like discovering after 40 years that you have not only married the right woman but that you are completely and hopelessly in love.”

So what is your own experience of this? What keeps you going? Is your work an act of love… or not? Can you remember a time when you allowed your love to show in your work? What happened? If you have some thoughts or stories to share, please do so in the comments below.








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Befriending Life

I grew up in a world without animals, in urban New York City in the 40’s, and all the children I knew lived in big apartment buildings like I did. None of my extended family or friends had ever had a pet, unless you count a goldfish or a turtle.

When I was 8 years old, I attended summer camp for the first time. This was my first experience of country life and I loved it. I also developed a crush on one of the camp counselors… a 16 year old who seemed like a prince or a knight to me. One morning at breakfast he gave me a small box. Looking inside I found a tiny kitten possibly only a week or so old. A mother cat had been run over in the camp driveway and this was one of her orphaned babies. I was thrilled. In the box was an eyedropper. My prince told me to feed the little one a few drops of milk as often as I could.

I have since helped mother cats to raise extra large litters of kittens. Those of you who have also done this know how much skill and attention is required. But I was only 8 and the camp directors, disapproving of this unconventional gift, did nothing to help me care for the kitten. One morning when I went to feed it, it lay still and cold in the soft little nest I had made for it. Reflecting back, this may have been the very moment that I became a pediatrician.

The impulse to befriend life goes back a long way in many of us, yet few of us are fully aware of this. In my classes and workshops with service professionals, I often ask people how old they were when they first realized that the needs of a living thing mattered to them. Most were under ten. The stories they tell from the early times before they had any training or tools to meet the needs of others are as beautiful as they are powerful. They reveal the heart that lies beneath the expertise so many of us use daily in our work. The expertise is acquired… the heart is not.

I collect these stories. Many of them are very simple. Once a workshop participant shared a story that his mother was fond of telling about him when he was small. Every day before he left home for kindergarten, she would give him a clean folded white handkerchief to take to school. Every morning when she did this he would ask her for another one in case someone else needed it.

One of my favorite stories was told by a young medical student who shared a memory from his childhood. As a child he had lived in a Victorian house in San Francisco and his mother used to bathe him every day in a claw footed bathtub. At the end of the bath she would stand him up, pull the rubber plug and reach behind her for a towel to dry him with. One day while he was waiting to be lifted from the tub he inadvertently stepped on the drain, cutting his foot badly on its sharp edge. He had shrieked and his mother had cried out too, lifting him out of the tub, holding his bleeding foot, and warning him to never ever stand on the drain again. So every day after that, when she pulled the plug and turned away from him to reach for the towel, he would be very careful not to stand on the drain. One day he was standing there looking at the drain and being careful not to stand on it when he suddenly noticed the water, circling the drain on its way out of the tub. Seeing this for the first time he became concerned. The edges of the drain were very sharp. What if it hurt the water to circle the drain? So every day after that when his mother lifted the plug and turned to get the towel, he would carefully drop his washcloth over the drain to be sure that the water would not be hurt going down the drain. We were all healers long before we were experts.

People often underestimate children and we underestimate ourselves as well. If you are a health professional, or someone who is involved in any kind of service work, your wish to befriend life is likely to be older than your training. Perhaps you have a story about this? Or perhaps you have another kind of story, of a time when you went along with a group of other children or adults and harmed an insect or an animal only to discover that this outcome was the last thing that you intended. Sometimes people have carried this sort of story for many years with deep shame, blaming themselves for not being able to stand up to the situation, never realizing that moments like these are moments of epiphany when we discover who we really are and what is most important to us. Eventually we all become old enough and strong enough to be able to live by these values.

I would love to hear your memories of a time when you first realized that the needs of a living thing mattered to you, or a time when your desire to serve others first surfaced. Please share them with me in the comments section.

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On Learning To Love

Years ago a friend took me to a talk offered by her spiritual teacher. I remember this because the topic of the evening was unconditional love. The teacher began by talking about the nature of pets. Years later I can still remember his definition of a pet: “A little tuft of consciousness that circles around a person like a moon around a planet, and completes their energy field making them more whole.”

As I read the deeply honest and very beautiful things that so many of you have posted on my website or Facebook page, or sent me in emails or texts, I am reminded of this. Perhaps pets are a little tuft of Divine consciousness, and by offering us a taste of the great Love, which is the foundation of this imperfect and impermanent world, they heal us in ways that are profound. And in some powerful and mysterious way even the youngest and smallest of them can kindle an echo of this Divine love in us as well.

I was born and raised in New York City and I did not really know an animal personally until I was 27 years old. As the child of a brilliant and intellectual family of doctors and nurses I grew up with the distinct impression that dogs and cats and rabbits and hamsters were a lower form of life. But perhaps this is not the case. How can creatures capable of such effortless unconditional love be of lesser consciousness than we are? How can lesser creatures embody the sort of unconditional love that can perhaps only be learned over countless lifetimes?

I have been fascinated by the idea if reincarnation since I was quite young, and at one point in my life read a great deal about this. I still wonder. What if each of us is a thread of consciousness which passes through many lifetimes like beads on a string, each lifetime offering its lessons and opportunities for growth, each one purifying the thread passing through it so that finally we become the pure thread of consciousness that is our essential being and we do not need to return. Perhaps some of those who are about to get off the wheel of repeated incarnations and go on to higher things may take one last reincarnation in order to accomplish a last tiny piece of karmic business, something left unlearned or undone that can be completed in 10 or 15 more years of living.

Perhaps our pets are such high beings, dharma teachers who have almost fulfilled their Karmic mission over lifetimes and whose hearts through generations of learning and practice have been made able to love unconditionally. Perhaps this is what makes our dogs or cats capable of loving us as they do and able to evoke in us a love more unconditional than that which we offer one another. I sometimes wonder when I meet a dog out on a walk, if I am in the presence of a spiritual teacher who is serving the person on the other end of the leash.

In the Presidio at the foot of the Golden Gate Bridge on the San Francisco side there is a little cemetery where for 75 years, service men and women and their families have buried their pets. I first walked through this cemetery 30 years ago, shortly after my mother died. I could not help comparing it to my recent experience of the very old cemetery in New York City which is her final resting place. My mother’s funeral was formal and somehow remote, managed competently by others. I was there mostly as a witness. But every creature buried in the Presidio pet cemetery had been tucked into the earth by loving hands. My mother’s Marker and the Markers of her neighbors are made of stone beautifully and expertly carved but somehow cold and even a little frightening. The Markers in the pet cemetery are varied: some are small wooden boards painted in an uneven hand, others are tiny hand-carved wooden headstones. The love expressed on them all is still palpable: deep, enduring, personal and unconditional. I remember thinking that I wanted to be buried here.

Unconditional love is a high spiritual state. It does not mean infinite forgiveness; it means the perception that there is nothing to forgive. It is love beyond approval (a form of judgment) and love beyond criticism (another form of judgment.) It is the capacity to love so profoundly that it is without expectation but only deep appreciation of a uniqueness in each one of us that makes all comparisons meaningless. It is the recognition of the one soul that is our essential self.

If all the people now alive and the people who have ever lived were gathered together in the dark, your dog or your cat would be able to find you. “Aha!” you say, “this is because of their keen sense of smell.” But what if it was something far more profound than that, the capacity to see the unique essence that is who you truly are? What if our pets know us, not by a sense of smell, but a capacity of their enlightened hearts?

The national course for medical students that I first developed at UCSF is also taught in schools of veterinary medicine. A few years back I asked a faculty at one of these schools why she had chosen Veterinary Medicine as a career. “Because of what my patients teach me” she replied. She later sent me this poem by Sharon Kunin:


a little

like meeting God

Through feather, fur, or fluttery thing.

To be judged not by words,

But by the timbre of my voice.

Not by ability

But by the gentleness of my touch.

And not for knowledge,

But by the Light that shines from my eyes.

To be loved

For the nature of my heart.

As I have grown older I find that being loved by an animal feels more and more like grace, a gift of immense value that is offered to me unearned, a clear mirror of who I might actually someday become as my true self. Even more I am grateful for the capacity to love that my cats have uncovered in me, a larger and wiser and somehow better love which I am grateful to find is becoming a part of who I am.


For those of you who would like to see pictures of the pet cemetery, you can find them here at this link.


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“With every step I arrive at my destination” – Thich Nhat Hanh

Click on the images for helpful information before you set off for the Summer Retreat.

“With every step I arrive at my destination” – Thich Nhat Hanh

Click on the images for helpful information before you set off for the Summer Retreat.

A Forever Home

I first heard the expression a “Forever Home” when I was looking to adopt a cat. The woman who had come to visit and interview me from a local cat rescue organization had said to me across her cup of tea, “If you adopt one of our kitties you will need to promise to give him a Forever Home.” I nodded but secretly I was daunted by the phrase and had the feeling that as an impermanent being myself, I could not live up to such a high goal. But I adopted Cashmere from another rescue organization and so I forgot about her comment.

Eight years later I was walking through my garden trying to choose a place to bury Cashmere. I was having difficulty deciding where to make his grave when from some deep place inside, the memory of her words came back to me. What if I was not looking for a grave, but for a place that would become Cashmere’s Forever Home. I instantly knew where this would be, at the foot of a stunted olive tree that I had planted about the same time Cashmere and I became family. For eight years the tree had struggled to live and whenever I passed it, I felt badly that I had planted it in the wrong place. Cashmere had struggled to live for eight years, too. Perhaps this tree was a kindred spirit that could shelter him and become a part of his Forever Home.

One of the most remarkable things about my cat was his will to live, his ability to find joy in a can of cat food, a nap in the sun or a warm cuddle despite all of his trials and difficulties.  Cashmere had his first seizure less than a year after he came to live with me. It had lasted for two days. He was started on one medication and when his seizures broke through, a second medication was added, and when his seizures broke through again, a third. Finally there was simply nothing more to do but set him free.

Grief, like healing, is a process. So is wisdom. A few months after I buried Cashmere I planted a garden for him under the olive tree and searched my yard for stones to make a border around it. Over by the back fence I came upon an irregularly shaped stone, very flat and thin, about the size of a salad plate. Puzzled by its odd shape I picked it up and saw that one side of it was uneven. Looking closer I could see that it had been engraved with words I could not read, so I took it into the kitchen to wash it off. It is now at the center of the little garden. It says:


I have lived in my house for 25 years but my house is older than that. Many others have called it home and walking this piece of ground I was not really alone.  A Forever Home for CashmereSomeone else who had buried a beloved pet here had reached across time to ease my pain and offer me healing. I had kept my promise to Cashmere and made him a Forever Home, not in my garden but in my heart.

It is now many months later and the little tree in Cashmere’s garden has begun to thrive. He has become a part of this little tree and perhaps his joy of living even in hard times has made all the difference.

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If Love Could Have Saved You, You Would Have Lived Forever

Six months ago my beloved cat Cashmere died. I had given him his epilepsy medicine three times a day and for more than six years I set an alarm for 4 AM every morning to be there with his first pill of the day. Now he is gone.

I live surrounded by compassionate people, most of whom have put service and the easing of pain at the center of their lives. Many people knew of my cat and his problems; a great many also knew him personally and over the years had brought him toys and treats and enjoyed a snuggle or two. In the week after he died, people expressed their regret that Cashmere was gone, usually in a single sentence. Hearing my “thank you” they then went on to business as usual. It was clear to me that I was expected to do the same.

Garden flowers - poppies and pansiesSomehow this seemed familiar to me. As a doctor I was not expected to grieve the loss of my patients or any of the many disappointments I had experienced in the course of my career. A cancer recurred? Sorry to hear it. A surgery failed? Gee that’s too bad. The way I was trained, John Wayne could have been the Father of Medicine. I kept my sadness in my heart for years. Keeping my sadness in my heart had almost caused me to abandon my soul’s work.

Many doctors carry their sadness in secret and so do many of us who have lost a beloved pet. When the cat or the dog dies we are expected to simply go on even though the relationship we have lost is not an ordinary relationship. I cannot recall anyone stopping to grieve the loss of unconditional love or even to talk about it. But grief is the only way that loss heals. People who do not grieve may carry their wounds unhealed for many years. This may make us cautious about loving again.

When Cashmere died I stopped writing and posting on Facebook. I was struck dumb. I had wrapped him in an embroidered pillowcase and put him under a stunted olive tree in my back yard. After a few months, I planted a little garden under the tree; white and yellow poppies, white and yellow pansies. White for his beautiful fur, yellow for his golden heart. I live on the side of a mountain near San Francisco and fog surrounds my house almost every afternoon. I did not expect the garden to do well. But the flowers are still blooming. And for the first time since it was planted 8 years ago the little tree is growing.

After three or four months, I began to talk to people about the silence that surrounded my cat and me. About the blessing of being loved unconditionally in a very conditional world. About the many ways a cat reminds you of what matters. About the space a cat can leave in your life when they are gone. At first this seemed to require a sort of courage. But not now. Almost everyone I spoke to shared a story of their own about the loss of a dog or a cat or a rabbit or a hamster; about the silence. Some people had carried this silence with them for many years, ever since they were very small. Almost everyone had a story they had never told anyone. Almost everyone cried.

The people I shared stories with seem closer to me now. More real. We have allowed each other a glimpse of our capacity to deeply care, and shown each other the openness that is covered over by the masks we usually wear. Turns out that everyone is wearing a mask. Telling our stories to each other has been important and intimate and deeply healing.

Do you have a story to share about the love and the loss of a beloved pet? I would love to hear it. Perhaps unconditional love is the thing our pets are here to teach us. Perhaps it is the thing that really matters.

If you would like to share, you can add a comment below or if you are on Facebook, you can share your story on my wall here.


Rachel Signature

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One Doctor’s Heartfelt Story (at Keegan Leadership Luncheon)

Press Democrat article May 24, 2014Rachel gave a luncheon talk to 400 people gathered for the Keegan Leadership Lecture Series on Friday May 23, 2014. She declared to the gathering at Rohnert Park’s Doubletree Hotel that “a doctor’s mind, training and experience can diagnose and treat disease, but only the physician’s heart can heal.” During her half hour talk, Remen told stories of her own experience as a physician in a profession that frowned upon bringing ones emotionally sensitivity to the job. Click on the image of the Press Democratic article to read in another window or click here.

The Keegan Leadership Lecture Series seeks to inspire others to serve the Sonoma Country community as James & Billie Keegan did for more than 50 years. Each year, outstanding community leaders are recognized who exemplify James and Billie Keegan’s philosophy of “giving back” to the community. Proceeds from the Leadership Series help support Memorial Hospital’s Palliative Care Center located in beautiful Santa Rosa.

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