Without a doubt, this word has come to mean something far from its roots. To make this easy, here it is right from www.dictionary.com:

sus·tain /səˈsteɪn/ Pronunciation Key - Show Spelled Pronunciation[suh-steyn] Pronunciation Key - Show IPA Pronunciation
–verb (used with object)
1. to support, hold, or bear up from below; bear the weight of, as a structure.
2. to bear (a burden, charge, etc.).
3. to undergo, experience, or suffer (injury, loss, etc.); endure without giving way or yielding.
4. to keep (a person, the mind, the spirits, etc.) from giving way, as under trial or affliction.
5. to keep up or keep going, as an action or process: to sustain a conversation.
6. to supply with food, drink, and other necessities of life.
7. to provide for (an institution or the like) by furnishing means or funds.
8. to support (a cause or the like) by aid or approval.
9. to uphold as valid, just, or correct, as a claim or the person making it: The judge sustained the lawyer’s objection.
10. to confirm or corroborate, as a statement: Further investigation sustained my suspicions.

What adds to my particular dilemma is that I have come to use the word regarding healing environments: to create and sustain a therapeutic space. Meaning, 30 minutes or one hour, or one day is not enough. This is about continuous…sustainability. However, the word is confusing. Well, maybe not.

Dallas and I recently attended a Sustainability Intensive sponsored by the Fielding Graduate University at the O.U.R. Ecovillage in British Columbia (www.ourecovillage.org). The whole weekend we talked about it, ate it, breathed it, soaked in the rain within in, and talked some more. Knowing that we were not going to suddenly pack up our high-tech, computerized home, rid ourselves of the many electronic technological advances that have allowed us to record our music where we sit, put away our HD television that brings us Sunrise Earth every day…it just was not going to happen. However, something else did happen.

I had not linked it all before. Consumerism = environmental decay because we take one substance born of the earth and transfom it (production defined by Marx)…and have done so in a way that throws it back to the earth, but hardly dust to dust. It is more like tree to paper cups. Or, oil to plastic blister packages. Or, …well, you name it.

So, what kind of definition could I use about sustainability when it comes to compassion, caring, skill, generosity, forgiveness? Is it possible to take it and not give it back? Could we run out of any of them? Well, we have transformed some into economic windfalls. Hmm. Compassion, according to latest television commercials, is offered through your local HMO. Caring is one every mission statement. Skill..a promise to deliver. Generosity…has not yet been found in an ad lately. And, forgiveness…well, short shelf life it seems.

However, all sarcasm aside, having lived for three days among people who are really putting their word into action, I believe and keep saying that the healing environment is, by definition, sustainable, if we sustain it. That, human interactions are consummated heart to heart in ways that are non-disposable.

I am no longer buying paper plates; I am using real cups at Starbucks; I am using my handtowels more than my paper towels; I have already switched our marketing to more online exchange than paper stuff through the mail. Most important, however, I am reassure that global warming and heart warming are related.

How is it for you?

As a musician, the loss of Luciano Pavorotti is profound…and, in truth, was experienced the day that he stopped singing. That he suffered through pancreatic cancer also saddens me. We are each so very human. Here he was, larger than life, his voice reaching the hearts of those who may never have liked the music…but, ultimately, it was the voice of gold. Then, here now, we find that he was most human, his voice residing in a vulnerable body whose life-time warranty had come due.

I wonder about that vulnerablity and how many losses we experience, where the voices are silenced and the legacy left is in our memory, only living in our action and thought. My Dad had a booming voice and laugh. He was silenced long before we lost him, suffering the toll of age and poor health, worsened by his awareness of the one-way street of life. My mother, Beatrice Mazer, who died in 1983, was slienced so young…and before I could have recorded her. She died so fast, she did not know she died. That still comforts me for some reason.

I was also saddened when Peter Jennings died. He was part of my life for years, now silenced. Recently, saxophonist, Michael Brecker was lost to cancer..at 51. We recently watched an older Joanie Mitchell recording…and there he was, larger than life, young, brilliant, and innocent…

I also grieved when King Hussein died, a voice of reason and peace, silenced. I grieved when Iztak Rabin died. I remain in wonder as to how the world would look had John F. Kennedy lived to join AARP. I also know that those whose opinions challenged all that I believe in still live within me. Richard Nixon…whose opening of China and establishment of the EPA remains overshadowed by his overt attack on democratic process and extension of the Vietnam War for his own ends.

Clearly, it is left to me, speaking for myself, to live as if they were each whispering in my ear… to make their lives and their unknowing impact on me alive in all that I do. But, far from having to be world famous, those in my world who have touched me and for any reason have left the immediate circle of contact, remain a living voice within me.

I then wonder the legacy of my own words and actions. Not so much from ego, but from accountability. You know, the pebble in the water. Like it or not, our words and actions resound and reverberate long after we forget what we did. It could be frightening…or could be the reality of how it is. But, more than this, I wonder if the young minds that are growing right now, the future leaders…and if the real task is to ensure that their voices are heard, that their questions and doubts reverberate around us all.

Yes, I miss Pavorotti. But, I can hear him again and again. It is the Pavorotti in each of us, unsung, un-recognized, and without voice that is the most profound loss.

If you have not seen “Sicko,” the new Michael Moore movie, then you will most likely harbor a prediction of its value from your opinion of his previous films.  I invite you to set aside any opinion and just look at the topic from the standpoint of your own experience as a patient, your skills as a professionals, and the maize of events that must occur for patients and the healthcare community to meet each other.  I was moved by the movie and, if only to consider the issues presented, it is worth many discussions both at work and at home.  My suggestion that you might take a chance on seeing it, spending both money and time, is based on how urgent the issues are and how marginalized patients have become in the discussion.  As far as I know and other than current sexy hospital series, not since the movie “The Doctor” confronted medicine, has another movie taken on the inside of healthcare.

Feudalism has returned to civilization through the portal of employer based health insurance.  Employees are indentured to employers for their insurance;  then, the next layer, employers are burdened and obligated to the insurance companies to provide coverage;  insurance companies are put in the position of seducing companies into contracts that they are hoping not to have to act on.  In fact, they are selling a product that they do not want utilized.  The ultimate conflict of interest.

You and I don’t have to debate the broken system.  If you did not agree, you would not be reading this.  However, the solution will only come forth through the door of values and priorities.  Once we as a culture, nation, and community decide that we are all damaged by the current system, that the health of the community holds our own security within in, then solutions will evolve.  Money?  There is enough in the system if just taken the CEO bonuses, the redundancy between companies, and the added costs to providers for the paper work.  That alone would cover most of the uninsured.

Medicare is the most successful universal healthcare system developed in the US.  Why we don’t expand this, add the taxes, reduce the costs, and eliminate the slavery caused by the current system?

Michael Moore took on the healthcare system from the point of the insured, the working, the good Americans who contribute to their communities and take care of their kids.

Try it out.  THe let me know your thoughts on why Medicare cannot work for all of us…

Having just come from the annual Association of Holistic Nurses
conference, I was moved by the words of Dr. Barbara Dossey.  She pointed
out, in great detail, not only that Nightingale’s legacy lives on
today, but she also introduced a new framework for Integral Nursing.
Holistic, she pointed out, in its historical definition, has now
become integrated into standard practice.  The next innovation facing
nursing is to balance qualitative and quantitative methodologies in order to
reconcile the subjective with the objective.

Clearly, we know from looking at the continually changing standards
promulgated by the FDA, that with each scientific claim accompanying every
new medication,there are stunning exceptions.

Evidence-based medicine was not, in its inception, designed to limit
available sources of relevant data.  The original concept of evidence-based
medicine was to expand the awareness and definition of evidence to be so broad as to bring attention to the patient experience and the intuition, hopefully informed, of the clinician.  A parent generally knows when their child is ill, even in the face of the physician’s diagnosis that there are no significant symptoms about which to be alarmed.  A woman whose mammogram comes back normal often knows intuitively when something is not right and demands further research.

Now is the time for clinicians…nurses, physicians, and others
involved in patient care…to take the words of Dr. Dossey ever so
seriously in looking at integral health:  that the whole patient
involves the whole cycle of information, not just half.

In the 15 years that we have been producing the C.A.R.E. Channel and
working with hospitals, the use and understanding of the term ‘healing
environment’ has not remained stagnant.  It has continually evolved to
redefine itself in accordance with practices that are dynamic and open to
feedback from patients, nurses, visitors..and others whose opinions may be
meaningful.  That we are looking at a television programming format seems to
equalize expertise on what works and what does not work.  If the C.A.R.E. Channel is effective, that is determined by the viewer, not the producer.  If a pain medication works, that can only be determined by observation and the response of the patient, not the prediction or knowledge of the provider or the pharmaceutical manufacturer.

Herein lies the argument for ensuring that the basis of evidence…to
be truly evidence-based…must necessarily include the voice of the patient,
the skills of the clinician, and the science that begs for more data and yet often yields so little.

Having just come from the 5th conference on Integrative Medicine, it is more obvious than ever that patients are taking their health into their own hands, like it or not. AARP and NIH have both published statistics that indicated (1) billions of out-pocket dollars are being spent on complementary or alternative therapies and (2) no one is talking. The part that indicates the gap between what patients do and what they tell their physicians is dangerous given the known conflicts between drugs and herbs, between over the counter meds and prescription drugs.

Hospitals that are setting new standards for exemplary care are intentionally venturing into the arena of CAM for all good reasons. The therapies in question, which includes everything from music therapy to therapeutic touch to massage to acupunture and more…these are effective, have low to no risk to patients, and bring back into a technologically based system the human and caring modalities that were the basis of medicine for hundreds of years. Furthermore, current practices are still not providing treatments that are 100% effective for everyone and therefore can benefit from complementary practices.

On this side of this conversation, it is clear to me that I use everything. I take seriously the advice of my hand-picked physician, I pay attention to other kinds of options that will keep me from overusing pharmaceuticals each of which has a long list of side effects, and I have integrated music, art, good diet, exercise, joy, laughter, and love into my life. Why is it that these same practices that make life worth living are not considered serious enough to be provided when life is threatened by illness? Florence Nightingale knew all along that what makes life good is ever more important to the confined patient who is already a victim of a malady over which they have little control. The best physician has a sense of humor, hugs patients, laughs with their staff, is open-minded enough to listen to their patients and give
information to prevent a patient from harming themselves.

In reality, CAM is not CAM but is good medicine, integrating all the modalities that may help their patients. Primary care will be redefined to include quality of living practices, not just taking aspirin and calling in the morning. It might even become clear that laughing …really a good belly laugh…is good respiratory exercise, that singing helps oxygenation, that being touched by someone who loves us is mandatory for each of us to thrive, and that food that is healthy tastes better than bare herbs and FDA approved pills.

This conference focused on the Optimal Health Environment which is, of course, where Dallas and I have placed our work for two decades. What is most encouraging is that the discussion has become so much broader, now including the built environment and, most critically, many other factors that in totality become the context in which one experiences either health or disease. The work of the Samueli Institute is bringing forward not only this broader definition of what the Optimal Healing Environment is, but is also funding the research needed to demand changes in our current allopathic system.