I’ll always remember Dan Domizio sitting in a corner of my bedroom on a quiet night in January, 1976, a bearded man in a white turban, seemingly lost in carving and sanding the hull of a model boat — as a few feet away Priscilla was lost in her thirteenth or fourteenth hour of labor. He’d look up occasionally, say something encouraging. His casualness both soothed and disconcerted me — was he really paying attention? He was supposed to deliver this baby.

As the labor continued, with no seeming progress and Pris near exhaustion, Dan examined her. If nothing happened in the next fifteen minutes, he warned, we’d go to the hospital. Pris began pushing with renewed determination. Dan, on his knees beside her, urged her on. In a few minutes, Mara was born.

A year or so later, relating the story of Mara’s birth to a mutual friend, I was told, “Oh, he always says that about the hospital. It makes them push harder.”

Instead of a turban, Dan now wears a tie, as clinical coordinator of the physicians associate training program at Duke University in Durham — but the tie doesn’t define him anymore than the turban did. He is a healer who straddles the worlds conventional and unorthodox medicine, with a global perspective that illuminates our sometimes parochial, albeit “wholistic” approach to health. In April, 1978, he wrote me from Barbuda in the West Indies, where he and his wife Hanorah were working for the Peace Corps:

“Admittedly, being caught up in an endless stream of scabies, hypertension, malnutrition, festering wounds and new-born babies, I myself have tossed THE SUN aside more than a few times. . . . Hanorah says, quite rightly, that we’ve lost some of our ‘gentleness,’ our ‘softness,’ our lighthearted sparkle. I suppose that is only natural given our front-line positions in a never-ending battle with the grim realities of developing worldom: disease, poverty, ignorance, and cut-throat politics (yes, even here). I suppose, too, that we knew that this was going to happen to us even as we set out; we were well aware from past experience that the intellectual/spiritual community we lived in in North Carolina was a relatively sheltered one. . . .” The boat, “masts stepped but still unrigged, sits on my dresser here in Barbuda. It will probably remain as it is until a later time and in some other place.”

Dan and Hanorah, who met “in Washington Square Park, by the fountain,” have been married seven years. Hanorah was less dramatically but no less intimately involved in Mara’s birth, and the other deliveries they performed in the Chapel Hill area in the mid-Seventies. She’s now a student at Watts Nursing School in Durham.

They both grew up in New York City. Dan, who is 36 years old, got his B.S. from City College in 1965; his B.H.S. (bachelor of health science) from Duke University in 1975 and is now studying for a masters in public health at the University of North Carolina at Chapel Hill. They live in Durham.

The boat is unfinished.

— Ed.

 

SUN: I just know sketchy details about where you’ve been and what you’ve done.

DOMIZIO: Where I’ve been and what I’ve done as a person and as a professional are all the same, so it’s easy. I was doing research that would have contributed to a Ph.D. in biochemistry. I left it and went into the Peace Corps in 1966. I spent three years in Micronesia having my head completely readjusted to the world, reordered, reorganized, refitted, and having an absolutely wonderful time of it. We travelled around the world on the way home, which was a very enlightening trip, all through Siberia and Europe, and came back to the United States in 1969, just before Woodstock. Everyone at the time was carrying signs and fighting, rioting and being very political. Everything was political in 1969, and for good reason. Unfortunately, the energy that I had cultivated living in the islands didn’t prepare me well for that kind of confrontive method. Everybody was confronting everybody — either support it or put it down. People were polarized to either extreme. I got an opportunity to go back out to Micronesia and spent almost another two years travelling, and then teaching in Japan. Hanorah and I were travelling together then. So we had another trip around the world for another two years. It was a fortunate set of circumstances for this lower-middle class kid from Astoria, Queens. No money, only subsistence money, just a little cushion in case we got into a bind. We weren’t down and out, but it was hostels, crashing on people’s floors and hitchhiking, not plane travel and hotel reservations.

SUN: The second time you went to Micronesia, you went as a physician’s assistant?

DOMIZIO: No, having been there and understanding the culture, I went there as a trainer of Peace Corps volunteers, a cross-cultural awareness trainer for an agency that was running a program for the Peace Corps out in Saipan. It was one of my first efforts to equip other people with awareness that I had gained through experience. I became interested in educational processes, what you do to enable people to learn.

When I got back to the United States in 1971, I was a full-blown hippie. We were on our way to a commune in New Mexico when we stopped in Durham to visit my sister and her family. And we house-sat for them, and I got a job at Duke, and we never got out of here. We set roots, and these were the first adult roots we’d set anywhere, outside Micronesia. I got into the Physician’s Assistant program at Duke, spent two years training there, spent six months or so looking for a rural healthcare job and in the meantime was delivering babies for people. We had a lot of grass-roots American folk medicine experience right here in the Durham-Chapel Hill area between 1975 and 1976, which leads me to some of my perspective now about what is possible and not possible in the health services. After six months or so of looking for a job —I wasn’t getting paid for doing any of those deliveries, that wasn’t a job, that was yoga — I got tired of looking and not finding, and the Peace Corps had a job-description from the eastern Carribean, the West Indies, that was pretty close to my dream — on an island, in a little community that had no health services, and needed health services of a primary care nature, for which I was well-equipped. I said, there it is. Hanorah wasn’t anxious to leave the country again, but I persuaded her, and though for a year she wondered why we ever spent more than three weeks on that island, now, in retrospect, she has even stronger attachments to that place than I do and has much stronger feelings about going back. So we both learned, as a couple, about medicine and primary health care and developing a system to provide those kinds of services for people. Discovering what people really need, how you define those needs and how you make a system work to meet those needs in a way they can deal with — that’s what I’m studying now, hoping to be able to export it, share it with whomever wants to hear about it.

SUN: What does health mean to you, and what has it meant in different places in the world where you’ve worked, and in this country?

DOMIZIO: The World Health Organization has a very simple definition that is also profound. It is something like, the complete emotional, spiritual, physical well-being of a person — not just the absence of disease. When you talk about ill health, you’re talking about somebody’s perception of it, and their tolerances for it. Basically, with most common illnesses, it doesn’t make any difference where you go: if you get a virus it’ll give you what everyone calls a cold. You’ll have the same headache, the same sniffles, cough, sneeze, the same tiredness, and you lie down. The body has a capacity for responding to that, and that capacity is part of the definition of health too. So you’ve got a baseline of some real things that happen to people invariably across the board, and when those things happen there are some minimal things that we have to offer that can improve the picture. But even if you don’t do anything, most people that have sufficient reserves of energy not to be completely depleted by the illness will get over it. What I as a health care provider see myself doing is helping someone decide whether to be patient with the process, and just let it go without intervening very much, or perhaps to do something to alleviate those objective discomforts. When you get a headache, an aspirin really does wonderful things. So you can help somebody in that sense. Then there are things that groups of people need to do about their environment to keep it straight, and health becomes a part of that too. There’s health in an individual sense, in a community sense, in an environmental sense, and you can’t separate those things. You can approach them separately but ultimately they are all interdependent.

SUN: How healthy are people in this country compared to other parts of the world?

DOMIZIO: This country is a big place, so there are a lot of groups who are extraordinarily healthy and there are other people who are terribly unhealthy. If you talk about abject disease, where you are incapable of getting up and moving around, of keeping body and soul together, we are much healthier than vast numbers of societies are around this planet. When you come to diseases that are a result of things we do to our environment, well certainly we do more, so we suffer more, and in that sense our society is not nearly so healthy, in parts of this country. I believe that in parts of this country there are still fairly pristine environments and I really don’t see much problem. Certainly on the coasts and in any kind of urban setting we do terrible things to ourselves and I imagine even in Montana people eat crummy food.

As a spiritual society, we’ve got a facade, we have a lot of imagery about spirituality, but when it comes down to the behavioral consequences of being high in the spirit, i.e. being patient, being gracious, being loving, serving, then we are in shitty condition in this country. There are many societies out there that are in better shape that we are — I can reel off numbers of them, even complex societies like Japan, very urban and polluting themselves like crazy, but in certain societal ways knowing how to behave and to live. There are a lot of places better equipped than we are.

SUN: Is this why you keep leaving the country?

DOMIZIO: Part of it is very definitely a general dissatisfaction with the ambience of American life. I don’t like cheap advertising surrounding me when I drive down the road, I don’t like garbage on the television and the preoccupation with negative things that you find in newspapers, or the sensationalism of our media in general, and the mindlessness of much of the very mainstream of America. It’s very thoughtless, it seems to me, habitual behaviors that people have gotten into. I’d much rather the ambience of Tokyo, for example, or a small community in the West Indies. Not that those places don’t have their own mindless habits. The difference lies in being a traveller.

As an outsider in those places, you have the privilege and responsibility of foreignness, that kind of distance you can never jump, the gaps you cannot cross. You are from the outside and may be of a different color, you speak a different language, you were not born there, and so you’re not expected to be doing all those things that everyone who was born there is expected to do. You can utilize that privilege to accomplish things. You can be invited into meetings where you could never go if you were from the inside. You can participate in activities that as an insider you could not get to, at least not directly. If you are gracious about it, appreciative of the invitation, acknowledge the privilege that you are given, almost anybody is willing to have you around, invites your participation and accepts what you have to say.

I figure it’s a very personal kind of relationship. I know the Minister of Health of Antigua as a person as well as in the role of Minister of Health, because that’s what I aim for. I want people to understand what I am doing and what they’re doing, why they’re doing it, why I’m asking them to do it. If they’ve invited me to do a job, to help them, then this is what that means, this is what the contract is all about. I feel that as an outsider in those situations you must be honest, clear, and up-front. If you don’t forget the privileges which that gets you and don’t, focus on the negative sides of the outsider role, you’ll do well — and people will enjoy your presence.

It upsets me to think of the giant rip-off that is perpetrated in this world . . . by the medical orthodoxy on the people that rely on them. . . .

SUN: What’s the most complimentary thing and the most critical thing you could say about the wholistic health movement in this country?

DOMIZIO: The wholistic health movement is taking a courageous stand in an environment which is fairly hostile to their product, the wholistic view of people and society. I think that really deserves a compliment. Not everybody’s got the time, energy, patience and courage to put that kind of movement together and stick to it. We can argue philosophy from any direction you want. I happen to agree with the wholistic philosophy. The most important compliment I think I can pay the movement is that they’ve taken on the responsibility of trying to sell that idea.

The most negative thing I can say — and I think that this is a consequence of that same kind of difficult environment that people find themselves in when they’re working with an alternative approach — is that, from my experience, the people who are inside are clearly inside, and they have an “I’m on the inside, you’re on the outside” kind of feeling about them. You are either on the bus or off the bus. This may be a consequence of needing support from one another — you’re certainly not getting a lot of support from the general society, and especially not from orthodox medical systems — so they kind of hold on a little bit. This criticism may not be fair — I’ve never been a part of an organization in the wholistic movement, and this may be very superficial observation.

SUN: Let me ask the same question about the traditional medical establishment — what’s the best you can say about it, and the worst?

DOMIZIO: I think much of the American medical system is despicable. It is pompous, insensitive, self-centered, self-serving to a degree that I find almost unspeakable. It upsets me to think of the giant rip-off that is perpetrated in this world — and it’s not exclusively an American phenomenon — by the medical orthodoxy on the people that rely on them for medical services.

It would be so nice if we didn’t have societal inertia, history, intransigence to deal with, but that’s a dream. We’ve got a system that was primitive, evolved to an enormously sophisticated set-up and is now riding on the myths and images and reputations of the past medical tradition. We need to recognize it, understand why it is what it is, and then step by evolutionary step take it apart and put it where it needs to be. I think this is happening, but as in any evolutionary process it takes time, and people who need care now have to suffer with the circumstances of the moment.

On the complimentary side, I’d say that some of the things that our system does are very fine. We have people that can ambulate because they have steel or plastic joints in their bodies. If you ask them what it’s like to now be able to walk, when they couldn’t, you suddenly find very fine justification for giant medical meccas, like Duke and N.C. Memorial. Those people really do benefit.

I think we have a lot of wonderful things that happen as a consequence of the level of public health organization that we have in this country. There isn’t a lot of preventable disease, in terms of immunization, that our society suffers from. There are those who argue against artificial immunization programs, mostly in terms of potentialities that we cannot foresee, but we are groping as a society and a world and we can’t know the consequences of everything in advance. How else can you make progress — technological progress or spiritual progress? We’ve got to grope, make mistakes, get up and try again. We’ve got to understand where we’ve been, how we got to where we are now, maybe make some guesses as to where we are going to go in the future.

But we can’t really see clearly what all the consequences are going to be of what we do, and certainly not the consequences of things like the insensitivity to people’s needs that results from the enormity of the system. You can’t see the consequences of the level of anxiety in physicians generated by the lawyers now present in the scheme of things. You can’t anticipate all of the problems that a society will experience as a consequence of our distant medical establishment, that we are at once alien from and dependent upon. Yet these are all important factors that will help determine where we go from here. We are beginning to learn this view of how our systems and society evolve — a long-range view. The task lies in spreading it around so everybody can see it, understand it, get involved, put some pressure on the system to change and make it evolve. I don’t think anybody is to blame for the way things are — we are who we are, selfish people, altruistic people.

SUN: What about the home birth movement? You talked years ago in THE SUN about how important it was to avoid a sense of “us versus them.” How do you view that now?

DOMIZIO: I think that since that time, five years ago or so, the home birth movement, at least around here, plateaued and waned. Some key figures left. I found when we came back into the country about two years ago, legislative things were happening in North Carolina, people were getting together and sharing views and there was a resurgence of enthusiasm about it. I think that within the home birth movement there are a variety of people, and some of them are still very polar in their views, refusing to work with the current system they find around them. That’s probably for justifiable reasons, since the system around them is refusing to work with them, and in most instances there isn’t very much compromise. Once you assume a similarly polar position, however, things don’t go anywhere. They just sit there and vibrate. Indeed, those people are still there. But there are a growing number of people who are moderate in their approach and would love to make some compromise arrangement where sensitive services were provided for women who wanted to have their babies in a situation other than what the orthodox system prescribes now. Those other situations have all kinds of forms — birthing centers, birthing rooms, lay and professional attendants, and so on. I think right now it’s not an issue for a lot of people. Childbirth only concerns people when they’re having babies; it doesn’t much concern them when they’re not. So there is a continuous stream of people who are going into this movement and going out of it, and utilizing the people who are around making the struggle politically as best they can to figure out how to make the services that are currently available work. It’s a piecemeal operation because the orthodox system refuses to compromise and help out. There are a few exceptions to that, and in fact they are making it all possible in their own way. I’m hoping that with the level of capability that I am developing now, with a fairly clear way of presenting information in an unthreatening posture, I might be able to do something at the legislative level, I might actually be able to get inside somebody’s head up there and make them see that what we are talking about is not bizarre, but rational, thought-out, justifiable for those women who want it that way. We certainly have the capabilities.

SUN: What are your observations about spirituality in this country, in terms of your own journey and what you see around you?

DOMIZIO: The spiritual movement we call ours was born out of the drug culture of the late 1960’s. I define it that way because that’s what it was for me, a drop-out from society into drugs, and a drop-out from drugs into the spiritual world, and then a drop-out from the overtly spiritual world to one where I’ve taken the lessons that I learned and incorporated them. Not everyday, all the time, but I’ve incorporated them into the fabric of who I am. That spiritual movement has been, for many of the people that I was intensely involved with, something from which we learned a great deal about ourselves, our society, God, things of the spirit. We’ve incorporated all of that into who we are as adults. The movement I think is probably still there, manifest in numbers, but certainly not in the same form. There aren’t as many people walking in the streets in the overt regalia of the spiritual world, so it’s really hard to pin down who’s doing what. I think, like drugs, like the Peace Corps, like leaving the country and coming back, like every other growing experience that people have, that spiritual experience is leaving its mark in our society. I’m 36. The people who came into that thing a few years before me are 40, a few years after me are 30, so we have this whole bloc of our society that is moving into positions of power, in some places, economic affluence, media channels, and that movement is making itself felt, though not identifiably as part of a movement. It’s there. A lot of people feel good about things, are seeing the world in a more healthful way, and if it isn’t the movement per se, it is something spiritual nonetheless.

SUN: What do you do to stay healthy?

DOMIZIO: Not much. At this point I’m probably as physically out of tune as I have ever been, and I am longing for some inspiration or perhaps simply some physical breakdown to turn me back around to caring for my physical house. I eat fairly intelligently, I consume too much ethanol, I enjoy parties, social interactions. Sometimes with the schedule that I keep, being a teacher, a student, a homeowner and a husband, care of my physical self is sacrificed. I’m still young and still capable of getting back into better form.

Childbirth is an essentially natural process which must be depicted as shot full of risks for mother and baby in order for the high-tech approach to seem rational and justified.

SUN: That’s a dilemma a lot of people are in, feeling they’re not taking care of themselves though they want to. How do people get into that predicament?

DOMIZIO: Probably because they can carry on in the state that they’re in, and unless there is some overt breakdown of some part of their body or their whole body, they’ll continue carrying on all right. And they think that because things are basically okay, they can keep going that way indefinitely. That has not got a very preventive mindset to it. Almost everyone could be in better shape. I don’t think there’s any great compelling moral thing that says you must take care. If you are aware of these things, then you do what you can when you will. But many people just don’t think about their health until something happens.

A lot of folks do think about their health and don’t do anything about it, and that’s a kind of fooling yourself. It’s silly to think you can’t afford the time to take care of yourself, because the quality of your other time would be improved dramatically if you were in better form. We just kid ourselves, basically, ignore inside voices, choose to do otherwise.

Doing something about it simply means that you stop not doing it and start doing it. That transition, that behavioral or motivational change, that quantitative or qualitative change you have to bring about inside of someone, to make that thing go, that is exactly what we mean by raising health consciousness. And that is a function of education. It’s what we mean when we say we’re going to develop a primary health care system for someplace that needs it. They say, “We would like to have somebody take care of our ills.” Usually what they have in mind is a medical model, not a behavioral model, and they say, “This is the problem; we need somebody who can give out this kind of drug or do that kind of procedure, to make the problem go away.” The preventive side of it is usually ignored.

When we’re talking about prevention, we’re talking about changing people’s behavior. Developing motivation and perceptual changes, encouraging people to feel differently about the things they do that affect their health — that’s hard. And the process is no different for me or you than it is for a person in East Africa or Nepal — saying to someone, “Brush your teeth because it’s good for you,” and then to have them do it more than once or twice, that’s the name of the game, whether you’re talking about Des Moines, Iowa or New Delhi.

Breaking down and analyzing the process of how you can make that happen for somebody, how at least you can establish an environment that is conducive to it, that is what prevention is all about. You can have ten million miles of “Don’t smoke cigarettes” signs, but until you get somebody to feel that way and do something about it, the signs are useless. Signs affect the environment that somebody’s walking around in, giving negative reinforcement for something that they’re doing, but an internal process ultimately has to happen. How that is brought about is hard to define, but that’s the business.

I’m challenged by it, and I feel that it may be a very subjective, time-consuming process of education, for ourselves and for those who we might try to reach. How do you prepare somebody to prepare people for that kind of change? How do you teach a future teacher to do it? That is tricky. You’ve got to be able to do it yourself before they can do it. And how can you teach about something that you don’t even know except intuitively? Unless you understand what is happening and can articulate it well, they’re not going to learn from you what you want them to learn, and certainly they won’t change their behavior.

SUN: How do you deal with images of authority and power projected on to you by people you’re caring for?

DOMIZIO: When people need health services, have illness and need caring for, the first decision about going to see a health care provider is theirs to make, usually. Most people would like to have a health care provider who is trustworthy, honest, can be told things that are not usually told to strangers, and be trusted with that information. They would like the provider to be very sensitive to their needs, to be able to listen. What we are describing here is an exceptional person. The characteristics that I’ve been describing are hard for anybody to achieve: to be gracious and understanding, and capable, supremely capable.

We would always like to go to the best person around to get our cut sewn up or our throat looked at. Usually, if we had to make a choice and we knew this nice guy was more competent than that nice guy, we would go to the more competent one, everything else being equal. Fair enough, you want competence and graciousness and charm, and understanding and sympathy, and you want it now. Who do you know who could live up to that standard? And this person is not some ordinary bloke; he or she has gone through medical school, an enormous educational process, cultivating in him or her an ability to sound and perhaps be credible. Able to look and be authoritative about what he says, and not equivocal — this ability is cultivated, partly because this is the way we want our doctors to be. Health care providers go through an educational process that is driving, competitive, demanding and a real hassle, while it is also preparing them for this bigger-than-life image and role — and, as I said, how many people can be all of those things? I walk into a situation feeling very democratic and very egalitarian. I’m just another guy. Some people like that because it makes me more credible to them, more reachable, and they feel I’ve really understood what they have to say. Other people think something like, “This guy isn’t what I think a provider ought to be like. He’s sounding like there’s some uncertainty about what we’re dealing with, and I don’t want to be uncertain. He sounds like maybe he doesn’t know for sure that the answer is X, Y or Z.” While it may very well be true that we can’t know for sure what the answer is, one provider will make that clear, and another might not. Some people who come in needing services want one image to be fulfilled, and others want the other. I prefer being egalitarian — I see doctors like carpenters, with skills, certain tools, materials to work with, and goals and objectives about what the outcome ought to be. And they don’t always know whether all of it is going to come together and turn out nicely or not. But I’ve got my tools, my capabilities, my judgment, and people in need are the material that comes in for me to work with, and the outcome is the function of the material as well as the skills of the provider. The responsibility is shared. That’s how I deal with the business of authority — but it’s not always easy.

SUN: How do you deal with all the suffering you see?

DOMIZIO: I deal with it all right. I think I understand your question — sometimes you can get heavied out by all of that. When people are really hurting, sick and in need, being in the position of a provider of care is tremendously satisfying. There is nothing more fulfilling, there is never a greater sense of privilege than when someone opens up and says, I’m hurting, I’m sick, can you help?

To be in a position to help I think is wonderful. I don’t tire of it. I do tire of people who whine, to be honest. There’s a lot of suffering going on in this world, no getting away from it, and the kind that comes on people as a result of their own lifestyle, their mind-sets and attitudes I can work with and give and give, but I reach a limit. I reach a point where I get tired and have to back away for awhile and get refreshed in order to be able to come back into it and offer what is necessary. That drains me.

Disease and injury and death don’t drain me because we are what we are. We’re biological things, and there is a need for some people in the ecology who try to help out, and I feel really good about being in that niche.

If there is anything that I feel privileged for and good about, it is the doors that open allowing me into that very special time in a woman’s life and a family’s life when they are going to have a child. People in the medical professions experience birth and death many more times than the average person, and so are able to get a handle on all of that which most folks will not. This perspective can help a provider do more for people who come for help.

Our health care systems are not all bad. There are giving and caring people to be found in them everywhere. Our obstetrics services system, however is awful. And because of it, childbirth for many women in this society is being perceived as a threat to their well-being, something to suffer through, something which they actually know very little about. Our obstetric services system cultivates a sense of inadequacy in the women it serves. Our basic educational system does nothing to prepare them for childbearing and the consequences for ninety percent of women who enter our standard system — those with little or no risk of problems — is that they get messed with.

Some of them are so convinced when they get there that they have no control and no capability that they are willing and eager, in fact, to relinquish every bit of responsibility for what’s going on to the providers at hand. Others who feel less willing are still caught up in that system, and confront a very dominating and manipulative situation where their own will, their own sense of purpose and direction, has been usurped by members of the system who have been given the responsibility.

Implicit in all of this is the message that women are not capable of fulfilling their most fundamental biologic functions, that without the intervention of our obstetricians, who are usually male, women simply haven’t got what it takes to cut it. That is a gigantic rip-off and an enormous burden for women, and therefore our entire society, to bear.

The bigger-than-life role and image that people often demand of their doctors is a big part of the dynamics which make our present system behave the way it does — and people must share the responsbility for its injustices and inadequacies. The system is self-serving. It is motivated by what is felt to be cost-effective and productive, making the most use of its personnel and equipment and facilities. Childbirth is an essentially natural process which must be depicted as shot full of risks for mother and baby in order for the high-tech approach to seem rational and justified. This could easily be changed but for one obstacle — the public has been convinced. If women are ever to have available to them some reasonable choices for childbirth services, then the word is going to have to spread and the political pressure for those changes will have to be potent. For now, the vast majority of child-bearing women have little or no say in what is going on, and I feel that is just awful.

I know there is a very strong spiritual lesson about being dispassionate, detached, moderate about everything. My response is that you have to be moderate about everything, including moderation.

SUN: How has being around dying people affected your personal views about death and dying?

DOMIZIO: I think I’m accepting of death, not being confronted with it right now. There will come a time when I will have to see how accepting I really am. I regard it as the ultimate statement of our biological reality and I relish that limit. I am ultimately comforted in knowing that I am a biological entity and do have those kinds of limits, that perfection is an ideal to strive for and is not necessarily going to be a reality. I don’t know if there are perfectible biologic species around. I think there is an optimal status but perfection is not going to happen very often for very many people. So knowing that death in a biologic sense is there defines things for me, it sets a limit beyond which I know we cannot go and that’s that, and that’s okay.

Having watched life gently slip away, having watched life be crushed out of people, literally, having watched an agonizing, torturous path through that door, all those approaches to that line over which there is no coming back, has made me feel pretty comfortable. I can accept that it’s going to happen and it doesn’t bother me because I’m familiar with it.

What happens after you die doesn’t concern me. I’ve got this body, and this place, with this head, and this is what I’ve got to deal with. I think I’ve learned a sufficient bit about myself and my spirituality to know that I am not going to be a full-time yogi, at least not now. I am not going to keep God consciousness right in front of me and all-encompassing all the time, and I’m not going to be in that blissful state. I’ve got karma to pay and what happens now is, given the things I’ve learned, given the good fortune that I’ve had, it’s time to be as positive and as serving as I can be, and I know I can’t always be like that. I get angry, I get upset, I get anxious, but there is a resiliency there now that might not have been there without all that good yoga. And I’m glad it’s there. Certainly I can’t divorce myself from it. It’s right there.

I know that there is a very strong spiritual lesson about being dispassionate, detached, moderate about everything. My response is that you have to be moderate about everything including moderation. Once in a while you let go of that too.

You’ve got to make your choices the way they come to you. Some people are lucky and have good options to chose from, some people are not so lucky and don’t have those options. Do we have a moral obligation to make those options available to everybody? For those who see it that way, yes. But for those people to whom it never occurs that this is something to be worked on, that’s the way it is for them. And if the guru, the grace of God, whatever it is, comes down and touches them on the head and lights the lightbulb and they start seeing it in that sense, then they have the obligation to do it. For the people who are on one side of that fence and see, it’s something to work toward. For those who are on the other side of the fence and don’t see — next time around, if there is a next time. That’s just the balance of things. And it strikes me as very imbalanced for everybody to be on either side of that fence, and I don’t think that’s the way the universe goes. Positivity, negativity, yin and yang, it will manifest itself throughout the range of human behavior, from the most despicable to the most beautiful. I think that somehow all of it has to be manifested at any given moment; it all has to be there. I don’t know what that means for those of us who feel compelled about reaching out to people. Does that mean we should stop reaching out and forget about it? No, that’s not what it means at all. That is part of the formula too, the reaching out, the trying, the struggling, the inspiration.