I sat there I thought wow, this is powerful. Just noticing the thoughts, the pattern of thoughts and then I can do something about it. I could de-stress, I could relax, I could stop ruminating thoughts. It was like a wow moment for me in that class. That's when I knew that was something I wanted to do. So for a very long time I've wanted to get certified in some type of mindfulness practice to bring it to my patients. But for myself, I just had to keep practicing for myself. That was when I fell in love with it. This is the power of the mind, that I notice the power of the mind and how that has an impact on my whole body and how your body follows your thoughts. All of a sudden, I'm kind of tense special [inaudible] and this is by button. I'm thinking what, why am I having neck pain? Well, looking where the state of my mind was if I was in worry or stress or thinking about work or whatever it might have been. My body was following it. So that bind gut body connection became quite clear being open, not coming in prejudgments, listening to others without judgment, trying to hear what they have to say in their point of view, understanding where they're coming from, and then, when I'm done with each interaction, being able to let go and say, "Okay well, take whatever I need to from that meeting or in that interaction and then move forward to the next project or the next meeting or the next interaction when I have." That's where I think the mindfulness actually has helped me the most is letting go and not hanging on something throughout the day. I can just move on to whatever is the next step or the next part of my day. I remember there was a meeting that I had with some leadership. We went in there with the ideas of what our goals were for the meeting and they were very different than their goals for the meeting. So the meeting had some interesting discussions that were really good. But I think my mindfulness helped me stop and look and say "Now, where exactly are they coming from? Why are their goals so different than what our goals were coming in for this meeting?" It allowed me to see their perspective on the topic that we were discussing in that time. It might've been a different point of view than what my point of view was. But I could understand where they're coming from because I didn't get stuck in what I wanted to be a certain way. I allowed myself to listen, and to hear their point of view, understand where they're coming from, and then be more accepting of it and say, "Okay, I understand where you're coming from. This is where we're coming from." I think it allowed for a much more meaningful discussion and open discussion instead of trying to push my point of my point of view or what I thought would be best. Then we started developing shared goals. I can see where their goals are coming from. They could hear what we were talking about on this plan that we had and came out of the meeting feeling much better about it because something productive came out of it. It wasn't just two sides trying to push their ideas firmly but being more open. When they see that when they could hear that we were more open going into or I was more open going into it, they became more open too. Mindfulness for ourselves definitely helps with burnout, stress in my own experience in some of the practitioners that I work with, and some of them my colleagues. Many of us have been there for 20 or 30 years doing this and all of a sudden it's interesting that this point of our careers were starting to seek mindfulness-based practices or other ways to help us live better. I don't know if it comes with wisdom of getting older or just seeing that our regular approaches to health and wellness isn't quite working. So let's bring in some other practices for ourselves because we see it every day in our patients that they were missing something in health care, in the mindfulness, and integrative approaches is what we can bring in to help them live better. Why not use it for ourselves, for our own personal health, and well-being, and stress, and burnout, and all of that? Health care setting is a stressful setting and very distracting setting. So I think we all can feel frazzled and scattered at work. So having the ability to even recognize that state and do something about it is really a great skill. Realizing that if you are more scattered or stressed, you will show up differently with your patients, with your colleagues, and perhaps your ability to think creatively will be narrowed down too. So being able to catch yourself when you into sub-optimal place can really shift things. For yourself, if you're alone in your office and feeling really tense and stressed out or if you interacting with patients or others. So I really value that being able to attune to that. Having the breath as my resource or sounds, that's often what I like to go to breath or sounds as a way to connect to the present moment and recognize that what's going on in my mind is maybe not the end to at all, or the worry, or the stress, is an experience that I can step back from a little bit. Then, working with, you can intentionally try to slow down your breathing and relax your body and shift that physiological state out of stressed mode to a little less stressed. Not necessarily fully relaxed. Having attunement to yourself which mindfulness skills give you can be helpful in two ways. One, you can assess better what's happening in the interaction or what's happening for the patient because perhaps your body's picking it up but if you too focus on typing your note, you may be ignoring that but actually a tuning to yourself can give you insight into the patient and that's especially true for treatments like psychotherapy because you have this prolonged time that you have someone and being able to knowing how you are and trying to distinguishes this in relationship to this person or is this my stuff that I'm bringing in, can really change what you end up saying or doing with the person. So it's almost mastery of your own reactions. So they're not interfering with you being present to the other person and having that ability to either listen or to really know what's going on for the other person. I emphasize this with patients but it's very true also with co-workers or with trainees, that ability to be present and to listen and not be clouded by distraction, or by your own reaction, or at least separate that reaction from instead of just acting on it to say, "What do I want to do with this reaction? Do I try to distance myself from it or is it telling me something important that now I can think of how to communicate to the person?" So it's not all about suppressing your emotion but just being skillful with knowing what to do with the emotion that may come up with patients or with the colleagues. I had a situation with a resident when my evaluation of her, which I thought was fair, was not received well by the resident. She emailed me and said, ''I saw the evaluation of me and I really feel bad. I've never been evaluated so low.'' Again, I just sort of maybe paused and feel a little frustrated because I felt like I'd given some thought into it, I think this was fair. So there's a question if, does she have a valid point? So it's the ability to be questioning enough of your own assumptions and questioning enough your own automatic initial reaction to it and saying, ''Is this person having a point or is it something that I just have to be very thoughtful to how I respond to?'' The patient gets the idea, they get the sense that you are really present with them. It helps us to key into each other or to figure out like what's going to happen here like what's the best way forward? As I'm in this learning process of my medical education, I find that particularly when I don't know what the right step is, medically, the best I can do is take a deep breath and allow whatever information that come to me to be made present. I find that when I'm very grounded and present with my own sense of self that not only is there a certain degree of ease, and relaxation, and interaction, but I'm also able to hear a lot better what patients are saying as well as what patients aren't saying. Like hearing the conversation that's happening and the words in between the conversations, and I think when dealing with patients there's a lot that they tell us that helps us to put the puzzle together. But some of the best attendings that I've worked with have had been real masters at listening for what isn't being said and being able to add that into what we are going to do for the patient. One of the best ways that I found to hear everything that's being presented by getting very present in my own body because when I'm present and I'm fully aware of what's going on in my body then I can see, I can hear, I can feel it in the room when a patient's response to a certain question has them a little more anxious, or triggered, or when there's a certain degree of sadness that comes along when discussing this other area of the medical care. Whereas in moments where I'm just speeding through, we're just not really paying attention, I keyed in mindfully. I would miss much of that and again a lot of the nuance of the practice of medicine as I'm learning is those in-between moments or in the unspoken aspects. So I find that it's very beneficial to be aware of what's going on. There's so many emotional ups and downs. One of them arguably the most significant one that I've had was the first time I had experienced a patient death. It was a rather traumatic experience and quite literally the patient died in my arms which, it was hard first-time having that happen. It was easy to see how people completely shut down and go numb when really intense and tragic things happen, because that was my first response. Like I didn't want to talk to anybody, I didn't want to do anything, I just was numb. There was a numbness with anger. I was angry at just everything. This happened like this and to this really patient, to this unfortunate human being that had to pass away like this, and I knew everyone passes away. But in that moment, again, the intellect wasn't processing. There was just this raw emotion and this numbness and I think one way that mindfulness is able to help in those moments is because the pain can be so intense, the numbing of the pain is at times a logical response. But unfortunately, in medicine, we go through so many challenging situations like that. Since then I've had other patients passed and in over time, the continued numbing of our experience creates a certain callousness in the heart and we end up swallowing and ingesting these hard feelings without really processing and being aware of what's going on. Early on, I had a couple of good mentors that encouraged me to find some practice, something that allows me to wash it away, to shake it off, to recognize, to let it go in some way. So one of the commitments that I have now in the hospital is that when things get really intense that I take 60 seconds away and I go into a bathroom or a private quarter, and I do some intense breathing exercises, some shaking exercises and then come back with at least to admit to a meditation to like loosen the tension from the body. Why this is an important and mindfulness practice is because even though I have this idea and this practice of shaking and getting rid of the tension, often times, the day is so busy that I don't take the time to check in with myself. So the practice of mindfulness is like family. Just slowdown check in with yourself throughout the day. As I check in with myself, I realized that during the day I need to take 60 seconds here, I need to take 60 seconds here. Instead of waiting to the end of the day when so many things have built up and I'm really frustrated and it's like an avalanche that's ready to tumble over when along the way, I could have simply released the tension as it came. Well, I think even within the first few years of more intentional mindfulness practice, one thing I definitely noticed is that the chatter in my brain just basically disappeared. I mean, I didn't force it to but one thing I definitely noticed is that when I decide I want to have my mind focused, or be aware, or have attention that my mind does most of what I wanted to do. So now, it's kind of like my servant rather than my master. So I just think broadly. That's been very helpful because I have to during the course of teaching and seeing patients and all the other activities, a chattering mind is not helpful basically to anybody. So that's I'd say one of the biggest things that I've noticed. Also, broadly I've noticed a great deal of emotional regulation, not that I was ever like a crazy person to begin with, but I've noticed under extremely trying conditions which certainly happens in any given clinical day that I'm able to control my emotional response to a situation. So for instance, I can't even think of the last time that I had one of my buttons pressed in a clinic or had issues with the classic difficult patient. When you are more present in any situation where there's another person regardless of whether it's a patient or your friend or a family member, when you are completely engaged in that interaction, that discussion, I think it's easier for empathy to arise and therefore compassion to arise. So I think I've noticed that probably as part of my mindfulness practice. Since I see a lot of patients who might have post-traumatic stress disorder, may have depression, they may be homeless, they may have issues with "the system" whether it was their service in Vietnam or in other theaters, sometimes the patients are actually and sometimes very justifiably quite distraught. I think many of the times they just want somebody to really hear their story. Most of the time, if you don't have mindfulness quite honestly, you are not interested in the story. You've heard it before, the complaints are often quite predictable. So I think with that whole category of patients, and as I said it's common it probably occurs every day in clinic, using mindfulness to just again be present, usually being present means sitting right in front of the patient, looking him in the eye, listening to everything they've said and then saying simple phrases like, "I understand, you said," just repeating what they said so they realize that you of course heard them. Mindfulness is not something weird or an unusual state that we've never had. All of us have experienced it and I think when you start piecing together some mindful moments in your life, you start to see the rewards pretty quickly and certainly in my patients where I'm doing these brief mindful interventions in reaping rewards literally within minutes, I think that can convince anybody to pursue this. The other thing is in terms of from the patients or the client's perspective, when you are looking at the alternatives as to what you are offering them for their issues, typically, you are offering psychotropic medicines and other things that have a somewhat a risk to them and here you have something you can offer to a client or a patient that is low risk and likely higher benefit. I just don't see any downsides to do it. The practice can be incorporated into your daily life. It's not just simply "another thing to do." I think it doesn't just improve your relations with patients and the staff that you are working with but there's no question that will filter into your interactions with all the people in your life. Certainly, everybody wants to have your presence, your complete presence. So as I said, this is basically a fundamental skill that human beings have and need to have nurtured.
