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Your Best Life: Mindfulness - The End of Suffering

2015; Lippincott Williams & Wilkins; Volume: 473; Issue: 2 Linguagem: Inglês

10.1007/s11999-014-4086-8

1528-1132

John D. Kelly,

Psychological Treatments and Assessments

After another demanding day on call at the hospital or seeing patients in the office, it is easy for a physician to ignore his or her loved ones at home. As a practicing orthopaedic surgeon, I understand this predicament. Our fatigue consumes us. We see others as a burden - one more demand in a day full of seemingly insurmountable expectations. In order to properly care for our patients at the office and our loved ones at home, we must first take care of ourselves. Ignoring our own needs for the greater good of our patients is noble, but misguided. The consequences - burnout, failed relationships, and illness - are real [9], and have been well publicized [1]. Failure to manage our own emotions and relationships contributes to professional dissatisfaction, leaves us vulnerable to divorce and social isolation, and may even contribute to depression and substance abuse [1, 5, 6, 9]. We simply cannot give what we do not possess. Like a two-pack-a-day smoker in 2014, we are aware of the problems, but are perhaps unwilling to change our ways, chalking up unfulfilled personal lives to just being “the way it is.” But it does not have to be this way. Your Best Life will address and examine some of the psychological, biologic, social, and spiritual aspects of attaining wellness and integrating more self-care into one's life. I will begin with a basic explanation of mindfulness, defined as the practice of living in the moment. Managing Emotions Being mindful means being completely present in everything we do - whether it is sitting down for a conversation with your family, speaking with a patient, or during an operation. The practice of mindfulness, or living in the moment, has been shown to decrease anxiety and depression, while increasing feelings of overall well-being [3, 5, 6]. Through the course of our workday, we will be inundated with negative emotions like apprehension and guilt, which have a way of draining our energy. Guilt is a preoccupation with the past - we dwell on what “should have been.” Excessive guilt drains passion and enthusiasm within us and compromises our ability to truly give to our patients, our families, and ourselves. Anxiety is merely an occupation with the future - or what “could be.” Anxiety is based on “what if?” thinking. For example, “What if the wound doesn't heal?” or “What if I get sued?” “What if I perform this surgery incorrectly?” Like guilt, anxiety robs our inner strength and impairs our ability to freely give to others. Most anxious predictions of the future never manifest; dwelling on the “what ifs” robs us of the confidence, creativity, and drive to deal with them if and when they do occur. Only through adhering to the principles of wellness - meeting emotional, physical, social, and spiritual needs - can one gain enough happiness, joy, and energy to share with another. Emotions are managed through adequate rest, nutrition, and exercise. Social connection predicts happiness and longevity, and those who believe in a kind of “higher power” may have greater resiliency when dealing with adversity. When we are immersed in the present moment, guilt and anxiety dissipate. Negative emotions lose their hold on us. When present, conversations flow effortlessly and are not forced, insights come to mind during patient encounters, and surgeries are completed lyrically. When we are in the moment, we truly become our best selves. Practice Awareness How does one grow in becoming more mindful in the midst of the chaos that is a busy surgical career? How do we become more “in the moment?” The answer lies in awareness and practice. Becoming mindful not only requires practice, but patience with oneself and others. Our egos are constantly at work, undermining our ability to achieve inner peace. Some simple exercises can help us silence - or at least peacefully coexist with - this chatter. In his masterpiece, The Power of Now [10], Eckhart Tolle explains that becoming aware of our body is perhaps the most efficient way to achieve inner peace. According to Tolle, when we focus on feelings, we are immersed in sensation and enjoy the peaceful state of “no mind.” That is, when we focus on bodily sensations, like our breath, for example, the endless chatter in our mind ceases, and we are no longer held captive by our thoughts [10]. To practice mindful breathing, assume a comfortable upright posture, close your eyes, and breathe deeply for 2 minutes. Practicing “breathing exercises” for as little as 2 minutes has demonstrated appreciable levels of diminished anxiety and stress. The absence of continual stimuli - the silence - can be jarring and overwhelming. We often avoid reaching into the inner sanctum of our own thoughts, hoping that our busy work schedules - the meetings, papers, and patients - will keep the inner anguish at bay. But this approach scarcely covers up our negative emotions. Feeling our breath is perhaps the most efficient conduit to the present moment. When intrusive thoughts enter your mind (and they will) let them pass and return to the feeling of each breath. Those who practice a daily mediation practice have actually shown increased activity in the prefrontal cortex, the area of the brain dedicated to focus and attention [2]. You can approach mindfulness in a different way. Become more cognizant of the basic physical stimuli that live all around you. In the midst of office hours, try feeling your own hands and feet throughout the day. This will bring momentary serenity to a scattered mind. When in the office with a challenging patient, attempt to feel the chair you are sitting in, become aware of the chart you are holding, and most importantly, try to be totally attentive to the patient and his or her story. If you tend to run behind schedule, it is easy to lapse back into an anxious state, fearful of “what if I get further behind?” When faced with such anxious thoughts, it is best to attempt to focus entirely on the patient who is there with you - his or her words and expressions, and the examination. Use your breath or another sensation to help get you back to the present. Anxious thoughts cannot survive when we are totally present. Embrace The Process A natural reaction for a reader would be: “I took a deep breath, I am totally attentive to the patient, and the patient is still a major challenge. This is not working for me.” You may even ask, “Can I truly become more mindful?” Another frequent query: Is this only possible for the spiritually inclined, or can a busy surgeon develop a mindfulness practice that supports his or her professional and personal well-being? Yes, complications do occur, and the challenges we all face - spiritual and nonspiritual alike - will remain. We are not trying to achieve the impossible by eliminating every obstacle we could ever face. Instead, we are adhering to the notion that we will engage our problems with our “best selves.” When we are mindful, clarity returns and we are more prepared to deal with what is. The greatest barrier to mindfulness is the chatter our minds generate when faced with stressful situations. Become aware of these thoughts as frequently as possible. Truly mindful individuals become the observers of their thoughts. Those who are mindful use their thoughts for a purpose and are not at the mercy of them. In order to achieve the benefits that mindfulness can offer, physicians must embrace the daily practice of being present. The daily institution of a relaxation technique such as yoga, meditation, or deep breathing can be transforming [4, 7, 8]. All of these are means of cultivating mindfulness and getting back to the now, which may help achieve peace and fulfillment - one patient, one operation, one relationship, one moment at a time. When stressed, take a moment and practice mindfulness using some of the tools I have suggested. Then, when you are ready to, refocus on the external environment, and address the specific cognitive, interpersonal, or psychomotor task at hand. You will be better equipped to do it. Tomorrow, Try This Before every surgery at the scrub sink, feel the soap and water on your hands. Be totally present to the rinsing of the stream of water as it washes away dirt and your thoughts. In the office, take three diaphragmatic breaths every hour and focus on one patient at a time. When you turn off the ignition in your car before you enter your home, pause briefly and take a few deep breaths. Create some space between the thoughts of the stressors of the day and the present moment. Decide to be the observer of those thoughts and leave them in your car.