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Her

9/30/2015

This morning I had a dream where I was abandoned by an old teacher. A palpable fear seized my belly. I awoke with the cold realization that I would lose all my teachers one day to death, distance, or disconnection. Wanting to explore the edges of this vulnerability without getting sucked into its black hole, I asked what my dear friend Jan Lundy often asks herself. “What is the kindest thing to do here?”

I listened to my favorite guided meditation Invoking Loving Presence in the Face of Difficulty by Tara Brach. When asked, “What are you believing can really go wrong?”, I felt a familiar choking sensation in my throat, a heaviness in my heart, and a churning in my upper belly.

I am afraid of losing Her, the spirit I call Galadriel or Great Mother, an avatar of infinite wisdom and compassion. I defend my meditation, yoga, and writing practice fiercely as if they are basic human needs as vital as food, water, and shelter. My teachers embody Galadriel, the Great Mother’s Spirit. Like a diligent and grateful apprentice, I am trying to learn all I can about the art of love before I lose them. Can I ever lose them?

Towards the end of the guided meditation, I was asked if there was a message from this wise, loving presence, a message of what was important to remember. With tears in my eyes and warmth in my heart, I heard the following words emerge.

I will fill your heart to completion.
You can never lose me.

Who is this ‘I” referring to ‘you’ and ‘me’?

She is the air I breathe, the space between thoughts, the stillness between waves of experience. She has already filled my heart to completion. Though I am afraid, I know I will never lose Her.

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Burnout

9/27/2015

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As human beings, we have this innate biological capacity to care for our young. Mothers who choose to nurse their babies release oxytocin and opiates. They bond with these tiny beings and respond compassionately to their numerous needs. Men (and women who choose not to breastfeed) can also release oxytocin and opiates in close relationship with others. Caring for others is a gift, a reason to celebrate life, especially in the face of adversity.

But what happens when caregivers burnout? How do we rekindle the flames of love when the embers are dying of physical and mental exhaustion? Whether you are a parent caring for a child, a child caring for a parent, a healthcare worker, teacher, or anyone providing care for other beings, you are asked to meet another’s challenge over and over again. What helps you to keep your heart open and interested in their stories?

At our recent Physician Wellbeing retreat, we were fortunate to have Dr. Rachel Naomi Remen, author of Kitchen Table Wisdom and My Grandfather’s Blessings as our keynote speaker. She talked about burnout, and referred to compelling research by Dr. Tait Shanafelt from Mayo clinic. According to Dr. Shanafelt, burnout correlated strongly (and inversely) with one's capacity to find meaning. Physicians who spent more of their time experiencing their work as a "calling" (rather than a "job" or "career") were less likely to burn out. "Calling" was identified in the study by measuring how often the work was experienced as a pursuit of core values and infused with meaning, or "making a difference" (rather than as a means of making money, or advancing one's own success in life).

To consider my work a calling, to find meaning in my personal and professional relationships, I need to slow down and recognize that suffering is occurring (mindfulness). Next, there has to be some desire to offer comfort and care (kindness). Finally, I must recognize that it is part of a universal human experience (shared humanity). This three pronged approach to compassion is well defined in Dr. Kristen Neff’s work with self-compassion. The self part implies that we are able to meet our own suffering with kindness, understanding, and acceptance instead of self-criticism and judgment.

If you are overwhelmed by suffering (chronic exposure to a child with special needs, an ill parent, patients, clients, students) without any respite for rest and self-care, it’s hard to remember compassion, even self-compassion. It’s no wonder as caregivers we often go into fight-flight-freeze mode as our survival instincts kick in. We totally forget the tend and befriend response to others and ourselves. How can we remember that this option is always available to us 24/7?

As a caregiver, I ask myself the following questions. How do I want to give? How much do I have to give? Why do I want to give? Holding the title of physician and working at an organization require that I show up at each patient visit and give a certain way. But the how, how much and why are all up to me. I also listen to my body – taking those bathroom, snack, and hydration breaks when I need to, retreating to my office or the nearest window in the building when I need to take few cleansing breaths and look outside for a wider perspective. When I’m not working, I try to engage in self-care practices that are meaningful to me, that refuel my compassion tank.

When a patient sees me for fatigue, we discuss diet and lifestyle, and investigate any medical conditions that might be contributing to their condition. I’m surprised at how often a person is burnt out by some aspect of overextension in caring for others and total self-neglect, especially women. It’s as if we are sprinting each day for the finish line, forgetting that the journey might be a longer marathon than we have anticipated. We must pace ourselves, stopping long enough to hydrate, eat, sleep, notice, and appreciate what we are passing along the way.

In order for me to receive stories from my patients, family, friends, and even strangers like thoughtful letters instead of junk mail, I must be present. I need to slow down, notice, care, and find some common ground with this being. Their story could be my own. If I bypass this possibility, I run the risk of dehumanizing them. We all do.

Waking Up

When your thoughts are in knots
and your scalp hurts from tension,
it helps to detangle with a comb,
a brush, the breath, this heart.
Only tenderness can separate
the strands of confusion, changing
the to do list into the to be list,
noticing his callused hand on your belly,
firm and reassuring
or the outline of morning light
against the blinds-
a kind invitation to a new day,
a new way of relating to yourself,
the sun rising inside you
to warm the hearts of others.

You can rekindle the flames of love when the embers are dying of physical and emotional fatigue. By pausing and asking yourself what you need, you can relate to yourself in a new way, the sun rising inside you to warm the hearts of others. You cannot give from an empty place. Please take care of yourself, so you can take care of others.

There are many ways to care for yourself. Self-compassion is just one way. For more information on this practice, please visit the following sites:

http://self-compassion.org/
http://www.mindfulselfcompassion.org/mscprogram.php
http://www.centerformsc.org/teacher-and-program-directory

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Praise & Blame

9/14/2015

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I gave my first presentation on Self-Compassion for Physician Burnout at OPSC’s Annual Fall Conference in Monterey, California on September 12. In the days leading up to the conference, I was caught in the worldly winds of praise and blame. I didn’t want to let praise inflate my ego. I wasn’t sure if my sensitive heart could handle criticism.

Preparing for another weekend of presentations and writing breakouts at PAMF’s Physician Wellbeing Conference, I wanted to become more intimate with praise and blame. So I listed to a talk by James Baraz on the subject. His guided reflections helped me explore my vulnerability when praise or blame arise.

If you’d like to explore these guided reflections, take a few minutes when you are relaxed and not easily distracted. Find a comfortable position (sitting, lying down) and let the following words wash over you:

“When someone praises me…” See if any thoughts or images arise in response to this phrase. Are there words, feelings in the body? Breathe with whatever is happening, and give the thoughts, feelings, images, or words space to be just as they are with kindness, without judgement if possible.

When someone praises me, I feel grateful for the opportunity to be of meaningful service. As years pass, I’m learning more that I am a conduit of Spirit and less of a solid, fixed identity called Kaveri (thought I am still attached to this identity!). My chest feels warm and open as my heart connects to this person’s heart

A similar reflection can be done with the following words. “When someone blames me…” I usually feel small, less than, incomplete. My husband often says he knows exactly what I’m feeling by reading my lips and jaw. My lips purse and my jaws tighten as if criticism has taken up permanent residence here. In addition, my throat feels heavy and constricted while my chest and belly feel like they’ve just been punched.

In times like these, it’s helpful to remember I’m not always at fault. Maybe the other person is confused and I just happen to be the closest target. Once I’ve had a chance to calmly reflect on the situation, I might find I am responsible for some unskillful act. I then have an opportunity to make amends. Whatever the case may be, I would like to respond to the reflection this way. When someone blames me, I might take it personally. May I remember to breathe.

A final reflection could be asking the question, “What would help me to remember my true self, my true nature in the face of praise and blame?”. For me the answer would come from silent contemplation, a lens that would help me see and appreciate a wider perspective of understanding than my zoomed in view of an inflated of deflated self. Meditation, yoga, writing, and nature help me cultivate this wider perspective. Conversations with objective, wise beings also help.

Whatever you choose to do with these contemplations, may you catch a glimpse of your true nature – a steady reflection of The Divine that cannot be blurred by any ripples from rocks thrown into your pond.

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Her

Burnout

Praise & Blame

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