Category: Burnout

Health Grades: Mindful Self-Compassion as a Doorway to Freedom and Joy

1/18/2019

Sandbridge, Virginia Beach, United States by Jae Bano

The lipid (cholesterol) and Hbaic (3 month blood sugar average) results are released online by my primary care physician. After a few months of changing the exercise routine due to a chronic piriformis injury, and celebrating Diwali, Thanksgiving, and Christmas with so much food, I know the numbers won’t be good.

Taking a few deep breathes, I click on the lab links. The numbers confirm my apprehension. Shoulders slump, the heart sinks in disappointment.

Judgmental thoughts abound. How could you possibly think hiking and walking would be enough? Can’t you control your food choices and intake? Isn’t it a bit hypocritical to offer advice to patients you can’t even follow yourself? The thoughts threaten to submerge the heart even more in the brewing anger, fear, and sadness conjured by them.

Mindfully aware of the thoughts, feelings, and effects they have on the body, I recognize an old pattern based on past causes and conditions. The lab values feel like health grades, a kind of report card defining my wellbeing. If the numbers are outside of a certain range, then I have failed.

Ouch! This hurts. It’s unpleasant. Does it have to be, or am I adding on extra arrows of suffering that don’t need to prick so sharply?

I don’t like the numbers, but like final semester grades, they don’t define what I’ve learned about physical, emotional, and spiritual wellbeing. I wonder what a wise teacher, loved one, or good friend might say to me in this moment to help me remember kindness.

Sweetheart, this is an invitation to the biggest wellbeing party of your life! How does your body want to move, to dance? What do you want to eat at this party that is not only sweet or savory when swallowed, but will last to support deep loving connections with self and others?

Radiant, the heart emerges with more care, communicating with a curious mind to expand a narrowly focused lens on experience. With a panoramic view, I think of my colleagues and other physicians who balance the wellbeing of patients with their own wellbeing every day, sometimes to their own detriment. Ahh, others experience this, too.

Though I work part-time, have so much support at home, and cannot attribute a change in health status to work alone, I know other physicians suffer from exquisite burnout. Burdened by the overwhelming weight of patient care, demanding electronic medical records that threaten the physician-patient relationship, and never-ending administrative duties that seem to proliferate at an alarming rate, mindlessness can feel like the only easy way out.

According to Diana Winston, Director of Mindful Education at the UCLA Mindful Awareness Research Center (MARC), mindfulness is “paying attention to your present moment experience with openness, curiosity, and a willingness to be with what is.” For years, I worked with definitions like this in meditation, movement practices, silent retreats, and meetings with a mentor. The “paying attention to present moment experience with openness and curiosity” piece was starting to make sense. The mind got it, but the heart still wasn’t convinced.

When I learned about Kristen Neff and Chris Germer’s research and teachings on self-compassion, and began to integrate them into mindful practices, the heart began to trust the combined capacity of heart-mind to communicate with the body, to be in tune with each other and sense when there was an imbalance of thoughts, feelings, and sensations leading to dis-ease. The capacity to stay with these experiences led to internal freedom and joy independent of external circumstances.

To this day, mindful self-compassion gives me the strength to stay with difficult patients and circumstances, to touch intimacy and vulnerability without overwhelm, to celebrate healing with patients in a larger context than ones limited by disease states and problem lists.

Clearing
by Martha Postlewaite

Do not try to save
the whole world
or do anything grandiose.
Instead, create
a clearing
in the dense forest
of your life
and wait there
patiently,
until the song
that is your life
falls into your own cupped hands
and you recognize and greet it.
Only then will you know
how to give yourself
to this world
so worth of rescue.

May we all create a clearing in the dense forest of our lives. May mindful self-compassion bring back the meaning in medicine.

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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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Health Grades: Mindful Self-Compassion as a Doorway to Freedom and Joy

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