Category Archives: Physicians

Navigating Aortic Valve Replacement (AVR) Surgery with mPEAK and Mindfulness

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Read this very personal story from a recent mPEAK participant and Join Pete Kirchmer for the next mPEAK 3-Day Intensive March 11-13, 2017, UC San Diego Center for Mindfulness, San Diego, CA.

By William R. Matthews, MA, LPC

Medical literature contains numerous references proclaiming the benefits of meditation and mindfulness on cardiovascular health and pain management. But to me, these were merely academic case studies, as I had not personally known anyone who had successfully used mindfulness to manage through a major medical procedure. That is, until August 17, 2016, when I had aortic valve replacement surgery.

I need to back up a moment. In March of 2016 I participated in the three-day mPEAK intensive that included six weekly one-hour conference call follow-ups. For me the follow-up sessions were critical for integrating the didactic and practice sessions taught in the three-day into a consistent meditative practice. mPEAK was my first hands-on experience with mindfulness. At that point in time, I had been aware for several years that I had a bicuspid aortic valve that would “eventually” need replacement (in fact it kept me from fully participating in the five-mile mindful walk that is part of the program), but there had been no discussion of surgery with my primary physician or cardiologist. Two months after returning from mPEAK, my new primary care physician sent me for an ultrasound of my heart. The results indicated significant blockage of the aortic valve, and that started the ball rolling for surgery “as soon as possible.”

When a date for surgery was set, I emailed mPEAK ccf9e-headshot2program director, Peter Kirchmer, asking if he could provide me with additional mindfulness resources on pain management, since that seemed to be a big concern connected to surgeries. In response, Pete wrote “Forget about additional resources. You have everything you need already. Just continue developing the skills you already have.” Wise counsel indeed. So I loaded up my iPod with all the meditation files mPEAK had made available to us on its website, added John Kabat-Zinn’s Mindfulness Meditation for Pain Relief, and a few other meditations. I played these every evening before bed, in the waiting lounges of airports, and in my office sharing them with my clients. Ultimately, my iPod was headed with me to the hospital.

The night before surgery I slept soundly without the benefit of any sleep aid other than my meditation-filled iPod. I arrived at the hospital at 5:40 AM surgery day and was taken back to pre-op shortly thereafter. The nurse remarked that my blood pressure showed no signs of anticipatory anxiety.  I too was surprised at how calm I was considering someone was about to cut my chest open and mess with my heart. I told the nurse about my mindful preparation and she asked a lot of questions of interest to learn more. A brief chat with a family member, a friend and a short prayer from the rector of my church was all I remember before waking up almost six hours later.

I awoke in recovery to see the same three faces that I had left there that morning. After a few minutes I was taken to cardiac ICU. A nurse and a member of the physical therapy team armed with a pillow were waiting for me. The PT announced that she was there to help me get into bed by “leaning into my pain and clutching the pillow” as my incisions were on the right side along with two chest tubes. Even in my post-anesthesia fog, my mind went immediately to a body scan, noting that my left side was incision- and tube-free. I also made a mental note that at home my bedroom is set up so that I can only get into bed from my left side. I got up off the gurney without assistance walked around the end of the hospital bed, sat down and got into bed on the left side of the bed without assistance (with minimal pain) and said, “I think I’ll do it this way instead.” The PT could only respond, “I guess that way’s OK too.”

The nurse waiting her turn with me announced that she was there to help me with pain management. She advised, “The key to pain management is staying ahead of the pain.” I interpreted that to mean don’t wait until the pain gets bad, keep taking your medication. At that point my mind recalled an activity from mPEAK where we were asked to insert a hand up to mid-forearm into a bucket of ice water and keep it there until the pain started to hurt. Most people removed their hands from the buckets in under a minute. The teachers explained that a large part of managing pain is changing our relationship to the pain. After sharing techniques and mindsets for doing so, we were given the opportunity to try immersing our hands into the ice water again. Most everyone were able to keep their hands in the ice water for considerably longer the second time around. With this recollection I informed the nurse of my plan – to measure my pain on a scale from 0-5 every hour or so, and if the pain number was not any higher than the last “reading” I wouldn’t be asking for pain medication. I received medication for pain only twice: 1) shortly after arriving in the ICU and 2) later that day when they removed the chest tubes. By the next morning, the day after surgery, I had discontinued all pain medication for the remainder of my hospital stay.

Prior to my surgery, my cardiologist and cardiac surgeon both agreed that I would need to go to a rehab facility “for at least a week” after being discharged from the hospital because I live alone. However, I created a dilemma for them because my recovery was so quick and complete. The discharge social worker advised me that I didn’t meet any medical criteria for rehab placement. She even had PT and OT evaluate me one more time in hopes of coming up with some reason to get me admitted, but neither could come up with a medical need. So I was discharged after 4-1/2 days, with my doctors agreeing that I could stay with a friend who lived within a mile of the hospital. I had a return visit to the cardiac surgeon four days afterward. At that appointment my cardiac surgeon said I was free to go back home and decide for myself when I would go back to work. I was back to work half-time three weeks after surgery and returned to full-time work the following week.

While I wouldn’t necessarily put AVR surgery in the category of a high performance activity, I am convinced that the skills and tools I learned from mPEAK, played a central role in my recovery.

William R. Matthews, MA, LPC is in private practice with the Great Lakes Psychology Group. Bill works out of GLPG’s office in Clinton Township, Michigan, where he counsels with children, adolescents and adults using family systems, EMDR, Mindfulness and sports psychology approaches. Bill is also a volunteer trainer and curriculum consultant for the University of Notre Dame’s Play Like a Champion Today educational program. Bill can be reached at bill.matt.GLPG@gmail.com.

Join Pete Kirchmer for the next mPEAK 3-Day Intensive March 11-13, 2017, UC San Diego Center for Mindfulness, San Diego, CA.

ccf9e-headshot2Pete Kirchmer is  the Program Director for the UCSD Center For Mindfulness mPEAK (Mindful, Performance Enhancement, Awareness & Knowledge) Program. Pete specializes in coaching his clients in applying the practice of mindfulness to making healthy lifestyle changes as well as improving performance in life, work and sport. For more information about Pete Kirchmer please visit his Mindfulness Based Health Coaching website.

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What Time is It? Inspiring a shift from tic-toc to lub-dub.

by Royan Kamyar

royanRoyan Kamyar, M.D., MBA is Founder and CEO of Owaves, a lifestyle medicine technology company based in Encinitas, CA producing software tools for wearable devices that inspire and motivate the next generation to engage in healthy lifestyle activities.  Royan has presented at TEDxUCSD and been quoted by Forbes, Reuters, FOX News, Xconomy, U-T San Diego and the San Diego Business Journal.  Royan earned his M.D. at Baylor College of Medicine, MBA at the Rady School of Management, UC San Diego, and BA and BS in Biochemistry and Business Administration at UC Berkeley and the Haas School of Business.  He serves on the Formative Board of Directors for UC San Diego Center for MindfulnessMindfulness-Based Professional Training Institute and is an active member of the American College of Lifestyle Medicine.

Image Credit: Dadara

[Image Credit: Dadara]

Imagine a flowering plant. A baking cake. A rising stock price. A healing wound. Time passing can be a beautiful thing.

Why then does the cartoon above resonate so deeply with us? Is it our fear of mortality? Our never-ending list of to-do’s and things left undone that haunt us moment-to-moment? Are we as a culture, as a species, doomed to brood on the past, fear the future, and run away from the present?

The Centers for Disease Control and Prevention (CDC) identifies our sense of “time scarcity” as a leading source of stress in the United States — a primary cause of heart disease, our number one killer. Meanwhile, growing positive psychology research demonstrates the healing power of “being in the present.”

What if our relationship with time shifted? What if we began to view time as a source of inspiration instead of dread? What if each glance at the watch put us more “in the moment,” made us feel more focused, centered and alive? Few realize that our modern timekeeping system is fundamentally arbitrary. Hours, minutes and seconds have no home in cosmology, but rather the digits of our hands…

Technology is evolving as we speak to put smartphones on our wrists. The era of smartwatches with heart rate sensors and real-time monitoring systems is dawning upon us. With processing powers greater than the earliest mainframes and NASA spaceships embedded into our timepieces, we are no longer compelled to settle for a construct of time rooted in hand gestures, ropes and rocks. What if we, as a community of innovators and healers, took the first step in evolving our modern-day answer to the age-old question, “What time is it?”

Mindfulness & Innovations in Timekeeping

The mindfulness community actually has a long and storied track record of innovation in timekeeping, centered around spiritual observations, holidays, rites, rituals, meditation and prayer:

32,000 BCE – Cave art found in France and Germany depicts lunar and seasonal cycles of the “heavens”, representing the first known calendaring system. Its creators are believed to be astronomer-priests of the late Upper Paleolithic Cultures.

4,200 BCE — Ancient Egyptians calculate 365 days between alignments of the sun and Sopdet, goddess of Sirius the Dog Star, marking the Nile’s concurrent flooding and enrichment of the soil.

3,000 BCE — Stonehenge in modern-day England demarcates the annual winter and summer solstices, serving as burial grounds and a venue of ancestor worship and rituals.

2,400 BCE – The first known clocks are the shadow clocks or “obelisks” of ancient Egypt, erected by clerics in pairs at temple entrances for ritual observances.

2,100 BCE — Assyrians, Sumerians and Babylonians of the Middle East establish twelve phases of the moon, or “moonths”, per lunar calendar year. Holy days are declared on the first, seventh and fifteenth of each month.

1,000 BCE – Egyptian clerics develop water clocks or “clepsydras” to continue tracking proper timing of rituals throughout the night, i.e. in the absence of sun and shadows.

100 BCE – Chinese, Korean and Japanese Buddhist monks advance incense timers to replace the more flammable and inaccurate candle clocks of the day. Utilizing various scents, one smells the time change.

1200-1300 AD — Benedictine Monks of Western Europe become the first clockmakers of the region and create the mechanical clock. Adding weights and escapements to water clocks automates ringing of the communal prayer bell.

1582 AD — To more accurately celebrate Easter in its relation to the March equinox, Pope Gregory XIII spearheads the Gregorian Calendar widely used today. The Gregorian Calendar arrives closer to the tropical or “solar” year than the preceding Julian Calendar.

The Origins of Tic-Toc

The divisions of years, months and days are rooted in cosmological events and account for consistent measurements across disconnected cultures. Subdivisions of weeks, hours, minutes and seconds, however, are largely arbitrary and varied more greatly throughout history.

Weeks, for example have seen lengths of 3 to 13 days depending on prevailing leadership. Decisions usually hinged on what was deemed a reasonable workweek as per autocrat or religious text, i.e. “… on the seventh day he rested.” Papal States used six hour days as recently as the 1800’s with 6 o’clock pointing fixedly to sunset, and the Japanese had a twelve hour system with intervals that varied in length according to the season. Decimal time was used by China throughout most of its history dating back to 1000 BCE, was espoused by the French Revolutionary thinkers of the late 1700’s and resurfaced in 1998 when the Switzerland-based Swatch company proposed “Internet Time” of 1000 beats per day.

The sexagesimal system which lies at the heart of our modern-day “tic-toc” was similarly devised for convenience, not derived from scientific fact or basic principles. The ancient Sumerians and Babylonians used sixty as a mathematical base due to its ease of counting with two hands. Each finger segment on one hand represented a number one through twelve demarcated by the thumb, and each digit of the other hand represented a multiplier. Multiplying twelve finger segments by five digits provided a max count of sixty. The number sixty is also considered a “superior highly composite number” in mathematics, meaning it is easily divisible and lends itself well to fractions.

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[Image Credit: Ministry of Education, Brazil]

The Problems with Tic-Toc

Dr. Jon Kabat-Zinn presents a valuable anecdote from the Mindfulness-Based Stress Reduction (MBSR) program he developed at the University of Massachusetts Medical Center, in his manuscript Full Catastrophe Living:

Linda described feeling as if a large truck were always right on her heels, driving just faster than she can walk. It was an image people could relate to; the vividness of it sent a wave of acknowledging nods and smiles through the room…

Her mind was the truck. It was always right behind her, pushing her, driving her, allowing her no rest, no peace.

In the modern age, feeling overwhelmed and out-of-sync is an increasingly common experience. Heart disease is real, heart attacks are real, and the CDC sobers us with the knowledge that this “time scarcity” mentality is a chronic stressor.

Perhaps it is not surprising then that one of the central tenets of mindfulness-based stress reduction is to encourage patients to adopt the present moment. As Dr. Kabat-Zinn explains:

Mindfulness is paying attention on purpose, in the present moment, and nonjudgmentally, to the unfolding of experience moment to moment.

The ancient Greeks embraced two definitions of time to help carry this distinction. “Chronos” was used to discuss chronological or sequential concepts of time, with which we are most familiar and tic-toc describes quite well. “Kairos”, on the other hand, translates to the “eternal moment” in which everything actually happens. This latter concept is missing from our current communication of time and resonates with Dr. Kabat-Zinn’s teaching.

Among pools of evidence collecting around the importance of present moment awareness, Science published a Harvard study in 2010 demonstrating a link between “mind-wandering” and mental health. Over 250,000 data points from 2,250 subjects between the ages of 18 and 88 shows our minds are focused on the past or future 46.9% of the day, leading directly to poor mood. As summarized by study co-author psychologist Matthew A. Killingsworth:

Mind-wandering is an excellent predictor of people’s happiness. In fact, how often our minds leave the present and where they tend to go is a better predictor of our happiness than the activities in which we are engaged.

The tic-toc almost by definition puts us in a sequential frame of mind rather than in the moment. This shift first took hold in the Western world during the Middle Ages with the spread of the mechanical clock. Benedictine Monks lived ascetic lives centered on punctual communal prayer six to seven times per day. Bells (Celtic = clocca or “clock”) were rung manually to inform the community of established timetables. By adding weights and escapements to water clocks, a bell could be rung automatically without requiring a brother present, and more dependably as well.

As the National Watch and Clock Collectors Association notes:

Time no longer flowed like water through a clepsydra — it ticked. It was no longer a seamless continuum, but a succession of short periods.

The streaming of water, passing of a shadow or burning of a flame became replaced by the now familiar “tic-toc”. With the dawning of the Industrial Revolution and mass scaling of clock and watch production, “dollar watches” put everyone in a mechanical state-of-mind and helped synchronize the workforce. Time became money as factories calculated hours worked as key labor costs and employees as wages. As per American historian Lewis Mumford, “… the archetypal model for the industrial era was the clock.”

The tic-toc represented a major departure from cosmological cues for the average person organizing her or his day, as the sundial became officially obsolete in the 1800’s. Perhaps the greatest divorce came more recently with the International Committee for Weights and Measures decision to re-define the second in 1967. A “second” no longer represents an arbitrary fraction of Earth’s rotation around the Sun, but rather:

9,192,631,770 periods of the radiation corresponding to the transition between the two hyperfine levels of the ground state of the caesium 133-atom.

While this advances our computer networking capabilities and satellite communications, the tightening of our “tic-toc” does not necessarily serve to heal our emotional relationship with time. In fact, the focus by such governing bodies on the physics and engineering components of time misses the human implications that actually define it.

Within some of our lifetimes, Albert Einstein brought forward the general theory of relativity, which proved without a doubt that a second for you is not the same as a second for me:

Put your hand on a hot stove for a minute, and it seems like an hour. Sit with a pretty girl for an hour, and it seems like a minute. That’s relativity.

Our speed, our culture, our circumstances, our environment, our climate, our neighbor, our mindspace all dramatically impact our individual perceptions of time. Further, Einstein’s contributions to quantum mechanics helped show the existence of time actually depends on our perceptions of it. No consciousness, no time. So these changes in perception that we feel and experience on a regular basis are not simply novelties or asides in the calculations of time, but real occurrences that get neglected in our current approach.

In the 1950’s, University of Minnesota biologist Franz Halberg coined the term “circadian” (Latin = around a day). Known as the “godfather of chronobiology,” he helped establish a fundamental, evolutionary relationship between our biology and time. We now know that every cell in our body, down to the DNA level, has some “awareness” of (or dependency on) the time of day. This is true for virtually every known organism, even those that are single-celled.

The implications of these “circadian rhythms”, or physiological patterns dictated by the rise and fall of the sun, are both broad and deep. Recent research encouraged the World Health Organization to label night-shift work as a “probable carcinogen”, in the same class as UV radiation, due to its devastating impact on circadian rhythms. Poor circadian rhythms are also linked to heart disease, obesity, diabetes, metabolic syndrome and mental health disorders. Our 24/7, hyper-connected, always-on smartphone culture makes the bulk of us “social-shift workers,” exposed to blue light late into the night… and shifting our hormones into dangerous patterns.

circadian

Why then has nothing changed? Does our new subjective, dynamic definition of time, no longer static and mechanical, not change the underlying formula? Does the realization that our biology has a fundamental, natural and overarching relationship with time not beg us to re-evaluate why this is not factored into the perennial question, “What time is it?”

Introducing Lub-Dub

The arbitrariness of our current timekeeping method, combined with the facts that it is out-of-date and fosters a stressful mindset, presents us with a wide-open opportunity to improve. Coupling our evolved understanding of time with modern needs and the latest technologies, perhaps we can imagine a way to re-define the concept so that it better serves our bodies, hearts and minds.

Consider your daily routine. It might look a lot like this: wake up, meditate, eat breakfast, drive to work, work, eat lunch, go for a walk, work some more, drive home, cook dinner, spend time with family, relax and read a book, go to sleep. What is the optimal way to get you from one “daily milestone” to the next? When you realize the bulk of these milestones don’t generally change from one 24-hour block to the next, you begin to sense there might be a better way to organize and track your day.

Peter Galison, physics professor, historian and philosopher at Harvard University defines clocks accordingly:

We’re always looking for things that repeat, over and over again… and that repetition, that cycle of things, forms a clock. That’s all time becomes, is some repetitive process.

So since my daily activity patterns generally repeat from one day to the next, what if they became my “tic” and my “toc”? So my cadence became linked to “breakfast time” and “exercise time” rather than some mechanical, arbitrary construct that lies beneath it? In essence, I become my clock. Lub-dub.

What we can imagine is a shift from a quantitative, mathematical and mechanical view of time towards a more heartful, experiential and soulful view of time — one that makes sense on an emotional and psychological level.

Amazingly, this approach has a biological basis as well. In his study of circadian rhythms, Dr. Aschoff also coined the term “zeitgeber”, German for “time giver” or “synchronizer. ” The zeitgeber is any external or environmental cue that “entrains” or synchronizes an organism’s biological rhythms to Earth’s 24 hour light/dark cycle and twelve month orbit.

Decades of chronobiology research tells us that these same types of intuitive markers for progression of the day, or daily milestones outlined above, are in fact biological zeitgebers. Meals, exercise, and socializing each play a role in establishing our cyclical physiological relationship with the solar environment. This has implications for: our sleep/wake cycle, body temperature, patterns of hormone secretion, blood pressure, digestive secretions, levels of alertness, mood and reaction times just to name a few.

brain

[Image Credit: Nature Reviews Neurology]

Timothy Monk, Professor of Psychiatry at the University of Pittsburgh Sleep Medicine Institute summarizes the value of this framework well:

Circadian rhythms are driven by endogenous processes, are self-sustaining, and rely upon circadian time cues (zeitgebers) to remain appropriately oriented to the individual’s environment and desired routine. The gold-standard measures of human circadian rhythms have been core body temperature and salivary or plasma melatonin levels. However, one can also make the case that the behavioral circadian rhythms related to the timing of sleep, meals, work and social interactions are just as valid circadian rhythms as the physiological ones. Moreover, these are the rhythms most salient to the individual himself or herself.

An additional “bonus” of shifting to this type of intuitive, biologically-based system is that these same behaviors — nutrition, sleep, exercise and socializing — are deemed by the American College of Lifestyle Medicine to be the fundamental building blocks of a long, healthy life. Also called “lifestyle vital signs,” measuring and monitoring these parameters might be more meaningful in predicting long-term morbidity and mortality than the traditional set of vital signs for current and future generations (due to an overall shift from acute to chronic and preventable disease). Following the age-old adage that you cannot manage what you do not measure, taking these health fundamentals into account would help prevent and treat diabetes, obesity, heart disease, high blood pressure, depression, anxiety and more.

For example, we know that heart attacks are most likely to occur shortly after dawn due to concurrent rises in blood pressure and cortisol levels. We also know they are more likely to occur at the beginning of the workweek, when stress from anticipating future events reaches its peak. What if your timekeeping tools took this knowledge into account, and helped you time activities accordingly? Perhaps optimizing algorithms to discourage Monday AM work meetings when possible? Or suggesting stress-reducing sounds or images during these times? Something as simple as a picture of a loved one, left in ambient view on your wristwatch at the right time, might go a long way in dipping your odds for a cardiac event.

CFM OWAVES

[Image Credit: Owaves]

Now time becomes something we can control, name, juggle, design, manipulate and relate to according to our personal biology, desires and needs. Granted, a universal timekeeping system would always need to lie at its base. Meeting times must be coordinated and train crashes prevented. And yet, analogous to “personalized medicine”, we can evolve or grow from this generalized base to create a truly individualized and relevant concept of time that inspires and heals rather than stresses and reduces.

Commonly in mindfulness courses today, we are taught that certain external stressors cannot be changed, and are best addressed by mobilizing our internal resources to better respond and adapt to our environment. Yet our maligned relationship with time seems to be universal and we know now, increasingly, that our historical perspective of time is incomplete, arbitrary and malleable. Perhaps we should learn from the mindfulness leaders of millennia ago, and play an active, creative role with regard to understanding, communicating and measuring time.

As we speak, physicists and engineers continue to develop incredible methods for fine-tuning existing calculations of timekeeping tools to better run the machines of the world. I propose it is our duty, as a community of healers and innovators, to ensure that human health and well-being is plugged more squarely into the equation.

Continue to explore the Mindfulness courses presented at the UC San Diego Center for Mindfulness. Registration is open for our local 8-Week Mindfulness programs along with our Mindfulness-Based Professional Training Programs that are held in various locations in North America.

 

THANKFUL: Appreciating Beautiful Gifts from Children and Youth

By LeesaMaree Bleicher

LiseeMaree-Bleicher-300x168-2Visit LeesaMaree Bleicher, along with M. Mick Gardener, at the 2015 Bridging the Hearts & Minds of Youth Conference in their 90-minute breakout session called enlighten: a Trauma Informed Mindfulness Based Therapeutic approach combining Restorative Justice as an answer to youth involved in the criminal justice system. Promoting the concept of: Survivor Empowerment not Victimization of Recovery not Incarceration.

LiseeMaree BleicherAlbert Schweitzer said, “At times our own light goes out and is rekindled by a spark from another person. Each of us has cause to think with deep gratitude of those who have lighted the flame within us.”

Nowhere is this spark as bright than in the heart of a youth. Nowhere does there lay a stronger elixir to waken your purpose than in the sparkling enthusiasm of a child’s spirit. And nowhere is there a grander purpose than the need to ease the suffering of a child.

The beautiful thing about helping children is that buried beneath the armor and attitude is this snow-white innocence, this flawless foundation, this feral potential still connected to God, or source, or that which is greater than us individually. This goodness remains steadfast despite the harm adults have done.

Our mission is to guide them back to this place of bliss, if only momentarily. In the shift to recovery, not treatment, we have come to understand “recovery” as recovering that which was lost from us: innocence, joy, light, that feral potential. Discovering the road back to that place of purity and reclaiming our power is the key to freedom from suffering.

Our mission, should we choose to realize it, is to be the guides whose purpose is to steer youth back to reclaim their potential. We do this each time we teach that even in the unbearable moments in life and in the dark of a night of unimaginable pain, there shines a dim but powerful light that will one day illuminate the darkness. And within this light, there shines their power and their way out of suffering.

Ideally we strive to plant the seeds of patience, tolerance and acceptance in our youth.

We affirm: “Life is not fair 8359890249_ed085986b0_b-360x200-1and no you did nothing wrong. No it is not your fault. No you do not deserve what happened to you. No one can make it better, but one day if you just hang on — have faith — one day, I promise you will be OK. One day you will emerge from this stronger and more powerful than you can ever imagine.”

When the testimony of sharing lived experience trumps our cool “professional boundaries,” we make a true and lasting difference. Speaking from the heart and sharing our human experience plants seeds of hope, inspiration, and resilience in youth. Nowhere can we feel the way of freedom from suffering than knowing someone who has walked down a similar path of torment, come out standing steady despite someone else’s best effort to make them fall, and still has enough fierce courage left to tell their story.

Speaking candidly, most youth who like myself come to be in jail, in foster care, or other programs do so by force of their external circumstances. Many come from fragmented, broken homes where they witness and endure unspeakable acts of cruelty from the adults who should be protecting them. Rarely do youth land in these places by their own choice.

Emotional, physical, spiritual, and sexual abuse manifest in the blueprint of our souls and spirits. Such abuse might express itself as a 4th grader bullying his classmate, a youth stealing, a youth who yells obscenities at authority figures, who refuses to eat, who is promiscuous, who skips school, who takes drugs, who cuts their flesh in an effort to feel or not feel pain. It’s the days of silence before an attempted (or successful) suicide where we often mistake the symptom for the cause and fail in our attempts to “treat” them. It’s that approach which undermines the very core of their suffering. And it’s where we as adults fail them yet again.

It was in the vacant blue eyes of an 8-year-old boy named Travis who came to live in my home when I first realized how futile, how misguided, and how inhumane this system to care for children was. It is still raw, and I am not sure yet if I can fully capture how profoundly my time with him altered my heart. This experience both expanded my heart beyond what I thought was possible and then reduced it to nothing when he was gone.

One day while we were together, Travis “disconnected.” Fell silent, withdrawn. And I asked him, “What are thinking about? What makes you so sad? You can tell me anything, and I will believe you. And there’s nothing you tell me I won’t think is important.” After awhile, he came to me and said, “I’m sorry. I don’t know why sometimes I can be happy, and all of the sudden I feel sad. It comes out of nowhere.” I looked at him, cupped his tiny perfect chin in my hand, peered into his blue eyes and wrapped my arms around him. I hugged him tightly and said “I know. And it’s OK. I feel like that sometimes too. And you know what? One day you won’t feel like that all the time. One day you’ll take that sadness and turn it into happy.”

All he was unable to say was conveyed in the way he hugged me back. And in that precious moment when he mumbled “Thank you.” I thought my heart would break.

There was nothing I learned from a text book, nothing from evidence-based practice, and nothing in the foster parent orientation that prepared me for that moment. I reacted from my heart.

My only desire was to ease his suffering and instill within him the tiniest notion that no matter what he felt, it was OK and that it was only temporary.

The reality is that when we come into a child’s life to aid them, they are held in a punitive, restrictive, inflexible system. We don’t always look past that to what brought them into that system to begin with. If we increased our awareness, we would see that few children are delinquent, homeless, end up in jail, or in foster care by their own volition. They come to these places battered, bruised, and sad, having been victimized by adults.

In the months that passed with Travis, after my heart ran ahead of any reason, I watched a sad little boy turn into a bright, happy, fun-loving child who didn’t need medication or to be bounced around from foster home to foster home. What he needed was to be loved.

Now, there was nothing I could have offered Travis that ever could have replaced what his parents failed to give him. My love was a Band-Aid to soothe him until he could grow enough to care for himself. But far more miraculous than anything that I gave him was what he gave to me.

One of my tendencies was to over-explain myself; to offer excuses and/or apologies for nearly everything to everyone. One day, I was going on and on to a friend about why I didn’t do something when from the top of the stairs I heard this little voice say, “LeesaMaree, stop that. You don’t have to explain yourself. It’s OK whatever you do.” I froze at his wisdom and the fact that he cared to try to ease my suffering. Wow.

Then, I came to deeply understand the bigger context of this whole boundary thing. And I came to know that anytime we seek to engage in the helping of another being, it is not so simply a gift we give. It is not one sided.

The moment we think this, we have already failed. We as the perceived “givers” are really part of a mutually beneficial healing exchange connected to a greater energy. Once we come to understand and seek to increase our sensitivity and re-establish the heart in recovery and treatment, once we incorporate living testimony in our practice, only then will we make a true and lasting impact.

This time of year we celebrate thanks for Bridging Badgemany blessings. But as a “profession,” we overlook the rich and beautiful gifts that the children we encounter give us: the opportunity to care, to express our warmest compassion, and to ease suffering. All these things alter us. They allow us to ascend toward the deeper meaning of our shared human experience. The next time a child or a parent or someone else says thank you for the work you do, with humility and honor defer him or her and say, “No, thank you.”

Thankful

(a poem inspired the youth who have walked into my life and left imprints upon my heart)

The leaves fall…fluttering to the ground…landing like a thrush
Awaiting winter’s rush from summer’s dream
I remember summer… bright green and sparkling
and I remember you…your hand extended towards mine…offering me your heart
Giving me that moment…your time…yourself
You said, “Come this way. Here, let me show you… See the sun how it shines?”
Your smile confused the sun and stole starlight’s sparkle
“Listen. You can hear the grass tell its secrets …follow the burrowing bunny, he knows the way…see the Stellar Jay…as he chats up dawn…urging the flowers to wake up…he knows what I am talking about. His blue wings touch heaven”
I ran away from you…but never far… You were everywhere…in everyone
You tied me with a fragile cord of compassion…bound me to the fertile ground…tied me to heaven…left seeds in my hand
You allowed me to fall but not be crushed
Like the leaves, I too have been pink, russet, pumpkin and golden
It was the seeds you left… clutched tight in my hand
One day I remembered…it all came back in one fell whoosh
You cared …You took the time…You forgave me
You gave me another chance and a million more
You listened to me…You reignited the spark
Oh I am so thankful for You
Oh those seeds you left… I planted them under the moonlight…and when they blossomed…I crushed them and stuffed them in my heart
I knew what to do ’cause you said “the best way to show someone how much you appreciate them is to pass on what they gave to you.”
So…I watered the seeds with tears…transformed my fears…infused them with love
Oh I didn’t have it for myself…that care and concern
But I do for them…the ones that come behind me
So I scattered the seeds in the wind of each encounter
Oh, and I did exactly as you taught me …I gave my heart generously and… I fertilized the seeds with glitter…so that those who come behind me will sparkle brighter…than I ever did

Mindful Matters: Nourishing Our Wellbeing in Clinical Practice

by Chris Gauthier

There are lots of people, many of them healthcare professionals, who are serving this world by caring for others. Something within some of them is so completely synchronous with the desire to heal others that there is nothing in this life they would rather do. The fact that there are people so committed to helping others become whole is awe-inspiring. However, too many times the basic premise of healing is forgotten: we must heal ourselves if we have intentions of healing others, so we can better serve all.

stethoscopeWith the world of medicine constantly changing, areas of improvement in patient care are abound while its practitioners continue to meekly manage mindful self-care rather haphazardly. In America, this recent structural revolution in the medical industry, regardless of personal opinions and politics on the subject, is significant. The demand for physicians, psychologists, and other medical practitioners is exponentially growing. Medical professionals that do well in their care – because let’s face it, we have or know someone who has had a needlessly negative experience seeking quality care, can be likened to an oasis in this increasingly desert-esque landscape. How do we as practitioners, continue to offer the top care that we do, while combating increasing instances of burn-out, fatigue, and a general lack luster experience where on occasion we may dip our toes into the depths of existential darkness? With greater work loads and less time that we do not have, it is imperative for us to find ways to care for ourselves. These sharp changes in the field require equally acute transformations of focus.

There is another movement germinating in this field z krasner9258-1within the western context that proffers a way for us to take care of ourselves so that we can do what we love: take care of others. This movement is towards mindfulness. Mindfulness in clinical practice is essential to thriving long-term in the duty of serving our patients to the best of our abilities. Mick Krasner, MD FACP practices primary care internal medicine in Rochester NY and teaches that the University of Rochester School of Medicine and Dentistry. Going strong after 12 years of integrating Mindfulness-Based Stress Reduction into the lives of his patients, medical students and various health professionals, Mick might be on to something. A plethora of research on this topic shows an improvement in quality of care of patients, and an increase in well being for the health professionals who practice it. An example of one of the aspects whereby we can incorporate mindfulness is within the context of communication education with our colleagues.

Howard B. Beckman et. al. published a fascinating study exploring mindfulness-based interventions with practitioners, finding that these kinds of mindful communications skills when learned and practiced, promote a sense of community and an increase in time devoted to personal growth. In the paper, “The Impact of a Program in Mindful Communication on Primary Care Physicians,” they conduct in-depth interviews with physicians who had completed a specific 52-hour mindful communication course, which had known effects of reducing distress and burnout as well as increasing empathetic capacities. Generally there were three main themes that surfaced through the randomized qualitative data: 1) sharing personally the experiences from medical practice with other colleagues in the class setting reduced professional isolation, 2) increased skill sets to listen attentively to patients, 3) developing a greater sense of self-awareness is a positive experience. It is clear here as is true in other studies, that learning how to engage in mindfulness practice (and practicing!) does tremendous good for the individual and by proxy, for the community as a whole.

This education in mindfulness has ineffable multi-facetted value, but we already don’t have enough time as it is! So what do we do? Well, one way is by looking for those CE’s that will offer us this kind of education that will teach us to nourish ourselves so we can continue to do the important work that we do. Being aware of the consequences, good and bad, of our decisions we make for ourselves and about ourselves is one of the pillars of this mindfulness journey to creating the life we want to live. We can seek out continuing education courses that we have to do anyway, that will also aid us in this journey towards taking care of ourselves therefore enabling us to sustainably care for others.

We are delighted Dr. Krasner is coming to San Diego on May 11, 2013 to present a daylong workshop on mindful practice entitled “Mindfulness in Clinical Practice: Our Patients, Ourselves.” This event will include an hour-long presentation on the Neuroscience of Mindfulness by Tom Chippendale, MD, Director of Neuroscience at Scripps Health and longtime MBSR teacher. The day-long training has been approved by the AMA PRA for Category 1 Credit.

Work Cited:

Beckman, Howard B., MD, Melissa Wendland, Christopher Mooney, MA, Michael S. Krasner, MD, Timothy E. Quill, MD, Anthony L. Suchman, and Ronald M. Epstein, MD. “The Impact of a Program in Mindful Communication on Primary Care Physicians.” Academic Medicine 87.6 (2012): 1-5. Print.

Krasner, M. S., R. M. Epstein, H. Beckman, A. L. Suchman, B. Chapman, C. J. Mooney, and T. E. Quill. “Association of an Educational Program in Mindful Communication With Burnout, Empathy, and Attitudes Among Primary Care Physicians.” JAMA: The Journal of the American Medical Association 302.12 (2009): 1284-293. Print.

About the Author:

Chris Gauthier is an alumnus of the University of California, San Diego with a degree in Cognitive Science and a focus in Neuroscience. He has many passions, most revolving around skills of wholeness, health, and self-discovery. Chris is affiliated with the UCSD Center for Mindfulness. He also travels and presents a variety of topics in a workshop style, mostly to college-level minds. Mr. Chris Gauthier can be reached at: chris.a.gauthier@gmail.com.