Aahpm3.10 mindfulness

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  • We will review different types of mindfulness – and we will offer an expanded perspective of mindfulness practices- reviewing the “MBSR” tradition, we will explore how the humanities might offer you a means to “practice” in perhaps a more familiar way.  And so, we start… I will invite you to join this talk by sharing one of my practices: I invite you to listen to the beginning of a Monday, in fact, just this past Monday.  Rumi wrote that God continues to break our heart open until we no longer know how to close it up again. Today is a day of lovely heartbreak: I-A daughter sits beside her mother's deathbed,
Seeing a reflection of her own future
in her mother's unclosing eyes
gazingupward to a space neither of us can see;
struggling to breath through lungs filled with fluid
blocked by tumors in her atrium
(tumors echoed by the thousands of black stars
on the skin of both mother and daugther)
by the kidneys that died long ago. "My mother is not afraid,"
She speak’s of yesterday's conversation.
"Her faith assures her of peace,
but she knows not how to let go." I reassure them. Both 
mother and daughter have known 
what to do before,
when others knew not.
They will know again. I need not teach them.
I do not know how to live with
my future foretold so vividly through
my mother's life and death. I know only how to watch
How to offer comfort through medications
How to acknowledge their courage
How to let go. II – The intern tells me,
"His abdomen is firm as a rock."
My thoughts turn to his smile,
his recitation of poetry with that accent 
that gives away his place of birth,
wondering who will care for his dog
he has so loved.
  • Larson wrote that his work is truly laborious… It demands of us our attention.He writes: However, there are many obstacles that contemporary physicians face as they aspire to develop empathy. These include a demanding work environment with heavy workloads, little importance attached to empathy, and cynicism. In addition, research indicates insufficient training and education in compassion and emotional aspects of health care for various health professionals.
  • Students tell me that they are still taught that distancing self from emotion is considered professional.Despite this, Kearney got published in JAMA, writing about how “being connected – key to [his] survival” He addresses the need for self-care through self-awareness in order to enhance the ability to practice exquisite empathy, to decrease risk of fatigue and burnout. That by actually delving into the uncomfortable moments – and knowing how – can prevent burnout.
  • It comes down the old adage to know thyself. This takes practice and work and discipline. This type of self-care is like practicing the scales for a musician, or weight training for a professional athlete.But, generally, this is not taught or valued in medical education or practice – cynicism, lack of time, lack of value seem to get in the way according to Larson.Yet it is this practice, this training that helps us to stay even in moments of discord…
  • This is an apparent paradox from what many of us are taught. Yet research is emerging substantiating this claim. Long term meditators were shown to have an increase stress response when they were exposed to images and sounds of suffering compared with non-meditators. However, the stress resolved quickly, unlike in the non-meditators who seemed to hold onto the strain of those images.Conflicting messages are prevalent in our profession: problem-list vs. goals of care, deconstruction of the person vs. personhood, curing vs. tending to the dying, the want to live vs. the recognition that one is dying.Family conflicts…
  • "Clashing discords, loss of equilibrium, 'principles' overthrown, unexpected drumbeats, great questionings, apparently purposeless strivings, stress and longing... This is our harmony.” V. Kandinsky It is another piece of this work we hope to pay attention to: how to stay when there is discord, discomfort. What is the role of mindfulness then?This discipline or practice familiarizes us to dissonance.How might we define this? Generally we think of it as a musical term describing disharmonic space between two notes. An example is the interval called the perfect fourth, sung at the end of most hymns, in the A – preceding the resolution with “men” It often builds a sensation of tension that leads into resolution – similar to the climax of a narrative.It is in this moment that we often find ourselves in this field – walking straight into it, without the benefit of the story that lead up to it.The tension may arise in ourselves: a medical, nursing or divinity student seeing for the first time the discomfort of seeing someone struggle, or speaking of their wish to be home when they die. The first connection is often with ourselves – learning how to stay and lend strength in this moment. How do we learn to come back and to lend strength when what we were taught is how to fix? When introducing family meetings to medical students and residents, especially when addressing the tension that often arises, I speak of the dissonance, the discord, the possibility of fireworks.These intrigue me. The possibility of anything raises my curiosity. I enter into the family meeting with some trepidation, excitement, nerves, and a lot of curiosity: what will emerge? How will the news be received? When the fireworks do emerge – or as in Kandinsky’s words: the clashing discords that sometimes lead to my loss of equilibrium, the sudden drumbeats and great questionings – how do we learn to stay?This is the question we raise today. It takes practice. Ultimately, much of this work of mindfulness is a form of practice: a practice of staying through discomfort and dissonance: theirs and ours. Of practicing non-abandonment.
  • Suzana
  • Ron
  • One of the things that comes out of this too, is that when you establish a practice of thinking more honestly, thinking more clearly, speaking more honestly, that definitely leaks out into your work everyday…it certainly opens you up to being more ready with patients, colleagues, family, to have those kinds of conversations and to have that kind of a more intimate, more honest interaction with people and that certainly was the case for me that came out in the rest of my work…It certainly made it much more immediate and easy to do in my practice.
  • SuzanaTurn to a person sitting beside you.Take 1 minute to consider the following question, with an answer you wish to share: Think of an experience, a person, a question that led to your being here, now.You each will have 2 minutes to share that story, while the other person listens – simply listens. Please, as you listen, do not speak – do not touch. Listen. I will ring a bell – which indicates time to finish that sentence, and take breath. “I have listened.” The listener may then say, “I have heard.”Another bell will ring, and roles are reversed.*Ring bell* Now – take a minute to sit with what you experienced.
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