Reflections

October 9, 2011

There are times when we stop doing and focus on being. We spend time with ourselves looking inward instead of outward. For physicians this is unlike most of our lives, in which attention, focused primarily on the needs of others, drives us in an often hectic schedule in which any reflection must be fitted into other activities.

 

Thus we have short times for thinking when we are driving, as we walk from one room to another, as we eat lunch, or in the moments of blessed peace in the bathroom. When we do think, it is still likely about others, about our work as detectives in figuring out just what is wrong and how can we fix it. Sometimes we wonder if we are doing the right thing, or if there is anything else we can do, or if we have made a mistake. Sometimes we agonize over a mistake.

 

 

Physicians are trained, sometimes severely, to not think about ourselves. In training, we learn to turn away from our own needs for sleep, food, exercise, emotional support, and time for reflection. We are supposed to be available to work long hours (the number of hours is now regulated, which was not the case when I was in training) no matter what we personally feel. In one extreme example, when I was an intern, the senior resident on call took care of the emergency room in the small community hospital, and the back-up physician was a faculty member who was on call to come in to the hospital when he was needed. One night when I was on call, I went into the resident lounge and saw the senior resident sitting on the sofa with an IV in his arm and a bag of fluid dripping into his vein. He was ill with a stomach virus and was so dehydrated that he needed the IV fluid to be able to stand up. I was shocked and asked why he was doing that, and was told that the particular faculty physician (who felt that residents should work under any circumstances) refused to come in to the hospital, and had told him to use IV fluids and go back to work. The senior resident felt that he had no choice but to do what he was told and kept working. In this way, we acquire the habit of putting our own needs last.

 

 

We learn that to serve others, we do not think about ourselves and turn our lives to “doing.” We are tremendously busy; it takes a lot of everything we have to care for our patients. And yet we have so much to think about. When we do stop, and be with ourselves, it takes time to move the focus in, to sit with our breathing and feel the boundaries that delineate who is “me.”

 

When I stop to think of myself as body-mind-spirit-together, to consider “me.” I create and reinforce a pattern of self-care that spreads out to nurture the wholeness in those around me, including my patients. I believe that when we can see the wholeness in people, and let them see that we see them, they are strengthened and can more readily find their own wholeness. Here is where healing begins.

 

Another way to think about this is the airplane analogy (one of my favorites — it may come up again). Every time you get on an airplane, you are told that in an emergency, if oxygen masks are released, you are supposed to put your own mask on first, before helping the person next to you.

 

Many traditions help people stop their usual activity and go inward to care for their wholeness, sometimes during particular holidays, others suggesting more frequent practices. Many people find times for reflection that are unrelated to any traditional practice, and can range from quiet time going fishing, running, doing music or arts or crafts, cooking, or sitting in the sun. I find quiet time for myself in music, meditation, and increasingly, in writing.

 

In my tradition, this is the Jewish New Year, Rosh Hashanah, the day the world was born, and the Days of Awe, Yom Kippur, in which we stop everything to be with ourselves. This is the time of reflection, when each of us asks ourselves “How did I do last year? Where did I stay on track? Where did I miss the path? What do I need to do in order to find the trail and start again? Where am I going?” And as a physician, “How can I be aligned with the path of service and still care completely for myself?”

 

And so I am reflecting also on the qualities of heroism, and what we do when we focus our attention inside. The physician is considered a hero for saving lives. But most of us don’t save lives in that dramatic way every day. I wonder if this process is part of what allows us to continue to persevere, to move through our lives with courage, to act from selflessness that actually is based on self-knowledge of our own wholeness.

 

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