Mindfulness: Airway, Breathing…

Mindfulness and the Emergency Healthcare Professional

Chapter 3: mindfulness exercise #1

Why would I benefit from mindfulness?

If you are like me, an average busy emergency shift gets fairly stressful by about four hours into it, with ambulances ramping and bed block – you know the drill. On those days, I feel like a tightly wound metal spring. Tight muscles everywhere, and just stressed. Anxious also because wards won’t take patients or clean their beds fast enough for the ED’s needs.

Sound familiar?

At the end of these shifts it can take a full 24-hours away from ED to recover our sense of calm. My partner says that it takes me two days sometimes to become normal again. I treat everything at home as a list of urgent tasks, all needing to be achieved at ED pace.

But it doesn’t need to be like this. What if there was a way to reduce the chronic and acute tension that we accumulate in our medical lifestyle all too easily?

OK, enough words, how do I start this?

Mindfulness is essentially about speeding up our conscious transitions from stress to calm.  It is also about becoming aware of our own level of alertness and anxiety, in any moment.

So what are you thinking about NOW? Lists, tasks, maybe some negative self-talk about a case that did not go so well, or….

If you can, do this exercise when/where it is safe enough to do so uninterrupted for a few minutes…say 5 minutes. Yes, of course, this stuff works better if you can put aside 10 minutes (or more) twice a day, but start small. Baby steps.

Take a slow, deliberate breath IN

Feel it flooding through you with new oxygen all around your body. 

Now, let the breath out. 

As you take another slow breath, try and exclude any other thoughts except the awareness of breathing. 

Let the breath out. 

Concentrate on a third breath – really observe it and how the air movement feels in your airway, or your respiratory muscles perhaps. 

Let that one go also.

Do you feel different, even after only three mindful breaths?  In mindfulness language, a “mindful breath” is a studied breath. Less tense? Less tightly wound?

So now go back to your “stress” default mode, deliberately filling your mind with all sorts of random thoughts, lists and emotions.  Study how you are feeling now, noting the difference from the state you reached after three conscious breaths.

Now, do 5 mindful breaths. 

In… and Out….

Study the feeling of the breaths. 

Don’t try and force them or achieve any state of mind. But do try and focus just on the breaths, and count them. Go for ten if you are getting really confident. It is really hard at first!

But notice the difference between the “pre-breathing you”, and the “post-breathing you”. 

The message you are giving your body and your emotions is that you are taking back control.

So back to the lists and worries again. Go for it, feel stressed.

And now do 5 mindful breaths

…and focus like anything on the breathing. 

Yep, it gets quicker doesn’t it?  Your speed of transition improves quickly, especially if you practise every day.

Imagine if you could practise every day for 5 or 10 minutes and maintain it.  And even a 20-30 minute practice each week? 

And is it that much of a stretch to grab a few moments WITHIN the work day to practise breathing mindfully?  And to identify moments where you need to do it, for example after a challenging phone call, or a meeting with a tired relative who can’t visit their mother in ED due to COVID rules?  And what if you set aside a few quiet seconds before that phone call, to transition from stress to calm before taking on the phone call, or meeting?

We talk about teaching-on-the-run, so why not mindful-on-the-run?

And the kicker is that as you get some runs on the board, regularly, with mindfulness practise sessions, you will see that your default mode starts to shift from being stressed mostly, to being calm mostly.  Things won’t get you wound up.  Triggers stop triggering.

I know it works.  But don’t take it from me. Try it.  It is only breathing.  Not that hard.

Next time we’ll talk about what changes anatomically in your brain as you develop your own mindfulness practice.

Take care of yourself and thanks for reading this.

Further reading

Waiver: These articles represent my own views and approach to mindfulness, and do not purport to be the official view of ACEM.  They are not intended to replace appropriate medical or mental health care, provided by professionals in these domains


A/Prof Andrew Dean, MBBS FACEM Grad Cert Clinical Simulation. Emergency Physician and DEMT at St John of God Hospital, Ballarat, Victoria, Australia. Head of Ballarat Rural Clinical School, School of Medicine Sydney, University of Notre Dame Australia.
Still searching for new and innovative teaching methods for emergency medicine education.  Also a committed advocate for mindfulness meditation, and the nurturing of emotionally intelligent clinical teams in health care.

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