Medicine, mindfulness, movement, mental (ill)health and creativity

Guest post by Dr Elizabeth Winson (@DrLemmingo); intensive care doctor in Melbourne, Australia.

Apologies for the title, the length alone deserves it.  But the clanging failure of alliteration at the end, if you’re anything like me, will be uncomfortable.  Because so many of us are perfectionists.  Which is kind of the point I’m aiming for – not everything has to be perfect, just honest and true.

My truth.  I’m an intensive care doctor.  I’ve never wanted to be anything else.  And I want, desperately, to be as good as I possibly can at it.  It has taken me some time to acknowledge that to achieve that, I have to be as whole, and as happy as I can be.  To replenish, to borrow from the cliché, that infamous cup.

Now this is something I am not good at.  Not natural at.  I am much better at self-flagellation and exhausting myself on the wheel of never good enough.  When it comes to work, I’m (rightly or wrongly) OK with this.  Our patients deserve our best selves, our best knowledge, procedural skill, communication and empathy, every day.  So, when exams try us, or screw ups (or minor imperfections) offer opportunities to be better, I think it’s only right to be exacting.

But, once again it has taken me a long time to realise, we are not just our job, profession, vocation.  We are people.  And the beautiful, essential thing about medicine, is that we are people there caring for people, and their people.  So, being happy, grounded, rounded people, makes us better doctors, see?

Despite the great work of so many within and without the field, medicine has this culture of just coping.  ‘Don’t be afraid to cope’.  ‘Man the f@$k up’.  ‘Put on your big girl panties’.  All noble sentiments; as I’ve said I believe our patients deserve nothing but our best.  But.  But.  How do we produce it, day after day, year after year, heartbreak after heartbreak?

I have come to believe that one way is to replenish ourselves.  Many people have found many ways to do this.  It may be time with your partner, your children, your family and friends.  It may be running, or cycling, or the thrill and bonding of a team sport.  It may be playing a musical instrument, or singing in a choir, or painting a beautiful piece.  But what if you’re single and childless?  Your family and oldest friends half the world away, your closest friends now interstate?  Your running days a distant memory and your musical, sporting or artistic talent always non-existent?

Now I’m going to ask you to humour me here and pretend this isn’t all too tragically autobiographical.  But I think all of us, no matter what gives us joy and fulfilment, sometimes find ourselves drained regardless.  So, the next M.

Mindfulness.  Or meditation I guess.  A definition: being present in the current moment, without judgement.  You may have gathered some idea of my ability to be in my own mind, without judgement.  I’d rather do a 20-hour retrieval shift.

There are so many wonderful things written by people, much more eloquent than me, about the powers and possibilities of mindfulness.  More and more, these writings are accessible and believable, even to those of us who find the idea of a moment of stillness ludicrous or – if we’re honest – terrifying.

There’s literally an app for this.  Well, there are many.  In its simplest form, it involves sitting with your full attention just on the moment for 10 minutes.  You don’t have to be clever, the thing will tell you what to do.  But just imagine, for a moment, ten minutes where you just be you.  Just feel what it is to be you.  Just notice what is going on in your own beautiful mind.

Don’t get me wrong, this scares the sh!t out of me too.  I find any and all excuses not to find the (frankly negligible) time.  There’s always something to distract ourselves with.  When I do manage to make it, I sit there, focusing on my breath (for example) trying to come back from thoughts such as ‘is this thing even on?’, or ‘I can’t do this’, never mind the million things that were on my mind anyway.

The thing about this stuff though, like all the good stuff, isn’t necessarily in the moment.  Full disclosure: I’ve now done enough that I’ve had some pretty magical moments, in the moment.  But I’ve sat a lot of hours for a few fleeting seconds.  The real magic is in the rest of life.  The person, who’s always managed to get a rise out of you, that you suddenly see as anxious and struggling themselves.  The situation, that always made you anxious, that suddenly you realise you’re as capable of handling as anyone else.  The Utter F@$k-Up, that you’ve always believed yourself to be, no matter what illusions you may have fooled the masses with – you realise is as worthy and human as those you admire. 

I think no matter who you are, mindfulness has something to offer.  But for those alpha wolves out there, might movement be more comfortable to consider?  For me this means running (as long and as wild as possible – not very much of either these days) and yoga – both combining movement and mindfulness.

I know lots of medical – and especially critical care – athletes, who do astonishing things in their chosen fields.  I love and admire them.  Taking that kind of commitment and drive into training and competing is incredible.  I used to count myself as one, managing a couple of marathons late in medical school and early in my medical career.

But what about when one isn’t really competing with anyone anymore?  Not even one’s former self?  What about when hours, or exams, or sheer bloody life means dreams of marathons and ultras, triathlons and ironmen, suddenly aren’t in the immediate future.  Should we stop moving?  For us alpha types, brought up on: ‘if it’s worth doing, do it properly’, or the shorter, sharper (previously drinking related) ‘go big or go home’ – it’s easy to say yes.  None of us want to be mediocre, or actually totally awful, at any endeavour.

But yet.  My latest transformative moment with running was with an easy, flat 10K.  It was the longest I’d run in years, and I hadn’t trained properly, so easy is disingenuous.  But the thing that blew me away during this race was my internal dialogue.  I’ve already alluded to the fact my mind isn’t a very happy place.  If I can keep my nerve, I’ll come to that M(I)H later.  But, for the duration of this run things changed from “you’re not good enough’, ‘you’re a piece of sh!t’, ‘look at you, you’re pathetic’ to ‘’we’re doing good, love’, ‘just keep going, we got this’, ‘look at you, upright and smashing this, I’m so proud of you’.

Actually, if I’m honest, that’s always been my favourite thing about running.  When I ran big distances, it was amazing.  But my best moments weren’t necessarily races or PBs.  A bit like those ephemeral moments in meditation, I ran an awful lot of miles for a few key moments.  Where I was fit enough that my legs would spin out under me, my heart and lungs would take care of them and I, well I could just be.  Perhaps the most meditative experiences of my life.

Touching on mental health a little early, my usual inner dialogue is horrid.  Honestly, she is a totally nasty bitch.  If anyone ever spoke to anyone I loved like that I’d go to war.  But yet.  Running, albeit slower and less far than I wished, enabled me to speak to myself with kindness.  This, as far as I’m concerned, is f@$king glorious in itself.  But, as the sages would vow, when we learn to treat ourselves with kindness, we extend that naturally outwards.  Hence, refilling the cup, extending compassion and empathy towards our patients and loved ones.

Yoga.  To me it fulfils many things, cures many ills.  I get that it’s not for everyone.  But I get to move my body, meditate, feel part of a community and maybe, even, embody some creative expression.  It, with running, is my movement nirvana.  But, despite yoga’s spiritual strength, I’ve felt something similar in a boxing gym, lifting weights, and playing (absolutely atrocious, entirely lacking in hand-eye coordination) hockey.  It doesn’t matter what your movement is.  Just move.

I haven’t and won’t go in to the obvious and undisputed benefits of keeping fit and active here.  I’m just trying to keep sane.

Ah, the last M.  Something I’ve kept aggressively and tightly secret and private throughout my medical career.  This was encouraged and shaped by the occupational health department of the medical school I came to attend and love when they asked me – an eager 17-year-old applicant – whether someone with mental health issues was ‘really cut out for this demanding degree?’.

I got in, I did well, I do well.  They had a point, it’s demanding.  But I think I’d be less happy if I wasn’t so fulfilled by my work.  I do much better on my long, busy, exhausting and complex working days than I do left to my own devices.

As I come to this part, the part which was always going to be the hardest for me, I’m not even sure what I want to say about mental health, or ill-health.  Those of you who know what it is to be crippled by sadness, bleakness, despair, anxiety, compulsions, addictions – you already know.  Those who don’t, thank you for your compassion.  But what can I tell either of you?

I guess that you can still get there.  The older I get, the more I realise I’m the kind of doctor I always wanted to be because of my frailties, not in spite of them.  Everyone’s journey will be different and I am not qualified to give mental health advice.  However, I believe everyone, especially those of us in difficult and emotionally demanding jobs, can benefit from time with a good psychologist.  Other specialties, such as social work, are much better at acknowledging this.   I’ve likened this lately to movement.  No one thinks twice about the fact that I give time and money to a good gym.  Why is it any stranger that I do the same for my mind?

Again, very personally, I spent too long being utterly closed to the idea of pharmacological help.  It’s a similar analogy.  If I needed a daily pill to help my heart, or kidneys, or liver to work their best I wouldn’t fight it.  In hindsight I’m not sure why I fought it for my brain.  I’m not going to claim that movement or mindfulness (or diet, etc), can entirely replace the need for good medical and psychological help.  They just form part of my better landscape.

What is most important for me to say is a huge, heartfelt thank you to those bold and brave pioneers in this job who trusted me enough to share their own mental health experiences.  When people you admire for doing spectacular work openly own their mental health it is phenomenally powerful.

What on earth does creativity have to do with any of this?  I can’t paint, or draw, or act (the thought of performing on stage makes me feel dreadful).  I used to sing as a child, but all adult attempts are abominably sharp.  I’ve always loved all expressions of creativity in art, music, theatre, but with a jealous knowledge it would never be me.  That’s OK, I’m a scientist.  Maybe even a runner.  Why should I be creative too?

A very clever man once suggested to me that medicine, let alone critical care, is incredibly creative.  An art, rather than a science yes?  I love that, but that’s not entirely what I mean.  What if, in between work, life, mindfulness and movement, we could also do something classically creative?  Would it add value?

Now again medics, the typically overachieving buggers that they are, are often creative.  Many are exceptionally talented in a wide range of visual arts, music, dance, drama and creative writing.  Again, gosh I admire this.  But what if this isn’t you?  Should you stop creating?

As someone who can’t draw a convincing stick figure, I am trying to draw, paint, throw clay.  Part of this is a continuous attempt to soften my inner perfectionist.  Part is a genuine striving to develop and improve – lessons are wonderful.  Part though, I think might be something more.  Go deep enough into any meditative practice (mindfulness, running, yoga), you come to this idea of a creative centre.

I guess what I’m trying to say, to those of us who try to give our all is – firstly – thank you.  Please also look after you.  If you are immersed in things that bring you joy and refill your cup, congratulations and please share your secrets.  If, in any aspect, you are not, please consider, as well as the vocation you are passionate about: finding time for mindfulness however that works for you, moving your body in a way that brings you joy, acknowledging and treating your mental health and embodying the creativity that calls to your soul.

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Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

His one great achievement is being the father of three amazing children.

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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