Mindfulness: down the rabbit hole

Mindfulness and the Emergency Healthcare Professional

Chapter 5: your journey

The first step of this journey is that we must decide whether or not mindfulness and meditation intuitively appeal to us. If not, the answer is to do something else for your mental health; exercise, a hobby or sport, for example.  

But at some time, and it might as well be now, we will all come to this area of our own development, especially once we see how it supports and enhances our lives. But the timing is up to you

Commonly, the impetus to start this learning curve about mindfulness may be a health or emotional crisis, when someone has a realisation that they just don’t have their own answers any more. We have probably all talked with patients like that in our ED work, or perhaps friends, or even faced a crisis in our own lives. 

For some of us, there is no one specific event or crisis, but the motivation is plain and simple curiosity, perhaps to see “how far the rabbit hole goes”…

You take the blue pill, the story ends, you wake up in your bed and believe whatever you want to believe. You take the red pill, you stay in wonderland, and I show you how deep the rabbit hole goes

Morpheus, The Matrix 1999

So, let’s take the red pill, but as we know from our work as emergency clinicians, the problem with medication, and meditation, is non-compliance

So why do people start meditation practice, and then stop?

The value, I hope, of an ED Physician writing about mindfulness / meditation strategies for busy people is that I know from experience that the transition from day-to-day brain activity, to mindful and meditative states, is particularly hard for us. So, if we don’t see early results with our first few sessions, we may give up the practice altogether. But it is especially important to persist, and I believe the strategies offered in these articles will help make the process quicker for you as it has for me. I mainly learnt through trial and error, stumbling around for ages, until significant breakthroughs occurred

My own experience is that the transition process between these states (‘day-to-day’ vs ‘meditation/mindful’ states) is initially quite jarring and challenging. 

I think that for us ‘Type A’ types, our brain actively resists the process

But if we work in persistently and assertively perfecting that transition zone, we can break it down to a smooth process, and then it suddenly starts to make sense. It just takes repetition, like the procedural skillsets we develop and eventually master in critical care medicine.

When we teach junior staff a skill, we break it down into sections.  Wash your hands, put on PPE, open up the sterile field etc.  Meditation is the same, in the early stages.  After a certain level, the intellectual constructs lose traction, and an increasingly experiential subjective paradigm takes over.  We will each have our own unique experiences, and some common ones of course, as we progress into the vast world of meditation and mindfulness.

But the early rocky stages present common difficulties to most of us, so let’s break it down and lay out a roadmap to make it achievable for ED clinicians. 

So, whether your mindfulness practice period is 1 minute long, or 20 minutes long, the transition zone can still be tricky from normal day-to-day consciousness to the expanded, slow thought patterns of meditation.

Our thinking slows as we do the breathing exercise, or a body scan, and then WHAMMO we are back thinking about shopping lists, and concerns about the future, or that patient with the X-Ray finding that we did not see.

At this point, we may feel like a complete failure at mindfulness. But it is not so.

All that is happening is that our brain is resisting being at peace like a cornered tiger. Calm and peace are not natural states for a lot of us. 

But the brain can be trained. There is a heap of good scientific evidence to support this.

The secret to transition zones into meditation levels of consciousness is to compare meditation to a smorgasbord meal, where you have a range of options on display from which you create a delectable meal. Not really the same as the usual snatched lunch break in the ED!

Once you have done it one time, you will speed up the process with repetition. Guaranteed.

And the real secret to the transition zone is to have all of the options on hand, and quickly change between them if one does not seem to be working for you. Our brain can only focus on one thing at a time, so if we fill the bandwidth with transition zone techniques, our brain faces a real challenge in dishing up the distractions, the lists, the worries.

In this way, as we “flood our brains” with a range of transition zone techniques, we can recall a line used by the Daleks in Doctor Who, “resistance is useless”.  We break through to spacious meditation consciousness.  And once you have done it one time, you will speed up the process with repetition.  Guaranteed. You will also learn what approach works best for you.

All of the great meditation techniques were developed by people who understood the crazy ways in which our brains operate, and think. The various strategies all have the same outcome, to help us centre, and stop the mental chatter of our minds.

Next time, we will take a deeper dive into the transition techniques, namely breathing techniques, mantra meditation, body scanning and visualisation. They are not of value in themselves; they just help us transition through the messy initial stages of meditation to a place we really, really want to reach.

Take care of yourself and thanks for reading this.

Further reading

• Goyal M et al. Meditation programs for psychological stress and well-being: a systematic review and meta-analysis. JAMA Intern Med. 2014 Mar;174(3):357-68.
• Wong WP, Hassed C, Chambers R, Coles J. The Effects of Mindfulness on Persons with Mild Cognitive Impairment: Protocol for a Mixed-Methods Longitudinal Study. Front Aging Neurosci. 2016 Jun 28;8:156.
• Wong WP, Coles J, Chambers R, Wu DB, Hassed C. The Effects of Mindfulness on Older Adults with Mild Cognitive Impairment. J Alzheimers Dis Rep. 2017 Dec 2;1(1):181-193.
• Brunner D, Abramovitch A, Etherton J. A yoga program for cognitive enhancement. PLoS One. 2017 Aug 4;12(8):e0182366
• McEwen S. Meditation & Mindfulness for Stress Reduction. Pacific Neuroscience Institute. 2020
• Hassed C. The art of introducing mindfulness into medical and allied health curricula. Mindfulness, 2021; 12(8): 1909-1919.

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Andrew Dean

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.