Mindfulness: mechanics

Mindfulness and the Emergency Healthcare Professional

Chapter 10: the mechanics of mindfulness

The time that we allocate to activities influences the outcome, and our skill level in that activity.  This applies to cookery, and to our domain specific skills such as IV cannulation. 

Mindfulness is no different; skimming through a mindfulness book in a bookshop is not the same as setting aside 10 minutes a day, and remembering to create brief mindfulness sessions “on the run” while at work, or on the train commuting, or playing with your kids at a park. 

So, in an average work day, let’s identify the moments we could use to help build mindfulness.

Mindful in the morning rush

Scheduling in slightly earlier rising, when the house is at peace, creates a chance to do something specifically mindful, whether it is a proper meditation session, or slow walking, or tai chi or yoga.  Animals and gardens are ideal mindfulness activities, but walking a boisterous young puppy perhaps not as ideal..

Even just a few minutes of deliberate slow walking, with some basic breathing focus, is like opening a door in our mind.  You would probably know of ‘walking a labyrinth’, which is certainly meditative, which is one example of how very slow and silent walking can be very calming.  Walking slowly anywhere works, but make your movements at half-speed; it sounds crazy, but just try it once for a few minutes, and notice what it feels like.  You can wash mindfully, or comb your hair, or brush your teeth, or eat mindfully.  All it takes is some imagination, silence, and a lack of interruptions.  The challenge is to maintain this in the thick of things, but it comes with practice.

Mindful commuting‽

While on the subject of commuting, driving a car is not a safe time to meditate, but it does however provide some excellent mindfulness opportunities – to do with Zen flow, trust, and plenty of forgiveness practice, involving our reactions to drivers demonstrating “sub-optimal driving skills”.

Certainly, commuting on a bus or a train both create practice time, for breathing, stilling thoughts, letting go emotional reactions, or just scanning our thoughts as they randomly float by.  There is no need to close eyes to practise mindfulness; just fixate on something in the lower visual field, and keep your eyes fairly still as you focus your concentration inward, on breathing, for example.  It is just practice, and this is another example of how transition zone practice becomes progressively easier and faster. 

Mindful moments in the hospital

This is all leading towards a discussion of the two narratives in our mind, the ‘out there’ one which we all need for busy concentrated cognitive activity e.g. running a ward round in the ED, and the ‘in there’ parallel mindful narrative that we learn to strengthen progressively with practice.  It all sounds a bit like a split mind but it is not really.  Perhaps it is more akin to developing an under-utilised part of our mind.

Examples of when you could hold your eyes still, drift into mindful breathing and awareness, while fully conscious and quiet, include waiting for coffee, watching the Urinalysis or VBG machine processing your test, waiting for people to arrive at a meeting or tutorial, walking to the carpark, or along a corridor to the Imaging Department…they need only be brief interludes, perhaps a minute or two, and you prove to yourself that you can do this stuff, and fairly quickly at that.

If you have the luxury of an office and some quietish non-clinical time allocation, well, where do I start?!  Plenty of chances.

“Micro-silences” through the day

We think often that we are our noisy mental chatter, and that our swinging emotional reactions are us. 

By working on identifying and creating even very short moments of mindfulness right in the middle of our busy days, we build the skill of “micro-silences”, where we realise that what is happening on the surface of our ocean, so to speak, is not the entirety of the ocean.

This skill of micro-silences also helps prepare us for difficult conversations, where our communication needs to be free from attack, focussed on listening, and open to creative solutions. Hayden Richards covers this whole topic so well in his blog, Comms Lab. The tiny silences that we sequentially create, in all sorts of unlikely moments in our day, have the effect over time of rebuilding us. They help us to reshape our default mode towards greater levels of equanimity, forgiveness, calm amidst chaos, and reduced abrasion in our interpersonal relationships, both at work and at home.

The “longer” practice sessions

Mindfulness ‘on the run’ is really useful, and extends our influence in the workplace, and has positive effects on others around us.  This is evidence-based from modern research in neuroscience.

However, much faster progress will come if a session of even a few minutes a day is set aside for a sustained practise of the transition techniques we have already covered.  Sitting in a comfortable chair, having freedom from interruptions, and a regular time to practise if possible, sets the scene for letting ourselves really ‘go deeper’ into a deep relaxation state, or mindfulness, or meditation – the wording is not the key thing.

These sessions are for experimenting, to try the various transition methods – some of which are listed here:

• breathing observation,
• slow movement, or a walking meditation
• body scanning, of muscle tension and other visceral awareness
• mantras
• music
• biofeedback devices
• concentrating on a picture
• focussing on a single light source
• reading ‘affirmations’ that resonate with you

With each method, really focus on what body and mind changes are occurring during the session.   If it feels uncomfortable, stop, and do something different.  Expect some resistance at first, especially for us ‘wired’ emergency health professional types. It passes.

Use other materials as catalysts; for example, you might find YouTube videos on the topic of mindfulness – there are some millions of them at last count!  You may be drawn to buy and read a book which reaches you.  Some people keep a diary of their mindfulness sessions.  You could join a group, either on-line or face to face.

Many roads

There are many roads to mindfulness.  Each person’s study materials will be different, and the pace of the semesters will be tailored to the individual, so to speak.  And we can certainly withdraw from the ‘course’, and defer our studies for a few years. 

My own journey in mindfulness has been of a rather stop/start nature, until the past few years.  Now, it is a central focus. Your own road to mindfulness will be unique to you.

And talking of roads, every morning in cities across the world, as traffic surges and blares incessantly, one will commonly see small city parks with groups of tai chi practitioners, who provide a brave counterpoint of calm to the noise and smoke nearby. 

Slow extension of gracious arms, fingers loose, with synchronised heel turns and sliding hands, moving into a ‘brush bird’s tail’ pose.

We can also be that brave counterpoint of calm.

Thanks for reading this, and take care of yourself.

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.