Mindfulness: the Ocean

Mindfulness and the Emergency Healthcare Professional

Chapter 11: Ocean explorations

Mindfulness can be conceptualised as an ocean

When we are active in our working ED day, we are metaphorically swimming in the surface waves, racing around, engaged in our left brain with conversations, clinical reasoning and analysis of information


By looking out for small opportunities, we can do ‘mindfulness on the run’, and briefly access the quieter layers of the water just below the choppy surface waves, using transition strategies such as micro-silences, and short moments of deliberate slow breathing, or slow body movement.

With regular thinking about mindfulness, and some practice also, you will likely find, as I did, that this becomes a whole new way of operating for you. 

Mindfulness does not get in the way, but it helps with personal stress management, having difficult conversations, resolving frustrating issues at work, and with family relationships as well.  You will think about mindful approaches instinctively, and even if you completely forget what you have learned (it is pretty common!) and react in “the old way” in some situations, progressively you will remember your mindful self, and it soon becomes an automatic skill.

There is no way back to the old you, and why would you really want that?  It could be described as a one-way door.

The deeper dive

But the interesting stuff comes in with scheduled mindfulness practice sessions, when we learn about what capabilities our brain has to “go deep” into meditation states.  The inner explorations do become fascinating in themselves, but are also very effective at restoring calmness and balance.  So if you are interested, how does one deepen the meditative state, in a no-nonsense description?

Using the ocean analogy again, the most turbulence is in the upper layers of the water.  As we settle into a mindfulness session, we drift down, but are just as likely to be distracted, and float back up to the normal wakeful thinking levels for a time, until we notice this, and concentrate on our breathing, and drift down again to slower thoughts and real stillness.

It takes a bit of practice to get the early transition techniques established, to access the first layers of meditation states.  Distractibility is our trademark, it seems, particularly for people who have a strong intellectual component to the way they live and work.

But every second of deliberate mindfulness makes a difference in terms of creating new connections between our dendrites and neurones in our brains.  New neural pathways are opened up.  And every time we reinforce this new learned behaviour, it edges closer and closer to becoming a reflexive way of reacting to any stressful thoughts or emotions.  In the language of the neuroscience literature, we are incrementally (and irreversibly) shifting our default brain settings away from reactivity, anger and anxiety.

The practice

Get yourself set up for a mindfulness session.

Adjust your position on the chair or cushion.

Eyes closed.

Watch your breath.

Slow your breathing a little, but mainly just observe it.

As everything quietens, study what sensations are arising, and fading away.

Try and maintain this for 5 minutes, then return to normal waking consciousness.

The theory

Focussing on the differences in the levels of mindfulness helps us to build a roadmap of this domain.

Descriptions of the levels in words is helpful.  Fir example, waking consciousness could be called  ‘Normal Noisy Thought’ or NNT, and as you go into a mindfulness practice session your thinking slows and oscillates less between multiple threads of thought.  I call this ‘Slowing Spacious Thought’ or SST for short.  You will quickly be able to compare the feeling of these two different  states. 

As you breathe mindfully, your mind in those moments literally cannot sustain NNT pattern.  It automatically changes more towards the SST mindfulness thought patterns.  These transitions in brain activity during meditation can be observed as increasing coherence of the brain wave frequencies on an EEG or fMRI scanner.

The timing, as they say, is everything in Cardiology, and also in mindfulness. The easiest practical options for mindfulness sessions are often at the beginning, and the end of the day.  On waking, my experience is that I need to get fully awake before I practise mindfulness, or else I tend to gravitate back to sleep and doze off.  Likewise, at the end of the day, if we try to meditate lying down in bed, especially if we are tired, sleep usually takes over.  So the sitting position, with a clear head, is the best preparation for mindfulness or meditation.  If you have spare time during the day, you can meditate anywhere and anytime.  Avoid excess alcohol and heavy meals in the lead up to mindfulness practice.

As for the length of mindfulness practice sessions, start slowly and work up to longer sessions as your mastery of the transition process consolidates.  Five minutes is fine, and gradually your brain will become a better student of sitting still for more extended periods.  An hour of meditation is not for the faint hearted, but rather for the experienced meditation aficionados.

With each session of mindfulness, you need to develop acute observation of what each level feels like.  Start with what normal waking thinking feels like.  That is easy.  Then observe how your muscles feel as they completely lose all tension, and flop to a completely still and comfortable position.  The initial discomfort and wriggling around that we all experience on entering meditation just fades away, and you will come to a point where your body is completely still, and completely comfortable to stay there, for a time.  It will feel very unfamiliar – but very comfortable at the same time.

Athletes develop muscle memory, and mindfulness sessions are similar.  You will develop an ability to rapidly transition through the early stages of distractions, and you will look back and wonder why you found it so difficult.

The composite feelings of the different levels of meditation are like signposts of sorts: for example, one level of meditation can be characterised by complete muscle relaxation, slowing languid thinking speed, and less spatial awareness of body size and weight.  When you stumble into this space, as you will by chance one day fairly soon if you practise enough, the feeling of that level will be stored as a memory.  Next time, in a mindfulness session, by pulling up the memory of that particular level of meditation, your brain will start to ‘go there’. 

As you deepen, thoughts can be used to guide you further into stillness.  But those thoughts need to be short thoughts, often single phrases or even single words, just quietly repeated to hold back the distractions which would pull you up to NNT levels again.

For example, as you settle and drift down, try saying mentally: ‘deeper, deeper, deeper..’ every few seconds, or to frame your mindfulness session in gratitude, you could say something like: ‘thank you, thank you..’, and eventually shorten to single syllable words.  It all works.  The word does not matter so much as the dedication or  intention behind the whole practice session.  The spacing between the words gets longer as you deepen, and then you realise that you have just had a few seconds of absent thoughts while being very still, and completely alert.  Very cool.

The trick to deepening meditation levels is to be gentle and not to force things.  Forcing brings emotions into the practice, which haul you straight back to NNT levels.  Don’t force things on the descent, and don’t force things on the ascent back to normal waking NNT states. Jumping out of a mindfulness session to full alertness is jarring.  It does not do you any harm, but it takes a few minutes to recalibrate and you may have a headache for a few minutes.

So set a timer, or use one of the meditation apps, which play a chime at the selected finish time, and give yourself a few minutes as you come out of meditation to stretch your limbs, open your eyes slowly, and gradually rise back to full alertness.  This also becomes quite fast, as you continue a regular practice.

And at the end of each session, give thanks for what you have experienced.  Gratitude is all over the mindfulness literature these days, for a very good reason.  It teaches us a humble appreciation for the many gifts we have and will continue to have.

Mindful Leadership, and some other concluding ideas

In discussions about meditation and mindfulness, people use terms like ‘downloads’, to describe the spontaneous thoughts and bright ideas that arise during or after meditation sessions.  Creative solutions to problems also commonly present themselves after we have had sleep or rest. Developing the discipline of daily mindfulness will give you an increased confidence in these processes.  Try it for yourself. 

Leaders in hospitals and EDs commonly need creative solutions to problems.  Trying to solve issues in an inner atmosphere of irritability or resentment is difficult.  Developing mindful leadership attributes in ourselves makes so much sense, especially now.

The strongest leaders come from the values of care, humility and trust in their colleagues.

As you go down the mindfulness path, everything softens, and out of nowhere you will find yourself pondering values and concepts such as patience, forgiveness, generosity and trust as your inner ‘reframing’ develops momentum.  We are, each of us, destined to become a gentler, more caring version of ourselves, it seems.   Mindfulness is certainly not the only roadmap, but it is a way.

Thanks for reading this, and take care of yourself.

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


Prof Andrew Dean LITFL Author
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.


  1. Another great post, Andrew. Thanks for the time you put into this.

    I can attest to the value of a mindfulness practice in accessing creative “downloads”. I love the idea of “falling into trust”. Sometimes when I stop trying so hard and give my brain space to do it’s thing, it presents the answer I’m looking for, often fully formed.

    Thank you and keep up the great work.

  2. Did you or have you seen this: The waves and rough surf on the surface is but a passing disruption on a temporal level. The deep, nurturing currents are always beneath the superficial chaos.

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