Mindfulness: Waiting to Arise

Mindfulness and the Emergency Healthcare Professional

Chapter 9: Waiting to Arise

To summarise the story so far, mindfulness and meditation are tools that help us to

• react less to triggers,
• be calmer,
• relate better to others
• develop a clearer sense of who we are, and our role here. 

Popular mindfulness and meditation books and self-help courses emphasise these as benefits to the individual, but few contextualise mindfulness in its greater function, which is to equip us to be stronger and more effective in helping others, and through providing such help we of course assist ourselves. The weary world needs your strength, and mine.

In other words, mindfulness has a social function, a contribution to those around us.

How does this work, in particular, in relation to hospitals or the ED?

What’s he talking about? A mindful workplace?

We intuitively know that colleagues radiate an energy when they enter a meeting, or a room in the workplace, or any room for that matter.  Stay with me on this.  Most people who are in a reasonable level of balance emit a neutral kind of energy, and we are hardly aware of that.  Hopefully we can do even better than that, and radiate a really positive energy to our colleagues and patients.

But some individuals who have significant antisocial tendencies will enter a room and the other people in the room may likely feel unease or discomfort.  The extreme form of this would be someone who is drug affected from amphetamines – they create a massive challenge (let alone the physical risk) for the ED staff caring for them, just because of the pattern of energy that radiates from a drug affected person. 

Another example is the frustrated or aggressive patient or relative who is reacting against the delays to treatment in a typical overcrowded ED.  We feel their bristling and perhaps even threatening energy, and to be effective we need to be extra mindful of this in the way we communicate with them, in our verbal de-escalation efforts.

…emit a mindful energy of care

Mindfulness helps us to create the opposite situation within ourselves, a calm centre, an eye of the hurricane if you like, and we can then be emitters of a mindful energy of care, empathy and compassion in the midst of a noisy and challenging workplace.  This is the inner workspace from which highly creative and effective interactions with other people arise.  I will come back to this again, the idea of a mindful parallel inner narrative.

In other words, we first need to create or access a mindful workplace internally in ourselves, and then effective communication just happens.  We say and do the right thing.  Having said this, in escalating situations with aggressive behaviour, staff and patient safety still remain paramount, including the use of physical or pharmacological restraints as needed.

I have just discovered the excellent Comms Lab posts by Dr Hayden Richards, which address this whole area of emotionally intelligent communication, in the midst of challenging ED situations.  These skillsets could certainly be described as mindful communication. I recommend watching Hayden’s vodcasts on expert interpersonal communication.  The lessons apply generally, not just in medicine or the ED.

So, of course, you’ve guessed that the topic today is ED culture, and awakening ourselves to the powerful contributions that we can make to culture, as mindful emergency medicine professionals.  Every staff member is included in this, not just the FACEM or the medical team.

Emulate the best, not the worst

I would not be the only teacher of trainees and students in the ED who says to them: “follow the example of the best doctor you can identify, because they will teach you what you need”. 

Of course, we need technical skills champions in the ED, who are expert in the cognitive and procedural skillsets, but also we need champions in the non-technical skills of communication and great leadership – and we need champions in mindfulness.  Every ED or workplace needs such role models of how it is really done well. A good workplace culture grows into good workplace health, and is the result of constant nurturing.

And as we know from our children, or trainees at work, we are measured on what we do, rather than what we say.  From here on, as you start your own mindfulness journeys, there are no holidays.  Every conversation matters, every person you deal with.   And do students of mindfulness sometimes get it wrong, and revisit conflict and get into occasional arguments?  Of course, but our overall default state moves towards reduction in conflict and harm.

The “values” of mindfulness

Hospitals and many companies have mission statements, values statements and the like which hopefully translate into the level of service they provide to customers, or in our case, our patients.

It does not always work.

Some of us will have roles in administration, to try and optimise policy and obtain enough staffing and resources to support the “front line” team, as they endeavour to deliver on the values of care.

Others of us just work in the front line. Regardless, each individual in the hospital has a role to play in convincingly delivering on the hospital’s values.  

The values that enrich our workplace are things like:

• patience
• gratitude
• appreciation
• respect
• being attentive in the moment

We can’t “do mindfulness” for ourselves, and not try to engage with our fellow humans in a mindful way.  Any inconsistency in this simply cannot be sustained.   Mindfulness is all about our dealings with others; it is a binary gift that must be given away to be received. 

The idea that we can separate out the elements of our lives (work, family,..) and have acceptable different behavioural frameworks for each (“s/he is a bully at work, but lovely to her/his family at home”) makes no sense, and as we explore mindfulness such dichotomies become glaringly apparent, and in need of resolution.

And this brings us toward the true mission statement for you, for me, for all of us.  We can use the tools of mindfulness and meditation to reshape ourselves, to bring health and joy not only to ourselves, but also to all of those other people in the spaces we inhabit, in our day to day lives.

The two triggers for getting started in mindfulness are pain, or curiosity

We will get back to the mechanics of mindfulness in the middle of our working days in the coming blogs, and then look at the longer practise sessions of meditation in more detail.

And even though I wrote in the early Mindfulness articles (for example in chapter 1) about how this mindfulness caper may not be for you, in a way, it always is. For all of us. The only variable in this that we can control is the timing. 

At some stage, you and I and every person will have to work all of these concepts into our/their lives.  The two triggers for getting started in mindfulness are either pain, or curiosity.  The concepts of elective surgery and emergency surgery are well known in healthcare.  Mindfulness is similar.  My question is:

Why leave mindfulness until the wheels fall off the cart?  Why not start now?

And so we come to the close for this week, with another line from a song, this time from the song Blackbird, by the Beatles. You indeed are a unique and special part of all things, and…

Thanks for reading this, and take care of yourself.

Further reading

• McCartney P, Lennon J. Blackbird. The Beatles ‘White Album’ 1968

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.