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Mindful : October 2014
beginning mindful workshop in the fall. Now in the spring they were learning how to teach. Dr. Krasner, a short man with lively eyes and a warm smile, tried to put them at ease. He told a self-deprecating story. “Twelve yea rs ago I was guiding a meditation, doing an awesome job, I thought. Then, I wanted the students to end a breathing exercise, so I said, ‘Stop breathing!’ ” The doctors got the joke. As people wandered off to other rooms, he sat down on the floor. “ Have you ever taught meditation?” he asked the group. A woman in her late 60s with short streaked hair sa id she’d never meditated before this weekend. The conversation turned to the cutthroat atmosphere in medicine. How were peo- ple using mindful skills to cope? A 55-year-old liver transplant surgeon shared a story. “ I had an operation where the clamps came off and I almost lost a donor in 50 seconds,” he recalled. “For the next six months, I couldn’t sleep every time I had a donor.” After getting some training, he introduced mind- fulness breaks into his surgeries. “It’s transformed the operation,” he said. Now other staff are drawn to this less-stress- ful operating room. But learning how to teach mindfulness was clearly a challenge for some of the doctors, who are used to being the expert in control. After a nurse-midwife led the group in a discussion about self-care, a middle-aged physician asked them to do an exercise simulating how one might behave while working burned out. He asked them to “swagger” along with him. They formed a conga line, laughing as they trailed behind him. “I don’t swagger,” said one of the women. “It’s a male thing.” “I don’t swagger, either,” said another. “ Why don’t we stop and talk about what that was like?” a female psychia- trist suggested. As they gathered in a circle, the doctor leading the exercise asked, “How could that have been better?” “More gender-neutral,” one said. “It’s the swagger,” said another. “ You could’ve been less directive, allowing us to find our own way.” After a n Israeli doctor guided them in an impromptu breathing exercise, they continued to unpack the experience of simulating burnout. “I’m embarrassed. I didn’t accomplish much,” said the doctor who’d led the exercise. “Not true!” some said in unison. “It became obvious I hadn’t been clear when people said, ‘What do you want me to do?’ Then apparently I was gender-biased, which I’d never been aware of before.” The group laughed. He breathed audibly and smiled. “Thank you,” he said. “As doctors,” Epstein told me, “we may never talk about what it feels like to not know. Your decisions affect people’s lives. No mat ter how you involve patients in decisions, they still don’t have the expertise. That’s a burden. It also creates potential for bias, a rrogance, a nd judg- ment—and you might not see that.” Dr. Jacobson sat on a bench in the lobby, and talked about the value of attuning to herself in the moment more. “Mindfulness helped me realize just how stressful my work is. We deal with the life and death of babies. When pa rents have a baby, they dream of what it’s going to be like. Dealing with people losing that drea m? I simply had not realized the depth of it.” She also noticed traits she wanted to change. “I always thought of myself as liberal, open. When I sta rted obser ving my mind, I realized how judgmen- tal I am.” When parents didn’t visit their babies much, she assumed they were neglectful. Being mindful helped Dr. Jacobson see parents in a more nuanced—and compassionate—light. “ When I took a deeper dive into my thinking, I realized I don’t really know what ’s going on with them. They may not have a car. They may not have child ca re. Also, I recognized just how overwhelm- ing being in a hospital might be for them, particularly if they’re afraid and don’t have a lot of self-confidence.” Ultimately, being sensitive to her thoughts and feelings, and how she was relating to her tiny patients’ fa milies, made her a better doctor. Instead of judging parents, she now focuses on delivering the psychosocial support they need. “The parents’ frame of mind can affect how the baby does in the hospital. There’s a high rate of divorce with pa r- ents who have babies in the tension-filled environment of the ICU. Knowing that, I pay attention to the parents more. I know the attitude they leave there with can affect the kind of care the baby gets, and the ultimate outcome two or three years later.” She now takes a bit more time to reach conclusions a nd opens her mind to more possibilities. “I incorporate the family’s needs in my decision-making more a nd hold a little space for the right a nswer to unfold,” she said. The neonatologist also loves her work again. “I’ve always felt privileged to do what I do. I continue to struggle with holding that gratitude in the face of increasing demands and bala ncing my work and my life. It’s still over whelming sometimes. But I’m able to lean a little more into the gratitude.” ● Doctors have to confront the fact that they can’t fix everybody. Mindfulness helps them make their work about connecting and listening to the person right in front of them. Mona Gable is a freelance writer in Los Angeles and a contributing writer for Prevention. She is the author of the 2014 memoir Blood Brother: The Gene That Rocked My Family. October 2014 mindful 57 medicine