Thursday, August 21, 2014

Self Care and Meditation

by: Betsy Tuttle-Newhall, MD, FACS

When one mentions the word “meditation”, images of saffron robed monks and lotus flowers come to mind for many; however, meditation is simply the act of quieting the mind and focusing the attention.  Meditation is a practice, no one starts the practice being perfect and “doing it right, (which is an important concept for surgeons!). It is by doing and making space for attention that one learns.  For those of us who work all hours of the day or night, and are constantly bombarded by phone calls, texts, pages, and other people’s needs, a moment of calm is invaluable to our own health and well-being.  Meditation is about training your mind to be in the moment either for that purpose alone, or for the other benefits of well-being- calm, relief of anxiety, cooling your anger and frustration, opening our own heart and preventing compassion fatigue.  It is about being in the moment- not worrying about the past, or planning the future- is it about being mindful of the present; it is about focused living. It is ironic that we all can “do this “ practice in the operating room. For many of us, we are “in the moment” with the gunshot wound to the abdomen, or the breast cancer in the breast or whatever our focus in the operating room. Where we are often not focused however, is on ourselves. Meditation has many benefits including promoting internal energy (or “prana” the life force), compassion, forgiveness, courage and patience with others, and most importantly, ourselves. Meditation comes in many forms and is often tied to the religious discipline with which it is associated although it doesn’t have to be religious in nature. There is active or walking meditation or sitting meditation, or even what I call the “office meditation” where you can sit in your chair and take 5 minutes to clear your head and re-orient. You can take advantage of any moment in which you can calm the mind and be “aware”. The practice is about being in the moment.

Meditation has been practiced by Christians, Doaists Buddhists, Hindus, Islamists and many other religious disciplines. One of the earliest references to meditation as a practice comes from the Hindu Vedas, the ancient Indian texts. It is here that one of the oldest mantras was written, the Gayatri mantra. “ Mantra” simply refers to a sound or phrase used during prayer or meditation.  The Buddha described meditation as a way to relieve oneself of suffering. A disclaimer- I am not Buddhist, and struggle with my relationship to the Divine either in the traditional Judeo-Christian faith in which I am raising my family or in any other form. I am grateful however, that God (in whatever form you believe in Her) is patient with me. I found myself more than 15 years ago traveling with my friend Dr. Shelly Stelzer, who now resides in Potsdam New York, to the Omega Institute for a week long yoga and meditation retreat. I had no idea where I was going with her, or what this all meant. I never got to spend much time with her, and it was an opportunity for another adventure. I found myself immersed in a weeklong instruction with Sharon Salzberg from the Insight Meditation Society regarding meditative practice and John Friend studying Anusara Yoga. To say it was a transformative week, is an understatement. It was a week that changed my life for the better although the bar was set pretty high for my next week away with my friend. It was a challenge for me to incorporate what I had learned into my daily life (and certainly, my surgical colleagues at that time were a little wary of my experiences. However, they were my experiences and I kept them to myself unless you asked me about them). Being more aware and having that invaluable instruction lead me to attend several other courses with Sharon Salzberg and inviting her to Duke for a weekend retreat regarding Meditative Practice as a prevention of Compassion Fatigue. We sold out tickets 2 days after we posted the conference. She is a Buddhist trained meditation teacher, and her training was in the classic Buddhist tradition.

There are 4 noble truths in Buddhism which make a nice context in which to discuss meditative practice, its goals and the benefits for those of us who spend energy on many people, and often have little left for ourselves.

The first noble truth of Buddhism is that life is about suffering; suffering loss, instability, dissatisfaction that things just haven’t turned out right for us, our friends or family, and our patients. The second noble truth suggests that suffering is related to attachment and ignorance-attachment to things that are not permanent and are not really that important in the big picture or things that are in constant flux, and ignorance about who we really are. Most of us have this ideal of who we “should be” – certainly I do, and more times than not, I fall short of who I think I should be. My suffering comes from my lack of awareness of who I really am and the acknowledgement that I am “good” and usually, doing the best I can at whatever moment in time. I hold myself up to an ideal that if I do not meet, I am afraid of being “less than” in this culture of high achievers and for me, that I may not really “belong” or “deserve” to be here (wherever here might be). When I am tired, or sleep deprived or had a busy day, I am often ignorant of my inner light. Of course most days, I know that I belong and deserve to be “here”. Like most, if not all the women surgeons I know, I have worked hard to be where I am and care for the patients I care for and teach the students and residents for whom I am responsible.  Sometimes the struggle with work and family and other issues can be overwhelming. Sometimes, I just need a little reminder of who I really am underneath the superficial layers of wear and tear and underneath all the work and responsibilities. Really all suffering is, is the practiced art of denial- denial to our real situation, denial to who we are and denial about what we can or cannot do. 

The third noble truth is about the possibility of the cessation of suffering and the fourth noble truth is about the path to take to relieve suffering.  In Buddhist teachings, the relief of suffering is through the noble eightfold path, but basically it is about the “right view, right intention, right speech, right mindfulness and concentration”. All of this sounds like Surgery to me- being where you are at the moment and “doing the right thing”. Staying focused on the task at hand, and solving the problem for your patient. Finding your “rightness” or center, and enhancing your courage can be enhanced by having a practice of quieting the mind and just being aware, learning to step back, and observe. It really doesn’t take a lot of time and the benefits to you and those around you are priceless.

There are several community forums and meditation centers that can help one develop a practice; however for most of us, that is impractical to fit one more thing into our already crowded schedule. From a practical standpoint, for busy surgeons, you can practice the “stepping out’ of your busy schedule and just focus on your breath. What follows is certainly not a complete description of a meditative practice, just a simple way to start; references are added at the end for your perusal. The key to the practice is making time, and space for it in your daily life. The simplest form of meditation is to focus on your breath. Taking a comfortable seat, closing your eyes (and turning off the radio, TV to make where you are quiet) and feeling your breath moving in and out is a simple way to start. Take 5 minutes in the morning at the breakfast table, to sit and just breathe -bringing your attention to the in and then out breath. Let the distracting thoughts about what the day requires come and go. The practice of meditation is the letting go and returning to the breath. You can sit in a chair, cross legged on the floor or use a meditation bench- it doesn’t matter. Just be comfortable and quiet the mind. There are many type of practices that you can pursue and both formal and informal instruction, however the one that I am most familiar with and what I use in my own practice is that of “Metta” meditation. 

I have had the great fortune to attend several workshops with Sharon Salzberg of the Insight Meditation Institute over the years, and this is her type of practice. Metta refers to “loving kindness” meditation and centers around the heart literally and figuratively. It is about fostering compassion in ourselves for ourselves and those around us. Again, in taking a comfortable seat, take a few breaths and center the breath on the center of the chest. Sitting quietly, in your mind – steadily repeat “ May I be happy, may I be healthy, may I be safe, may I live my life with ease”. Use the intentions of kindness for yourself to restore or enhance your reservoir of energy that you expend on others. I find that by using this kindness mantra focusing on myself, then my family, my friends,  and most importantly, and finally, for the people I don’t like and that challenge me- enhances my ability to keep an open heart, my compassion and equanimity. It also allows me to “see “the challenging people in a light that allows me to deal with them, in fashion that doesn’t drain me and makes me less judgmental of them. When stray thoughts butt into my mind, which they always do, acknowledge them and let them go. Restore  your focus on your mantra.  It really is that simple-set your phone for 5 minutes, and try it.  I reach for this practice daily and whenever I just can’t “find it” (whatever “it “is). There are many mantras available for you to repeat, or you can just focus on your breath, the practice is of quieting the mind. I also find that when I have had a particular challenging day, or am about to face one, and I am busy, I can find 3-5 minutes to listen to a guided meditation or spiritual music in my office or on my iPod driving in. (I know you are not technically supposed to multi-task while meditating, however, you do what you have to do to find the space.) I believe that even if you do not pursue formal instruction or delve into this further, the practice of just making 5 minutes daily for you just to “be”, will be transformative for you. I encourage you to care for yourselves as well as you care for others.

Betsy Tuttle-Newhall, MD, FACS

  1. Insight Meditation Kit: A step by step course on how to develop a meditative practice by Sharon Salzberg. One of my favorite gifts for people who ask me about meditating.
  2. Unplug: Books and Audio by Sharon Salzberg. This is a set of cards, and audio you can use whenever you have time and listen to and from work. It is a set of restorative practices that simply teach you to let go. Included is a guidebook as well.
  3. Voices of Insight, written by the teachers at the Insight Meditation Institute. This is a group of stories about how these regular people found their way from the West to a mostly eastern based meditation practice and guidelines for assistance in developing your own practice.
  4. Any of the following books by Sharon Salzberg: Loving Kindness: The revolutionary art of happiness. Real Happiness at work: meditations for accomplishment, achievement and peace. Faith (my favorite). Quiet Mind: A beginner’s guide to meditation. Love your enemies. Heart as wide as the world.
  5. CDs or iTunes purchase, Don’t bite the hook: findingfreedom from anger, resentment, and other destructive emotions. This is more Buddhist in nature as it is taught by Pema Chodron as a weekend retreat that was in part recorded. Again, easy to listen to in the car or as a Podcast. She teaches about the concept of patience, and focuses on what we can practice to change our habitual response. I find her incredibly funny and very wise.
  6. CD or ITunes purchase: Mantras for Life. Deva Premal. It is a very beautiful rendition of some ancient Hindu Mantras with specific intentions.
  7. For retreats or more focused time :
    1. Omega Institute in located in Rhinebeck, New York and offers multiple type of retreats regarding spiritual practices, yoga, meditation, or leadership development.
    2. Insight Meditation Society, located in Barre, Massachusetts. Their schedule is located on line and the website is a fabulous resource.
    3. Shambala Sun. A predominantly Buddhist magazine , online and by subscription. Great resources for finding good meditation communities where you live.

In Memoriam: Thomas R. Russell, MD, FACS

AWS lost a long time friend and supporter this month. Dr. Russell is remembered fondly by those Council members who had the privilege to interact with him during his visits to the annual Spring Council meeting that was held at ACS headquarters in Chicago. 

He is seen in this photograph accepting the AWS Nina Starr Braunwald award on behalf of the ACS in 2006. He worked hard to support women in surgery. Read more about Dr. Russell here.

Some thoughts from AWS members are included here.  Please comment below or visit our Facebook page and share your stories about Dr. Russell or comment on this story.

"Dr. Russell was very accessible, even to the resident. He came to speak at our institution, and in his answers, he discussed how he attempted to answer as many inquiries or problems as possible in his position as executive director of the ACS. He understood that medicine was changing, and tried to make sure that no surgeon was left behind. He acted as both guardian and muse."

“[Dr. Russell’s first interaction with the AWS as Executive Director of the ACS came at a Spring Council meeting in Chicago.] When he had the politically sensitive task of mending the fence [after a prior meeting of the AWS with a colleague had not gone as well as expected]. The look on his face as he entered the room was not unlike the ones I've seen on residents walking into an operating room to discuss a difficult situation with an edgy attending. It was clear he was trying so hard to let the AWS know he really felt bad about what happened, that all is defenses fell away and he spoke from the heart. He talked about how his own daughter wanted to be a surgeon and how he really and sincerely wanted the AWS and ACS to work together to make things better for all women surgeons. He was so genuine and earnest in his talk that no one had the heart to re-hash the hurt feelings. We thanked him for his sincerity and have appreciated his efforts on the part of the AWS ever since.”

“I have been fortunate to mentor and train Katie Russell, Tom Russell’s daughter, as a general surgery resident for the last 6 years. Katie is truly her father’s daughter, someone who approaches every situation with kindness and enthusiasm, and someone whom you can unequivocally depend upon. Although I peripherally knew Tom before Katie joined us at Utah, I got to know him better during her time here, which was a genuine privilege. Every time I would run into Tom at a meeting, I would get a warm hug and he would express his gratitude for my mentorship of Katie. What I couldn’t ever explain to Tom was that Katie is one of those superstars for whom I feel like I have had to do relatively little - I’ve simply encouraged, provided opportunities, and enjoyed being within her orbit. I see his grace and humility in all of my interactions with her, and I am better for knowing them both. Tom will be deeply missed. I’m grateful that another generation of the Russell family is part of our wonderful profession. He leaves us an amazing legacy in many ways.”

We look forward to reading more memories from our members.  Please respond of below or on our Facebook page.

Tuesday, August 12, 2014

Book Review: Success Under Stress

The AWS Clinical Practice Committee reviews Success Under Stress: Powerful tools for staying calm, confident, and productive when the pressure’s on by Sharon Melnick, Ph.D.

“The best time to plant a tree was 20 years ago. The second best time is now.” – Chinese proverb

We recently reviewed the book Success Under Stress, by Sharon Melnick, Ph.D., a business psychologist affiliated with Harvard medical school that works with leading business professionals nationwide.  The subtitle of the book sums up the reasons to read it: “Powerful tools for staying calm, confident and productive when the pressure’s on”.  While her examples are very business oriented and may be difficult to apply directly to our daily lives, the principles and ideas behind her examples are very applicable and resounded with many of us on the committee.  One of the key points she makes early on, is that we cannot control (or be responsible for) everything in our lives.  We must focus on the things over which we can influence the outcome, and do those well.  Take ownership of your contribution, and don’t stress over portions not within your control. 

A key to succeeding in stressful situations is in understanding the source of the stress.  She defines stress as an internal response “when the demands of a situation exceed your perceived ability to control them”.  When she describes the average business professional as having 30-100 ongoing projects, being interrupted 7 times an hour, and facing communication from multiple technologies 24h a day, suddenly their lives seem a little more similar to ours!  She also emphasizes that you cannot give 100% of your effort for 24h all day every day. Your mind and body need recovery time.  Planning “off-button” activities not only decreases your level of stress, but makes you more productive when you are “on”.  The key to surviving, and succeeding, is in how you perceive your role, how you exert control over your day, and what you consider to be success.