SECOND INSTALLATION

Parts Four through Six

Note: This is the second installment of a three part series exploring how ancient wisdom teachings may be relevant for health care professionals. For background, see the first installment of this ongoing series here.

Part 4: Third of the Three Jewels, Mindful Health Care Community

Health Care Professionals Version:

I have hope for a more mindful community of health care practitioners. I recognize that the practice of mindfulness and love is not solely an individual practice, and that a “beloved community” is vital to continue on the path that leads to lasting transformation. Recognizing my interconnectedness with every other person in my health care community, I know that when I care for others I am at the same time caring for myself, and when I care for myself I am also caring for others. I know that my own capacity to show up with full presence and unconditional love will be stronger when I am supported by caring colleagues, especially in situations of deep suffering. I also know that I can allow my own light to shine, and offer it to others. I will do my best to find or create opportunities both small and large learn and practice mindfulness with other health care professionals, even with just one other person. I believe that together, we can learn from each other, inspire each other, and co-create a more mindful health care community together.

Commentary:

At a 2013 conference at the Harvard T.H. Chan School of Public Health, Dr. Jon Kabat-Zinn (developer of Mindfulness-Based Stress Reduction) asked Zen Master Thich Nhat Hanh, “Now that mindfulness is becoming mainstream, what are we still missing?” Thich Nhat Hanh replied, “Sangha,” which means community. Secular mindfulness, and much of Western medicine and psychology as a whole, have historically been perceived as very individual-focused. Excessive individualism, isolation, and loneliness is at the root of much of the suffering and malaise that we experience in society and in health care.^[1]

When we look deeply into ourselves and our relationships, however, we recognize a deep interconnectedness between ourselves, all beings, and the entire planet. Thich Nhat Hanh calls this the “insight of Interbeing.” Dr. Martin Luther King Jr. described it this way: “In a real sense all life is inter-related. All men are caught in an inescapable network of mutuality, tied in a single garment of destiny. Whatever affects one directly, affects all indirectly. I can never be what I ought to be until you are what you ought to be, and you can never be what you ought to be until I am what I ought to be... This is the inter-related structure of reality.”^[2] With this insight, we can see that our suffering and our happiness is deeply interrelated – even in situations of conflict and disagreement. This insight invites us to move beyond transactional relationships, which are premised on asking “What can I get from you, and at the least cost to myself?” Instead of seeing “you” and “I” as separate, the insight of interbeing challenges us to create solutions, cultures, and relationships that benefit us all, so that we can heal from suffering and be at our best together.

At the BC Children’s Hospital Centre for Mindfulness, we believe that the next wave of development in mindfulness in health care will be “interpersonal mindfulness.” It will be about the power of mindfulness in families and communities.  Mindfulness practice is simple, but it is not always easy. Meditating by ourselves, as helpful as it may be, is not enough to sustain our practice over the long run. Dr. Martin Luther King Jr. also recognized the need for a “beloved community” to create long lasting change. We need a more mindful health care community in order to wake up together, and to transform our health care culture and system together.

Part 5: First of the Five Mindfulness Trainings, Reverence for Life

Health Care Professionals Version:

Aware of the suffering caused by harmful actions and the destruction of life, I am committed to protecting life and preventing harm. I will look deeply into the ways in which my own life and well-being are deeply interconnected with the well-being of my patients, families and caregivers, colleagues, trainees, society, all living beings, and the entire planet. May this insight give rise to fierce compassion and love. May my words and actions in health care express my profound reverence for all life. May I do my best to avoid causing harm and contributing to unnecessary suffering. May I do everything in my power to prevent harm to others, especially those impacted by systemic harms and discrimination. May I bring awareness to the ways both large and small in which our own health care system may protect life as well as cause harm. In situations where harm is unavoidable, may I do my best to cause the least amount of harm possible.

Commentary:

“Do not kill” is a core teaching for wisdom traditions around the world. The Sanskrit word Ahimsa, non-harming, is the ethical basis for much of the wisdom coming from South Asia. In health care, we are called to “do no harm.” Many of us may have been called into the healing arts because of a deep intuitive reverence for life. As I have developed my own awareness and understanding, I have come to see how deep and subtle this seemingly simple practice is. Compassion, and harm, can be present in every moment, and in every decision.

In health care, life and death, healing and suffering, are deeply interconnected. How do we practice non-harming in situations when our actions may cause unintended adverse effects, such as pain? What about when our patients are too young or otherwise not capable of understanding what is happening? Are there situations in which our attempts to delay death may cause unnecessary increased suffering? In our roles as leaders and as educators, how do we handle hard decisions and hard conversations and tell difficult truths, which may cause pain to others? How can we look more deeply into the ways in which we may cause indirect harm that we are not even aware of, through our work or the way we live our lives?

In difficult these situations, I try to show up fully with the discomfort of moral distress, recognizing moral distress clearly for what it is. I contemplate how I might be able to avoid causing additional suffering. I am inspired by Larry Yang’s loving kindness meditation:^[3]

“May I be loving, open, and aware in this moment;

If I cannot be loving, open, and aware in this moment, may I be kind;

If I cannot be kind, may I be nonjudgmental;

If I cannot be nonjudgmental, may I not cause harm;

If I cannot not cause harm, may I cause the least harm possible.”

I consider this aspiration like a “North Star” which can always guide me, and also which I can never reach 100% (and that’s OK.) I also remember to offer compassion for myself as part of the circle of compassion. Reverence for life is a lifelong journey, not a destination.

Part 6: Second of the Five Mindfulness Trainings, Generosity and Compassionate Livelihood

Health Care Professionals Version:

Aware of the suffering caused by inequities and oppression in health care and society, I am committed to practicing generosity and compassionate livelihood. I will do my best to share my time, energy, presence, and resources with those in need, including myself. I know that finding meaning in health care does not come from accumulating wealth or status, and is only possible through deep and compassionate inter-relationship with all beings and the earth. I see part of my responsibility as a health professional to do what is in my power to clearly identify and dismantle marginalization and oppression in my own consciousness, the health care system, and society, and work towards a more just and equitable distribution of power and resources. May I remember my beautiful aspiration which brought me in to the healing arts in the first place, and may I continue to look for ways to align my work with my deepest values.

Commentary:

The traditional and simple translation of this precept is “Do not steal.” When I look deeper into this, I see it as an invitation to practice mindful relationship with resources, including material, mental, and emotional resources. Many of us in health care professions came into this work not only for a “job,” but as a kind of calling. The great wisdom traditions teach us that accumulation of wealth, power, and prestige does not bring lasting fulfillment. We need a different kind of fuel to sustain a career in health care, and continue to show up fully every day in the face of illness and suffering.

There is also a strong culture in health care of selfless service and selfless sacrifice, which may have noble origins, and at the same time may increase the risk of health professional burnout by placing unrealistic expectations on ourselves and others. We do need to recognize that our time, energy, and material resources are not unlimited, and we need to take wise care of them. Can we find ways to both offer and receive support, grounded in awareness of how interconnected we all are, rather than on transactional relationships premised on separateness? Is it possible to find ways of caring for our selves and caring others at the same time?

In addition to looking at our own personal time and resources, this training also invites us to bring more awareness to how our society’s use and distribution of resources, including colonialism, slavery, and exploitation, has caused immense harm through many generations. These harms are is still present today, and their legacies show up in our health care settings every day. Practicing generosity and compassionate livelihood also invites us to recognize and mitigate these harms in our work, as advocates for justice and equity in health care^[4] and in society.