Part 4:  Inclusiveness

Note:  This is part 4 of a 4 part series.  See Part 1, Part 2 and Part 3 here.



Introduction:

I have a deep aspiration to bring LOVE back in to medicine. Love is not a word we use much in medicine, and for some very good reasons. It has become misunderstood or cheapened through the way it has been used and/or abused in popular discourse. At the same time, love is at the root of why many of us chose to enter the healing professions, as a calling, not just a job. Love is part of my personal definition of mindfulness (adapted from Jon Kabat-Zinn): Paying attention in a particular way, on purpose, in the present moment, and with unconditional love. We need to tend to this precious root, so that it can become a beautiful flower. Like any other living thing, if we don’t tend to it, it will wither and weaken. If this happens, we may run out of the energy and aspiration we need to sustain ourselves in this sacred work.

WHY do we love? My mentor, Dr. Kenneth Ginsburg (Adolescent Medicine Pediatrician, Children’s Hospital of Philadelphia and University of Pennsylvania) says, “We love so that people know that they’re worthy of being loved. Love can bring us energy and courage to face pain and suffering. Love can provide us connection and meaning in our work, and in our lives.

WHAT is love? This four-part  series will examine what Zen Master Thich Nhat Hanh describes as the Four Elements of True Love, and how they can enrich our work in medicine. This is the first piece of the series. 

This fourth element of true love, upekṣā in Sanskrit, has been translated in a variety of ways in English, such as “inclusiveness,” and “equanimity.” To me, these words can seem abstract, elusive, and counter-intuitive. I find it more helpful to consider situations and experiences in bringing this loving quality to life.

I remember working with a teenager and her mother a few years ago. We were talking about pain management, and I asked them if they had ever had any experiences where there was pain, but not suffering. The mother said, “When I gave birth to my daughter, it was physically painful, and also very joyful at the same time.” I asked her, “How did you experience this pain in a joyful way?” 

She said, “I breathed, and I embraced the pain.” Embraced the pain. What a beautiful descriptoin of inclusiveness! Not resisting, not fighting, not judging pain. Embracing it!

I asked the mother how she learned to do this? She told me that her physician coached her to “Breathe and embrace” during childbirth. I later learned that this physician was teaching mindfulness, well before mindfulness was a common word in popular culture in Canada. (This physician has since gone on to become a highly respected mindfulness teacher.)

The poet Rumi asks us to be like a “guest house” when we encounter pain in our hearts:

The dark thought, the shame, the malice,

meet them at the door laughing,

and invite them in.

Be grateful for whoever comes,

because each has been sent

as a guide from beyond.

Can we bring the loving quality of inclusiveness into a difficult conversation, into a conflict with a patient or colleague? Could this help us to transform for our workplace community and our relationships? How could we cultivate this capacity? 

I find it helpful to meditate on an image of the sky, inspired by the teachings of Thich Nhat Hanh. Inviting the qualities of openness, spaciousness, embracing the present moment and all that it brings.

Breathing in I see myself as the sky

Breathing out I see myself as spacious

Inviting and embodying the qualities of the sky

Spacious

Open

Open hearted

Open minded

Open to hear difficult things

Open to learning and growing and changing my mind

Open to holding multiple truths at once 

Breathing, and embracing any pain that I may be experiencing

Breathing, and embracing any pain that the other person may be experiencing

Invitation to Contemplate: How have you practiced, or seen, the loving quality of inclusiveness, at work in the past week? Perhaps it was with a patient, or colleague, or trainee, or caregiver. What has made it challenging to remain open, inclusive, and spacious during difficult moments? Take a moment to contemplate situations where inclusiveness was present, or where it might be helpful. Feel free to write some reflections in a journal, or share them with a trusted friend.