In the moment

I had reached a point when I knew that something had to give. I could no longer listen to the constant “would haves/could haves/should haves” and “when I become a ______, when I reach ______, when I no longer ______, when I finish ______” that screamed in my mind drowning out the potential to fully participate in life at hand. The opportunities to fully engage and experience the here and now were increasingly lost.

“Live the actual moment. Only this actual moment is life.” – Thich Nhat Hanh

Serendipitously, I was invited to spend three days immersed in a mind-body facilitator course with a group of multidisciplinary professionals from several colleges at the University of Cincinnati. The training, lodging at a beautiful rural hotel in Amish country Ohio, and gourmet meals were free (supported by grant funding). The catch? Commit to facilitating at least one 9 week Mind-Body Skills course annually for professional students. After serious consideration and discussion with my husband regarding my desire to attend and participate in what I anticipated to be an incredibly meaningful activity and my sincere concerns about making yet another long term commitment, I decided to attend.

“Mindfulness means paying attention in a particular way: on purpose, in the present moment, and nonjudgmentally.” - Jon Kabat Zinn

The course started on a Thursday evening and I had a full day of cases lines up before I could depart. My first patient that morning had undergone neoadjuvant chemotherapy for locally advanced breast cancer with a good clinical response. However, when I saw her in pre-op she stated that felt the mass in her breast growing back. After examining her, I was also concerned. After finishing my cases, I went to her room before leaving to tell her that the sentinel lymph nodes biopsied had been positive, multiple of them were positive. Yes, even after the chemotherapy. I had completed her axillary lymph node dissection. She understood and expressed obvious fear in her eyes but also a deep strength and courage to move forward regardless of the outcome. I left the hospital feeling the weight of the day on my shoulders.

“That’s life: starting over, one breath at a time.” – Sharon Salzberg

I was the last to arrive at the hotel about an away a little late. My navigation application mixed up the directions only about a mile from the hotel leading me on a short detour through the rolling hills of the countryside. The hotel owner saw me pull up knowing that I was the late straggler. He pointed me to the restaurant where the others were already preparing for dinner while he kindly carried my bags to my room. As I walked into dinner and was introduced to the others with whom I would sit and work for the next three days, I found myself more than a little unsure of why I had come. I was glad to see three other women physicians at the table. But I didn’t know how I could relate to the pharmacists, architects, basic science professors, nurses, and lawyers also in attendance. And I was quite sure that I was the only one (the impostor) who had come to the course because I was struggling to find peace in my own life.

“Don’t believe everything you think. Thoughts are just that – thoughts.” – Allan Lokos

As the weekend passed, I realized that most of us were attending for similar reasons. We, the professors, needed these skills just as much as our students in order to manage stress and foster well-being. We spent the weekend practicing meditation, guided imagery, journaling, biofeedback, and yoga among other mind-body approaches. While I was far from an expert in the practices at the end of the weekend, I knew that I had gained skills that would allow me to provide our students with exposure to the tools. Medical training and practice is so incredibly difficult and often the external rewards aren’t enough to sustain us. We must be able to find the internal satisfaction and peace to continue moving forward.

“You can’t stop the waves, but you can learn to surf.” – Jon Kabat-Zinn

Fast forward one year, and I readily admit I continue to struggle with making mind-body practices habitual. However, I use the Calm app on a somewhat regular basis and my children do as well (at least, they like to listen to the sleep stories). I try to journal, but fall short of my goals here also. My most mindful activity is running, and am committed to participating nearly daily. And despite my shortcomings, I have noticed a change in myself, in my ability to be present, to experience without judging.

“Take a walk outside – it will serve you far more than pacing around in your mind.” - Rasheed Ogunlaru

I am now facilitating my second Mind-Body skills class with another group of ten medical and pharmacy students. The reasons why they chose to participate in the course are similar. They are struggling with the time commitment, the disengagement from families, friends, or themselves, wondering if it’s all “worth it”. They worry about future challenges, regret mistakes made in the past, and mull over potential lost opportunities both behind them and yet to come. They feel that they rarely experience the moment. Then in our two hours together as we practice our skills for the session, they notice their minds and breathing slow down. And during our time together the stresses fade and we are fully engaged in the present.

“In today’s rush, we all think too much — seek too much — want too much — and forget about the joy of just being.” – Eckhart Tolle

Yesterday I was informed that my patient is dying. I had last seen her a few months ago when I diagnosed her recurrence only weeks after she completed radiation therapy. The cancer progressed rapidly, unwilling to compromise with efforts to slow it down. She and her family now understood that time was short and they were ready to move to hospice. I sat for a few moments at her bedside and prayed for her and for her family to experience peace. I hugged her brother and asked him to give my regards to their mother who had finally gone home to rest. I stepped into the hallway and tearfully thanked her nurse for the compassionate care she was providing. No expectations, no judgement, only awareness and acceptance for what it is.

“Everything that has a beginning has an ending. Make your peace with that and all will be well.” – Jack Kornfield