Today I thought I would simply share as my post the article that I wrote for ehospice.com this week. It tells a story that continues to resonate even after twelve years. A story of presence, of kindness, of attending with gentleness. I hope it resonates with some of you and you find the simple exercises of value.
Mindfulness – our sixth sense: perception and appraisal
Today is the third week of our ten week mindfulness series by Dr Patricia (Trish) Lück, a palliative care physician and facilitator of mindfulness-based stress reduction (MBSR) programmes, exploring perception and appraisal in everyday palliative care moments.
One of my very first hospice patients that I was called to visit at home many years ago was a challenging engagement with age, gender, culture, religion, and more. He was a young Muslim man, bedbound now due to a spinal tumour, being tenderly cared for by his mother.
We had many communication bridges to cross before I could be of any real assistance to him, many moments of just sitting quietly together, through the at times awkward silences, as I waited for what was needed beyond the obvious of pain control, advice for his mother, and time spent drawing pictures with his little sister.
Eventually after many visits of patient silence and growing trust, he asked the question that had hung in the air for so long. “Please, tell me again, about my tumour, and what it means.”
And so the conversation started. The inquiry into what he knew, how much he wanted to know, the full discussion and eventually release into the truth that he would die with this. What remains with me is not so much the discussion and his subsequent death, but his response to very first question I asked him that day. A response that to this day informs every encounter I have with a patient and their family. I asked him: “How do you want me to tell you?” And his only response was: “Gently,” having previously been at the receiving end of a very callous and harsh disclosure process. My perception of this young man, and for that matter, any young man, did a complete rotational shift and with it my approach to all subsequent difficult conversations.
Perhaps it was an obvious one; there is no other way to have such a difficult conversation, other than gently, but having a paralyzed, bedbound, dying young man name it so openly for me, shifted my world. It could only do so because I had been paying attention and been open to what he needed. I had not prejudged what it was that he needed me to say.
We all probably have had the experience of watching clouds drift across the sky changing their form and imagining various images and shapes in them. Everyone has a different idea of what the cloud looks like, and this is a little bit like our own life experience. We all have a different opinion of what difficult is, what stressful is, what it is that we struggle with, and as such really can not know the experience of the other, other than offering our presence, our kindness and our willingness to walk the road beside them. This applies both for those we care for and for ourselves. Stress, as we understand it, is not what happens to us, but what happens anyway and how we respond to it.
Our capacity to stay present for and have a greater understanding and awareness of our own experience enables us to have greater capacity to stay present for others and allow their experience to be held in a way that can assist them on their difficult journey.
You may have noticed last week with the short meditations as you paid attention to breathing or to eating and drinking, that your mind tended to wander off on its own to other thoughts, memories of past events, planning the future, perhaps discomforts of the mind and body, and before you knew it the breathing, the eating, the drinking was forgotten until your remembered anew: ‘Oh..! breathing, eating, drinking…’ and you guided your attention back to what you were engaged in. For now that is the practice, noticing as your attention wanders and as soon as you notice, your attention is present again in this moment. It is present to choosing to attend back to the breathing, the eating, the drinking. This practice grows our capacity for patience and asks that we look at each new moment with curiosity and wonder, letting go of any preconceived idea of what this moment should look like, allowing it to show up just as it is, not needing to embellish any of it, not needing it to be anything in particular other than being intensely curious about how it actually is. You bring a sense of kindly curiosity to that enquiry. You might be surprised to find that this moment that perhaps seemed to take a prejudged quality, when engaged with mindfully, holds a multitude of moments that cover the full spectrum from pleasant to unpleasant, and even neutral.
So as you move through this next week, notice your moments of deciding an outcome before it has already happened, cultivate patience, curiosity, and kindness to whatever this moment may be unfolding for you. Continue to take a few moments to notice and follow your breathing through the day, noticing as your mind wanders to thoughts, other body sensations, emotions, returning as soon as you notice, to being aware of the moment of breathing, exhaling, inhaling.
Here are two short meditation exercises for you to practice:
For about 10 minutes a day, over the course of this next week, sit in a quiet space, comfortable in a chair or on the floor. If you wish, you can allow your eyes to close or keep them softly focused ahead of you. Begin with settling into breathing as you have been doing this past week. Noticing breathing in and breathing out, either at the nostrils, chest region, or abdomen. Noticing the movement of air, the rise and fall of the ribcage, diaphragm and abdominal wall. Then slowly allow your attention to shift to the feet, the legs, and notice sensations in this area of the body: front and back surfaces, external and internal sensations, contours, creases, clothing, air, temperature, pressure, discomfort, without needing any of these sensations to change. Gradually shift your attention up through the body: through the lower legs, the knees, the upper limbs to the hips joints and on to the torso. The pelvic area, the back, the abdomen, the chest region, the shoulders and arms from fingertips, lower arms, elbows, upper arms, shoulder joints, gradually moving onto the neck, the face, the head, paying attention to all the small areas of shift and change in sensation. At times you may not have any awareness of sensation or be aware of discomfort, all of this is okay, and as best you can, just notice what is present without needing that to change. Attending to all sensations with gentleness, openness, and kindness, and if needing to move, doing so with engaged choice and awareness. Ending the meditation exercise with becoming aware of the body in its completeness and wholeness, all of the individual areas being part of the whole that make up this body, your body, so much more of it being okay than perhaps you have noticed before.
For this week chose one routine activity you do every day and attend to doing it with intentional kind attention. Noticing the movement, the sensations, the thoughts and emotions that may be present. Be intimately engaged with what you are attending to and curious about a perhaps habitual activity to which you generally give little thought – showering, brushing teeth, washing dishes, or anything else you may choose for this activity – noticing movement, flow of water, touch of air, what you do that you normally don’t notice so intently.