This week’s surprise lesson for me was experiencing how it can be quite stressful to be kind to oneself. Might sound paradoxical, yet this was my direct experience.
Simple practices – like letting the computer screen hibernate for the 5-7 minutes I have lunch, finishing my shift on time, allowing myself to not eat the fast food brought in by a well wisher and instead have a salad pre-prepared for work… Simple practices of self compassion and self care that should feel easy – but didn’t. Similar to the initial discomfort that comes when (re)learning a skill.
A big positive for the week – recognising this week’s ‘pause’ provided the team with the kind of time and space that nurtures psychological safety. Will this be at the cost of losing project momentum ? Or will individual and team motivation be boosted instead ? We will find out as the new week dawns …
“I saw the angel in the marble and carved until I set him free.” Michelangelo
The stand out moments for me this week have mostly been around 1:1 development time with different members of our wider ED clinical team. Letting them grow and spread their angel wings as I hopefully reinforce their sense of autonomy, authenticity and ways to engage.
The most precious encounter was with one of the registrars taking care of a patient who visits our ED frequently. This time though, the registrar was able to shift his focus to work with that part of the patient that keeps coming back to the ED for help – instead of the part of the patient that makes her relapse into destructive behaviours as soon as she leaves. This change in intention opened a whole new path for both the patient and the registrar (who had seen her several times before with the same problem.)
Compassion in practice, one patient at a time.
From a systems point of view, the ED older patient flow pathway we put forward last week has been accepted and the pilot starts tomorrow. A record breaker for getting stakeholder engagement (not to mention agreement !) so quickly.
For the week ahead, my intention is to prioritise some self care and self compassion. To remind myself of what I share so often with my team – when we pour for others, we must sometimes stop to fill our own cups too.
The external growth this week has mostly been in the intellectual and physical energy domains. Notably – delivering the first session of a training program I am offering to ED clinicians interested in quality and clinical audit. And upgrading a proposed ED geriatric referral pathway to a patientflow pathway – shifting the central focus back to the patient.
Diminishing psychological safety at the organisation-ED interface has been the challenge for a second week running. I find myself coming back and taking refuge in the spiritual domain of our work – a purpose and perspective that helps me acknowledge the suffering without it becoming overwhelming.
Serenity to accept what I can not change, courage to make the changes I can, and experiential insight to recognise the difference. Compassion in practice.
Positives this week – seeing leadership and new confidence express itself in an ED registrar’s board round. Plus nurturing the leadership wings in a member of an ED Frailty Intervention Team (that I am responsible for).
The monthly ED journal club continues to mature, in particular relationships and shared learning between the registrars. An opportunistic teaching moment this week – reinforcing the ethics/integrity that must be at the heart of everything we do as clinicians – research and beyond.
My most difficult moments this week – experiencing the physical symptoms and the hit to psychological safety that arise from management meetings without good governance. Observable changes in concentration, mood, energy levels, headache – not dissimilar to carbon monoxide poisoning!
Personal area to grow – allowing myself the self compassion to focus on what matters most and let go of career aspirations that necessitate carbon monoxide type toxidromes.
Feels like a good week. The Europe wide research study our department is participating in connects us with a bigger picture and higher purpose, nourishes social engagement and provides a channel for physical action.
Also protected some 1:1 time with ED Quality Improvement Project registrars. Helped them understand the difference between medical research and quality improvement. Reinforced the importance of a moral compass – looking deeply and understanding where our (project) volition comes from.
Personal positive – concentrated most of my time and energy on my sphere of influence. Action and agency.
Personal area to grow – meeting people where they are, and not where I want/expect them to be ! Balancing the real life time pressure of delivering on research and departmental change while still providing young minds a safe space to learn.
What does “human factors” mean in an Emergency Department world of Covid 19 and how can my ongoing training in it make a difference to where I work ?
As a first step, I am introducing Zoom based sessions on quality improvement methodologies, adapted to my local setting. Gently redirecting attention from our circle of concern to our sphere of influence – individually and collectively.
My belief – action and agency in these difficult times help relieve suffering and maybe even promote well being in the workplace. Compassion in practice.
It’s a little over three decades since I joined medical school and I find myself starting a new journey – exploring deep compassion in clinical practice.
I will be doing so through a Masters program “Human Factors in Patient Safety” offered by the Royal College of Surgeons of Ireland from this September. A little nervous, and very excited.
“Human factors” can mean different things to different people. For me, it is about exploring how compassion influences the interdependence between human beings and clinical systems. Anyone who has experienced genuine compassion knows the effect it can have on clinical outcomes – how might it be possible to reproduce this at a “system” level ? And if we did, what kind of effect might it have ? In short – could there be #AnotherWay to how we deliver care ?
I hope to share what I discover over the coming months through this blog …
As I prepare a resilience workshop, I would like to offer you a simple tool called the three breath Traffic Light.
In essence, you keep an image of a traffic light somewhere easy to find – like your phone or on your desk. Have an alarm prompt you every so often to look at this image.
The Red Light – is to remind you to just stop and breathe.
The Orange Light – to breathe and be aware you are breathing.
The Green Light – to breathe and then go.
While this may sound childishly simple, it’s power can be immense. Neurophysiologically speaking, “stopping” interrupts fear and flight or fight circuits from continuing to spread beyond their origin in the amydala. Becoming aware of the feeling of our breath, strengthens the links between the right and left sides of the brain. Finally when we breathe mindfully and “go” it restores brain function and control to the executive centres in the pre frontal cortex.
Or put simply, it gives us the power to choose how to respond, rather than be driven by subconscious lower brain impulses.
Faced with the breaking point pressures in the NHS as we have been for 3 years, it is worth remembering tools similar to this have helped rebuild inner strength and resilience in children exposed to much worse – the devastating trauma of 9/11. If it can work for them, it can work for us. Will you give it a try ?
Over a coffee yesterday, my friend Saad told me about “Genius” – a National Geographic tv series based on Walter Isaacson’s book on Einstein. An amazing story of the man within a scientist, allowing us to perhaps reflect on how a journey of sacrifice and suffering lead him to his amazing insights – insights that have fundamentally changed the trajectory of human evolution.
Yet within his scientific discoveries, we also find the insight of compassion. In his words –
“A human being is a part of the whole called by us universe, a part limited in time and space. He experiences himself, his thoughts and feeling as something separated from the rest, a kind of optical delusion of his consciousness. This delusion is a kind of prison for us, restricting us to our personal desires and to affection for a few persons nearest to us. Our task must be to free ourselves from this prison by widening our circle of compassion to embrace all living creatures and the whole of nature in its beauty.”
The challenge for us – how do we “widen our circle of compassion” ? A first step might be – simply opening to what is in our immediate circle – including ourselves – with joy and gratitude …
The “Duck” test: “if it looks like a duck, quacks like a duck, and swims like a duck – it probably is a duck”. How do people and patients perceive not just their own care but the care of other patients beside them in the Emergency Department corridor or Acute Ward ?
The Expert test: What do the people who work with humanitarian crises day in and day out think about the situation ? The Red Cross has spoken, how about other similarly experienced individuals and organisations – what are their views ?
The Rationing Care test: how are clinicians and managers deciding on the best use of resources ? For example when the Emergency Department is overcrowded, which patient do we move into the corridor – the one least likely to come to harm or the patient most “likely to die anyway” ?
Difficult questions that we as clinicians, hospital managers and a community need to answer honestly and together. Not out of anger, but out of understanding and compassion.
“We who have experienced the war directly have a responsibility to share our insight and experience concerning the truth of war. We are the light at the tip of the candle.”
Vietnamese Zen Master to US War Veterans