Equanimity

The time is coming,

For a change in scene,

The beauty of this time is near,

It’s for our hearts to hear,

And our wisdom to know,

That we are all here to “grow”,

 

Like the melting of the snow,

That which we cherish in its solid form,

With the coming of the spring we are torn,

Both by the beauty of what is to come,

And the loss for what has been,

 

For all the magic cannot last,

But still we enjoy the blast that we had,

For it was experienced in the moment,

So, we must love the rain,

As much as we love the wind and the snow,

But the question is how?

And the answer is “it doesn’t have to be now”,

 

For through the intention of your journey,

You can find the direction,

And only through deep introspection,

Can you find the key,

As the quest for love,

Resides within thee,

And at its deepest point we see,

The truth of “Equanimity”.

 

28-12-19 Seeing beauty in all things, all experiences and all states, is the quest for the bold, courageous and sublime. I first came across the concept of “equanimity” when learning about the “Brahma Viharas” from the Buddhist philosophy. In this teaching of the Dhamma I can remember learning about the 4 kinds of love, Mettah (loving friendliness), Karuna (loving kindness), Mudita (joy for the happiness and success of others) and Upeksha (equanimity). “Dhamma” is the Pali word that refers to the “wisdom teachings” about the “true nature of life” as described by the Buddha’s insights, which he encouraged us to find and see for ourselves.

 

“Upeksha” or equanimity has been referred to as the “crown jewel” of love, for it is the hardest to practice, yet the most rewarding in terms of generating peace for oneself.

 

When I did my first 10 day silent meditation retreat in 2009 in Sri Lanka (which was vipassana retreat according to the S N Goenka style), I came again into contact with the concept of “equanimity” for it was practiced daily, and within every sitting meditation session at first laboriously (for it took effort), and then with joy after I got the hang of it.

 

In essence, what we did was recognise that by scanning the body, with our attention, we could detect that there were both pleasant and light sensations in different parts of the body at any given time, and also deep and painful parts (eg the feeling of pain in the hip after sitting in one place for 45 minutes without moving and getting up).

 

The practice was to observe our reaction to both the pleasant and the painful sensations that we were experiencing and challenge ourselves to treat both pleasure and pain with the same greeting. The greeting was that of “letting go”. We acknowledged the sensation by deeply entering into the experience of whatever was there, without prejudice, and then moving on with the body scan. By practicing this state of “non-reactivity”  were able to more clearly observe the principle of “anicca” – ie that all things eventually pass. This was quite liberating, for after one had sat through intense pleasure and pain in a one hour sit (perhaps more of the latter in most of my sits to be honest), then there was a feeling of liberation, right then and there.

 

I remember sitting once for two hours, and this wasn’t that common. I felt as if my legs were on fire. All sorts of thoughts arose, including “I wonder if I will be causing my legs serious and permanent damage by sitting here cross-legged and not moving”. I remember being determined to make it to the two-hour mark, the end of it would be through the chanting that preceded the ending bell and the familiar recorded voice of SN Goenka who told us to “take rest… take rest” after each sitting session. In that particular two hour sit (which was unusual as most of the sits were 1 hour in duration), I felt like I was experiencing an abstraction of “hell”, and yet I was sitting in a peaceful room. It perhaps dwelled upon me that the hell I was experiencing was not “out there” but was deep within me. I also experienced the ability to not react, but to enter deeply into this state, and “let go”.

 

Through the letting go I was practicing equanimity. At some point the pain left me and I was left in a blissful state. Again I remembered (through prompting of the audio recording that we listened to whilst doing sitting meditation) that this blissful state was also something to enter deeply into and “let go”, for attachment to pleasure was perhaps in some way as unhelpful as aversion to pain, and we learned this through our own observations of our own bodies, or at least I did.  In that moment I also “let go” again. In letting go of “my reaction” to both pleasure and pain, I experienced them fully as states passing through me, rather than abstractions of myself, and also realised that “I” (whoever that may have been) was not who I “thought I was”, nor was I limited by my experience. Rather, perhaps I was largely that which observed these things.

 

It’s hard to explain things that were experienced in the moment or can be experienced in every moment for the minute one tries to label something there is an abstraction from the experience itself. However, sometimes poetry and prose can describe these things, and trigger one’s own memories of experiences of different states of consciousness. For me Equanimity was one of the most profound insights, that has helped me so much in my life. Whenever one experiences hardship, I always remember that sitting meditation where I felt like my legs were on fire and noted the power of non-reaction. Also treating pain, the same as pleasure.

 

I was perhaps forced to practice equanimity when I broke my ankle (unbeknownst to me, and my medical friends at the time) whilst 10km into a 40km hike. It was very painful, but I could still walk with a backpack and it seemed like a bad sprain. But still I managed to complete the walk after 2 nights of camping, only to discover about a day later that perhaps it was broken, and indeed it was. The disappointment was intense as it rendered me incapacitated at a time when I needed to be in full flight (right before a clinical exam requiring lots of study and activity). Again, there was an opportunity to practice equanimity, to see things with a clearer perspective, to understand that I was not my experience, but rather an observer of these things. Still there was hardship, but I had the choice of experiencing the apparent tragedy with creativity and choosing my response with what I wanted. It was much like how I choose my response every time I choose my response to the change of state from being dry and warm, before plunging into the ocean that always feels initially cold and wet.

 

If equanimity symbolises a space of “peace”, then perhaps letting go is key. And the easiest way I have found to learn and practice how to let go is to simply take a deep breath in through the nostrils, and exhale slowly through the mouth with slightly pursed lips, noticing the experience of letting go with each out-breath.

 

This can be done once, for one minute or one hour. All can be equivalent in the moment; the most important thing is the “practicing” of it. When that out-breath comes, I am reminded of how simple it is to let go. It is simply, but not “easy”, if that makes sense. The two concepts of simplicity and easy are different things. The more one practices a simple, yet hard to do thing, the easier it gets.

 

“Letting go”, the path to equanimity, and “breathing mindfully”, the path to letting go.

Serendipity

Sometimes we see the things we need to see,

Other times we just know,

 

Some people let it show,

Others simply grow,

 

No matter how it may seem on the surface,

What really counts hides deep below,

 

For when we trust in the inner glow,

Perhaps this is when we hit “Flow”?

 

12-12-19

I felt inclined to reflect in the serendipitous nature of success. I write this statement in an element of “tongue in cheek”. Let me explain. This morning I started listening to the Audiobook titled “Success is for You” a book written by Dr David Hawkins, with an original manuscript that was initially drafted in 1991, and the Audiobook was recorded for Audible only recently, this year.

 

I was actually alerted to the recent audio version of this old, yet significant piece of writing by a comment made on this blog, to one of my blog posts. I was really chuffed to read the post as it was written by the person who had recorded David Hawkins book titled “Letting Go”. This book had a profound effect on me, beyond that cliché statement may imply. I actually refer to this book, and others, in talks that I give on wellbeing, stating that is wisdom that I have picked up from such text that help me on that path (towards inner wellness).

 

This morning I woke up and went down to the ocean to pay gratitude to mother nature, in more a physical sense rather than a verbal interaction. It felt divine, as it always seems to. I feel quite blessed to live so close to the ocean, for jumping in the water is a beautiful start to the day. I am very aware of the positive elevation of my consciousness, or at least my perception of this happening, as I submerge myself deep into the water and swim out to sea, and then ride the energy of the ocean’s wave back to the shore. The true joy of both catching a wave and missing a wave, in that state are equivalent, and effortless.

 

Jumping forward an hour or so, I start to listen to the new Audiobook I have just downloaded. David Hawkins, MD PhD and psychiatrist (translated through Peter Lownds, PhD) talks in his book “success is for you” about the power of “making it happen”, and the “aha moment”. He relates to concepts that I have been made aware of previously through coaching, and deep reflection. However, he seems to be able to effortlessly illustrate that the most important things in success is are to do with a “state of being”, something that is already within us, rather than “out there”. In this realisation there is an “aha moment” and sense of power, perhaps even an awakening that goes far beyond a desire or intention. I related to this deeply when I heard the words spoken, for it took me back to the moment of submerging myself in the ocean water this moment. In an instant the journey is effortless, and one of effortless joy. I am sure that the beach goers, swimmers, surfers and nature lovers of the world relate to this, although probably not in the same words. For in that moment there is no quest to having things or doing things, for this is already happening automatically by that enhanced state of being.

 

I do not profess to be able to present such simple, yet profound concepts in the insightful and eloquent prose that Dr Hawkin’s book lays out, however, I do feel the inclination to try and translate just a little bit of how an early part of that wisdom integrated effortlessly in to my being (and for this I am very grateful). A guess, the reason for doing so is that I have aspiration to champion “knowledge translation” , a movement I came into contact with when writing up my PhD thesis, some years back, and have thereafter incorporated in my way of being. To this motto I believe that the effective translation of even an ounce of wisdom, is perhaps more helpful, than holding on to a tonne of wisdom that stays buried and dormant within. To this last proposition, I reflect upon what I just read/listened to in the audio book, which talked about the  “aha moment” illustrating true power, the power of realising the greatest part of external wisdom was something we already know inside, and perhaps what we always knew. To me this moment is one of true Serendipity.

Love and Gratitude – seeing the light

Looking for the light,
For it is always there,
Rising up from behind the ocean,
Knowing it will break through the clouds of despair,
But even though they are there, It’s the cloud that has its own flair,
As the light creates patterns through distraction,

But don’t look too long, Or you will get lost,
Instead look inside yourself and become engrossed,
With “awareness”, See the changing nature of life,
And the transformation of “strife”,
Nausea, pain, fear of the future,
Whatever it may be for you,
Then see it turn it into something new,

Perhaps something exciting and inviting?
For me it is hope.
For with hope comes the belief in something good,
Like a monk who draws back his hood,
Only to see with new eyes,
The same picture, only with meaning,
For love is all around us,
And gratitude is the best way,

For it is not what we say, But rather “how we say it”,
And not whether we win or lose,
But “how we play it”,
That makes the impact on our own humanity as well as theirs,

And this is not just for them, but for us too,
For when we look with these wise eyes,
We never see just two,
Because there is far less difference between me and you,
Than we can ever imagine,

For beyond what we may think,
Is what we already know,
So connect with your inner glow,
And understand the blessing that you are already living,
Life with all it’s twists and turns,
Life is what will take you beyond strife,
“Love” is the vehicle, and “Gratitude” is it’s fuel.

27-5-19 Birthday Poem after my morning meditation. Grateful for the day – May all beings be well and happy.

Ocean swimming and “overcoming barriers”

Awakening to the Ocean within

Overcomming barriers,

Is like jumping in the ocean,

And as the cold water rushes past your body,

There is an initial fright,

Perhaps even an “internal fight”,

Of emotions and thought?

.

Things like; –

“Can I do this?”

“Should I do this?”

“Is life better on land?”

“Will it all not turn out like I had planned?”

.

But who wants to live on the sand anyway?

Especially when we have a choice?

Why not listen to that inner voice?

Which is quietly saying,

“yes you can”

“Actually it ‘is’ part of the plan”

A plan of adventuring deep beneath the surface,

And exploring the inner world of possibility,

Excitement and flow,

A time to let go,

And become who you hadn’t even dream of,

.

For with the first wave, whether you catch it or not,

You feel ALIVE!

.

Alive within magic of the ocean,

Barriers broken,

For you dove through the fears and expectations of the mind,

You learned to be kind,

And in cold water its warmth that you did find,

A moments peace before the daily grind,

Or perhaps even better,

A chance to let go of the fetter once and for all,

And instead chosing to have a ball,

Whether you run or fall,

Knowing you can always stand tall,

In the solitiude of your heart.

7-1-19 Overcoming barriers, and moving through a sense of “inertia” has always been the most difficult challenge for me with any project, or task, be it getting up in the morning, going to work, starting a literature review, or even looking at my schedule.

Its funny but I often rationalise the inertia, and sometimes justify it, by the perceived magnitude of the task at hand. Ocean swimming is perhaps a great simulation of this process of “overcoming barriers”.

This morning when my partner Sanna and I went down for a body surf in North Wollongong, the sky was overcast, and the sea, from a distance didn’t look as inviting as it has done in recent times. This is the best time to observe oneself and one’s own resistance. For in this awareness one can see how easy it is to be trapped in the minds stories of doom a gloom, the river of “what if’s” and all its associated tributaries.

Thankfully instead of listening to these fleeing internal stories there was a pre-arranged commitment to go for a swim and a body surf. It was a cocktail of feelings of resistance, thoughts, followed by the experience of surrender and success, only they happened rather rapidly. Often when having a coffee after the body surf my memory cuts to the chase and all I seem to focus on is the second half of that mindful journey, which is where I have surrendered my fears, entered the ocean and started having incredible fun.

However, to really understand oneself and learn from one of the greatest teachers I know, “the ocean”, it pays to slow down this internal process, at least in reflection. You see, after getting in the water and meeting with a fright of what feels like “cold water” (and it isnt’ that cold, only relatively cold to the state of night time hibernation), the percieved chill was quickly replaced by an internal warmth of my bodies muscles being active, trying to catch a wave. This process usually only takes about two waves where I feel the water go over my head and immerse me in the ocean. Then I feel like I am amongst the magic of the ocean.

Then a big wave came and I greeted it with a duck dive, followed by another and another, and before you knew it I was out “the back”. Here I found myself surrounded by a community of friendly fellow swimmers and/or body surfers. Men and women, who had also courageously chosen to “take the plunge” early in the morning, only I’m sure they wouldn’t look upon their actions quite as magnaminously as that. Perhaps for them, they are just doing what they usually do – going for a swim. I just like to frame this in a more maginificent way.

Actually, in North Gong (the beach which is in the northern reaches of the city of Wollongong) there is a group of people who go out every day, all year round, mostly older men (and I am cautious to qualify this statement, for after all who am I to talk), and some ladies who also are part of this sublte local practice.

Today I saw a couple who we often meet down at the beach, both enjoying the ocean and all it’s viscitudes. These men who regularly go out have a colloquial name;– they are fondly known as “the corks” for often as you walk down the hill to the North Gong promenade after about 7:30am in the morning, you can often see their heads bobbing in the ocean waiting for the next wave, or if they haven’t reached the ocean yet you see them traversing from the North Gong Surf club to the waters edge, donning their blue and red stripped speedos laced with a white imprint of “North Gong” on their posteriors. The morning daily ritual of bodysurfing is a wonderful thing to both witness and be part of.

Overcoming Barriers – traversing through inertia…

The transition from cold to comfortable reminds me of several other instances of overcoming inertia. I remember when I lived in a shared study house in rural Sri Lanka whilst conducting experiements as part of my PhD research back in 2007-2009, I recall having a cold shower every morning. It was a welcomed experience because the outside temperature was a humid 27 degrees, which increased during the day. However, still there was a chill in my modest ensuite bathroom, where there was only cold water. I remember vividly the emotional wave of inertia, not wanting to get under the water, expecialy coming there from dreamy sleep state. However, after the initial chill of piped water exposure, I noticed a rapid period of “acclimatisation”. I felt there was a curious feeling of empowerment in this transition period. It was neither comfortable nor uncomfortable, in the same was as jumping in the ocean this morning, I felt “alive”. Then shortly following this period came a state of enjoyment of being in the water and sense of attachement to the steady state of having a cool shower in a hot environment. It was blissful, and I didn’t want to leave. Again the inertia state had arisen and had to be overcome in order to get on with my day. Getting out of the shower, drying off, having a cup of tea, breakfast, and writing, or going to the office – which ever it was.

Water is an incredible medium for taking us into different states. A shower can be magical, pool swimming magnificent, but and ocean swim – now this is what I call blissful. But perhaps more than all of these experiences, it is the “transition through the barriers of inertia” that can bring us many opportunities to become more alive!

Here’s to that journey – have a great day!

An intention for 2019 – the power of “letting go”

The power of letting go

Letting go,

Is to go into a flow,

A state where you know what there is to know,

And where going slow, is okay,

For beyond what you say there is always “how you say it”?

And what about holding still,

Rather than simply chasing the next thrill,

For perhaps life is more than the bitter pill,

That you must swallow,

Emptiness is never hollow,

When one sees the nature of all that is.

.

Eternal bliss is within the grasp of all,

If you are willing to take the fall and tumble,

Insteady of wanting to rumble for the greatest prize,

For in every deafeat there is a subsequent rise,

Beyond perceptions of power and size,

Happiness is but sorrow in disguise,

For only the wise know what is truly real,

And perhaps this begins with knowing “how we feel”,

Only to watching it change like the wheel,

Revolving and evolving,

And experiencing the beauty of the moment,

.

This is when we have learned to let go,

It is not the end of the show,

But rather experiencing our performance stripped bare,

With or without flare,

And regardless we share our wisdom with the world,

A world where awareness comes with peace.

6-1-19

A new year, and reflections that follow. As this is the first post of the year I feel the pressure of expectation in the form of a feeling, and then I acknowledge, relinquish and let go.

I think the most profound realisations happen unexpectedly. For me, 2018 has been a significant year, one where there perhaps has been a development of a little bit more of inner awareness. Of course, there was the challenge of getting through my Emergency Medicine training which was an incredible personal achievement, and one that was a long time in the coming. However, there was also the discovery that the challenges of life do not end at this point. The true nature of life is that is every evolving in complexity, yet there is always the opportunty to stop, reflect and change perpective. This perspective comes with taking a moment to stop, sit, and be with onself.

This is the awareness, and habit that I was fortunate enough to discover in my mid-teens and further developed in my early 30’s. Put another way, this habit encompasses the ability, no matter how pressured I felt at the time, to take a moment to stop, and notice my breath. It sounds crazy, but in that moment there is promise of complete peace. In that moment one can realise that greatest questions of life remain unasked, and simultaneously answered in a language beyond words.

Perhaps it may seem like I am writing either complete giberish, some kind of cryptic code. None of these options are my intention. I do not profess to “know anything” but rather am trying my best to shae what came to me when I just now sat in silence of 10 minutes (referring to a short sit before writing this post).

In this space I realised that I had oppened a door to my subconcious, which seemed like a multidimensional repository of knowledge, wisdom and magic. Magic in the sense that it was increadible to see what lies beyond the surface, something that could not be predicted (in a way that the analytical mind is so skilled at doing).

Just a few days ago, on the 2th of Jan I had the opportunity to partake in a “Dhane” (a daily giving ceremony to help the monastic community survive) held at the Santi Forrest monastry in Bundanoon (in NSW, Australia). It was a great gift to be able to hear the Buddhist nuns and monk speak a few words of wisdom before eating the food that was uncerimoniously offered to them, and then partake in the shared meal. I was also able to set quietly in the coolness of the man made gave, nearby the main monastry building. This took me to a space I have longed to re-visit for some time now. On this day i had two separate sits, where I noticed my breath for 1 hour at a time. In that moment of spending time within myself, away from thrill seeking holidays, work and a never ending collection of “to do lists” which can easily infuse one’s semblance of a peaceful life, there was a momentary shift in my perspective of life for the better.

A reflection on 2018 , and an intention for 2019…

So looking back at 2018 , I am compelled to make a comment about three books that changed my life for the better. Brene Brown’s “The power of Vulnerability”, and Kaushik Ram’s, “The hidden world”, and the most recently completed book called “Letting Go” by David Hawkins.

I could write at length with reflections about each of these books, but perhaps in a conglomerate summation I can say that in their own way this – the secrets ourselves and the world that we experience also lie within ourselves. I am grateful for the teachings that I inferred from reading/listening to these books.

We can easily be burdened by negative patterns of thinking that often operate at a subconscious level. There are strategies to overcome this and perhaps it will not be readily accepted by the thinker within us, for perhaps it is this very process of excessive thinking that goes against the very thing that we are seeking, in my case “the path of inner peace”, and perhaps “letting go” is the vehicle that can help us voyage down that path.

I certainly don’t profess to know the answers to the questions of life, but what I do know is that I have an intention and aspiration for 2019, and that is to take a step down that path.

What is your intention for 2019?

Emergency Medicine Fellowship success – Love & Gratitude

This journey is hard to explain,

Beyond the pleasure and the pain,

Like chasing the sunshine through the rain,

 

And then looking for the rainbow,

That has always been there,

But without guarantee,

 

For the heat is more than you can think,

Momentary defeat could arrive with a blink,

And cripple your confidence,

 

Until you become aware,

That what you seek has always been there,

….deep within,

 

So when you would want to shout,

Crippled by doubt,

Reach to your core, and pick yourself up,

 

Feeling and trusting what you know inside,

And then confide,

Making sense of the ride,

 

Beyond fiction and fact,

Providing safety with great tact,

You show that you care “beyond” the task at hand,

 

For in this approach and way,

You are sharing “more” than the words you say,

In a style and conviction that resonates,

 

So thank you to my amazing team,

And especially those who backed me in my dream,

Through a process that could just as well ended very bleak,

 

Had I not realised the simple fact,

That “trust” is strongest at its peak,

And “fallability” is an essential part of humanity,

 

So rise with every fall,

Smile again and stand tall,

No matter what comes your way,

 

And for me, kindness was the key,

Giving oneself permission to simply “be”,

Letting the wisdom of mind, body and soul run free.

 

With love and gratitude

– thank you.

 

 

1/8/18 – I’m sitting in Doha airport, having a left behind a beautiful winters morning first in Wollongong, and then in Sydney. My next destination in Stockholm, Sweden, to see my partner in life and love.

 

I have wanted to write this post for some weeks, a post of about my gratitude for passing the Fellowship exam ( the final chapter of the emergency specialist training program).

I am so increadibly grateful for all the support I have received to make it through, for it has been no easy feat. There have been so many forces at play to get through this exam, tangible and existential. Not least to thank is my partner, Sanna, who was supportive well beyond the call of duty, for she had to put up with me during the last two and a half years of fellowship study, on the back of supporting me through a PhD write up (and I’m sure I lost my mind for the latter part of this process). Not only Sanna, but my family and friends. I had been studying for the fellowship written and clinical (OSCE , or objective structured clinical exam) for just over 2 and a half years, prior to my recent completion of exams. During the last two months of study I didn’t see my brother who lives just over an hour away, or my little nephew, and I also ended up moving out of home into a solo appartment for the final 6 weeks – despite knowing the territory when going into it, I never would have forseen it being so challenging.

 

These strategies were to help me manage the intensity, and to help me focus my efforts to give it all that I had to give, physicially, psychologically and emotionally. At the same time they allowed me to spend a bit of time to “look after myself”. I never let go of that last principle. Being kind to oneself, was so important to me, and that included meditaiton and swimming in the ocean, surfing or body surfing.

 

Everyones journey is unique in the fellowship, and it is a very tough process, and also imperfect. There are some who pass straight through to “fellowship”. There are many who fail and then pass at subsquent sitting, and then there are those who don’t make it thought.

 

My heart goes out to the people who both fail and pass. I know the pain of failure in this exam because I failed the written on my first attempt and sat it one year later, and passed. Then I sat the OSCE immediately after and failed this the first time. Despite putting my heart and soul into the exam I failed, and this was devasting. I didn’t give up, although I did think about it. In my case I had search deep within to realise why I was doing this training in the first place.

 

Connecting with “the Why”

 

On the surface it looked as if this was just an exam I had to pass, but the real reason was that this was going to be something that was going to make me a better “Emergency Physician”, and provide the structure I needed to practice for the rest of my career. Also back in 2006 when I went to Sri Lanka for a 1 year expedition, both cultural and professional, I discovered something that I was passionate about, helping develop EM systems in resource limited settings. That interest lead to a PhD in knowledge translation, that covered the topics of toxicolgy, resuscitation training, simulation and health services research. Doing international work, and working in rural Sri Lanka was so inspiring to me, I became so passionate about teaching Emergency Medicine and Resuscitation in settings like rural Sri Lanka because junor doctors on the ground were so hungry for education, and it made a difference to their ability to support their patients (particularly in critical care).

 

In addition to gems in medical training, I also spent time exploring parallel paths of personal develomement, including poetry writing, music, mindfulness and spirituality. It was from this point that I had a dreamt of giving something back to society through bringing in some of these extra academic skills and soft skills into mainstream medicine. One dream plan was to to support a more kinder and human system of training, where junior doctors felt inspired to go through training, rather expecting loose large chunks of their life from which they may or may not recover. The project I started back then was called compassionate health education, which championed teaching behaviours where “kindness” and “respect” at basis of all topics of education.

 

I also believed that through research I could help contribute internationally to lower resource sttings I guess you could say that I had to travel to Sri Lanka and practice medicine in a rural setting that I found my “why” for completing both a PhD and EM specialist training. I had to re-visit and re-solidify that “why” on several occasions during the fellowship training when hitting difficult spots and it was helpful thave them mapped out. In returning to mainstream training, I saw EM through a triple lense, that of a trainee, and that of a researcher and through the eyes of being a human being. It sounds counter-intuitive, but in order to train in and brand of hospital medicine, it’s quite easy to forget one’s humanity through the sheer force of intensity of training, and consequent lack of life balance.

 

Wellbeing, burnout and maintaining mental health in training

 

During the middle of my training I was exposed a series of suicides, and became involved in mental health and wellbeing. I had lost two friends and colleagues to suicide of a period of years, both of whom were accomplished and inspiring medical educators. These events had a subtle but important impact on me. Today, researching wellbeing strategies in EM, and addressing “physician burnout” is my current focus of research. Through some preliminary work I have realised that perhaps there are many factors to do with work culture, and education systems that could augment burnout and mental heath issues, representing a gap between where we are and where we could be.

 

Another reason why I am so passionate about this topic is that during my training I experienced burnout myself. This occurred when I was trying to write up a PhD thesis and also do advanced training simultanously. I was training not only to be a better doctor for the individuals I was treating, but I was also simultanously training to improve systems of health care, including the systems of training. Thankfully I had a supportive work team, including ED director, and director of training at that time who helped me facilitate some time off, to address what was missing in my life-work balance. I ended having three months off, seeing my GP, and also going on a 10 day silent meditation (vipassana) retreat, which allowed some important rejuvenation, and change in perspective. When I returned to training I was better than before, and approached it with new vigor, and greater balance.

 

The Gratitude Roll

 

I feel such gratitude for all that has happened to allow me to get through this fellowship process. However, there are too many people to thank for this point, and no words can really express how I feel, especially for certain ones. Some of these people probably don’t realise what an effect they had on me. An exhaustive list will be futile as I’m bound to miss writing someone, and lists don’t make interesting reading. I will try and mention some of the area of gratitude and it is important for me to have you know that if you ever had a good thought towards me, you were part of the process that helped me get there.

 

Thoughts matter, and when you wish someone else well, you are actually wishing yourself something good at the same time (the Buddhist philosophy has a word for this sentiment, which is called “Mudita”, or sympathetic joy, the happiness in anothers success. So think you for any Mudita that came my way before the exam!)

 

I was inspired to write this post today because I am accutely aware of my inner circle of support, being my partner, and my coach Juli, as well as my parents brothers and families. I also have my teachers and mentors in EM and my friends and the community groups that I belong to like www.onewaveisallittakes.com. If there was a process that helped me immensly it was surfing in the ocea, meditating, playing guitar and exercise. It amazes me how lucky I have been to live close to the ocean and have access to this.

 

I am also proud of myself for being able to stick to regimen of self discipline, during the fellowship exam and enlist the joy of “missing out” on some of the things and activities that I loved the most.

 

The amazing Team of Liverpool ED

 

I have to make a special mention about the entire department of Liverpool ED, where I worked for the year leading up to my success in the Fellowship OSCE exam. Liverpool has been one of the most amazing hospitals to work at in my career to date , because of the complexity and diversity of patients who we look after, and the amazing team based culture that prevails in the Liverpool ED between senior staff and junior staff, and doctors, nurses and all levels of staff from cleaning staff, wardies to the consultants and senior nurses. This culture of Liverpool ED is a testimony the leadership of our director Dr Serena Ayers, who has empowered innorvation and leadership along the ranks and had a vision for this. Also the director of EM training Dr Jenni Davidson who had created a Fellowship training program that I could not have dream of, backed up by a motivated team of staff specialists and VMOs, and such a cohesive, supportive, and fun bunch of ED co-registrars. I remember, in somewhat of a hazy blur (despite this being only 3-6 months ago), working weekends where I would finish a shift past midnight, stay in hospital accomodation, get up for a coffee and less than average breakfast (I say this because I live for our home made museli and fresh fruit) and squeeze in a couple of hours OSCE practice before another heavy 10 hour shift.

 

Anyway, my plane is about to take off and I will look forward to getting this post up on my blog. I usually write a post at least every 3 months. I haven’t written since december last year, which is a big deal for me. It is one of the things that I put on hold. But I’m so happy to be able to write this post. I am also happy to be going to Sweden

 

Looking forward seeing Sanna and her family, and having a holiday, including going to a Music festival in the heart of Sweden! I can’t wait 🙂

 

Take Care

Best Wishes

Bishan xxx

 

PS – Thanks again to everyone who helped me along the way – I really appreciate it!

 

PPs – I give my sincere apologies for those nice people whose lives and important events I missed out on whilst in this intense study period. Sorry for missing parties, and all the communication about important things (including births, and deaths of loved ones). I endeavour to get in touch in the months ahead – please don’t take it personally.

Impossible is just a perpective #ACEM17

Impossible is just a perspective,

So let us be reflective,

And ponder with mild imagination,

.

Letting go of cessation,

And seeing what may fly,

Like babies and adults that cry,

.

Let’s not deny, the humanity that exists within,

But instead let our dreams open and sing,

The song of becoming,

.

For in observation we can only find,

That medicine can also be quite kind,

If we first reach the heart within,

.

Perhaps “this” is what possibility may bring.

21-11-17 Reflecting on the the first day of the ACEM 2017 ASM (that is, the Australasian College of Emergency Medicine’s 34^th annual scientific sessions), held this year in Sydney, with a conference theme of “Impossible is just a perspective”, and a secondary theme of “getting the balance right”.

When I heard about the planning of this conference at the SMACC Dub conference last year, I was waiting in anticipation. The welcome speech by Sally McCarthy, an ex-president of ACEM and conference chair, confirmed the importance of the theme. It highlighted just how far the specialty of Emergency Medicine had come in recent decades, perhaps partly owing to this positive perspective where “impossibility” was only an impostor. However, Sally also highlighted how this rapid progress had also brought about new challenges which included keeping one’s career sustainable, and thereby released the secondary theme of “getting the balance right”.

This first speech was very powerful, and also relevant to me having recently attended the very first EM conference in Sri Lanka(SLEMCON 2017), and seen the rapid evolution of the specialty of EM since I was living there in 2006. Sally herself was a keynote speaker at this inaugural conference in Sri Lanka, and referred to this incredible progress in EM development as further evidence to the primary theme of this years ACEM conference.

Opening Plenaries – (day 1)

The opening plenaries where all gripping and impactful in their own ways. Maaret Castren’s, a Finnish Professor in Emergency Medicine, took us to the frontiers in resuscitation. This talk was delivered with Scandanavian precision, and factual flow, but also a tinge of nordic humour (“I only share Polar Bear photo’s that I take myself” – classic!). Maaret shared some pearls from her own research on leadership training in CPR as well as shedding light on controversies in the resuscitation literature. Included in Maarets many accolades is the fact that she has been a chair of the European Resuscitation council, is part of ILCOR, and had also trained as a nurse prior to training as a doctor, and a professor.

Then there was the Westmead trained FACEM , Rick Brennan who is the director of emergency operations for the WHO, who shared his insights, horrors, and triumphs form being tasked with dealing with the Ebola outbreak in West africa in 2014 (resulting in over 28,000 cases and 11,500 deaths), along with another FACEM Ian Lawton. This was a truly heroic effort by the entire response team, and it was inspiring to see an Australasian trained Emergency Specialist in the leadership role of this challenging global health crisis.

Next was Sue Ieraci, a senior Emergency Physician from Sydney. She took us on a reflective journey through the creation and subsequent evolution of Emergency Medicine as speciality. Having seen, and been part of, the initial changes in the creation and earlier stages of evolution, she put it to the audience, in an ever so metaphorical manner, that whilst creating a dream specialty, we have along with it also been party to the creation of a few nightmares. These included things like the backlash of 4 hour rules, EDs been driven by performance targets, and triage creep, just to name a few. She left us with some great food for thought about the potential steps for re-creating the system which put “leadership” and “wellbeing” at the helm of the ship.

Finally, in the opening plenary we were introducted to Karen Hitchcock, a Physician and a writer, and favourite by many in the conference for the ongoing creative “outside EM” perspective, which she so eloquently brought back to the centre of the emergency echelons at this conference. She presented so humbly, yet so powerfully. On this first day, she presented on this first day ethically challenging talk on Euthansia and a range of scenarios and attitudes that could associated with this term in modern medicne.

Prioritising Wellbeing culture in Emergency…the future?

There were so many brilliant talks in the ensuing 6 parrallel tracks run at the conference, which make it impossible to even cover with any meaning (perhaps check out the tweets at #ACEM17), however, perhaps one talk that stood out for me, and really struck a chord with my heart was that by Bethany Boulton, from Queensland, which was about creating a great working environment and specifically “why wellbeing is so important”.

One of the most memorable aspect of Bethany’s talk was the storytelling of her own challenging, yet interesting and creative personal journey in medical training that led her to taking an active role in creating cultures of wellbeing at her local Emergency Department, and collaborating internationally with this movement. She also brought to light some uncomfortable yet striking evidence about how prevalent psychological impairment, and burnout, are in modern Emergency Medicine. Bethany also highlighted key international literature outlining strategies for the promotion of wellbeing and also how this had been translated in her local hospital setting. This inspiring talk highlighted that sharing one’s vulnerability is surely a sign of strength. Well done Bethany – your talk was so good, and the model presented was very inspiring!

The Ripple Effect

Every drop of effort counts,

Don’t underestimate the power of the mind,

Love, then trust, and see what you will find?

For the world is not what it seems on the surface.

 

Those who have the courage are the ones that beam,

Using energy, inspiration and gratitude as a team,

 

With positivity, we can only but learn,

Growing like a fern,

Unfolding and understanding,

That in fact “to try our best” is to actually “to be” our best,

 

Beckoning success as our “fate”,

Accepting this journey in “flow-state”,

 

For after all,

To be fast is really to be slow,

And to question wisely, is perhaps to know.

 

26-6-17   Taking the plane home after after an inspiring journey to Melbourne indulging in the world of resuscitation and trauma management at Andy Buck’s ETM course (i.e. th Emergency Trauma Management course). I have come away with a multidisciplinary, multi background “total immersion educational experience” in trauma management. As part of this one of the highlights was meeting some wonderful and inspiring people coming from different stages of training (residents through to experienced and creative consultants educators in EM and Anaesthetics) and coming from different backgrounds of practice (eg. rural GP anaesthetists, Public Health anthropologists, experienced life-style oriented career medical officers) who are perhaps helping us lead health care into better directions.

Thanks for a great course everyone – it really hit the spot! 🙂

 

Two Poems for champions of my heart

Equality

 

We are all equal,

There is no sequel,

For we have only this one life.

 

Heaven or strife,

This is our choice,

 

So use your voice,

And your heart,

To rise above the dirt.

 

Make use of your mirth,

That heals up the scars and the pain,

 

Let it flow, let it rain,

 

For perhaps solace lies in the “insane”,

Who can feel the beauty of the life that we live,

Giving of ourselves without a seconds thought.

 

 

16-6-16

 

At the moment my world is inundated with study, work and exams.

As I am progressing through the arduous and challenging joruney of completing specialist training in Emergency medicine, most aspects of my life outside medicine have taken a back seat, to dedicate focus to wards the path of learning the matrix of what is is to be a specialist. I am doing what I feel is effective, and and have learned to possibly be helpful, such as reading widely in books, attending practice exams, studying alone and in groups. I have sometimes been sharing the highs and lows with others on the path, but mostly experiencing them alone, in a solitude that will never be known to the world at large (apart from in daring writings such at this).

Today I learned of the exam results being released for the OSCE (objective, skills and clinical examination), and it is with great joy and simultaneous sadnesss that I heard of the success and failure of friend who are dear and near to me in both my heart, but in terms of the journey that all fellowship candidates are on, past and future.

In the joy of one particular friend I breathed a breath of relief, and for others I shared in a gasp of despair. It seems unfair that some individuals who have such a heart, such skill, and such potential for this profession, have not made it through (this time) final gate of a greater than 10 year training. Whilst this exam processess is well intentioned, and designed to empower these very qualities, it can arguabley, on occasions, be seen to perhaps fall short of what it set out to achieve.

As a researcher in education systems, and someone who has been observing their own progression through various stages of a very diverse journey of education in the arts, sciences, surgery, research and now emergency medicine, I am acutely aware that “assement” and “qualification” are but a prediction tools of relative certaintainty, but are simultanously not gold standards in this objective. In my own endeavours to help improve education and assesment systems, I’ve realised that training, sitting exams, and passing are but steps on a much greater journey, in which the destination can perhaps never fully be realised, for it is ever-evolving.

So then how do we evaluate the concepts of failure, or success?

Is it not an imaginary line (albeit, calculated through a process and mechanism), on a continuum of life-long learning?

Perhaps in specialist training, and many other forms of education for that matter, this line forms a both an psychological, and actual barrier to progression. I wonder how well the impact of examinations correlate to the end product of achieving skilled, well rounded individuals?

These may seem like esoteric questions, but to an educational researcher they questions that could potentially form a life’s work.

 

Coping with Success and Failure – through the relationships we make along the way

As a friend who was studying for his own specialist exam in another field, Anaesthetics, once reminded me “failure is an event, not a person” (taken from a line provided by personal development legend Zig Ziglar). This advice came in incredibly handy when I sat, and failed, my own big exam, the fellowship “written” exam. I have now been studying for a whole year since then, whilst working, getting over the loss of esteem, and building an entirley new strategy. If I pass this time around in August, I have the opportunity and privelidge to sit the same exam, the OSCE, that I am celebrating and mourning the results of with my friends, who are at this next stage.

It seems like a very long and uncertain journey, and perhaps this is why the final result will be so very special.

However, in the meantime there is so much pain, and equivalent joy. The joy partly lies in the hope of achieving what I set out to do, partly in feeling the success of others, but perahps the most guaranteed joy of all, is the wonderful relationships that are forged along the way – irrespective of outcome.

When studying for this exam we are in positions of vulnerability and humilty that most would not actively choose to occupy. Some, perhaps, will quickly forget how uncomfortable it feels to not definitely know if one can make it “there”, whilst others will never forget, no matter how well they perform, for it is in their nature to help others on the path.

Two of these such people, who are always there to help others, ironically did not pass the the OSCE this time around (and I’m sure there will be more good candidates to come, who also didn’t pass, for the OSCE has a pass rate often hovers around the 50%, or less, mark).

Perhaps you also know someone like this, someone who is clearly capable and desrving of such a pass? Perhaps it is even you, the reader.

Whatever the case, the following poem wholeheartedly dedicated to all of you, and all of “us”, life-long learners, who courageously endeavour to live, learn and love.

 

Wisdom, compassion and humility

 

Champions of wisdom, compassion and humility,

Using a pathway to divinity,

That has guided us thus far,

 

Whether we drive a sailboat or in a car,

The vehicle is of no consequence,

If we are not guided by light.

 

Use your sight to look within,

And feel the unity of “Humanity”,

As we once knew and later forgot,

 

We only have this shot,

To get it right,

To live without fright,

For there is really no fight,

 

When we use our energies together at large,

Voyaging in natures communal barge,

That can only be experienced as “Love”.

The rising tide of burnout – a major threat to our healthcare system?

http://catalyst.nejm.org/videos/physician-burnout-stop-blaming-the-individual/

The above is a link to a brilliant talk by the program director for Physician Wellbeing from the Mayo Clinic, Tait Shanafelt, illustrating how physician burnout is a “system issue”.

“We tell physicians to get more sleep, eat more granola, do yoga, and take better care of yourself. These efforts are well intentioned,” says Shanafelt. “The message to physicians, however, is that you are the problem, and you need to toughen up.”

Shanafelt goes on to describe how the six drivers of burnout amongst physicians are largely derived from the characteristics in the work environment.

These drivers are stated as;-

1) Excessive workload

2) Inefficiency and undue clerical burden

3) Loss of flexibility and control over work

4) Problems with work-life integration

5) Loss of meaning in work

6) Organisational objectives that conflict with the altruistic values of the profession

He also states that promoting professional wellbeing is the shared responsibility of individual physicians and healthcare organisations.

Whilst this talk comes from the US setting, I believe the themes that are discussed are becoming increasingly relevant to the Australasian healthcare. My own observations from working in a number of busy tertiary and secondary hospitals across Australia and New Zealand is that we have developed highly efficient systems of delivering essential medical “management”, however, heartfelt “care” appears to have become optional extra.

Hearts in Healthcare

An increasing number of doctors, and doctors in training, have experienced disillusionment the conditions of medical training, and practice, and at the consequential neglected dimension of “care”. I have had countless conversations with caring physicians over the past 5-10 years, at all levels, which has led me to believe that there is a deeply “broken” element to the current healthcare system. Some have felt strongly about the issue of restoring humanity, and the heart, back into medicine that they have also made it their life’s work.

For example, Dr Robin Youngsen, who is a NZ Anaesthetist, has highlighted the importance of creating “time to care” in his first book, which takes on this very title. He also furthered this message his recent TED talk “perfectly broken and ready to heal”, and has set up an organisation dedicating to rehumanising healthcare, called “hearts in healthcare”.

The power of humanity in health care

Looking both forward and backwards in time, isn’t it “humanity” that is at the what is special and important in healthcare?

It seems to me that through a greater understanding, and appreciation, of the benefits of the “human side” of medicine, it is still possible to steer the evolving culture of healthcare in a better direction.

The opening story in Tait Shanfelt’s talk perhaps conveys this better than any, where he recalls how one particular doctor took a deeper interest in his son on a personal level, when he was a patient in hospital. Despite the all round exceptional treatment his son received in hospital, it was this one persons humane interactions that stood out, and also meant so much to him.

Which future shall we steer towards : physician burnout, or, physician wellbeing?

I am a big believer of the notion that often the question is more important than the specific answers.

We now know that burnout exists in high proportions than ever before , but the question remains, how do we respond to this rising tide? Perhaps one strategy can be rather than reacting to the negative effects of burnout, we can proactively create more wellbeing?

But how do we apply this vision in local physician settings settings? Perhaps a start is by asking the question “what can we be doing to improve physcian wellbeing?”.

What am I doing to improve my wellbeing?

What is happening within my hospital or training organisation?

…and

How can I help this ever-growing movement?

What are your reflections on preventing physcian burnout, and promoting a culture of physician wellbeing? I would love to know your views.

I’m just putting this out to further the coversation, between the ever-growing, increasingly diverse network of caring physicians who have a vision of healthcare that values the wellbeing of all, starting with the one who cares.

Ref: http://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(17)30940-6.pdf