I think therefore I am? – Alcohol hand-rub and the clinical application of Mindfulness

Mindfulness in recent years has become increasingly fashionable throughout the world and is popping up as part of treatments in Psychiatry, as part of the rehabilitation of prisoners, and even in the Palliative Care world. Is it really all that new or is it the repackaging and re-marketing of what Buddhists have been doing for thousands of years? What follows is my own personal experience of Mindfulness and how I apply it to my practice of Palliative Care.

I had been interested in meditation since the late 1980’s when I read in a Batman comic that when he was completely exhausted, instead of sleeping, Batman would meditate briefly. This would leave him refreshed and able to go out and fight the bad guys again in a few hours’ time. Having never been a fan of sleep in general, the idea of a sleep substitute really appealed to my younger self. Throughout the 1990’s I explored various types of meditation practice, but had largely given up by the 2000’s.

In September 2013 I had signed up, in my usual last-minute fashion, to a pre-conference workshop at the APHC 2013 conference held in Bangkok, Thailand. Having registered for the workshop very late I was left with only one option. The workshop entitled, “Mindfulness in Clinical Practice,” turned out to be the highlight of a very enjoyable conference.

Less than a week later I was in Montreal, Canada for the 1st Whole Person Care Congress in which a number of the sessions and workshops were devoted to Mindfulness. It really had become the flavour of the month on a global scale, but did it spur me into a programme of regular Mindfulness practice? Heck, no!

It wasn’t until October of last year that I decided to give Mindfulness meditation a proper go, via the Headspace app. This easy to use program of guided meditations has led to me doing 236 sessions and has had various benefits. A greater sense of calm, better observation skills, greater ease at falling asleep, and even benefits for my patients.

What is the connection to alcohol hand rub?

As a Medical Registrar the importance of clean hands was drilled into me by an Obsessive/Compulsive trait possessing Physician who went through 500ml of Alcohol hand rub per day in his quest to limit the spread of hand-borne contagion. Apologies for the next sentence…some of it rubbed off on me. As part of my own personal ritual, prior to knocking on the door of patients, I will douse my hands with a good squirt of the alcoholic jello-shot. While I am rubbing my hands together I take a deep breath in, and slowly release it. This brief amount of time allows me to centre myself so that I can be truly present in the clinical moment that follows.

Being in the moment with the patient allows me to “tune in” to what they are going through, and to gift them my full attention. I’m not thinking about what is for dinner, what my plans for the weekend are, what an interesting shadow is being cast on the wall, but instead I am able to focus on what they are saying, verbally and non-verbally. Of course this doesn’t happen with every single patient encounter that I have, but when I am “in the zone,” the patient’s situation becomes much clearer to me. I end up with a much better idea of what they want and need. This fleeting moment full of human mind connection still surprises me at times. It feels like it is a little piece of magic, something to be approached with wonder.

The patients seem to enjoy it too.

At the end of the visit I say my goodbyes and reverse the entry ritual. Another squelch of disinfecting viscous chemical is applied to my hands, another deep breath is taken and released. The ward round continues.

5 thoughts on “I think therefore I am? – Alcohol hand-rub and the clinical application of Mindfulness

  1. Great post James. Nice to meet another person who tries to slip some moments of mindfulness into their day. Likewise I think discovering mindfulness has enriched both my clinical practice and my personal life.
    I like the idea of using the hand-rub as a prompt. I have also used hearing the phone ring at work (another almost inescapable presence). It would be great to hear comments from anyone else using mindfulness at work at how they prompt themselves to remember to be mindful.

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  2. Thanks for sharing James. I try to employ mindfulness on the way to work on the train. When my train emerges from a tunnel coming out of Perth, I look up from my phone (usually Twitter) to beautiful, calming views of King’s Park and the Swan River. I don’t turn back to my phone until I can no longer see the river (several minutes down the track). This clears my head and is often when my best ideas come to me. I need to do this more throughout my day. Hand-washing and phone-ringing both seem like fine prompts.

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  3. Thanks James, I actually have the same process with hand gel but I have never linked it to mindfulness. I aften get asked to consult on difficult wounds, particularly fungating malodorous ones, and I pride myself on not flinching or showing any form of disgust when confronted by an unpleasant wound, they are after all connected to a person who has to live with it. The act of cleaning my hands, taking a deep breath and relaxing at the same time does put me in the zone of being with the person and their suffering and working with them on a solution.

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