I think therefore I am? – Mindful Room Reading

Photo by Tyrell James on Unsplash

I’ve been practising Mindfulness meditation for the past seven years and I feel that it helps me to tune into my patients’ situations better. I still do my usual alcohol hand rub routine prior to entering each room, to bring myself into focus, to be present in the room.

I need to take in the whole atmosphere of the room, who else is in there, how are they interacting with each other. What is the emotional temperature of the space. It might be an inpatient room, an outpatient clinic, a hospital room, or at a patient’s home that I find myself.

A quick survey of the environment prior to beginning the assessment proper is useful. You look for extra equipment in the room. A commode chair can indicate difficulty with mobilising. Monkey bars or bed levers may confirm restricted independence. Is there equipment in the room, like oxygen tubing, oxygen concentrators, nebuliser or suction systems. Are there any hand held devices such as inhalers of sprays that the patient could give to themselves? Any walking aids? A sensor mat would indicate confusion and possible delirium. Not safe to transfer independently. Urinary catheter bags and tubes, and other drainage devices.

With observation alone you can find a lot of information, even before speaking to them. All of the above is assessed within the first 30 seconds of meeting someone. You also check out their visitors at the same time.

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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.

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