Photo by Stainless Images on Unsplash

I have spoken previously about impermanence, but it is good to be reminded of it because it is the very nature of everything, and we suffer if we don’t accept that. We try to fight or deny impermanence because we see it in a negative way – change and death. But when we accept impermanence we develop a true appreciation for every moment of life.

For example, the magic of a sunset is its temporary appearance, just like a rainbow. It appears under special circumstances and only remains for a short time. And we have to be in the right place at the right time to see it. That’s why we stop for a brief moment of awe when we see a rainbow. If it were to last forever we’d take it for granted and never really appreciate it. At the same time, we don’t suffer or lament its passing once it disappears. Knowing its impermanence means we don’t become attached to it, therefore we can experience joy at its appearance yet let it go when it disappears.

It is interesting that almost everybody is able to do that, yet we all suffer so much because of attachment to other things in our lives, thinking of them as permanent. We suffer when we have some loss, separation, decay and all kinds of changes that are part of life. Sadly, it seems only after we lose someone or something do we really appreciate it. When it is actually too late.

This is why contemplating impermanence is so important – not to depress or upset us but to help us fully appreciate life and everything in it. Once we understand impermanence we can enjoy every moment, just like the fleeting appearance of a rainbow. The company of loved ones, nature, material comfort etc, when we fully appreciate the moment, we can give ourselves to it completely and really experience it. And when that moment is over, we let it go. Of course we still have our memories, but we shouldn’t cling to them or allow the past to dominate our present. Instead we should use our past as inspiration to improve everything that we do now.

Even for the worst experiences in life, contemplating impermanence is helpful as we understand that nothing lasts forever,……


Guest Post – PRR – WHO’S FREE?

People are always talking about being free and independent – kids want their own car and house so they are independent and free from their parents, people want their country to be independent and free from unwanted rulers. But nobody is free and independent.

Who really has control over themselves? We don’t have control over anything, not just external things, but even our own mind. We can’t control what feelings and thoughts we have from one moment to the next. And when these thoughts and feelings come, we are completely carried away by them and our life becomes like a roller coaster.

Modern technology makes everything faster, which in one way is good as we have access to more things, but in another way, the roller coaster of our emotions becomes much faster. For example, previously people exchanged letters by mail which took days or weeks, but now people exchange emails and text messages almost instantly.

We have no control and are totally dependent on conditions. For example, being in a relationship, if you talk to him or her every night and then one night you call and there is no answer, then you start to have all sorts of thoughts and emotions.

But if you have mindfulness and awareness of how you are dependent on causes and conditions then no matter what happens you won’t get completely lost or carried away.


Guest Post -PRR – GIVE 100%

We are living in a very busy and competitive time. No matter whether we’re in Asia or in the West, we grow up with the idea that we have to work hard in order to “make it” – whatever this might be. Maybe we want to get a good job, have a happy family, a nice house, loyal friends and an interesting lifestyle.

We think that if we always give 100% of our strength then we can achieve all our goals. And you know what? I think that’s true. But maybe we have to look at this from a slightly different perspective.

Doing something 100% doesn’t necessarily mean being extreme. It doesn’t mean getting obsessed by something or thinking about it all the time while neglecting other things which are important in our life.

It means that in the very moment while focussing on something you really concentrate only on that. During your work you shouldn’t think too much about other things which are not related to it. And when you are not working you also shouldn’t think all the time about the work.

Rather while you are working, concentrate on your work and do it in the best way possible without being distracted. And when you are together with your family or friends focus on them and give them all your attention, care and love. Likewise when you have some free time for yourself let go of all the other things, enjoy and just relax.

In this way you can follow various activities without being distracted. Try to train your mind to be focussed. Be aware of your actions. Know what you are doing with your body, speech and mind. Ask yourself if you are really doing what you are supposed to do right now or if your mind is distracted by thinking of the last or the next year’s holidays.

In these times if you want to accomplish your goals without getting worried, stressed or crazy this seems to be one of the best methods: give 100% in every single moment.



When you do meditation, quality is more important than quantity.

People have a lot of ideas about how much practice one should do. Some Lamas might say you have to spend a particular amount of time doing certain pujas. If you can listen to them and practice accordingly that’s great! But sometimes it doesn’t work even if you do exactly what they say – if your mind doesn’t change at all even after a lot of practice something is going wrong.

For example you can do two hours of Tara practice each day. But if you are distracted during that time it might turn into a mere lip service or just another duty which is to be done on top of your other worldly responsibilities.

Some people who focus mainly on quantity might end up with daily sessions of discursive thoughts or “planning sessions” rather than doing meditation sessions. The mere amount of practice might turn into nothing more than fodder for a proud ego. In this way your practice might have a good quantity but not a good quality.

A good quality is like pure milk. Whether you have a glass or just a teaspoon of it, it remains pure milk. Discursive thoughts are like water. Good thoughts are like clean filtered water. Bad thoughts are like dirty polluted water. Now, whether you pour the clean or the dirty water into that milk, in both cases it’ll dilute the pure milk.

I’m not saying that you should let go of your practice! Don’t use this as an excuse in order to minimize or escape from your daily meditation sessions. A regular practice is very important. It’ll gradually train and transform you. But you should always examine whether you are really focused on the practice or simply counting hours, minutes or mantras without even trying to tame your mind.

Don’t fool yourself by thinking that you’re a great practitioner because of quantity. Likewise don’t fool yourself by thinking that you’re a great practitioner because of quality. No matter what you say to other people about your practice – if you are insincere you won’t fool anyone but yourself.

What matters most is that you discipline yourself. Be your own boss. Take responsibility – for your life, your actions and your practice. Don’t depend on others or particular situations to make things happen. Otherwise nothing will ever happen. As I already said in one of my previous posts: Just do it!

When you practice try to make the time you spend really meaningful, no matter how long or short it may be. Develop a positive attitude towards it so that you can generate a natural habit and sincere wish to practice regularly.

This is how I try to approach my daily life and practice. Since it works quite well for me I thought of sharing it with you. However, if what I am saying is not helpful for you then better just do what you consider to be best for you.

As I said: take responsibility for yourself. Things don’t just happen. You have to make them happen.


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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