When We Need a Hand

The life of us doctors has always been life serving, and there is no greater service than helping someone in sickness. The satisfaction one gets each time your patient overcomes their disease or disability is the best reward. Helping a mother deliver a baby, or helping a sick child or adult become better, seeing your patient with crutches walk again, seeing a trauma patient come out of it alive, being a part of the bigger miracle is the hope which keeps a doctor going. But I also remember very clearly one day, stepping out of work on a Monday evening, checking my WhatsApp as I saw a few articles that shifted something in me.

“The death of a 28-year-old doctor in Gandhi Hospital in Hyderabad has sent his colleagues and the medical fraternity into shock. Dr T Purna Chandra Guptha, who had just completed his senior residence in general surgery, reportedly died from cardiac arrest.” 

“Dr. Yunus (41), from Mumbai has reportedly passed away due to a heart attack after coming from the gym.”

I had to pause. I had to feel this loss deeply. What are we doctors experiencing to the extent that we face such tragic circumstances? Why do we care so much about everyone else and so little about our own selves?

This road is long, hard and often exhausting, we face challenges from all directions that constantly test our potential to grow, and this often can lead to burnout, languishing and a general lack of hope and purpose. A career in medicine means jumping out of bed in the middle of the night for emergencies, making rounds after hours, treating cranky patients, and dodging malpractice suits. It’s a stressful occupation. What’s not so easy to tell is what stresses physicians the most.

Stress is a part and parcel of many professions, however, there are challenges that we medicos face that perhaps are unique to our field. Now, we may be reluctant to acknowledge just how stressful practicing medicine may be, but it is real, and it does take a toll on our entire life if ignored. Long work hours, sleep deprivation, fear of being sued, fear of not performing “perfectly”, and difficulties in balancing work and family. More annoyingly, the mountains of paperwork, committee meetings, and teaching responsibilities all weigh heavily on us, and can sometimes make us ill. There are other stressors unique to doctoring—the need for fast processing of loads of information; daily exposure to emotionally charged encounters with suffering, fear, failure, death; and difficult interactions with families.

At some point in their career, many physicians face not just the biggest stress—a malpractice suit.

“Asha Bairwa, 22, had died following a delivery at Anand Hospital in Lalsot, Dausa, on Monday. Following her death, her family went back to the village with the body but returned to the hospital sometime later — with the body, and some local BJP leaders. Upon protest, Dr Archana Sharma and her husband Dr Suneet Upadhyaya were booked under IPC Section 302 (murder) by the police; the couple ran the Anand Hospital. Apparently disturbed by the developments and the FIR, Dr Sharma left a note and died by suicide.”

I would guess around 20 percent of us describe malpractice suits as the worst experience of their lives. We see the fire of talented, and compassionate doctors who offer their help with utmost authenticity and professionalism, slowly fizzle out with such experiences. We see them blame themselves, often driving them out of their medical practice; whether or not it was their fault.

It must come of no surprise that doctors now experience higher rates of suicide, alcohol and substance abuse, and job burnout than most people. The past few years, studies have shown that the mental state of physicians has much broader repercussions. It affects not just the doctors themselves (and their families) but also the quality-of-care patients receive. Interestingly, the emotional well-being of doctors largely determines the quality of the health care system.

 A part of the culture of medicine is that we are caregivers, not care receivers. At times, our sense of worth as a doctor is directly related to how many hours, we exert ourselves. Although this is truly remarkable for us to do, its impact is futile if we are unable to take care of ourselves as well.

“Always put your mask on before you put someone else’s”; a line we always hear during every flight trip.

However, in a profession like ours, doesn’t it become difficult to unlearn years of training that teach us the importance of altruism and always putting your patients first, and constantly being available for them, instead of also practicing self-care?

To be resourceful, we need to be resourced. But what makes us more resourced?

There are many; exercise, therapy; arts; reading; socializing, and my personal favourite, Heartfulness.

We all know the life of a doctor is a notoriously busy one. Now, something I like to do is take 10-15 minutes in the morning to connect to myself. I start by sitting comfortably and gently closing my eyes. I give a thought to myself that there is a warm, divine light already present in me, and it is drawing me inside my heart. With this, I establish a connection with myself and the Universe around me. If I get any distracting thoughts, I gently draw my attention back to my heart, and I stay there for as long as I like.

This is defined as Heartfulness meditation.

 Over the years, meditating for myself before I step into work has become a crucial part of my day, and I invite you to try it out for yourself. Starting your day with just a 10-minute meditation or reset can set you up for a productive, efficient and satisfying day. It allows your mind to catch up with your body before you are drawn into your busy schedules. But more importantly, it helps us show up better as doctors. We are more settled, grounded, productive and more importantly, empathetic. This empathy is both for ourselves, as well as others.  I believe that we tend to be overly critical of ourselves. In a field that requires us to be compassionate to others, I believe we very rarely are compassionate to ourselves. Having compassion for oneself is no different to having compassion for others. With self-compassion, we give ourselves the same kindness and care we’d give to a good friend. Self-compassion involves acting the same way towards ourselves when we are experiencing a difficult time, failure, or notice something we don’t like about ourselves. Instead of just ignoring our pain with a ‘stiff upper lip’ mentality, we stop to tell ourselves, “This is really difficult right now, how can I comfort and care for myself in this moment?” Instead of mercilessly judging and criticizing ourselves for various inadequacies or shortcomings, self-compassion means we are kind and understanding when confronted with personal failings. After all, who ever said we are supposed to be perfect?

I also notice that sometimes, many of us have a difficult time drawing boundaries between our work and personal life. Meditation in that respect can help us feel in control of our actions, emotions and thoughts, thereby regulating how we integrate the dimensions of our life. By this I mean, our family life, our social life, our personal life, as well as our professional life. All in all, centring and connecting to ourselves through heart-based meditation can improve our methodology and perceptions as doctors. We are more joyful, welcoming and warm. Trust me, this impacts our dearest patients in ways we cannot imagine. Being able to treat people with illness, as well as touch their soul and hold their pain as well? There’s nothing more rewarding.

Now, as much as we try to prepare ourselves to have a good day, there is always something or the other that can possibly stress us out. These are called daily life hassles. These include small annoyances like missing the bus to work, having coffee spilled on your white coat, your subordinate expressing their anger to you or a fight with your spouse. All these can pile up over days, weeks and even months and bog us down. In fact, these daily life hassles can push us into burnout if we do not “clean” them off our system.

Just like now meditation is a centring to start our day, the Heartfulness Cleaning technique is a process to end our day.

The role of the Heartfulness Cleaning is to rejuvenate us and purify our system of any accumulated heaviness. It is a way to remove the emotional burdens that we carry on a daily basis. These burdens are the emotional content of our experiences, and the emotional residue that lingers from our past, our memories.

To experience the Heartfulness Cleaning technique, sit comfortably and gently close your eyes, imagine all the complexities and impurities you have accumulated over the day are leaving your entire body. Let them flow from your back in the form of smoke. Remain alert and do not brood over the thoughts and feelings that arise. As this heaviness leaves for your back, you may begin to feel lighter. After a couple of minutes, feel a current of purity coming from the Universe entering from the front of your body. This current is flowing into your system and you may experience balance and lightness.

It is best to practice Heartfulness Cleaning in the evening after you have finished the majority of the day’s work. It is like coming home and immediately taking a shower before doing anything else.

The last part of what I like to do to enhance my mental health as a doctor is introspection, or the Heartfulness Prayer.

 The role of this is to enable me to shut down gently for the night, and ensure that I prepare myself for a good night’s rest. This is especially important as it establishes circadian rhythms and improves sleep quality. This introspection involves resetting and connecting with a source of energy that connects you to the Universe.

Whatever it is that you wish to change, know that everyone’s priorities and perspectives are different. While stabilizing a sleep schedule is a top most priority for one, deepening social connections could be a priority for another. It is important to embark on a journey that is on your terms and in accordance with your needs. We experience things in our life in a way that no one else does. So, it only makes sense to trust our hearts in showing us the direction of where we are meant to go.

Tapping into the life source inside us with authenticity, vulnerability, and inner connection; this is the truth of the Heartfulness way of life.

The Heart of Heartfulness

Heartfulness is a heart-centred approach to life, where you will be able to live each moment by the heart. It is to live naturally, in tune with the qualities of a heart enlightened and refined through spiritual practices. These qualities include compassion, sincerity, contentment, truthfulness, and forgiveness; attitudes such as generosity and acceptance; and the heart’s fundamental nature, which is love.

Our heart is our very conscience. It leads us to the good, the unselfish, and the noble. By referring to the heart over and over again, we grant it a prominent position in our lives. It is there to guide us at every moment.

Listening to the heart’s signals is the first step. The second step is to make use of those signals, to ask the heart questions in such a way that we get clear indications. Slowly we get a hang of it, and the more we listen the clearer the messages become. When we don’t listen, we lose the art of listening to the heart. Neuroscientists describe it as losing the neural circuitry or pathways that we don’t use. Then it takes a lot of effort to reactivate them. The more we use the neural pathways, the stronger they become. Now, comes the third step:

Having listened to the voice of the heart, do we have the courage to follow it?