Living in the Moment

DOI: 10.1200/JCO.2010.30.7835 As an oncologist and palliative care physician, I was vaguely aware of the concept of mindfulness, “the quality of being fully present and attentive in the moment during everyday activities.’’ Originally a Buddhist practice, its purpose was “to alleviate suffering and cultivate compassion.’’ Hence, it is not surprising that this discipline might have application in medicine for our patients as well as ourselves. Mindfulness techniques appear to be effective in helping patients cope with pain, disability, and stress, and, similarly, may reduce stress in health care providers and enhance their ability to care for their patients. Physicians and patients can learn mindfulness techniques in a series of sessions devoted to gaining an understanding of this discipline and how to practice it. But until recently, whenever I heard the word, “mindfulness,” and heard others extol its virtues, I did not really understand what it meant, or what relevance it had to me or the work I do. In fact, the whole concept of mindfulness confused me, even intimidated me. It just seemed sort of “out there,” abstract, even a bit weird. Then a few years ago, at my medical school at the University of Rochester, I was asked if I would be interested in teaching mindfulness to our residents. I am not certain why I was asked; perhaps it was because I am a relatively senior clinician, perhaps because I practice oncology and palliative care, or perhaps because they took one look at me and felt that I could use a good dose of mindfulness. They went on to explain that if I was interested, I would be required to take a course in mindfulness-based stress reduction to get a better sense of what it was all about, and be able to more effectively teach the residents. I am not sure why I signed up, but I did. I told myself (and others) that I was doing it not for myself, not to help me with the stress of my work, but rather, so I could qualify to teach the concept to others. But, in retrospect, I do not think it would take a rocket scientist or a psychiatrist’s in-depth probing to find that I was doing this because I was stressed, and this was my own obtuse way of reaching out for help. So with considerable trepidation, I signed up, and when I rushed across town from a particularly intense day of work and walked into my first evening class, I was not at all sure what I was getting myself into. There was our instructor (a physician himself) sitting cross-legged, barefoot, in jeans, ringing a gentle-sounding, high-pitched gong to get our attention. I remember thinking, “Oh, my God, get me out of here!” But I stayed and listened to the 20 or so people from various walks of health care explain why they were there. They were good people, and like me, they felt that the weight of their work was sometimes so crushing it could interfere with their ability to do that work effectively, and live their lives well. The next thing I knew, I, too, was sitting crosslegged, listening to the ring of the bell, closing my eyes, quieting my beleaguered brain, and just being there. And as the weeks rolled by, and I would rush over to class after hectic days of work, and sit, eyes closed, legs crossed, I began to feel this wave of something that is hard to explain: a sort of combination of relaxation, relief, rest, rejuvenation, a feeling of being unfettered, uncluttered. It felt good. This class that I had so dreaded gradually grew to be one I cherished. But other than serving as the spiritual equivalent to a good glass of wine (which also works quite well), how has mindfulness helped me on a day-today basis with my patients, with coping with my work and with my life? While there are many intangible ways, I can think of three very specific ways it has made a difference. Focus. I will never forget the time, about 20 years ago, that I brought my son to the pediatrician for a regular well-child visit. As is so often the case for pediatricians’ offices, the place was a zoo; a lot of noise, bedlam, and utter chaos. I remember how our pediatrician found us in the waiting room, ushered us back to an examination room, closed the door, and the noise and the chaos quickly fell away. I will never forget how focused he was on my boy; I would guess that he did not spend more than 5 minutes with us, but it seemed like all the time in the world. In retrospect, I think my pediatrician was practicing mindfulness. We might not have called it that at the time, but I believe that is what it was. He was so focused, so free of distraction, so totally in the present. I walked out of that office feeling good about my son and the care he received; all my questions had been answered and all issues addressed. JOURNAL OF CLINICAL ONCOLOGY T H E A R T O F O N C O L O G Y VOLUME 28 NUMBER 31 NOVEMBER 1 2010