On Patients, Bonsai, and Orangutans: The Value of Mindfulness in the Practice of Medicine.

In 2008, I (JO) met an elderly gentleman selling tiny trees at a roadside stand, a chance encounter that sparked a change in how I see the world and live within it. I began to learn about bonsai, the Japanese art form that literally means “tree in a dish.” Initially I thought it would be fun to grow a miniature tree, but as I acquired the knowledge and tools to care for my plant, I wondered, “How can one little tree be so complicated?” This was years before I became a resident with patients of my own. Now I care for fifty bonsai and many patients. Both have taught me about nature, patience, and mindfulness. As it turns out, trees and patients are not so very different. My patients and trees come in all ages and sizes. Young patients and trees have one set of needs, while adolescents, adults, and ancients have others. My patients and trees come from all over the world. In addition to their physical differences, they know different climates and diets and communicate distinctively. Both embody lifetimes of stories – of love and neglect, peace and strife, sunny weather and lightning strikes. How they prosper, or sicken, has everything to do with these experiences. Good care must consider all these factors, not to mention the practitioner’s own agenda. I have had many hobbies. I’ve collected coins and raised tropical fish. I’ve followed sports teams. Legions of action figures gather dust in my childhood bedroom. Bonsai is different. It is a practice. How does a hobby differ from a practice? Hobbies are leisure pursuits providing enjoyment and escape. A practice involves studying an activity from multiple perspectives, including one’s mind, body, and emotions with unconscious integration of all these areas. Mastery requires energy and discipline, yet paradoxically yields flexibility and calm. Mindfulness is quite the rage these days: meditation, yoga, stress reduction. Proponents cite a wide variety of beneficiaries, ranging from quarreling preschoolers1 to sufferers of irritable bowel syndrome,2,3,4 chronic pain,5 mental illness,6 and physician burnout,7 to note a few. Research demonstrates mindfulness to improve acceptance,8 calm, and empathy.9 Perhaps mindfulness is having its moment because so many folks, including physicians, are living lives that are anything but. Drivers chug coffee and text. Teens do algebra while watching feature films and instagramming their friends. Physicians and staff deliver patient care amidst minefields of high-maintenance electronic medical records, administrative hurdles, and smart phone intrusions. Technology designed to simplify life and connect people falls short, adding complexity and increasing isolation. In medicine and beyond many suffer overwhelm and scatter from the attention deficit disorder of technology. This may be the appeal of mindfulness. It teaches people to slow down and focus on this moment, right here, right now, and nothing else. At its very best, medicine is a mindful practice, in spite of countless current trends. Cultivating mindfulness in any setting sows these skills throughout work and life. Mindfulness draws on ancient meditative practices of the East, including Buddhism. Practitioners learn to focus on this moment through awareness of breathing, a stepping stone to noticing the many sensory signals we constantly receive. There are physical sensations, like a tense muscle or itchy elbow, as well as visual, auditory, tactile, olfactory, gustatory, and intuitive ones. Pings arrive continuously from all these fronts. So do waves of thought and emotion, not just from this instant, but also the future (“Will I meet that deadline?”) and past (“They were so irritating!”). Stop for a moment. Observe your breathing. What else do you see, hear, feel, taste, smell, and intuit? Note thoughts and feelings rolling through. An astonishing amount of data continuously streams into our experience radars. High-octane living mandates we ignore most of this input in the name of productivity. Who can notice every breath, sensation, idea, and emotion when we need to understand yesterday, plan next week, and figure out dinner? Ironically, while ruminating on the past and future, we miss the cornucopia of this moment, the only time and place we can truly be. Mindfulness teaches “bare attention,” noticing each morsel of input as it floats through, not in order to respond to it, but rather to cultivate focus, openness, curiosity, observation, acceptance, and non-judgment.10 Create a simple moment of mindfulness. Close your eyes and strive to breathe with an attitude of focus, openness, curiosity, observation, acceptance, and non-judgment (hereafter “attitude”). You may ask, “Am I supposed to breathe through my nose or mouth?” or, “Should my belly fill as I inhale or exhale?” Note “supposed to” and “should.” You are bringing in judgment, as though there is a right or wrong way to breathe. Let that judgment go, and return to your breathing and attitude. You may feel, “This is frustrating!” An emotion has snuck in. That’s fine. Notice it. Return to your breathing and attitude.