Vacations...

Tomorrow morning I leave Vancouver for Nanaimo where I will spend the next ten days in a small guest house on Westwood Lake, relaxing on my own throughout the day and spending evenings with dear friends.

I have packed good books, good music, walking shoes, and paper and pencils but I most look forward to slow, easy hours of doing nothing. It is healing to be apart from the busyness of life at home. There's something about being geographically away from familiar environs that refreshes and restores, providing a new perspective on the life left behind.

Whether you're a family caregiver enjoying respite or a helping professional taking this year's quota of holiday days, there are benefits to be accrued through getting away on vacation:

1. You live longer. A State University of New York study of men ages 35 - 57 suggests that men who take vacations every year reduce their overall risk of death by about 20% and their risk of death from heart disease by almost 30%.

2. Your mental health is better. Women who vacation frequently are less likely to become tense, depressed or tired and are more satisfied with their marriages according to a study published in the Wisconsin Medical Journal in 2005. Vacations provide a break from everyday stressors, allowing release of built up tension.

3. You can enrich your relationships. Vacations provide time to reconnect with yourself and with friends and loved ones who may take second place to workload, on- call shifts, emergencies or deadlines during the rest of the year.

4. Your creative side has space to emerge. Once you have had a chance to catch up on your rest, there is energy and space for the right side of your brain to find some expression in creative pursuits - art, building, music, crafts, writing, dancing.

5. You have the opportunity to play. Away from the responsibilities and pressures of your daily work schedule, the child lurking within finds permission to come out to play. Whether playing cards on the deck of your cottage, windsurfing at the beach, throwing a frisbee or exploring new fields or villages, vacations give you the uninterrupted freedom to play.

6. You can be more productive. Taking regular breaks to rest and renew your strength allows you to become more efficient in your caregiving work, to problem solve outside the box and to enjoy the process more. Life looks different when you're rested - there seem to be more options and possibilities.

Now, these benefits are available only if we do actually take vacations. A 2006 survey by Harris Interaction and Expedia found that 36% of workers didn't plan to use all their paid vacation and 37% never took more than a week off at a time. So, think about when you last had a good break. Was it more than six months ago? Then it's time to start planning, start saving, start asking for help so that you too can experience the joy and refreshment of a good vacation.

See you in August!

Mindfulness...

I took a picture of this lovely rose two summers ago while in the garden of Rochester Cathedral in England. I had walked back and forth along the garden path several times that morning but hadn't noticed the single blossom's deep apricot hue or it's perfect state of openness. As I settled on a wooden bench nearby I, an avid rose gardener, wondered at my lack of awareness, my "mindlessness".

It is so easy, with the busy pace we set, to run through life without noticing things that matter. Have you ever arrived home without recollecting the last few miles of your journey? Have you missed out on a Sunday dinner conversation while preoccupied with thoughts of work on Monday? Have you been oblivious to the sweet weight of a toddler on your lap as you've watched the hockey game?

Mindlessness is like living on automatic pilot. You may get things done but you miss out on important information - information that gives life richness or that keeps you safe or well. How often have you noticed the beginning of a headache and wondered, "Where did that come from? When did my neck muscles start feeling tense? When did that tension turn into pain? What happened to make me tense in the first place?" You may not find the answers to these questions if you haven't been present and aware in the moment. If you haven't been mindful.

Mindfulness means paying attention to things as they actually are in any given moment. (Not how they were in the past and not how they might be in the future.) And it means doing so non-judgmentally.

You can learn to be more mindful by practicing mindfulness meditation. You can ground yourself in the present by sitting quietly and noticing the sensations of your breath moving in and out. You might want to notice that the breath going into your nostrils is cold and that the breath coming out is warm. Or you might want to focus on the movement of your abdomen, just below your belly button, noticing its rise and fall with each breath. If your thoughts disrupt your focus on your breath, gently return your attention to your nostrils or your belly without judging your thoughts or yourself for having them.

Practice this meditation for a few minutes, morning and night, and gradually increase your time until you are meditating for 20 minutes a day. It will take lots of practice to develop this new skill, so don't give up for at least 8 weeks. And don't expect to experience instant peace. Our minds are notorious for increasing their chatter when we try to quiet them. Just notice when you've gone off on a thinking tangent and return, without judgment, to your breathing. Over time, you will develop a more mindful, centered, and de-stressed life.

If you're interested in learning more about mindfulness meditation, try Jon Kabat-Zin's books, Full Catastrophe Living or Wherever You Go, There You Are or listen to his meditation CD's, Guided Mindfulness Meditation Series 1, 2 & 3. You might also like to try the meditations of Thich Nhat Hanh, the Buddhist priest and founder of Plum Village in France. (www.plumvillage.org or www.learnoutloud.com).

Self Care for Physicians...

It's nice when my teaching pace slows down for the summer, leaving time to read and reflect. This week, I read an interesting article from the Journal of the American Medical Association entitled, Self-care of Physicians Caring for Patients at the End of Life: Being Connected ... A Key to My Survival. (JAMA 2009, 301(11):1155-1164).

This article is one of the clearest and richest articles on Compassion Fatigue that I've read in a while. It defines and contrasts burnout and CF and delineates the causes and symptoms of each. It then goes on to specify self care suggestions, including those employed by the writers of the article. These strategies are well worth sharing regardless the field of people-helping in which we're engaged. (I have taken the liberty of paraphrasing for the sake of brevity and have added a few comments and sources in italics.):

1. Ground yourself by attending carefully to the sensation of your feet on the ground as

you walk through your workplace.

2. Set your watch alarm for a certain time each day to remind you to perform a simple act of centering. eg taking 4 slow, deep breaths, thinking of a loved one, reciting a line of a favourite poem or prayer, imagining weights around your waist and repeating the words, "ground, down".

3. Reward yourself after completing a task. eg an early coffee break, a walk outside or a quiet moment in the chapel or quiet room.

4. Call a "time out" after a traumatic incident in order to deal with emotional flooding. (See the Trauma First Aid post - January 12, 2009).

5. Stop by a window in your workplace and consciously notice something in nature for a

few moments.

6. Open team meetings with a moment of quiet and a reading of a poem or quotation.

7. Pause to take 2-5 breaths, ground and refocus before entering the room of your next

patient.

8. Take a healthy snack between meals.

9. Don't be afraid to ask the question, "Is it time for a break?"

10. Deliberately make connections with colleagues and patients as you go through the day. eg use humour, notice a birth date, comment on something special in the room.

11. Keep a notebook in which to write notes on traumatic or meaningful encounters and

events; occasionally take time at interdisciplinary meetings to share this material.

12. Find an opportunity to touch your patient during the visit, if that is appropriate.

13. Practice daily mindfulness meditation before leaving the office for rounds or clinic.

14. As you wash your hands between patients, say to yourself, "May the universal life-force enable me to treat my patients and colleagues with compassion, patience and respect." (And myself, as well).

Farmers Markets...

One of the things I love best about summer is the return of the Farmers Markets. I love everything about them - the brilliant displays of young fruits and vegetables, the happy chatter of folks lined up to buy delicious and decadent cookies, the comforting scents of fresh bread and hot coffee wafting from their respective stalls.

But most of all, I love the vitality of the atmosphere. The sense that one can grow more alive just by being there. An energy and a nurturing that soaks in through one's pores.

Early in recovery from compassion fatigue, we need to find experiences that will fill us up, gently, without asking anything in return. (Most of us are too exhausted and empty, initially, to give anything to anyone or anything else.) Visiting the Farmers Market is just such an experience, as is walking quietly at the beach at sunset or listening to a chickadee's call early in the morning, or holding a sleeping child or sitting in silence to welcome the day.

Can you think of any other undemanding but nurturing experiences that might help to fill the hole left by caring for others? Can you choose one to do this week?