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?

Healing Hobbies...

Happy summer! With our longer days and, if we're lucky, a stretch of vacation time finally in sight, our hearts and minds can turn to activities that ground us in joy and refreshment - our favourite hobbies.

Some people think that hobbies are a waste of time or a way of avoiding the responsibilities of life. For hobbyists, their favourite passtimes are anything but. For us, hobbies are emotional releases, creative outlets, sources of life long learning, ways of building community, ways of contributing to community and means of keeping minds and hands active. They are also a source of Compassion Fatigue recovery and a route to achieving overall wellness.

Most hobbies provide an ideal way to relax and to manage stress. Twenty minutes unwinding with knitting needles, your guitar, or an ax and a pile of wood can make an excellent transition from work to home. An hour's yoga, painting or reading (depending on the content!) can stimulate a relaxation response that will help you to sleep. Focusing on the intricacies of sculpting, cooking a gourmet meal or building a doll house with your daughter can distract you completely from worries over things you cannot change. Planning a quilt, poring over seed catalogues or choosing colourful yarns for a new project bring a sense of peace and hope.

For those of us whose work is always in process, baking a loaf of bread, finishing a wood carving or hearing a motor run smoothly after hours of tinkering provides an end result, a finished product, to balance the ongoing nature of our work.

This weekend, I discovered a great blog for hobbyists called, Craft to Heal, by Nancy Monson, an author, editor and avid quilter and crafter. In her November 22, 2008 post, she writes about how to reap the benefits of hobbies:

"To tap into the healing power of hobbies, follow these guidelines:

Match your hobby to your personality. If you're a detail-oriented person, you might like hobbies that require precision, such as quilting or decorative painting. If you're more spontaneous and like to make a mess, activities that make you do a lot of measuring will cause frustration rather than relaxation. You might prefer ceramics, gardening or photography.

Try rhythmic and repetitive activities such as knitting or sewing. The act of doing a task over and over again breaks the train of everyday thought and relieves stress by evoking the relaxation response, a feeling of bodily and mental calm that's been scientifically proven to enhance health and reduce the risk of heart disease, anxiety and depression.

Make time for your hobby every week, and ideally every day. Experts advise meditating for at least 20 minutes a day, so try to do the same with your hobby to get continuing benefits.

Create a space just for your hobby. Set up a dedicated hobby area in your home, so you can play whenever you have a few moments to spare. If you don't have a whole room or office to putter in, put your supplies in a basket or the car for easy access.

Take a class or join a club to meet other people. Human beings are social animals and research shows that socializing with others helps release stress. Plus: Life-long learning and having a strong social network are two keys to healthy, happy aging.

Enjoy the process. Many people rush to finish a project, but the fun and the healing benefits are in the process. That's when you push worry, anger, anxiety and everyday worries out of the way.

Don't be a perfectionist. Give yourself permission to enjoy your hobby without expecting you projects to be masterpieces. If you make your hobby another chore that you have to accomplish perfectly, you'll lose the therapeutic benefits and the fun.

Don't compare yourself to others. If you're a beginner, let yourself be a beginner. Persevere with your hobby because you love it, and whether you ever become a master at it or not, it will bring you joy. You don't even have to finish your projects if you don't want to. The point isn't to make a ton of stuff. The point is to find what makes you happy, and what helps to relieve your stress.

Be bold! Pursue your hobby for yourself and yourself alone, and to express yourself. Don't worry what other people think of your projects. As Mary Tyler Moore was once quoted as saying, "What other people think of me is none of my business." "

To these wonderful suggestions I would add:

Give yourself permission to change. If you've never had a hobby, allow yourself to try several before settling on something you like. And, if you tire of that, try something else. Having a hobby is not about making a lifelong commitment, rather, about finding what works for you for now.

This week, why not choose a project and take the first steps toward getting started?

Summer Comforts...

Every season has it's particular comforts and rituals. Summer is no exception. When we take time to become mindful of the natural rhythms of the season, we open ourselves  to an almost inexhaustible source of support and nourishment.

With summer almost upon us, why not take a few moments to close your eyes and remember the joys, large and small, of summers past. What are the activities and experiences that brought you the most happiness, the most peace, the most refreshment? Try making a list and choosing one thing to enjoy each week through the summer.

Stuck for possibilities? Maybe you could try...

1.  Reading a whole series of mysteries by your favourite author.

2.  Building sand castles at the beach - borrow a child if it feels odd to do this alone!

3.  Eating cherries and spitting the pits as far as you can.

4.  Getting hot while cutting the lawn then jumping off  the dock into the clear, 

      cool water.        

5.  Making orange popsicles.

6.  Going to a drive-in movie or showing a movie in your back yard and inviting the

     neighbours.

7.  Eating breakfast out in the fresh air.

8.  Playing hopscotch in the driveway.

9.  Filling a wading pool or large bucket with water and splashing in it.  Or running under                the sprinkler.

10. Eating strawberries warmed by the sun.

11. Celebrating the summer solstice with friends.

12. Going for a bike ride or a run really early in the morning and listening to the dawn                       chorus.   

13. Having a picnic at the beach.

14. Lying on your back in the grass and watching the clouds.

15. Exchanging responsibilities with a friend so you can each get away for a few days.

16. Going to the farmers market and sipping a latte while you choose fresh vegies.

17. Picking blackberries, dandelion greens and other free stuff to enjoy for dinner.

18. Listening to the Beach Boys while you clean the kitchen or wash the car.

19. Smelling a rose.

20. Making a batch of red plum jam.

You may be surprised to find that the best of these pleasures are the simple ones...         

 

*  Photo by Bigstock Photos  

       

Calm...

While walking in Santa Barbara, CA earlier this spring, I was surprised to see that the street banners, rather than announcing a local festival or naming a given neighbourhood, bore the outline of a little girl's face, a heart, a home and the single word, "Calm".

"What a wonderful idea!", I thought, as the tension melted away from my neck and shoulders. Had it been that city's conscious intent to create an atmosphere of peace in the downtown core? I don't know. But I do know that every time one of the banners caught my eye over the next few days, I experienced the same quiet sense of calm.

What, exactly, does it mean to be calm and how do we achieve this illusive state? To answer these questions fully, I will direct you to Babette Rothschild's excellent book, Help for the Helper: The Psychophysiology of Compassion Fatigue and Vicarious Trauma and Peter Levine's seminal work, Waking the Tiger: Healing Trauma. To give you the short answer, I invite you to read on.

The Autonomic Nervous System (ANS) is the part of the nervous system that prepares us to fight, flee or freeze in response to a demand or threat and then to calm down afterward. The ANS has two branches, one that creates arousal to meet the threat (the Sympathetic Nervous System) and one that reinstates calm once the demand or threat is dealt with (the Parasympathetic Nervous System). Working in tandem, these branches create the arousal cycle described by Peter Levine:

- "We are challenged or threatened

then aroused;

- the arousal peaks as we mobilize

to face the challenge or threat

- then, the arousal is actively brought

down, leaving us relaxed and satisfied."

It is important for anyone who has experienced trauma personally, or through caring for others, to be aware of the signs of ANS arousal (fast shallow breathing, quicker pulse, dilated pupils, pale skin, sweating) and the signs of ANS calm (slower deeper breathing, slower pulse, flushed, dry, warm skin). Learning to be aware of our increased arousal is the first step toward reinstituting calm.

Some strategies that can help us to return to a state of calm after a period of arousal include:

1. Arousal awareness

Learn to become mindful of your level of arousal by carefully noticing your internal physical state - the signs listed above, areas of tension etc. Then, practice noticing how that baseline changes when you remember something pleasant in your life or when you anticipate something mildly unpleasant. Move back and forth between the two states, a few seconds at a time, until you get a sense of how varying levels of calm and arousal feel in your body. Use this knowledge to assess your arousal whenever you're feeling uncomfortable. ("Calm" post-it notes, placed strategically at home and in your office, can be a good reminder to check in.)

2. Reducing general arousal

You can reduce your overall level of arousal, over time, through meditation practices, centering prayer, reducing your trauma input (ie how much trauma you see on TV, in the newspapers, in your work), engaging in personal therapy to resolve past traumas, and keeping your muscles fit. ("Relaxed" or lax muscles and "calm" are not necessarily the same thing. We may need a degree of "friendly tension" in order to manage our stress.)

3. Learning to put the brakes on

It is important to know different strategies for "putting the brakes on" when your level of arousal gets uncomfortably high. (This level is different for each of us.) A couple of these include:

(a) Using Peter Levine's instructions for Trauma First Aid to complete the arousal cycle and calm yourself after confronting a traumatic situation. (January 12 ,2009 post)

(b) Finding a Sensory Anchor to which you can retreat when feeling too aroused.

A sensory anchor is an internal image of a safe place/situation. Choose a memory of something pleasant that makes you feel safe and calm. (Don't look for the perfect memory because almost everything can have a negative association if you look hard enough.) Awaken your sensory memory of that place or situation. How does it look, smell, feel, sound, taste? Notice your body responses - has your calm increased? If so, practice switching from mildly unpleasant memories to your safe anchor until you can switch quickly from arousal to calm. (Be patient. As with any skill development, this will take time.)

These are just a few of the ways we can return to the calm I experienced in Santa Barbara. I invite you to try them out and to continue looking for ways to increase your own calm as you care for others.