Saturday, 28 August 2010

Nursing, living and dying - Ian Miller, mindfulness and Flow

I owe this post to Ian Miller, the "impactEDnurse" (see blog/website.) As well as a great deal of no doubt invaluable practical medical advice for nurses (how would I know? What is a cannula, anyway?) he writes about what's needed between the ears of a good nurse in A&E, as we tend to call it in Pomland. (Ian is an Australian. He has that Australian directness as well as a powerful line in cauterizing crudity and black humour which I enjoy very much.)

You might think that meditation practice is a long way from the urgency, mess and pain of a busy emergency department in a large hospital. What Ian has done, it seems to me, is to show us that to survive and do a good job in such an environment, you need total immersion in what you are doing. If you can't achieve a relaxed concentration on this task, and then the next and then...but let the urgency of the whole situation throw you off balance, you will a) probably make mistakes (and we don't much like the idea of mistakes in A&E, do we, people - especially not if it's us groaning on that trolley!) b) burn out under the huge stress of it all and get cynical and exhausted. He writes of vertical workers, and horizontal workers. If you want to find out what he means, do visit his blog.

Ian tells us that "Mindfulness is a way of learning to relate directly to unfolding experience."

That doesn't tell us
how to get there, but it sums up neatly enough the way being mindful enables you to be totally absorbed in the reality of what is happening in front of you, as opposed to letting in the dozens of possibly relevant but not in the least helpful thoughts that are just waiting to fragment your clarity of awareness.

Anyone who has consulted a really good medic will have felt that calm concentration, as they watch you, listen to you, and think/take in absolutely nothing but the you that is in front of them at that moment. Such people are likely to be healers, not just doctors and nurses. They can allow the reality of a patient to absorb their consciousness.

Ian then relates this necessary mindfulness to a concept new to me - Flow.

I quote from his website again:
"The psychologist Mihaly Csikszentmihalyi coined the term Flow to describe this state of engaged activity. Total immersion in the present moment produces an energized focus in which the doer of the action and the action itself merge. Time may condense or expand, tasks are accompanied by feelings of calm or joy, complex activities seem effortless."

At this point, I began to get unmindfully excited. Things connected, bells rang.

Great writers describe the way a story sometimes seems to take over and almost write itself; they talk of a character that simply walks off and does what s/he wants on the page. (They also point out that is not always, or even often, like that!)

If you enjoy jazz, you will know that sometimes the same musician can be improvising nicely enough, other times the instrument seems to be playing them and the music is in a different league (one said to me that it was better than sex when this happened - well, he'd know...)

If you enjoy cricket, you will have seen some of that quality in Broad's batting yesterday and today - great batting looks unhurried and entirely right, whereas in fact I believe that the delivery from a fast bowler leaves you, when it bounces, about 1/3 of a second to decide what stroke to play - except that's not a decision, it's the whole highly trained person responding instantly and in totality to the situation before them. "Time may condense or expand..." A great goal in football - ditto. Good defenders suddenly go into slow motion around the striker, there's only one place for the ball to go, and it does.

Great dancers make it look easy. They seem to hover for a moment. They don't reach an arm up, their limbs seem to float. "The doer of the action and the action itself merge." Can we tell the dancer from the dance, the musician from the music?

Of course these people are "technically" masters, disciplined and fantastically hard-working - but that alone can't do it. A classical musician once told me there is no such thing as "pure technique," that doesn't make music, it is necessary for music to happen - which is a live thing. What does do it, is mindfully addressing the moment, it's the Flow.

Most of us aren't masters at anything, but we can develop our mindfulness, we can allow the Flow to develop in less complex and challenging circumstances.

Maybe people who can manage a degree of mindfulness in life and work, maybe people who have at least sometimes felt the Flow, can face their own mortality more calmly, live more fully, with awareness of death enriching rather than constricting their lives?

Calmness is catching, just as panic is - you can see that in any stressful situation. Mindfulness also enables fellow-feeling and compassion (more of this big idea later.) A degree of mindful calm is a valuable thing in a funeral ceremony, especially if something goes wrong - the bereaved family will forgive you anything except getting in a state. They need your calm. How much more important this must be in a busy A&E. How wonderful it is when we read of it in a disaster situation, where a calm centre saves lives (though sadly, not always that of the unselfish and calm person him/herself)

More another time on
how to develop this much-vaunted mindfulness. because when the pressure is on, it's a bit late then suddenly to decide to be mindful!


  1. Marie De Hennezel wrote a fantastic book called Intimate Death about her work as a palliative care psychologist in a Parisian hospice. It has been a huge influence on us, and I would urge anyybody who works in anyway with the dying, the dead or the bereaved to read it.
    She describes walking into the room of a newly admitted patient in deep distress, struggling with the nurse to climb out of her bed while her hysterical daughter screamed by the side. Marie describes the nurse 'smiling warmly like a flame of reassurance in this vision of hell.'
    That centered calmness is a good position for any nurse/undertaker/minister to be coming from.
    Of course, having been a seven year old boy in 1977, I am unable to accept the word 'flow'. It is, as any fuel kno, The Force, and it is strong in this one...

  2. Aha! A Molesworthian! I might have known. Hail, feloe wede, bulie, roter, cad, swot or sneke...
    (Non-Molesworthians - don't worry about this, it passes quite soon.)
    Thanks for the book recommendation, very helpful.
    May the Force - well, you know the stuff.

  3. Well this is very interesting.

    It seems that certain areas of your interest are fitting more and more with mine.

    The idea of mindfulness couples well with healing and seeing the person and moment (or even the screen that you are reading I suppose) in front of you right now.

    I have been wading through my reading list in preparation for becoming a student (again!?) and there is a lot of overlap in what you are saying.

    Birth, living,and death are certainly made more positive by mindfulness.

    If only i had known this when I was a youth - or Yoot as they call 'em round here.


  4. Yeah, me too, all that rushing around after the wrong things! Still and all, better to realise it in, shall we say, the prime of life, than not at all, at all, at all....

    It just must be a healing thing, over all, I think. i.e. it won't get a splinter out of your finger, but it will help your immune system fight any consequent infection. And may help the splimnter hurt less.

    I'm pleased to read that our areas of interest overlap increasingly, because it helps me to understand that no, it is not just me...

    Thanks for comment.
    Go well,brother Arkers.

  5. Well, you know, I have been thinking about this a lot, for several days. And about your previous posts on this. I have always noted as a personal fault the fact that I have little of what I've always called presence of mind -- which you call mindfulness. When my heart is full I get carried away, go over the top. It's a fault which I've supposed ineradicable. In times of stress and misery, even great anger, my brain goes icy.

    But I have always reckoned that public performance is something I'll never do well because of this ineradicable fault. I was with a radio presenter the other day. She had mindfulness to the n'th degree. I have never seen such self possession.

    I was struck by the image of you composing yourself in front of the coffin as the seats fill.

    Maybe it's not an ineradicable fault?

    Thank you for giving me heaps to think about. At the end of a long life I'd rather given up on myself. Who knows...?

    Molesworth, i'faith! I Must dig out my copy. Do you remember Nigel's line-up vs the Rest of the World footer team?

  6. I seem to remember it involved the Skool Dog, and maybe Jack the Ripper? Molesworth was an inspiration and a lifeline to me at my own St Custards...Back in the Jug Agane...

    Ah Charles - it (however you characterise "it") is not a fault nor is it ineradicable, because it can't and shouldn't be eradicated, I'd say. As so often, you've given me the seed of a post. But for now - who would not rather have a full heart and what you call an over-the-top response, as opposed to an empty heart and no response?

    But I'm very pleased if my ramblings have provoked thought. More anon.



    Romulus Remus

    Skool dog self Richard I

    Julius Caesar Cain Jack the Ripper Livy Esau

    Ref. Solomon