Stopping the Noise: Unshakeable Mindfulness for Students

It is Day 1 at a teaching course, and the topic is multiple trauma —  we are teaching 100 medical students how we as senior doctors and paramedics care for people involved in accidents and injury.  It’s about the systematic way that we must all learn when we approach a seriously injured patient, perhaps at the roadside or in a wilderness location.  There’s a thinking sequence which we abbreviate to “CABCDE” and the letters refer to compressing bleeding wounds, airway, breathing, circulation, disability and exposure.

Over coming days the students will learn how to insert various tubes into the blood vessels, the airway and the chest.  They will learn how to stabilise someone with a spinal or pelvic fracture. We will also be using simulation with various imaginary scenarios involving injured patients, to give the students a feeling of how challenging these examples are when they really occur.

Now here’s the really interesting bit.  There were many discussions through the day about how we look after ourselves as health care providers in the face of such confronting trauma.  The questions came from the students — how do we reduce the PTSD, the “burn out”, the ruminating worry that can come from seeing and caring for people with very serious injuries.  So amidst discussing blood loss and airway management we were talking about mindfulness, about emotional self-awareness, about finding the balancing activities like exercise, yoga, debriefing and emotional resilience.

I found out that a major state ambulance service is so concerned about these issues that they now have an entire department dedicated to the health and wellbeing of its paramedic employees. The wave of burnt out, psychologically traumatised paramedics is finally being addressed in a comprehensive way. 

If you’ve seen my book you’ll remember that I subdivided mindfulness into 4 areas, which each go into more detail about strategies that we can use as health care professionals (and all of us actually can use this).  I represented them as the “Mindfulness Triangle”, consisting of (1) mindfulness on the run, (2) becoming the observer, (3) scheduled mindfulness practice, and (4) read a book. We need to think about these things ALL the time, and it gets hold of the way we think about everything.

That’s my experience anyway. During each day in a stressed healthcare job, the ‘mindfulness on the run’ chapter refers to the tricks and tips that we can EACH develop, including at a very basic level the “take three deep slow breaths” technique that our parents used to perhaps tell us to do when we were angst-filled teenagers.

By watching our own emotional reactions through each moment, we can learn that it is possible to take back control, that we own our emotions rather than them ‘owning us’ — that’s what I mean by ‘becoming the observer’. These two things together are not enough, because there is a real beauty to be discovered when we become a little disciplined about this wellness path — here I am saying that we should EACH set aside some time each night before we sleep, to meditate or practise mindfulness exercises to deeply relax before sleeping. 

The final area, ‘read a book’, is me being humorous and serious at the same time, reminding myself and all of us that we can seek out sources of inspiration to help us on our way… like books, like inspiring music, like walking quietly or any number of calmness creating activities.  You will know what resonates for you.

Students at the course were asking about my ideas on mindfulness today.  One of the teachers was sharing how he had been so stressed when looking after an injured child that he decided to move away away from that type of care.  This is a form of mindfulness, taking our own temperature, and realising that our own mental health requires a change in our career.  This is what I mean above by ‘becoming the observer’.   Unshakeable mindfulness does not require us to ‘push on’ and stay in a job that no longer suits us, but rather the strategies of mindfulness enable us to make career (or life) decisions in a calm and very clear way.  And of course, our wellness and day-to-day resilience in any role are helped by introducing these techniques into our own lives.

So tomorrow we start teaching the skills to the medical students — how to put in a chest tube for someone with a punctured lung, how to use a video camera in a device that shows us the vocal cords when we are inserting a breathing tube into the lungs.  It’s going to be fun.  And it will save a life or two someday.