Rheanna Hoffmann – Grow Mindfulness

On the Frontline During COVID – Self Caring for the Carers

Professor Cynda Hylton Rushton and Rheanna Hoffmann recently engaged in a moving video podcast conversation that highlighted the scars and distress of what it means to be a frontline nurse during the COVID pandemic. They covered not only the impact on nurses physical and mental health but also explored strategies that could be adopted by nurses to manage their distress. Cynda will be a key presenter at the free, online Healing Healthcare Summit in early February 2022.

Cynda is incredibly well-informed about nurses experiences during the pandemic, being a nurse herself and working with nurses to develop what she calls “moral resilience” – the ability of an individual to “restore or sustain” integrity in the face of the onslaught of challenges to their inner harmony and capacity to align their words and actions with their values and deep commitments.

Cynda, whose focus includes clinical ethics and contemplative practice, brings to the conversation penetrating insight and deep caring and compassion – characteristics that are manifested in her faculty work with the clinicians training program, Being with Dying. Cynda is the author of Moral Resilience: Transforming Moral Suffering in Healthcare.

Rheanna is an emergency nurse who is also a meditation practitioner and teacher with extensive experience in mindfulness and its benefits. During the worst of the pandemic in the US, she volunteered to work in New York City. Her personal recollections of this experience can be found in an interview where she shares an intimate insight into what happened for herself and others during the overwhelming crisis. Her presentation is part of the Mindful Healthcare Speaker Series which is readily available as a “resource for challenging times”.

In her discussion with Cynda, Rheanna provided an expose of her emergency nursing experience during COVID that is raw and vulnerable but manifests her openness and courage. I have previously reported on Rheanna’s interview about death and the dying process with Frank Ostaseski, Founder of the Zen Hospice Project. Rheanna herself is the Founder of The Whole Practitioner designed to help nurses “to rediscover health, balance and their core values” after experiencing burnout, exhaustion and deeply personal frustration.

The distress of frontline COVID nurses

Rheanna recounted in telling detail the nature and extent of distress experienced by COVID nurses, especially those who were engaged in emergency wards. She spoke emotively about the following experiences and sensations:

Reaching the limit of effectiveness of personal resources – whether that be yoga, friends or colleagues
Experiencing isolation and loneliness – tendency to withdraw physically and mentally to deal with the overwhelm
Feeling incredibly bare and vulnerable – the challenge of people dying and grief (that of relatives/friends and your own grief)
Physical exhaustion – tired beyond belief and suffering from lack of sleep, resulting from replaying adverse incidences
Feeling chronic hopelessness and helplessness – the challenges were beyond the capacity of individuals and the health system itself; exposure to personal limitations in the face of so much death and suffering. Associated with this sense of helplessness are nightmares, flashbacks, randomly crying and insomnia.
Separation from self – the natural consequence of traumatic experiences.
Loss of a sense of balance – impacting how time, health and relationships are valued or devalued (because of lack of time allocated to them)
Burnout – on physical, psychological and moral levels. Rheanna described this as “acute burnout” reducing the energy for self-care and potentially leading to thoughts of suicide.

Rheanna pointed out that nurses, including herself, were normally able to “compartmentalise” their adverse experiences and do so in a way that was healthy, However, the adverse experiences from the pandemic were “unrelenting”, leading to chronic distress. Part of the frustration was the inability of frontline nurses to help others at times when they were feeling so “fragile”.

Self-caring strategies for frontline COVID nurses

Cynda offered several self-care strategies for COVID nurses during her conversation with Rheanna. Some covered ways of addressing negative self-talk while others focused on adopting a changed perspective and mindset or instituting a mindfulness practice:

Mindfulness practice: Cynda offered a mindfulness practice that could be used by COVID nurses experiencing distress and burnout. This focused initially on the breath with the out-breath being viewed as a release of stress. In the exercise, the exhale stage was lengthened to accentuate and support release. Participants were encouraged to rest in the gap between the in-breath and out-breath and, where possible, extend this gap between breaths. A slow body scan was the next step with emphasis on identifying and releasing points of tension. Participants were encouraged to focus on an anchor of choice to stop their minds addressing their extended to-do list or diverting into worrying. Cynda suggested that nurse participants become conscious of how many miles their feet have travelled in pursuit of their daily caring and the level of support that their feet have provided. Lastly, she encouraged the nurses to employ statements such as:
- May I trust the wisdom of this moment consciously and fully.
- May I have the courage, honesty and openness to see things clearly and without judgment.
- May I be willing to let go of what impedes me rather than helps me.
- May I encounter a wise mentor to assist me to deal with these challenges.
Confronting your own limitations: Rheanna pointed out the sense of guilt and shame that she experienced that were driven , in part, by her self-talk – “you could have done more”, “if only you had acted faster”, “if you had paid attention more fully you could have saved more people”, “if only you had been able to convince people to make different decisions”, etc. Our minds are very creative when it comes to self-denigration and negative self-evaluations. It is important to acknowledge that no one could have handled the challenges for nursing presented by the pandemic and not experience their debilitating effects. Cynda suggests that nurses need to “turn towards their limitations” and do so “with as much compassion “ as they extend to others. There is scope here for loving-kindness meditation for oneself.
Changing your perspective: Cynda stated that the tendency in these crisis situations is to think that you are carrying the load by yourself because there is a natural tendency to turn inwards to cope with what is happening. She argues that what is required is a change in perspective. For example, she asked Rheanna to think about “Who else is carrying the load of the pandemic? “Who has your back? (e.g. friends, family, colleagues local and abroad & mentors).
Separate effort from outcomes: Cynda maintained that a form of self-care is to acknowledge that the health outcomes are often beyond the control of a nurse. She stated that In her own work she does the best she can in the circumstances to meet an identified need but recognises that the specific outcomes are not in her control – there are too many intervening aspects impacting the final outcome. Cynda maintains that freeing yourself from expectations and outcomes is crucial for a nurses’ welfare. In the pandemic, COVID nurses such as Rheanna attempted to “fix unsolvable problems”. Nurses’ health outcomes were not the result of lack of effort or smarts but because the pandemic situation exceeded the capacity of individuals and the health system itself.
Savour achievements – Cynda reinforces the view that the brain has a natural negative bias and is more likely to “mull over” what did not go well rather than “honour what we are able to do in the moment”, given the circumstances thrust upon us. She stated that nurses need to focus on how they made a difference in people’s lives, e.g., holding someone’s hands as they were dying, gasping for breath or having a tube inserted to enable them to breathe. This thought expressed kindly by Cynda precipitated a chain reaction from Rheanna who began to identify numerous moments when she “deeply showed up with people” and , in the process, rediscovered “what it means to be a nurse” and gained insight into the very core of her being and who she was. The other aspect that Rheanna savoured was her deep connection with people who were suffering – in spite of what was happening around her independently of her best efforts.

Reflection

Much of what Cynda proposed as strategies to help nurses deal with the extraordinary level of stress of frontline work during the pandemic can be incredibly useful for all of us to manage stress and resultant distress in our daily lives. As we grow in mindfulness through meditation, reflection and other mindfulness practices we can reshape our perspective and expectations, savour the positive in our lives (including being alive), confront our grief and limitations and achieve the freedom of separating outcomes from effort in our chosen endeavours.

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Image by Gerd Altmann from Pixabay

By Ron Passfield – Copyright (Creative Commons license, Attribution–Non Commercial–No Derivatives)

Disclosure: If you purchase a product through this site, I may earn a commission which will help to pay for the site, the associated Meetup group, and the resources to support the blog.

Living in the Light of the Lessons from Death and Dying

Frank Ostaseski in an interview with Rheanna Hoffmann about death and the process of dying, mentioned his book based on his experiences of being with a thousand people as they died. His book, The Five Invitations: Discover What Death Can Teach Us About Living Life Fully, provides five principles or guides for living life with integrity, meaningfully and in alignment with our true purpose. Frank was the co-founder and director of a thousand-bed hospice, so his book is based on lived experiences and real stories of how people faced death, as well as the distillation of the “wisdom of death” from these deeply personal and moving experiences.

Frank maintains that death is the “silent teacher”, imparting understanding and wisdom about how we should live. He expounds his ideas and principles in a number of recorded podcast interviews, including What Can Death Teach Us About Living Mindfully. His recoded talk at Google focused on his book through the theme, Inviting the Wisdom of Death Into Life. A succinct explanation of the principles in his book, which he describes as “invitations to living”, is provided in his 26-minute edited interview with Steve Heilig of Palouse Mindfulness.

The five invitations to living learned from the dying

Frank emphasises that these invitations to living have been taught to him by the dying and by compassionately helping many hundreds of people with the process of dying. Understanding the following five principles and putting them into practice enables us to live life fully and mindfully:

Don’t wait – we assume that life will go on as it always has, that our health, wealth and relationships will persist into the future. If nothing else, the Coronavirus should disabuse us of this belief and the associated perceptions. There is a tendency to put off changing the way we live because of this belief in continuity. However, living is precarious, nothing is certain. We can become absorbed in the busyness of life and put off any change – avoiding the need to slow down and really experience life and relationships. We can spend so much of the day planning our next activity or sequence of events. Frank maintains that we are reticent to fully “step into life” – “waiting for the next moment in life, we miss the present”. Frank urges us not to wait till our death to find out the lessons of dying.
Welcome everything, push nothing away – whether it’s grief, loneliness, boredom or suffering, there is a lesson to learn if we don’t push away the feelings, emotions and thoughts that pervade our life. Frank suggests that we should welcome grief and fear and difficult feelings because these “moments” of discomfort are pivotal in our life for developing sustainable personal change, if we fully face them. He spoke of the grief he experienced working with the dying and how he adopted meditation, bodywork (the touch of a practitioner on a source of physical pain in his body) and holding and rocking newly born babies (a life-affirming activity) as a way to face the full emotional, physical and mental experience of grief – it’s as if he ritually experienced the life cycle of birth, living and dying as a way to manage his overwhelming grief.
Bring your whole self to the experience – Frank made the point that in his work with the dying, the part of him that was most helpful was his vulnerability and helplessness because it acted as an “empathetic bridge to their experience”. These “weaknesses” became his strengths and enabled him to be fully present to them, to be-with-them. He has stated previously that authentic presence and compassionate listening are healing and supportive of people’s transition in both the challenges of living and of the dying process. He asserts that none of us is perfect but that we can bring our whole self to whatever we are experiencing – leaving no part of our self out of the interaction.
Find a place of rest in the middle of things – we can find a place to rest amidst the turmoil and tenuousness of life and despite overwhelming emotions that beset us. The “place of rest” could be a breathing exercise, a ritual, mindfulness practice or reconnecting with nature. Finding such a “place” is critical as a self-care approach for healthcare professional, particularly in these challenging times. Rheanna Hoffmann, who volunteered to work in the Emergency Department of a New York Hospital during the height of the Coronavirus, stated that this principle, explained in Franks’ book, helped her deal with the exhaustion, grief and overwhelm she experienced in helping suffering and dying patients while working under unimaginably difficult conditions. Frank also recounts the story of how he helped a woman to find a place of rest who was dying and experiencing extreme difficulty breathing, a struggle to breathe exacerbated by fear. He asked her, “Would you like to struggle a little less?” He then helped her to put her attention to the gap/pause in her breathing and began to pace her by breathing in and out with her. He reports that “fear left her face” and she died peacefully. Frank pointed out that none of the conditions had changed for her (including difficulty with breathing), only her relationship to her experience of dying.
Cultivate a don’t know mind – this is not designed to encourage ignorance. Frank quoted a Zen saying, “Ignorance is not just ‘not knowing something’ but the right thing”. Ignorance is knowing the wrong thing and insisting on its truth and universality. The principle is not about accumulating information (the “what”) but cultivating a mind that is “open, receptive and full of wonder” – a mind that is curious and pursues the truth and understanding in everything. Frank suggested that we should talk with our children about death and, in the process, learn from them (not tell them). He recounts his experience as a Director of a pre-school when he organised for the children involved to go and collect dead things in the woods nearby. He marvels at the insight of the children and their perceptiveness. They had been discussing the theme of endings becoming beginnings, e.g. a caterpillar becoming a butterfly, when a four-year old girl said, “I think the leaves on the trees are very, very generous – they fall and make room for new leaves”. Frank maintains that a “don’t know mind” is fluid and flexible and “infused with a deep interest to know” and to know what is true right now.

Reflection

Frank’s approach to fully facing all that life presents (both discomfort and joy) is in alignment with Jon Kabat-Zinn’s concept of Full Catastrophe Living and Frank’s personal process for handling his grief accords with Deepak Chopra’s recommendation that we adopt a ritual to symbolise our release from the stranglehold of grief.

Frank epitomises in his life and work what he advocates through his talks and video podcasts. He pursues a life that is meaningful and purposeful. For example, in addition to his book and public presentations sharing his knowledge and experience of the dying process and its lessons, he has established a creative approach to educating end-of-life carers through the Metta Institute. His words and actions manifest a life of integrity, compassion and wisdom.

Steve Heilig, the person who interviewed Frank in one of the video podcasts mentioned above, has also found a way to live a life full of meaning and purpose. One of his many mindfulness endeavours has been to collect resources and permissions from leading mindfulness practitioners, including Jon Kabat-Zinn, to enable him to provide a free, 8-week, online course in Mindfulness-Based Stress Reduction (MBSR).

As we grow in mindfulness, by employing the five principles that Frank espouses, we can live our lives more fully and expansively and truly aligned to our energy and purpose. We can find our expansiveness and spaciousness which Frank evidenced with people who were dying – their capacity to find the personal resources to face their fear and death despite their belief that the challenge was beyond them. We can also become a calming presence to others who are experiencing difficulties as we progressively overcome our own reactivity. If we develop the discipline of the daily practice of meditation, we can live in the light of the lessons of dying and death.

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Image by mostafa meraji from Pixabay

By Ron Passfield – Copyright (Creative Commons license, Attribution–Non Commercial–No Derivatives)

Disclosure: If you purchase a product through this site, I may earn a commission which will help to pay for the site, the associated Meetup group and the resources to support the blog.

Understanding Death and the Process of Dying

Rheanna Hoffmann recently interviewed Frank Ostaseski on healing grief through compassion and love. Frank founded the Metta Institute whose mission is to provide innovative educational approaches to developing skills in “mindful and compassionate end-of-life care”. Rheanna herself is the founder of The Whole Practitioner, dedicated to helping nurses move beyond frustration and burnout to “rediscover, health, balance and their core values”.

Frank and many other writers on the process of dying maintain that it is not just a medical event but is much broader and more holistic than this form of the mechanical model. Increasingly, research is confirming too that consciousness is more than our physical brains. Frank argues that the unwillingness in our culture to talk about death and the dying process is preventing us from learning the lessons that the dying can teach us and our children. He contends that if we learn about the dying process and face the reality of our inevitable death, we can better appreciate the “preciousness of life” and live our lives more fully and in alignment with our values and purpose.

The process of dying

Frank describes dying as a process of “stripping away”. It’s as if everything that is associated with our “ego” – our sense of self – is peeled away. Undoubtedly, our mental and physical capacities decline, and this begins with the aging process. But the stripping away is much more than that – it is losing attachment to everything including our spouse or partner, our home, our roles, our possessions, and the animals in our life. Frank also talks about dying as a “sacred process of transformation” through which we see things in a new light, have a deeper understanding of the meaning of life and the value and true purpose of our own life – in other words “an awakening”, no longer limited by our concept of a “small separate self”.

Peter Fenwick, when talking about What Really Happens When We Die, suggests that the more we hold on to our ego needs and refuse to let go, the more difficult is the dying process. Living our life in a selfless way – not totally self-centred — makes the process of dying easier because we are not absorbed in holding on to our attachments. Being “other-centred” in the pre-transition phase of our life makes dying easier and enables the final transformation that Peter describes as entering a “spiritual domain” where you lose your identity as a separate self and become identified with the total cosmos – the universal whole.

Peter discusses the change in our level of consciousness in the light of research into Near Death Experience (NDE). He maintains that consciousness research focused around NDE experiences confirm a “widening of consciousness” that manifests in:

Losing the self-narrative – the self-talk that we employ to boost or deflate our egos
Being just in the moment – not absorbed in the past or anxious about the future
Experiencing “unbelievable” happiness
Tending to be transcendent – losing a sense of duality (our self and others) and becoming merged with the cosmos.

Peter has co-authored The Art of Dying with Elizabeth Fenwick which provides personal accounts from those who have been dying and people (healthcare professionals, carers and family) who have been with them and supported them in the process of dying. The accounts discussed, as well as other research into NDE experiences, confirm that consciousness is much more than our physical brains. Monica Renz, author of Dying: A Transition, provides a process-oriented approach to end-of-life patient care that incorporates confirming the dignity of the patient, understanding the transition process of dying and being able to sensitively engage in the symbolic journey described by dying patients. Her observations and detailed accounts are based on attending 1,000 cancer patients during the process of dying. Monica describes the dying process as both an archetypal and a spiritual process and contends that, in the process of transition, patients move through fear into a “space of peace, acceptance, dignity and tranquillity characterised by connectedness and even luminosity”.

Reflection

Our cultural blinkers blind us to the reality of the dying process and the nature of our own inevitable death. As we become more aware of the dying process through our own research and study, we can learn to appreciate how precarious our life is and how precious is the process of both living and dying. As we grow in mindfulness through meditating on death and reflecting on its implications for how we live our life, we can progressively come into more alignment with our life force, our values and our life purpose.

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Image by Hans Braxmeier from Pixabay

By Ron Passfield – Copyright (Creative Commons license, Attribution–Non Commercial–No Derivatives)

Disclosure: If you purchase a product through this site, I may earn a commission which will help to pay for the site, the associated Meetup group and the resources to support the blog.

Healing Grief through Compassion and Love

Frank Ostaseski was recently interviewed during the 2020 Mindfulness & Compassion Global Summit by Rheanna Hoffmann on the topic, Grief and the Healing Power of Love and Compassion. With so many deaths worldwide from the Coronavirus (410,000 at the time of writing), the issue of grief and its manifestations becomes increasingly prevalent. Frank is the cofounder of the Zen Hospice Project (now called The Zen Caregiving Project) and founder of the Metta Institute designed to provide creative education in the art of “mindful and compassionate end-of-life care”.

Healthcare professionals may not have lost loved ones through the virus, but they can experience grief too with the loss of patients that they have been caring for – this is in addition to other stressors that challenge their resilience. In his interview responses, Frank explained the nature of grief and the power of compassion and love to heal people who have experienced profound grief.

The nature of grief

Frank who has supported more than 1,000 people in the process of dying maintains that grief is not a single point but a process – an evolving process of “loss, losing and loosening”. There is the initial shock of the loss that can result in physical collapse and total disorientation. Shock impacts people differentially – some people may experience numbness, there is no “one way”. Beyond the initial shock of the loss, is a process of “losing”, where in the midst of other things an overwhelming sense of loss returns accompanied by strong emotional and physical symptoms. “Losing” can persist for many years and eventually become an intermittent event. In the meantime, the process of “loosening” commences with progressive release of the hold that grief has over a person.

People grieve in different ways – some withdraw and have a strong desire to be alone with their grief, others experience tears and crying uncontrollably, while still others may take out their grief by aggression and violence (such as is occurring in the riots in America in relation to the Black Lives Matter movement). Grief and our response may be aggravated in challenging times such as the pandemic where everyone is experiencing a form of “emotional inflammation”.

Frank maintains that grief has many faces, e.g. anger, rage, sadness, depression, fear and even regret. He also suggests that grief results not just from the sense of loss of a loved one but also from the associated lost opportunities – a young life cut off in their prime, a missed opportunity to reconcile with a loved one, a lost chance to say goodbye or to be physically present with someone as they were dying. For people exposed to dying and death as a result of the Coronavirus, there can be a collective grief brought on by the lost opportunity to save lives, as well as the lost opportunity of the lives lost.

Healing grief through love and compassion

The starting point for being able to show compassion towards the people experiencing grief is having an understanding of the nature of grief and its many forms of expression. It is important not to add to the stress of people who are grieving by communicating expectations of how their grief should be expressed. Grieving is a very personal process and requires compassionate attending and listening, not the projection of personal preference.

Pema Chödrön discusses ”compassionate abiding” in our own grief and suffering as the pathway to expressing compassion for others. Frank suggests that we need to “metabolize” our own fear and suffering by facing it fully, experiencing it in our body, mind and heart and converting it to compassion for others. He maintains that when we can explore our own experience through self-observation and self-inquiry we can “build an empathetic bridge to other people’s experience”. Otherwise we can be working out of our own distress and needs rather than the needs of others who are grieving. Without this level of self-intimacy we can appear dishonest or disingenuous to others we are trying to help in their grief.

Frank explained that he has difficulty expressing self-compassion but has developed a number of processes that enable him to express compassion for others. Each night before going to sleep, he focuses on the suffering of others – those who might be suffering through loneliness, those experiencing grief or those who are caring for others who are dying. Through this process he feels love and warmth towards others and the emergence of his “innate compassion” that is broad and deep enough to absorb or dissolve his own experience of suffering. In the morning, with his hand on his heart, he asks himself, “What would love have me do today?”

Reflection

Self-intimacy is a key to genuine compassion towards others who are grieving. Compassion and love help to heal grief because they involve abiding fully with someone who is experiencing grief, not trying to fix them. Our very presence, uncontaminated by unrealistic expectations of the other person, can be a source of healing just as “listening generously” can be. As we grow in mindfulness, we can develop self-intimacy, calmness and peace and be better able to be present to and compassionate towards others.

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Image by Gordon Johnson from Pixabay

By Ron Passfield – Copyright (Creative Commons license, Attribution–Non Commercial–No Derivatives)

Disclosure: If you purchase a product through this site, I may earn a commission which will help to pay for the site, the associated Meetup group and the resources to support the blog.