an act of kindness

Sit back and enjoy

http://www.amazingoasis.org/2013/11/best-coin-ever-spent.html

namaste to all

stay safe until the next post

Design Think Paradigm

Assignment

Select an article that inspires or contributes to the focus of your paper and apply the Design Thinking paradigm. Your blog post may cover all or one phase of the framework and should total 3-4 paragraphs in length. At the end of your post, invite your audience to provide feedback.

The title of my final paper is ‘Silence Pedagogy in Life and Clinical Practice: The Embodied Experience’. The practice of Silence was initially a point of interest due to its reverence in spirituality, as in prayer, solitude or in transcendational practices. Research revealed a much larger body of interest in this subject ranging from Silence in the classrooms and educational settings, in Law as in the Right to Silence (the Miranda Rights), in Linguistics and Music, and silence used in clinical encounters such as in psychotherapy and medicine. The original article “Compassion Silence in the Patient-Clinician Encounter: A Contemplative Approach” was selected to analyze using the Design Thinking Paradigm (Empathize- Define-Ideate-Prototype-Tests).

Empathize: does the article reflect needs?

This article calls upon the need to improve communication skills of clinicians. It examines how silence is currently used amongst clinicians, and between clinicians and patients for well intentioned purposes, but instead can create an awkwardness or indifference that can be interpreted as judgmental, disapproval or uncaring.

Define: How does the author define the problem?

The article begins by describing how a resident physician gives a 67 –year old woman the news that her colon cancer had spread to the peritoneum, and the resulting awkward silence that followed. The authors (Black, Bauer-Wu, Rushton, & Halifax, 2009) describe two types of patient encountered silence; first the awkward silence, a type of silence that does not have clear intentions and is viewed as untherapeutic, and secondly, an invitational silence where patients are given a few moments to reflect or feel what is happening. They noted that within the palliative care context silence has not been empirically studied and they believe that clinicians are primarily responsible for the effects of silence during the patient encounter.

Ideate: What are the authors’ recommendations to the problem?

The authors introduce the concept of a ‘contemplative silence’, one that draws on the wisdom of contemplative practices of Buddhist and Christian traditions. This type of silence is characterized by the clinician’s ability to be attentive, to maintain a stable focus and to show clarity of perception of clinical issues. These mental qualities are likened to mindfulness and compassion practices where the moment –to- moment experience engages the clinician to better understand the patient’s narrative, be more receptive of the patient’s experience and be more insightful in making diagnostic, prescribing and other patient related decisions. To cultivate these mind qualities the authors suggest physicians take moments for introspection and ‘anchor silence in the breath’. By introducing breath awareness, the clinician’s awareness of their senses, perceptions and even biases become more apparent to them, they are able to attune to and reduce their tension levels, and, in doing so can cultivate attitudes of understanding and compassion for their patients.

Prototype: a new practice, program, protocol, procedure, or policy

While the paper did not offer any specific guidelines for developing the techniques or attitudes necessary for a contemplative silence, the authors made reference to the “ Being With Dying Program” (Upaya Zen Center). After taking this program a clinician reported, “ I feel that my sense of being able to … enter into a very non judgmental space is different as a result... Now I have the ability to create a space of receptivity…”

How does one develop a contemplative silence practice? Begin by knowing that silence is

omnipresent and permeates every single cell, what we must do is cultivate awareness of it. Silence and sound, reside in the spaces that surrounds us, our homes, cars, offices, schools, malls, gardens, parks, trails, and in the spaces within us, lungs, heart, digestive tract, glands, bladder, nostrils etc. Below are six activities I practice to cultivate Silence awareness; I invite you to sit with me:

1.     Sit quietly and take a few moments to observe all the sounds you hear, near and far. As you begin to hear these sounds you will eventually begin to hear the silence between the sounds.

2.     Play your favorite song and this time you listen for the spaces and silences between the words, between the music.

3.     Read from 3 -6 first then practice them. Sit comfortably with back upright, your chin slightly tucked in and gently close your eyes. Bring all your awareness to the space that surrounds your body; what sounds do you hear

4.     After a few minutes of (3) above, bring your awareness to your scalp and forehead…relax them, relax your eyebrows, relax your eyes, relax your nose, relax your cheeks, relax your jaw, relax the corners of your mouth, relax your chin, relax your neck, relax your shoulders… relax your mind

5.     Feel and follow the flow of breath in your nostrils with each inhale and exhale…relax your nose, and gently quiet the sounds of your breath. Keep this awareness for about 3 minutes

6.     Slowly open your eyes, maintain the awareness on the quiet breath

Practice, Practice, Practice

In conclusion, if as the authors suggests that Contemplative Silence and anchoring in the breath can cultivate a deep healing and therapeutic encounter, then I pose this question and ask that you contemplate on it before answering: Are you in control of your breath?

Namaste to all,

Stay safe until the next post

Bibliography

Black, A. L., Bauer-Wu, S. M., Rushton, C. H., & Halifax, J. (2009). Compassion Silence in the Patient -Clinician Encounter: A Contemplative Approach. Journal of Palliative Medicine , 1113-1117.

Upaya Zen Center. (n.d.). Retrieved November 20, 2013, from http://www.upaya.org/

Haven of Quietude

Walking into the chamber was an incredible awakening….mother Silence reached out and took my hand, gently guiding me inside, and in the most soothing voice I’ve ever heard, she whispered ‘welcome home’. An immediate feeling of lightness overcame me, I felt the unnecessary sound frequencies packed on my shoulders lifted, and then experienced for the first time a change in muscular tension, the discharge of 'acoustic tension'; I felt a deep wave of muscular relaxation ripple through my body. If this is what Silence does to a body then everyone should have a dose of it; I felt very blessed to have discovered this hidden chamber filled with the treasure of Silence.

The chamber, scientifically known as an Anechoic Chamber (an-echoic meaning non-echoing or echo-

Fiberglass wedges lining all the walls of the chamber

 free) is a specially designed room /chamber lined either completely, on all walls including the roof and floor, or partially, with sound absorbing material thus making the inside of the chamber a haven of quietude. Under normal conditions when talking in a room, the sound waves generated through voice will reach our eardrums as well as the walls of the room. Some of the sound waves that reach the wall will be absorbed by it, while the remaining will be reflect back from the wall into the surroundings, and if loud enough we will hear an echo. In the anechoic chamber, the design and type of absorbing material used to line the walls will absorb most, if not all, of the sound waves that initially contacts the walls. While doing research on the topic of ‘Silence’ I was surprised to learn that the University of British Columbia (UBC) actually has an Anechoic chamber, see the article at this link. (http://www.silentpcreview.com/article45-page1.html)

Feeling beside myself and with extreme excitement I email the Professor inquiring about the possibility of spending some time in the chamber; after all if I am going to research and write about Silence it seems reasonable that an embodied experience might be in order. I was very pleasantly surprised when the professor agreed that time in the chamber was indeed a real possibility depending on his availability to orientate me to the chamber. I arranged my schedule accordingly and met with him at the scheduled place and time. A delightful gentleman who was so very knowledge and patient when explaining the characteristics of the chamber and answering my questions. He even measured the level of the noise in the chamber at 20 decibels, a value that’s normal for most chambers of this sort (I decided to measure the noise level in my clinic space using a free, noise meter, downloadable app …average reading was 62 decibels). For very simplified explanation about decibels see this link (http://www.howstuffworks.com/question124.htm)

A point of interest: the University of Salford’s Anechoic chamber is measured at minus 12 decibels, unarguably the quietest place on earth and perhaps where one would truly hear the ‘sound of silence’. (http://news.bbc.co.uk/local/manchester/hi/people_and_places/newsid_8224000/8224555.stm).

After the orientation chat the professor took his leave and I had the opportunity to sit alone, with lights turn down, for 25 minutes in the chamber.

I sat on a small wooden box in the corner of the room, back straight, chin slightly tuck in and adjusted myself into a relaxed, steady and comfortable posture.  The first noticeable sound was the incredibly loud ringing in my head; this must be my central nervous system at work, neurons firing away, stuck in old habits and patterns and now wondering where the heck are the familiar noises; the 60 decibels I’m usually surrounded by. The ringing held my attention for a few moments not getting any louder, but not getting any quieter either. 

It was clear hearing the high and low pitches, I had a flash of the Nascar race track and the screaming noise of those super fast cars as they fly by. After a few minutes I slowly and carefully focused my attention to the breath, and with each inhale and exhale the movement of the lower belly. The ringing noise gradually subsided into a background noise as my attention shifted to the sound of breath in the nostrils. At first there was one sound in the nostrils, a deeper sound that was soothing to hear, a sound that I focused on for about 2-3 minutes. Then, I hear the second sound, a higher pitch sound, also in the nostrils, now two sounds occurring simultaneously with inhalation and exhalation, the higher pitch sound in the upper nostril and the lower pitch in the lower nostril. According to ancient yogic Pranayama scriptures, on inhalation the sound ‘so’ is heard, on exhalation the sound ‘ham’ is heard; I continued with breath awareness in the hopes of hearing these sounds… but not today.

My Caribbean backyard

I soon felt my breath slowing down becoming more rhythmic and my lungs were now filling and expanding with ease. I envisioned the movement of the diaphragm, the main muscle of respiration, and which in my opinion, is the ‘muscular switch’ that shifts us into physiologic recovery. As I shifted my awareness to the diaphragm another wave of relaxation rippled through my body, the shoulders, face and neck muscles felt really, really relaxed; my belly softened and I relaxed the organs on the inside. Soon after I became aware of the heart beat, the centre of my chest and the upper ribs moving in synchrony with the gentle but strong lub dum sounds of the heart. These sounds are hypnotic, my mind drifted off riding the wave of the pulse, my entire body was now pulsing, at times the pulsing was so strong it moved my torso, I imagined this wave saturated with my vibratory signature merging with the akashic field and telling my story. Another downshift of deep relaxation, this time it was the eyes, the eyelids relaxed so much they felt heavy as if one was hypnotized and unable to open them; the eyeballs were floating, suspended within their bony cavity, my eyes feel refreshed, my mind revitalized.

rational brain: ‘ it’s about 25 minutes, wrap this up’

blissful brain; ‘ no way, my soul is recharging’

There was this deep inner knowing that I was indeed back home.

Namaste to all,

Stay safe until the next post.

Fall, Fog and Horse as Teacher

What does October mean? Well, Wikipedia’s explanation is as follows:  ‘it is the tenth month of the year in the Julian and Gregorian Calendars and one of seven months with a length of 31 days. The eighth month in the old Roman calendar, October retained its name (from the Latim "octo" meaning " eight") after January and February were inserted into the calendar that had originally been created by the Romans’. Ok then…moving right along…

Fall, autumn, a time when the air is crisp and the leaves transform themselves from shades of green vitality to red, yellow, and orange vibrancy. There’s a subtle energy in this transformation, from life and photosynthesis to death and decay. Perhaps a lesson we humans can learn from nature is to embrace the vitality and vibrancy of transitions be it between the in and out breath, the spoken word, our thoughts or any of the millions of things we do. During my 45 minute walk this morning the light fog swaddled me with a force that lifted by spirits.  What started off as a quick brisk walk after about 15 minutes, transitioned into a more meaningful contemplative reflection about the many things I am grateful for, the lessons I am learning and the transformation of self. I reflected on spending time with family on Thanksgiving and it reminded me of this poem I wrote to my self several years ago:

to discern colors and shapes with clarity and crispness, I am grateful for sight

to enjoy the pleasure of food, drink and nourishment, I am grateful for taste

to be caressed with tenderness, and feel stroking circles, I am grateful for touch

to be aware of breath as it mingles with heartbeats, I am grateful for sound

to recite and quote the words of greatness, I am grateful for speech

I am grateful for the sangha

This weekend our class was held in the red barn; we travelled to Chilliwack to experience the Horse Expo called ‘The Mane Event’ with a particular focus on ‘The Trainers Challenge’. This was a competition between three experienced horse trainers; each had an hour to train their horse to perform

In the Show Pen

tasks such as moving in specific directions on command and crossing over obstacles like poles and tarp. Class readings such as ‘Becoming Horse in the Duration of the Moment: The Trainer’s Challenge’, ‘Experiencing Animals Minds’ and ‘Interbeing and Inter-species Communication’  and the lively classroom discussions prepared us for observing the pedagogical development of the horse human relationship.

What resonated for me during these sessions:

• Observing how each of the horses, on entering the pen, sniffing the ground and tentatively walked around the confines of the round pen, in other words the landscape (penscape). They were getting to know the area
• How the trainers gradually reintroduced them selves to the horse (this session was the 2^nd of three sessions) – lots of rubbing and patting the forehead then progressing to rubbing and patting the thorax and legs
• How the trainers used touch, either gentle or firm, with their hands or other objects (ropes etc) to nudge and encourage the horse into a specific action and then allowed the horse to rest and ‘think’ about what was just done
• How the horse’s attention was maintained by using certain verbal cues, body and hand gestures, or ropes and what appeared to be certain types of whips used either on the saddle or cracked in the air, and
• The repetitive reinforcement of positive speech to the horse ‘ good horse’, ‘good boy’ after successful completion of an action

Each trainer adopted a unique approach in how they developed a relationship with their horse. General impressions:

1^st trainer: overall impression was – more of an authoritarian approach - while the horse completed many of the tasks it appeared the trainer seemed to  ‘push’ the horse to perform the task as opposed to allow the horse to first understand what was asked of him and then to find the confidence to perform the task. At times, I felt too much force was used and the horse actually seemed very scared with obvious changes in breathing patters

2^nd trainer: displayed more of what I expected to see after our class discussions about the flow and transition between leading and following where both horse and trainer took turns at leading and following. This trainer talked a lot to the horse, he allowed the horse freedom in discovering new spaces, take the time to explore the space, and then gently coaxed and nudged the horse to go into the space. What particularly stood out during this session was when the trainer increased the width of the tarp, just after the horse crossed it for the first time, the horse’s facial and body expression was one of ‘bewilderment’. It seemed as if the horse was thinking to itself… ‘what the heck…give me a break I just walked over the tarp, and now you want me to do it again…and it looks wider than before!!!!’  And that was exactly what the trainer did, gently coaxed the colt to cross over the much wider tarp.

3^rd trainer: this trainer was primarily involved in training horses to work on cattle farms where the work of the horse involves quick, sharp, stops and turns. The trainer spent quality time teaching the horse how to respond to head and neck movements using ropes to guide and hold the head in certain positions. His approach was gentle yet firm enough to lead the horse with either ropes/ reins or when on the saddle with cues (gentle heel strikes) on the torso, into certain movement patters such as quick right and left rotations, and backing up and standing still, movements that are useful for rounding up cattle.

What started out as observing the trainers challenge, the interaction of the trainer with the horse, slowly shifted into a lesson with the horse as my teacher.

I reflected on how my behavior at times mimicked that of the horse. During my schooling certain teachers pushed or forced me, and others, to go to places while we were in a state of fear; and then there were other teachers who took the time to allow me to explore and develop trust, offered guidance and walked the path with me. In my own experience as an educator I realized how these past teachers influenced me in my teaching especially since I was now the one taking time to guide others in their learning.

As a practitioner I wondered about which of the ‘training styles’ reflected my practice, and how I developed the pedagogical connection with clients. I realized that perhaps I push certain clients too quickly down a healthy highway without giving them the chance to express their thoughts on what health means to them. With others, they invite the discourse and the challenges with charting a new health direction, while there are those who are contended with their health disposition. I observe that after the Mane event I became more attune to what the client is saying; and more so to what was not said.

When I work with the body the notion of following and leading is very clear. There are times when the body leads and I follow. I listen for breath, observe for movement and sense safety. Sometimes the body moves too fast and I slow things down to allow and invite inquiry and curiosity. When necessary I take the body through new kinesthetic patterns and unfamiliar spaces using verbal cues and gestures such as brisk touch, encouraging words and allowing time to think, somewhat similar tools and methods to those used by the trainers. What is indeed obvious to me is that we humans are not so different to horses, we experience fear, we need spaces for inquiry and discovery, we develop trust and seek safety and, we need a push ever so often. 

As I watched the horses canter around in a confined and very unnatural space I reflected about the man made notion of the social determinants of health. I liken the determinants to the round pen that keeps individuals confined within a space. I wondered if I / society stigmatize and reinforce this stigma of poor housing, low income, non-education etc., onto individuals so they eventually believe that they belong in this round pen/ social pen? Have we considered what effects wars, unnecessary pharmaceutical use, nuclear disasters, natural disasters and diseases such SARS and other contagions have on the social determinants of health?  Just imagine every hour taxpayers in the United States are paying $11.26 million for Total Cost of Wars Since 2001. This number $1,485,468,360---.00 and counting (http://nationalpriorities.org/cost-of/) is what it was at the time of writing this post.

Backyard sunset

How do you even say that number! I wonder what that amount of money can do for the social determinants of health! Perhaps there is a ray of hope and we might touch on this inquiry at our next class in late November.

That’s all for now

Namaste (I bow to the divinity in you) to all

Stay safe until the next post