“Eyes closed everyone. Just be in the moment. No extraneous thoughts at all, only your own sensations. Stay completely in the moment . . . totally relaxed. Soon you will be able to do this anywhere, any time, without even closing your eyes.”
The soothing voice flowed over the group of overstressed health professionals, who were straining to absorb the latest and the best in stress management. Doctors, nurses, and dietitians were trying hard to capture a feeling normally foreign to health workers: total submission to their immediate sensations. But the simple instructions proved difficult for people coiled as tightly as springs, always ready to face the next challenge or assault. Our enthusiastic young physiotherapist tutor looked disappointed and decided to call it a day earlier than expected. As we filed out he handed out printed summaries for us to study later.
As we emerged from the dim interior the issues of the day descended on us like a toxic cloud, filling our thoughts. Although we knew that most of the problems we wrestle with each day are forgotten in a year, swamped by even greater challenges, crises, and threats, the adrenaline flowed into our veins on cue. Trying to empty my mind had merely opened a set of floodgates through which barely suppressed deadlines and imminent disasters flowed unchecked.
During the session I had left one eye half open to see whether the others were doing any better; a few did seem to be in a calmer place. However, I felt that my burden was greater than theirs, for my domestic demands included caring for my elderly mother, herself once an extremely clever and devoted physician. In advanced age she had progressive memory loss, with all that accompanies it. It is not necessary in a medical journal to describe the profound indignities of the ageing process itself, but the final affront had been her loss of the memory of everything that mattered in her life. Some have described dementia as being like slipping back into the dependency of childhood—but facing only further undignified decline, not ascent as a child does.
One night I told my mother of the death of a lifelong friend of hers who had had a major stroke. Having watched my mother become unable to recognise even well loved faces or names, I had considered not mentioning the death at all. She often forgets that her friends are dead and is surprised and upset with each reminder. So I wrote a couple of bland, meaningless lines in my mother’s name on a suitable condolence card and put it before my her, merely hoping she would sign it legibly. She spent some time writing clumsily and then laid the pen aside. Later, when I put the letter in the envelope I had prepared, my eyes filled with tears as I read the words she had written in a relatively clear hand: “Mollie was my dear friend for many years. We wrote to one another often over the years. I will think of her with love, till I too follow her.”
I expected so little of her, yet she wrote something simple and beautiful. I have copied it and left it on my desk, to remind me for ever (till I myself follow them both) that we never really know everything that lies in any human mind. We feel important in our busy jobs but may still estimate poorly what is in the mind of someone with “limited cognitive abilities.” Some of my “retarded” patients are the emotional heart of their family: one girl with Down’s syndrome provides piercing insights into the psychodynamics of her family. As the child of a psychiatrist I spent many childhood years living in mental hospitals, where I often attended Christmas parties with the long stay patients. It was a life full of delightful experiences for a child with no preconceptions as to who or what is regarded as “normal.” Contributions from mentally “impaired” people can far exceed our limited expectations of them and give unexpected insights into the brain’s plasticity.
I followed my mother onto the balcony. She had wandered out there and sat gazing into the trees and garden as she often does now, watching—and yet not watching—the birds and butterflies darting among the flowers. She spoke little, just following the beauty of a bird soaring down to drink from the fountain or the panther-like progress of our cats through the undergrowth. I followed her gaze and realised that she was “in the moment” in a way I had found impossible at the previous day’s session with the physiotherapist.
It was soon time for me to begin my frenetic working day. I left my mother in the early sunlight, quietly absorbing the sounds of the morning. She, who had once been as anxious, harrowed, and busy a medical professional as any of us, had acquired the elusive art of relaxation very late in life. Perhaps most doctors nowadays are doomed to live an overcommitted, fretful life until the inevitable degenerative processes empty our minds of all thought and we discover a similar enforced type of peace. We must accept that our vulnerability is the same as that of our patients and that we all huddle together under the inevitable blows of fate and time. With the great privilege in medicine of sharing our patients’ journeys, we doctors should learn to live more fully the moments remaining to us.
Perhaps most doctors nowadays are doomed to live an overcommitted, fretful life until the inevitable degenerative processes empty our minds