I believed that the psychologic and physiologic benefits of yoga were as portable as a yoga mat. I believed that when brought into the hospital, it would fulfill its promise to reconnect us to our center and convey the wisdom and clarity we were all searching for. Yoga is, after all, the original experiential learning, why wouldn’t it work in medical education? All of the intangible competencies of medical practice were embedded in the postures and meditative practices. Lessons that would simply lack power if offered as observations or in didactics had the potential to transform when self-discovered.
It’s been difficult watching it fail.
One issue is that it was brought in to augment resilience in individuals, in institutions that weren’t addressing more systemic issues. A physician struggling with the documentation requirements of the electronic medical record is documenting at lunch, not attending yoga. Workload and compression of time dictate the day’s schedule. Additionally, by nature of where and when the courses were offered, the yoga itself was reduced to its barest elements. It was by nature, made reductive.
It’s as if we thought that by bringing in the “asana” physical postures and “pranayama” breathing techniques, we were bringing yoga. But it was never just about the postures and the breath. yoga makes observances such as non-judgment, integrity and balance available to us, but they are not immediately apparent. They require discipline and practice to emerge. Those of us encouraging in-hospital yoga had experienced the transformative power and deep resonance of the messages embedded in the practice. Perhaps our mistake was believing the inherent value would reveal itself even to people who weren’t quite sold on revealing themselves to yoga.
What were we actually hoping yoga would bring to medicine? So much more. The five lessons I most often apply to medicine, all began on my mat.
Lesson 1: non-judgement
In yoga we learn to cultivate space in many ways, but perhaps the most important is the space between the stimulus and the response. By learning to observe the limits of my body’s flexibility without judgement, I — by extension — learn to observe the people around me with more neutrality. I learn to relax into the areas of tension that I cannot be strong without also being soft because strength without softness is only rigidity. Sinking into the resistance, is a metaphor for times in life when we encounter resistance and rather than fight, we first seek to understand. This lesson comes off the mat into medicine each day, as I practice being gently fierce in difficult situations — of having the conviction to be direct and honest with a softness that comes from understanding our shared humanness.
Lesson 2: forgiveness
Understanding that life is a series of cycles of attainment and loss, creation and destruction, growth and disappearance. That, although we are striving for health and happiness, when it doesn’t come, we must bow to the wisdom and the teaching of those experiences. Illness, loss and even mistakes require us to surrender to the experience of pain. Yoga teaches us that suffering is a result of wanting reality to be different. Forgiveness is a spiritual decision to remember the lesson but drop the weight of what constricts us. So much of the guilt and shame that accompanies the complex nature of our field would benefit from dropping that weight.
Lesson 3: observance of emotion
So often we hide from our inherent knowing in favor of habitual, unconscious choices and behaviors. So many of the unhealthy habits that we develop as dysfunctional coping mechanisms in medicine are attempts to avoid difficult emotions. Simply allowing our thoughts, feelings and fears to exist as reality without running from them is necessary for our well-being. Silencing our mind enough to create space to hear our feelings as they bubble up and sit with them — without judgement — allows for acceptance of all emotions. We are allowed to observe them and invite them in and asking: “What are you here to teach me?”
Lesson 4: balance
Balance isn’t easy to obtain. And it isn’t found, as many in medicine have tried, swinging from one extreme to the next. Long shifts countered by excess and chemical numbing. Balance is actually a far more active pursuit than we have been taught to believe. Balance comes from discipline. It comes from making choices mindfully and embracing the time you are spending in each space — being fully present. Balance in yoga relies on focus and attention. Drop either of those and you will fall out of the pose. Balance is also about how you use the ground to lift you and give you buoyancy. How we find strength in purpose that lifts us into other areas of our lives where we can create and be expansive. And that is sustainable and nurturing balance.
Lesson 5: intention
In yoga we begin each practice by setting an intention for ourselves. An intention asks that we bring our attention to a quality or virtue that we wish to cultivate. By setting an intention we connect what we work through on the mat, and what we continue to focus our mind on when we step off. It’s an energetic way of taking the practice into the world. This practice is not limited to yoga. In life, we may work with intention, in service of a noble purpose greater than ourselves. We may choose as we enter an exam room to remind ourselves of our intention,and — for those few moments — work with an awareness of who we choose to be. We may remind ourselves that it is the energy we choose to bring into each encounter that has the power to change the lives of others. Often far more than any medication we can prescribe.
Everything we desire, of ourselves and of our colleagues is available to us. We just have to unlock the practice.
Rana Awdish is a pulmonary physician.
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