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Take Care of Your Life, Take Care of the World
Seeing My Own Limits with Compassion
All the passages below are taken from the book,” Being with Dying: Cultivating Compassion and Fearlessness in the Presence of Death” by Joan Halifax. It was published in 2008.
IN BEING with dying, as in the boundless abodes, we’re asked to offer loving-kindness not only to those with whom we work, but also to ourselves. Just as a mother can care best for her child after her own needs have been met, it’s crucial that we recognize our own limits with compassion--in the same way that, in an airplane crisis, we’re instructed to place the oxygen mask over our own face first before we try to help those around us.
Keeping your personal life together is not an optional indulgence but an absolute necessity when it comes to being of use to others in the world. We aren’t separate from everything else; when we suffer, others suffer. Our well-being is the well-being of others. So make time to connect with your heart, for as the Zen saying goes, “If you take care of your mind, you take care of the world.”
When you have not seen the light of day in a month except for the short walk between your house and your car, when you find dishes in the sink from last week and laundry in a mountainous pile, stop. Take a time-out. Clean up the messes, bring order to the chaos around you, and consider what you can do to bring things back into balance. Especially when working with the dying, you need your home to be a refuge, a place in which to rest and restore yourself, a sanctuary in which you can be nourished and safe. If you try to cut corners by ignoring your personal or domestic needs, you might eventually pay with your sanity and health.
In addition to your literal home, another precious place to take refuge is within a contemplative practice. Without this inner home--an uncluttered place into which we can retreat and close the door for a time on all the dramas around and within us--our lives will be limited by the conditioning that drives us, without our even knowing it. A spiritual practice offers a concentrated, still place in which to cultivate calmness and kindness toward ourselves and others, and can bring insight as well as refreshment.
Here are a few good principles for self-care:
· Set your limit with compassion
· Set up a schedule that is sane.
· Know what practices and activities refresh you, and make time for them.
· Actively involve, include, and support other caregivers.
· Develop a plan for doing your work in a way that is mindful, restorative, wholesome, and healthy.
I once worked with a hospice nurse who had a hard time taking care of herself. After we talked, I suggested she direct loving-kindness to those parts of her life that felt the most worthless. This was difficult for her precisely because she felt so undeserving, but finally she agreed to practice with the phrase “I turn toward my suffering with kindness.” When we feel psychologically impoverished, it’s initially not easy for us to take care of ourselves. But after a while, she felt able to add, “May I be happy.” So she practiced breathing in and breathing out while saying these phrases to herself--in the morning on waking, while she drove to her hospice job, as she walked from one patient’s room to another’s, while falling asleep at night.
Slowly, as she became comfortable with sending herself kindness, she began to say these phrases to herself while actually working with patients. And eventually, she felt ready to turn her heart and mind toward those with whom she worked, sending them loving-kindness. But long before that became possible, without any conscious effort on her part, her spirit naturally began to brighten. Her love and concern for her patients arose from a more genuine place, one that was well rested and brimming with self-respect. Her faithful practice of self-care led directly to her increased availability as a caregiver.
All of the world’s spiritual traditions share a belief in the importance of non-harming. Yet we often forget that non-harming doesn’t just apply to others, but to ourselves as well. You harm yourself when you neglect your own needs, and you create harm for yourself in hurting others through your self-neglect. If we really value this precious human life each of us has been given, then we will take care of it, helping others indirectly just as much as through direct service.
A physician I knew turned his attention to practicing self-care only when he found himself passing through a long valley of depression. When he started gaining weight, having difficulties sleeping, and looking out at the world with eyes of despair, he wondered what to do. He felt trapped in a dry, gray, dusty corner of his mind, and began to think he didn’t deserve to care for others any longer. He admitted to me, with great honesty, that he could barely tolerate his patients and saw them as a burden. He had worked too hard, seen too much suffering, cared too little for himself, and had a big dose of compassion fatigue. Yet even in this emotionally desolate place, he somehow knew his pain wasn’t permanent. He wisely recognized sadness and fatigue for what they were: invitations to slow down, to give more attention to his life. He cleared his calendar and, in spite of his painful inertia and busy schedule, made himself go on a two-week hiking trip in the mountains of southern Colorado.
One evening at sunset, in the blue and red dusk of the San Juans, he suddenly began to cry. He had never mourned the death of his own father, or wept for the many patients he had lost. The precious road of grief opened for him in those mountains. Face wet with tears, he vowed to give himself the necessary time to turn toward the well of sorrow--the only way, ultimately, he would be able to retrieve his heart of compassion.
Too many professional caregivers experience burnout when their medical institutions push them. You often see professional caregivers being financially rewarded for working overtime or taking on the night shift. And this kind of overwork inevitably results in the very numbness that makes it almost impossible to perceive an institution’s dysfunctional work demands and expectations. Stress, exhaustion, and numbness become a vicious cycle in which both caregivers and patients--and ultimately, institutions themselves--suffer.
Caregivers also burn out when they believe they don’t do enough for their clients and overcompensate in response. A hospice worker who loses a patient may feel so guilty that he redoubles his efforts on behalf of all his other clients. When such fear and guilt drive our urge to serve, they have the power to destroy us. Over the years I have met far too many former health-care professionals who have left their jobs because they don’t know how to break the cycle of overwork or they are burned out by secondary trauma. They were simply used up. Most of us only realize our limits once we have gone far past them; a professional caregiver may already be dangerously fatigued or ill herself by the time she realizes she’s used up. At that point, leaving caregiving altogether is often the only solution.
Family caregivers, too, suffer burnout just like professionals. The same fear and guilt, added to inadequate financial resources or community support, can tip the balance for a caregiver who may already feel unbearably alone in caring for her loved one, and can lead her to depression, anger, despair, and even abuse or neglect of the dying one. But if caregivers find ways to respect their own limits, acknowledging them with compassion and sensitivity, they can offer powerful and loving assistance in the right proportion to their own priorities.
I was very impressed when I observed Michelle helping take care of a man who was dying of AIDS and needed both physical and spiritual support. Michelle spent several hours a day looking after some of his basic needs, including cooking and cleaning, bathing him, and making sure he took his meds. His partner also had AIDS but was not as ill.
Each morning when Michelle arrived, she brought a sense of order into the house. She did the simplest things easily and quietly. When the practical tasks were attended to, she would sit with the couple and listen to them talk about their concerns. Then the three of them would spend time together just being quiet. Occasionally, I too was there during these quiet times. The house was clean and peaceful, and the four of us would sit on the bed or near the sick man while he rested. No one felt the need to do anything, including talk. After a while Michelle would leave, slipping out of the room without a goodbye.
One day I asked Michelle how she took care of herself. She said that, first of all, she never stayed longer than three hours with her friends. She had created a sane schedule, one in which others stayed with the men so that she could let go of them when it was time. She also had a daily meditation and exercise practice, and she made sure she got plenty of sleep and regular meals. Her serene, humble presence, without a doubt, contributed to the deep feeling of calm that surrounded their home.
Michelle’s friend died first, very peacefully; and then it was our job to support his partner through his grief and his own dying, which followed some months later. Again, Michelle was involved in a kind and measured way. She was present for that death, along with other friends--a death as peaceful as his partner’s had been. Michelle’s contribution to the whole situation was profound. She helped to create an atmosphere of sustaining peacefulness that touched everyone. Her way of caring for others was simple, clear, and inspiring. And she did this by having clear boundaries and a set schedule, gathering others to help, and taking kind, compassionate care of herself.
Michelle knew herself well. She wanted to give her friends the best care possible, and she knew that this would require pacing herself, so she set up a system that worked for her friends as well as for their caregivers. In working with a dying person, it helps to establish a strategy that builds in pacing, a rhythm of care and self-care that will permit us to be fully present instead of strung out and stressed.
Like Michelle, we need a reasonable, responsible plan; without one, we can be pretty sure that self-care will probably remain low on the list of priorities. When we train professional caregivers, we ask each person to create a plan for how they will take care of themselves when they return to their jobs--and a few months later, we mail them a copy as a reminder. One busy New York nurse created the following plan for herself, and kept a copy on her fridge at home and in her mailbox at work so she could review it regularly:
Body: Stretch fifteen minutes in the morning on rising and in the evening before bed. One-hour yoga class on my day off. Fast walking to and from work twice a week. Dance aerobics class every two weeks. Less junk food! Eat mindfully. Eat healthy foods on a regular schedule of meals and snacks. Take daily vitamin supplements.
Mind: Cut down on TV and morning newspaper. Read more in the fields of psychology, philosophy, spirituality, complementary therapies. Look into holistic nursing. Go to a museum and read a really good book at least once a month.
Spirit: Investigate mindfulness-based stress reduction program. Sit quietly after morning and evening stretching. Find a meditation group and participate at least twice a month. Practice walking meditation and sitting with patients. Go on retreat once a year. Explore all this with colleagues.
Psyche: Continue therapy. Start a nurse support group addressing grief and burnout.
Social: Have more fun!
Of course, your own self-care plan will be different, depending on your personality, needs, and circumstances; maybe you need more snacks and less reading. My own experience has been that regular vigorous exercise and a strong meditation practice are absolutely essential for grounding and stabilizing our energy, especially when we feel fatigued or vulnerable. But the point is to have a plan that will work for you, incorporating islands of care and nourishment throughout your life. Find ways to remind yourself to do these things for yourself, and learn to forgive yourself when you fail to remember.
A social worker wrote me the following note after the Being with Dying professional training program:
One of the messages I got from our meeting was to focus more on my own contemplative life, so I’ve been building a solid and dependable meditation practice . . . powerfully simple and helpful. I’ve also been attending the palliative care service at my hospital, and daily I practice the art of straight talk and silence.
I also highly recommend working with a partner. We all need support and feedback, but too many caregivers find themselves working alone even within a team. Working in twos makes it possible to offer a richer and more flexible kind of support. Coworkers can support each other during complex situations, evaluate each other’s work and make constructive suggestions.
The more peaceful and accepting caregivers are, the more helpful we can be to dying people. So recognize your limits with compassion; share your joy, stability, strength, openness, and humor; help to create a strong, supportive community; and above all, don’t neglect the practice of self-care. If you really want to take care of the whole world, start by taking care of your life.
Bringing together the strength of equanimity and the tenderness of compassion, the courage of presence and the openness of surrender, the following practices can nourish healthy caregiving practice as we offer our lives to the well-being of others. In the experience of giving care, there is a delicate balance between opening our heart endlessly (compassion) and accepting the limits of what we can do and how we and others feel (equanimity). Most of us need to cultivate this balance between compassion--the tenderness of the heart in response to suffering--and equanimity--the spacious stillness that accepts things as they are. The balance of compassion and equanimity allows us to care without becoming overwhelmed and unable to cope because of that caring.
The phrases we use reflect this balance. Choose phrases that are personally meaningful to you. Remember to find as comfortable a position as possible, and to take a few deep, soft breaths in order to let your body settle. Bring your attention to your breath and silently repeat your chosen phrase.
· May my love for others flow boundlessly.
· May the power of loving-kindness sustain me.
· May I find the inner resources to truly be able to give.
· May I remain in peace and let go of expectations
· May I offer my care and presence unconditionally, knowing it may be met by gratitude, indifference, anger, or anguish.
· May I offer love, knowing that I cannot control the course of life, suffering, or death.
· May I see my limits compassionately, just as I view the suffering of others.
· May I accept things as they are.
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