By Mick Krasner, MD
Several years ago, a colleague and good friend, one of the core faculty in the original project that led to what we now call Mindful Practice in Medicine, shared an interesting aspect of how Mindfulness has affected his professional life. A very well-trained anesthesiologist, he entered that field after initial surgical training. Early in his anesthesiology career, he realized that his work-related stress was largely due to how he practiced, which was with a constant vigilance to considering what he would do if the case he was managing turned for the worse. He lived during, and even before, each case within the algorithms; he was taught with their outlined and branching logic patterns as he considered the multiple options from moment to moment during the surgeries. He often felt exhausted and nearly frozen by simply anticipating an upcoming complex case.
That was until he began to practice Mindfulness, and not simply the formal practice on the cushion, but the process of integrating Mindfulness into his actual work, the “real meditation” so to speak. And when this transition process began to take hold, he found that his anxiety and stress levels lessened, at least the downstream effects of living in that constant state of “what-ifs.” As he described it to me, he realized that he was very well-trained and experienced and knew what to do should complications or other challenges arise. His job, as he now understands it, is to be present, to monitor, to notice, to bring as full awareness as possible, monitoring the patient, the team, the room, and himself in the process. And he related to me that it was at that transformational point that he realized he had become an excellent anesthesiologist.
Boyd Varty is a Life Coach and a family member of the founders of the Londolozi Game Reserve in South Africa and has refined the art of using the wilderness as a place for deep introspection and personal transformation. He wrote The Lion Tracker’s Guide to Life. As a student of the world’s most skilled animal trackers, he quoted one of his mentors in the book, a member of the Shangaan Tsonga tribe whose history of lion tracking covers several millennia, “I don’t know where we are going, but I know exactly how to get there.” Within the dynamic of tracking an animal like a lion, the tracker makes a profound commitment to find the animal, working with their (the tracker’s and animal’s) presence from moment to moment, operating with awareness of the signs that the animal is leaving. The tracker does not need to know the outcome but must be completely attuned to what is described as “the next first track,” distilling the tracking process as flowing from one moment of knowing and presence to the next moment of knowing and presence.
As Boyd worked through significant and paralyzing trauma that he and his family experienced, he began to see the tracking experience and his approach to tracking in a new light and as part of a more significant personal transformation. The elements of that healing process for him include the following: 1) Becoming comfortable with the “super uncomfortable” unknowns. 2) As a corollary, letting go of all the ways he tells himself he knows what to do and admits to the statement, “I don’t know what to do.” 3) Developing a more nuanced “track awareness,” which involves attunement to signs through self- and other-awareness and a letting go of what he thinks he needs while syncing with the larger tapestry of information in his life. 4) This allows him to move towards what he finds most curious and what makes him feel most alive, beyond preconceived ideas of what that should look like. 5) As these develop, discovering the ability to enter “the following state,” how to take the next step, to be open, creative, at play, and willing to welcome the inevitability at times of “losing the track.” 6) And finally, integrating the part of him that already knows, beyond cognition or rationalization, of what to do next.
Reflecting on this, I am struck by the similarities with my anesthesiologist friend’s process and by the correspondence to Mindful Practice in Medicine: Attentive Observation, Critical Curiosity, Beginner’s Mind, and Presence. Our professional work as well as our personal lives (the two, of course, are not separate but co-extensive) in so many ways can be thought of as a lifelong tracking practice, from the very specifics of the medical encounter and all that clinical care entails to the broader patterns and movements of our lives. We indeed do not know where we are going at any given moment, but we do know exactly how to get there. In that, we may place our trust.