IT’S ALL YOGA by Aynsley Forsythe

“You can’t connect the dots looking forward, you can only connect them looking backwards. So you have to trust that the dots will somehow connect in your future. You have to trust in something- your gut, destiny, life, karma, whatever. Because believing that the dots will connect down the road will give you the confidence to follow your heart, even when it leads you off the well worn path.” -Steve Jobs

I learned to meditate with an app on my phone. I started with 10 minutes a day, usually at 5 am when it was still dark out and everyone in my house was still asleep. During the first session, I felt what I can only explain as a feeling of…… coming home. I remember thinking, “This is it. What I’ve been looking for on the outside has been here, in this silence inside me, all of my life.” For the first year, I never missed a day. Meditation was a life preserver tossed to me in a time when I was seriously sinking.

After I became a mom, I crumbled under the pressure of balancing work and home life, not to mention keeping up with the insane social standards my generation sets for themselves. I felt like I was running on a hamster wheel, trying to raise tiny humans while working and making sure my life held up to the standards of others. I remember washing the dishes one day after about my 4th cup of coffee. I was willing my hands to go faster because my to-do list was still endlessly long and I just couldn’t see how I would find the time to get it all done. As tears streamed down my face, I remember thinking, “This is not how I’m supposed to be living. Where is the peace? Where is the happiness and gratitude? I’m barely keeping my head above water- I want to enjoy my life, all of it, before it’s too late.”

When my youngest child was about 1, I listened to a podcast about the founder of an iPhone App for meditation called Headspace. I was so taken with the journey and wisdom of the young founder whose name was Andy Puddicomb. He had been a buddhist monk for several years and had a deep desire to share the benefits of meditation with all sorts of people, not just monks. He dreamt of a widespread way of sharing what he had learned as a monk with people in households so they could find better conflict resolution and contentment in their lives. I downloaded the app and adopted the practice of meditation into my life. My practice has since morphed into other disciplines like yoga and pranayama and I have gathered knowledge from many wise teachers.  

From the beginning, there was no doubt that I had adopted a wonderful practice that improved my life in countless ways. It was unbelievable to me that from just 10 minutes a day, i was able to slow way down, get rid of extra things, commitments, and even people who did not line up with the still, small voice I had found as my compass. I was able to really BE with my children, and not just be near them while my mind was still away somewhere else. I began to sleep better, I changed my diet and abandoned many unhealthy crutches and habits. My relationships with others changed. I slowly began to drop judgement of others and foster deeper compassion for all people. I began to see that every person was suffering in their own way and that each was doing the best they could with what they were given. When I look back, I laugh because I began meditation to slow the chaos and find peace in my home life. It never occured to me that the benefits of meditation would spill into ALL areas of my life.

Yet, changes started to happen for me at work. I began to notice that I was more focused on caring for patients and less about issues at home or issues with other staff. I could be more fully present for patients when I entered the room. It became more about them and their needs, and less about any agenda or power struggle on my end. I began to foster deep connections with my patients and was able to better serve them from a place of neutrality and compassion. I also had a lot less conflict with other staff and I could be way more direct in asking for what I needed. I was also less nervous in the room with family members and when doing patient teaching.  

Physically, I noticed I was less exhausted on the days that I did my meditation practice during my lunch break. I also had more reserves to give my family when I got home. It was abundantly clear that in doing meditation as a form of self care, my experience at work improved. I wanted to share this my co-workers.

During this time, I had also begun getting reiki therapy as a form of self care. I became a Reiki master hoping to use it on my children to make bedtime calmer and help my family feel more balanced. As with meditation, I didn’t consider using Reiki therapy at work. As a nurse, I had never been interested in healing touch or massage. I just wanted to focus on direct nursing care. Yet, I almost immediately noticed many areas that Reiki could be beneficial for patients and even other staff members. For those of you unfamiliar with it, Reiki is a form of energy medicine; it works in a way similiar to acupuncture. Reiki originated in Japan and was closely guarded as sacred, so it’s use has not been very widespread until recent years.  

The energy is channeled through the hands of the practitioner, and it provides relaxation and healing to the person receiving it. While Western medicine typically focuses on eliminating or changing a disease process through drugs, surgery, or radiation, Reiki seeks to provide a direct connection between the positive healing energy thought to exist in the environment and the recipient’s energy. Reiki allows energy to work with the body’s innate intelligence to improve energy flow and balance. It can be used on both healthy and ill persons.

In the west, The description of Reiki sometimes sounds too esoteric for our minds to grasp. Our western medicine model is intellect-based, requiring that our modalities be able to be seen or to be studied with a microscope. Reiki medicine is energy and can be felt but not seen with the naked eye. Reiki also comes steeped in tradition to preserve the sanctity of the practice. For these reasons, Reiki has been difficult to integrate into western healthcare.

Personally, I immediately saw a use for Reiki at work. Patients would frequently come in before surgery in an extremely anxious state, just watching the clock until it was time for them to get “something to relax” in the form of medication. The nursing staff, surgical team, and anesthesia teams would come at the patient from all sides to carry out various duties getting them ready for an operation. Because of a tight schedule, there is little time allotted for staff to spend quiet, one on one time with a patient that is about to undergo a painful procedure. This seemed like a great place to offer Reiki to relax patients and help them feel connected.

In the post-operative area, where patients were waking up from surgery, I would feel helpless while a patient was in pain or very anxious. Reiki therapy was something I could do while I was waiting for the doctor to see them to prescribe another medication to calm them down or help the pain. At this time there began to be national press coverage on the opioid crisis and the way we use narcotics has changed drastically. Recently, the city of Boston has charged all of the major hospitals with putting together a “tool box” for non-narcotic pain and anxiety management and a symposium has been formed to do this.  

A member of the MGH pain team that is on the symposium, came to the PACU to chat with nurses about the tools they were exploring. Mass General was closely looking at things like video games for distraction and virtual reality headsets. Although Reiki would be one of the primary pain and anxiety tools looked at, Mass General itself had not yet explored it as an option. My own investigation into other hospitals led me to discover that Dana Farber, and Cancer Treatment Centers of America actually send their nurses for Reiki certification in large numbers and it is widely used on the patients. Brigham and Women’s Hospital also has a well organized Reiki presence. I also learned that Children’s hospital has a large Reiki presence for both patients and families, and even has used Reiki as an anesthetic to perform minor procedures. As a bonus, Wellness practitioners even lead nursing staff in weekly meditation class every wednesday morning. With the benefits I was seeing in my own life through my meditation and reiki practice, it became apparent that there may be a place for these practices at work as well.

Typically, Oncology patients at MGH have access to Integrative therapies such as acupuncture and massage, but this is not available to other patient populations. In the case of surgical patients, standard procedure has been that when a patient receives a phone call before surgery, they are asked briefly if they are interested in alternative therapies without a real explanation of what these are. In the recent past, If a patient asked for Reiki, the PATA nurses (or Pre-admission testing nurses) then sent an email to the one Reiki nurse that they all knew, and IF she was on that day, and IF she had time, the patient may get reiki. Elsewhere in the hospital, many clinicians stayed after their shift or used their lunch break to give Reiki to patients on a volunteer only basis.

 Usually these patients were selected by nurses; as someone who was failing despite all other methods we had tried, as someone who had lost hope, or someone who just needed that extra staff attention and one on one connection. General surgery nurses even set up a system where they would text one of the nurse practitioners who was a reiki master, and she would get to the patients after her shift. Sometimes, after 6 or 7 phone calls to various places, the floor nurses would track me or the other reiki master in the PACU down. We would go see the patient on our break or after work. If the patient was one of our surgical patients, and somehow we heard about the Reiki request, we could see the patient if we had coverage for our other nursing duties. As it is now, there is no system in place to generate a list of patients who ask for Reiki. It gets passed to us by word of mouth only. Given all of the afore mentioned circumstances, I felt there was a great need to make reiki more accessible to patients.

I drew up a project proposal and presented it to my nurse manager. My project was called the patient and Staff Well-Being Committee. It would be comprised of PACU nurses and would embody, promote and distribute a presence of wellness through the practices of Reiki therapy and mindfulness-based techniques for reduction of pain and anxiety in perioperative patients. In short, it would make Reiki more accessible to patients and create an awareness of mindfulness and meditation in staff members for both their own benefit and eventually the benefit of the patients.

My hope is that in using the PACU as the cornerstone for these practices, MGH at large will also benefit from and have access to them. Right now, the committee is working on certifying more nurses in Reiki therapy, keeping a list of those practitioners readily available in each PACU to decrease any chance of a request being lost, and educating the staff on what reiki is so that they may better identify what patients might be good candidates. We are also actively trying to educate the anesthesia teams on Reiki therapy so that they can have an awareness of it, and perhaps identify patients that could benefit. We organized a Reiki day so that we could give as many anesthesia providers Reiki as possible. Reiki is easier to understand by experiencing it. Members of the Anesthesia team have a tight schedule and could not free up any time to come for Reiki though, so currently I am trying to get around to them one by one. They can’t avoid me forever.

My hope is that eventually Reiki will be something we actively offer during the pre-op phone call and admissions, that a list of Reiki patients is generated each day in EPIC and distributed to on-call practitioners, that practitioners are given a space in epic to document treatment and efficacy, and that once a patient consents to reiki that we ensure that time is actually allotted for it. Last year I was taking care of a young woman in pre-op area. She was an MGH nurse who had a medical history of anxiety and was on medication at home for anxiety. This patient became incredibly tearful and anxious in the pre-op area, despite having taken her anxiety medication prescriptions. I offered her Reiki and she was thrilled and grateful to get it. Yet as the session began, we were continually interrupted by the surgical, anesthesia, and OR teams that needed to see the patient before her procedure. The patient was not able to receive Reiki. Once someone consents to Reiki, and the staff have more knowledge about it, hopefully we can purposefully allot the time for it.

Besides the PACU, there are other Reiki practitioners scattered throughout the hospital. They are still operating on a volunteer basis, without leadership structure, recognition from the hospital, and with rudimentary documentation options. Hopefully the work of the committee will be able to help the hospital-wide Reiki therapy presence in gaining unity and structure.

Another branch of the Patient and Staff Well-Being committee is dedicated to helping the staff to learn mindfulness and meditation. Mindfulness has certainly became a buzz word, we hear it used all the time. Is there a difference between mindfulness and meditation? Both are practices in themselves, but the way I like to explain it, is that meditation is the exercise you do in order to be more mindful.

Meditation is a way of training your brain, so you can then be more mindful in all areas of your life and therefore more fully present. So when you meditate, it’s like going to gym for your brain, and mindfulness is the benefit you reap from that. Yet mindfulness is also an exercise in itself. It’s a way of practicing being in the present moment more than being lost in thought. Simply put, you are using reminders that are short and small, usual something habitual like opening a door, eating, or taking a walk, to come fully into your body. You do that task fully and with all of your attention, instead of doing it but your mind is elsewhere like on your to-do list or rehashing an argument with your husband or something.

Meditation itself comes in many different forms. It has no religious affiliation, although many religions use it as a cornerstone for their practices. Modern Science is catching up with the benefits of meditation and more and more studies are being done on it. They have found that through the practice of meditation, brain activity is redirected from the limbic system to the prefrontal cortex; basically from the reactionary part of the brain to the rational part of the brain. This change causes us to "change the way we react to everything," and enables us to rely more on our executive functioning rather than impulses. Plainly speaking, we begin to response consciously and not just react impulsively.

Many large companies have their employees doing meditation to improve focus, prevent burn out, be more efficient, and be happier and healthier. Companies like Google, Nike and Apple all provide employees with access to meditation training. With the nature of our work in the hospital, this practice could be incredibly beneficial for all sorts of staff. As I mentioned earlier, it could help with conflict resolution, improve quality of work life for employees, and improve patient’s hospital experience. I am happy to report that our committee has applied for a research study that will study the effects of a mindfulness practice on PACU nurses. I am hoping that this will help introduce staff to a practice that will decrease stress and foster coping skills, not just at work, but in their personal lives.

Mindfulness and meditation would be an excellent adjunct to direct patient care as well. I had a patient in the pre-op area who was growing increasingly anxious waiting for surgery. I offered her Reiki but she declined. Wanting to help in some way, I then offered to lead her through a guided meditation. It was a simple meditation and something that other staff could even read from if they had a script. The patient grew increasingly calm and eventually even fell asleep. She felt supported by the hospital staff before surgery, physically relaxed and we were able to avoid additional medication administration for anxiety.

I owe the creation of this committee and it works to the moment that I allowed the practices that were very private and sacred to me to touch the other areas of my life.

There was a time when I would practice meditation, and then I would proceed through the rest of my day, keeping the two separate. I hoped that the few quiet minutes I spent training my mind would assist me in everything the rest of the day had in store for me. It did. It offered a fraction of more space between me and all of the circumstances I encountered. Yet, inevitably, the lines between my meditation practice and the rest of my life began to blur. My practice carried over into the way I raised my children, the way I spent my time, and how I conducted myself at work. Sometimes when I find myself hurrying to get to my meditation practice, I have to laugh at myself. I am hurrying so that I can relax.  

The great spiritual teacher Ram Das has been known to say “It’s all Yoga” when referring to our dharma... or life’s path. The yoga he is referring to here is not the trendy work out class that you need expensive pants for, it is the union between you and your divinity. Yoga comes from the sanskrit word “Yug” which means yoke or unite. Yoga really means uniting individual consciousness with Divine consciousness, or uniting our individual experience of reality with the essence of truth (something we can find when we quiet the mind and reconnect with the source within). Ram Das asks us to explore the ways in which every task we are presented with and every person we encounter becomes a chance for practice. Our yoga is how we respond to the challenges we face in our lives. Perhaps there is room for us to add space to our reactions when things get tough.

The truest work we will ever do is not on the days when everything is going right, we feel great and have a lot of help. The truest work is actually not even done on our meditation cushion. The truest work of our lives happens when we are spread so thin we actually have no idea how we will ever move forward in one piece. It happens during times of personal trial, when no one is watching, no accolades are being given. It happens during grief, the loneliest path we will ever walk. I never thought my practice would move from the cushion out into the world and have an impact on my children, my friends, my co-workers, those in my care. But it is truly all yoga.  

From my own journey, I urge you to look at the ways in which your own spiritual practice may better serve you if you take it off your proverbial cushion and allow it to flow into the other areas of your life. It can seem a little vulnerable and scary at first. I always tell people that allowing my personal practices to flow into all parts of my life has moved my experience from black and white to technicolor. It has brought me the deepest satisfaction I have ever known, but MOST importantly has allowed me to serve greater numbers of people, more fully and with joy.

I’ll close with a quote by motivational speaker Emma Tiebens. “Going inward. That’s the real work. The solutions are not outside of us. Get to know who you really are, because as you search for the hero within, you inevitably become one.”