Latest / Flourishing in Medicine: From Surviving to Thriving / Flourishing in Medicine: From Surviving to Thriving Episode 7 Cynda Hylton Rushton, PhD, RN, FAAN

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Flourishing in Medicine: From Surviving to Thriving Episode 7 Cynda Hylton Rushton, PhD, RN, FAAN · Flourishing in Medicine: From Surviving to Thriving

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Welcome to Flourishing in Medicine from Surviving to Thriving.
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I am your host, Dr. Mick Krasner, and this podcast is brought to you by EmPRO, a medical
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professional liability insurance carrier headquartered in New York State whose deep commitment and
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actions to support physicians include many wonderful learning opportunities, this podcast
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being among them.
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Today I'm very excited to share with you my conversation with Dr. Cynda Rushton, the Anne
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and George L. Bunting Professor of Clinical Ethics and Professor of Nursing and Pediatrics
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at Johns Hopkins University.
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Cynda is an international leader in bioethics and nursing.
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She co-chairs the Johns Hopkins Hospital's Ethics Committee and Consultation Service
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and is a founding member of the Berman Institute of Bioethics and co-led the first National
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Nursing Ethics Summit that produced a blueprint for 21st century nursing ethics.
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She was a member of the National Academy of Medicine's Science and Engineering Committee
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that produced the report, Taking Action Against Clinician Burnout, a systems approach to professional
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well-being and is co-creator of the mindful ethical practice and resilience academy, MEPRA.
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The recipient of many awards, she received the Marguerite Rogers Kinney Distinguished
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Career Award and the Distinguished Researcher Award from the American Association of Critical
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Care Nurses.
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She's the editor and author of the book, Moral Resilience, Transforming Moral Suffering in
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Health Care and co-creator of the Rushton Moral Resilience Scale.
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Her involvement as a student of Roshi Joan Halifax and as a teacher at the Upaya Zen
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Center has contributed to her phenomenal capacity of not only articulating but also embodying
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the role of curiosity, integrity, and compassion in the health professions.
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A champion of health professionals and the patients they serve, please enjoy this wide-ranging
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discussion of who Cinda is and the very practical ways her thoughts and actions can help us
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all to flourish in medicine.
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Well, it's so really nice to see you, Cinda.
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It's always nice to talk with you.
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We have so much to talk about today.
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And what I'd like to do as a way of beginning is to hear a little bit about what experiences
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led you to enter healthcare in the first place.
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You know, the work I've done with colleagues, with students, with other teachers, clinicians,
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etc., I found some fascinating stories about what really sort of inspired them to move
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into healthcare.
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Some of these stories are related to some early experiences.
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Some of them are related to things that happen further on in education.
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But I'd love to hear what you're, we could call it an origin story is related to your
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work in healthcare.
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Well, Mick, that's an interesting question because, you know, a lot of times we choose
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our professions, but I really feel like this one chose me.
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I knew I was going to be a nurse from the time I was probably 11 or 12.
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I started when I was in high school working in our physician's office, filling pill boxes,
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cleaning syringes, and then doing statements just so I could be around patients.
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And then when I was in high school, they had a program where you could get training as
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a nursing assistant.
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So I took that course and at the end of it, we had a really small community hospital that
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four of us got to be assigned to.
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And I was one of those.
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Well, I thought I had just arrived because I was in the hospital and had the chance to
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start taking care of people who had had surgery.
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And you know, I didn't know anything really.
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And I loved it.
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I absolutely loved it.
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I loved the complexity of it.
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I loved being with the people.
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And you know, here I was probably 17 and I learned about, I saw my first code, my first
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death.
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And at first, you know, I was terrified, you know, like how do you manage all of this?
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And then I found I was actually really curious about how do you support people through those
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periods of time?
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You know, I went to nursing school.
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I worked as a nursing assistant all through nursing school and midway in that process,
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I had started out on the adult cardiovascular unit, loved it.
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But this is it.
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I love this.
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This is what I'm going to do.
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And then they informed me that that unit was going to primary nursing and we weren't going
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to need nursing assistants anymore.
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And so my choices were psych or PEDs.
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I was like, wow, I don't know if I want to do either one of those.
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So I said, okay, well, I'll do PEDs.
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Well, of course, I loved it.
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I thought it was the home run because you could be with kids and they don't want to
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be sick.
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And they were incredibly adept in teaching you what you needed to learn.
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And so that launched me into pediatric ICU when I graduated.
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And it's just gone on from there.
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You know, I found myself drawn to the hard cases.
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I wasn't afraid of the messiness.
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And then as a clinical nurse specialist, I often was with families having to make hard
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decisions.
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And that was what sort of drew me into the ethics work of how do we help people make
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decisions they can live with?
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And of course, right alongside that was how do we accompany them at the end of life?
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And you know, in pediatrics, children aren't supposed to die.
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And yet they do.
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And so in 1999, I had an opportunity to have a fellowship where I ended up going to UPIA,
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Zen Center and participated in the Being With Dying program.
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And that was one of the sort of threshold moments in my career of sort of pivoting my
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whole approach to how to be with people, children, families, adults, through that period of time
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at the end of life in a very different way.
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And it's gone on from there.
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Wonderful.
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You know, some of the words that came up for me as I'm listening to you is a lot of curiosity
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that was there from an early point, excitement, compassion and caring.
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The ethics were kind of built in, as you saw practically that being applied.
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And then what we could call beginner's mind as well.
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Can you maybe talk a little bit about how those elements, that beginner's mind, that
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excitement that you describe is still alive in you?
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And what brings it out for you most?
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That's really interesting because when I think about the first time I went to UPIA, I had
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no idea, absolutely no idea what I was going to be stepping into.
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I had never been in the Zen Center in my life.
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I had never meditated.
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I didn't know what I was doing.
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And yet it was the best way to go because I didn't have a lot of expectations other
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than I'm on a big adventure here.
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I hope it turns out well.
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And of course it truly was life-changing.
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To be able to be in a place of receptivity, I think I was very open to receiving what
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was there.
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In many ways, it was a validation of what I had intuitively and instinctively been doing
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with children and families before that.
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And so there was a kind of nourishment that came from that experience that has propelled
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me over and over again.
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When I think about the work that I do teaching and chairing an ethics committee, going back
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to those places where we can be nourished has been how I have sustained myself during
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my whole career.
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So there's the work that you do and the challenges that you're in, but having that place where
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you can go back to again and again, and UPI has really been that.
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To sort of get reoriented and recalibrated, having a chance to really pause and see what's
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true now, it has also really, I think, propelled my curiosity.
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I've always wanted to understand things in a different way.
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So what else is going on here?
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And well, what else is true besides what we keep repeating or what seems obvious?
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And so that has been really generative in terms of just trying to think about, for example,
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the work that we've done now for decades looking at the issues of moral suffering and how much
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time we spent describing the problem.
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And then I kept asking myself, so what else is possible?
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Is it that we have to be stuck in this suffering forever or is there a path forward?
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And that was where it really started the journey in trying to understand this concept of moral
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resilience and how we could actually preserve or restore our integrity in response to these
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inevitable ethical challenges and our work as clinicians and how we might be able to
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actually leverage those qualities in ourselves as a protective resource, not to turn away
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from the hard things, but actually to meet them in ways that didn't degrade our health
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and wellbeing and our integrity in the process.
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And so that's what I've been kind of wallowing around in now for, I don't know, eight or
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nine years, trying to see how we can help clinicians to access what's already inside
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of them that they've maybe forgotten and to amplify that in ways that helps them to be
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whole but also helps to sustain them in their professions.
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I'd like to come back in a bit to your work with moral resilience, moral suffering.
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I was hoping you would go there and we can talk a little bit about that.
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In particular, I think listeners would be curious to hear about the Being With Dying
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program and the GRACE program there.
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But also if you can share your own understanding from your lived experience about the connection
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between the contemplative practices and flourishing as a health professional, nurses, physicians,
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other health professionals, that connection for you, what it's been like and how you see
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that maybe as being applied more broadly in whatever way it can be.
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Yeah, the connection to our flourishing and contemplative practice, I think, is a really
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important one.
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And it's unfortunate in some ways that that set of practices has been sort of relegated
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as optional rather than absolutely central to who we are and how we can be who we are
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in our roles as clinicians.
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We know for sure with all the research in neuroscience that when our minds are dispersed
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and distracted and just unfocused, it uses a lot of energy that we don't have available
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to us to use in our work in ways that are really beneficial to ourselves and others.
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And so the practices of being able to notice what's happening in the moment, to be able
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to calm our nervous system using things like breath and attention and awareness, and also
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to be able to cultivate the qualities that in Roshi Jones' approach to compassion that
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allows compassion to arise.
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And how we do that, not only on the cushion, that's very important, but in our day-to-day
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moments of how we show up and how we are in the world and how we can use those practices
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in the midst of confusion and chaos and uncertainty to help us come back home to really having
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a more clear and intentional stance where we make decisions and how we exercise our
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actions.
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So it has really, as I look over my own experience, the more that I have practiced, the more resources
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I feel like I have and that I can access them more easily.
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Of course, any new skill requires practice.
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That's why we call it practice.
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You never really get anywhere, but the practice is so important because it does build those
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neural pathways.
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And then the stronger they are, the more accessible they are.
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It's also, you know, in the Being With Dying program, it truly is a deep dive into the
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whole territory of what it means to be a human.
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And that means not only the people we're serving, but ourselves and exploring our edges around
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our relationship to life and death and suffering and how we might be able to begin to notice
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our own patterns of how we, when fear shows up, when we become defended, when we shut
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down, when we are open, when we are able to actually be empathic toward another person's
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experience.
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And so that container of end of life care, I think, really has been a place where people
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have said to me, oh, you know, focusing on death, it's just so, oh, so depressing.
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Actually, I have found it to be the best lesson for how to live.
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And the practices that we do every year, contemplating our priorities, being able to think about
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and imagine ourself as an old person and then getting closer and closer to, you know, we
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don't know when that last moment will be.
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And what is left undone and how are we relating to that possibility in ways that actually
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might be hurting ourselves and others, but also could be transformed in a way that would
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help us to meet whatever reality we're in.
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So I feel like a lot of what I've learned about living, I've learned in that space of
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contemplating the end of life.
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Your work on professional flourishing in the nursing profession is one of the practical
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ways that you've provided support to help colleagues build skills to support themselves
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and others.
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And one of the ways in which you're applying the contemplative practices to help change
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systemic factors that contribute to burnout that help health professionals, especially
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nursing flourish.
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I think our listeners would also like to hear a little bit about the mindful ethical practice
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and resilience academy, MEPRA for nurses, how it came about, how it's structured, what
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are some of the outcomes of that program.
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And then one more aspect, because I find it really inspiring, can it provide part of a
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model for a wider application to mixed health professionals?
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Yeah, MEPRA.
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It's funny, people ask, you know, how did you get to where you are now?
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And mostly the answer is I just said yes, a lot.
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I didn't really have some grand plan.
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People think you do.
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I didn't.
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I just continued to pursue the things that I was passionate about that I really mattered
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to me.
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And when the opportunity came, I said yes.
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And so that's what happened with MEPRA.
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Our dean, Trish Davidson, was concerned that our students were leaving the profession after
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one year.
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And she said to me, what can we do?
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And I was like, well, I'm pretty sure we can figure that out.
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And so we created MEPRA, the mindful ethical practice and resilience academy.
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And it was it is a program that was designed for nurses who had graduated from nurse residency
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programs and nurses who have been in practice for many, many years.
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And it was designed really with the core elements being mindfulness.
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So creating a foundation of mindfulness and awareness, how we cultivate the qualities
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that support our resilience and in particular, our moral resilience and how we cultivate
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moral efficacy to respond to ethical challenges.
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So it's sort of those three pieces.
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And we created a 24 hour program that before COVID was delivered all in person.
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And it really begins with an exploration of why we're here.
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What is it that's motivated us to to choose our profession, nursing in this case, how
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we can reconnect to our values.
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And I find it fascinating all the time how much we take our values for granted and often
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are have a difficult time articulating them.
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And so we spend time sort of unpacking what is the anchor for your life and work and how
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can you use that as both a resource and a guide when you're not sure about what to do
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and then how we begin the process of creating a plan of self stewardship and self stewardship
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is the term we like to use that's beyond the sort of self care language that's been in
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many ways created a capitalistic billion dollar industry to a much more robust, I think, concept
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that starts with knowing ourselves and embodying our commitment to our own well being that
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acknowledges the limits that we have and approaches them with compassion, where we actually choose
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how we allocate our gifts, our talents, our time in ways that reflects who we are and
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what matters to us.
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And then how our choices reflect healthy and wholesome choices.
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So that process starts at the beginning of MEPRA and throughout the program, our participants
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reflect on their moral compass and how well they're living their values, but also an evolving
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process of creating a self stewardship plan that actually nourishes them over the period
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of time.
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We also focus in on a lot of skills, many of them reflective of areas within contemplative
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practice and mindfulness, perspective taking, the ability to speak up with integrity.
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We practice communication.
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We have a high fidelity simulation as a part of this program where we practice those skills
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in a real life situation.
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And then how we work with our moral suffering in ways that maybe have the potential to reduce
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the negative and sometimes really harmful consequences of those situations.
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And then the last piece is using those skills and tools at the unit level to begin to contribute
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to a culture of ethical practice where it's not just the individual, but in the collective
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experience in our teams of how we cultivate relational integrity and how we actually begin
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to spread those skills and practices into our everyday work.
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So it's been quite a journey.
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We started in 2016.
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We've had over 350 nurses who've been through it in lots of different cohorts.
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We have done research and we have really, I have to say amazing to me results.
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We looked at the impact of this program and had statistical improvements and ethical confidence,
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competence, work engagement, resilience, mindfulness, and decreases in emotional exhaustion, depression,
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anger, and intent to leave.
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And so we're pretty excited about that.
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Something happened.
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We are now partnering with an EAP group in New York to try to scale MEPRA because it
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was three of us trying to do this whole program.
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And obviously that's the rate limiting factor.
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It's been an incredible journey of often watching people arrive in a disempowered, discouraged
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space and over the course of those typically sick sessions, it's like the lotus unfolding.
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You start to see people remembering why they chose this profession, remembering who they
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really are and that they matter in this process of delivering care and how they can actually
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empower themselves to take control over their health and wellbeing and their integrity and
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not be expecting some external source to do that for them, but to see that they actually
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have the capacity themselves to put themselves on the list of consideration and to really
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decide that they matter and that there are things that I can be in control of that will
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nourish my wellbeing, but also nourish my sense of wholeness as a person.
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I wanted to circle back to moral resilience.
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It's a word you've used.
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You've described it as the capacity of an individual to sustain or restore their integrity
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and response to moral complexity, confusion, distress or setbacks.
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And I'd like to just sort of focus in, hone in on one of the words.
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I'm drawn by the word integrity, which can mean a lot of things to people.
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You've used it already in our conversation.
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I'd like to hear a little bit more about that.
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You can unpack what that means for us and how you conceptualize it in this setting of
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moral resilience and moral suffering.
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Yeah, integrity is a big word, isn't it?
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And it does mean different things to different people.
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And for me, the idea of how we can be whole, you know, in the midst of all of this complexity
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and confusion is a very important grounding.
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And so the idea of moral resilience really is grounded in this idea of integrity.
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Integrity being living our values rather than talking about them, knowing who we are and
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what we stand for and being clear about what our values are, being willing to sometimes
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have the courage to speak up when those values are in some ways threatened or violated, being
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able to listen to what we call the call of conscience.
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You know, we've all experienced that twinge of our conscience that starts in our body
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to alert us to danger, to threats to our integrity, our values.
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And to cultivate the capacity to actually turn toward that with curiosity, why is this
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showing up now?
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What is it that I'm not seeing or that I need to pay attention to in this situation that
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has activated my nervous system to perceive threat?
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The ability, integrity is to me not about perfection.
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It's actually about being able to hold our whole experience with compassion.
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And that means our limits and being able to not expect ourselves to solve unsolvable problems
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and not to expect ourselves to go beyond what is healthy and wholesome for us.
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And I think integrity also requires us to take action.
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And sometimes inaction is the integrity preserving thing.
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It might be that compromise, although in our world right now, compromise is viewed as failure.
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Compromise is a path that can preserve integrity of all people involved.
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Sometimes our integrity requires us to say no and to refuse to participate in things
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that truly degrade our values and our sense of wholeness.
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And honestly, it also includes deciding to remove ourselves from situations that are
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not healthy and wholesome, that are toxic.
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And that's an important one.
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I think in our professions right now, we have sometimes felt that saying no or removing
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ourselves is, you know, we've abandoned ourselves or others.
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But in fact, it might be that removing ourselves is the right thing to do.
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I know in nursing, I've advocated pretty strongly that nurses may need to remove themselves
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from their jobs.
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But my hope is that they will find another place in the profession where they can serve.
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And there are so many ways to do that as opposed to abandoning the whole profession and saying,
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well, that's not the right thing for me.
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It might not be.
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But I think often when we are so depleted, we feel that there aren't any options.
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And the only thing is to completely sever our connection, which may not be true.
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And so being able to use those elements and skills of mindfulness to be able to clearly
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discern what is right for me, how can I serve now, is really, I think, a central question.
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How do I serve now in this environment and be open to the possibility that maybe what
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we thought before needs to be revised?
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I think integrity also requires us to be open to re-examining our assumptions and our beliefs
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about whatever the situation is.
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So it's a complex and nuanced idea.
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And I think it also gives us a place where we can begin to articulate why the situations
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that are so problematic to us are causing the distress because it's not just overwork.
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It's that our values are being challenged in one way or another.
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And that suffering that we experience in response to that is moral in nature because it involves
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our values and it involves our sense of identity, of who we are, and what we stand for.
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And that is not inconsequential.
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So being able to name clearly what that source is is really important.
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What has become a term that is a catch-all term now for everything that is unpleasant.
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We need much more precision in what the source is to be able to design interventions to be
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able to address it.
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Completely agree with you, Cynda.
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I was struck by you mentioning saying no, learning to say no.
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And what I actually heard, the subtext of that is also learning to say yes.
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I know one of my favorite writers, Anne Lamott, I just enjoy reading a lot of her writings.
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She says, no, we have to learn that no is a complete sentence.
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As we're in this discussion with you, I'm beginning to think actually it's not a complete
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sentence because it's no, learning to say no, and it's also no and yes to this other
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alternative, this other thing.
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Maybe it means I have to make a change as you described, or maybe it means yes to what
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we should be focusing on.
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So thank you for that.
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I'm beginning to expand my own understanding of the saying no, which isn't just completely
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turning away and cutting off.
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It's a no and yes, both.
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I want to come back again to your book, Moral Resilience, which for listeners, it's just
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a phenomenal book.
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It's edited in the sense of there's a few other contributors, but it's really your voice
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throughout that book is very clear and very helpful.
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In the introduction, you talked about our suffering was not something to hide or be
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suppressed and that we can skillfully work with it so we can transform it and feel the
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future of, again, that word integrity and compassion rather than allow it to disable
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our human goodness and moral community.
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We've come and spent some time with our program, the Mindful Practice in Medicine program,
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and we use a similar philosophy that seeks to identify strengths and capacities to turn
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into and transform the pain points experienced by those delivering healthcare.
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So I'm wondering if you can just talk a little bit about this idea of turning into the difficulties
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as a way to create a more workable future.
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As you describe your life, Cynda, it's been a series of yeses to things that for many
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of us would just seem like obstacles.
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So yeah, just a little bit about turning toward these difficulties.
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Yeah, turning toward.
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I think often as humans, when things are hard, we want them to go away and we want them to
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be resolved.
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And what I realized sort of midway in my career was for some reason, I was actually drawn
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to those hard places because it seemed like that was where things were most real.
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And when I was a clinical nurse specialist, I worked with a group of surgeons who really
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did not like to talk about anything hard.
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And they would do anything to avoid having to talk with a family about something hard.
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For whatever reason, I wasn't afraid to step into that place and found myself doing that
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again and again.
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One time I vividly remember the surgeon having his hand on the doorknob and had just given
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a family of a teenager a diagnosis of osteosarcoma.
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And they were just devastated.
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And he walked out and I stayed.
34:46
And I spent some time with the family and with the young person and their mother.
34:52
I was really pretty outraged that that news had been given in that way.
34:58
And so I followed down the hallway and I said, you have to go back.
35:03
You have to go back and talk to this family.
35:08
And he didn't want to.
35:11
I said, we are going.
35:14
And I stood in front of the door so that he couldn't leave.
35:21
So turning into it is to me facing our fears and being able to really be curious about
35:33
yes and what else is true and what else is true and what else is possible here.
35:39
That takes practice to not allow our fear to distract us or to shut us down or to take
35:46
us out of the room when our instinct is to do exactly that.
35:52
Part of that process in this context of moral suffering is being able to develop a vocabulary
36:00
that is more precise and more specific to naming what it is that is causing the suffering
36:09
that is really weighing on us.
36:14
And what I've seen again and again and again, and if you think about this in the context
36:19
of Warren Reich's sort of whole phases of suffering, mute suffering is when we are unable
36:27
to name or even articulate the source of our suffering.
36:34
Or it can be when we are so overwhelmed with the suffering that we become mute.
36:40
And so part of this process that we've been in is giving people the space and the support
36:48
to move from that place of mute suffering into what is a challenging phase of expressive
36:56
suffering.
36:57
That's the phase of lament where our voice is often really angry.
37:04
It is combative.
37:06
It can be unskillful.
37:08
It can be loud.
37:10
But it's important to be able to name the source of our suffering.
37:15
And then the third phase is transforming that suffering.
37:19
How do we take that as gris for learning, for being able to deepen our awareness of
37:27
ourselves and others, to actually harness that in a way that ultimately produces good
37:33
for ourselves and others?
37:35
And that's in many ways what we've tried to do in MEPRA.
37:39
That's part of what we do in Being With Dying.
37:42
And it's really closely related to the work that we do with grace, which is about creating
37:48
the conditions that support the ability for compassion to be manifest.
37:55
And so it's been a thread for sure in all of those programs.
38:02
As you described this expressive suffering really being real, and then the transformation
38:08
that can occur as we begin to identify, name, express, that there's also some beauty in
38:15
the expressions, can be beauty in the expressions, especially when we listen to, say, for example,
38:21
melancholy music.
38:23
There's a certain kind of beauty.
38:25
One thing I know about my experience with you is that when someone is with Cindy Rushton,
38:33
it's real.
38:36
That's all I can say.
38:37
It's real.
38:38
It's also fun, but very real.
38:39
And there's something very honest and authentic, and it's refreshing to be in that orbit with
38:45
you.
38:46
So thank you.
38:47
I'd like you, if you can, to unpack a little bit about this approach for large-scale change
38:53
that you write about in the book, conscious full-spectrum approach, and how this vision
38:58
could be employed for cultivating more resilience and even making change for a healthier health
39:06
professional workforce, meaning in our work satisfaction, joy, and better quality of care.
39:13
Well, it's a great question.
39:15
And trying to think about how do we actually change the cultures and the systems we're
39:21
in.
39:22
It's not an easy answer.
39:25
If it was, we would have done it a long time ago.
39:28
What I appreciate about this approach, and it was really created by Monica Sharma, who
39:33
was at the UN for 20 years in charge of leadership and capacity building.
39:38
And she's used it all over the world to address really challenging questions, how we address
39:45
human trafficking, HIV AIDS, other things that are big problems.
39:52
And what I appreciate about it is that we tend to start with tactics instead of starting
40:00
first with who am I being?
40:03
How am I showing up?
40:04
And how will my values be the anchor for everything that I do?
40:09
And that work has resonated so much for me in terms of aligning it with our individual
40:17
values and our individual purpose for being and how we can use that collectively.
40:26
What I've seen again and again in using this model, and we did it at the University of
40:30
Virginia for three years, we worked together starting first in bringing people together
40:38
to reflect on who are we?
40:41
Why are we here?
40:42
What is it that binds us together?
40:45
That when we stand together, it harnesses that value, that sense of purpose in a way
40:53
that fuels us to make change.
40:56
So that's the beginning.
40:58
Then the next part is having a systematic way to identify the patterns in the organization
41:05
or in the situation that we're trying to change.
41:09
So for example, in well-being, we have a lot of system drivers that impact the well-being
41:16
of people in the system.
41:18
We have reimbursement, we have all kinds of issues around resource allocation, we have
41:28
electronic medical records, the list goes on and on and on.
41:33
And being able to hone down on among all of those things, what is a pattern that we can
41:41
identify in our organization that if we were to change it from say, for example, a pattern
41:49
would be ineffective communication around goals of care for a patient.
41:55
If we were to actually be able to shift that so it was a routine conversation, that would
42:01
begin a process if you think about a fractal of change within that organization.
42:07
The methodology then is to identify those particular patterns that we want to focus
42:14
on documenting what they are and then from there to design what the actual intervention
42:22
would be to change that pattern.
42:25
So it's an inside out process.
42:27
It's not starting with, oh, now we're going to make everybody ask this series of questions.
42:33
Well, this would say we start first with articulating why it matters and how it connects to who
42:40
we are and what we stand for as clinicians, respect for all persons.
42:47
And then that becomes the anchor for saying, you know, there's a pattern in our organization
42:51
that is actually degrading that respect for not only the patients but others.
42:57
And here are the ways then that allow us to be able to change some aspect of that.
43:05
And of course, there's measurement of how that happens, which is always a challenge.
43:10
But in the process, we have encouraged people to think about how do you capture the immeasurable,
43:19
not just the things that we can count, but the other parts of our human experience.
43:26
So it's been a really fascinating process.
43:30
And one of the big areas that I've learned from Monica in terms of a leverage point for
43:35
change is around the narrative, noticing what we say about ourselves, what we say about
43:42
others, what we say about our work and how that can be contagious, both in the positive
43:51
direction and the negative direction.
43:54
So if you want to change something, notice what people are saying about it.
43:59
And I've been doing some really interesting work on this with nurses about how we talk
44:04
about ourselves.
44:05
And if all we talk about is everything that's wrong, that's what we're going to give energy
44:10
to.
44:11
We have to notice the whole picture, which includes the things that we do that actually
44:18
produce good and not overlook them or dismiss them as somehow, I'm just doing my job.
44:25
We've got to capture all of that so that it gives us the fuel and the focus to make change.
44:34
I want to ask maybe two more questions.
44:40
One is really, I'd like you to share a narrative, a story when you experienced a deep sense
44:47
of joy, what we could call eudaemonic happiness in your professional work, that Aristotelian
44:56
notion of flourishing, of living well, of real meaning, something that's happened recently,
45:05
something that's happened a long time ago that was formative, whatever you'd like to
45:08
share.
45:09
I'd love to hear about that.
45:10
Gosh, there's so many.
45:12
The situation that comes to my mind right now is in the context of an ethics consult,
45:19
where we were called about a case that involved a patient who had been in the hospital for
45:27
a long period of time, had been in and out of the intensive care unit, had multiple system
45:33
involvement, including an infection that was not responding to the treatments.
45:40
And the team felt like they were at the end of what they could do.
45:43
They felt that she was probably dying soon.
45:47
She was not from America and language was a barrier.
45:53
And yet we were interacting with her through an interpreter.
45:59
And I remember walking into her room expecting to see someone who was near death.
46:06
And what I saw was a person that was as alive as everyone else standing there.
46:13
And instinctively, for whatever reason, we had to put gowns on.
46:18
And I walked in and we sort of met each other.
46:23
And I instinctively took her hands in between mine through the interpreter, asked her about
46:29
was she in pain?
46:32
And she said, no, I'm not really in pain.
46:35
And asked her what was the most troublesome thing to her right now.
46:41
And it was she wanted to eat.
46:44
And she had had a trach and she had a feeding tube.
46:49
She wanted to eat.
46:51
And so through this conversation with her, we learned what mattered to her most was she
46:57
wanted to be with her family and she wanted to eat.
47:02
And that she wasn't probably dying immediately at all.
47:07
That she had a pretty complex medical situation.
47:11
And there was something in that moment of being with her where I knew she had a faith
47:19
tradition just by the history.
47:23
And so I asked our chaplain, I asked her, would it be okay if he prayed?
47:28
And so he did.
47:29
At the end of it, I asked her, was there anything she wanted us to know?
47:36
And she said, thank you for listening to me.
47:40
And I remember walking out of her room thinking, I never expected anything that just happened
47:46
in there.
47:47
And yet it was such a real, again, a very real experience of coming in without an agenda.
47:56
I didn't know how it was gonna be.
48:00
And ending up being so surprised and then being able to share that with the team and
48:06
later with her son who was struggling mightily about, you know, is my mother gonna die?
48:12
And so I asked him, tell me about what you would be doing in your country in this time.
48:20
And he said, well, we would be eating something that was sort of like a, you know, like a
48:27
gruel of some sort.
48:28
And I said, you know, she said that what she really wanted was to eat and she wanted to
48:33
be with you.
48:35
And he started to cry.
48:37
And I said, you know, I see how much do you love your mother?
48:41
And he said, you know, she's the rock in our family.
48:44
And it was like, who knew?
48:45
I'll tell you, just listening to that story has me inspired to listen better, to become
48:52
a better listener because, you know, that's to be seen and to have a sense of belonging,
48:58
to be really truly heard.
49:01
I'd like to know what you like to do for fun, how to take care of yourself, what you do
49:05
to take care of yourself.
49:07
And you know, if you're like me, it's not that far from the works things that I do,
49:13
you know.
49:15
So it can be related to work.
49:17
You know, it's interesting.
49:18
People say, oh, you know, isn't that work overwhelming?
49:23
Sometimes, but mostly it's nourishing.
49:26
If you know, when you're doing what you love and what you're here for, it doesn't feel
49:30
like a burden, really.
49:33
I get a lot of energy from being with students, with being with my colleagues, with being
49:38
with patients and families.
49:40
There have been plenty of times when I've been in my office across the street from the
49:45
hospital and I'm feeling, oh gosh, you know, I just can't put one foot in front of the
49:50
other.
49:51
And I'm like, I have to go, I have to go across the street and be with the people where the
49:55
things are happening, where it's all messy and it's great.
50:00
So you know, there's that.
50:02
I love to travel.
50:03
I love to go to places where I haven't been before.
50:07
And my favorite thing is to really go where the local people are and to see their art
50:15
and their craft.
50:17
I'm a knitter.
50:19
So I really appreciate the effort it takes to create beauty out of fibers and art.
50:29
So I love that part.
50:31
You know, and I love being in nature.
50:33
I love to, I love Datcher Keltner's, you know, sort of taking an awe walk.
50:41
I've actually been doing that with some nurses this last year or so and having them take
50:47
an awe walk and everyone takes a picture of something that has produced awe and we've
50:53
created this montage.
50:54
It's just noticing just how those moments that kind of take your breath away in one way
51:03
or another, just like, ah, it just shifts you out of whatever's happening, even if it's
51:10
just for a moment.
51:13
It's so great to allow yourself to pause and take in, you know, where is the awe moment
51:22
right now?
51:24
And how that, you know, I like to think about you put it in your pocket for later in addition
51:32
to the moment you're in so that, you know, you can come back to that feeling of awe and
51:40
how it can actually be a nourishment to us, maybe when we're not feeling we're in that
51:49
space quite so much.
51:52
Yes, it is so nourishing and this conversation has been very nourishing and I think awesome
51:59
for me.
52:00
It's been full of some awe and some revelations as well.
52:04
So I want to thank you so much again.
52:06
Thanks for listening.
52:08
We will include a summary of today's podcast and links about Dr. Rushton and other references
52:13
that were discussed in the show notes.
52:16
I would like to conclude by sharing another practical exercise to help you flourish during
52:21
your workday.
52:22
I hope you can add this to others that I've shared in prior episodes and create a toolbox
52:28
of skills that you can draw upon to enhance purpose, meaning, and well-being.
52:34
So this exercise comes out of the poignant clinical vignette just shared by Cynda earlier
52:40
in the podcast.
52:41
It involves the practice of deep listening and it can be practiced not as a separate
52:47
activity in your life but during actual moments in which you are in relationship, in conversation
52:53
with another person or a group of others.
52:57
And the way to start is simply to tell yourself, right now I'm going to engage in a deep listening
53:03
practice.
53:04
So there you are in conversation with a family member, a loved one, a colleague, a patient,
53:11
and the instructions are fairly simple.
53:14
There are just three steps I'd like you to keep at the forefront.
53:17
You can write these down on an index card and keep them with you until this practice
53:21
becomes learned and more a habit.
53:24
The first instruction is set an intention to truly and deeply listen.
53:31
The second instruction, notice but do not act on the impulse to interject with your
53:37
own story and interpretation or advice.
53:41
And then finally, the third step is to allow your authentic voice including curiosity,
53:48
interest, desire to understand better, the authentic feelings that arise you as you listen
53:54
to inform your speaking, your response, and you're part of the conversation.
54:00
So it's not just a quiet listening.
54:02
You are actually engaged with these three instructions and intention to truly and deeply
54:07
listen, notice but don't act on the impulse to interject your own story or interpret or
54:13
give advice, and then allow that authentic voice to come out of curiosity, out of an
54:18
interest to understand further, out of your authentic feelings that arise.
54:23
I hope you found this podcast and this simple exercise useful to you and I look forward
54:27
to having you join us for the next episode of Flourishing in Medicine from Surviving
54:32
to Thriving.
54:33
If you'd like to learn more about EmPRO, please visit www.myempro.com.
54:43
And for more information about me and my work, please visit my personal website, www.mickkrasnermd.com
54:53
or www.mindfulpracticeinmedicine.com.
55:00
See you next time.