G.R.A.C.E.

Working in healthcare these days can be physically and emotionally taxing, especially when caring for critically ill patients who are suffering and distressed, in a setting where many patients don't get better, despite our best efforts, and in an atmosphere that is driven by demands in productivity, staffing, and revenue.  I find that there are days when I feel very far from my original intentions and ambitions that called me to this career.  It's easy to become task-oriented in this setting, treating patients like they are items on a checklist, rather than connecting and spreading joy.  To prevent burnout, it's absolutely essential for caregivers and providers to revisit our purpose, ground ourselves in mindfulness and body awareness, and renew our minds and hearts to providing compassionate care.  The G.R.A.C.E. training/retreat I attended last week at the Upaya Zen Center in Santa Fe did just that.  

G.R.A.C.E.® is an acronym that stands for:
Gather attention
Recall intention
Attune to self, then other
Consider what will serve
Engage, and end.

It's a scientifically-grounded program designed by Roshi Joan Halifax aimed at cultivating compassion through active meditation and mindful practice.  Applying G.R.A.C.E. in patient care and interactions with others helps raise awareness of triggers and biases, prevent empathetic distress, and actualize compassion in the world.  It helps caregivers and providers to feel grounded and present in the face of suffering and allows us to better perceive the narrative of others and give undivided attention.  G.R.A.C.E. recognizes that there is a lot of suffering and trauma in the world and what we all need is more compassion.

One of the very first steps of G.R.A.C.E. is to contemplate the values that I as an individual stand for and exemplify these values in my encounters with patients.  I found it is very easy to identify and verbalize the values that I think I stand for, but it is much harder to believe it in my heart and to manifest values through behaviors, which is ultimately the basis for integrity.  This part of the training also calls us to reflect on why we chose our profession in the first place.  Why I am here?  And what do I stand for?

In practicing the final steps of the G.R.A.C.E. process, we talked a lot about selfish prosocial behavior.  There is such a strong urge during a conversation to react to that person, to validate his or her feelings, and to respond with a similar story in an attempt to make a connection or to illustrate that we know how he or she feels, but I learned that when we do this we are actually projecting our own personality onto that person's narrative and managing the relationship in an inauthentic way, which actually inhibits that person from sharing.  To listen attentively without responding or sharing our own perspective takes a lot of courage, trust, and metacognition in the form of recognizing the limits of one's knowledge and dropping below the level of the ego.  These interactions require wisdom and mutuality more than knowledge or answers.

The training also got me thinking a lot about confirmation bias, or the tendency to selectively respond to new information to confirm a prior belief or judgment while disregarding information that contradicts that view.  We all have this tendency as humans, pertaining to everything from reviews of restaurants or schools to actions of political leaders or celebrities.  Confirmation bias greatly impacts our interactions with other people, the accuracy of medical diagnosis and treatment, and our abilities to evolve as a species.  By attuning to ourself and others and considering what will serve (in the G.R.A.C.E. process), I have come to value the benefit of clearing the slate and approaching an encounter with an open mind, allowing space for possibilities and new insights.

After the retreat, I feel better able to tune into my own feelings and devote undivided attention my patients.  I noticed during some of the exercises we did in the training that it was much more difficult for me to perceive my physical and emotional experiences in an interaction than to describe my cognitive processes and thoughts.  I find myself taking a breath and centering myself before entering a patient's room, letting go of any interaction (positive or negative) that I had before I arrived, and entering into that encounter with a blank slate and open mind.  I also find myself maintaining eye contact with patients for longer periods of time during our initial encounters, noticing their faces and listening actively to their stories.  I have always been able to detect the feel or emotion of the room when I greet a patient, and regulate my own emotions or behavior to match that of my patient, but now I try to be aware and cautious of my tendency to jump to a conclusion too quickly or respond before I have heard the entire narrative.

It has also allowed me to accept the limits of our care and to not become attached to outcomes.  I recently had a patient in the hospital for 49 days during which he became progressively sicker and more debilitated, and our team did not achieve the outcome that I felt would be most compassionate in this case.  I have had to come to terms with events that are out of my control.  The best we can do in these situations is to acknowledge that compassionate care was provided, and that everyone did their best, and to not only forgive ourselves but also to show gratitude for the opportunity to serve.

After the G.R.A.C.E. training I feel a renewed sense of moral grounding and purpose, and I feel more prepared for being morally resilient in the face of challenges in healthcare.  I want to forgive (myself and others) more and clear the slate from past encounters so that I don't approach new encounters with defensiveness or resentment.  Ultimately this world needs more compassion, and tuning in to ourselves and others can help actualize that compassion.  

I am working on approaching patients, coworkers, and others with a "Strong Back and Soft Front."