Enough Is Enough: knowing when to stop

Look at the photo above. Isn't it a beautiful view? I took it last week, during a walk with my two children. We were planning to go to Old Harry, on the Jurassic coast, then head into Studland to catch the bus back home.

We packed a picnic, lots of water (but as it turned out, not enough), a camera, and our sense of adventure. Seemingly intact, we left home and made our way along the beach.

We hadn't even made it to the bottom of the road before my 11 year-old daughter began to complain. Actually, we had had a morning of everything being not quite right in my daughter's world. I had tried to enter into her space, to try to help lift her out of her sense of irritation and negativity. She didn't want to invite me in, though, so she remained where she was, and I hovered around the outside, hoping for a free pass, or at least the offer of connection.

I kept things upbeat: "what a beautiful day it is!" (it is the SATs season: both children are sitting them this term and so I can almost confidently assume I have learned to use the recently-controversial SpAG exclamation mark correctly) I repeated, smiling, nudging and hugging both children. "We are so lucky to live here. Let's enjoy the day". My remarks were met with "I'm hungry and thirsty. When can we stop to eat?" We had only just left home, being fully watered before we set foot out of the door.
We decided to stop after we had walked for half an hour. In that time, we made one toilet stop, a water bottle refill, a rucksack adjustment and two shoe-lace re-ties, scattered with cries of "I'm hungry!", "My feet hurt" (what, already?), "When can we stop?" and "My eyes hurt". I confess that I uttered at least two of these statements. My 7-year-old was buying into the sense of adventure, but my 11 year-old was still in her own space, to which we were neither invited to join nor a party to, but rather the sounding boards for her irritation.

We enjoyed our lunch whilst admiring the view overlooking Swanage bay, on a bench which seemed to have jumped forward a few feet since we had last visited it; actually it was due to cliff erosion which had reduced the distance between the bench and the cliff edge. We had a lovely lunch, the mood lifted and we joked about being "hangry".

After a while we continued on the path up towards the top of the hills. Things were going well until my daughter felt she couldn't continue up the steep steps. I patiently encouraged her to carry on, one step at a time, but after another 10 minutes of complaining, bickering with her brother and getting cross with the steps, I felt it was time to stop. I tried to explain that it was OK to find it difficult...that not everything is easy nor intended to be, that the pain and difficulty we can experience can often end up giving us a completely new view and experience. After another round of sibling conflict I decided that enough was enough, so we turned round and walked back down the hill.

The lessons for me?
I have learnt that sometimes, it's easier to quit whilst I'm ahead. I learnt that the view we had on the midway point of the big scary hill will still be there to re-visit another day. Some days are meant for just climbing half-way up the hill, which is the successful point - that getting to the top of the hill isn't always the indicator of success.

I have learnt that my daughter was able to articulate her feelings because she felt safe and listened to, and because she is strong-willed in her own ways, which I am honour-bound as a parent and as a woman to listen to and respect. She is strong, fit, healthy and persistent: so the fact that she was telling me she couldn't do this walk to the top of the hill and beyond was an indicator of her own strength in admitting to herself and to the world outside her own space that "enough is enough".
I have learnt that my own projection of failure to meet my goal for the day (to get to Old Harry, walk into Studland and catch the bus home) to my children is not helpful for them or for anyone; and I have also learnt that I too felt that "enough is enough" when I caught myself spiralling into negative self-talk and buying into the cortisol-adrenalin mix that was swirling around me in the past week or so prior to this walk.

The view: oh what a beautiful view! The ability to see with clarity, to understand and gain an alternative vista had lifted me out of my head and into a beautiful possibility to turn things around from a negative into a positive.

To know is to understand, but to feel is to reach within the depths of empathy, compassion and sample the richness of experience from a higher perspective.

If we can accept that there is not always a right answer, a right way to do something, that things can go wrong; if we give ourselves permission to make the mistakes, then we can learn something beautiful from them.

S T R E N G T H

In the past year I have gone through a marriage break-up; launched my work as The Mindful Nurse; got into the knack of being a single parent; and continued my part time work as a nurse. I am taking on other responsibilities as well, and I am doing up bits of the house that needed attention, in between cooking; reading stories, going for walks, climbing trees, counselling and having loving cuddles with my children, taking them here, there, and everywhere for after school activities and taken them for various hospital appointments; writing the book I have been trying to get out of my head for a year; going through the process of divorce; unblocking my outside sewage drain in the pouring rain (several times) as well as self-taught a few other plumbing techniques to see me through the winter; started to collect tools for my own toolbox and can use confidently; and of course, very crucially, meditating.  I have pushed myself as far out of my comfort zone as I dare. I have tried to be as calm, compassionate, kind and as good a person that I could want to be during what has been a tremendous wrench out of where my life was a year ago, whilst still acknowledging my own sadness and confusion at the trauma which has unfolded.

It took me two years to build up the courage and the strength to be where I am, now. If I had been allowed a peak at myself now, back in 2013,  I could never have believed where my path has led to. Two years ago I was frightened, weak, dis-empowered and had some vision of what I wanted to do/be, but was too under-confident to pursue it. Although I was practising mindfulness and meditation, events in my life had somehow caused me to lose my way, like being in the deep, dark wood, unsure of which way to turn for the best. I knew I had to move in the right direction, but I had no idea of what it looked like.
I had to summon up the courage and strength to take brave steps forward. Things got really tough – heartbreakingly so -for all sorts of reasons. However, one baby step at a time, I gradually found a patch of brightness in these woods, which gave me some energy and power to take bigger, firmer steps which became strides.

Looking back at how things were one year ago, and who I am as a result, I can only put it down to the fact that, through using my mindfulness techniques, meditation, the odd glass of wine and a few amazing friends and family who have supported me through this whole process, I am nearly out of the woods and onto a clearer path. With flowers, birds, butterflies, fluffy rabbits and a merry tune that I can skip along to…

OK, that might be a bit far-fetched – but why not aim for that? One of my regular meditation techniques has involved powerful visualisations of what I want my life to look and feel like. I am therefore striding in that direction, in contrast to the deep, dark world that I am walking away from. Along the way I have encountered various and numerous events to trip me up; I have had traps I have walked into; I have walked into thick mud to pull myself out of. But I’m still walking towards the clearer path.

For me, being able to see that I am doing so much and trying so hard to get things right for myself and for everyone around me, shows me my strength. Two years ago I couldn’t see that, because I was simply too busy trying to fit a square peg into a round hole. What I thought was going on didn’t fit the bigger picture. Now I know that, so I  have given up trying to fit into the bigger picture. Instead I am creating my own.

When life gets tough, you may feel that you are not strong enough to handle it. But when you gather all the little bits of who you are, then fit these pieces together, you might be able to see that you are stronger than you thought you were. Strength brings structure; structure provides resilience.

MIndful NHS

I have been practising mindfulness techniques in my work as a nurse in the clinical environment for a while, now. I am finding it works well. So much so, that I am beginning to measure its effectiveness and outcome in my patients. I have also run some introductory mindfulness sessions for staff, to help them de-clutter for a while before heading back into their work. I am keen on developing this much further: I have so many ideas to put into practice. Models and clinical plans to develop, deliverable in a variety of methods. I am so excited about what I can do. But I need investment. The NHS, as we all know, is in a critical period, with a possible £2.5bn deficit looming over the nation’s health service. I am so passionate about what mindfulness can do to help patients and staff, and how it can help improve the service at national and local level.
So it was exciting to read how doctors should be taught mindfulness during their training. As someone who knows the NHS from the inside, works with a variety of patients and has undertaken mindfulness training, I couldn’t agree more. The all-party parliamentary group on well-being economics recognise a need to train doctors (and teachers) in mindfulness. But it needs proper investment, it needs to be done carefully, considerately; and with the patient and staff’s best interests at heart. I believe I am able to deliver training and support to both staff and patients. I’m chomping at the bit to get going on this project, knowing that my methods have shown positive results; and that staff need the help to deal with the workload and manage stress every day. Mental health and mindfulness is the tip of the iceberg: I want to embed mindfulness into NHS culture. There is so much potential here, who can afford to ignore it?

Nikki Harman is a mindfulness tutor to adults and children; and a nurse who works in an acute NHS trust in England. All enquiries to innerspaceproject1@gmail.com

Pain, Relief

I used to work as a nurse practitioner in a GP surgery. I would see patients who were complaining of pain which had lasted anything from several hours to several weeks or more. In each case, I would ask what they had tried to help settle their pain. Often, the patient would explain that they hadn’t tried anything, not even a paracetamol. Often, this would then be followed up with “I don’t like taking tablets”, or “nothing works”. I would make suggestions about painkillers, ice, rest, activity, suggest exercises to ease back pain or refer on as required, depending on what type of pain the patient was experiencing, as well as other symptoms.

It is interesting to reflect with patients how they perceive their own pain, how they manage it, and what action they take to relieve it. Examples include those who stoically carry on without taking pain relief or other steps to manage their pain; others, who have tried lots of different medications but found that nothing works; and those who are reliant on their analgesia to get them through the day. As someone who has suffered with chronic back pain resulting from a car accident years ago, I used to fall into the “nothing works” category. I found that my life was dominated by the pain in my back: I had lots of time off sick (working in a hospital as a nurse is hard-going on the spine and one of the worst jobs for back pain and injury), which eventually led to surgery which required more time off, more pain, more medication, subsequently led to me being made redundant and then a subsequent  bout of depression, before finding a job I could manage comfortably. Gradually, I came to the realisation that I could control my pain through the meditation I practised, as well as yoga. Over time my pain management improved through a combination of painkillers, exercise, and meditation, as well as visits to an osteopath or chiropractor.

What I also find interesting is the way in which our NHS and healthcare system is dominated by pharmaceutical interventions to manage pain. In an article for the Mail Online, Dr Mark Abrahams explains the various options for treating pain with medicine and different medical interventions such as spinal blocks for relief, and discusses the dangers of over-reliance on medication to treat pain. He also suggests mindfulness as a method of managing pain. In my job I spend a lot of my time dispensing various pills and administering injections to patients in pain, but recently I have started to teach mindfulness to help with their pain, too. I have found it a very useful and successful tool in helping patients manage their pain, whether it is acute or chronic. I have also discovered that the exercises I teach my patients has altered the outcome of medicated pain relief, because the time I spend with them talking them through the exercise has reduced their pain score and their subsequent medication. I would never advise anyone to completely swap medication for meditation, but I do find that in the ward environment, spending five minutes teaching some simple mindfulness work with a patient who is not due pain relief according to their drug charts, has eased their pain. I see no reason why we can’t use mindfulness as well as painkillers.

As for my own experience, I can say with absolute certainty that mindfulness has helped me overcome pain. I don’t know where I would be without it!

Be Brave!

Last summer, whilst out running in the woods, I headed towards a path I tend to feel wary of. It was a gloriously warm summer morning, and as I ran along the sunlit-dappled path, I became mindful of looking out for Adders. Now I used to be terrified of snakes as a child; and even as an adult, I’m really not that fond of them.
Despite my fear and dislike, I have never seen a snake anywhere other than behind a plate of glass at the zoo: a sanitised, safe environment – perhaps not so much for my benefit – as for the snakes themselves.

I reflected upon this as I left the woods and entered an open space, that the fear I have of meeting a snake on my own well-travelled path, has little basis. Why must I place the emotion of fear into a situation I have never encountered, and may never face? Surely it would be better to experience the fear and react accordingly if need be?

As much as I love being amongst woodland, I do tend to run a bit faster in the areas where I am likely to encounter an Adder. This might knock a couple of seconds off my time, but if I run too fast, I may miss the beauty all around me – even that of the adder itself.

To confront a fear allows us to learn something deeper about ourselves. If we permit the fear to control our decisions on, say, which paths to take in our life, we restrict our choices, and may inhibit our own growth. Although it might feel easier to avoid anything scary or unknown in order to protect and preserve – to sanitise – our comfort zones, these seemingly easy decisions can prevent us from learning more about ourselves, and forming a deeper connection within.

By facing our fears, we can begin to open up to what it is that has influenced our decisions and perceptions. If we fully experience our fear, we can then see the beauty of our deeper selves, learn as we conquer our fear, and evolve on a spiritual level.

So look for your own strength and courage in your heart, and allow the light within you to be the sun dappling upon your path less travelled.

The Mindfulness of Love

This post encourages you to ask yourself what love, in its implicit sense, means to you. Can love be implicit, or is it more fragmented, than that?

Suppose I declare: “I love chocolate”. But when I really think about it, it isn’t the chocolate I love: it’s the sugar rush I experience whilst eating it. It’s the moment I allow myself to sit quietly and relax whilst I am enjoying the sugar rush. It’s the reward I give myself, like I’ve given myself that permission to enjoy the chocolate. It isn’t the chocolate itself. This might be a different experience to the next person, but it is my perspective.

So do I love chocolate? Maybe; but not as much as I love listening to the radio on my way to work. But when I think about it, it isn’t the person on the radio or the music that I love, it’s the act of driving and being quiet that I love. It’s the time spent alone with my thoughts, peppered with music and conversation that I love.

So, do I love listening to the radio? Maybe; but not as much as I love running. I LOVE running. I have to run to feel human, again. Running gives me headspace, time to meditate, time to listen to the radio (and sometimes reward myself with a little chocolate, afterwards). Running makes me feel happy and relaxed.

Yes, I love running. But I love nursing, too: I love coming to work. Seriously, I do. It helps me forget about any negative stuff going on in my life; I get to meet all sorts of different people from all walks of life; to me, nursing is an art where it is a constant project of learning to understand others, help alleviate symptoms or pain, help to make someone better, as well as have the privilege of sharing some of the most personal experiences of someone’s life, with joy, happiness or sadness and grief. There is little in life more rewarding than seeing someone come into hospital ill and in need of help, and leave with a smile on their face, fit and ready to carry on with their life. It is the same with my reiki and my mindfulness work. I feel such gratitude and love for the work I am lucky enough to do – and be paid to do it!

I love my children. They are the biggest, most love-inducing, intoxicating part of my life. I live and breathe for them. I will walk to the ends of the earth and back for them. Who wouldn’t do the same for their own children? My children are funny, silly, clever, annoying, talented, argumentative and unconditionally loving towards me. No matter what mood I’m in, they can snap me into a smile just by the things they say or do. Their hugs, our chats, the singing and dancing, their little notes telling me “I love you” or  their paintings and drawings show me that I am so lucky to have them in my life. They love life from moment to moment and at full speed. My family and friends carry the same significance to me.

And finally, I love myself. There is nothing wrong with saying this. In fact it is crucial for the rest to fall into place. If I didn’t, I couldn’t enjoy and treasure everything that is my life. My life is made up of these loves and joys. If it wasn’t, I couldn’t be happy. If I didn’t love myself, I couldn’t love my life the way I do. I have my off days, I have the days when I have to search a bit deeper to find that love and joy, but it is always there. I believe that without that love for myself, other aspects in my life carry less meaning. I nurture myself and  others. It’s what I do. Nurturing the love within means that everything else can grow, too.

The Seventh 'C'

The more I embed my use of mindfulness into my nursing care, the more strongly I feel about how important it is that as nurses, we make a meaningful connection with our patients.

I started nursing back in 1993. I took a gap year before starting my training, to work in a nursing home. I wanted to develop my basic nursing skills, to begin to learn the art and science of being a nurse.

To me, nursing was about caring. I wanted to care for people. I wanted to make my patients comfortable. I wanted to understand what they were experiencing, as well as empathise with them. I wanted to know everything. I was an eager beaver, keen to do the best I could, but was still very wet behind the ears, completely naive, but full of enthusiasm.

Working in the nursing home was a shocking experience. Standards were poor: the home smelt awful. The residents were not properly looked after, but although I knew at the time the things I was witnessing was wrong, I did not know what to do about it. The company I worked for didn't pay us on time each month (once they arrived at the home to pay us by cheque at 5pm on Christmas eve); they didn't pay the bills on time, so at one point the phone line was disconnected and if we needed to make a call one of us had to leave the home and run 5 minutes up the road to the nearest phone box. The bill for incontinence pads was left unpaid for months, so the new orders were not delivered. We were told to cut up towels to use as pads, or dry the used incontinence pads on the radiators. No wonder the place smelled. No wonder, either, that most of the poor resident's pressure areas were breaking down. I, along with some others, refused to do either of these things, much to the chagrin of the company director.

It was a diabolical place to live and work. Most of the care staff did care about the residents, and wanted to make a real difference. We all knew of each individual resident's likes and dislikes (Betty loves cheese sandwiches, but Ethel hates cheese; Sam likes to listen to classical music in the morning with his porridge but Mabel prefers silence to eat hers; Rose always has to sit by the window, to see who is coming in and out of the front door - but everyone of us knew that she sat there each day in the hope that she would see her family walk into the home to visit her - but tragically, that event only took place a couple of times each year; partially-sighted Anne has to have her clothes laid out in a certain way each evening, so that she could find them in the morning). We all knew the routines and we followed them as much as we could, each day. But this did not take away from the fact that dreadful things were going on in that home, things that I could not bear to see. I felt a real connection with the residents, and that was the thread that weaved in the compassion, the care, the (attempted) competence, and the commitment, which led to the courage to communicate the terrible goings on to the authorities.
It was the connection with one or two in particular, that led me to write poems about the struggling, elderly bodies that tortured their fiery minds each day. One lady, on waking each day, would cry, because each night she prayed that she would die, rather than wake in pain each morning, her arthritic joints agonisingly taunting her heart, which longed to walk hand in hand with her husband on the beach, or hug the grandchildren she loved, who smiled at her from their gilded frames on the windowsill. I would try to be in her room before the others, to help her get dressed. Why? Because she insisted on wearing her tight-fitting satin blouses each day, which were almost impossible to bring her tense, creaking arms through. But I had found a way of being able to do so, unlike some of the other staff, who would take out their annoyance of the perceived inconvenience as they wrestled and tugged at the poor lady's arms, roughly pulling and tutting as she winced and cried out in pain. I couldn't bear to see it, so would try to get to her room first and gently, slowly ease her arms out as straight as I could, one at a time, apologising repeatedly, but knowing that the smart, pink blouse the lady wanted to wear, along with her matching lipstick, would make her feel just a little bit better about being alive, a little bit more "in the pink" than she really felt: quite simply, it made her feel human.
In the end, a good year or so after I left and started my training, the home was closed down after several serious complaints from relatives. There were staff there who were deeply caring and concerned about the treatment of the residents, as well as the living conditions and the mismanagement of the company (who subsequently found themselves in the position of being broke, forcing the closure of the other homes they owned, too), but 22 years later, I am still very saddened by the thoughts of the events I witnessed. I wish I could have done more to change the circumstances. I wish I could have stood up to the company and banged my drum louder for more to hear, so that changes could have been made. But I was green, I was naive, and I didn't know what I needed to do to make things better.
Ironically, when I started my training at a London teaching hospital, it was comparative luxury to be able to walk to the cupboard when I needed soap, incontinence pad, sheets or clothing, to see shelves full of everything I needed to be able to provide the basic nursing care required. It was bizarre to me that NHS staff were complaining of a shortage of equipment and resources. On reflection, it showed me just how bad things were at the nursing home I worked in.
On my first night in my nurses digs, I put up the poems I had written about the residents I had looked after on the wall next to my door. I read them each day, to remind me of the sorrow and pain these folks had suffered, in order to do the best for my patients. These and many, many more patients over the years are the connection within me to each one of those I have seen suffering, in pain or anguish, in fear or terror. The connection of human spirit within the nurse and patient relationship is what weaves the sometimes achingly beautiful compassion, care, courage and commitment into the art of nursing. Connection is the thread that holds everything else together. Without connection, the most basic, yet most complex circumstance is flawed.

So, 22 years later, I am no longer green or wet around the edges. I still love my job. I still make mistakes, each one leaving its mark for me to learn from and grow. I have seen so much heartache and pain, like other clinical staff; I have seen miracles, I have seen the fragility of the tiniest life to the vulnerability of the mightiest of men, anguish and grief in many; and joy, pride and acceptance in those too numerous to count.

But now is different. Now I am using my skills in mindfulness to help my patients across a wide spectrum of age, illness and diseases. I am discovering how best to use the connection I can make with my patients, to help them connect with themselves to understand that they can help to ease their discomfort. I am seeing results, sometimes instantly, just with a tweak to the way I work with each individual. So in my clinical practice the six 'C's have another recruit. Who wants to connect with me?