Dr. Lawrence Cheng MD, CCFP(EM), MPHFunctional Medicine, Goals, Stress

Any crisis presents a perfect opportunity to examine the nature of our mind.  Where is our attention going?

Dr Lawrence Cheng, MD

Are we ruminating on the latest news of COVID 19, not in any productive way but just becoming worried and anxious.  Are we being present and aware of  what is actually happening right now? The quality of our consciousness from one moment to the next is really what determines the quality of our experience.

I am sharing this from my perspective as a front-line ER doctor who is preparing for a potential tsunami of sick COVID patients here in Vancouver, Canada. In the past few weeks, I have found myself having trouble balancing the need to stay informed on all things related to the outbreak both from a professional and personal standpoint and being in the present moment.  This really hit me the other day as I was intensely reviewing case reports of severe cases in Italy and becoming more and more anxious but drawn to look outside the window by the sound of birdsong.  When I looked outside, the sun was shining, the sky was blue and birds were signing carefree just as any other amazing day.  The juxtaposition of the impending doom of what I was reading (experience in my head/thoughts) versus what was true in this present moment (warm sun shining through the window etc.) was remarkable.  Fortunately, I  was able to shift my attention and re-direct my experience.  I have been reflecting on the idea that we do always have the choice on how we direct our attention as long as we are reasonably aware of the tendencies of our own minds.  It is no doubt much more challenging when we are facing an unknown challenge, drowning in reports and sensationalized news bites that are delivered with ever increasing velocity to our devices non-stop.  This is why, during these times, it is even more important to be deliberate in developing tools and practices to focus our attention, regulate our nervous system and be empowered to determine the quality of our moment to moment experience.

Self-isolation, closure of all our usual entertainment options (restaurants, bars, gyms etc) is a real challenge for all of us who are so used to being productive, active, “busy”, occupied and distracted.  I am beginning to see how this is a gift in many ways beyond the benefits of “flattening the curve” of the pandemic.  What do we do with ourselves when our usual distractions and activities are removed?  Are we bored, miserable, irritable with our partners and family whom we have been forced to spend all day with now?  Are we afraid of our own thoughts?  Fortunately, the internet is still working and we still have endless options of distractions available to us at a single click.  The question is, can we take this opportunity to slow down, to be more mindful, to be more present?  I recall the stories from New York city when they had a prolonged power outage, when many New Yorkers recall this period  as a special time when they could  spend hours just talking with friends by candlelight or looking at the stars.  In a world of so many distractions, noise; retreat – either self-imposed or forced (like now) can be an invitation to being more present, embodied and having a deeper experience of who we are.

This is where meditation is one of the best tools for becoming more aware of the quality of our thoughts and regulating our nervous system.  It is pretty clear that our mind states have profound implications on all of our body system functions including our immune system.  A chronic stress response increases the chances that our immune system can become dysregulated (either under active – increasing susceptibility to infections or over-active – increasing risk of autoimmunity, allergy etc.).  This is why regulating our nervous system is so very important in the face maintaining a good defence system against infectious threats.

Social connection is also vitally important.  Although we are in the need to be physically self-isolating right now, we should do everything we can to connect with our family, friends, our community through technology.  We can still be outside connecting with nature while maintaining physical social distance.  I say physical social distance because in these times, we have the opportunity and need to be actually becoming closer together.

There are lots of amazing meditation apps (Waking Up, Headspace, 10% Happier), online videos, books etc. that can help us get started.  I try to find 20 minutes in the morning to “set-up” where my attention/consciousness lies as well as anchor the baseline of my nervous system before things get busy.  Ideally, I do the same thing before bed.

I will be going into the ER tomorrow for a shift.  I won’t lie, I have some anxieties about whether I will see a sick COVID19 patient who is crashing and who needs intubation.  Will I be able to save this person’s life, will I remember all the complicated steps of doning an doffing personal protective equipment, will be at risk of bringing something home to my family?  How do I deal with this uncertainty and risk which seems ever more present now?

The best thing I can do for myself and for patients apart from being prepared from a technical medical standpoint is to ground myself, be present, regulate my nervous system so that I am prepared to deal with what ever it is that I need to deal with tomorrow. At some point, we can only prepare as much as we can and just do the best we can.   Right now – the sun is shining and the birds are singing.

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