Humans survive by the brain interpreting impulses from various sensors located in every millimeter of your body and interpreting the sum total as safe or a threat. Every sense has a threshold that indicates danger—hot, cold, bitter, loud, bright, sharp, pressure, burning, nausea, etc. Without that immediate feedback, you could not protect yourself.
Humans have a unique characteristic in that unpleasant thoughts create the same defensive reaction, but since we can’t escape them, we are often subjected to prolonged elevations of stress hormones and inflammation. Suppressing them, which is somewhat the norm, makes the situation even worse. What can you do?
Instead of doing battle with these thoughts, you can switch sensory input. There are many choices. You can listen to enjoyable music, practice meditation, mindfully notice small details of your day, take slow deep breaths, pay attention to your breathing, engage with your passion whether it is at work or play, and deepen your relationships with your friends, family, and colleagues. In other words, by fully engaging with what is directly in front of you, your mind has gone that direction.
But it goes both ways. If you choose to remain angry, complain, be critical, and constantly discuss your problems, your body will react in kind, and you will remain on high alert. Being aware of your environment, whether it is pleasant or unpleasant is the first step and then you have a choice to remain in an agitated state or to use tools to calm down. The exact tool doesn’t matter as long it is effective for you. As has been mentioned, many of us are so used to being agitated, we aren’t aware of it or its impact on others.
Being aware of your senses—known as environmental awareness—is a strategy that allows you to switch sensory input from racing thoughts to another sensation. It doesn’t matter which sense you choose. I practice one that I call “active meditation” or “meditation on the run.”
During my years of performing complex spine surgery, there were occasional complications that were considered well within the scope of care. But the consequences were sometimes severe, and I was committed to bringing them down to zero. But no matter how hard I tried, I wasn’t able to eliminate them. My own thoughts were interfering with my performance.
Things changed when I decided to enlist the help of a performance coach to improve my consistency. I brought him into the operating room and clinic so he could better understand my world. For 18 months, he and I underwent regular debriefings and coaching. I began to use “active meditation” in the operating room. The most common interferences I felt during surgery were frustration, anxiety, distraction, complacency, and moving too quickly.
Active Meditation in Action
This meditation model is not based on suppressing interference—for instance, if you’re frustrated, you don’t pretend otherwise. Rather, face the frustration, detach from it, and proceed in the manner of your choice. I learned to identify interferences either before or during surgery, and then used mindfulness-based approaches to let go of them quickly.
This version of mindfulness is fast. It took about 3-5 seconds and was repeated frequently during a case. It was often connected with one quick deep breath in and a slower one out.
Setting Up the Day
Each surgical morning, I woke up and assessed how I was feeling. Like everyone, my feelings ranged from calm and relaxed to tired and anxious. I would sense smells, touch, and taste, etc. I felt the water on my back in the shower. I savored my coffee. I also reminded myself that although that day’s surgery is “just another case” for me, it’s one of the most important days of my patient’s life.
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I continued this process in the operating room. I carefully arranged the room, talked to each member of the surgical team, and reviewed the imaging studies. I remained focused and immersed in what was right in front of me.
During surgery, awareness allowed me to perform my next move at an optimum level. I felt my grip pressure on each surgical tool; noticed the shape of the contours of the anatomy; felt my shoulder and arm muscles stay relaxed; and watched the flow of the case.
If I noticed disruptive thoughts and emotions enter my consciousness, I quickly practiced my environmental awareness techniques in order to re-focus. I would usually focus on light touch. With practice, I learned to be fully connected to each move, so I could “program” myself into the “zone.” Eventually, it all became automatic. I was so connected to each move that I might experience 10 distracting thoughts in a six-hour case. It was a remarkable shift from dealing with endless racing thoughts.
Surgery evolved into a wonderful experience for me. I eagerly looked forward to Monday instead of surviving until Friday. I committed to getting a good night’s sleep before every surgical day. If I woke up “wired” and uneasy, I slowed down until I felt relaxed, no matter how many things were on my to-do list. And by the way, there was a dramatic improvement in the consistency of my surgical performance.
The same approach is a core tool to remain calm throughout your day. It is more difficult outside the OR, where there is often less structure. But with repetition, it will become automatic.
The “To-Do” List
I use my “to-do” list as an opportunity to practice mindfulness. I remind myself that this list is an expression of my life, and so I deliberately become aware as I go about each item.
For instance, when I had an appointment with a patient, I would carefully focus on listening to myself talk to him or her. Of course, carefully listening to them was critical. I felt my pen on the paper as I jotted down notes. I also practiced meditative techniques, such as “watching” disruptive thoughts such as “need to finish up here, I have other things to do” enter my consciousness and then leave. I reminded myself that my goal was to engage and enjoy every second of my “to-do” list. It didn’t always work, but it’s surprising how often it did. It is still part of my day.
Environmental awareness connects you to the present moment regardless of the circumstances. It is not positive thinking, but just switching the sensory input. With repetition, it becomes and remains somewhat automatic. In the presence of ongoing pain, it is not the final solution, but will calm you so other tools can contribute to your healing. It is a simple strategy without a downside.
This is the first and most basic of the different types of awareness. The other types of awareness are more challenging—emotional, judgment/storytelling, and ingrained patterns. It is one of the reasons it is important to implement your own version of environmental awareness that will help you deal with the other ones that are more stimulating.
Questions and Considerations
- Many of you have heard the phrase, “be here now.” It is brilliant except it is rather hard to do. By actively turning your focus to a given sensation, you are here now. Your attention cannot be in two places at once.
- Then consider a more complex awareness in action. As you engage in various activities, interesting or not, by immersing yourself in every aspect of them, you’ll become more connected and calmer. For example, you are sitting in an important lecture. By listening to every word, you’ll find it more interesting and have a much higher chance of learning what you need to learn. Detailed notetaking also has the same effect.
- If you can learn and consistently use this skill, notice how much calmer your mind becomes.
- Consider how much of your waking hours are consumed by racing thoughts that have little to do with your circumstances. Active meditation can make a big difference in your quality of life and requires almost no effort.