The Kindest Thing You Can Do
By BARRY BOYCE
 "I’ve
been with patients all my life," says Susan Bauer-Wu (shown at left), associate
professor of nursing at Emory University in Atlanta. "Patients are not a
special class of people. They’re us. When we become patients, we are
experiencing greater pain and greater limitation. We may need to be
confined. We lose sleep. Perhaps we can’t eat or walk or talk in the
same way. How we respond defines the difference between pain and
suffering. Pain is an unpleasant signal. Suffering is how you relate to
that signal. It’s the meaning or story you create in your mind in
response to it."
Susan
Bauer-Wu has indeed been with patients all her life. Her mother was a
nurse at New York’s Central Islip State Hospital, a sprawling
psychiatric facility on Long Island. Bauer-Wu sometimes even went to
work with her mother and shadowed her. She went on to study nursing
herself and during her sophomore year in college, when her mother was
diagnosed with advanced stage breast cancer, she went home to take care
of her.
From
the start, Bauer-Wu’s interest has always been in the patient as much
as the illness. Her doctoral study focused on the emerging field of
mind-body medicine, primarily because her work with cancer patients
impressed on her that the clinical treatments alone did not completely
explain how well patients fared with their illness. “I always want to
know the whole story,” she says, whether visiting with patients in their
homes, staying with them in the hospital during lengthy courses of
cancer treatment, or teaching them how to use mindfulness to deal more
effectively with the limitations caused by illness.
Today, Bauer-Wu, author of Leaves Falling Gently: Living Fully With Serious and Life-Limiting Illness through Mindfulness, Compassion, and Connectedness (New
Harbinger, 2011), is one of the foremost clinical researchers looking
into the effects of chronic stress on patients with debilitating and
life-limiting illness and how mindfulness and compassion practices can
help such patients. In addition, she studies how caregivers—both
professional caregivers and family members—can more effectively serve
their patients or loved ones while maintaining their own equilibrium.
Bauer-Wu’s
main prescription for working with pain and limitation is to “tune in
to your body” and what’s going on with it rather than turn away from it.
She says, though, that it’s important to develop sensitivity to the
difference between chronic and acute pain. Chronic symptoms are
unpleasant sensations or bodily experiences that linger for weeks,
months, or years. Acute symptoms are physical sensations that come on
quickly or increase sharply and reach the height of our pain tolerance.
“These,” Bauer-Wu says, “are neither to be tolerated or ignored. They
are critical messages that require action,” such as seeking immediate
medical attention. By contrast, chronic pain and irritation are the very
stuff that mindful awareness can most readily ameliorate, thereby
changing the whole way we view being ill or in pain.
“Our
most common reaction to pain is to resist it, so when someone tells you
to turn toward your pain it seems counterintuitive, almost like
punishing yourself,” she says. In fact, Bauer- Wu notes that many of the
mind-body programs for cancer patients reinforce this basic tendency by
using guided imagery “to take you to the mountains, to the ocean, to a
tropical island in your mind.” The cornerstone of the mindfulness
approach to illness is that you need to learn how to accept where you
are, and then you can notice the sensations and respond appropriately.
“If your pain really is acute and reaches a seven or eight out of ten,
then guided imagery or other methods of dealing with such intensity may
be appropriate,” she says. “When you know that the pain is not at that
kind of acuity, you have the power to investigate it with mindful
awareness.”
The
first step, says Bauer-Wu, is to be aware of sensations as just
sensations. So often we have a single solid label for our pain and we
interpret what it means. We can begin to construct storylines of
worst-case scenarios or self-loathing. “However,” Bauer-Wu writes in Leaves Falling Gently, “if you step back and curiously observe what your body is feeling, you realize that pain is not just one big overwhelming thing,
but rather a constellation of many subtle bodily sensations, such as
dullness, sharpness, aching, or throbbing, that likely change from
moment to moment.” Noticing the nuanced qualities and fluctuations of
sensations gives them less power over you.
“If
you have pain in the lower back,” Bauer-Wu asks, “what are its
qualities? Is it throbbing, burning, and piercing? Is it constant?” You
can direct your attention to different parts of your body and experience
the sensations in each one. “This gives you a richer sense of your
whole body,” she says, and you begin to realize that you are not your
pain.
Of
course, illness, hospitalization and facing the possibility of death
can bring on overwhelming emotions. Just as with bodily sensations,
patients are encouraged (as are caregivers) not to turn away and resist,
but rather to become familiar with what they’re experiencing by
observing it. Whether they’re experiencing fear, sadness, anger, or
unhelpful thoughts like dwelling on the past or regretting that the
future will not turn out as they’d like, patients can let it pass
without judgment. But if need be, powerful thoughts can be redirected.
Intense fear or anger can be hard to look at, and at such moments simply
gazing out the window at the sky may bring some calm. Eventually, the
upheaval will subside.
Since
patients confined to hospital rooms or bedridden at home often become
restless and irritable, Bauer-Wu encourages them to use everything in
their environment as an object of mindful attention. For example, she
says, you can scan the vast soundscape that surrounds you and use the
aural equivalent of a flashlight to land your attention on a sound, such
as wind rustling or rain falling. Rather than being annoyed by the
sounds around you, by tuning in you can choose how you engage with them.
Likewise, rather than seeing everyday activities such as bathing and
brushing your teeth as drudgery, you can allow these activities to
ground you in present-moment awareness. “You don’t need to do anything
special,” she says, “or go anywhere exotic.”
Compassion
and connection fill out the picture in Bauer-Wu’s methodology for
changing the way patients experience their condition. Tuning in and not
turning away from pain grounds you in the present moment. It is
compassion that enables you to rediscover “your innate goodness” and the
warmth of your heart. It enables you to communicate and connect with
others, and counteract the isolation and self-involvement that turns a
painful condition into repeated suffering. In fact, Bauer-Wu says,
“Compassion is a part of mindfulness itself right from the beginning.
Mindfulness is the kindest thing you can do for yourself and others.”
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