Zen and the Art of Dealing with Stress
by Ross Elledge,
Consultant Oral and Maxillofacial Surgeon &
‘You Okay, Doc?’ Ambassador
It was about a year ago when I had to take some time off work for mental health reasons. There were multiple factors that were contributory, but ultimately there was a tipping point where stress got the better of me. I had practiced Ashtanga Vinyasa yoga for many years but of the eight limbs (“ashtanga” means “eight limbs” in Sanskrit) set out by Patanjali in his Yoga Sutras, like most Western practitioners I was concerned really with asana (postures) and pranayama (breathing). And so, I began to read about meditation and mindfulness, and started to cultivate a regular meditation practice.
Stress is really common among doctors. We shoulder a lot of responsibility and invariably don’t accept imperfection and “things going wrong” very well. A few weeks ago, a medical student let me know that she had failed her exams and was facing resits. She was extremely upset. I spoke to her about what an important opportunity this was. It was an opportunity to fail. At first, she didn’t get my meaning, so I explained. I told her how well I had done at medical school. How I had never failed and walked away with a lot of prizes and the gold medal, finishing first in my year. And then I told her what a disservice this had done for me. Because medicine can be messy, imperfect and unpredictable. There is only so much you can control and the rest is open to a degree of chance, which is why medicine is an art as much as it is a science. Importantly, things go wrong. Things that are outside of your control. If you have never learnt to fail, the result is where I was a year ago.
When I started picking up the pieces last year, the first thing I realised was how much my identity was wrapped up in being a doctor. But this was a fundamentally flawed notion of myself. I was so many more things: a father, a husband, a guitarist, a yogi, a voracious reader, a terrible gardener. But even these things didn’t paint the whole picture. The key thing was that all of these attributes were different facets of me, but not the complete me, or indeed the essence of me. The parable of the blind men and the elephant springs to mind, one recorded in the Tittha Sutta, a Buddhist text from 500 BCE. In this story, a group of blind men are tasked with inspecting an elephant. They each feel a different part of the animal: a tusk, the tail, the trunk, and so on. As a result, they each come away with a different idea of what constitutes an elephant.
I had been doing this with myself for a long time. Many medics are guilty of this. Think about it. When someone asks you “What do you do?”, we all automatically reply with our professions. When I was taking time off work and dealing with the fallout from stress, my answer was: “Nothing”. But that wasn’t strictly true. I was sanding furniture and painting doors around my house, I was learning to meditate, I was picking my kids up from school and I was growing vegetables. There were lots of other bits to my elephant. Lesson one from a regular meditation practice was that the clouds may come and go, but the sky remains the same. There is something within all of us which is consistent and transcends any notion that our profession defines any of us. We would do well to remember that whilst medicine can be a calling and a vocation, it is ultimately a manmade construct with rules and regulations, expectations and behaviours that are there to guide us in our day to day lives but which can feel overly restrictive when we use them to define our every waking moment.
Lesson two was about control. Around about the same time the medical student told me about failing her exams a few weeks ago, an operation I was carrying out resulted in a recognised complication. Still, I took it personally and beat myself up about it, as I always do. But I had to remind myself that not only was it okay to fail, but that I am not in control of every external circumstance. What I am in control of is my reaction to these circumstances. The 8th century CE Buddhist monk Shantideva said that you could not possibly find enough leather to cover the face of the Earth, but that wearing leather just on the soles of one’s shoes is equivalent to covering the Earth with it. I could, like my medical student, choose to identify this complication as an opportunity for learning, reflection and growth. I reflected on what I might have done differently to minimise the risk of such a complication occurring, I discussed the case with mentors and I kept a close watch on the patient, who knew that I cared about them and had their best interests in my heart and who continues to honour me with their trust.
The third lesson was about loving - kindness or Maitri in Sanskrit. One of my trainers once said that “everyone goes through training to be given a tough time, except Ross because he does it to himself”. People think they should meditate to transcend the humdrum of day-to-day life, but in fact the purpose is not to enter some ethereal state but to work with the mud we are given to grow lotus flowers. Part of that is accepting and embracing everything about ourselves, befriending ourselves. We accept our imperfections and through finding peace and benevolence within ourselves, we can extend these qualities outwards to those around us.
So, the next time you think you are stressed, remember to realise the accuracy in that assertion that you are stressed. The circumstances around you only cause them stress because you allow them to, because they do not meet your expectations of “how things should have gone”. Being truly mindful and present, being aware of who we are, being kind to ourselves and allowing ourselves to acknowledge that circumstances in medicine may be outside of our control, we can live the words of Confucius: “The green reed which bends in the wind is stronger than the mighty oak which breaks in a storm”.