Embodiment
Embodiment is being in tune to our body and integrating thoughts/feelings into action. It is a wonderful skill that allows you to feel at home in your own skin.
The truth is: embodiment while providing clinical care is difficult. In fact, to get through the day you may find that you have to ignore what your body is telling you. And, you may find that after years of coached clinical encounters you have a separate "Clinical Persona" - one that checks the boxes you were taught, or compartmentalizes difficult emotions or scenarios.
It is also true that clinical work provides a lot of opportunity to practice embodiment. When we see patients in difficult situations, when we interact with each other in cases, when we collaborate with the interdisciplinary team – we have a chance to bring moments of embodiment into the day-to-day work. The power of doing so is real. You probably can recall an interaction between a patient and master clinician that demonstrated skillful embodiment. An interaction where both parties were able to bring their whole selves. The impact of that on the patient and outcome is profound.
When we learn a skill, it is normal to feel awkward but leaning into that can help us master it. Sometimes our instinct is to suppress, to shove aside feelings of inadequacy to move quickly to mastery. Understanding this helped me figure out the first steps of embodiment in clinical encounters. Early in my residency, I still had a narrow view of what I could say in patient interactions, and I often found myself disengaging. I remember the day though when I realized there was a different way to process a moment and respond. I was a senior resident and was dealing with a patient who was frustrated by their length of stay. The intern walked in and they started joking, talking to the patient as they would a friend or colleague. The ease of the interaction came from the intern's ability to use their own sense of self to provide a sense of calm for the patient. The encounter turned out well, and as we walked away, I complimented the intern and thought to myself, “Ah ha! There is a different way.”
Now, I recognize that embodiment is much easier said than done. It's not just flipping a switch. As healthcare professionals, we spend years being monitored, evaluated and coached on our clinical interactions. As mentioned, you may feel you have a separate Clinical Persona. It is hard to figure out what is "you" - separate from the remnants that are left behind from working with others - and to feel what is really "you". This may be particularly hard if you never have felt you have seen someone like you in medicine before. This is particularly hard when all you are thinking is "How do I get through the day?!?" It is hard, but worth it.
Embodiment provides us a sustainable and integrated way to engage with clinical work. We often go through the day without necessarily paying attention to what our body is experiencing, and that disconnect leads to a lot of wear and tear. Using embodiment skills can allow us to find sustainable ways of practice. There will be times when you have to get through, and that's OK. There will also be times when you can find a moment and check in with what you need, and attending to those basic needs will help you maintain your energy and focus. Finally, there will be times when you can do a bit more and build skills. As you build skills, you can start to bring even more embodiment into your interactions.
Ultimately, just like vitals are an important part of addressing health in on our patients, checking in on your own vitals and needs is important!
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Yoga, pilates, stretching - these are ways to reconnect with what your body is experiencing. Understanding what your body is experiencing, can allow you to recognize, honor and address it. Even small moments to drop into breathing, or a stretch, can provide insight and connection.
Consider exploring the following resources:
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During internship, I used to race home after sign out or the end of the day. Arrive in the house to drink a liter of water, run to the bathroom and then eat whatever I could find in the fridge. I didn't even realize I was doing this until my partner pointed out, "Hey, do you drink any water during the day?" Or "When was the last time you ate anything?" It seems simple, but the system can feel relentless how it pushes us to forgo addressing our own needs to complete the next task, the next order, the next thing... Building in a moment of check-in can help.
Find a 2-3 minute natural break point in the day. It could be before clinic/rounds, after morning work, etc.
Create a mini check-list of basic needs. This could be water, food, restroom, deep breaths, helpful movement, etc.
Incorporate this into your routine.
If you consistently find it difficult to meet a need, you are likely not alone in having difficulty. Reach out to others and explore how to change a small part of the system.
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If you've read House of God, you may recall that one of the "Laws of the House of God" was: "At a cardiac arrest, the first procedure is to take your own pulse." While this may have come from a cynical place, the kernel of truth is that recognizing your own emotional and physical state is very important to navigate stressful situations.
You can practice grounding yourself through recognition of your pulse, and also use this skill when examining patients.
Find a quiet space, and take a few deep breaths. Find a comfortable position where you can be uninterrupted for two minutes. If you feel comfortable, close your eyes.
Hold your left wrist in the palm of your right hand, wrap your fingers around the wrist so your index finger is right below the base of the thumb.
Feel the pulse, and pay close attention. Which finger is the pulse strongest in? How does it change with pressure? Does it feel fast or slow? Explore the sensations.
Take a couple more deep breaths.
Open your eyes.
The next time you're examining a patient, see if you can provide the same attention to their pulse. And feel how this may allow for connection.
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Having a firm understanding of your capacity and limits helps you stay connected with yourself and embody the spirit of compassion. This is really hard as a physician, when we may be asked to break or push our boundaries in order to provide safe, quality patient care. But fundamentally, we cannot do the work, we cannot be there if we are depleted. As Brené Brown writes in Atlas of the Heart: "Boundaries are the prerequisite for compassion and empathy. We can't connect with someone unless we're clear about where we end and they begin. If there's no autonomy between people, then there's no compassion or empathy, just enmeshment."
Check out:
Podcast/Video Interview on Set Boundaries, Find Peace by Nedra Glover Tawwab
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A 10 minute practice exploring how to offer self-compassion to the feelings exploring embodiment may bring up. Often exploring embodiment may bring up where there are spots of pain or tightness - and meeting these feelings with self-compassion can help with processing.