Kindness: Reflections on a Year of Pandemic
By Mick Krasner, M.D.
"No amount of sophisticated technology can do what health professionals have done these past few months. Offered care with uncertain evidence, sat with the dying, comforted family members from afar, held one another in fear and grief, celebrated unexpected recoveries, and simply showed up. We have asked and expected clinicians to show up in ways they we were never trained to do. No one has been trained in how to emotionally manage months of mass casualties. No one has been trained in how to keep showing up despite feeling feckless on the job. No one has been trained in how to keep regular life afloat at home and anxiety at bay while working day after day with a little know biohazard."
~Christine Runyan, PhD, Professor of Family Medicine, University of Massachusetts Medical School
Although local and small in a certain sense, each of us as health professionals, directly or indirectly, has been those health professionals who Dr. Runyan describes, leaning into the unknown and showing up for whatever presents itself moment by moment, day after day. Although she mentions a lack of training in the skill sets required to meet the ever-changing demands of this crisis, I would submit that we, as resilient, curious, and potentially flourishing clinicians, by the very nature of how we have been shaped genetically, epigenetically, psychologically and socially, have all the necessary training, informal as it may be, to be of real service in this crisis and for future challenges, be they small or large.
We understand the role of the autonomic nervous system with its exquisite, primary physiologic response to acute stress, its “sympathetic” arm’s fight-or-flight-or-freeze responses that have insured our survival as a species. Despite this, we can reasonably ask the question, why then would civilization develop altruistic societal institutions and hence individual responses that has its members move toward danger, provide care for others who may risk the caregivers themselves, and even elevate those responses and individuals in some way as responding to a higher calling? What biologic, sociologic and behavioral systems reinforce that calling? What survival advantages result from those behaviors?
A related more behaviorally driven but biologically supported response to acute stressors, one that seems to have a gendered dimension to it, has been described as tend-and-befriend, involving nurturant activities designed to protect self and offspring, promote safety and reduce distress, and create social networks that aid in the process. Supported by oxytocin, female reproductive hormones, and opioid peptide mechanisms, this response can be viewed as equally contributing to our survival and helping build present and future responses to challenges and crises. Small amounts of the biochemical supports mentioned above that are released in response to the tend-and-befriend behaviors are interestingly released even before the response, priming us to consider choosing tend-and-befriend behaviors, and affording us a “hit” of these connecting and pleasure-producing messages, drawing us toward the difficult and the dangerous.
As I contemplate this tend-and-befriend part of our stress response repertoire and think about the committed health professionals I have been fortunate to share Mindful Practice with, I consider deeply the reward system that supports my own continuing professional and personal life. In that contemplation the word Kindness arises. Kindness is an opportunity that we as clinicians have each time we meet with a patient or a family member. Kindness is self-reinforcing. Kindness is the inward and outward awareness and manifestation of the tend-and-befriend response. And although opportunities for kindness are ever present in the lives of all the people outside of Medicine, in Medicine, kindness is what we do, and kindness is who we are.
Many years ago, while facilitating mindfulness courses with colleagues, we explored the traditional and modern versions of the Hippocratic Oath. In doing so, we touched upon our collective professional commitments that we freely make, providing the scaffolding for the unfolding of what we do and how we are in our work. As part of that experience, I often asked participants to spend some moments writing their own oath and then share it with each other. Here is one such oath:
"May I know the simple grace of witness — the healing salve of patient listening. I vow to slow down enough for tender honesty and to speed up enough for joy. I hope that patients will find in me a compassion for their suffering, a keen mind for ways to relieve it, and a dedication to share my knowledge in language they can understand. May I remember… — that my patients are loved by others who suffer in their love. This is to be respected and tenderly acknowledged — while being ever mindful that in the end the patient is at the center…"
As I read this now, I am struck by many of the words: joy, suffering, dedication, love, listening, honesty, understand, respect, tenderly, grace. Tend-and-befriend, with kindness at its center, lives within the very heart of medicine, inhabits the heart of our commitment, and resides within the hearts of all health professionals who show up, day after day, moment by moment, for the unfolding of this uncertain, beautiful, painful, joyous, and in Mary Oliver’s words "one wild and precious life."
References:
1. Oliver, Mary. The Summer Day in House of Light, Beacon Press, 1990
2. Runyan, Christine from the Podcast: What’s Happening in our Nervous System in On-Being with Krista Tippett, March 18, 2021
3. Taylor SE et. al. (2000) Biobehavioral responses to stress in females: Tend-and befriend, not fight-or-flight. Psychological Review, 107, 411-429
Emma Strujo |
4/5/2021
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