Witness to suffering

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As a doctor, a lot of the care that I provide has nothing to do with prescribing medications or performing procedures. Sure, they form a significant part of my training and my day to day work. However, there are also many times where all I can provide for the patients is my presence, to be a witness to their suffering and to create space for them to grieve and mourn.

This was a huge revelation to me in the earlier stages of training – recognizing that there are many things we can’t just “fix” in medicine, and that care doesn’t end with telling a patient “I am sorry, there is nothing we can do”. I never realized how difficult it is to be truly present to witness someone’s suffering until I had to do it myself. It is so easy to give into the temptation to comfort, or to give false hope or even mislead. At the beginning, I told myself that it is because I care deeply about the patients, and it was difficult for me to watch them suffer. However, the more I did this, the more I realized I was NOT helping these patients by quickly wrapping up their suffering in a neat package to replace it with something prettier – I could see how this made them feel confused and lost. Why then, was it so hard for me to change my behavior?

Problem solving engages the prefrontal cortex of our brain – the part that allows us to reason, filter and regulate our emotions. Being forced to turn away from problem solving therefore leaves us feeling exposed, out of control and yes – vulnerable. However, in turning away from problem solving, we can truly be present and focus entirely on the suffering of the individual in front of us. In psychiatry, this is called “holding space”. Having the space to grieve without feeling pressured to go into problem solving mode can be a deeply therapeutic experience that allows one to just “be” and not be judged.

Think about our daily lives – how often do we simply listen to our friends, family or significant others and be fully present to witness their experiences? As children, how many of us had the luxury of this experience when we tried to share difficult experiences with our parents?

I tried to imagine what it would feel like to have someone fully present to witness my suffering, to have an understanding of how this could help my patients. My mind shifted to when I pray or meditate at my altar. Sometimes, I am looking for answers – but more often than not, what I desire is to have the time to sit in my grief and to let it all out, and to have someone sit WITH me in my grief. The sheer presence of my goddesses and spirit guides had always comforted me in my darkest times, and this is what I could do for my patients when there is nothing else I could offer as a doctor. Simply being present in their suffering was a service I could provide in those dark moments.

Now, when I deliver bad news, I sit with them, quietly, with a tissue box in my hand. I stay present with their grief, and in doing so I hold space for them to process their suffering.

It is true that this is much harder with family and close friends – those who we consider part of ourselves and can make us feel particularly vulnerable when they share their suffering. Practice makes perfect and I am still working on it.

Sitting with your feelings

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I was reading “Maybe you should talk to someone” by the brilliant Lori Gottlieb this morning just before work, my little morning ritual, when one message really struck me: it is horribly difficult to sit with one’s own feelings, even for psychotherapists. I am no psychotherapist, but as a doctor, I always ask patients to reflect on their actions, thoughts, and feelings, and encourage them to do mindfulness exercises where they try to notice their thoughts and body without judgement.

The practice of witchcraft also asks one to recognize their thoughts and feelings, so that they can be used to enhance one’s craft and power. An aware witch is a powerful witch – she who rules herself can rule the world.

Why then, is it SO HARD for me, to sit with my feelings? I spend most of my days reading, watching TV, scanning through Youtube, or scrolling through my phone when I am not working in a desperate effort to distance myself from my emotions. In a way, working is almost an escape, because focusing my attention entirely to my patients shifts me away from thinking about myself.

A common concept discussed in psychodynamic theory and in family therapy is that a child who grows up learning that their feelings are invalid, internalize this and grow up to be adults who cannot tolerate their own emotions. The act of noticing and acknowledging their internal processes become associated with deep shame, rejection, and feelings of being misunderstood such that they learn to cope with this by becoming avoidant, not just of their own emotions but of that of others as well.

The difficult part of this is that our thoughts and emotions influence our judgement and worldview whether we acknowledge them or not. Being able to sit with, notice, and acknowledge our internal processes help us realize why we see ourselves, others, and the world the way we do, and lovingly readjust if there are biases at play.

This of course, doesn’t come easily at all. I realized my own tendency to avoid my feelings when a supervisor pointed out how I tend to get flustered if I don’t know something I think a patient wants of me, and how I would completely shift my behavior without even noticing that I am doing this. My supervisor asked me to sit and slow down, and notice the thoughts that arise in my head when this happens. This was an EXTREMELY difficult exercise – at the end, I identified a DEEP SENSE OF SHAME that arose when I felt that I wasn’t giving the patient what she/he wanted. Because this emotion was so difficult to tolerate, I avoided it completely, not even giving myself a second to think about it – unfortunately, this did not stop shame from influencing my behavior. Once I did notice the thought, also called “hot thought” in cognitive behavioral therapy, which in my case was “I am a failure”, I was able to lovingly tell myself: it’s okay to not know everything, you are doing the best you can. In slowing myself down and lovingly readjusting myself, I was able to be more present and authentic with my patients, which in turn made them happier.

When practicing magick, we ourselves form as much of the spell as the ingredients, incantations, and the spiritual forces that we summon to help us. When dark thoughts reside behind the spells that we cast without our knowledge, these thoughts can cause the spell to be weakened or even backfire. See the parallel here?

I still find sitting with my emotions extremely challenging, but I consider it an important part of my journey as a physician and a witch to become more self aware. I will be sure to keep you updated on that journey – wish me luck!

Anger, Compassion, and Forgiveness

It was the first one of my series of night shifts at the Emergency Department – I was excited to work in the ED again (one of my favorite places to work at) and was looking forward to having a productive and rewarding night.

Unfortunately, not quite having adjusted to the night schedule, my brain was foggy and my body was exhausted. I still tried my best to be chipper with the team and present for my patients, reminding myself of my goal to be a good team player and a healing light. Despite my efforts, I made two consecutive mistakes within the first 3 hours of my shift – both small mistakes not affecting patient care, but still quite a deviation from my usual performance. I tried to not think about it and move on, telling myself that I need to be more careful tonight as I am having an “off day”.

After suturing a patient at 3AM in the morning who had decided to do laundry in the dark in the wee hours of the morning, my staff and I had a disagreement over the type of sutures I chose to use. I decided to go with patient preference in the choice of sutures, and he wished that I had used a different suture which has evidence for causing less scarring. It was a matter of opinion and practice, and he did not hold this against me in any way. He just provided me education and made it clear what his preference would be if we were to suture another patient that night. Normally, I appreciate this kind of straight forwarded communication because it allows for a smooth shift and running of the team. That night though, I found myself getting extremely angry over this, thinking to myself “HOW DARE he decide to make an issue of this on a very busy overnight shift”.

Recognizing that my anger was completely out of proportion and irrational, I took a small break and sat in the lounge area where I could take off my mask and breathe. I went over my shift and my experience working with him so far. He was a great supervisor – he had clear communication, let me know right away what he likes and what he doesn’t like, and allowed me a good amount of independence. Why then, was I so upset with him over this small disagreement?

In situations like this, psychiatrists recommend that patients go back to the time before the argument had even started, to check in with their emotional states that may have influenced their reactions to the argument or discussion. In that moment, it became crystal clear to me that I was already very upset at MYSELF for making those small mistakes in the earlier hours of the shift. Despite my best efforts to suppress these thoughts, my mind was already on edge by disparaging thoughts targeted at myself. Specifically, I was telling myself that I was a failure and a bad doctor because I had made those mistakes.

Everybody has off days. Doctors and nurses are human, and therefore, are vulnerable to making human error. The mistakes that I made had not harmed anyone, although they did cause minor inconveniences. I took a deep breath and meditated. I looked at the sigils I wrote on my badge – protection, peace and patience. I thought of my goddesses and asked for their guidance. I then thought of what I often tell my patients – What would you have told your friend if they made these mistakes? This made it clear what the issue was. I had no compassion or patience for myself and immediately jumped into a judgmental mindset – an attitude I would have NEVER taken towards any of my colleagues. The consequent feelings of being a failure was so painful to sit with, that I had displaced my anger towards myself to my supervisor as soon as there was opportunity for such transference.

Displacement, according to Freudian principles, is one of the maladaptive defense mechanisms where one unconsciously transfers/ displaces their inner conflict, usually stemming from earlier life experiences, to a situation or a person that is not a part of that inner conflict.

I was grateful for the guidance of my goddesses for giving me the space and calm to realize that self-compassion, or lack there of, was at the root of this issue. I inwardly expressed my gratitude to my goddesses and allowed myself to feel the feelings of shame and disappointment at myself for the mistakes I had made. I then told myself “I forgive you – I forgive you for these mistakes and for being harsh on yourself. I honor that your desire for perfection came from a place of wanting to be a healing light. I embrace you and I love you”. Immediately, I felt a sense of relief come over me.

I was able to return to my shift and had a great night – we helped many people and my supervisor and I made a fantastic team through a very busy ED shift. While this shift had not gone exactly as I had planned, I was grateful it happened. It was a wonderful reminder of the importance of self-compassion and forgiveness. I was also reminded that when all else fails, I will always have my spirit guides and higher self to show me the way.

Embracing the darkness

Wow, two blogs in a row! I am quite pleased with myself. Although I must be honest and admit that my algorithm (yes, the same one as yesterday) is still running on my desktop, forcing me to use my energy elsewhere while waiting for my poor computer to sort through this giant dataset.

My first dabbling in intentional magic (I was having visions and interactions – wanted or not – with spirits before this thanks to my witchy genes) came when I moved back to my country of birth after having lived years in a foreign country, attending international school. Having been, if I may say so myself, quite popular in the international school, I thought that I would enjoy the same welcoming in my hometown. I was terribly wrong – to these students, I was a spoiled, entitled brat with a stuck up nose and a funny accent. After they grew tired of asking me questions about “foreigners”, their customs and language, and having determined that I am just a big show off and there is in fact, nothing special about me, I was mercilessly bullied. Three years of bullying, in fact. In my “home” country, there is a term describing a student who is bullied by the entire class, and a separate term describing a student who is bullied by the entire school. I was the former, and my best friend was the latter, so you can imagine the kind of humiliation and painfully disfiguring abuse we went through on a daily basis. My mother, well meaning but very unwell, swung from one day, feeling motivated to help me and inviting my bullies over to try to make good with them, to making fun of me and humiliating me for being friendless, which of course, makes me “worthless”.

In this darkness, and being inspired the Harry Potter series sweeping across the country at this time, I decided to conjure up a spell of my own. I studied runes, talismans, goddesses, elements, and sigils. Looking back, I was embarrassingly green, barely understanding the basics of the aforementioned topics. Maybe it was Karma, or maybe my spell did work, but magickally, one day, my bully became the bullied. She was a terror no more, and I was happy to be able to to hang out with my friend at school without being afraid of being sworn at or otherwise humiliated. To be completely honest, this didn’t last long, as it didn’t take long for another bully to make my life a living hell again. Looking back at my life, my magick was always the strongest in my times of darkness, and for the longest time, I resented this. There were exceptions to this, of course. I have been fortunate to have money mysteriously flow in during times of desperation, for things that seemed impossible to just “work itself out”, for people who were obstacles to somehow disappear from my life, etc. It did bother me, however, that when I had dark thoughts about someone, willingly or not, there was a high chance that something bad would happen to this person.

After becoming an adult, I declared that I will only use my magick and intentions for “good” and reject/ suppress all my negative thoughts, cleansing and purifying them with whatever method was trendy at the time. Smoke, essential oils, singing bowls, crystals, tuning fork – name it, I’ve tried them all. It is only recently, emerging from the tribulations bestowed on me during my residency, that I have begun to feel the darkness again, rising from the depths within me. One of the reasons why I switched from an entirely research-based career to medicine was that I was being consumed by this darkness – the cut throat competitiveness and general toxic personalities that research unfortunately tend to attract grew so much anger inside of me that I felt like I was losing myself in it. I thought dedicating myself to medicine, to a more stable career where the goal is to care for others, where one does not have to step on someone else (supposedly) to make an earning, would help me abandon this darkness all together. However, life has its surprises. After 3 distinct, rather catastrophic events (without exaggeration) that happened in the earlier stages of my residency, I have, yet again, started feeling the darkness consume me. At the beginning, I tried to run from it – I meditated, cleansed, and had lavender running on my diffuser 24/7. I tried reminding myself that darkness can only bring about more darkness, that I must stick to the way of the “light”.

The point of this blog is to tell myself, and you, that I have chosen to take an entirely different path. I have realized, from reflecting on my life, that my magick is in fact, the strongest in the darkest times of my life. As witches, some of us are called to the light, some to the dark, some both, and some to absolute neutrality. I have come to accept and embrace that I have been called to the dark, and that there is no escaping it. My life, as thankful for it as I am, has been, to use the words of a psychiatrist that I saw for a single consult, “mostly traumatic”. In this life that I have been given, I have learned to live and even thrive in this darkness and to reject it would be to reject my entire being. The four goddesses that I look for guidance is a good representation of this. Hekate – goddess of crossroads and guide to those heading to the underworld. Persephone – a young maiden and goddess of spring taken by Hades to the underworld by force. At the beginning, she is a victim, but she emerges from it victorious by accepting her situation, embracing the dark and emerging as the goddess of hell as an equal to Hades. Psyche – a naive young woman emerging as a goddess of the mind (psyche – psychology, see the link?) and metamorphosis after going through literal and figural hell and arising from the ashes. Isis – goddess of magick and medicine going through the grief of having her husband cruelly murdered and dismembered, but using this grief to amplify her magick and power to restore her husband to become the rightful ruler of the underworld alongside Osiris. See a theme here?

Trauma work in psychiatry has two steps – first is to learn the coping skills to manage the devastating effects trauma has on one’s mind. Coping skills in stage one includes – wait for it – grounding, mindfulness, and drawing boundaries. Sounds familiar? Yes, these are the basic skills that any good witch book will have as one of the first steps of becoming a witch. Second part of trauma therapy is actually revisiting the trauma and learning to process and even harness positive changes from it ONCE one has obtained the basic skills to be able to hold and maneuver the trauma without completely succumbing to it. I am lucky that by practicing witchcraft, I have learned how to ground myself by extending my roots into mother Gaia, and how to co-create my reality instead of being a victim to circumstance. As the author of “Initiated” has wisely put, I need to “stop looking to escape the underworld”. My next challenge is to use these skills to harness the darkness for my highest good without letting it take control over me. One of the elemental forces, fire, stands for transformation and producing light from darkness. I started the practice of harnessing my darkness by asking the element of fire to turn the darkness rising from inside of me into a bright flame, which I then used to invoke the three fold law that I mentioned in my last blog. I am hoping that this becomes a precursor to my journey in embracing and ruling the darkness instead of running away from it.

Wish me luck!