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This would definitely make it difficult to slip away for a few minutes to recharge your mental batteries. Also they don't take into account your emotions. It was terribly upsetting giving birth to our baby with all these problems. We felt exhausted, betrayed, and grieved her death. You can't hear things in an objective way under that pressure, let alone formulate decisions. I think it's a kind of pseudomutuality. We wanted someone to act like a real doctor and help us make the decisions in the realities of our life. Not dump everything in our lap. If things turn out badly, we did it, we're to blame, but I guess they are off the hook, legally. Kevin O'Mannix is a fifty-two-year-old Irish American insurance executive with chronic obstructive pulmonary disease, an outcome believed by his physicians and his family to be the result of more than thirty-five years of extremely heavy smoking. His wife, Martha, a college-educated housewife and mother of their adult children, three daughters and a son, comments on the effect of Kevin's disease on the family: Psychiatrists compete with social workers and psychologists in the counseling of families. In certain places obstetricians compete with nurse-midwives for delivering babies. Biomedical institutions, though usually controlled by physicians, chiefly employ persons who are not doctors. Nurses, social workers, psychologists, physical therapists, occupational therapists, dental hygienists, respiratory and radiology technicians, physician assistants, laboratory technicians, ambulance drivers, mental health aids, translators, nutritionists, experts in the fitting of prostheses, and the large numbers of support staff in hospitals and nursing homes comprise more than 95 percent of the employees in biomedical institutions. Much of the care received by the disabled is provided by members of these other health professions. Even when the chronically ill visit their physicians, most of their time is spent with receptionists, nurses, and various paraprofessionals. Such workers tend to be undervalued by physicians. Their contribution to the patient's care is often unrecognized, as is their contribution to delays, insensitive communication, and patients' frustration with treatment. It is my personal experience that even when physicians are sensitive to psychosocial issues their office staff and the paraprofessionals who collaborate with them may not be.

Indeed, some of the most reductionistically mechanical and insensitive caregivers I have come across are relatively low-level clerks and technicians who seem unaware that what they do is part of the patient's experience of care. But you can use mindfulness in any situation, and doing so will help you gain a sense of calm and balance. Become engrossed, even fascinated in whatever tasks you need to perform. Concentrate on each and every minute physical action, and tackle each chore with purpose. If your inner voice tells you to panic, allow that demand to just float away, and focus instead on what you're accomplishing. Deep breathing Whether you're dealing with difficult clients, or working on a challenging project, you can reduce stress by breathing deeply and calmly. Meditate on the sound and feeling of your breath as you deeply inhale and exhale. Make your breaths slow and full, and hold each breath for a few seconds before releasing it. Screensaver Choose a beautiful screensaver for your computer. He keeps putting us in a bind. On the one hand, he is so self-absorbed by his problems he seems remote from us and yet wants attention. On the other hand, when we ask him, no, beg him, to stop smoking, he tells us to stay out of this--it's his problem. But it's not his problem alone. It is ours, too. And if we didn't respond to him, he would accuse us of not caring about what happens to him. What to do? Do we mollycoddle him? Or are we supposed to shout and argue our point of view?

The O'Mannixes' son, George, a law student, sees the double bind placed on the family as part of the chronicity of the disorder. Clearly, all members of the helping professions should be trained in a framework that respects the patient's suffering and attends humanely to the illness experience. The professional sector's institutions are profession- rather than patient-centered. Zerubavel (1981) has shown this to be the case with the organization of time in the hospital, which is ordered to fit the work hours and needs of hospital staff more than the needs of patients and their families. And this is true of the way space is arranged, too. Movement through the professional sector of care bewilders many patients. There are few maps to make sense of the system for users. Communication between its components breaks down. Chronic patients spend such a large portion of their lives in the professional system that they know better than their doctors which structural barriers and unnecessary bureaucratic steps waste their time and energy and create frustration and bitterness. This insider's knowledge of the bureaucracy's failings is rarely taken into account to accommodate the professional system to patients' needs. The challenge is to do this. When you want to relax, meditate on the picture and imagine going inside it for a moment. It's not necessary to draw attention yourself if you don't think that your boss would approve (though many would likely appreciate it). You can easily meditate at the office by taking a few moments to yourself, or by being mindful about tasks as you perform them. You can pay attention to your breathing, or your screensaver. Reducing work related stress has a big payoff: a more enjoyable life. Who knows, you could end up getting a promotion! Meditation is the ultimate mobile device; One of the great things about meditation is that it doesn't actually require any equipment. Basically, it takes you, plus something to sit on, which could even be the floor or the ground.

But there are a few items that can enhance your experience: This is very much the structure of our family, anyhow. Dad is authoritarian, yet sometimes he seems to treat Mom as if she were his mother, and at that time he wants us to help out or take over. It's always been this way. The illness has just made it all that much clearer. I think it's not good. It sustains his smoking and messes up what treatment program has been prescribed. If you want to know my view, I'd have to say, this hot and cold cycle is part of the problem. I'm sure it has made him worse off. And for us, it's impossible. In the Pain Center But the professional institutions of care also frustrate practitioners, especially those interested in addressing the patient's and family's illness problems. I have already mentioned how the time constraints and reward structure of clinical practice work against the kinds of therapeutic interventions that are most useful in treating the chronically ill. Medical legal concerns are particularly mischievous here. Physicians must constantly attend to the potential legal implications of their care, which tends to dissuade innovative therapeutic approaches while it encourages caregivers to cover their backs and stick to the letter (not the spirit) of bureaucratic constraints. Can a physician work out empowering treatment algorithms for enhancing his patients' self-care if he fears that a mistake by a patient or family member may place the doctor at risk for a legal suit involving millions of dollars? The tendency to allow the courts to resolve ethical questions about, say, how much care must be given in the terminal phase of illness to prolong life--even when patient and family wish to terminate care--discourages practitioners, making them hesitant and suspicious at just the stage in chronic illness when their humanity is most needed. The immense profusion of bureaucratic paperwork is meant to control the practitioner's actions through a regulatory approach taken over from various governmental sectors. It ends up numbing physicians and usurping huge blocks of time better spent with patients. The bureaucratization of care arguably has worsened the problems experienced by the chronically ill in negotiating health care institutions.

For bureaucratic efficiency can be (and frequently is) the enemy of high quality care. Some sort of mat or cushion - you can use a yoga mat, or a folded blanket or beach towel. This gives your bones a bit of padding if you're sitting or kneeling on a hard floor, and keeps your clothes clean if you're on the ground. There are poofy cushions to sit on that raise your butt up a bit when your hips and knees need some TLC. You can also find large square, flat cushions useful for lotus or kneeling positions. Or you may prefer a meditation bench to kneel against. They're usually made of wood, so are quite stable. And of course, easier on your joints than kneeling directly on the floor. Music - a nice mood setter. You may like to try guided meditations, too, if you prefer getting some direction. Incense or candles - burning incense can bring a feeling of the sacred into your space. For several years I supervised the psychiatric liaison with a major chronic pain center. In the center's inpatient unit a conference was held each week to review the status of cases. The conference was chaired by an anesthesiologist cum pain expert, and it included up to fifteen other participants from relevant fields: rehabilitation medicine, psychology, nursing, social work, physical therapy, occupational therapy, psychiatry, and other medical specialties (for example, for a particular case, orthopedics or neurosurgery). The treatment plan evolved as an attempt to combine biomedical and behavioral approaches for patients with severe pain problems who had failed to improve with conventional medical and surgical treatment. The hospitalization of many of the patients was paid for by the state workmen's compensation program or other disability programs. The weekly meeting took place in a narrow, rectangular room with one set of windows opening onto the outside and another onto the ward itself; There were often not enough seats to go around for our group. What seats there were had been arranged into an elongated oval, the closest approximation to a circle possible in the crowded confines. The meeting was presided over by the anesthesiologist who headed the inpatient pain unit.