The art and heart of ‘briefing about an Illness’

I was brought one evening in May, 1982, to the Christian Medical College, Vellore with a fracture in my right leg, which I sustained at Chennai, while riding pillion on a friend’s scooter. I was given first aid at the Madras Medical College and transferred to the emergency unit of CMC Vellore. The Orthopaedic specialist on call arranged for an X-ray and admitted me in the S ward. Late that evening, professor Selvapandian and his team came to examine me. Seeing my hugely swollen knee joint and the shortening of the leg due to the fracture, they decided to give me a posterior slab and apply traction. Dr. Selvapandian turned to me and said, ‘Sorry, M.C. you seem to have a fracture and some blood in the knee joint. We will offer you some pain relief and decide tomorrow about the treatment plan. We hope we can do something to fix it’.

 

The next morning, with more X-rays taken, Dr. Selvapandian and the team spent a long time discussing my condition, outside my room. There was gloom in their face, which made me feel that they too were anxious. After further clinical examination, Dr. Selvapandin, said, ’M.C. it is a bad fracture which extends into the joint with multiple pieces of the upper end of tibia. We will wait for the swelling to subside and then decide about the next step. We will keep you pain free as much as possible and I hope we can find a way forward’. Five days later, Dr. Selvapandian ordered for more X-rays and consulted each of his colleagues to make up a plan. When he came for the morning rounds, he said, ’you have made some progress, and we are hopeful. We will keep you on traction for the time being. It will hopefully bring the fractured pieces together’. 

 

As I look back, I am amazed the way, Dr. Selvapandian ‘broke the news’ little by little, mixing facts with hope in a good balance.  It was a bad fracture and residual disability of limited range of movement of the knee joint was almost certain. Every time he came for rounds in the first week, he conveyed optimism and caution. He spoke gently and thoughtfully. He even had a sense of humour. One day, seeing me siting up in the bed and reading the newspaper, Dr. Selvapandian said, ‘I hope you would not decide to stand up’. Everything, Anna and I needed to know medically, he conveyed on different occasions with sympathy, understanding assuring us of the best possible help. Each time he visited me, he would want to hear from me and wait for my questions or comments. During the next two months, till I was ready to go back home, Dr. Selvapandin communicated his keen interest in my full recovery.

 

I was already a consultant in Paediatrics for four years by then and had no idea of what it means to ‘break the news’. This was a first hand experience of some guidelines about ‘breaking the news’ of a medical condition, outcome of treatment, complications or adverse outcome.   Let me list five guidelines for us to consider while ‘breaking the news’:

1 Content  

2 Setting

3 Attitude

4 Dialogue

5 Difficulties

 

1.The Content

 

In one sense, the phrase, ‘breaking the news’ is a misnomer. I wish, we use phrases such as, ‘briefing about an illness’ or ‘sharing the health details’, etc. The visual media has sensationalised the phrase, ‘breaking the news’ with stories and photos, which to me adds stress, anxiety and humiliation in most instances. The intent of ‘briefing about an illness’ is to bring comfort, clarity and direction to the patient and his or her relatives and reduce the level of fear and anxiety. Let me suggest that the phrase. ‘breaking the news’ has outlived its use and it is necessary for us to have another phrase to express its intent and content. 

 

The content of what we intend to share with a patient or the family is central and need to be defined. Let me illustrate. 

 

The content will vary according to the gravity of the illness and the immediate implications. When a patient is brought unconscious following a road traffic accident, there is some uncertainty about the course of illness and the outcome. The family needs to know about the prognosis and the several immediate measures needed to revive the patient. If Leukaemia is diagnosed in a young healthy asymptomatic adult, the family will be in a state of shock and grief, in which case, the facts about the diagnosis and its implications would need to be shared in stages and in portions that the family can comprehend and respond to. In such situations, grief counselling will be part of the initial briefing about an illness. If a person has a chronic illness such as Diabetes, the content will correspond to the extent to which the disease has progressed affecting different organs. If a new born is acutely ill, following the birth, the content of the discussion with the family would involve the immediate and distant implications of the illness. In such a situation, the family has many pressures weighing on them, such as mother’s health, care of other siblings at home, etc. that, briefing about the illness ought to be just enough for the family to be aware of the progress or decline in the health of the baby. 

 

A senior doctor is the best person to define the content of this briefing, which in consultation with the team needs to be communicated in a manner the team decides to do. It is necessary that briefing about an illness is done by the designated member of the team, preferably a person with experience and full knowledge of the state of health of the pateint. The disclosure would elicit questions from the family, which would need appropriate and contextual responses. It is for this reason, it is better for this to be done by a person, who is involved in the decision making about the treatment plan of the patient.

 

There is sometimes a question, how much of details need to be included in the briefing! Some families need lot of details and others are content with just enough information. In some situations, families may have questions or confusion about the benefits of treatment. It is for this reason, at every stage of a new treatment plan, the consent of the family or the patient is needed.

 

There are clinical situations such as terminal illness, where the health care team has the responsibility to introduce the family to palliative care. There may be an unfortunate situation when a patient is brain dead, in which case, dialogue with the family would extent to include organ donation. 

 

Having worked with families, who have children with neuro-developmental needs, for the last thirty-five years, the challenge that I often faced was to define the content of the briefing. When the parents come with their baby of few months of age with definite indications of neurological insult, they would have had previous consultations and investigations. They are often in a state of shock or denial. In such situations, I have found it more useful to listen to them and help them to pursue their thinking by directing them with relevant questions. It is easier if they find answers to their questions on their own. This form of briefing about an illness needs more time, patience and rapport with the family. The families may know the facts, but they would need an affirming setting to internalise them and respond to the challenges emotionally and responsibly.

 

The content is central while briefing about an illness, but the setting determines its effectiveness.

   

2. The setting

 

The ambience of any hospital is busyness, hurry, and anxiety. There are events happening all the time, such as a new patient arriving or someone leaving the ward, or someone suddenly becoming sick. Patients and relatives are witnesses to these happenings. The professionals are under pressure for time and have a long list of important things to do. It is in this context, we need to appreciate the need of a setting in which briefing about an illness can take place.

 

The physical setting of a quiet and airy room is a desirable facility. A room with good seating arrangements, with wall pictures and text can make the room homely. It is necessary to have low decibels of noise in the vicinity and in the room.

 

It is important to welcome the representatives of the family, two or three with whom confidential matters can be discussed. The privacy and rights of the patient need to be protected, and we want to avoid any lose talk about the patient and his or her illness. One or two professionals need to facilitate the conversation, out of which one person ought to be the senior member of the team. In some instances, especially when a patient is terminally ill or family is in distress, it is important to have a chaplain in the room to continue being in touch with the family and patient. 

 

It is a good practice to begin by getting to know the members of the family and sensing their state of anxiety. Similarly the professionals need to disclose their identity. So the time of introduction is most valuable. Following this, the current state of the health of the patient needs to be presented in brief. It is good to let the family ask questions rather than give an exhaustive coverage of the treatment details. The details would get drowned in the emotional upheaval that the family may go through, while listening to all that is happening to the patient.  

 

The setting is often emotionally charged as any information about the patient does arouse concern and anxiety. There has to be pauses in between the conversations to allow the family to take in and feel the issues discussed. Occasionally it may push a member of the family into a state of grief or anguish, which needs to be received with understanding and support. 

 

It is one occasion, when the professionals need to show availability and openness without indicating rush or hurry. The pauses of silence need to be welcome as they are a means for emotional recovery and an opportunity for the family to come to terms with the reality. 

 

It is good to have all the mobile phones in silent mode during this period. It is for this reason the briefing time has to be chosen when there is no anticipated interruption. 

 

Occasionally it may be useful to show pictures of what one may want to explain about the illness. It is also necessary to avoid loading the occasion with too many details.

 

The closure of this time has to be planned in advance. Let the professionals decide before hand the time allotted for this briefing. Avoid prolonging the time, even if the family seems to seek for more time. It Is good to plan for another occasion to meet, as such times are intense in attention and listening and prolonging it can become demanding on the professionals. It s good to greet each other while closing, and agree to meet with the family again.

 

3. The Attitude

 

The briefing time about the illness is one occasion, when families would expect sympathy and understanding. One way of communicating it, is through the modulated tone of the voice, which befits the occasion. We can convey confidence and nearness to the family by synchronising the voice and the body language. 

 

Families are comfortable if we can use non-technical language while communicating with them. It may be better to use the phrase ‘swelling all over the body’ rather than the phrase ana sarca while describing the clinical condition of a patient with liver or renal for heart failure.  It is good to use short sentences with pauses in between to allow enough time for the family to take in and giving them permission to interrupt with questions if they so desire. 

 

I remember one occasion, when a senior colleague called the family aside and bluntly told that their nine years old daughter was about to die and disappeared back into the ICU. It was an abrupt communication without a prelude of postlude. Later talking to me about the hospital experience after one month of the child’s demise, the family referred to this incident with much regret and remorse. 

 

For some reason or other, people assume that doctors and nurses would be kind, courteous and thoughtful. This is expected to be our natural temperament. It is for this reason, families are most uncomfortable when we get angry, shout, or show arrogance. A hospital is also a place of hospitality, which calls for utmost understanding of the needs and aspirations of people, who come for medical attention.

 

Let me suggest that as health care professionals, we are engaged in knowledge pursuit. This privilege can make some of us self-sufficient and condescending in our attitude. ‘I am the doctor; I know what I am doing; you listen to what I am saying’. This attitude towards patients and families would hurt them. 

 

Instead, if we have an enquiring and considerate attitude, we would be able to keep in touch with the families and patients during the time of their need. They would turn to us to confide and to find direction in their lives when they are overcome by sorrow or bereavement. A doctor or a nurse is a companion to patients and families and not just a provider of treatment. 

 

Most patients and families would need life style changes and order in their lives economically, socially and spiritually when they confront a serious illness in the family. The time of briefing about an illness is the staring point to build relationships. 

 

A few weeks back when I was admitted to a hospital for a major surgery, the senior surgeon introduced us to his team and mentioned about what would happen during and after the surgery. I thought for a moment, that he almost trivialized my medical condition by speaking about it as just another ordinary illness, in an attempt to take away my fear and anxiety about the surgery. Looking back, I realized that his welcome, approach and friendly ambience helped me to look forward to the coming weeks with ease and expectation. 

 

The professionals sometimes deliberately keep a distance from the patient and family emotionally, so as to safeguard their professional status. This contradicts the very character of health care, when we are supposed to engage in alleviating suffering and offering wellbeing, ‘physically, emotionally, socially and spiritually’.  There is a humane dimension to health care, about which late Dr. K. N. Nambudiripad, professor of neurosurgery and Director of the Christian Medical college, Ludhiana used to refer to as ‘compassion - an adjunct to therapeutics’. I believe that the role of the mission hospitals is to demonstrate this dimension in practice. A consultant working in CMC Vellore mentioned to me the other day, that, the dignity and care offered to those admitted with AIDS is so touching and affirming that ‘I wish we could do the same to all the other patients who come to us’.

 

We are constantly engaged in communicating good or bad news in health care practice. How we convey that is the question at stake! One family was overtaken with all the anxiety associated with cancer, when the young mother was diagnosed with breast cancer. During the course of stay in the hospital stay, the patient and the family felt comforted by hope and prospects of recovery, because the attitude of the professionals conveyed that abundantly. Each conversation and contact with the family ought to become an up building and path-finding experience for the family. 

 

4. The Dialogue

 

Every communication becomes useful if it creates opportunities for dialogue. The briefing about an illness to the family is an important occasion to prepare them to make several decisions. There are treatment options; there is the economics of the treatment; a choice of the hospital for treatment; outcome of the treatment; and for some families, the option may be not to choose any radical treatment, but only palliative care. 

 

One of the rights of a patient, according to the Geneva Convention is, autonomy and right to choose. Even in an emergency situation, the relatives are bestowed with the right to choose the nature and the extent of treatment, for which a detailed presentation of facts and implications need to be made to the family. It would appear to be easier, if the medical team, ‘who know best’ was the sole decision makers! However, with the Internet offering all kinds of information, most families would have come with some thoughts and choices. It is for this reason, all decision making is arrived at, after dialogue with families. The prescriptive approach we are more comfortable with, in decision-making, is non-conducive to developing rapport with patient and families. 

 

One family with their twelve-year daughter came for consultation for intractable seizure because of which, she discontinued attending the school for the last six months. They have been to a few well known centres and had brought reports, treatment schedule and multiple prescriptions of medicines. I refrained from looking at them till I heard their story. Their story of 11 years of coping with the frequently occurring seizures in their daughter did take a toll emotionally, financially and socially. While I requested my psychology colleague to have conversation with the girl, I allowed the family to continue with the narration of their story. After one hour, they were still ventilating their disappointments with doctors, hospitals and teachers who according to them had not supported them during their difficult times. The girl narrated her story of loneliness, tiredness with treatment and emotional weariness over the reduced social life she lives at home. For fear of having a convulsion, she cannot accompany her family for shopping.  

 

What the family needed was for someone to listen and understand their struggles. I offered them another time to discuss about the treatment options.  The parents and the daughter looked comfortable to return for further discussion. I realize from several such experiences, it is necessary for me to create time to listen. I find, when we listen, we get to know many deeper issues, which are linked to the illness, treatment or long-term implications. When we listen, we affirm the family and open the door of dialogue, including searching for options that they had hitherto overlooked. In case of this family, at the end of the third consultation, they seemed ready to look at the option of epilepsy surgery. Although this was already told to them, five years back by different consultants, they ignored it. I heard recently that she is free of convulsions after the surgery.   

 

I have found it valuable to involve my colleagues in an active way, even to delegate the responsibility of continuing the dialogue. It is when, conversations take place in different settings and with different people, we can capture the whole picture to guide the family forward. 

 

When a patient is In critical care, or in an emergency situation, or facing complications, the dialogue will often be brief. But while planning for organ transplant, cancer therapy, assisted reproduction, HIV counselling, etc. a detailed dialogue is central and crucial for optimum therapeutic outcome.

 

5. The difficulties

 

Most professionals may not have had any format training in briefing the family about an illness. This is a challenging issue in itself. Even now, this has not become part of the formal medical training. Most doctors pick up some precepts and practice from what they see and hear from their seniors colleagues.

We are still not conditioned to respect the autonomy of the patients adequately. This is because, we are not introduced adequately to the foundations of medical ethics, during our undergraduate or postgraduate training period. The professionals seem to exert authority over their patients by virtue of their skills and position.

 

Engaging the family or the patient for briefing about an illness consumes time, attention and need openness to revise our approach based on the choice a family might make. Some doctors convey disinterest to pursue a treatment protocol different from what they think as the best. This adds stress to the families and causes strained relationships between families and the professional team.  

 

Most hospitals do not have designated space for briefing the family about an illness or to offer counselling to the family or to prepare them for treatment, discuss options or support them during their bereavement. It has not yet become one station of service in the care pathway we offer to patients.  

 

We are in a fast changing scene in health care in India. There are commercial interests in health care. The Insurance sector is breaking the service pathways into tangible components, each of which is charged separately. The consumer forum is active to find out if there was neglect or omission in the service provided to a patient. The professionals are attempting more risky surgery or interventions for treating complicated illnesses. All of these and the increasing consciousness the public has about the rights of a patient, should make the professionals consider how they are using ‘briefing about illness’ as an opportunity to build rapport with patients and families. 

 

It is necessary to conduct training programmes to help the health care professionals in the art of ‘briefing about an illness’. This needs to be introduced to the interns and postgraduate trainees at the beginning of their programme with refresher training programme during their training period. The consultants and senior members of the team would need advanced training to help them to be equipped to face difficult situations. 

 

A hospital is a place to communicate to patients and families sensitively and lovingly. Let it be so always!

 

M.C.Mathew (text and photo)

Integrating life and work!

When I live now in the scent decade of my life, I have an advantage to look back over the last 40 years of my professional life. I have viewed work as an expression of myself. That helped me to regard work beyond being a task or an activity or a job. Work is an expression of our being. As doing comes from being, being is the resource for doing. 

On my way back from work one evening, one of the children with whom I have regular chats, stopped me and asked, ‘Are you tired at the end of the day?’. I was tired enough to stop doing what I was doing all day long, but had not felt that the day was over yet. Seeing my long pause for replying, he asked whether I would go with him to see something interesting. He led me to a bush where there was a nest with two eggs. We saw the mother bird flying away as we approached the nest. We talked about it and decided to have a nature walk the next day to look for more nests, as it was the season of breeding for birds. When I arrived home, Anna mentioned to me that I looked fresh and ready to start work again. 

 

Some of us are often tired, whether it is the beginning of the day or the end of the day. Some others have backlog of work that does not seem to finish and carry a guilt feeling of not being able to cope. When we are younger, we are on regular clinical roster that we get caught into a pattern of working for long hours. We attribute our tiredness to work and take holidays to get away from work. But we return tired from a holiday. 

 

Somehow, work does not seem to be the only factor, which adds tiredness. Something external or internal can make us tired or stressful. Life is in equilibrium, because we follow the rhythm of work and rest.  Some experiences can trigger within us a new enthusiasm and displace tiredness or boredom, however occupied we are at work or have long working hours for days together. 

 

Let me try if I can suggest from my experience an overview to integrating Life and Work. 

 

1. Called into being.

There is enough indication in the Bible that we are created beings and our origin is from God. Our parents are God’s chosen people to bring us into being and give us the shelter and nurture of a home. In psalm, 139, vs. 13 to 16, the psalmist gives a vivid description of this process, which God oversees for our formation. The propositions that ‘..thou did weave me in my mother’s womb....’(v.13) and ‘My frame was not hidden from thee, when I was  made in secret’ (v.15) are authentic expressions of God’s foreknowledge of our formation. Just as the earth had no form or substance and was void, before the Spirit hovered over the space and water (Gen.1: 2) to bring into being what the Lord God called forth into creation, we too have been formed into a being from the pre-existing chromosomal and genetic substance of our parents. There is a creative and formative activity of God in this process of our conception, birth and growth. While this takes place in the setting of intimacy of a loving physical union of our parents, God is the initiator of this process because the gift of love for procreation is a gift from God. 

   

A Japanese friend while walking in the Botanical garden in Singapore, picked up driftwood, which I happened to kick unintentionally, looked at it intently and secured it in his pocket. A year later, when we met in Switzerland, he showed me a beautifully carved wooden spoon. He had carved it from that driftwood. He had a design for that wood and crafted it according to his intention. This illustrates that our formation is according to a design and plan. God owns our creation and formation. We are owned by him, which gives us an identity- God is our father and we are His children.

 

A three-year-old child expressed his obligation to his mother in a moving way on her birthday. Having nothing else to give his mother on her birthday, he picked a banana leaf kept for serving lunch, sat on it in front of his mother and said, ‘ I am yours, because you brought me into being’.  The psalmist refers to it, in a touching confession: ‘Thou hast enclosed me behind and before..(v5) and in v 18 of Psalm 139, ‘When I awake, I am still with thee’. 

 

As health care professionals, let us honour this divine heritage we are blessed with. We were forewarned not to get preoccupied with, the existential dimension of ‘ what you shall eat or what you shall drink …or what you shall put on’ (Mat.6:25). We are to live celebrating and remembering our heritage that we are ‘created by Him and for Him’.

 

2. Called to belong

Fish belongs to the water; a baby belongs to the parents; a wife belongs to her husband and husband to his wife; a heart belongs to the pericardium; fingers belong to the hand; Red Corpuscles belong to the blood… all these are inherent physiological associations. It presupposes inseparability, unity, and connectedness. Our belonging to God has this foundational character, that we, ‘live, move and have our being in God’, in the words of St. Paul. It is God’s initiative towards us that reinforces our belonging to Him, because He loved us, while we were estranged from him (Romans.). His self giving initiative of love at the cross and His accompanying presence according to Christ’s promise, ‘I am with you always’ (Mat.) make this belonging a sacred reality intended to prime us into a loving response to Him.

 

I like this sense of belonging beautifully symbolised in the way Ruth responded to Naomi in the book of Ruth. Ch1:vs.16 and 17, Ruth asserts her allegiance to Naomi, out of her choice, ‘where you go, I will go and where you lodge, I will lodge. Your people shall be my people and your God, my God….’. Orpah chose to return to her family, while Ruth clung on to Naomi. It was from then own, Naomi’s responsibility to offer protection, provision and prospects for Ruth. Naomi carefully guided Ruth into a fruitful marriage and family life.

 

This decision to belong or not is a personal choice. Not all who acknowledge that, they are ‘called into being’ by God, will travel this path of affirming by their consent that they are also ‘called to belong’ to God. Some will falter when this choice has to be made.

 

I begin to wonder whether young doctors, who acknowledge that they  are, ‘called into being’ by God experience a desperation for post graduate training that many spend one or two or three years attending coaching classes to get into post-graduate training. Instead should they not be spending those years in clinical work, which will give them work experience, learning opportunities and a broad range of skills doctors need such as communication, debriefing, team work, hands on experience, critical decision making! 

 

If we believe that we belong to Him, He will initiate us into what is good for us. That is why, personal pilgrimage of following Jesus of Nazareth is a faith journey.

 

3. Called into a vocation

Late Dr. C.K.Job, former Principal of Christian Medical College, Vellore, made up his mind after his under graduate training, to pursue General Medicine for his specialty training and to become a cardiologist later. But the professor of Pathology, Dr. Gault explained to Dr.Job the need of a pathologist for Leprosy work, and Dr.Job responded to that invitation. Later Dr.Job became a world renowned Pathologist, who described the electron microscopic findings of nerve damage and multi-organ involvement in Leprosy, and published the highest number of articles on Leprosy. When he was asked, how he could change his mind to take up pathology, he said in an interview, ’God called me into medical training. I wanted to go the way he led me. That was my vocation’.

 

Let us be more satisfied with God’s ways in our lives than desperately be driven by our longing. That is how we can convey that we believe in the One who has planned a vocation for our lives.

 

I almost failed in my post-graduate examination in Paediatrics as I did not present well the clinical discussion of a child with neurological illness. I decided then not to have anything to do with Neurology in the future. I was all set and at the threshold of joining for training in cardiology to become a Paediatric cardiologist. Following the arrival and home call of our daughter Anita, and through some trying times after that, I was led to Developmental Paediatrics and Child Neurology, which is what I have been practicing for the last 35 years. Now, I love this specialty as if it was my first love. Through circumstances of disappointment, failures, interruptions in our plans, denial of opportunities, God may be showing us another way than what we have set our heart on. It is good to consent than resist God’s surprising ways. 

 

I like the way, Jeremiah was given a call for a vocation, when God spoke to him: ’Before I formed you in the womb I knew you. I have appointed you a prophet to the nations..’ (Jer.1:5). St Paul also had a similar calling in to his vocation:’ But, when, He who had set me apart, even from my mother’s womb and called me through His grace, was pleased to reveal His son in me that I might preach Him among gentiles, I did not immediately consult flesh and blood..’(Gal.1:15, 16) . This calling is often to attempt something beyond our normal abilities. 

 

When we choose a career path, we estimate our capacity and skills and make a proportionate decision consistent with what can be naturally achieved. When God calls us into vocation, it can be disproportionate to our skills and current stature. Moses was called to a spokes person to Pharaoh, even though he stammered. God provided Aaron to be his companion. Together they released the people of Israel form captivity in Egypt. 

 

I have a suspicion that many settle into naturally comfortable and compatible positions of vocation!

4. Called to be content

Anna and I have  known Drs. Frank and Val Garlick for about thirty five years now. They lived and worked at Christian Medical college, Vellore for about ten years in the sixties. Dr. Garlick felt called to spend his time with medical students and graduates, which led to the formation of EMFI in 1974. After his return to Australia, he was involved in establishing an Emergency medicine department   in a large hospital in Brisbane, offering leadership to Patan Hospital at Kathmandu, leading marriage enrichment seminars, visiting India and Nepal regularly until recently. He has had several changes to cope with, and face adjustments and setbacks. In all such situations, he conveyed gentle confidence in the good purposes of God and reliance in the mercies of God. I have found Dr and Mrs. Dr.Garlick in a state of contentment, whenever I met them in the recent years. Their lives pursued the call of God. It was not ambition or prosperity, which determined the course of their lives. They felt at home in what unfolded before them. They did not live passively, but making choices all the time to conform to God’s general direction in their lives.

 

Let me suggest that positions may evade us; opportunities may pass us by; friends may let us down; the path ahead may look long and stressful. But all of these are subject to the authority of God, ‘who holds all things together, by the power of His word’ (Col.) It is this which shall give us peace to resound in our hearts the words of St Paul, ‘ I have learnt to be content in whatever circumstances I am’ (Phil.4;10). 

 

We invite misery on ourselves by striving to get what we think we deserve. This will push us to live driven lives. Often the more we chase what we think we should have, the farther it may move from us, which makes us live in a perpetual state of discontentment. This unsettles us individually, professionally and emotionally.  

 

The parents brought home, presents for their three-year-old twin boys in connection with their birthdays. The family were to have the birthday celebrations next morning with their gifts. Joshua went to sleep as usual at 8.30 pm. But Jesusha slipped to into parent’s bed room, while his parents were in the drawing room, talking to guests and opened one of the presents. That is when mother came to the bedroom hearing a noise. Jesusha was caught in his naughty act. As adults we can behave like children who are not prone to wait, or be content when there is a delay or hold on when there is an uncertainty. This contradicts our claim of rootedness in God.

 

5. Called to live restfully

Our pace of living has become faster with many things in the list of items we need to do before the end of the day. We attempt to do many things quicker; we drive faster; we walk and speak faster; we attempt to perform surgeries in shorter time; we rush in and rush out even while visiting friends. The concept of leisure, taking time to do what we do with mindfulness or a sense of presence and living with a measure of ease and gladness have become estranged from us.

 

We normally move from rest to work and from work to rest. It is yet anther experience to work restfully, which is an experience of being fully present in the given situation without wanderings of mind, preoccupations with other thoughts and drawing energy and fulfilment from what we do. There is a concurrent interior well being we can experience while being immersed in work. Whether it is listening, performing a surgery, preparing for a meeting or performing some chores at home, the activity is not energy draining, but energy giving. Our body and mind would need sleep and recuperation. It is one source from which we replenish our energy levels. The other source that supplies us energy is work itself.    

 

This is well expressed in the way Jesus approached the challenge, when called upon to feed the five thousand people. The disciples chose to let them go home, as it was too difficult to find money for food or search for food in a lonely place. But Jesus was quick to ask, ‘What do you have?’ It was a searching question to arouse in them a sense of presence, and awareness what is beyond them. It reinforces that resources are present within or around us even when we are desperate to look for them. This generates a measure of confidence and comfort. There is freedom from anxiety and liberation from stress. This spares energy from being dissipated by worrying, blaming, manipulating or straining. 

Rest is a creative response to stress. When we feel or go under stress, we fight it with depleted energy or clouded perception. When we get used to letting go of the heaviness that is associated with a difficult situation or a disappointment, then we have the prospects of finding a new direction- to receive the situation with greater openness.  Our disappointments can be like a tall tidal wave, causing initial fright. What remains on the shore after the tide recedes is a variety of unusual collection of corals or shells of beauty brought from the sea bed.  Every mountain has a valley. It is in the valley there are springs and meadows. To seek only a mountain peek experience in the journey of life is to deny the abundance of insights and learning which come from the valley experiences. This freedom from expectations or a compulsive pursuit after one's own desires is the experience of rest. We live freely and leisurely without an addictive passion for one tract journey path. We learn to live no matter what might be the circumstances, because life is becoming richer and deeper through the convergence of different experiences. 

I share the above from my experience on a theme which is close to my heart. I continue on in this learning journey of making life as the learning resource!

M.C.Mathew (text and Photo)

(Most of this reflection appeared in an article earlier elsewhere)