Tuesday, October 2, 2018

Teaching Yoga in a Hospital Setting

by Bhadrakali Lia Akhilanda
I have the honor of teaching yoga in an inpatient hospital to patients with blood cancer. This offering has been a meaningful addition to the care of our patients, and our patients often share after class how practicing caused them to feel a deep sense of calm and gave them a break from the worries and constant activity that comes with a hospital stay. For me, it has been a heart-opening opportunity to connect with our patients and to invite their healing to occur on all levels—mind, body and spirit.

The class is a diverse group of usually 4-8 patients, from all across society and who have a wide range of functional abilities. Patients are at different stages of their treatment: awaiting, receiving or recovering from chemo, stem cell transplants, or immunotherapy, or waiting for the results of a crucial biopsies, etc., sometimes within month-long hospitalizations. All are immunocompromised and often have extensive weakness, fatigue, nausea, GI symptoms, pain, stress, and anxiety. Patients leave their hospital rooms to come to our group room. Some also bring a loved one with them to our class, though all come with their other close companion, their IV pole, which may be actively transfusing chemotherapy or blood products.

Leading this group demonstrates the importance of Krishnamacharya’s core teaching of adapting to the individual because every patient is so vastly different in their life experiences, diagnosis, treatment, and side effects. And often cancer treatment regimens may cause a patient to feel strong and energized one day but completely weak and fatigued on the next day. This class is also a constant reminder of the importance of detaching from outcomes and choosing to be present in relationship with ourselves—mind, body and spirit—and in relationship with those around us. Many of the patients are consciously and subconsciously affected by grief related to being diagnosed and being unable to function as well as they did before their diagnosis. Encouraging patients to increase their awareness of their bodies provides them with a rare opportunity to quietly check in with themselves, an essential first step in making a yoga practice therapeutic.

Though all have heard of yoga before, for many of the patients this is their first yoga class. I first invite them to think of this class as an entirely new experience. Their imprints of yoga often associate the practice as purely physical and with postures involving strenuous hyperflexibility, which are unlikely to be accessed by most people and potentially harmful for patients with a serious illness. In order to create an environment of comfort and safety, I offer poses that are accessible in an approachable sequence.

My classes are at most an hour long, including about 40 minutes of movement and approximately 10 minutes of guided meditation before and after, depending upon my impression of their interests and abilities. Although I teach alone an RN is present to assist with patient assessment and needs. I generally teach Mukunda Stiles’ Joint Freeing Series, Pavanmuktasana, which focuses on increasing fluidity in the joints and coordinating movement with breath. This series can be done on the floor, in a chair, or in a bed and is easily adapted, approachable, and dynamic. During the ending meditation, I guide patients into stillness and rest, and provide a long period of silence to use the space for sending positive thoughts to themselves or others, sending or saying prayers, breathing, or whatever they feel they need. I thank all members for their willingness to attend and their effort in serving themselves.

Here are a few of the guiding principles I implement:

Medical clearance is essential. In this group, all members are cleared by the medical team and an RN also attends the group to assist in being attentive to their IV pumps and keeping patients safe.

Screen for symptoms at the beginning of class. I specifically ask about weakness, fatigue, nausea, shortness of breath, dizziness, pain, etc. If anyone has these symptoms I consult with the RN before proceeding to make sure the medical team knows and that it is safe to have them participate. I let members know that if any of these symptoms arise during the group, they should rest back in their chair and let us know immediately.

Teach chair sequences to minimize fatigue and increase support. The chair poses I teach increase fluidity and ease in the body and breath and are not intended to build strength.

Give members full permission to take a break, a rest, or leave the class. Sometimes members decide they are too fatigued in the class and the RN supports them in safely returning to their room.

Focus on members building a relationship with their bodies. Cancer and its treatment can be traumatic to this relationship. So, I begin with a meditation based in pratyahara, withdrawing from overwhelming sensory experiences in the hospital and into a sense of inner stillness. Then I provide a guided visualization, starting with the feel of their skin, next feeling skin connecting to muscle, tissue, organs, bones, and then feeling their circulatory system and visualizing their blood energized by their breath. I guide them to rediscover their breath in the moment and pose open-ended reflective internal questions: What does your body feel like right now? What is it like to be with the intimacy of your own breath? Who are you in the body you have now? Where do you feel openness? What is your body seeking?

Sthira sukham asanam. I suggest that members use approximately 70% effort in poses. To illustrate this, I have them flex their arm to 100%, then ask them to flex to only 70%. This prevents over-exertion and stiffness, keeps their body fluid, and helps their minds focus on their relationship with their bodies.

Cautiously and skillfully instruct any pose that lifts the arms above the shoulders or a twist from the midline. This is necessary due to the need to not disturb central venous catheter insertions (PORTs/PICCs/Hickmans), which are internal lines that if displaced can lead to serious health issues or a delay in treatment. I encourage members to keep one line of energy and slowly and gently lift the arm up and down, one side at a time. I have them avoid twists from the midline greater than 45 degrees.

With all of these adaptive considerations, this group has created some of the richest examples of a yogic experience that I have observed. I regularly see that despite experiencing some of life’s greatest challenges, the patients experience a state of interconnectivity with the group and themselves, and often feel a state of inner stillness and contentment with things as they are. Again and again, I bow to their courage.

Bhadrakali Lia Akhilanda is an accessible yoga teacher, ayurvedic bodyworker, and nationally certified oncology clinical social worker currently at the University of California San Francisco Medical Center. She has taught in an array of non-traditional spaces, including several non-profit organizations, an LGBTQ+ youth homeless shelter, an inpatient psychiatric facility, and an oncology and bone marrow transplant hospital service. She is inspired by teachings that are accessible, decolonized, socially aware, and full of reverence. She bows to all of her teachers, all who have graciously given her the blessings of sadhana. For more information, see akhilanda.org.

This post was edited by Nina Zolotow, co-editor of the Accessible Yoga blog and Editor in Chief of Yoga for Healthy Aging.

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