Serenity

Definitions

1. Serenity: An internal state of calm and focus amid external demands.
2. Recollection: Gathering one's attention around what matters rather than being scattered by noise.
3. Interior silence: Quiet attentiveness cultivated through meditation, reflection, and pauses throughout the day.

What Is Serenity?

Serenity helps a physician remain present while responding to a busy and demanding environment. The outline emphasizes regular silence, mindful attention, and an examination of the day through gratitude. These practices create opportunities to notice how we respond and to choose our actions more deliberately.

Why Should We Practice Serenity?

• Attention: Recollection helps bring the mind back to the person or task before us.
• Judgment: A pause makes room to respond thoughtfully when pressure or irritation rises.
• Reflection: Quiet review helps us recognize moments when we did, or could have done, a good.
• Formation: Reframing difficulty can reveal an opportunity to practice an ideal or virtue.

How Do We Practice Serenity?

1. Begin in silence: The outline suggests 15 minutes of quiet meditation or contemplation before work, at a consistent time.
2. Return gently to attention: When the mind wanders, bring it back to the present without harsh self-judgment.
3. Find brief pauses: Recollect yourself before entering a room, returning a page, or completing a task.
4. Review with gratitude: Set aside five minutes at day's end to notice gifts and important choices, then make a resolution.
5. Reduce unnecessary noise: Identify distractions and create reminders that help you return to silence during the day.

Clinical Case

Ruben is an intern on the general medicine inpatient service. In his residency, the model on the inpatient service is that he gets alternating long-call and short-call days, and works from Monday to the Friday of the subsequent week (12 days straight), with long-call days on Saturday and Sunday. Long-call days usually start at 6:30am with pre-rounds, followed by touching base with one’s senior resident by 7:30am, and attending rounds starting by 8am, and sign out at night around 8pm. Short call days start at the same time, but end by 3pm.

The day starts with running from patient to patient. Today is Ruben’s long-call day, and he rushes in a bit earlier, at 6:10am, because he has a full patient load of 10 complicated medicine patients. He spends about 5-10 minutes with each patient in the morning, and just makes it to touch base with his senior resident. They run the list and attending rounds start right away. Rounds end just around 12pm, and Ruben runs to noon conference to eat lunch and listen to a lecture. The lecture is interspersed with pages from nurses about fluctuations in blood pressure, family at bedside, consultant follow up questions, and lab alert values. The afternoon is spent executing the plan from morning rounds and writing progress notes, discharging patients, and admitting new patients coming in from the Emergency Room, as well as updating family members.

Ruben feels like the day is a marathon, and though he feels he is trying his best to do everything as efficiently as possible, he feels there is no time to even grab a glass of water today. He makes it to 8pm sign-out exhausted. In college, Ruben used to spend at least 15 minutes in meditation daily. However, he feels like this is impossible in residency, and even though today, a patient ended up coding and dying, he feels he has no time to process this incident, and he just moves on with his day. He is beginning to feel burnt out, and he is increasingly feeling anxious as well as irritable with colleagues and consultants.

Sources: LearnWorlds outline; Canva one-pager, page 11.