Integrative inpatient care with yoga therapy?

By Mary Duryea

As a retired medical doctor, I often muse about how my patients could have been helped by having a yoga therapist contribute to their care. Unfortunately, the International Association of Yoga Therapists and its certification were still in their infancy when I retired in 2005 and turned to the study of yoga.

As a family practice physician, I would have loved to offer hospitalized patients the skill sets of a yoga therapist to bring comfort and promote a healing state. This addition would have been incredibly valuable for end-of-life issues, too. Respiratory therapists, physical and occupational therapists, dietitians, chaplains, and other professionals contribute to integrative inpatient care, and it is time to add yoga therapists to this list for a more holistic approach to medicine.

Addressing illness isn’t necessarily healing

If you’ve ever been in the hospital, you know that hospitalization is not very conducive to rest and recuperation! Someone is always coming into your room to poke, prod, draw blood, ask questions, or take you somewhere for a test. There are tubes, lights, and alarms going off—and you’re in a strange place, likely without your loved ones, instead of home in bed. Add to this the stress of being sick, not feeling well, or having uncomfortable procedures done, and it’s easy to see how hospitals can be hard on your ability to truly heal.

A yoga therapist’s main goal is simply to help clients toward well-being regardless of physical or mental condition—in other words, to try and help you feel better, no matter what circumstances you’re experiencing. What a relief to have someone come into your room for that purpose!

Some hospitals and medical systems are already working with yoga therapists, who can adapt tools such as imagery and breathwork to just about any situation. (Read more about my own experience below.) These coping techniques can help with physical and mental stress, aiding the healing process by working with the parasympathetic nervous system. Spirituality may also be addressed if so desired by the patient.

This one-to-one human interaction whose sole purpose is to provide comfort to the body, mind, and spirit would be a worthy addition to inpatient and hospice care. No high-tech, expensive medical procedures or equipment are needed—just a well-trained, compassionate yoga therapist. I urge healthcare institutions to consider yoga therapy as a cost-effective and humane addition to their integrative care programs.

Experiences of wellness

When I had the honor of substituting for my daughter, yoga therapist Kelsey Underwood, at Simon Cancer Center’s CompleteLife Program during her maternity leave, I gained personal experience of how effective yoga therapy can be in an inpatient setting. Many of the hospital’s patients were getting cancer treatments or organ transplants, or they were experiencing relapses or complications.

Providing moments of physical and mental relaxation to these people was lovely. I would often help them with guided imagery and breathwork, and I could see their facial expressions and other muscles relax, and their heart and breathing rates decrease.

One technique I used often was asking people to imagine they were in a favorite place and guiding them to silently experience what they saw, heard, felt, smelled, and tasted there. Then, I’d invite them to imagine holding or being held by someone or something special, feeling the exchange of love and compassion, and holding that emotion close to their hearts.

How it works in practice

One day I was asked to see someone with a lung problem. When I walked into the room, I realized the patient had just returned from surgery. He was having acute rib-cage pain because of the incision and had a chest tube in place. He was also on a ventilator, which controls the rate of breathing.

The breathing tube from a ventilator is uncomfortable and feels unnatural, and a common response is for a patient to try and pull it out. This person was medicated, but he was still agitated because of the pain; he was fighting the breathing tube and pulling at the chest tube. He couldn’t speak because of the tube down his throat, but he was alert enough to communicate by gesturing. I asked his permission, and both the patient and his nurse waved me in.

I usually start with breathing practices for stress reduction, but because the ventilator was breathing for him at a certain rate and depth, I could not give cues to guide the patient toward changing his breath. It was the first time I was seeing a patient who could not voluntarily control their breath, and as I stood by the bed I wondered what to do.

I decided to use a meditative technique involving guided imagery. I asked him to envision himself on a peaceful lake, floating safely on an oversized air mattress, then to perceive what his senses were experiencing. What did he see and hear? The smell of the water and fresh air, the feeling of the sun warming him while the water cooled him? I suggested sounds including lapping water and birdsong. Next, I added the sensation of proprioception by suggesting gentle waves lifting and lowering the air mattress as he floated. As the patient relaxed, I correlated this movement of the waves with the movement of his chest caused by the ventilator breath.

I was amazed at how quickly he calmed down and stopped struggling with the ventilator. His heart rated decreased, and he stopped trying to pull at the tubes. I introduced the concept of impermanence—the fact that these tubes and pain were temporary and just there to help him recuperate. I also offered a guided meditation for pain relief, which he later told me helped. When I left the room, he seemed to have shifted from an agitated state to healing mode.

I include this anecdote, adapted from my upcoming book, to demonstrate how powerful yoga therapy can be. In my career as a physician, my usual postoperative remedy was to give more medications for pain and agitation. Prescription drugs certainly have their place, but this episode showed me how redirecting the patient’s own powerful energy and attention can be immensely helpful, too.

Mary Duryea, MD, C-IAYT, E-RYT 500, has pursued a second career as a yoga therapist. She loves sharing her passion for yoga, anatomy, and physiology, including in her upcoming book Yoga as Integrative Medicine: Yoga Sutras Meet Gray’s Anatomy.