Becoming the Teacher

Just sat down for breakfast with mother-in-law and we were talking about -purpose in life.  I was actually trying to reveal to her a new "teaching job" that she is symbolizing  by having the grand kids witness the respect and care we give to our elders.  She was a servant of the church and with current physical limitations, the feeling is that with no further means of self care and transport, there is no further service to be offered.  (I think letting go of independence is difficult for anyone; in addition when one transitions from 25 hours a day of work to hanging out and watching Church TV, self worth can be broken down to being more of a burden than a servant).  Discussion made me think back to my grandmother.  I only remember one time in my youth (about when I was 3 year old) when I was in the back seat of my Dad's car and grandma let me place my head on her arm (my Lola Mac had chubby arms and compared to 1960's car upholstery she was my comfy pillow!)  I remember the love my parents showed toward Lola and although she wasn't in my life much, I had great respect for her.  This observational lesson relates to my mother-in-law now and the unconditional love and respect I give to her even if she is not able to contribute to covering bill paying or reliable babysitting.  Hopefully my kids experience their memories that stick for life as I age and lose independence.

In residency training, we rotate through all the departments of the hospital to learn application of medical school didactics to real world patients.   I translated that to "stealing techniques" from  supervisors and building my repertoire of knowledge.   As I progress up the ladder of learning, I am privileged to sit and speak with some of the worlds greatest minds in medicine and healing.   With the death of my mother in 2009, the feeling of being bullet proof with no time for being sick had quickly dwindled away.   My doctor skills self diagnosed reactive depression to her loss so I did what any family medicine doc would do, I prescribed therapy for myself.  (But I did it in the disguise of taking courses to satisfy state requirements for continuing medical education!!)  So here I am sitting in front of guys like David Simon and Deepak Chopra, Andrew Weil, Tierona Low Dog, Wayne Dyer and listening to these present day sages speak in modern medical terms but translate ancient information on the power of the body to heal on it's own.   The information presented is very empowering and I feel a great urgency to share knowledge with patients.....only problem is that the bulk of my practice is in immediate care and there seems to be no time for educating on how to maximize healing with mind body medicine and nutrition.    So I tuck the information away and continue "band aid medicine" wondering how and when can I apply all this knowledge....or even if I am supposed to do anything with it.  (I do cool video tutorials but short of a few views....the world is quiet)

Then the unthinkable happens and I am called by my Dads neighbor about the worst experience anyone is not supposed to have.  I rush to his bedside and during my Dad's last 2 weeks on earth, I was grounded by the fact that all the healing I went through while attending classes with the giants of medicine had been to support me in my journey.  The man who created me had given the biggest lesson that I was to learn:  heal myself the way I would heal others and everyone will prosper.   Turns out the guy who inspired me to become a doctor also became my greatest teacher during his final hours.

I am reluctant to take the torch of knowledge and pass it onto others....mostly due to the selfish reason that in becoming a teacher means there will be an eventual student/class/community that goes on after me to do more things (realizing my own mortality).   Seeing my teachers go through to their next summits, helps me realize that it is my duty to pass the knowledge onto anyone who is willing to accept it.   In this current dynasty of information/technology, the knowledge of healing is coming at light speed and seems fantastic and exciting.  So there is a bit of honor to know I can "handle the torch" but equal apprehension on the volume of knowledge I have to pass.   Stay grounded, eat mindfully and keep moving....
.....my time at the front of the class should be awesome!   Thank you for direction Guru's!

Andy Weil

Tierona Low Dog

Claire Diab

Herb Benson

David Simon

HMI and Joseph Helms

Davidji

Deepak Chopra

Ossie and Nora Saguil

At Peace Inside/Creating Peace for Others

It's been 3 months since I said goodbye to Dad.  Through introspection and soul searching, I was able to accept him being gone but more importantly understand that his spirit/memory/legacy is more important to my future than ever before.  I used to tap into his wisdom asking for advise whenever life was challenging.  He served as a grounding force for me.  I remember a picture he painted for me in high school when I was frustrated in fixing a car; when ever he would get flustered in surgery and what he planned wasn't working to save a patient

-he would pause/step outside the operating room/let go of the frustration/return with a sense of peace and calm.

I carried his teaching with me into my practice of medicine.  When a patient presents to me and seems complicated, frustrated, suffering without hope; I help them step back, ground, recollect strength and set goals.  No matter what the disease or how advanced it is, there is always a way to find peace again.  Medicines and surgery may help but it is up to the patient and his/her spiritual team to reconnect with the most abundant form of healing-the Universe.  I often run into people (guys especially) who see the world in concrete terms. "Life is a biological process and events that occur are purely coincidental without any spiritual connection".  I personally believe in God but don't force others to follow how my parents raised me.  I see that when all hope is erased from someone due to medical complications or a terminal diagnosis, if the person I am examining has no spiritual practice or belief....they are essentially at a very dark abyss with no light.  When that realization sets in, fight or flight is turned on every minute of every day until the adrenals are just burned out and can't produce enough adrenaline/epinephrine to keep up with daily suffering.  At that point, they are still at the abyss but just so fatigued and depressed that jumping off seems the only way to end the suffering.  My goal in the 60-90 minutes I spend with them is not necessarily to cure the diagnosis they arrive with but more to help them....

-step outside their frustration and return to a sense of peace and calm

It is proven with developing a meditative practice (or just practicing mindfulness) that brain tissue grows, DNA gets turned on, white blood cells work more efficiently and the adrenal cortical system slows down.  At the least; a patient suffering can step back from the abyss for a while.  At the most; the trillions of self repairing/designed to exist/never taking-a-break cells can function at their peak to fix what toxins/damage/trauma has been presented.  I can usually create a plan for lifestyle change that I review after printing and wonder ...."where do I get these ideas?!".  It usually comes from an article I read a few months back/or a lecture I attended during fellowship training or with a previous experience in my past.  Regardless of how answers come, I have to be in a state of peace or else my brain can't pull these ideas together and I don't get to tap into that message that resonates inside me while face to face.  (The opposite happens in most medical practices-when the doctor is flustered and stressed and hungry; creativity decreases and problem solving just reverts to an algorithm so the patient is turned into a statistic and standard therapy is prescribed).

I don't mean to say every doctor should spend 60-90 minutes with their patients.  With reimbursement the way it is now.....all medical offices would be bankrupt in 12 months.  When I work the immediate care (my main source of income) I am moving quickly (I reluctantly admit to seeing a patient every 10-15 minutes) but in this setting, I justify it as important for people to start the healing process early to decrease time off work/infecting other family members/decreasing pain/stopping vomiting......and I have to work these numbers to help show that there is a need for the hospital to keep an immediate care center open and de-fuse the ER.  (Not to mention cutting back on the spending government insurance pays for patients with no docs to be seen quickly).   Today at noon, 9 people walked in at the same time and I had an immediate wait time of 1.5-2 hours (if I spent less than 15 minutes each)....and more people continued to arrive (cough/cold/flu) pushing back the wait time further.  I could have freaked out and showed my frazzled state to each patient I greeted but I chose not to.  I sat through the 21st day of  Deepak and Oprah's Energy of Attraction and remembered the centering thought "My presence creates peace".  I had to be the beacon for the staff to stay calm and the patients to know they will be seen and attended to 110%.   (I had one patient that was coughing for 7 days, getting worse and worried she would have to cancel her breast cancer double mastectomy next week......and here I am worrying about getting out on time and having something to eat!)

During my Dad's last 2 weeks on earth, I stayed by his bedside and scrutinized every specialist, reviewed every order in his chart, made suggestions and "controlled his case".  I didn't want him to go and I saw rays of light when I reported to the family daily progress.  In the end, Dad decided to leave on his terms, at his pace....no matter how I had the medical team intervene and no matter how many hours I stayed up next to him.  Dad became part of what Lao Tzu calls "invisible forces" and his final lesson to me was:

-step away from chaos, comfort others by becoming peace....and purpose in life will find you.

Dad knew I was adopting healing traditions outside the standard medicine and I was still searching for how I could fit in with "my kind" of practice. The day I cremated him I received a call from my old medical director stating she wanted me to join her in private practice.  We hadn't spoken in 10 years!!!  I asked her why she decided to call me at that specific time....said she had been thinking about me for the last year but was "drawn to reach out" on that day.  I then heard from a physician recruiter at the Advocate Sherman Hospital....we had spoken in the past but she was "praying for an answer" to find a physician to spear head a new medical center being built!!! Whether you believe in God, a higher source....or have no spiritual "insides"....at the least, these happenings are way too coincidental.  I feel it's my Mama and Dad/the Universe telling me that when life doesn't seem to be going the right way, maintain mindfulness in the emotional tsunami and the right path off the abyss with show itself.

Shifting Gears

As of August/September 2014, I have been a witness to the inadequacies in insurance based medicine.  The old adage of when you have a hammer everything looks like a nail is still true.  The talents in some of the doctors graduating from medical school is fantastic.  Unfortunately, there are also some very average healers out there.  The problem is if you have someone fighting for your life, it would improve the odds of survival if that person was as committed to maximizing health as you.  On a good day, in the morning, after a good meal and sleep....most doctors will probably be "on their game" in problems solving your predicament.  But as you know, most people "on call" for the ER probably slept poorly.  Most people trying to get through Monday morning traffic to arrive on time for office hours probably have been through 2-3 episodes of being cut off before arriving at destination.   Most people running late in the office are contemplating how to apply the "care algorithm" for your 2 biggest problems and delay addressing the others down the list until next visit.  Most people by the end of the office day have not eaten properly and are saving the most urgent calls for immediate call back and postponing other messages so they can "get the hell home" and let the office staff deal with the left overs.  Note that the higher you go with medical training (the sub-subspecialists) the less likelihood a response will be.

Speak of the devil, I just got a text from my wife.  She is in Florida caring for a relative who is being released from a chronic care facility as the insurance just ran out on the 20th day.  The nurse was teaching how to give an insulin shot to a newly diagnosed diabetic.  She was also teaching last minute (right before discharge) education on high glucose foods choices.  Some of the info was wrong....see this picture for the "average diabetic hospital meal"

....if this meals looks like it is sustainable to you then you are probably very thin, meditate and exercise daily.  This will be an eventual failed nutrition change that a patient will use to fall off the wagon and go back to eating starchy salty foods ....or go back to smoking, drinking and watching TV/with no exercise.   

Thinking outside the box is very important for designing lifestyle changes.  As well it is helpful for maximizing survival if in a hospital.  I watched as my father suffered a catastrophic medical event, and then was witness to sustaining his life for his last 2 weeks while in CCU, step down unit, surgery, ICU then hospice.   The hospitalist was outstanding and listened to my concerns.  The initial neurosurgeon was hard to speak to, and gave black and white answers quoting statistics (so giving the average answer.....treating my Dad as a nail).  The neurologist and 2nd neurosurgeon were excellent.  The pulmonary doctor who we didn't need (of all people!) was the most compassionate and helped with the ultimate decision of withdrawing all lifesaving measures.   Biggest problem I have is with the initial doctor who evaluated him while the event was happening.  12 hours prior to event, Dad was a 78 year old independent "grandfather" who was complaining of double vision.  If the doc may have investigated further, the brain bleed may have been halted sooner.   (...but what do I know, I'm just a primary care doctor who thinks anyone with double vision, headache and on coumadin should be considered for a CT scan stat).  This is the ultimate slap in the face that if someone is not invested in the care of every patient that s/he greets "hello"....then you are ultimately being treated as a nail by a healer with only a hammer.   

Having been educated by Andrew Weil, Deepak Chopra, Joseph Helms I have imbibed the idea that the current paradigm of insurance based medical care is not the only way to heal.  There are "energy based" whole systems of medicine that have been in place for 2000-3000 years.  Some people don't identify with the artsy-fartsy softer science of healing but one doesn't have to be trained in it....just have to acknowledge it exists- so if all else fails, entertaining another path may get the suffering expedited.   (suffering of the patient in pain/suffering of the family in sorrow/suffering of the community in loss of productivity/suffering of the nation in the burden of medical bills for procedures).  I love what my gurus have taught me about being more than just a hammer.  I believe it has helped my family stay safe.  Followers of my suggestions/videos can attest to a happier level of functioning.  They can also witness the disease that presents in others who don't follow my suggestions (got some 30-40 year olds that are the living embodiment of what happens when you don't exercise, don't eat mostly a plant based diet and don't learn to meditate/be in nature/practice yoga-pray for them!please!)  

Sometimes the only way to help people realize the changes they have to incorporate in their lives is the threaten.  Like any fight or flight response, threatening a heart attack or cancer will be effective only for a short time - until the f or fl response is extinguished.  It is then up to the patient to grasp the great feeling living with a springier step, faster injury resolve, better digestion, better sleep in order to keep lifestyle changes going.  More recently, one of the bigger ways for lifestyle change maintenance has been to have a little taste of the catastrophic event.  Perhaps this is where modern medicine is good.  With all the surgical techniques and expensive medicines available, we have been able to reverse some events temporarily.  So some people get to feel what a heart attack is like, what a round of chemo therapy does, what getting around with a handicap placard is like.  For them, maintaining lifestyle is inevitable or they go back to the same negative experience.  But what of the 500,000 people that will have their first heart attack the the last thing they feel?  This is where family can come in handy.  What ever the way, your average American will have a catastrophic event occur before 50year of age.  Shifting gears before the event happens is so crucial to improve survivability.  If the patient doesn't care-the family might; if the family doesn't care the community might; if the community doesn't care the nation should.  The burden of the sick is on the backs of the surviving.  

LUCY (spoiler alert)

Just finished this movie written and directed by Luc Besson.  I went for the action and CGI but was amazed to experience the emotion he was trying to convey.   The previews were "tasty" to movie goers looking for car chasing, guns, drugs and human blood.  Weaved into the scenes was this recurring theme of enlightenment. Watching this made me feel validated on my search for deeper healing/medicine with some of our modern day sages (Andrew Weil, Deepak Chopra, Herb Benson).  I had been on a journey to quench a thirst that the standard 200 year old texts we use for learning health are not the answer to understanding the healing power of  inherent human energy.  This energy is replicated and passed on via DNA in efforts to improve the vessel that is doing the passing.  If the vessel evolves, the universe benefits from the improvement in energy shared.   When the universe benefits, the vessel is supported to "do more".  A win win scenario to this existence.

First scene was bloody involving Asians underworld and drugs.  Innocent American  thrown into a frenzy of killing and contra ban-typical opening action movie.   The twist is when a man made substance used to bring a depressed society (with rotten teeth and poor health) into a few seconds of high/happiness- actually unlocks the path to the ultimate existing in infinite bliss. The rest of the movie was a roller coaster  used to carry viewers to the directors message of universality.  The reason most dont experience it- we have not learned to apply the true power of the mind.  Humans have just created a scaffolding of science and math to help teach knowledge and intelligence.  The problem is when the vessel passing on the information cant continue to grow/evolve due to the limits of the language the vessel created.

Knowledge is empowering, teaching is fulfilling.  I think we get too bogged down by the concept that we are all individuals and "I have a better concept" instead of "how can I can help".  We are hardwired to be heard, to be acknowledged, to feel good about being part of something (contribute).  This built-in message in our individual DNA proves we are all connected.  Ultimately we are all vessels built by a universe to contribute to its constantly flowing energy.  I believe society has destroyed this message of wanting to be acknowledged (to be liked on facebook).  The social media has taken us away from the beauty in finding our strengths and purpose in life and instead has cultivated the urgency of going for the fast reward of posting or creating what ever gets people to say WHOA!!!   Creating what is in your heart takes effort and energy.  Shooting a gun, crashing a car, stealing is has high shock value but doesn't chisel out the reward that is hidden in the bolder of a sculpture, in the paint brush of an artist or the soil of a gardener.  Our modern use of the internet has united a world separated by continents but has also stagnated growing artists healers and nurturers.

The proof to my contemplating: in listening to the moviegoers discuss what they just watched, I heard one gentleman saying to his younger texting companion:  "if you get uncomfortable with the emotion the director is trying to convey and go straight the your smart phone to feel comfortable again.....you will just have to start all over again in building up an emotional level the actor/story teller is trying to bring you to."   I liken it to computer games and ADD- if young people are constantly bombarded by speed, sound, visual experiences that demand focused attention, it will be hard to "unplug" and experience the true rewarding power of nature/the universe/existence.  That part of the brain that is getting the the stimulation programed into a computer code is small compared to the part of the brain responsible for creation, happiness, love.   Thing is, the computer programmer has found a way to deliver the "caffeine rush" to the fight or flight brain-parts that bypasses traditional "unlocking" of the reward system built in our DNA.  If given a choice to effortlessly get a caffeine rush vs read, learn, interpret, create....most people will choose the proverbial apple in the garden.

The point I was able to arrive at with Lucy: when we only go for the apple in the garden, we don't learn to utilize the massive gift created by the universe.  The vessel we exist in may have evolved from homosapien to modern day Prada wearing creatures of plastic surgery and hormones but our minds are still functioning at a little higher than cave man status.   Bottom line with Luc Besson's creation; it delivers the visual reward for Hollywood but also has the hidden lesson that we are all interconnected not only to each other but to nature/the universe.  "I am everywhere" (I give it 2 thumbs up)

The Duality of Healing and Healthcare

I just got tagged for 4000.00 malpractice insurance payment and a 700.00 license renewal.   I spent 2-3 hours on a "mandatory" online education that was supposed to take a few minutes.   Multiple meetings to make sure all doctors are "on the same page"- making diagnosis and treatment plans universal.   Yet my malpractice climbs every year (even though in 20 years I have never been sued); reimbursement falls every year; my paycheck is the same as a 27 yearold just getting out of residency training (since the Kelly Blue Book says all family practice doctors should be practicing and making about the same all over the US).
Most of the doctors I know went straight from college to medical school to residency (a few of us to fellowship and a handful to a second fellowship).  Suffice it to say, most of my colleagues have not been trained in business so running an office is a tough learning curve we don't have time to do the correct way - going back to school.  This is why many choose to be an "employee" of a large corporation so you can practice with "autonomy" and leave the business to the hospital administrators.  But your med school guru didn't teach you that if your practice is run by a non medical human, compassion and time are not in the formula for turning a profit.  If a director has to answer to a board, he won't be saying "our doctors are very loved by the community, one of our physicians gave a great lecture at a local high school, we had a doc interviewed on television".   The director report is real time paper/graph generated results with prospective graphs for the future and comparison statistics to local competition.   I will never forget working for a Hospital in the Center of Dupage, the immediate care centers in the 90's closed doors at 9-10oclock to save on electricity and payroll.  All the centers except one; this Convenient Care just happened to be in the neighborhood of several board members in Wheaton!!!  (the rumor was it was closer to the Wheaton-ites than going to the hospital so they were advised to stay open later)    Alot of hospital high ranking administrators will want their employees to streamline, follow protocol, not give away anything but yet whenever I hear a COO/CFO is bringing his kid in or a board member wants to be in and out quick....it sounds like the people that make the rules of how doctors are supposed to heal, follow a different set of rules.
If you look at how much sacrifice was spent in school, how little reimbursement is given for invested problem solving, how much time is lost away from children and spouses/ waking up answering phone calls in the middle of the night and seeing sick people in the hospital.....and compare to a business major finishing college, starting a company, hiring employees (doctors) and starting another business-it doesn't compare.  It used to be an honorable and guaranteed business in the 70's and 80's ....but not now, in fact the stressors of being brought up to "do great things" but then being told that you are "standard and should be practicing in the mean average of doctors" is so heart breaking.
This is where the schizophrenia of medicine exists.  We are groomed to heal others, give back to the community, continue learning since it will help humanity.....but at the same time, don't used intuition, don't listen to your heart, follow protocol make sure you don't deviate from policy.  Isn't healing a dynamic thing that varies from person to person, from country to country, from harvest to harvest?

The Saguil Approach is to take a regular paying job (so the kids can get a great education and walk home safe).  At the same time-Sow my Healer oats-take a chance with practicing medicine from the heart, outside the wallstreet paradigm without worrying about following hospital protocol, government restrictions and getting reimbursed for healing lives and not just making pharmaceutical industry wealthier.  I joined several groups to increase chances for 40 hours a week of steady income, I also have a twice a week consulting service where I practice "no holds barred" medicine (weaving between western and alternative medicine, educating and empowering, making suggestions for relaxation practice, hand picking herbal supplements and embracing physical changes to help immunity/recovery.)
This is my duality = DrRicOnDemand-using modern technology to administer old fashioned healing.   

Pebbles on the Path

Pushing buttons

Had a long Sunday at Immediate Care.  Seems that the people coming in were not interested in getting healthy, they were more interested in getting back to the way they were before getting sick.  (What they don't get - they are sick because of the unhealthy lifestyle....may not seem obvious now but I can wait, when ready, I can help)  So I buzzed through the walk-in patients....kept the wait to 15-30 minutes and handed out a lot of prescriptions.  Kinda easy to agree with a diagnosis of infection and just write a prescription.  Another symptom, another prescription; another trauma, another xray.  This is "cook book medicine", if your symptoms fit the ICD9 code, you will get the predetermined treatment algorithm for that code.  I detached myself from the need to educate and empower and just picked up charts and discharged patients.  After work, I was looking forward to spending the remainder of Sunday with my family so we took a walk at a local forest preserve then looked for a place to eat.  Son wanted Japanese food so we drove to a local place..  After reading through the menu, I asked to waiter about the portion size for some soup.  He said "it was big".   I wanted to make sure it wouldn't be too much to eat.  He said "I don't know how much you eat".  Finally I asked how many scallops come in an order/dish and he said it was "alot of scallops".....(perhaps his full time job was at a Japanese comedy club so I went on to decide my order by just reading ingredients and guestimating portion size by price point.  We all ordered and received our food....except for my scallop order which seemed to take a long time to come out.  I ended up having some of my wife's sushi order and asked for the check and some boxes.  He came with the check and the missing order.  He said scallops take a long time to cook and he mentioned it to me (of course it was probably between the fantastic descriptions he arduously built up of the menu choices when taking our order)  I took the price of the scallops out of his tip and left saying the food was good but service not appetizing.  Then it started raining on the drive home.  I usually drive the right lane and during downpour make sure I watch my periphery and rear since people underestimate wet stopping distance.  (dry = 1 car length for each 10 mph  or follow using the 4 second rule)  Regardless, if someone is tailgating me in the right lane, they have the option to use the left lane for passing.  If they don't take the option I slow down both of our cars and increase the distance to the guy in front of me so in the event of a sudden stop, I have ample braking distance and the tail gaiter will hopefully do the same.  So on this day with windshield wipers going full speed, the only thing I saw in the rear view mirror was a very 3D looking set of headlights.   I let up on the throttle to "gently" indicate that he should distance himself or pass (not sure if male or female -too much rain).  Headlights got even closer.  I continued to focus on the scene in front of the car while my son was making fun of me pretending he was the waiter from the comedy club/sushi place we just left.  (I didn't want to invite wife and sun into this movie that was taking place behind us -reminded me of a 70's film by Spielberg called Duel where Dennis Weaver was being stalked by a relentless big red 18 wheeler villain)  The narrow right hand turn into our neighborhood was fast approaching and he was intentionally getting closer so I had to slow to a crawl to navigate the intersection/the rain/his front bumper.....and while my son was laughing from the reenactment, the car behind me started wailing on his horn.  I did the civilized thing and made the turn waving my finger to him saying you are driving to close.  I couldn't make out if male or female as my eyes were on the road hazards during the peel off.  I always like to memorize the driver and license of reckless drivers thinking that one day I will be able to discover an amber alert fleeing vehicle.  My son immediately says this is the worst day ever, then my wife say poor Daddy "so stressed".   I then calmly say...I'm not stressed....that guy is.
This is one of the reasons why it is important to practice relaxation exercises daily.   To remain calm in a fight or flight situation will help with problem solving/be a beacon for others in the frenzy to emulate me /and I believe if you react to anger or a stressful event with more stress, the options for moving forward will be limited. Think of the typical ER star- cool calm and collected physician that runs the recusitation, leaning back against the wall, calling out orders, controlling the chaos erupting over the dying patient and having everyone work in unison to bring the patient back from death.  The human body can only exist in fight/flight or unity/procreation.  If the only way you know to live is fight or flight, adrenaline/epinephrine/cortisol will be the dominant hormones and inflammation will be the dominant reaction in every cell.  (FYI....inflammation = heart disease, autoimmune disease, Alzheimer's, diabetes and cancer.)     If you develop/practice a relaxtion response regime, you can choose to be proactive/calm before an event.....(the opposite would be reactionary to all events).   Having a healthy life practice doesn't guarantee immortality but at least you did what you could to shape the future.