Perform action without regard for the fruits of action. -Bhagavad Gita

Being "well centered" allows for a tolerance to the forks in the road.  There will always be decisions to make on the journey to a summit.  Of course you have to commit to a summit to begin with.  At the Chopra Center's Yoga Teacher Training we are taught to live our purpose in life.  Sometimes it will be obvious- what we were put on the earth for; other times it will take journey to find it.  Either way, if we have connected with that ever lasting energy of nature/the universe, our time on the path will be effortless.  The difference between investing hours of our lives to a project vs effortless ease in living in the moment is light years apart.  It is not the belief that you don't care but more of accepting the next fork in the road as part of the journey.  Both ways of seeing a goal will get you to a summit but the latter will get you there with less expression of disease and disability.

When CEO's come to see me for "check ups", most are educated, well read and have embraced problem solving skills that have launched them into the current state of "success".  The question I have is if in their "success", are they feeling fulfilled.  Most are missing something inside although they are surrounded by material reminders of their journey.  No question that it's cool to have expensive stuff that only a few humans will ever glimpse, but how long will deep happiness last holding onto that temporary object.  (...it's more of a caution to note when the interval between requiring the next object shortens-red flags should go up!).  I remember my guru saying "we buy things we don't need with money we don't have to please people we don't like".   I don't expect patients to take a life of celibacy but I do believe that neutralizing objective reward with a practice of contemplation will keep one foot in the real world but the important foot will be connected to a sense of oneness.  If you haven't taken a yoga class taught by a good healer then you probably can't fathom the value of silent mindfulness.  There is usually an aha moment with people that sit down with the intention to remain in quiet for some time.  I teach my guy patients (males are very visual and can comprehend a concept better with data/facts) that relaxation and spirituality can best be demonstrated by the "floating on a cloud" feeling you exude during the first few days of coming back from vacation/nature.  You can see it in the blogs and post of people back from vacation.  Energy in words, actions, attitude for a few days.  That is the serotonin high on a trip that started when you unplugged and just learned to be in the moment.  The high is usually maintained with just a shared thought, story or reflection on feeling really good.  When people feel good serotonin and oxytocin are released into the blood stream.  These feel good hormones help little RNA/DNA, white blood cells, digestive system, brain tissue do what their dharma (purpose in life) was programed for-survival and continued existence.  When every cell is working efficiently, people feel creative, fast problem solvers, have great sleep, and appear emotionally attractive during the serotonin high.  The sense of ecstasy can be reproduced even without being in Punta Cana or Yosemite or with friends and family.  But it takes practice, regular practice to be able to reproduce that state of happiness without having to fly across a continent.  The more you practice the deeper you get in a shorter amount of time.  After a while you end up not caring about time because during your regular practice, the serotonin and oxytocin secreted by all 3 trillion cells of your body work with maximum efficiency in the "sanctuary of time" you create.   When the factory is buzzing, you product is good!

Science has tried to reproduce the feeling with SSRI's (Zoloft, Paxil, Prozac, Effexor...) medicines to synthetically increase serotonin.  They work for the worst cases of mood disturbance but usually mild to moderate depression gets the same amount of a bump in serotonin with meditation, St Johns Wort, sunshine and counseling.  What I have experienced is when you're doing what you were born for, time stands still, serotonin is endless, your investment in any action is infinitely rewarded.  In the journey to my summit, I used to question if all of my efforts of burning up time would be worth it to accomplish a goal.  I was always focused on the goal and it made me insatiably anxious that I was "burning up daylight" and possibly going down the wrong path.  My aha moment was attending a seminar at Harvard by the author of the Relaxation Response.  I realized that there were other doctors that were "great listeners" both their own cellular intuition and the patient's ailments.  Herb Benson showed me that there was validity to mindfulness, energy based medicine and the idea of letting go and trusting in some unseen "pull" that guides you to fulfill dreams.


So picture the Steve Jobs of the world, setting a summit, launching on the journey and staying unshakable in the moment of decision making at their fork in the road. Then imagine the CEO that seems financially successful but looks stressed, unapproachable, and unhealthy with some form of substance abuse.  (I don't name anyone but you can probably think of someone in an executive or managerial position that may be great at what s/he does but also looks 20 years older than his highschool classmates ).  Initially it seems counter intuitive to let go of a dream but I think back to what Deepak taught me-detaching yourself from the outcome doesn't mean you dont care, it just means being open to when "something" will happen and knowing the next step to take.  Think of it this way:

                                          -you can hold tight on the stick and chase the carrot

                                                                                       or

             

                  -you can throw the carrot into the abyss before your journey trusting you will find it again

It works for a while then stops....

I always wondered why patients say "the prozac worked for a while then stopped....my psychiatrist had to switch me to another".   "The GI specialist started me on Prevacid but my gerd flared up again and he tried nexium".   "The pain doctor put me on a a vicodin and I was pain free for a while but now I'm on oxycontin (oral morphine)".   The blood pressure pill was helping but for some reason he had to give me a stronger one after a few years".   In the short visits spent with patients in the immediate care setting, I would see this over and over; along with a typical 30-40year old with a list of 3 meds. 40-50year old with 4 meds/2 vitamins, and a 50-60year old with 5meds/3 supplements.  Oh....I make it a hobby to ask about weekly activity and relaxation practice-same answer: no time for "exercise" and "I'm not stressed out".  I don't usually have the time to go through quid pro quo about nutrition knowledge but my hot button there is to look at weight/BMI and that's the answer to eating style.

Returning to primary care office work (seeing patients routinely and getting follow up vs the take care clinic band aid work) I can see a repetitive occurrence of people leading unhealthy lives; coming in for short fix prescriptions; coming back with temporary but unsustained response; going onto multiple rx management, eventually being sent to the specialist care for BIG medicines or surgery.   On the flip side- around every 20th patient is taking my advise for beginning a relaxation practice, switching to some form of nutrition practice, starting a supplement and fixing sleep.  I had a lady with severe symptoms of hypothyroid/fibromyalgia/sleep disturbance see me last month very frustrated with previous docs....made a few recommendations like the aforementioned and 1 month later she is a different person.  (that is one of the fastest turn arounds yet!)  My pessimistic self says maybe it is all placebo and just the fact that I told her she will get better orchestrated the flip of her switch.   My optimistic and evidence based self said she is getting better because she removed herself from poor nutrition practice, supplemented for deficiency, started breath work and templated a healthy schedule of sleep and exercise.   Bottom line is -doesn't matter how it happened, I just have to help guide change and keep the ball rolling.

I feel that in most cases, the reason pills give a temporary response is because no one changed the unhealthy thinking/eating/activity of the person taking the pill.  New drug will give a nudge to the system.  Forcing the brain to simulate happiness: the gut to stop secreting acid: the body to ignore inflammatory signals from twisted body parts....but if no change is made to the "body part" then this magnificent machine called the human body will find another way to send signals saying SOMETHING IS NOT RIGHT!!!.  At least until a different medicine is used to suppress the annoying alarm.  Better than spraying foam on the kitchen fire is turning off the gas main.

A patient yesterday said she was worried before she came in that I was a Family Medicine doctor and not Internal Medicine trained.   She went on to say"....but I can tell you are different and that makes me feel hope".   I believe telling people their "blood tests say the medicine is working,  see you in a few months" is reassuring.  I feel guiding people to develop sustainable changes in areas they didn't recognize needed change -is empowering.  Pulitzer prize winner Dr Siddhartha Mukherjee said "Physician honesty need not equate with hopelessness".  He was referring to life ending disease.  As a primary care doctor I deal with life altering disease but the same fundamentals are in play - don't just surrender to the disease and wait -empower people to live life with hope.

Push back check out time please

The other day in the office, one of my favorite 80+ yr oldie's came in to see me.   She was quick witted as usual but after checking out, she started "checking out".  First she started slowing down her snail pace to almost a stand still.  Then she remained silent while standing (this is one of those souls who makes play by play commentating like she is talking to a radio audience...."it's cold", "it's so white out", "that will take forever"......)  Then as I sat her down the well known slump of death started.  It's when a human that was previously made of flesh and bone suddenly is a 110 lb bag of melting ice.  You would be surprise at how difficult it is to carry someone when there is no life, turgor, or blood flowing through the body.  I'm pretty fit but as I picked her up like a sleeping child, she started sagging like gravity was pulling body parts between my arms.  Got her up on an exam table and had her in semi flat (in the field if someone passes out I place them in trendelenburg with head down and feet up to pour life restoring blood into the brain but with her age, I wasn't sure if she was having a stroke out so I rigged this first aid position).  Blood pressure was really low and she was unresponsive so I asked relatives if she was DNR-they said yes and after some debate, we decided to postpone calling 911.  As I mentioned hospital and IV ...she suddenly started speaking with a muttering in a barely audible voice.  I went closer and she said "I don't like the hospital".   Huumm.......I decided to get her grand daughter on the phone and asked the kid to say hello.  Guess what, grandma started talking louder....albeit her blood pressure wasn't reflecting any level of what I would consider normal for a human, in fact it was still dropping.  I was very uncomfortable with keeping her in the office; because the experience I have working in ER's the resources available to  orchestrate resuscitation in second and begin a diagnostic work up makes it temping to use the God Complex to say I can fix this.   But then...my Dad popped into my head (-being guided by my favorite mentor).  He told me...wait.  So I continued to observe, provide comfort and just reassure the patient I was there for her.   I felt like I was back in med school where I was the "human cardiac monitor" and had to repeat vital signs every 10 minutes and assess color, turgor, heart sounds, neck veins, level of consciousness to determine what the cardiac output was; preload, after load, cerebral perfusion, peripheral perfusion - all the basics of human physiology which will give just as much information as a $10,000.00  monitoring system in the ICU (yes, this is why a 10 minute trip to the ER for a fever and Tylenol will cost you and your insurance a thousand bucks).

Bag-o-Jello suddenly started to take human form again, voice strengthened, color returned, blood pressure was normal.. then she said she wanted soup (probably the brain triggering the need for fluid volume and salt?!)  I asked her how she felt and she said I'm OK, can I go now?  What the #@$@, such a resilient generation this lady was born into.  I told her she had to take it easy because she just went through a life threatening experience.  She just said "I'm hungry" as if nothing just transpired over the last 60 minutes that in my mind was like an eternity.  She got back up, finished checking out at the front desk, proceeded to the parking lot and left with her care giver.  I heard her say in a loud voice...."it's so cold!!".  They went on to eat Sinigang and Lechon at a Filipino restaurant (2 pork heavy traditional meals!).

The hour  of "back country" monitoring this tough but delicate lady was more than a a review of basic physiology and wilderness medicine.  More importantly it showed me that sometimes there is more to lifesaving than just running protocols and algorithms....the human soul ultimately decides when it's time to check out.  Learning to listening to it is good for the patient and the healer.

Living with Disease

When I work shifts at immediate care centers, as I am going through my questions and answers to template an idea about who my patient is.  In medicine we follow this concept that Lawrence Weed developed in the late 60's called POMR.  (modern version is called the SOAP note) It's a way of organizing data collection while speaking with patients so a clear understanding can be made of the problem.  He created it due to the complexity of medical conditions in patients.  In 1969 he wrote:

"...accept the obligations of meeting many problems simultaneously and yet to give to each the single-minded attention that is fundamental to developing and mobilizing his or her enthusiasm and skill, for these two virtues do not arise except where an organized concentration upon a particular subject is possible."

-an old SOAP note (note _OAP to left margin)

So the doctors of today are not dealing with anything new when it comes to tackling the "laundry list" of issues that patients arrive to the doctor with.  Many of my contemporaries claim current society is so overexposed to processed food, biased television/internet news, unhealthy work hours, lack of exercise, alcohol/drug consumption and now over utilized prescriptions that the health care of today that the modern day patient is different than yesteryear.  Guess what....no matter what kind of plate you put the meal on - its still a meal.  I will always teach my medical students, the importance of establishing rapport first.  Get the trust of the patient and you will figure out the answer in the ailment.  The problem I see with going to the doctors office today is that there is a concept of hurry (no doubt started with medical insurance industry "streamlining" billing) to limit a visit to a diagnosis.  So no longer are we treating Joe Schmoe, we are now taking care of a high blood pressure reading or an elevated sugar or a month of feeling depressed.  Doctors are being encouraged by an industry to label a visit with one bullet diagnosis.  Savvy doctors will list down several diagnosis to attain maximum reimbursement for services rendered but the problem I see is docs concentrate on claiming "I found diabetes in you with your blood test" or "your X-ray says arthritis" so much so that we tend to make an la carte treatment plan based on a list of 3-5 diagnoses and hope the treatment "takes" when the patient come back in a few weeks.....100% better.  So.... if I send a Porsche with strut problems to a Chevy volt mechanic and he tries to fix what is basically a suspension issue-it will probably not perform like it did before.  On the same analogy if an automobile just has a loose nut...most mechanics can tighten the nut and stop the rattling.  But......human nature is to wait until the lose nut has caused a cataclysmic suspension failure resulting in cashing in your 401K to fix the problem.  There is nothing like the experience of being given a long list of things that have to be fixed when you thought it was just a loose nut.  I guess it's the same way with an annual wellness screen, you go in healthy, you come out with an inventory of what is abnormal and "has to be fixed."

As medical insurance steps in the make the visit to doctor and hospital an affordable event, they need an algorithmic way to translate SOAP diagnosis into something they can reimburse (and not just trust the doctor is billing properly for expertise rendered during a visit)  Here comes ICD coding.  As a patient you leave the doctors office with 3-5 ICD codes.  This is what it has come to, you are now an accumulation of codes.  Even as I call my specialists to let them know of my patient I am sending, the conversation usually starts as: "...I have a 76 year old Alzheimer's patient with depression and subdural bleeding on Aricept and Lexapro coming to see you for non control of symptoms."  The answer will usually be: "...add Namenda over the next month and I will see him in the office for further adjustments then".   I hope and pray that during the 30minute visit with the specialist, my consultant will see more than a few ICD codes in the exam room, and try to give expert advise on better options for treatment.    The back room event that occurs is the specialist with a booked up schedule will rely on my ICD codes in building up opinion, possibly do some "fancy" testing to refute or support the codes and stream line additional treatments.  Doc will then have the patient come back after another month or two (booked up schedules!) or come back and see me.   So goes the typical "spin" of going to the doctor/hospital.

If you look at why ICD was created...it was to record causes of death in Europe.  Like a registry.   Since the 1700's it has changed from International Lists of Causes of Death to the current WHO adaptation of International Classification of Diseases-10th revision.  The original lists were compiled as population studies for figuring out why kids were dying early and scientifically devise an intervention for this large group.  Great application....and it probably was key in curing many childhood diseases.  My bias is that when you use population information and apply it to the individual....it doesn't guarantee success.  In a broad sense you may prolong life for the species but only at the sacrifice of ignoring suffering from the individual.   The Ecological Fallacy points out that the outcome of the individual is not determined by the outcome of the group (my truncated version).  In medicine when someone breaks through the usual statistics of a certain disease; specialists call it an "atypical reaction"/lawyers call it a missed diagnosis/laymen would call it a miracle.  What ever it is called, its the demonstration of the human cell/energy to attempt repair and survival.  I believe if you provide the soil for DNA to "do its thing" it will continue forever.  Science says cell replication ends at about 70-80 years of life.  Living an unhealthy lifestyle (bad soil) will bring death sooner (Standard American Diet).  Living a healthy life will push back death (The Blue Zones of Sardinia, Okinawa, Nikoys and Ikaria where people are leading productive lives into their 100th year of life).

So how do we become a centenarian?  I don't mean an American Centenarian-(nursing home, bed bound, depressed, diabetic, demented, cancer-ed, bypassed, dialyzed, catheterized, emaciated)....I mean a centenarian from one of those previously mentioned places in the the world.  No question we have to live with a diagnosis and try to neutralize each ICD-10 code with the best protocol treatment plan possible.   My calling is to think with an Integrative Medicine mind.  I would attempt to "reverse" what ever brings you into the doctors office.  The problem is knowing when to go.  If you are listening properly to the cues your life is giving you, it will be easier to recognize abnormal change.  This requires knowing what is normal.  This requires education.  There are so many ways to empower with knowledge; books, seminars, hospital lectures, DVDs, Cd's, internet.  From former to latter you have to be weary about reliability of the information.  Once you recognize the cues, then see the propelyr trained healer, you should be able to revert your "flare up" to "status quo".  The same knowledge that helps get out of temporary illness should be used to determine if your lifestyle is going to sustain you.  My patients have a choice to change their disease manifestation for the best chance at arriving to their 90th birthday.  By living with disease, it doesn't mean taking the prescribed medicine for the ICD-10 code and going about your business.  It means always looking ahead to that "miracle", always trying to provide your DNA with fertile soil, it means adjusting the loose nut before your suspension crashes.  It usually means seeking out the advise of someone who can vacillate between using the awesome power of modern medicine and the awesome potential of ancient wisdom.  Don't ever just settle for being a disease controlled on medicine because the likelihood is......another disease/code is coming-listen for the cues.  

Destination Disease

Listening to Joel Osteen he began today's sermon with a story:
-two lumberjacks were working away in the bitter cold and one said I have to take a break and sharpen my axe.
-the other said I have no time for that and continued to chop away
-1st guy comes back after 3 hours with a razor sharp axe and slices through more wood in faster time than the guy with "no time"

In many of the 50-60 year olds that come to see me (CEO's included) I present a lifestyle plan to change and get back to feeling health and wellness.  Many times the plan I create encroaches upon the "untouchable" 50-60 hour work week.   I certainly try to design a change that is gradual and sustainable but it is usually first accompanied by resistance until I let them know that if they embrace "sharpening their tools", the 50-60 hours of work will be performed more efficiently to the point of creating time to indulge in more healthy endeavors....that in turn will open more creativity/more productivity/better sleep/faster problem solving (you can see the positive cycle of events that usually follows).   I also have some obese, hypertensive, emotionally drained, cortisol depleted moms that care form 3-5 kids and don't even have time to carve out for 5 minutes of breath work.  (I even obliged a mom who came desperate for help but unwilling to risk changing her unhealthy routine...saying ok, how about if we combine breath work during your daily potty break.....she said "can't do it"!  I pointed out her speed of speech, her emotional fragility, and difficulty with finishing sentences without distraction....if she could harness her own practice of calm-her duties may just become an iota more efficient; providing her with at least more poop time instead of splash and go.)

Whether its running a company or running a household, we get into a rhythm that seems to carry us from breakfast to bedtime.  It would seem that we have reached our destination in life with the only routine available; and deviating from it could end up a disaster.  But the realization I point out is the disaster is already occurring when my 50-60 year old looks like a 70-80 year old, weighs 50 pounds heavier and average, is on 3-5 medicines, and considering a divorce lawyer since the counselor didn't help.   Running a company or running a family takes a lot of talent and making it to that point has its rewards but my point is that there is still alot of learning to occur.  It is said that most Americans after high school will not read another book from cover to cover...ever!  Learning is not period in life...it is a way of life.  There will always be more knowledge to impart to even the most well read people.

The act of "sharpening your tools" goes for doctors as well.  I had a priest come to my wife's office blessing (Dental Radiance) and he asked me about L Arginine for cholesterol lowering.  Of course I dug a bit deeper in the short time I spent with him, and turns out he was placed on a statin after a few years of "trying on his own" with diet.  The medicine helped drive his cholesterol down to 150 (good!) and he said his HDL was good at 65 (mediocre if you ask me) but his last 2 blood tests showed "enzymes were high" and doc wanted to take him off the statin since his cholesterol levels were good in the last few years.  I wasn't there for the conversation he had but I wanted to question his doctor as to what the hell he was doing suggesting statins before nutrition change.  When I queried the Father on his fiber amount or if he was on an omega 3 fish oil or which nutrition author he was following....didn't have much of an answer except he tried to switch veggies for meat but was unsuccessful.   So just bringing realization to his fork in the road, I said if the nutrition practice he adopted before the statin didn't help; and after the statin he didn't continue any great switch to vegetarianism....how can stopping the cholesterol medicine now be met with anything else but the same high blood test results as before.  It was at the request of his chiropractor to consider L arginine during the next 3 months while his doctor wants him on a break from liver damaging statin.  The chiropractor had a good idea to think in terms of nutritional deficiency but this should have been the doctor inquiring on: the lifestyle of a priest, his exercise routine, his wine indulgence.  But guess what.... most doctors reach this pinnacle of medical knowledge and just do the basic minimum in keeping up with CME training as per requirements of board certification and maybe the occasional visit from a drug rep who is promoting her newest statin with great results from a study funded by the same company.   What if we allowed CSA vegetable delivery or Whole Foods Market into doc offices for pushing produce on doctors "backed with evidence" in some of the oldest studies (Framingham, Lyon, Nurses Health)....I think docs would make stronger suggestions for meals, dishes, nutritional practice.   But alas, the docs have no time; trying to break even with the vast number of patients to be seen, refills to be faxed, procedures to be performed to make up for the stagnant salaries we get compared to the diminishing reimbursements paid by medical insurance.   Who has the time (2-3 years) and the money (30-40,000$) to "sharpen their tools"?   Joel Osteen was right, the apparent disease is thinking when you arrive at destination, all the work is done.   I feel the answer is always stepping back, reassessing your purpose in life, honing your skills then reapplying them for the benefit of yourself and those around you.....you will never over-sharpen an axe.  

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.