Like a high wire trapeze swinging
Fearless from stand to stand
Listen to the concerns
And confidently traverse the
Possibilities till you land
Emphatically on the solution
Of your patient's problem
 
To see the problem clearly
You have to follow thoroughly
The path that led
Your patient to your door
Only then will you know
All that is facing you then and there
And with that clear understanding
Resolve to treat their problem
 
Such sleuthing cannot be done
Chained to a regiment
Dictated by seekers of profit
Or chasers of fortune
For medicine is an art
Of personal interaction
Not a brick in the building
Of a chaotic tower of confusion
Only by meticulous learning
Can a solution be found to every problem!

The political atmosphere of the day demands clarity as we enter the new year. The world in 2023 will be preoccupied with many regional and international problems. In Europe, the Russia/Ukraine war shock of 2022 reverberates. Many European countries looking to the US for answers, are disillusioned by our polarized and distrusting political parties. The ongoing chaos in Brazil is troubling at the least. And in the far-east, resource-rich China is quietly filling the economic void created by western infighting, adding more uncertainties for people of all nationalities. As though these calamities were not enough, mother nature is on her own rampage, further confounding the challenges. 

In the middle of this chaos, live millions of homeless and refugees that, due to no fault of their own, have lost everything and are looking for hope and a chance to begin anew. Yet the protectionism of many is drowning that hope. As the United Nations Secretary-General; Antonio Guterres said; "I remember the times when most borders would be open and now, we see borders closed, now people do not even have the right to be a refugee in many parts of the world."

In these times of uncertainties, psychological as well as physical hardships sicken people. Not to mention the deplorable conditions they live under. Moreover, the recent epidemics are further isolating many. The only hope for them is a visit to a healthcare provider – if there are any among them.  The challenge for us healthcare providers is to be able to treat our patients without prejudice and bias of our own.

Fortunately, our new technologies help us reach more of the needy near and far. It even allows us to care for our enemies, without jeopardizing safety. Let us all get out, communicate with more people and spread hope! It’s a resolution worth having.

There is a treehouse in our backyard
I do not know who built it
As to my recollection it was always there
I do recall a day when I smashed my thumb
Trying to hammer a nail into the floor
It got black and blue, and hurt for days
A week later, when uncle John came to visit
He fixed my treehouse and even put a new roof
My dad said it was my kingdom and that
I was the princess of the tree castle
I cried that I didn’t want to be a princess
That it was my castle, and I was the queen
But a pretty little girl should be a princess
NO! I said and my mom agreed that
It was my castle and if I wanted
To be the queen, it was OK.
 
Now many years later, when I go home
I see that my castle is in need of repair
My daughter, now three, claimed
That she wanted to be the queen
So last week, visiting my folks for X-mas
I took hammer and nails to fix the castle
And smashed my thumb again
It is black and blue now, and
The pain brings back many memories
Having a castle can be painful but fulfilling!

FIFA or the World Cup is usually held in the summer.  But due to the location of the event - this year in Qatar - it was moved to December. Qatar is on the south side of the Persian Gulf and the northeast side of the Arabian Peninsula where it is known as ‘God’s Anvil,’ as was said in the movie: Lawrence of Arabia.  The formidable winds from North Africa, further heat up as they cross this scorching barren land.  Even though FIFA is being held in December, the games are played after sunset, to protect the players from heatstroke.
 
The games have been a good distraction from an otherwise very difficult year. Like millions of people around the world, I’ve been glued to the TV for the past weeks. Yesterday’s match between France and Morocco was a nail biter. Even though France won, Morocco sure gave them a run. The first African nation to make it to the semi-final and play so well. The final game between Argentina and France will be on Sunday (Dec. 18) 8 AM mountain time. It will be another exciting game.
 
How I wish we could get this excited about our healthcare. Even a little excitement would add to the well-being of us all, and with all the technology available to us, it would be at a fraction of the cost of establishing, providing and participating in these international pastimes. Of course, I realize that it is the teamwork and competitiveness of sports that make them so exciting and healthcare is not a competitive sport. But it does require and demand teamwork. That teamwork could be built upon. As healthcare providers, we can assure that the service we provide is to the best of our ability. And showing a little enthusiasm in providing it, well, could be contagious.
 
Let us hope and pray for a better year full of contagious enthusiasm ahead.

With the cold weather, we limit our exposure and shelter in, isolating ourselves from the elements. As we celebrate this holiday season of customs and beliefs, let’s not overlook the nature around us.

On an unusually warm day awhile back, my wife and I were hiking a mountain trail behind our house. Even the blue jays and chipmunks seemed dumbfounded by the heat. I was leaning on my walking staff, lost in the magic of the day. My wife, walking a few passes ahead, suddenly stopped, turned and whispered; "We are not alone!" pointing to the side of the trail.

I turned to see a rather large rattlesnake coiled up, soaking the sun on a massive bolder by the side of the trail. Seeing us, it slowly raised its head and darted its slit tongue in and out a few times in gesture of greeting. It raised its tail and lazily swung its rattler a couple of times before resting back on the warm rock. Not feeling a threat, it did not seem alarmed.

Just then, an unnatural sound silenced the nature around us. Disturbed, I reached into my pocket and retrieved my cell phone. It was our daughter, wanting to know of our whereabouts. I answered her, and shutting the confounded thing, placed it back into my pocket. Turning around, I noticed that the snake had slithered away and was gliding under the rock and out of sight. I cursed the annoying phone, and we continued on our hike.

Having lost my line of thought, I focused on the fantastic tools at our disposal. I grew up studying by a kerosene lamp. Out of town communication was by telegram and we took horse and buggy to school. Though we were bundled against the cold, we could still experience the world around us.  The horse’s heavy and steamy breathing, the cracklings of its hooves on the icy earth, and the bite of the cold air in our face. Winter was present and experienced – even in the city.

In my lifetime, we invented jet aircraft, color television, went to the moon and back, computers, the internet and the blasted cell phone. So that we can be found and contacted miles away in the wilderness. This technology, I fear has severed our relationship with our nature, with dire consequences.

The world, however, is still a wonderful place. Let's slow down a bit, talk softly, listen more attentively. Hear the blue jays, coyotes, chipmunks, and the crows. Say hello to the sleepy snakes, lizards and the frogs. Let’s not forget that down below our buildings and vehicles, there is a planet that our very existence depends on.

While we are at it, let’s be more tolerant listening to our patients. The good Lord has given us two ears and one mouth. If we listen twice as much as we talk, we will understand them better and avoid mistreating each other. Let us wish everyone a wonderful and joyous season and thank mother nature for all the blessings bestowed on us.

When I was appointed to the NM Medical Board, it was winter and my first attendance was the December meeting.  A cold front and an associated early winter snow storm the previous night, caused havoc for my morning 65-mile drive to the state capital for the meeting.   I ashamedly arrived an hour late for my first board meeting. To my relief, I learned that two other board members making the same trip had not arrived yet either. This is significant for this article, as the member’s tardiness allowed a lengthy discussion by the members present about a complaint received by the Board on a particular practitioner – apparently well known to them.  The entire incident was memorable enough for me to still recall it today.
The particular practitioner – I will call him Dr. T. (for trouble) – became a regular at our Board meetings for the entire seven years, I served on the board.  Dr. T. was an intelligent and good medical practitioner.  The repeated complaints were not about his knowledge or practice of medicine. Mostly, they were not even from patients, rather, they were from his colleagues or co-workers on his abusive conduct.  What made this case particularly difficult for us, was his level of intellect and astute arguments he presented.  Of course, he was placed on probation multiple times, even referred for psychiatric evaluation.  But even the psychiatrists seem to have trouble identifying his behavior.  He was diagnosed with narcissistic vs bipolar vs anger management, etc. type of conduct.  Our inability to deal with him adequately, compelled us to ask the governor to appoint a psychiatrist to the board when a vacancy became available.

At one point, we were pleased to hear that he left for a position with the federal government in a neighboring state.  But since the federales did not require him to be licensed by that state, he practiced under his NM license.  And it wasn’t long before we received a complaint on him, forwarded to us by the Medical Board of our neighboring state. 
If there was one thing that I learned about such cases, was how such behaviors were common in highly intelligent, educated practitioners.  I also came to appreciate that trying to change such behaviors, seldom works. Sometimes, I feel that a real jolt or as the old saying goes a kick in their attitude works best.  There are, of course, other ways to deliver such a jar than an actual physical contact.
A young member of our family got involved with gangs in his school, and a close friend of his was killed in an altercation with the rival gang.  The incident had a profound effect on him and as his mother said, “totally messed up his mind.”  To a point that the family was worried that he might do something drastic, and asked if he could spend sometime with us and away from his toxic environment.  I agreed, but soon after his arrival realized that I had a real problem on my hands, as we were not even on the same level of communication.  He looked at me as an older person and repeatedly said: oh, you just can’t understand what is going on these days. All my efforts failed, and I was feeling helpless. Then I noticed a pamphlet I had received in the mail about a medical conference (CME) happening soon, in a resort city of a developing country in Central America.  An idea came to me and I told him that I was going to the conference and would like him to come with me, and that it would be a good break from it all. He agreed eagerly.
We flew to the capital city. From there I opted to take the train to the Resort City. I purchased a couple of coach tickets on the overnight train.  On the ride, the average citizenry got on and off throughout the night. Often carrying their children, belongings and goods of all kind. Even occasionally their livestock like chickens, goats, sheep, etc. my young relative’s eyes widened and he was totally fascinated by all he witnessed.
At the resort, I checked in at the conference which was held at a 4-star hotel on the beach, but then checked in at a hotel in town, close to the marketplace – making cost, an excuse. The vendors, arrived at five in the morning, carrying their goods for the day.  The commotion woke us and despite his objection, I made him get up and go to the market. Again, the seemingly primitive layout of the market engrossed him.  Of particular interest was the meat market. We watched with fascination as butchers, expertly cut the meat from the hanging carcasses for the customers, as they swatted the flies (no refrigeration here.)  To catch a ride to the conference, we had to walk through the meat market, which added to the effect. When we returned at the end of the day, the marketplace was dark and empty. Even the flies seemed to have gone home.
I can’t believe these people live like this; he commented once. To which I pointed out that I was glad he noticed, as 90% of the world population live thus. As a matter of fact, I said, many places would consider this a luxury.
I was especially pleased when, on the last day of the conference, he decided to remain behind at the hotel and do some souvenir shopping. Later, he couldn’t stop talking about other fascinating discoveries of his. We flew home the next day. His mother could not believe the changes she saw in him.
Now just think of the possibility of our Boards requiring our unruly practitioners to spend a couple of months practicing at a rural clinic or hospital in a Third World country.  I am willing to bet that much of such recidivism would resolve.

Reza Ghadimi

Oh Great Creator
Whose voice I hear in the wind and running waters
Whose beauty I see in flowers and the setting sun
Whose breath I feel in all living creatures
Whose warmth I sense in the heart of my children
Myself, my parents and their parents before them.

Hear my thankful prayers
Thankful for the nature that keeps me alive
Thankful for the teachings of all your prophets
Thankful for the order of your universe
Thankful for the knowledge of all your creation
That allows me to see beyond what can't be seen.

Oh Great Creator
Give me the wisdom to see my insignificant
Give me the wisdom to realize the fragility of existence
Give me the wisdom to comprehend the balance of nature
Give me the wisdom to discern right from wrong
So that I can add to your blessings and not take away from them.

Oh Great Creator
Guide me toward that which is the right path
Guide me to know my limits
Guide me to not harm all things that I can see and not see
Guide me to rise above my ignorance
And see that all mankind are my kin
That without them I am nothing
My very existence meaningless.

I pray so when I come before you
My hands and heart will be clean
And I can stand tall and without shame.

                                                                         Amen.

Reza Ghadimi
From the book: Practicing from the Heart in the Age of Technology

Elections are over, some have won
Others, lost
All the changes and nots
Affect many, but none more than us.
 
In times like these, when uncertainties abound
The nights are long, doubts and fear cry loud
Lying in bed with questions and doubt
Will we ever be homebound?
 
Sometimes under a crescent moon
The memories of youth and childhood
Nag at our soul, and ask
Whatever was our task?
 
But here, in this new land of ours
Ideas are paramount
Everyone's voice counts
No matter the reason or cost.
 
And in this world lies our faith
As it's home now, and we wait
For the call of the day that'll shout
That our votes, too, will now count!

It's Veterans Day. So we salute all veterans.
As a veteran myself, I truly appreciate their service to our country and people.  But it is saddening how some of our veterans are treated.  In the last twenty years, more than 30,000 active duty personnel and veterans have died by suicide - compared to the 7,057 killed in combat in the same 20 year period. The US is number 22 in the veteran suicide rate in the world - this is appalling and unforgivable.
 
Throughout history, many nations treated their veterans better than we do today.  Persians, Chinese and Romans, for example, had high respect for them.  Julius Caesar, for instance, gave land to about 15,000 of his veterans. And it is well known that Emperor Augustus settled more than 300,000 veterans in colonies across the empire. The honorably discharged veterans also received about 3000 to 5000 denarii's depending on their rank. Furthermore, they had certain rights and immunities. They could be a city councilor or serve in their local or regional governments. It seems that our leaders could learn a lesson from the ancients when it comes to caring for our veterans.
 
Today, many of our veterans are homeless or live below the poverty level.  We have the rich spending billions frivolously, like buying a social platform for 44 billion. Just one billion of that could help thousands of veterans out of poverty. There are VA benefits, of course, and I was one of the recipients, but it is hardly enough, these days. Here is an idea; how about interest free mortgages for every veteran who wants to buy his/her first house? How about rent-free dwellings equal to the number of years served, to help them get on their feet in civilian life. Or a guaranteed state or federal government job, or free (really free) education.

There are many ways, our government, organizations, and wealthy citizens can help our veterans further. Let's try!

It was on November 1st 1938, that the racing horse Seabiscuit, made history winning against War Admiral.

Seabiscuit was small and ugly, his legs were crooked, and he injured often. He was named "sea biscuit" a hard bread eaten by sailors, because of his undesirability. It was during the Great Depression, and people needed their spirit lifted by a winner, and Seabiscuit did not seem the one to do it. His trainer had given up on him and he was all but forgotten. Then someone saw potential in him and bought him. A new trainer and jockey also saw prospects and started training him anew. They discovered that if they let him study his opponent, he would feel superior, stare them down and win. So it was that he started winning and on November 1st 1938, a race was set just between him and a younger, attractive horse named War Admiral at Pimlico Race Tracks in Maryland to a sold-out crowd. Millions more listened on the radio. For the first half of the race, they were running evenly, then his jockey eased up on him and let him get a good look at War Admiral, and that did it. As though saying "Oh no, you don't!" he sped off and won the race by four lengths. At one-to-four odds, against him, he not only had a great win, he gave a much-needed boost to a dispirited America during those trying times.

If history has taught us anything, it is that - like Seabiscuit - winners do better if allowed to proceed on their own terms. They cannot be forced to win. Healthcare providers, too, do better without the unnecessary demands of managed care organizations, legislatures, and legal system. Not a single doctor working for an organization has ever won the Nobel Prize. The most unlikely winners in our profession have been solo practitioners serving humanity, often in most dire condition. We salute them all.