News that’s sold, swirling
Spinning and whirling, hitting hard
Rotating tentacles of opinions
Views and thoughts.

Do we see the problems only
In our sobriety?
Then relapse, thankful for our levity
Too hard to handle, let it slip away.

Most people just watch and read
Day and night as the world goes by
Sold news, to them, a passing fly
Flew into view and then away.

Wishing that they could do a bit, and
Maybe change something then, but
Maybe is a very big word
In an uncertain world, all told.

For tomorrow, MAYBEs were in yesterday
Perchance, perhaps, and possibly
They’ll return, should there be something to pursue  
Till then we’ll promise, next time maybe?

Reza Ghadimi
August 2023

One of the most contentious sentiments among people around the world is the matter of their ethnic and racial genetic purity and originality. Many races abhor the thought of genetic diversity.  Proudly claiming the purity of their race, nationality and bloodline. History is filled with stories of atrocities performed under the pretense of preserving one’s race. However, today’s science of DNA studies reveals our inherent composition to be anything but unique or pure.
While serving in the US Air Force and stationed in RAF Lakenheath, England, I had the opportunity to travel to Scotland several times. I liked flying there because the route took us over some spectacular Scottish countryside. Often, we reached the place at the end of the day and returned the next day. I habitually spent my time visiting the countryside, talking to the locals and learning their history – which I found fascinating.   
Despite the adamant pride Scots showed for their heritage, one historical fact that stayed with me was; how routinely the area was raided by the Vikings throughout the ages. During these raids, along with commodities and other goods taken, many of the Scottish women were kidnapped as well.  So, it was common knowledge that the people of the area were of the Viking/Scottish mix.  Years later, when DNA testing of the population was done, this fact was proven.
Such interactions and exchanges – forceful or not – are common around the world among many tribes and communities. Right or wrong, they contributed to our genetic diversity and cancel the notion of our race or national purity. Does this mean that our identities have been stolen or strengthen?
In medicine too, this fact has been something we have worked with, struggled and dealt with all throughout our profession and practice.  We have seen firsthand how genetic diversity results in stronger off spring and the lack of it, devastating problems. Still, it is disturbing to see that at times, our prejudices carry into our decision making and interaction with some patients. We can and should do better. Our practice must be a sanctuary for all.

On a nature documentary, awhile back, a couple of male zebras were shown fighting over their territory.  They were so engrossed in fighting each other that did not notice lions stalking them and ended up losing their lives. 
The new and ongoing military and political aggression around the world, reminds me so much of that grim and egotistic encounter.  The most dangerous and life-threatening issue in our world today, is climate change.  Yet many world leaders are ignoring this grave threat, playing the blame-game, and fighting each other for nonsensical issues.  Despite all condemnations, the wars in Eastern Europe and Middle East continue. New conflicts in Africa and the frightening call to arms in the Far East add to the uncertainties.

These hostilities add to the already intolerable refugee crisis around the world.  According to The UN Refugee Agency, by the end of 2022, 108.4 million people worldwide were forcibly displaced – up from 82.4 million at the end of 2020.  The war in Ukraine is attracting much attention, and everyone is talking about the refugees from that country.  As unfortunate and inhumane as this is, it must be remembered that the Ukrainian refugees are not replacing the other displaced people. They are joining them, exasperating an already dire situation.  
 
As the climate change overtakes island countries and low laying ocean front communities, more people will be displaced, and this time, they will have no physical home to return to.  By some estimates, more than half a billion people could lose their home with the rising seawater.  Add to that, all who will be displaced by drought, deforestation, increased fires, floods and storms, and well over a billion could get affected. That will make the job of healthcare providers ever more challenging. We must beware the lions of climate change, for they are here and gnawing at our heels!

We’ve been struggling to make sense of all that is happening in our world today, only to find ourselves spinning in the merry-go-round of excuses and blames. In this search for a rationale, one wonders how we got to this point, and realize that our information highway has sent us so far off course that we are hopelessly lost in this jungle of data. For the only thing worse than the dangers of little knowledge is the perils of too much information. And in the process of being smart, we are losing our connection with our humanity and the nature supporting us.
We are reminded of the belief and philosophy of the indigenous people around the world, whose connection to Mother Earth is essential to the very way of life. Like the Mapuche people of southern Chile and Argentina:
“When the world was born, the creator wanted us to protect it.
He put his soul inside every being so it would live forever.
Without soul, the rivers and forests would dry up,
The wind would not blow, the fire would die out,
And the earth would disappear.
The spirit of the earth lives inside all living things.
It speaks with sacred words to all living beings here.”

“I am because you are! You are because we are! A person is a person through others.”  African Ubuntu proverb.
“Quality of Ubuntu gives people resilience, enabling them to survive and emerge still human despite all efforts to dehumanize them.” Desmond Tutu
Ubuntu makes us aware of our responsibility to others, especially to the vulnerable among us. But perhaps more importantly, makes us aware of our responsibility to the world around us, our environment. The understanding that our very existence depends on the nature around us, as we are an undividable part of each other.
As, the American naturalist John Muir said: “When we try to pick out anything by itself, we find it hitched to everything else in the Universe.”
But perhaps it was best said by Johann Christoph Friedrich von Schiller (1788-1805), the German physician, philosopher and poet, in Ode to Freedom – which Ludwig Van Beethoven later used in his 9th symphony; Ode to Joy;
How the magical power of the creator, binds and unites all that man’s selfish practices has divided. And how all mankind can become brothers again and enjoy nature’s bounty together.
Nature, a selfless giver of her goodness, to all her children, deserving or not. As the light of her roaming sun shines on all, giving her kiss and blessing to us all.
Many have tried reminding us of these lessons of nature to no avail.  But as Ubuntu teaches us, indigenous knowledge of the people of the world is valuable and for the future to be tolerable, we must not forget our kinship and our bind to others and the surrounding nature.
Nowhere is this reminder, more applicable than in the practice of medicine.  For despite all our western education, we can find our knowledge inferior to that of the elders of our world.

Life is an accumulation of memories. Memories of experiences amassed throughout years of work and play. Some, life changing and profound, others, whimsical and fanciful. All said and done, though, often it is the small and minor incidents in life that leave a lasting impression.

Lake Powell is a large man-made lake along the Colorado River, in the hot dry deserts of Southern Utah and Northern Arizona. Rainfall is rare and far between. A few years ago, we rented a houseboat and spent a week exploring and sightseeing the many canyons and gorges, filled with the water of the lake and accessible only by boat. It was late summer and we were expecting a hot trip down the lake. However, we were pleasantly surprised when a rare summer storm gave us cloud cover and a much welcoming rain. The many magnificent waterfalls fed by the downpour, over the precipitous canyon walls, was a treat.  The boisterous waters of the lake added to the memories of the day. We have made many trips down that lake in the years, since, yet that summer trip is the one with a lasting impression.

On another occasion, while camping on the shores of the Gulf of California, by the town of Topolobampo, Mexico, during the Christmas Holidays, we were surprised at sunrise on Christmas Day, by a Mexican fishing boat, who precariously approached us on the shallow waters and made us a generous gift of freshly caught shrimp.
"Feliz Navidad," they shouted with a smile. We ate fresh shrimp for breakfast, lunch and dinner for the rest of our stay there.

And a colleague working on an Indian Reservation tells the story of a time, when his patient was an adorable boy of four who was there for a checkup. For the exam, he needed the child to disrobe, which he did but refused to take his shoes off. His mother talked to him in their native tongue but to no avail. She finally informed my colleague that there was a hole in one of his socks and he was embarrassed to show it. My colleague says; I laughed heartily and sheepishly took my own shoe off and showed him a hole in my sock. The child beamed gloriously, and we became good friends to the delight of his mother.

Here is to those junctures of life. We find them in the narrow crevasses and detours, often experienced in places far from annoying crowds and busy practices. Look for them and build lasting Little Great Memories.

Practicing From the Heart in the Age of Technology tells of many occasions where the humane interactions have left undeniable memories, making the practice of medicine joyful and magical.

We’re on the far side of school
A new life awaiting and soon
All efforts to get paid
Song of the future serenade.
 
A dream has been fulfilled
And a perfect life to build
Yet outstretched hands await
To steal the future at the gate.
 
Bundles of money to entice
And show a false paradise
Of luxury and wealth
But a real façade is dealt.
 
For one morning, all is clear
The hoped for future has not appeared
As it was stolen at the gate
All is not lost though, wait.
 
There is a rich world that is yours
Past the luring hands at the doors
To show the true magic of
What can be done with skill and love.
 
Just look past the ruse
To see the real needs to choose
The hardest job you’ll love
With rewards far and above
A shining future to speak of.

Reza Ghadimi

Thank you, Dr. Waters, and The DO (Journal of the American Osteopathic Association), for reviewing this book.

Dr. Waters’ observation of the core message of this book is a testament to its importance, especially for our students.
You can read the full review in this week’s The DO.  As Dr. Waters thoughtfully puts it:
“…(Ghadimi) provides dozens of heartfelt reflections on what is central to everything we do – the simple act of caring for another person.
I was struck by the unique voice of each one (vignette, essay) even though the subjects are many and varied. …They’re all personal observations, steeped in the experience of a long career in patient care.”
             (Daniel J. Waters, DO, MA, FACOS-D, FACS – The DO)

This, along with other reviews by leaders of our profession, reveals the need to address the increasing disparities in patient care in our country and around the world. I appreciate their support and hope that all in healthcare read this book.
Reza Ghadimi
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Here is the full text of Dr. Waters' review:
(Re-Printed with permission from 'The DO')

“Practicing From the Heart (In the Age of Technology),” Reza Ghadimi (Foreword by Humayun (Hank) Chaudhry, DO, MACP), ThPulse/PAPulse, LLC (2021) 264pp.
By Daniel J. Waters, DO, MA

This enjoyable, self-published volume arrived in the mail on the very same day I first saw something about ChatGPT®. It took me awhile to read the collection of essays and reminisces. By the time I was done, Bard® (Google) had arrived and, as of this writing, there are a half dozen or so more on the way. As a New Jersey native, I’m a diehard fan of Bruce Springsteen, but we might have to tweak one of his lyrics to, “Is that me, baby, or just some brilliant A.I.?”
Now, I don’t think a chatbot, even on a good day, could do what Ghadimi has done. He has organized his musings (vignettes might be a better word) in 12 chapters headed by the calendar months, although the stories told are not in chronological order. He’s been a practicing physician assistant for decades, and even though he’s not a physician, his close professional association to physicians provides a unique observational perspective on where we are and, just maybe, where we’re heading. We’re all prone to parallax, and so a take from another angle can be illuminating.
Ghadimi does not rail against technology or progress, instead he readily admits to using one of the first home computers (from Radio Shack!) to write. He provides dozens of heartfelt reflections on what is central to everything we do — the simple act of caring for another person.Some of the stories are less than a page, others are much longer. I was struck by the unique voice of each one even though the subjects are many and varied. This would be a good book to keep in your office and maybe read a bit between cases or patients.
Skip around the story selections if you’d like — short or long, each is a stand-alone piece. They’re all personal observations, steeped in the experience of a long career in patient care. Perhaps, in the end, what will separate us from purely programmable authors is our ability to contextualize. I certainly hope so.

“I am going to venture that the man who sat on the ground in his tipi meditating on life and its meaning, accepting the kinship of all creatures, and acknowledging unity with the universe of things was infusing into his being the true essence of civilization.”
Luther Standing Bear (1868? - 1939)
Oglala Sioux chief

I find it fascinating that such enlightenment filled the mind of many scholars, philosophers, thinkers and intellectuals throughout history. But I don’t think that any of them envisioned that all that thinking and philosophizing would bring us to the world of today.  Not Aristotle, nor Confucius, Epicurus, Lao-Tzu, Socrates, or the Indian in his tipi, for that matter, ever foresaw that the 21st century man will be fighting wars, poverty, famine, inequality and suffering from diseases, epidemics, and …

How did we come to this?  Was it an instance in history that set us astray? Or was it that we really never did become civilized? Despite all the scientific and technological advances, we allow our ego, self-righteousness, prejudices, hypocrisy, and unrealistic expectations control our very existence. Maybe it’s time we retreat back into the tipi and meditate some more. For we have forgotten the kinship of all creatures and the unity with the universe of things. Or perhaps we never did learn it to begin with.

As music is a universal healer
Of all that ails us, our troublers
Of all that weighs down our spirit
And makes the heart heavy with pain.
 
No matter what the affliction
Or what wind blows it in
All can get stopped by a note
Played on the strings of the soul
Or drums of the heart.
 
Though the pain of the deprived
And the tears of a hungry child
Can shout out with anger
The melody of a tune
Can shine a light and lift the spirit.
 
And if one thing is sure in life
Is that the sky is darkest before dawn
Through all the cruelty and despair, shine
Comes from hope, and hope always rises
As the crescendo of a song.
 
And all that trouble can get sung away.
So, bring it on, oh whisperers of melodies and hope,
Make it sing. Make it sing for us all.

Reza Ghadimi
March 2023