Dr Patrick Hanaway, Walking Between the Worlds

Dr. Patrick Hanaway is a board-certified family physician and leading role player in the evolution and expansion of Integrative and Functional Medicine across the globe. He is also an initiated Mara’akame (indigenous healer) in the tradition of the Wixarika people of the Sierra Madres in Mexico, holding community fires, leading ritual ceremonies and offering traditional healing sessions. A modern-day shamanic healer who walks between the worlds and traverses the different healing paradigms with incredible skill, humility, compassion and grace. 

In this episode of Awakening Doctor, Patrick shares his personal story of overcoming stage 4 laryngeal cancer and reveals the many different ways in which this experience transformed his relationship to nature, medicine, health and healing.

Whether you’re a doctor in search of meaning, a patient grappling with a challenging diagnosis, or simply curious about integral perspectives on health and wellness, join us for an inspiring and thought-provoking conversation with an eminent leader and educator in the medical field and discover the power of nature, community and holism in medicine to heal.

Chapters

• 0:00 Healing and Growing
• 9:59 Transformation in Healing Practice
• 24:06 Cancer Diagnosis Journey
• 37:44 The Power of Sitting in Circle
• 49:52 Healing and Connection in Medicine
• 56:38 Buddhism, Cancer, and Healing
• 1:03:42 The Value of Self-Compassion

Transcript

Patrick Hanaway Guest 00:00

Cancer is the opportunity for learning and growth. Breathe into it, step into it, move into it. What do I have to learn in this process? Engaging life with that openness and curiosity and wonder, is what is, for me, the opportunities that we have to become more whole. To heal. And the world needs more of that. 

Maria Christodoulou Host 00:21

I guess that ties in also in functional medicine, to the difference between healing and curing. There's this idea that if you make the right decision then everything will work out well and if you make the wrong decision then things will go badly. And if you have the right treatment then you'll get better and if you have the wrong treatment you won't get better. But I think for people to understand that healing doesn't always include curing and that cure… you can go into remission, you can be cured of your cancer, but that doesn't necessarily mean you've become a more whole person. 

Patrick Hanaway Guest 00:50

Well stated. I agree with you and the focus for me is on healing. 

Maria Christodoulou Host 00:55

And that may or may not include cure.

 Patrick Hanaway Guest

 Exactly.

 Maria Christodoulou Host

01:00

Welcome. I'm Dr Maria Christodoulou, and this is the Awakening Doctor podcast. A space where we discover the personal stories of those who work in the medical and health professions. Join me as I explore the hopes, the fears, the aspirations and the real-life challenges of those who carry the title, responsibility and privilege of being a doctor. 

 My guest today is Dr Patrick Hanaway, a man who has dedicated his life to transforming medical practice through innovative education, research and clinical care. He's a board-certified Family Physician based in Asheville, North Carolina, and has been one of the key, leading role players in the evolution and expansion of integrative and functional medicine across the globe. Patrick has also been initiated as a Mara’akame, or Indigenous healer, by the Huichol people of the Sierra Madres in Mexico, and so he holds community fires, leads ritual ceremonies and offers traditional healing sessions. I've known Patrick for maybe 15 or 20 years, and each encounter that we've had has been transformative in some way or another. So, I'm really looking forward to this conversation and just to say, welcome, Patrick, and thank you for joining us today. 

Patrick Hanaway Guest 02:15

Thank you so much, Maria. It's my pleasure to be here to be able to explore the world of healing with you. 

Maria Christodoulou Host 02:22

I want to mention that also in the room with us is Amy Kaye. Amy is a writer and narrative coach who helps people tell their stories, and the producer and editor of the Awakening Doctor podcast. So welcome, Amy. So, Patrick, where do we start? Where do we start to tell the story of you? 

Patrick Hanaway Guest 02:39

What do you want to know? I think the place to start is actually going to medical school and being a doctor and thinking that I was going to learn about healing. I don't know why I thought that, but that's what it would be about. Thus my journey, and in that journey, it's actually necessary for your listeners right now to know that we all have two lives to live. The second one begins when we realize we only have one, and so for that I would jump into my journey with stage 4 cancer four and a half years ago, which really opened my eyes to the world and opened my heart to healing and a deeper understanding of what that is. How about, if we start there? 

Maria Christodoulou Host 03:23

Thank you for bringing that up so early in the conversation. 

Patrick Hanaway Guest 03:26

I've worked in the healing domains as a medical doctor and as a healer for a long time and in that. I feel like I have been, for the most part, blind to the depth of being versus doing. I’ve lived in a Western paradigm of fixing and taking care rather than giving care, and that umm… I didn't think I would start crying this early in the conversation. What I began to recognize was that a lot of my desire to be in the field of health and caring had to do with me feeling okay about myself rather than really deeply caring for people. Now, it's not that I did bad things. It's just that my motivation was always about, I have to help people so I can feel good about myself. What I began to realize, the cancer... I'll just put a little colour on that journey for a moment. 

04:28

A day before the US Thanksgiving in 2018, I was diagnosed with stage four laryngeal cancer. I was like, oh, I could die from this, I'm okay with moving through whatever happens. And my eldest son… We told our son's on Thanksgiving Day. We being my wife, Lisa, who you know, who's also a wonderful doctor and healer, and he said, well, you say that as though you don't care to live. He said, I'll help you as long as you - and be with you all along the way - as long as you actually want to live and go forward. If you don't, then you're on your own. And it kind of hit me in the face, because I was like, oh, I'm going to just be evolved with the whole thing and living into… healing into living and dying. Which is possible. But do you want to live? I had to look at that. It was very fast and very clear, oh, I want to live. 

05:19

Then, in going through that, as the timing would work out, I was actually fasting and preparing to go on pilgrimage to the sacred desert with a group of people, and I was several weeks into fasting and preparing for that journey, and I said to the doctors, is there a problem if I go? I want to go to the desert. I want to follow through on my obligation. Oh yeah, that won't make any difference. No, we'll just do the testing. Well, actually, it's the physics to determine the radiation therapy right after that, anyways, so there's a gap, go for it. And I went and I did that. 

05:54

And what occurred for me in that pilgrimage and that awareness was that I needed to ask for help from my friends and my family and from people, and that actually gave them an opportunity to care for me. I'm always like, I got it, I got this, I can do it. Oh, I'm actually vulnerable and I need help. And asking for help allowed me to begin to receive not only from friends and family an outpouring, but also helped me to begin to really feel all the guides and spirits and protectors, the beings that are present with us in this world, in a way that wasn't conceptual. It was a felt experience. 

06:34

There was so much more there to help me in this healing journey than I could ever imagine and I'd seen pictures and I'd read things and it's like, oh, that's nice, that's quaint, that's cute, but it's happening. And that doesn't mean that the journey was an easy one. There were times that I had to refocus and say, yeah, I do want to live. My oncology doctors were like, you're not moving through this like other people do. You're not losing weight and you're not having problems. You're not reacting to the... so it was chemotherapy, radiation therapy. I had a feeding tube. You know, I was able to move through it, thank goodness, in a way that was not draconian. 

Maria Christodoulou Host 07:15

Tell me about the emotion that it brings up for you all these years later. You've been in remission now for some time. What is it about that story that makes you cry? 

Patrick Hanaway Guest 07:25

I think there's several aspects of it. I think one is just recognizing the preciousness of life. I feel so blessed to have gone through this and being able to feel that. There's also a connection to the vulnerability of that ephemeral nature. It can change in any moment. I've said to friends and patients, our lives, they actually tend to change on a dime, in a moment, a phone call, an instant. Things that fundamentally change the trajectory of our lives and we have no idea.

 What's unfolded for me is that in this uncertainty of what's happening in the world, that's actually where the aliveness is, that's where the dance and the interplay of everything is. Our culture becomes so insulated and isolated from that uncertainty. We try to protect ourselves from that uncertainty. It’s the very nature of life itself. Indigenous peoples seem to have a much greater awareness of this because they live closer to the edge and that's where their life is. But that's where the aliveness is. That's where the gods are, that's where the request for help, that's where the listening and connecting to the plants and the animals and other beings that are present there, that's where that resides. The tears also have to do with a sadness. 

08:50

Wow, I've lived 60 years of my life unaware of that. Thinking, first of all, that it's about doing. Within my career, I've been very praised, valued, appreciated for all of that doing. Yet, that's not where my heart essence is. When I tell the story, I drop into that heart essence. I feel like a different person. I feel like, well, this is who I really am. But I've been putting on a mask, or a whole series of masks, to be able to look good in the world and have people say good things about me. But that's not me. That's a story of me. That's a narrative rather than the essence. 

Maria Christodoulou Host 09:35

So what is the essence of you? 

Patrick Hanaway Guest09:37

It's about healing. 

09:38

It's about being able to listen and work on my own journey to become whole, and to listen and help people on their journey to become whole, and having the courage to be able to state directly and clearly where I feel that healing journey is for individuals as I work as a healer. 

09:59

And I say courage because I've been afraid to say that. I observe something and it's like, oh, I'm not going to go there. Oh, that person doesn't want to… they're not asking me for that. But now I'm more likely to do that and my practice now is mostly working with people sitting around the fire. I don't do a whole lot. I have current patients and I'll see some new cancer patients, but that's really where my primary focus is, in my healing work. And it's not so much on the functional medicine that I've been given, but it was an appreciation for it. I still teach it, but I'm teaching it from a perspective of wanting people to connect to the mental, emotional, spiritual aspects of the centre of, who is this person, what is their meaning and purpose, how to help them, and how is the process of whatever symptoms of imbalance are going on, a representation of them not connecting to their true meaning and purpose in the world?

Maria Christodoulou Host 10:59

So you spoke about the doing versus being and the career trajectory that has one being celebrated for all sorts of external ‘doing’ things, and then you speak about the essence being expressed through the healing work that you do now. What is different in the way you were approaching patients before and the way you're approaching them now? 

Patrick Hanaway Guest 11:20

It really comes down to listening to fix them because they're broken, versus listening to support them on their journey and being able to not listen to their symptoms as a function of being out of balance and broken, but listening to the symptoms as a cry for, how do I move back into my own meaning and purpose and expression in the world? And there, I am not a fixer, I'm a guide who's walking with them along the path and offering my perspective in what will be of benefit. So I'm actually listening, not to my knowledge. I'm listening to the world around me because the world is talking. And I'm listening to the clouds and listening to the fire, listening to the animals that come in. It's stunning at times. I do my Indigenous healing work that I learned from the Wirriarika people. The Wirriarika is what they call themselves. Huichol is what the Spanish call them in the Sierra Madres in Mexico. 

12:18

So I'm out of the fire and I have a series of tools that I've gone on pilgrimage and made offerings and received blessings for and they help me to listen. I prepare the fire and I go in and I get my things and I come back out and… we have this beautiful council house that's eight-sided with windows around it. They can all open, but in this case it was in the winter time and all the doors were closed, except the one that I walked in and out of. So I walk in and the fire is going and I sit down and I begin to say my prayers and I hear this noise and I turn around and about 10 feet from me is a pileated woodpecker that's about 15 inches tall. So what is that? About 40 centimetres. And it's got a beak. These are the ones, in the US, people say, oh, Woody Woodpecker. Beautiful bird, but big and strong. Somehow it's flown inside and it's trying to get out. I’m looking at it, and I have to go about three feet from it and open a door to try to help it get out. So I go and I move and I open the door and it's not moving. It's still trying to get out where it was, through the glass, and so then I walk around outside, right up in front of it, and kind of startle it, and it startles and it flies away and it flies out and it lands on a branch and is looking at me. 

13:43

What is the energy of the Cardinal [woodpecker]? Well, the Cardinal is, in relationship to the Tsalagi people where I live, the Cherokee people, it is about being able to find a home in the place of a dead tree. Of being able to bring forth, helping support, either family, and growing in that way of making a home of what life gives you, and being able to do that in a strong and majestic way. It's a very strong protector. So the client comes in to sit down and that's exactly the story that they're sharing with me and exactly the medicine that they need, and the medicine is right there. Those things, they're not unrelated to each other. In fact, they're intimately related to each other. 

14:29

Being able to have that awareness, what is the wisdom that is being shared with me all the time? And so my focus is on listening to the world and the client, the person I'm with, is a part of the world. The world wants us to be there. Needs us to be there. We're not separate. I've flippantly said Mother Earth will be fine. I don't know if the humans are going to make it, but Mother Earth will make it. In fact, the world and nature needs us to be in the dynamic relationship with what's going on as it changes and grows. I think I had some peripheral idea of acceptance of these concepts for some period of time, but now they're not concepts. It's just how the world moves, and is, and sometimes the tears are sadness that it's taken me this long to realize that. 

Maria Christodoulou Host 15:21

I hear you. I will admit to feeling quite inspired when I listen to you and my heart feels really full because it's the first time I'm hearing another colleague validate my own sense of what it is to sit with a patient, that it's really not about me having the answers or directing the process, but really just listening and trusting what's showing up in the space around both of us, and that I don't have to direct anything or fix anything or make anything happen. And I remember reading something.. I think it was Janet Quinn, who is a nurse, who wrote about the difference between facilitating versus consulting, and that in consulting, failure is that we don't meet the outcome we wanted to meet, whereas in facilitation, failure is giving up on the process, not just allowing the process to unfold and to guide and direct the journey and to not make any judgment about what a good or bad outcome is. 

Patrick Hanaway Guest 16:19

Yeah, and that's difficult. To not have some expectation of what it looks like. 

Maria Christodoulou Host 16:26

You spoke about going to medical school and naively thinking you were going to learn about healing. If we go right back, what do you think took you to medical school? Why medicine? 

Patrick Hanaway Guest 16:37

I'm that little kid who... My father was a lawyer, my mother was a nurse and I know from the time I was five years old, I said I want to be a doctor. I had a little microscope and the visible man dissection thing and that's what I said I want to do. I don't know why I said that. I had a few health ear infections and tubes and stuff like that when I was little, but I've never dissected how much it's internally part of what I knew versus externally the mother and father. What's the integration? I'm the oldest child. How do I move beyond where they are in our cultural way? Curiously, my mother taught nursing for 30 years, my sister's a nurse, my other brother's a doctor, a transplant surgeon, so it was almost like the expectation. My father was a judge and I remember going with him to work at 10 or 12 and it’s like, who cares about this? It seems arbitrary and capricious. And so it just seemed like it was what I always wanted and expected to do. Of course, I was very connected into the science aspect of it. I was enthralled by the way in which we described science and biology and chemistry and something shifted for me - or it was always there - when I went to medical school I was interested in nutrition. I was interested in mind-body therapies. I was interested in, how do people move along this. I was not that interested in the surgical kinds of interventions. I could do them. I learned them. In my journey through my residency training, where I would get a lot of exposure to obstetrics and different things and I put myself in being able to deal with trauma, being able to deal with alcohol abuse and things of that nature. 

18:28

I moved to the Bering Sea and worked with my wife. We had 10 doctors. We covered an area that was as big as South Africa, as big as the state of Oregon. About 20,000 people in 50 villages. But it was very, very difficult living on the Bering Sea and I learned so much, and I learned from those people. 

18:48

I needed to feel like I could be a cowboy doctor out in the bush, figuring it out, so that I felt good enough about myself that I wasn't running away from being a Western doctor in order to be able to help people with body, mind and spirit and the emergence of what we call functional medicine. 

19:06

So I did that, but it was more like I had to justify that I wasn't doing it because I wasn't good enough as a doctor in the Western way. So that was kind of my journey. To be able to get to a place of, oh okay, I can do that. I can take care of an ectopic pregnancy in the bush and I can deal with eclampsia, You know, you don’t think eclampsia happens, or I can deal with DTs and a 28-year-old woman dying from alcoholism, and dealing with death. I saw a lot of death and dying. I knew that, when I left there, oh, life is transient, so I need to bring that into my being and into my relationships so that… no expectation that, I'll see you next year, see you, bye mom and dad. Anything can happen at any point in time. That's what we see. So how do we use the opportunities that we have to support and promote transformation, healing and growth? That's what I'm interested in. 

Maria Christodoulou Host 20:02

Part of you that felt that you had to prove that you could be a cowboy doctor and you could treat eclampsia and you could deliver babies in the bush. What do you think that's about? Where does that come from? 

Patrick Hanaway Guest 20:13

I think it's a cultural thing. Are you good enough, are you able to succeed? For me, I did reasonably well in high school and in college and I got to medical school - I went to a very prestigious medical school, Washington University - and it was the first time that I wasn't able to excel. I wasn't able to be at the top of my class and I put everything into it to prove it and I couldn't. It just didn't happen. Oh, okay, well, maybe there's other things to learn. And so in medical school I decided, okay, I'm just going to be average If I just get to the top of the curve, I don't have to put in as much time and I'll still be a doctor at the end of it. I mean, the question was, do you really want to be a doctor? And as I wrestled with that, I realized that I would be able to do more in the world if I had these two letters behind my name than if I didn't, and it’s proven to be the case. I'm going to jump forward in a moment to the irony of it, but it was… 

21:11

I began to learn acupuncture with an old Chinese master. I began to learn hands-on healing and chiropractic and guided imagery and nutrition, and I just incorporated those into what I learned. I still have to be accepted and I still have to do well in the dominant paradigm of medical school. I was constantly paying attention to what do I have to do to be able to meet their criteria of success. That criteria of success was something that was… I don't want to be an outlier and I don't want to be someone... I mean, there's some brilliant doctors out there and, interestingly enough, my three favourite doctors, who were teachers, they’re all South African. One who was the father of a friend of mine who was my mentor when I was in high school and college and I would go and be with him. And there were doctors who had learned so much of how to use their listening skills and their stethoscope and their awareness in the bush to be able to help people. You don't need an MRI to figure this out, you just need to listen. I wanted to exemplify that, to be able to bring that forward.

22:18

Jump forward, what was interesting is I was most interested in medical school, in clinical prevention. How do we demonstrate that actually caring for people and listening and using simple tools of lifestyle actually leads to greater health and well-being at a lower cost. That's what I was interested in. Spent time working in the nutrition division at the Centers for Disease Control as part of medical school and was involved in health policy conversations to be able to do that, and thought I might go into health policy, but I found that caring for people really touched my heart. It is curious that that was in the early mid-80s that I was in medical school. So then, 30 years later, to be working at the Cleveland Clinic and in the Center for Functional Medicine and doing studies around taking time to be with people and taking a systems-based approach of functional medicine and focusing on nutrition and lifestyle and looking at patient outcomes and being able to demonstrate, published in JAMA and the British Medical Journal, that they do better than the standard of care and even the standard of care comparing it to the Cleveland Clinic. We're comparing it to a pretty high standard and we do better than that. 

23:26

And so I was able to, 30 years later, take that and be able to do the research that I wanted to do when I was in medical school. The arc of life and the blessings that I've had... that to me, probably in my MD/ Western medical career, that's the capstone of my work. Shortly after doing that… In fact, we were in the publication process when I developed cancer, then becomes the shift. Okay, now it's time to enter what some might call the third act of your life. Where are you going? So that's where I sit right now. But I still work to educate doctors because I think it's an important voice to hear. Trying to find the best way to be able to do that. 

Maria Christodoulou Host 24:06

What do you think distinguishes someone like yourself who goes to medical school and is aware very early on that something is missing? You already had an interest in nutrition. You were interested in body-mind medicine. You began studying acupuncture. I've spoken to colleagues who are either going to dismiss those things as irrelevant and nonsensical or to colleagues who keep it in the closet that they are interested in those things and find quiet ways to bring them into their own personal lives and often don't incorporate them into their practice. What do you think made it possible for you to really pursue that path? 

Patrick Hanaway Guest 24:43

I don't know. I see there but for the grace of God. I feel like there was some calling, some knowing inside me. But I also feel like the majority of people who are going into medical school and training have these beliefs, have these views, have a focus on compassion. Take a relatively intelligent population that could go and become software engineers or business people and make a bunch of money and do things, but they're not choosing that. They're choosing this path. That's a more difficult path because they care and it's the socialization phenomena of medicine that causes a shift to occur. I thought it was about compassionately listening to people and caring, but I'm seeing that it's actually about doing things. That is what medicine is about. So that's what I'm going to do. And so they become relatively indoctrinated. One friend was talking to me recently. It's like a shamanic initiation. Take you through it. Sleepless nights and the stress, push, and changing your view of your mind, and it's done in a very deliberate manner to be able to get people to connect to that way of doing things. There was something inside me that said that's true AND that's true, I don't have to push against it. There was a point where, I'm going to leave medical school. I can't do this. And yet I felt like, oh no, there's actually probably more opportunity. I can make it through this. 

26:09

The researcher I worked with before I went to medical school. She said I don't think medical school is a good idea for you. You're too nice and too open to go to medical school. And I laughed. And I have friendships, they're still friends, but their focus is on the dominant way of doing ophthalmology or surgery and they're really good at it. And when I need someone in that domain, I trust them and I know that they'll do a great job. 

26:37

But the one thing that always is curious to me is that I find so many people kind of in the closet. Not willing to share their belief systems. And then they come to me and they say would you help me with this, or would you help my mother with this? I'm having difficulty with this patient. I don't know how to be with them in their cancer, but it seems like what they need is what you have to offer. Or when they say, would you help me with my family with some nutritional support, or what would you suggest for helping to decrease the effects of COVID or long COVID? They're willing to listen, they're really interested. 

27:13

And I say, what about your patients? I would never experiment on my patients with something like this. And I laugh and sometimes I say, but you'll experiment on your family. You mean you care about your patients more than you care about your family. No, no, no. Well, why, why? What's the diff.. like, if it's good enough for you and your family, isn't it good enough for your patients? I don't know enough about that. That's a curious way of looking at the world, and now I'm asking those questions more. Curiosity. It’s the coin of working with human beings, and that the coin of working with the world is just to be in wonder and awe. 

27:49

Those are the things that help me in this journey. 

Maria Christodoulou Host 27:52

I love that. So you're sitting here thinking about how you've walked this path. You got cancer four and a half years ago, so you're in your mid 50s. You’ve spent your entire career investigating and exploring holistic medical things integrative medicine, functional medicine, root cause medicine. You've worked with people who are dying. You have extensive experience and then you find a nodule in your throat. What goes through your mind when you discover this? 

Patrick Hanaway Guest 28:23

I had a long relationship with indigenous elders, so there was an elder, a couple actually, teaching at our place and they were visiting. Their teachings were over a weekend and it was Thursday night. I was in bed and I had just kind of done something in my face and neck and also I'm like, oh, there's something right there, and I'm poking on it and it's like okay, well, this is a two-by-two centimetre hard nodule in my neck that's non-painful and I don't have any upper respiratory infection going on. This is not good. But I didn't want to make it be about me and so the next day I called the ENT doctor, friend of mine, and got scheduled to come in on Monday. They were leaving Monday morning and I didn't say anything to anybody. 

Maria Christodoulou Host 29:15

And you have two indigenous healers in your home and you don't say anything to anybody. 

Patrick Hanaway Guest 29:22

Right, because I was scared. The story was, I don't want to create some drama around me in the whole thing. We went through the weekend and their teachings and it was beautiful and people were connecting to it, and then they left, and Sunday night I told my wife. I had her put her hand on me and I said, I'm going to see Ted tomorrow morning to have it biopsied. She was like, okay, I'll be with you. 

29:49

Ted was fairly certain it was cancerous from the location, but we didn't know what it was and ended up getting… it was an MRI, that day. What's the source of this? This is clearly a lymph node, so it's a secondary. What's the primary? Got the MRI and then got a PET scan. Literally all in two days. In the United States, Thanksgiving's on a Thursday, it's usually a quiet week. So Wednesday I had a PET scan that showed it disseminated. All pretty quick. Sometimes when we're doctors we get special treatment and it happened very quickly. 

30:26

What was going through my mind? It was that... a dear friend, Lee Lipsenthal. Lee was a doctor, cardiologist, worked with Dean Ornish, developed the whole dietary program. Like me, was President of the American Board of Integrative Holistic Medicine. I think he was there just before me. We were very close. He developed esophageal cancer in his mid-fifties. He moved to a place of acceptance pretty immediately. 

30:51

His wife would say, he got the diagnosis at five o'clock and by eight o'clock - by the time she got home - he was already at like Kubler-Ross’s phase of acceptance. I felt like he didn't fight for his life. He was accepting of this as the trajectory and that's what happened for me and I fought him on it. Why do you not want to live?

When I had that diagnosis it was the first time that I understood why he went there and it was, as I said, more of the confrontation with my eldest son that kind of said, okay, that's one arc. But, I was scared. I was really scared, and I honestly feel like the phrase ‘stage four’... If it was stage three or something else, it'd be like, I got this, but stage four it's like, oh no, you don't have it. You actually have to ask for help and bring everything and I used a series of different tools, from acupuncture and shamanic healing to radiation and chemotherapy to ketogenic tube feeds. A lot of different things going on there. 

Maria Christodoulou Host 31:58

Did I hear correctly that you were liquidizing or purifying sardines and putting them down your tube? 

Patrick Hanaway Guest 32:05

Yeah, exactly. It's hard to get enough fat in a tube feed to actually be able to stay in ketosis. I know I was looking at a lot of stuff at that point in time. I was reading about ketosis as a useful thing, but it was only later, when I was doing research to kind of talk about it, that I realized oh, the specific cancer of head and neck cancers that are radiation sensitive, are particularly susceptible to a ketogenic diet. It was like, I chose the right thing for that answer. I didn't even know that at the time. I was acting more intuitively and impulsively and now I can talk about ketosis and cancer and I can talk about which cancers are more susceptible to ketosis and which ones are not. It's not every cancer. It's a very clear process that we can dissect and understand and talk about apoptosis and what's going on, and it's useful for some people. But in the end, it was really more of the work of family and others to help me in that healing process. I also want to just talk about nature, because to me, the asking for help and having that connection… the ketosis, and then at the depths of treatment, not being sure if I wanted to live anymore. It’s hard. Was feeling like I needed to be outside in the natural world. I didn't have enough energy to walk a couple hundred yards. Walk a hundred yards, go into a little spring, lay in the water. Just to be outside. It’d be raining out. I have to be outside. 

33:46

What I noticed curiously was that… I've monitored my heart rate variability for probably now almost eight years, and at that point in time, all of a sudden, I observed my heart rate variability started going up and up. For your listeners, we all have a normal beat to beat variation. When we're young we have a lot of spaciousness between our heartbeats and so there's a lot of variation, up to a tenth of a second of variation between each heartbeat. But as we get older and as we become more stressed, that number goes from a hundred milliseconds down to 20 or 10 milliseconds, 20 or 10% of the variation, which is an indication of our sympathetic overdrive, that imbalance between parasympathetic and sympathetic tone. My heart rate variability, which had been kind of in the 20s, not great, but was down around 10. 

34:37

And when I started going out in nature, it started going up to 40, regularly. And I'm like, oh, this is actually part of the healing process and how important connecting to the natural world is. It's not like, going for a walk, I'm going to get my steps in, I'm going to reach cardiac 70% of heart rate max… None of that. It was just about being and listening and playing, and that's what made the difference. 

35:07

And so, to me, I credit those aspects of family and connection, of diet, of the shamanic healing, the awareness of that, and being in nature, as being the most potent parts of my healing process. But, that said, I still wouldn't do it again without chemotherapy, radiation and a feeding tube. Those were part of it as well, and that, to me, is the beauty of holism. Smuts talked about holism in the 20s I think it was, if I remember correctly. Well, holism is everything. How do we bring it all in? And that's where I feel privileged to, in this time and in our culture, to be a doctor who has a holistic view. Let's bring all these things in and now shining a greater light on that aspect of connecting to the heart and healing. 

Maria Christodoulou Host 35:55

Was there anything about having cancer that surprised you? 

Patrick HanawayGuest35:59

Besides having cancer? 

Maria Christodoulou Host 36:02

Well, did it surprise you? 

Patrick Hanaway Guest 36:04

It did, and yet it made perfect sense. I had, for at least 20 years, talked with my patients about, well cancer’s a transformation. Are you going to listen to it? And boom, okay, I got it. Perfect. The antidote for my growth out of control. The world actually wants me to succeed. The natural world. They're supportive of that process of healing and wholeness. The depth of it… the concept of it didn't surprise me, but the depth of it really surprised me. And continues to. 

Maria Christodoulou Host 36:34

That's the wonder and the awe, right?

 Patrick Hanaway Guest

Yup.

 Maria Christodoulou Host 36:36

 I'm thinking back to the time I spent with you in North Carolina, which would have been at the end of 2013. We had just had the retreat with the IFM core team, and one of the themes we discussed in that time together was practitioner self-care and how we bring that to functional medicine and what we model for our patients and for our colleagues. And two things stand out for me about that time. The one was a conversation you and I had about the fact that you needed to slow down and that you maybe needed a coach and that you were pushing yourself to the limits. So you knew that already back then in 2013. But the thing that I carry in my heart from that time was having the privilege of attending one of the fire rituals that you hosted that week and having the privilege of sitting in circle with the community that lives around you there in North Carolina and listening to people share with each other about their challenges and their joys and getting support from community. And I remember, after everyone had left, it was just you and I and we were sitting around the fire and you said to me, because I was in a bad place. I had just quit my position as the program director of integrative medicine and I wasn't sure that the proposal I’d put in for coaching at the faculty would be accepted. Really burnt out. And you turned to me and you said, you need a teacher. And I said, I don't do teachers, I don't want gurus, I have to do this my own way. And we came back inside and I found an email on my computer from the Awakening Women Institute. You might remember. I read the email. You were standing right there in the kitchen. 

38:19

I signed up for that retreat, found myself in Corfu a few months later for a four-week retreat in this circle of women that has been hugely transformative in my life. It really… it changed everything and challenged my thinking about what a teacher is. Because when you said you need a teacher, I had assumed you were talking about a guru. And the girl, the woman in me that was raised in a very patriarchal culture really pushes back against the idea of a guru. Typically in my minds image, a white male or an Indian male with a white robe. And I discovered that sitting in circle was my teacher. Sitting in circle with other women and having the space held in a particular way, was my teacher, and so I think for me it was such a profound insight into the power of sitting in community with the intention to just be there with each other and to not be trying to fix and to not be trying to change anything actually, and how profoundly transformative that was. 

Patrick Hanaway Guest 39:16

Humans have been sitting around fire, often in a circle, it's sort of the natural way to do it, for hundreds of thousands of years. It's how we connect to ourselves and each other. Part of the journey as a firekeeper is learning to just be holding the space. I think there were times where they were very much in their mind and they were espousing ideas and I, instead of being with them as, that's an expression of their concern in the world, I shut them down because they weren't feeling enough. That's not holding space. I mean, that person has fear and concerns and they're expressing it in this way. How do we work with that? How do we work with everyone where they're at? As opposed to trying to push people to be a particular way. I continue to learn from them. 

40:02

I didn't remember the first part about the coaching aspect, because it's interesting, because from that time in 2013 my life went into hyperdrive. I thought I was stressed and pushed then. Going to the Cleveland Clinic with 50,000 employees and 7,000 doctors and starting a new centre reporting directly to the CEO, and everyone looking at, what is this and can you do this? Suddenly, I'd been a big fish in a little pond and now I'm a little fish in an ocean and can you swim? And a lot of people were like, the growth of functional medicine depends upon doing this well. You got to show up well in this setting. It turns out that I was able to do that, but at a cost. 

40:40

The cancer is a direct relationship of not having balance in my life, but I also feel blessed that I was able to learn from that. So, here we are and how do we help our colleagues? For me, I'm interested in helping our colleagues to be able to find their journey, to find their centre, to find their heart. Ian McGilchrist talks about the matter with things, and that is that when we objectify life as things rather than as relationships and connections, we miss so much of what's going on. How do we deepen that? It's going to be interesting. I'm giving a talk later this afternoon, but it's more of a vascular health and inflammation and post-COVID and… it’s about that. My medical work now, in that way, is really about long COVID. Spending a lot of time in that domain, because it's a huge area of need and requiring a systems view. I'm still curious about the energetic and spiritual signature of that. 

Maria Christodoulou Host 41:41

Do you have any thoughts on that? 

Patrick Hanaway Guest 41:43

I think, first, in terms of SARS-CoV-2, the way in which the indigenous elders that I've talked to have talked about it, is like, this is a message from the ocean, carried around the world, as the ocean is, and it's talking about how out of balance we are. And so, recognizing that. So using that as the backdrop of the infection. And then two-thirds of the people with long COVID, they weren't hospitalized, they weren't really sick, but they've got stuff. It catches people who were otherwise healthy beforehand. But when I listen to their stories, hold on well, you weren't healthy. It's just like I wasn't healthy. My cholesterol was fine. My blood pressure was fine. My this and that were fine, but I wasn't healthy, I wasn't in balance. And when I listen to the people's stories, they weren't in balance before they got the infection. And so it's unlocking something that is, where were you out of balance and how will you move back into balance. And it's different for different people. 

42:42

It's not formulaic, so we have to personalize. But unless we're asking the question about their mental, emotional and spiritual centre, we're not going to be able to shift this. Like, we can take the systems approaches that look at the mitochondria and the microbiome and chronic inflammation and viral persistence and ACE2 mediated damage. And yeah, and work with that. And in fact, we have to. With their nutrition, and get them eating whole foods again and helping them to sleep and move their body. But unless and until we have something that also focuses on meaning and purpose and balance, we're not going to be able to help the majority of people. The quote unquote functional medicine things will help move in the right direction, but in order to move to healing, we need to be able to meet the person. 

Maria Christodoulou Host 43:34

How do we do that, though? Without creating a situation, because I see it often with people. There’s this, okay, so what did you do wrong? This is your fault, this has happened to you, and if we can just figure out what you did wrong, we can fix it, and then you'll be OK. 

Patrick Hanaway Guest 43:49

It's such a cultural thing because our Western culture focuses so much on the individual instead of the community and the interrelationships that are going on. Within the framework of family and community it’s about supporting each other. When there are imbalances in the family or in the community, the whole community is looking at what have we done to create this situation? How do we help to bring balance? But in our culture, it all focuses on you must have done something wrong, because this is happening to you. I think that finding a framework that is really about allowing for people to explore and express what's going on, whether in a one-on-one therapeutic relationship or in coaching or around a community fire. It's about creating the space. Our medical elders, those from Osler and before, and the elder physicians who would teach me, would say, the patient will tell you what's wrong. They know. You just have to create the space for them to be able to express that. And we don't, because we are so much objectifying things rather than deepening relationships. I feel like, as we work to deepen relationships and we connect to where people are at, that is where the opportunity comes in, and when they name it, it's also important for us not to brush it aside. Listening to say, what's right there? 

45:16

As again in the interview right here. 

45:19

You saw and you focused on the tears that emerged, because there's something more underneath there. There’s cues that we're being given. Many times of… even a laugh. Let’s go back there. What was happening? And you begin to find, and you begin to see what's really happening for that person. But you have to be present and be aware, and one of the things I've found the hard way is, when I have feelings that are arising when I'm with someone, that's in the field. It’s not like I'm doing something wrong. I have to be aware of what's going on for me in this interaction and then exploring. Being curious about what's going on for the person in relationship to that as well. Now, that's very different than blame. Or, that’s very different than, oh, this person makes me angry. I don't want them to be my patient anymore. I'm going to attack them with anger. None of that's useful. But seeing and feeling the anger that's arising and exploring that together, well, that's really useful and that's not blame, because if it's coming from that place of heartfelt concern and interest, they feel it. 

Maria Christodoulou Host 46:33

Do you think being a doctor and being a healer are the same thing? 

Patrick Hanaway Guest 46:38

Absolutely not. No. Doctor from the Latin docere, to teach, but we don't act as doctors. Actually, we act as physicians. 

46:45

Physicians, which is… I'm forgetting the Greek derivation, but it's really more about doing and intervening in that way, and so in the classic way, as physicians, as we were trained, that's in some ways the antithesis of being a healer, because it's focused on fixing. Something’s wrong, I need to fix it. Now, if I'm hit by a car and I'm going to the emergency room, I want that. Or even in the aspect of stage four cancer, like I need something that's an aggressive intervention. Sure, people get through stage four cancer, some do, who are able to not take that approach, but that's not the common way. There's value in that component, but that is very different than, not the antithesis of, healing. 

Maria Christodoulou Host 47:32

You said something interesting. You said, the physician, something's wrong and we've got to fix it. And for me what's always interesting is that it's in that individual place of, something is wrong. The patient has brought their problem to me. I need to fix it. There is never a we need to fix it. Where do you think that comes from? 

Patrick Hanaway Guest 47:51

I think some of that comes from the training. The deification. Physicians acting as demigods. It's like, we are the arbiters of health, and we're not. It's a false view, but it's one that is around propping up our profession and also one that, I think, is… It's the mask that's hiding the painful truth behind it,  that we know, we really know that we don't know, but I'm not going to show that to anybody. 

Maria Christodoulou Host 48:18

And the public don't necessarily want us to show that either, because if we don't know, then who does, and that's quite terrifying. 

Patrick Hanaway Guest 48:25

It's going to that edge of uncertainty, which is where life is really alive. Where we can choose to work together to be able to help support each other move through the world. 

Maria Christodoulou Host 48:35

What do you love most about being a doctor - healer? 

Patrick Hanaway Guest 48:39

Surprises. The friend… she probably was at that fire you were at in 2013... Early 50s. Year and a half ago, neck pain ended up being a rare lung cancer, metastasized to her vertebrae, to her brain. She’s a dancer. She lost use of her arms, her hands, you know, and feeling like, wow, this is really sad. Like, she'll do what she can, but I sort of, in my mind's eye, saw the deterioration, wanted to prepare her and her family to be able to move towards an acceptance of death and dying. And to see her… She did a documentary in that council house, around the fire, dancing. She would, daily, dance, and she would record for two to four minutes, of just movement, of whatever she could do. Here she is a year and a half out from a very aggressive stage four cancer and she's dancing and she's still getting chemotherapy and she's still having challenges. But the resilience of the human spirit, that's what amazes me. It surprises me to be able to see that. Helps me see how little I know. 

Maria Christodoulou Host 49:50

Beautiful story.

 Amy. Is there anything you would like to ask? 

Amy Kaye Other 49:54

This painting that is behind you. I don't know who did it.

 Maria Christodoulou Host

 He’s in a hotel room.

 Amy Kaye Other

 Okay. So this painting keeps speaking to me, but it looks kind of like flowers. It's quite fiery, the brush strokes. It looks almost like flowers on fire and your hair is kind of part of the painting and it looks like you've walked out of the painting into this hotel room to speak to us. It's really interesting that it is behind you. Obviously you didn't choose it to be there. 

50:19

All the things that you've spoken about. It feels like you live in different realms and different worlds, and it's interesting that we're having this conversation in a completely different world in terms of technologically, that we're doing this via Zoom. You're in America, we're in South Africa. The shamanic journeys that you've been on. Despite all these things that could technically be disconnecting us, you feel so incredibly present. It's so wonderful. It feels like you're in another realm but in the same universe, whatever moment we are in right now, and I just want to say that it's, for me… You mentioned having masks on. You just feel like there are absolutely no masks. All the masks are in that flowery world or have been thrown away or have been destroyed. And I just want to thank you, because it's very rare to have a human moment like this where you just really see somebody for who they are, that are really present. So I really appreciate that. So thank you. 

Patrick Hanaway Guest 51:14

Well, I'll say thank you, but I'll also say well, there's still masks. 

Amy Kaye Other 51:17

I'm sure. Got to have something. 

Patrick Hanaway Guest 51:22

Some I'm partially aware of and some I'm probably completely unconscious of. What it brought up for me was just, what I find when I'm engaging others is there's so much of a deeper, richer texture of their lives that I have no awareness of, and so, how do I open myself to all the layers and the unfolding of that? Not as a way of trying to validate some illness narrative that's going on, but rather to explore and care for who they are as human beings. Being able to connect to their story and listen and allow it to continue to grow. I'm very different now than I was when we were together nine years ago. Essence is still there. I'm not pushing that away, but there's a deepening that's unfolded for me. That’s a good thing and it will continue to deepen and unfold. 

52:29

I feel like, what a blessing. And that's true for each of the patients that I'm seeing and the people around the fire that I'm listening to and being with. We have this opportunity to be able to walk on this journey and connect with individuals. It's not coincidence who we're connected to or for reasons... I don't know why you and I are connecting again, right now.

 Maria Christodoulou Host

 I’ve wondered too.

 Patrick Hanaway Guest

 Each time we have connected, it's been deep and profound, mutually. I just appreciate what you're doing in the world to be able to bring voices forward that are about awakening, so thank you. 

Maria Christodoulou Host 53:09

Thank you. I have a few more questions. The one is, if you could go back and start this journey all over again, is there anything you would do differently? 

Patrick Hanaway Guest 53:17

My interest in healing since I went to medical school was about a synthesis of approaches to healing. It continues to be actually. So, the synthesis of lifestyle and functional medicine and integrative medicine and various modalities and shamanism and Western medicine, and how that relates to the different medicines around the world and how to be able to connect to the natural world and listen to the plants. All these things are all aspects of the healing process that to me, you know, I continue to be wanting to have a bigger conversation about healing, the one that we're talking about here, that includes all of these things. Theory of everything.

 But what I found in my journey was that each different perspective that I take will lead me to recognize one aspect of what's going on. I don't know if I talked with you about this at the time, but the way in which I see it is that facets of a diamond. An individual has many facets of this diamond. You actually have to look at it from multiple different views to see the whole diamond of what's going on. Those are the patients and that if there is a facet of the diamond that three of my colleagues are seeing and I'm not seeing, I'm probably not seeing that part of myself either. It becomes the healing journey of the healer, as well in the process. So you said, what would I do differently? The way in which I constructed this in my mind is that in the seventh century the Tibetans held the first international congress on medicine that's known and brought forth Persian medicine, Greek medicine, West African medicine, Ayurvedic medicine, Chinese medicine, the Shamanic medicine that they call rock medicine, and brought that all together. I feel like that's what's happening now. 

55:12

I had an opportunity to study with one of the Tibetan Doctor elders who was the head of the medical school in Lhasa. The Chinese came. It was in India at that time, in Darjeeling. After, when I met him in the 80s, I had the opportunity to be able to study with him and we had a beautiful connection. He said, first, you need to learn Tibetan. Thirty years of age. I can't. Thank you, but no. Obviously, 32 years later, I wish I'd done that. You said, what would I do differently? I may have studied Tibetan medicine and gone in this whole domain, but that would have been a different life. To that extent I wouldn't have done anything differently. I wouldn't have learned all the lessons that I've learned along the way. I bet I got some more coming up too. 

Maria Christodoulou Host 56:00

I guess that's how we know we're alive, right? 

Patrick Hanaway Guest 56:02

Exactly. 

Maria Christodoulou Host 56:03

You reminded me of a conversation I had with Akong Tulku Rinpoche. I think you've met the late Rinpoche. He was a Tibetan healer. 

Patrick Hanaway Guest 56:12

No, I did not meet him. 

Maria Christodoulou Host 56:13

This was even before I took refuge as a Buddhist all those many years ago. But he came to South Africa and I… somehow I was on the mailing list and this newsletter arrived saying that this Akong Tulku Rinpoche was coming to Cape Town and that he was a doctor of Tibetan medicine and that he would be giving a talk at the Buddhist Centre, and that, if people wanted, they could set up individual meetings with him to talk about their practice or any challenges they were having in their practice. I was not a practicing Buddhist. I hadn't ever thought that I might become a Buddhist. I'm not a Buddhist, but something in me said I have to meet this man. I phoned the Buddhist Centre and I asked if it was possible for someone who wasn't part of their community to have a meeting with the Rinpoche, and they said yes, it was, but that typically people came to discuss problems they were having with their practice, so I need to think about what I want to talk to him about. So I went in and I sat down, and he stared at me and I stared at him and I didn't really know what I was going to ask him and eventually he said, so why are you here? And I said well, actually I don't really have any questions, but I have such a sense that you embody something profound and something that I want more of in my life, and so I felt that perhaps it's almost like putting the log that isn't burning in the centre of the fire, like, I thought that if I could come and just sit with you for a little while, something might rub off on me, something might catch alight from your presence that would wake something up in me. And he laughed. And then he asked me about my work and what I did and spoke about HIV, which was very topical at the time because our government was not using antiretrovirals. 

57:42

But he then asked me about cancer, and this is why I bring it up now. He spoke about cancer, because I was seeing a lot of cancer patients then and he said, in the West, when somebody is diagnosed with cancer, you look to the childhood and you look to lifestyle habits and you look at trauma. And he said, we have a very different perspective on that. And I said so what's your perspective? And he said, in my culture, when somebody is diagnosed with cancer, it's an opportunity to step off the karmic treadmill. It's a call to come back home. And I remember giving a talk about that a few weeks later and having someone in the audience put his hand up at the end and say, you almost made me feel jealous that I don't have cancer.  I wonder what does that say to you? Does that speak to you in any way? 

Patrick Hanaway Guest 58:30

Oh yeah. You know, I've used the term around transformation and growth out of control, but it's a beautiful expression of stepping off the karmic treadmill, those [?] patterns that we have, of moving in particular ways, we're unconscious. And cancer’s an opportunity to be able to show us that, to shine a light on that. It certainly did for me. 

Maria Christodoulou Host 58:50

So what advice would you have for somebody who gets diagnosed now with cancer, having been through it yourself? 

Patrick Hanaway Guest 58:57

Well, I would give the advice that I do give, and that is what is the cancer telling you? There's a lovely book from a woman in the UK called the Cancer Whisperer. I use that as a tool to help people, because some people, when I say that, they get it right away, and some people they have no idea what I'm referring to. Like something's happening in your being that is wanting and needing to shift. Understanding what that is will be critical on your journey. I can help you on the offering some perspective, having been through this, and I can help connect you to how to improve the lifestyle aspects that are going on. But ultimately, it's your journey, and you're going to bring people along with you, but it's your journey. Understanding where that journey is going, what you're learning and how to be able to move forward with that, really is critical. 

59:48

How do you listen to the cancer? What is it telling you? And it says different things. For some people it is a moving into the process of dying and connected to that, and that's okay. Stephen and Andrea Levine talked about your healing into life and death, and it's a beautiful book and it's a beautiful awareness. It's not about having some expectation that if you do this, the cancer is going to go away. We're all going to die. 

Maria Christodoulou Host 01:00:10

What's emerging for you next, do you think? 

Patrick Hanaway Guest 01:00:13

The focus is really moving into the awareness of the natural world and being able to deepen the listening. Now, how that relates to some aspects that I've been asked to talk about and lead on COVID and long COVID, that kind of caught me by surprise when it happened. But what happened for me with COVID was, I was asked to help out and in it I got so caught up in how we work with that and how we educate people that I actually lost my awareness of what I learned from cancer. It hit me, oh my God, I'm not caring for myself. I'm using my intellect and I'm using my leadership and I'm using my pulpit and I'm not caring for myself. And so I stepped back from that. 

01:00:57

And then from that has emerged the whole aspect we've been concerned about… post-viral syndromes and it feels like it's an indicator of something that's been going on for a long period of time, of a group of people who have been marginalized but they're actually sensitive and something is emerging. So I'll be interested to see how that unfolds, the inter-relationship between those two. But I'm kind of going in on the medical side in that direction and on the shamanic side in terms of leading others on pilgrimage and really deepening an awareness of listening to the natural world and what it has to say. Elders who have been teaching this for many, many, many, many years. When and where they converge? I'm not sure. 

Maria Christodoulou Host 01:01:41

Anything else that you want to share, that I haven't asked about or that feels important to say in this moment. 

Patrick Hanaway Guest 01:01:48

Relationship with those that we love, with our close friends and family, is often where the challenges are. Where we're seen for our whole selves, good and bad. We each, as individuals, are challenged. I was speaking with someone yesterday who I’ve mentored for some period of time. Don't bail on the relationships because you're having a difficult time. That's actually the exact opportunity for learning and growth to occur. Just like cancer is the opportunity for learning and growth. Breathe into it, step into it, move into it. What do I have to learn in this process? Engaging life with that openness and curiosity and wonder is what is, for me, the opportunities that we have to become more whole, to heal. The world needs more of that. 

Maria Christodoulou Host 01:02:36

I guess that ties in also in functional medicine, with the difference between healing and curing. There's this idea that if you make the right decision then everything will work out well. If you make the wrong decision, then things will go badly. If you have the right treatment, then you'll get better. If you have the wrong treatment, you won't get better. But I think for people to understand that healing doesn't always include curing, and that cure… you can go into remission, you can be cured of your cancer, but that doesn't necessarily mean you've become a more whole person. 

Patrick Hanaway Guest 01:03:05

Well stated. I agree with you. The focus for me is on healing. 

Maria Christodoulou Host 01:03:10

And that may or may not include cure.

 Patrick Hanaway Guest

 Exactly.

 Maria Christodoulou Host 01:03:10

 Of all the things we've talked about today. What's going to stay with you? What are you taking away? 

Patrick Hanaway Guest 01:03:19

I feel heard. I feel the explorations of what's going on inside me have been able to be externalized. You've been able to ask questions and care about me. What I'm going to take away from this is feeling cared for as a human being who has something to offer in the world, and to remind myself of that. What that is, is not about what my knowledge is, the way in which I think about things, but rather about who I am as a person, and that there's value in that. I need to continue to remind myself. I've got a strong critic. The self-judgment is high for me. It's pushed me. It's deepening the self-compassion to be able to do that. You've helped me to connect to that, thank you. 

Maria Christodoulou Host 01:04:09

Thank you, Patrick, for your honesty, for your vulnerability, for making the time and for sharing yourself so freely with us today.

 I'm Dr Maria Christodoulou and you've been listening to the Awakening Doctor podcast. If you enjoyed this conversation, please share it with your friends, follow Awakening Doctor on Instagram, Facebook and Spotify, and go to Apple Podcasts to subscribe, rate and give us a good review. Thank you so much for listening.