I have shifted from a narrow focus on the diagnosis and treatment of illnesses in the individual to a broader focus on the health of the landscape which contributes to the health of a community. My landscape design product is essentially a history and physical of the land, leading to a list of constraints and opportunities for improvement, followed by various specific recommendations. While I focus on bringing balance to distressed environments, my unspoken intention is to help people heal by strengthening their connection to the land.

Initially I was so disillusioned with the business of medicine that I wanted to divorce myself from the practice. However I soon realized that the skills I use as a physician carry into my land assessments. I enjoy looking at the whole situation. Who are the people? What is the environment? And what are the various forces affecting everything? My role is to observe the entirety, to identify the intersections of different problems, and then to coordinate care with other specialists and collaborate across different disciplines. This is similar to the role a primary care physician takes in helping to coordinate care for an individual. Ideally, interventions happen in an efficient, practical way in order to produce a successful outcome.

Last year I started to design for individual homeowners. While this is enjoyable, it is not wholly satisfactory. My part has been the analysis and design. I have not found a likeminded contractor to work with, so I've been unable to see the design ideas implemented. I have always enjoyed the collaboration among medical specialties to arrive at the diagnosis and treatment of an illness. Now I would like to join with other contractors and community developers to share information and collaborate in creating community green spaces that match the health needs and desires of a neighborhood. It is enlightening to exchange ideas with colleagues who have similar goals, but different paths. I think a joint process makes for a stronger and more flexible product.

I enjoy working one on one with patients. It is a challenge for me to step out from the background to share my ideas with a group. It turns out that there is no model for a permaculture doc, or landscape medicine. So not only do I need to find the language to link human health to land health, I will have to speak up if I want to have an impact beyond one person at a time. At present I'm practicing expansion by volunteering as a mentor with the Master Gardeners and Tree NM here in Albuquerque.

There is so much to learn -
- how to manage a small business
- what are the constraints on various contractors
- more about water harvesting and earthworks
- how to work with government at all levels
- how to shift the assumptions we make about how things work.

* 40 years in the study and practice of medicine (emergency and internal) - a great deal of time listening to what is said and unsaid, and observing the obvious and hidden
* A lifetime of curiosity and love of plants
* Certificate of holistic landscape and permaculture design from Bastyr (while working in medicine)
* Travel to various countries to experience cultures and to learn about traditional medicines and dryland practices (Mexico, Peru, Kenya, Morocco, Spain)
* Financially, spending down savings and retirement to get started, and finally quitting medicine in 2021 because it was unbearable
* Beginning again with business consultants, webinars etc.
* Being willing to know nothing

The most important/ mind boggling/ soul shifting things in my life-
* My third grade natural science teacher, Mr. Cadbury, who took us on nature walks
* My first experience with Vipassana meditation
* Graduating from medical school
* Childbirth
* Learning about how we become ill and how we heal - through works of Carolyn Myss among others
* Expanding love and respect for the desert - Gary Nabhan
* Reminder of the strength in patience and endurance - Nelson Mandela

All creation is one. What we do to one, we do to the entire web of life. (Chief Seattle)