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My Mom recently challenged me that if I talk about God to my patients, it is unethical. I totally disagree. I don’t proselytize, which we don’t practice in Messianic Judaism. At my Synagogue, Simchat Yisrael, you must choose the narrow gate that leads to life, Yeshua Hamashiach. Your existence as the light of Adonai Echad, is what draws the person to the narrow gate, but the person must choose the highway, the narrow gate, and not the Broadway, as my Rabbini, Paul (Yaacov) August would say. He reminds our Shabbat Bible study every Shabbat, that Judaism is la familia, the way of the family of B’nai Israel. It’s very grounding and humbling.

My Rabbi, Joshua Brumbach, during membership classes emoted that all we have to do, to imbue the light, is always practice mercy, Tikkun Olam (repair the world) and Shalom (peace, tranquility, wholeness, completeness and wealth), everything else, is noise/commentary/irrelevant, as per the great sage Rabbi Hillel.

Currently, in the United States there is such anxiety and loneliness, secondary to the valuation of ourselves as capitalistic wage slaves on the military complex plantation of rampant capitalism. I am a capitalist myself, but I practice symbiotic/commensalitic capitalism, in other words societal corporate governance promoting Shalom fiscal health. Thus, all fiscal policy negotiations must be mutually beneficial, as per Game Theory.

Ultimately, we have to regress towards the mean of our Godliness, that is, the image of God, in the Tanach. That is our inherent/innate identity, nothing more, nothing less, and all else is commentary, as per Rabbi Hillel. Shalom.

As a Surgical resident I quickly surmised that the administrators were running medicine, and deciding the faith of physicians. Ultimately, medicine has become a trifecta of revenue cycle management/billing and coding, financial management/accounting and last but not least medicine.

During my second year of Surgical Residency I devised a plan to create compentency in the trifecta of the business of money, medicine had become. Firstly, complete a MBA in healthcare management. On the road to the MBA I realized I needed knowledge of government taxation. Additionally, I thought the road to healthcare equity was healthcare law. Fortunately for me with prayers the answer turned out to be the most utilitarian degree was Accounting with specialization in Government taxation. The answer to equity in healthcare was appropriations, encumbrances and expenditures, that is, the budget and budget justification.

Ultimately, I wholeheated agree with the great Suzy Orman, people first, then money, then things. We have to return expeditiously to the Hipprocratic way of practicing medicine, thus, people first at all times, that is, to inherently be in the business of people, and NOT in the business of money.

The main pathway to turning the tide of the opioid epidemic is medicine for opioid use disorder (MOUD) Telemedicine with Pharmacists being allowed to give IM Buprenorphine shots if needed. Additionally, patient who are revived with Narcan should be given IM Buprenorphine immediately or medical cannabis for sustainable medicinal therapy.

We must destigmatize mental health care for opioid use disorder and, thus, Behavioral Health Wellness Centers should be established. Treatment with Buprenorphine/Nlatrexone/Medical Cannabis with NADA acupuncture protocol, and Transcranial Magnetic Stimulation (TMS), should be first line treatment and standard of care.

The solution to the eradication of the opioid epidemic is Telecounseling, Telegenetics and Telemedicine MOUD. A patient who is admitted to a Behavioral Health Wellness Center should have a pharmacogenetic test, and a spinal tap to evaluate cerebrospinal fluid (CSF) for neurometabolic deficiencies that are a part of the organic component of mental illness. The organic components of mental illness must be treated aggressively to minimize the neurospychiatric side effects, and weight gain with current psychiatric drugs.

Ultimately, it’s all hands on deck, relative to healthcare clinicians, such as Doctors, NP’s, PA’s and Pharmacists, so that there is a possibility of stemming the tide of the opioid epidemic, and mental illness in the United States of America.

I too, (Langston Hughes), once got lost in Saint Louis, Missouri in the pouring rain, and when my car got stuck in mud. I walked to the nearest house with my white coat on, and knocked on the door, saying I was a resident, and needed to use a phone. The person handed me their cordless phone, and left me outside on the patio with rain still hitting/beating my face. Ultimately, I am alive to tell the whale of a tale. I am grateful that I could say I am a Doctor who was just lost.

During Surgical Residency, there were many times I felt as the only black woman at social events, that I would be lynched, or put in a boiling vat of “double, double toil and trouble cauldron” of the 3 Stygian Witches in Shakespear’s Macbeth. Surgical Residency was no joke for a black woman who was considered too ethnic/black, with shoulder length locs, and a very deep Jamaican accent when I got very tired.

It was not until I watched, Get Out, by Jordan Peele, that all my thoughts were put into words in a movie. I felt validated and relieved, that my cognitive reality was really the vestiges of slavery in the United States (US). This is also the crux of medical racism in the US, and of course the Flexner Report of 1910, was the nail in the coffin.

Ultimately, everything is NOT about color, but in the US a lot of things are. As a Jamaican of Maroon descent, I have learned to create CockPit Country/Wakanda wherever I go, and that has made all the difference in my life experiences. Go boldly in the directions of your dreams, live the life you’ve imagined, Henry Walden Thoreau.

We need to educate the population of the United States relative to sexual public health about responsible sexual habits/behavior. In the meantime, while at the ranch, we are recommending Pre-exposure Prophylaxis (PrEP) for HIV prevention, and in the future PrEP for STI/STDs, doxycycline.

Irresponsible sexual habits have caused a resurgence in congenital syphilis, and chlamydia/gonorrhea infections. We have populations since the Suffragette movement, who believe that Woman’s liberty is about sexual liberty, and that lack of inhibition/freedom is the ability to have sex in a frivolous manner with anybody. We have to be very discriminatory in our sexual habits, and check STI/STD comprehensive panels prior to engaging in sexual activities. We have to teach ourselves impulse control, and reign in our neurotransmitters, namely, dopamine, endorphine and oxytocin. We have to understand that behavioral health issues such as anxiety, bipolard disorder, ADD/ADHD, as well as, substance use disorders can drive these sexual disease epidemics.

Thus, sometimes when you feel the urge, call a friend or 988, for impulse control. It can mean the difference between life and death. As my Grandmother would say, actions have consequences, can you live with them in perpetuity. There are healthy coping mechanism that give the same dopaminergic hit as sex, that also does not involve binge eating/food.

Please call 988, and your health insurance behavioral health/mental health hotline when you need to talk to someone. Behavioral health/mental health is extremely important, it’s like breathing oxygen, very fundmamental to living.

Racism, bigotry and discrimination are all unconstitutional. Ultimately, the Constitution is blind, and the color of a man’s skin has no more significance than the color of his eyes, as per Bob Marley via Haile Salassie.

For some reason Justin Jones invokse the spirit of Thomas Sankara for me, one of the greatest Pan-Africanist of our time. Justin Pearson reminds me of Stokely Carmichael. A change must come, and the change begins with us. Each one of us, must epitomize a Founding Father, and continue their ground breaking social justice work, by making sure that E Pluribus Unum, “Out of Many One”, is every American’s reality. The United States is our land, as it was the Founding Father’s, and firstly, the Indigenous Tribes of the Continent.

We have to create, the Wakanda, the Founding Father’s envisioned, where the self-evident truth that all men are created equitably is made manifest. It takes work, and we have to put our shoulders to the plow, and make E Pluribus Unum, the reality for black, brown and indigenous people in the United States of America.

To achieve Universal Healthcare-Equitable Healthcare in the United States (US) we will have to develop healthcare jurisprudence jurisdictions similar to the 13 Federal Judicial Jurisdictions that exist in law.

Affording equitable healthcare via Telemedicine, so that Universal Healthcare can exist, will allow for easily accessible, and extremely affordable National Healthcare in the US.

Thus each healthcare jurisprudence jurisdiction will mimic-follow the 13 federal judicial circuit branches-apellate courts-Court of Appeals of the US geographically, which have their early beginnings in the original 13 colonies of the US. These include 12 intermediate appellate courts whose jurisdictions are geographically allocated, and the 13th circuit appellate court which is the United States Court of Appeals for the Federal Circuit, whose jurisdiction is subject focused and national.

The First Circuit comprises of Maine, New Hampshire, Massachusets, Rhode Island and Puerto Rico.

The Second Circuit is comprised of Vermont, Connecticut and New York.

The Third Circuit is comprised of New Jersey, Pennsylvania, Delaware and the Virgin Islands.

The Fourth Circuit is comprised Maryland, West Virginia, Virgina, North Carolina, and South Carolina.

The Fifth Circuit is comprised Mississipi, Louisana and Texas.

The Sixth Circuit comprises of Ohio, Michigan, Kentucky and Tennesee.

The Seventh Circuit consists of Indiana, Illinois and Wisconcin.

The Eight Circuit consists of Minnesota, Iowa, Missouri, Arkansas, Nebraska, North Dakota and South Dakota.

The Ninth Circuit consists of California, Oregon, Washington, Arizona, Nevada, Idaho, Montana, Alaska, Hawaii and specific Pacific Islands.

The Tenth Circuit consists of Colorado, Wyoming, Utah, New Mexico, Oklahoma and Kansas.

The Eleventh Circuit consists of Georgia, Florida and Alabama.

The Twelve Circuit consists of The District of Columbia Circuit for Washington D.C.

Thus, any healthcare jurisprudence jurisdiction with more than 4 geographical states should require physician state license in 2 of those states to allow care in that specific healthcare jurisprudence jurisdiction. Otherwise, only 1 physician state license should be required to cover a 4 state healthcare jurisprudence jurisdiction. This is the pathway to Equitable Healthcare in the United States with subsequent elimination of gender disparity, ethnic and racial disparity in Medicine, secondary to increased access and affordability to black, brown and indigenous physicians-clinicians, as well as, academic physicians-clinicians nationally.

Preventive Medicine in the United States (US) should have only 2 components: the dentist and the Internist-General Practitioner. It boggles my mind that dental hygiene is not a part of standard of care of the whole person-human being.

Most diseases can be diagnosed from the oral cavity. Poor dental hygiene is extremely deleterious to one’s health. It is so germane that cardiac/heart death, and brain death secondary to a massive stroke is awaiting the person who does not care for their dental hygiene.

The relevance of dental hygiene to one’s overall health cannot be understated, since dental hygiene encompasses one of the most important aspect-advances in medicine. We tend to forget that the gastrointetstinal (GI) tract begins in the mouth. Ultimately, dental hygiene has to be marketed as the first line of defense relative to heart health, and gut health-preventing gut barrier failure.

The importance of gut health in the gut-brain axis cannot be overstated. Of note, 95% of serotonin is made in the gut, and that’s how one increases serotonin in the brain, not just by Prozac/Zoloft. Additionally, our immunity hinges on the prevention of gut barrier failure, and keeping the gut lining sealed, else there is no nutrition, since nothing is absorbed and all foods end up in the toilet, and the community’s sewer system.

Adjunctively, the gut is the center of the body’s innate immune system relative to immunosurveillance. Cells from the gut travels via the circulatory system and potentiates natural killer-lymphocytes to kill cancer cells. This is why gut microbiome health is of utmost importance, since that’s the main surveillance system of the body relative to cancer prevention.

In the United States society, the culture is that one pill will cure all ills-ailments. It has led to the opioid epidemic and a pill popping culture, that has been categorically deadly. Now, the CDC is pushing for non-opioid management of pain. Really now? That should have always been first line.

As a Surgeon, I am trained to take care of injury locally, but taught the fundamental physiology of the body as a whole system. An infection in your mouth-poor dental hygiene, can cause a stroke, endocarditis and a massive heart attack. As a General Practitioner, I stay ahead of internal injury, and try-attempt to place the patient in a state of healing and not repair. In repair, pain is uncontrollable.

The solution for non-opioid treatment of pain is to change the narrative about how pain is processed. Pain occurs at the site of injury, normally distally-infratentorally, but is processed supratentorally, that is, in the brain.

This is why I mainly use Therapeutic Medical Cannabis, Preventive Medicine and Meditation-Mindfulness techniques to treat pain. If I teach-hypnotize the patient, about how to stay in a high enough endorphin state, pain vanishes, and mental illness is extremely controllable or cured with some shocking in the mix (transcranial magnetic stimulation-TMS). Yes, you heard correctly, the cure for pain is mainly a hyperbolic endorphin state, as well as, high antioxidant/anti-inflammatory state, and minimal leaky gut, that is, a super tight gut lining microbiome seal- in essence the prevention of gut barrier failure.

“A Tale of Two Cities”, the United States (US) is a land of dichotomous extremes, and hyperbole. How can the wealthiest nation in the World have such crushing, and annihilating poverty?

We have all become wage slaves in the US. The Federal minimum wage is still $7.25, since 1990. During the Reagan era, labor started to be outsourced to China and everything was subesequently made in China, including generic medications. I watched President Bill Clinton espouse that it was a good thing that China was opening up to the capitalistic ways of the West. I thought at the time it was a beautiful kaleidoscopic recipe for disaster. We were outsourcing our health to China, no good shall come of it. This business model and product cycle, were not sustainable, and would not end well. Fast forward to the pandemic and COVID, causing a halt to the Machiavellian capitalistic supply chain involving China and India.

Thus, the labor market of the United States is in the throes of a Franz Kafka like Metamorphosis, we are hurtling toward a French Revolution in some shape or form. We have to evolve from a country in experimentation, to a country that is always healthily breaking free of it’s Chrysalis to become a Butterfly of the self evident truth of the Constitutional Republic that is the United States of America..