The Joy of Presence

Red Leaf Trees Near the Road

Today is a beautiful day. I sat on my porch as the sun bathed my face with a gentle warmth. It was quiet. The only sound was the melodious song of birds as they chatted with each other. My beautiful Japanese Maple, with its deep red leaves, stood to my right. The air was light and fresh. I let my eyelids close and meditated for twenty minutes. Upon opening my eyes, I felt refreshed and calm. I also felt present.

There is really a lot to be said about being present. Just being in the moment. Wherever you are and whatever you’re doing. Right here and right now. It seems like such a simple thing. Well, it actually is a simple thing. Yet, its effects can be profound and permeate into all aspects of your life.

The joy of presence. Lying on a beach. Hiking along a mountain trail. Having a hectic day at work. Being stuck in traffic. Petting your dog. Eating a crisp, juicy apple. Cuddling with your spouse or children. Trying to bring awareness to the moment you are in, rather than the future or the past, can be a wonderful undertaking. It doesn’t have to be an official meditation session.

I am tying to be more cognizant of this. There are many times when my body is in this moment while my mind is in some other time and place. Of course, sometimes daydreaming can be a wonderful way to generate ideas and spark creativity. I do enjoy letting my mind wander at times. However, I want to get better at being where I am right now. I know that, over time, it will help to bring more clarity and tranquility into my life.

Tsunami Aid?

Ocean Wave at Blue Hour

In the April 2020 issue of Scientific American, there was an excellent article entitled “The Aid Tsunami,” authored by Ajay Saini and Simron J. Singh on pages 59-65.

They discuss the catastrophic tsunami that that hit the Nicobar Islands (off the coast of Thailand) on December 26, 2004.

They discuss the devastation that affected the indigenous people and their villages.  They spoke about the massive humanitarian effort that ensued, with more that $14 billion dollars donated by both private and governmental benefactors. The relief effort seemed like an amazing pouring out of kindness by people.

However, it turns out that there would end up being a darker side to this.  The authors of this article were trying to convey several key ideas to the reader. One of these ideas centered around health. As the authors point out, “…benefactors inundated an essentially isolated society with packaged foods, a wide range of electronic and consumer goods, and enormous cash handouts.” Years later, with regards to the natives of the island, “…many of its members were beset by alcoholism, diabetes and other formerly alien ailments.”

They go on to state, “…over the years prolonged stress, sedentary lifestyles and a taste for processed foods had taken a toll. Previously unknown ailments such as hypertension appeared. The islands lack modern medical facilities, and most of the traditional healers — with their extensive knowledge of plant-based medicines — had perished during the tsunami. The Nicobarese began to die of heart attacks, diabetes, injuries, respiratory diseases, pneumonia, malaria and other diseases. Alcohol became a scourge as well.”

One of my take aways from this article reinforces ideas that I already feel strongly about. Specifically, that physical inactivity and poor diets will greatly increase the risks of developing many chronic degenerative diseases, such as diabetes, hypertension and heart attacks.

However, there is very good news here. Similar to the tragic outcomes suffered by the Nicobarerse when their lifestyles were changed, the converse is also true. When unhealthy lifestyles are transformed into healthy ones, many of their associated disease conditions can be improved and even reversed. This is incredibly powerful information.

Not only is there power in this information, there is power in you. You have choices everyday.  Over time, the choices you make will determine your life.

In school I learned that one of the reasons it is important to study history is so that present day people can learn from the mistakes that were made by others in the past. I believe that we can all learn a valuable lesson from the Nicobarese.

Be Kind to You




Be kind to yourself.

Treat your body well.

In general, it is always best to take great care of yourself. Eat right, move your body, get adequate rest and take some time every day to be in silence. These are healthy habits to cultivate and maintain.

Although some of us, such as healthcare providers and other first responders may be much busier during the current pandemic, we must not forget to care for ourselves. Especially now, we should keep our bodies fit and our minds clear.

If it does seem difficult, then perhaps focusing on doing a single thing daily to care for ourselves is a good place to start.

Taking baby steps and being consistent is a great way to be healthy.

Humanity United



I love to be inspired.

And I can tell you that I have felt so much love over the past few weeks.

I am not surprised, yet still amazed by the number of people that have stepped up to help each other.

Local restaurants have donated food everyday, even twice a day, to the Emergency Department.

A friend of mine delivered food on a church bus to people’s homes.

Healthcare workers, hospital employees, first responders and employees of essential businesses are putting themselves in harm’s way each day they show up for a shift-to help and serve others.

People have been staying indoors and have put their lives on hold to protect each other.

This gives me hope for humanity. Although so much of what is broadcast by the media is violence, terrorism, greed and scandals, I know that we can be so much more. This pandemic has proven that. We are all one people-a global community. We stand together and care for each other. God bless!

Helping to Create a Better Version of Myself

pexels helicopterMistakes. Failures.  In the past, I hated to make mistakes. I despised failure even more.   Years ago, I would become quite upset over mistakes and failures. It wasn’t until several years ago that I learned that mistakes and failures are important.  They are essential in that they are necessary for growth. If mistakes lead to learning and improvement, they are invaluable.

I find it curious that although I understand a concept, sometimes that comprehension does not translate into actual thoughts and feelings.  I had this experience recently during a flying lesson.  For a while, I had been interested in learning how to fly a helicopter.  I guess it was my fear of heights that held me back, but one day I decided to inquire.  I took an introductory flight and loved it.  I was scared up in the air, but I loved it and decided to continue.

One thing we practice is hovering.  It is challenging to coordinate brain, hands and feet to keep the aircraft in a hover in one place a few feet above the ground. I had been showing some improvement over the course of a few lessons. However, during my most recent lesson my flight instructor gave me greater reign over the controls and I did much worse than I had in the past. In the moment I felt disappointed with my performance. It wasn’t until the drive home that I realized that my mistakes were vital for my learning and growth.

Later that day, my son Joey was on his pogo-stick.  I watched him with amazement.  He was good!  I remember when he first got it. He couldn’t even do a single jump without falling off. He practiced.  Over time, all his mistakes and little failures created quite a talent for using a pogo-stick.

In the future, I am going to try to make a conscious effort to truly understand the importance of my mistakes in the moment. After all, if I learn from them, they are helping to create a better version of myself.

This is Steve Piriano ready for departure.  Until next time…


Clean Lenses

I can remember working a shift that ended at 11:00PM.  One of my last patients was a young lady in her thirties. Per the nurse’s notes in the chart, she had come to the ER secondary to complaints of chronic abdominal pain and constipation. After reading that, a barrage of thoughts flooded my brain.  “Did this patient come here just to receive narcotic pain medications?” “Is she lying about her pain?” “It’s almost the end of my shift, why did she come here so late at night with a complaint of constipation?”

Almost immediately, my perception of her was distorted. I already had thoughts about the type of person she was when I had not yet exchanged a single word with her. I was seeing her through cloudy lenses.

However, I decided to approach her as I do every patient–with kindness and an open mind. I spoke with her at length and learned a bit about her.  It turned out that she was a genuinely warmhearted individual who was going through some difficult times.  I tried to figure out what would be the best way to help her. She actually declined any offer of pain medications.  All of my initial perceptions were incorrect.

We all encounter people in a host of different locations and situations. So often it is easy to prejudge other individuals without ever giving them an opportunity to express who they are, what they are feeling or what kind of day they are having.  Have you ever had the experience of interacting with an unpleasant and impatient cashier at the checkout counter of your local supermarket?  I would propose that instead of acting in a similar fashion, you look at that individual through clean lenses.  After all, perhaps he has a sick child at home, maybe his car just broke down, or perhaps he doesn’t have enough money to buy dinner for his family. Or perhaps he is just grumpy all the time.  In either case, a little kindness on your part can go a long way to brighten that person’s day.

Thus, before you venture out into the world each day, please be sure to clean off your lenses.



We typically make decisions and take action based upon the things that we know-upon how we understand the circumstances that surround us.  Many times our conclusions are correct and our behaviors are appropriate. However, I’m fairly certain that on numerous occasions our assumptions are mistaken and thus our conduct will reflect this. I can definitely say that this is true of myself.

The manner in which we see a situation is our perspective. The eye of a hurricane looks and feels quite a bit different than other parts of the storm. Perspective. As a practitioner of medicine, I have an entirely different perspective than a layperson. A person who suddenly has the onset of severe abdominal pain will likely have a different meaning for me than for, let’s say-an astrophysicist. It would be like I am on an entirely different level of understanding with regards to the situation.  Similarly, if there was some enormous cosmic event that was going to impact our Earth, the converse would hold true. The astrophysicist would have an understanding that I could probably not even fathom.

I have two dogs- a yellow Labrador and a miniature poodle. Until a few months ago, I thought that I knew a lot about owning and raising dogs. Not so. Our Labrador was beginning to display behavioral issues that we were concerned about. I didn’t know what to do. Around that time, I happened to come across a copy of “Cesar’s way”, by Cesar Millan. Mr. Millan taught me an entirely different way to view canine behavior.  I learned how dogs see the world, and it is a lot different than I had once thought. I gained a new perspective, and it has helped immensely. (As an aside-prior to the behavioral issues, my wife had watched some episodes of Cesar’s television show and had mentioned some of his ideas to me. Of course, I didn’t listen at the time. She was right 🙂 – I should have listened.

Thus, proper perspective is essential.  It can help in all life situations. It can be especially valuable in difficult circumstances. When these circumstances arise, take a step back and ask yourself if there is any other way to look at things. Seek advice.  Read an article or book. Many times the perspective of others can be a wonderful gift, helping to provide the enlightenment needed to assist us in solving many of life’s most challenging quandaries.


Inspiration from Tomatoes

Tomato Top of White Ceramic Plate

Early in the summer I started my vegetable garden.  I pulled up the weeds that had grown in the spring and put in fresh soil. I planted a few different vegetables, including tomatoes.  I had purchased them as small plants. They seemed so small and delicate-no more than six inches tall. Over the ensuing weeks I tended to them regularly. I ensured that they were adequately watered, and secured them to posts to assure they would be well supported.

Yesterday as I admired the garden, something struck a chord within. I noticed just how much my tomato plants had grown. I had recognized this every time I cared for the garden.  But yesterday I really understood it. They are at least two feet tall-very green and lush.  They are so big that their leaves are overhanging the wooden planters. I even saw a small tomato here and there.  They are truly majestic.

As I marveled at my garden, the concept that I became aware of is that the plants are supposed to grow. I know it sounds obvious, but bear with me. The young seedlings were meant to develop and flourish. All that potential was in the tiny seeds from which they originated. They were destined to become magnificent wonders of nature.

The same is true for all creatures. Every living thing on this planet was brought into existence to rise to its full potential. Think about it–have you ever seen a mature six inch tall oak tree?  We too were created to rise to our highest. We were all given special gifts and talents. We were meant to use and develop them.  We are not supposed to keep inside that which eagerly desires to be released. We should be using our gifts to create, serve and be of benefit to humankind and this planet.

It’s amazing how much one can learn from a tomato.





Heart Attack

A forty four year old male came into the Emergency Department complaining of chest pain. He described it as feeling like somebody was standing on his chest, and it had been going on for an hour.  He also reported feeling sweaty and was nauseous. An EKG was performed and it revealed the terrifying reason for his symptoms-he was having a heart attack.

A heart attack.

This forty four year old man with a wife and two children was having a heart attack.  Unfortunately, everybody who works in an Emergency Department has seen this patient.  So in the ER, we do what we do best-we are part of a team that helps save lives.  Within twenty minutes-this patient will have IVs and will have received several different medications to prevent the heart attack from getting bigger. Very soon after that, he will be taken to the cardiac catheterization lab where they will open up the clogged blood vessel and place a stent to keep it patent. He will then be started on medicines to keep his blood “thin”.  This man has been fixed.

He has survived his heart attack, and given a second chance to continue his life and be with his family. The good that can be done by practitioners of modern medicine is nothing short of miraculous. It is a truly amazing thing to witness and also to be a part of.

Sometimes when I think about all of the incredible feats that medicine can accomplish I begin to wonder. The thing that I wonder about-is it always necessary? What I mean to say is-did this man really need to have a heart attack?  Was it at all possible that it could have been prevented?  Could a healthier lifestyle have staved off such a tragedy?

We may never know the answer for this particular gentleman.  In general, however, a healthier lifestyle can absolutely lower the risk of many diseases-heart attacks included. We all have control of our own destinies. We do not have to be at the mercy of our genetics-even if it seems as though bad genes run in our families.  We do have the capability to help keep ourselves well.

We have the power to keep our own arteries clean. My body is a beautiful gift-and I sometimes think of caring for myself as a magnificent responsibility. Perhaps we should keep this obligation for ourselves-and not give it away so often.






Baby Steps


No matter the goal you are trying to achieve-take it slow.  Whatever ultimate outcome you desire-break it up into smaller pieces.  There are a couple of good reasons to do so.  Oftentimes our goals may be large and challenging. This can be overwhelming.  So overwhelming, in fact, that it creates discouragement.  “This is too hard.  Why bother? I’m never going to be able to do this.”

However, turning a single large goal into many smaller ones will create a sense of achievement and reward after the accomplishment of each one.  This will enable one to build up momentum (remember that?) and remain motivated while moving onto the next smaller goal.

For instance, let’s say that your goal is to lose forty pounds. That’s your ultimate goal. It may seem a bit daunting.  But how about losing five pounds?  Or even three pounds?  Now, that’s not so bad, is it?  Set up these smaller goals and have a plan to achieve each one. With each goal accomplished, you will truly feel wonderful. And why not give yourself a small reward for each little goal you complete. It could be anything- a massage, a new outfit, a special night out, etc. You get the idea. That’s even more motivation.

So, let’s learn from those tiny infants.  When they’re trying to figure out how to walk, they don’t go straight from crawling to walking around the house. They stand and fall. Take a step and fall. Cruise.  Take a step on their own and fall. Two steps and fall. Three, four-fall down.  Then, suddenly they can walk across the room! And they did it in baby steps. Just as we should.