Dr. Mona Balogh had a name for patients who showed up in her ER on a regular basis. Frequent flyers. These were the patients who came in due to the results of issues such as addictions and unhealthy lifestyle choices but never changed their behavior to combat the problems they faced. They were using the emergency room as an ineffective way of dealing with chronic disease.

In her new book, How to Stay Out of My Emergency Room: Master Your Health and Find Joy in Life, Mona combines western and eastern approaches to help readers overcome the harmful mindsets that prevent them from recovering from chronic disease. This book is chock-full of all of the information Mona wanted and sometimes tried to give those frequent flyers so that they can balance the power of their mind, body, and higher-self, to lead a happier, healthier life.

Nikki Van Noy: I am joined today by Dr. Mona Balogh, author of How to Stay Out of My Emergency Room: Master Your Health and Find Joy in Life. Mona, thank you so much for joining me today.

Mona Balogh: Thank you.

Nikki Van Noy: I would love to start by giving listeners an idea about your background and career as an ER physician?

Mona Balogh: I’m a standard doctor, I like to say. I got my medical training in Dallas. Four years of medical school and then three years in Los Angeles at LA County+USC Medical Center general hospital in emergency medicine training. And then right after that, I went into practice at a local Keiser hospital and I was there for 27 years doing my thing.

I retired about five years ago. I spent a fair amount of time practicing my business but also getting to know people in a rather intimate way, not just as a physician but as a person concerned about improving their health in ways that maybe I hadn’t been taught.

That is the main reason I wrote my book is that I have a lot of questions. How to improve people’s health that wasn’t being answered by the medical establishment and my medical training.

Nikki Van Noy: That’s so fascinating hearing from your perspective that you had questions that you wanted answers to.

Mona Balogh: Yeah.

The Frequent Flyers

Nikki Van Noy: Can you give me an idea of what some of those questions were for you?

Mona Balogh: Well, it really involved a certain patient population that kept on coming back into the emergency room for often the very same problems over and over again. We call them, among other things, we call them frequent flyers. This is what my book is geared towards, this somewhat small but very difficult population of people who just didn’t seem to know how to care for themselves without somebody like a doctor or the healthcare system to step in and pull them out of their situations.

A lot of these people were addicts, drug addicts, violence addicts, overeating addicts, a whole number of people who just had an addiction to something that they had no clue how to get out of. Of course, we have all heard of the 12-step program, so I do address that in my book, but I had to get to know the people, the population that actually became addicts, and stayed that way without some kind of outside intervention.

I felt bad for these people, they were stuck in a sort of a cycle of self-destructive behavior. Then there’s a flip side of other people who were being destroyed as well by their behavior. Mostly caregivers, loved ones, family members but every now and then, it was somebody who stepped in, trying to help these people like me or the healthcare professionals who actually got sucked into their troubles. There’s something known as caregiver syndrome, and doctors and nurses and the healthcare profession sometimes fall into that syndrome where they get stuck in a patient’s woes, a patient’s problems, and they can’t get themselves out.

That patient population for me was just a real challenge, they didn’t like me on a certain level because I expected them to get themselves out, and I did recommend things like 12-step programs. But the main problem was for me, to figure out how I could approach them outside of the normal dialog or the normal healthcare situation where you fix them up first but then you tell them, now it’s up to you. You have to do something to help yourself. They either were unwilling or they had some kind of blockage to helping themselves and that’s what I was trying to understand and then figure out how to get them out from that point.

Nikki Van Noy: This strikes me, and correct me if I’m wrong, but this strikes me as an interesting conundrum for someone specifically working in the emergency room because you are by nature generally just having these or should be having these, once-off experiences with patients, correct?

Mona Balogh: Yes, that’s right.

Nikki Van Noy: Tell me about as you began to educate yourself, what would you do when you saw some of these frequent fliers continuing to come back in and ending up with you over and over again?

Mona Balogh: I’ll give the example of the patient with congestive heart failure where their heart was just so weakened by their diet mainly and lack of exercise, among other things. They would come in and I would say, “Do you think you ate something that may have gotten you in trouble?” Invariably they would say no because they don’t think they did anything wrong.

Then, I would ask, “Well, list the things that you ate, that you had prior to going into heart failure.” And so invariably they would list something that was on their list, they would say “Well, I ate a bag of chips,” or something that sounds innocuous and benign but if you have a sick heart, that doesn’t tolerate a lot of salt, you can’t do that. There are certain things you just can’t do. These people would get very defensive and angry that I would call them on their behavior, and I would draw little pictures and I would say, this is your heart, it’s really sad. I added all this extra salt and now your heart is unable to pump blood into your body and your lungs are filling up with fluid, why didn’t you see your heart as something you need to take care of? Again, they would get defensive and not infrequently, they would ask another doctor to see them. Well, if they’re frequent flyers, then that other doctor doesn’t want to see them either because they just ignore us basically.

They’re always right and we’re always wrong. We’d see them in the ER and patch them up and hope that at some point in their lives, they would hear the truth that we’re trying to tell them and actually, be able to alter their own behavior for the better. Sometimes it worked, actually. I saw quite a few people who once I did the little sad heart picture would get into a program where they fixed their diet and exercise and do all the things that we tell them to do and sometimes they wouldn’t be coming into the ER again. Those are the exceptions though.

It’s very frustrating to interact with them and then see them get worse and worse over the years.

Nikki Van Noy: Yeah, before we dive into what’s in the book here. That is my question for you is, on a human level, how that impacted you?

Mona Balogh: Me personally? Frequently, I would just dig my heels back in and I would get angry at them and I’d say, well why are you hurting yourself? This is just ridiculous. Then they dig their heels back in and say, well, don’t’ I have a right to eat what I want or do what I want?

Yeah, but don’t you feel sorry for your body? Basically, it was kind of a power play between me and the patient. I, on the one hand, trying to help them and they, on the other hand, trying to maintain their sense of their own identity and their own power. It’s like this standoff between the two of us. I would get frustrated and sometimes not infrequently–I hate to say this, I admit it–not infrequently, I would yell at them and then they’d report me to administration and write a nasty letter and refuse to see me again, but that was the exception.

Eastern and Western Approaches

Nikki Van Noy: I mean, we should all be lucky enough to have doctors who care that much, and really, how can anyone resist a sad heart picture? I would have a hard time arguing back against that.

Mona Balogh: Yeah.

Nikki Van Noy: In your book, you’re tying together both western and eastern approaches. Talk to me a little bit about how you came to that?

Mona Balogh: I really was pretty much the typical doctor who didn’t believe anything except western medicine and western ideas about health but then, when I was a medical student, I had a lecture about addictions. There was a man who was invited to our class who had been going to AA, Alcoholics Anonymous, and he was an alcoholic, although he looked remarkably healthy. I remember thinking, this guy doesn’t look like an alcoholic but he was so cheerful and so totally into the fact that he was yes, he was an alcoholic and he would be an alcoholic for the rest of his life, and as a result of his realization that he is an alcoholic, he also realized that he needed some help that he wasn’t able to do for himself. That’s where it started in medical school when this man came and admitted he was an alcoholic. That was a big shock to me.

Then, after I practiced medicine in the ER for a number of years, I went to an addiction medicine conference and one of the presenters talked about alternative medicine and that’s where I was introduced to eastern approaches to addictions and health just in general. I was fascinated because it seems like there is a whole element of humanity that responds to that kind of pathway. One of the things I really looked into was Buddhism and Buddhism has a way of dealing with addictions that basically makes you into the highest power, not really a god, there’s no god in Buddhism, it’s more of a discipline. But the buck stops with you. You’re the highest authority in your existence. Really, returning power to that individual, one being at a time, is what really appealed to me and being able to make choices based on how your body and your being responds to how you’re being told to be healthy.

Somebody who really can’t make it on their own and they admit that or somehow their soul acknowledges that they can’t make it on their own needs a higher power outside of themselves that’s a 12-step program and they do turn their lives around frequently. But somebody who doesn’t have any connection to a higher power outside of them, Buddhism is that path and it doesn’t matter whether you were raised in a western environment or an eastern environment. What does matter is your individual unique way of approaching your power. Either through an outside power or through your own internal power. That’s what I did, and I try to combine the two of them. You make your choices, and you can do both. You can do 12 steps, or you can do Buddhism or any other form of eastern practices.

Nikki Van Noy: I love this idea of choice and what you’re talking about and figuring out what works for the specific person. I have a loved one who was an addict and the western approach just clearly did not work for him. And I remember thinking, so many times, there has to be something different and not being able to identify it.

Mona Balogh: Yeah, that’s frequently what I hear from my friends and family and I think many of us can relate to that kind of conundrum where something just isn’t working but you know that they want to do something, they want to try something else, they just haven’t been told it even exists. That was how I started approaching my understanding and then my actual treatment of patients in the ER and that’s how I wrote my book.

Nikki Van Noy: I’m curious how people responded when you would present that idea to them–this idea of the higher self?

Mona Balogh: The higher self, I am totally convinced is present in every one of us. It just means you can always be better than you are. That’s what higher means. It doesn’t mean the highest self, it doesn’t mean you’ve reached enlightenment and Nirvana and you have no place else to go. You can always improve yourself. That is the concept of the higher self. So, when I tell people that, of course, it makes perfect sense to them. Most people see themselves as powerful in some ways. The frequent flyers don’t like to see themselves as powerless in any way. They tend to shut down when you try to talk some sense into them but when you deal with their higher self, your higher self is speaking to their higher self.

We’re both in the same place, we’re in the same rarified position and speaking as equals not as a person in the medical field looking down on somebody who just can’t control themselves but as equals and that’s where the conversations starts or should start.

Repairing Relationships

Nikki Van Noy: You know another thing, you cover so much ground on this book, and one of the things that was really interesting to me and that I love is that you included a chapter about how you can repair your relationships. Talk to me about how and why that plays a role in a book about this topic.

Mona Balogh: Well, anybody who is a frequent flyer, whether they know it or not, or anybody who is an addict, whether they know it or not, they will eventually find out that they have damaged their relationships with others–mainly I think because they damaged their relationship with their bodies. This is something I bring up in the book, their bodies are separate from them, which to many people sounds really weird. But I explain how that’s the case but also how that’s helpful in seeing relationships with others.

If you are an addict of some sort or you are a frequent flyer, you just haven’t been able to see yet your higher-self speaking to your body in a more kindly, decent way. It is a matter of practice, which goes back to people that you’ve hurt. I mean every one of us has hurt somebody, right? But unfortunately, an addict doesn’t just hurt themselves. They have collateral damage, people who are trying to help them and are trying to pull them out of their addiction or their bad behavior or whatever it is. So, in order to make a relationship whole, I do give some meditations. I give some suggestions on how to do that. I even give some scripts on how to talk to people you’ve hurt.

They first of all need to start talking to their own bodies. They need to be more respectful of their own bodies. And then after that happens, they can start seeing other people as having been disrespected by them or hurt by them. That is a big part of the 12-step program–to make amends with people that you’ve harmed, and it works. It does work if a person is willing to have the humility. That is a big problem though–to lower yourself and be humble. I suffer from that too and I give some examples of Dr. Balogh getting humble pie.

I think we as humans all suffer from that because we do have a sense of ourselves as being powerful and correct. So, it is a lot of work. I admire people who complete the 12-step programs. If you know anybody who’s going through a program and you see them on the other side, they’re really grateful for the chance to have corrected themselves, their relationship with their bodies, and their relationship with others.

Nikki Van Noy: Absolutely. I agree with you so much and it is incredible to me how the people I’ve seen who come out of 12-step programs and it becomes a lifestyle for them. It’s a very permanent transformation, in my experience at least.

Mona Balogh: I agree. It is permanent. That is my hope at the end of my book if people start doing the work–that they will have a permanent change for the better.

Nikki Van Noy: I am curious, over the years, have you seen medical practitioners on a larger scale move more towards this idea of fusing western and eastern ideas into their practice or do you remain somewhat of an outlier in that at this point in time?

Mona Balogh: I think ultimately people are moving more towards a combination. I did work for Keiser–that was my hospital system and they have done a fabulous job of integrating or trying to integrate an alternative type medicine. They even allowed Keiser physicians to train in acupuncture. So, they have done a lot. I admire the administration of Keiser who really put that forth but ultimately, we’re western trained physicians. So, it is always going to be alternative medicine.

I don’t see anything happening in a big way that is really incorporating eastern ideas into western medicine, certainly not in the medical schools. It is always going to be alternative and the reason for that is alternative medicine tends to be more individual-based, sort of like the placebo effect. For the most part, there have been studies done showing that acupuncture really can physically alter your perception of pain and nausea and things like that. But beyond the placebo effect, alternative medicine just does not have a place I think in standard western medicine but is definitely something we need to keep looking into and not dismiss, at the very least.

Nikki Van Noy: Got it, interesting and that is fascinating about Keiser. I didn’t know that.

Mona Balogh: Yeah, they’re great. They are willing to try a whole bunch of things. They have made their mistakes here and there but yeah, they are very open to new therapies and new treatment plans.

Nikki Van Noy: I’m curious, have you ever had one of your frequent flyers come back to you and thank you at some point down the line?

Mona Balogh: No, because if they become more aware then they just don’t come into the ER. I did have a patient who I talk about in the book, if I meet them casually, say, like at the grocery store–if I happen to see them or if they remembered me and they see me again like in the hallway of the hospital, they will come up and thank me. I think on a certain level, I am kind of standoffish. So, I don’t think they feel warm and fuzzy around me.

But the other thing is, if they stop being a frequent flyer, they have a stronger sense of themselves and they certainly don’t want to come back to the ER. That is the last place they want to go. I’ve had some very lovely letters by people saying that I did a good job with them but never a frequent flyer.

Nikki Van Noy: Got it and that makes a lot of sense. If you’re no longer a frequent flyer, they probably were not going to be around you in that environment anymore. Mona, as you were saying that it struck me. Being a doctor in the ER strikes me as such a specific role. What was it that drew you to the ER?

Mona Balogh: Oh that’s a great question. When I was in medical school in Dallas, Parkland Hospital, we were all medical students together. All 204 of us in the class that I was in and we studied hard, we worked hard, we even played hard every now and then. But one of the places my colleagues and I loved to hang out was the ER in Parkland Hospital. It was a hopping place here in medicine that is the kind of thing you have fun in.

Nikki Van Noy: For sure. It is like a disco for medical students.

Mona Balogh: Exactly. So, we would frequently spend our hours off in the ER and try not to be too much of a burden and not in the way of the actual doctors practicing. I remember, multiple times I was asked to help out and I just loved helping people in need as opposed to a regular family doctor, the patients come to you not necessarily in need but just for a routine checkup or, you know, your blood pressure is high or your blood sugar is high and you get some counseling. That sort of thing.

The actual emergency patient is in true need of intensive care. I loved that dynamic. It was not just fulfilling but it was exciting to me, I guess, on a certain level. I am an adrenaline junkie. So that makes sense to me but also the variety. I love the variety of patients coming in and ultimately the vast majority were grateful. I enjoyed that as well.

The other thing that appealed to me–this is a little mystical thing–I always wanted to have a family, get married, and have kids. I remember walking through the hospital at Parkland, from the ER and I ran into a woman physician. She was an anesthesiologist and I chatted with her and I said, “Well you know, I know anesthesia is a wonderful specialty for having a family and not having your hours always somebody else’s. Do you know any other specialties that would appeal also?” And she said, “Well you know ER is an up and coming specialty.” So, since I love the ER and I heard her version of the ER being something where you can actually have a life outside of medicine, I put those two together, and here I am.

Nikki Van Noy: How has it been for you in retirement? Have you missed that adrenaline kick that you were talking about?

Mona Balogh: A lot of people ask me that during this COVID lockdown and with all of the things going on with healthcare, they asked me, “Well gosh, if they called you back, are you going to go?” and I said, “Well, if they need me, of course, I’ll go but nobody called me.” They’re so competent. The healthcare system has dealt with pandemics before. This isn’t the first pandemic and when you go into the ER, you are used to a certain amount of danger.

I think in retirement, I felt I kind of needed to, and I hate to say this, but I did feel burned out at the end of 27 years. I work mostly nights. That was my shift. So, as I got older, I realized that nights were not a good thing for my body but I was used to it. When I did retire, I actually retired from the ER first and then I went to urgent care. I went to urgent care at Keiser for a couple more years. So that was my wind down, which was just wonderful.

It was a real good place to keep practicing medicine but also not the extreme adrenaline of the ER. Then after two years in urgent care, I had to retire because I had family members I had to take care of–not that I am calling them frequent flyers but I do have experience with family members that needed a lot more care than I could give them when I was working. So, I really stopped completely in order to take care of my loved ones.

Then I realized I liked to be retired. It was nice to be put out to pasture. I can garden. I could write my book finally. I have been trying to write this book for years and I did everything I wanted to in the past few years since retirement.

Nikki Van Noy: Congratulations. Have you started sleeping at night?

Mona Balogh: Oh, no. No, I think I still am the typical shift worker neurotic sleeper. That is never going to go away. Yeah, I basically found something I could get neurotic about besides not sleeping at work. I have a grandson, so I worry about him.

Nikki Van Noy: That will do it. If there are any frequent flyers and you know who you are listening to this podcast right now, what is the one thing you hope they’ll take away from this?

Mona Balogh: Oh definitely, it is never too late, no matter how frequent the flyer you are. If you really are searching for some way out of your pattern, there is always a way out and it’s just a matter of you finding that way. Don’t ever give up.

Nikki Van Noy: Perfect. Again, the book is, How to Stay Out of My Emergency Room: Master Your Health and Find Joy in Life. Mona, is there anywhere else listeners can find you outside of the book?

Mona Balogh: Well, I do have a Facebook page and a variety of other social media that’s been set up right now. So, at this point, I think Facebook is the best way and I will have a website as well.

Nikki Van Noy: Perfect. Mona, thank you so much for joining me today and best of luck with the book, enjoy.

Mona Balogh: Thank you. Thank you very much.