'Tling" the bells call out just once, high and pure. There's a pause, not too long and not too short, and once again, Sager rocks her hands just slightly: "Tling." Sager waits, and gives the bells a third and final shake that's just loud enough to be heard without startling the listeners in the class she's teaching on mindfulness and stress reduction: "Tling."
Ten years ago, Sager, now 51, shut down her private medical practice, in part because she was sued for malpractice — she said wrongly — three times in five months. She walked away from a career as one of Maryland's few board-certified female surgeons to study, and eventually teach, holistic healing.
"I may have closed my practice and let my medical license expire, but I really believe I'm still a healer," she said. "I still take care of people, but in a much less stressful environment and much more completely than I every could before."
A new study seems to bear her out.
According to a report released Feb. 15 by the Bravewell Collaborative, such nontraditional methods as meditation, yoga, acupuncture and herbal supplements can lessen the symptoms of certain chronic conditions. (The collaborative is a Minneapolis-based advocacy, research and funding group that promotes holistic practices.)
In a survey of 29 integrative medicine centers in hospitals and medical schools throughout the U.S., doctors and patients reported success using holistic techniques in 75 percent of cases involving chronic pain; 59 percent alleviating gastrointestinal disorders; 55 percent in reducing depression and anxiety; 52 percent in lowering stress; and 52 percent in diminishing the discomfort caused by the diagnosis and treatment of cancer.
While the percentage of some outcomes might appear little better than chance, advocates say a low-cost technique that helps many patients and causes no harm is valuable from a treatment perspective.
"The important news in this research is that it can help treat chronic conditions," said Delia Chiaramonte, who is the director of education for the University of Maryland School of Medicine's Center for Integrative Medicine, which participated in the Bravewell study.
"If you have meningitis, you need antibiotics. If you've been in a car accident and you have 20 broken bones, you need a trauma surgeon. But for many chronic conditions, we don't have wonderful pharmacology we can use.
"The results of the study are very heartening. It means that now we have a bigger toolbox for treating patients."
Today, Sager travels from site to site around Maryland, teaching yoga, meditation and stress-reduction classes six days a week to medical students, cancer patients and the public.
During the growing season, she can be found at farmers' markets in Bel Air and Takoma Park conducting demonstrations of healthful vegetarian cooking techniques. She leads biannual retreats at a ranch in the New Mexico desert.
During a recent class in Ellicott City, Sager sprinkled detailed scientific information about brain activity into a reading from "The Velveteen Rabbit," a discussion of the perils of giving advice, a guided meditation and such body-centered exercises as "mindful walking."
After the session, participant Nina Lagervall, 50, of Catonsville, said that Sager's medical background gives her teaching increased credibility.
"It's very inspiring to think of her giving up her life as a surgeon and doing this now because she believes in it so fully," Lagervall said. "The payoff for me is that it's increasing my happiness. I've found that if I slow down and take the time to experience all my senses, I can even find housework enjoyable."
Sager has never been easily dissuaded by naysayers. Since the age of 6, when she first announced that she was going to become a surgeon, she has never looked back. Never mind that relatively few surgeons are women, even today.
And once Sager decided that her deepest passion was for holistic healing, she threw herself into the new career wholeheartedly. Never mind that the medical establishment has traditionally viewed meditation and yoga with disdain.
"When I was in medical school, yoga and surgery were not often said in the same sentence," Sager said. "It's still not that well accepted today, because it's very difficult to generate data that can be validated by a peer-reviewed study. But I don't care if it's validated or not. My life is my validation."
And as befits someone who has achieved a measure of peace with the past, Sager is candid with her clients about the factors that resulted in her decision to close her surgical practice.
After graduating from the University of Virginia's medical school in 1986, Sager served a five-year residency at Baltimore's Union Memorial Hospital and then opened her own medical practice. Both by her own account and by the accounts of those who knew her at the time, she was a perfectionist.
"I felt like I had a contract with my patients," she said. "I didn't feel right operating on them on a Friday and then taking off for the weekend. I was working so hard I could barely feed myself. I left innumerable carts of groceries in the store aisles because my beeper would go off before I could get to the checkout line."
Donna L. Dow, who practices internal medicine in Baltimore and Towson, attended medical school with Sager and said she was "intimidated" by her classmate.
"Gina was very smart, ultra-competent, and you could always depend on her," Dow said. "Some surgeons want to do the surgery but leave all the medical stuff to other folks. Gina took care of everything herself. She was a little scary."
On the whole, Sager thinks her uncompromising policy served her patients well; in 2000, she was named one of Baltimore's best doctors by Baltimore magazine.
But the surgeon was in danger of burning out.
"I didn't know if I would live long enough to retire," she said. "I was certain I was going to get a stress-related illness. My colleagues were having all kinds of heart surgeries and getting perforated ulcers."
In the fall of 1997 and early winter of 1998, Sager was sued three times for malpractice in quick succession.
The first suit was thrown out of court by the judge. In the second case, a woman was operated on by other doctors, developed complications and then sought Sager's help. After she died, her family filed suit against everyone who had provided her with medical care. A jury found in favor of the plaintiffs and awarded them a seven-figure judgment.
Sager said she was so emotionally drained by that trial that she insisted that her insurance company settle the third case out of court — against their attorney's better judgment. As a result, her annual malpractice premiums skyrocketed from $21,000 to $61,000.
Sager said she was fully exonerated by the Maryland Board of Physicians, which looked into both cases that made it through the legal system.
A spokesman for the board said the organization has no public records pertaining to the cases because the lawsuits were disposed of more than 10 years ago. But he added that Sager apparently faced no disciplinary action during the 14 years in which she was licensed to practice medicine in Maryland.
Nonetheless, she was devastated by the allegations.
"The trial just broke me," Sager said. "I thought I was going to die. It's like one of your mother's precious Christmas ornaments that you have to be careful with had gotten smashed. I left because I couldn't pay the bills, and I left because I was becoming afraid that if I touched my patients, I was in danger of being sued."
As the lawsuits progressed, Sager began practicing yoga to relieve her stress and found that it provided her with some peace of mind. After she closed her medical practice in 2002, she lived off her retirement savings for 18 months and began delving deeper into holistic practices, including Tibetan Buddhism and Ayurveda, a 5,000-year-old Indian medical practice that focuses on nutrition.
In 2004, she began to teach. In the past seven years, some of Sager's former colleagues have been startled by the transformation in her personality.
Margie Baratta is a registered nurse who has known Sager since the late 1980s. After taking a mindfulness course from Sager last year, Baratta walked up to her old friend and asked, "Who are you?"
"Gina has profoundly changed," Baratta said. "It's stunning. She even looks softer and more relaxed. She still has all the passion, intensity and commitment that she had as a surgeon, but she's much more self-forgiving. She's much more peaceful and calm."
For her part, Sager said she wouldn't take back a single sleepless night or harrowing bout of self-doubt.
"Though my journey has been hard, I regret none of it," she said. "I don't think I could be so sure of the value of my work if all these things hadn't happened. My crisis was the opportunity that helped me find my authentic path."
Career Path: A former board-certified general surgeon who closed her practice in 2002 to teach holistic healing.
Residence: Phoenix, Baltimore County
Birthplace: Timberville, Va.
Education: Bridgewater College, Bridgewater, Va., B.S. in chemistry and biology, 1982; University of Virginia Medical School, M.D., 1986; completed her residency at Union Memorial Hospital in Baltimore.
Personal: Single, no children.
If you go
Gina Sager's next classes open to the general public will begin April 10 in Towson and April 11 in Ellicott City. The cost is $475 for an eight-week session. To register, go to ginasager.com.