How does a pediatric physician become an entrepreneur?

It’s not a common path, but it’s the journey God has given Dr. Mark Piehl. While he continues to work in hospital ICUs, Dr. Piehl also founded 410 Medical after losing a patient. 

Dr. Piehl was sparked by the tragedy and set out to use the skills and resources God had given him to serve patients by offering timely and effective care. Now, 410 Medical aims to save the lives of critically ill patients by developing innovative tools that assist healthcare providers by improving resuscitation.

He joins the show to talk about his unique entrepreneurial journey and to share how God can use our experiences–both good and bad–to create something incredible that serves others. 

If you enjoy this episode, leave us a rating or share the episode with your friends, and be sure to follow the show for new episodes every week.

Episode Transcript

Rusty Rueff: Welcome back, everyone, to the Faith Driven Entrepreneur podcast. Not all entrepreneurs innovate for children on the brink of life and death, but Dr. Mark Piehl co-founded 410 Medical in 2013. After one such child bled to death in his arms from severe injuries sustained in a car accident 410 medical aims to save the lives of critically ill patients by developing innovative tools that assist health care providers in improving resuscitation. The organization was founded out of the biblical motivation to use the skills and the resources given to the organizational team by God to serve others by ensuring that clinicians have timely and effective care. Dr. Piehl is a board certified pediatrician and pediatric intensivist who loves taking care of critically ill children. Teaching pediatric emergency medicine to others and dreaming up better ways to take care of sick children. He is also a medical director with Wake Med Mobile Critical Care. Wake Med is a nonprofit hospital and level one trauma center serving central and eastern North Carolina. Dr. Piehl joins us today to share more about the biblical directive for us to use whatever gift we've received to serve others as faithful stewards of God's grace in its various forms. It's a fun conversation. Let's listen in.

Henry Kaestner: Welcome back to the Faith Driven Entrepreneur. Episode number 857. I don't know. It's not probably it's probably not 857.

Rusty Rueff: Maybe 858 850. Yeah, you're right. You're right.

Henry Kaestner: So I actually think about this Rusty and the last one that we had, we were talking about, I don't know, maybe we're on to 220 or 230 and I continue just to marvel at the fact that that's nothing for you. It's absolutely nothing for you. You have been faithfully writing your blog, your daily devotion to help people in the marketplace for thousands of days. Where do you at now?

Rusty Rueff: I think today's 3186 or 168. One of the two. One of the two.

Henry Kaestner: That's unbelievable. And tell everybody again where they can find it, please.

Rusty Rueff: It's called purpose working, purposedworking.com. And, you know, we'd love to have anybody who wants to subscribe. It'll show up daily Monday through Friday, early in the morning for you. It's obviously free. And it's just my little way of, you know, when God speaks to me through his word. And I can relate that to what's going on in the workplace. Try to bring two things together. Or sometimes I actually read things that are happening in the workplace. And I look at that and said, wait a minute, there's a Bible application for that, and then try to bring those two things together. So it's fun.

Henry Kaestner: It's fun. So 220 or 230 of however many podcasts we've had is Child's Play. But I tell you, I've loved doing this with you. We missed William today, who's out. We're going to get him back here for the next one. But today is a special episode, the Faith Driven Entrepreneur podcast, because as our special guests are very, very, very special guest said before you went live that this guy, Mark Piehl, is my favorite podcast guest that I thought we'd had on, but we never have. And Mark, what do you mean by that?

Dr Mark Piehl: I mean, in front of large audiences, you have said you've got to hear the podcast I did with Mark. It was one of my favorite episodes, and yet we had never done it. So in your mind it was a great episode.

Rusty Rueff: Mark, he's just being prophetic. That's what he was. He's been prophetic. He knows the day is going to be the day.

Dr Mark Piehl: You can see that having been said in front of a large group. And of course.

Rusty Rueff: Of course I can. Of course I can. Yeah.

Henry Kaestner: And the reason why is because we've share our faith stories together before in a number of different places. It clearly not the podcast but early Sovereign's Capital shareholder meetings and just Mark for the audience probably doesn't know is one of my very, very best friends in the world. Great Christian brother, just a great encouragement to me in my walk with Jesus since I met him back in 1997 and I have the pictures to prove it. Mark is a very faithful man of God and Faith Driven Entrepreneur. He's a doctor. He's a great husband. To Megan, father of three, and has a great entrepreneurial story. And we're going to talk a lot about that. We don't spend as much time as we should talking to entrepreneurs in the medical field, and we got a great one today. So Mark, thank you for being on the episode. Thank you for being a long suffering friend, but thank you for being willing to share your story with the audience that is FDE.

Dr Mark Piehl: Thanks for inviting me. It's a total privilege to be here.

Henry Kaestner: Yeah, and as it turns out, of course, is that we have thousands and thousands, many, many more listeners now than we would have had if we'd done this before. Right. I mean, we're in, I don't know, 165 countries now or something like that, Right?

Dr Mark Piehl: You had me on before, Henry. You might have had even more than that.

Henry Kaestner: Oh wow, I have not thought about that. I hadn't thought of that. That's right. Okay. Okay. Touché. All right, Mark, when you're not just being Henry Kaestner's friend and encouragement, what do you do? Because I know you've got a ton on your plate. Let's start off with what you do right now. You're balancing a bunch of different balls. What are they?

Dr Mark Piehl: So in addition to being husband and father, as you mentioned, I'm a pediatric intensive care physician at a place called Wake Med in Raleigh, North Carolina. So that means I take care of sick kids, trauma patients, children and young adults with life threatening injuries in the hospital, on the E.R., in ICU, I help lead a team of folks who go out and transport those folks back in a critical care ambulance. And then I do a lot of teaching to groups of docs and nurses and paramedics around how to best care for critically ill kids. So that's my day job.

Henry Kaestner: Okay. And it's a pretty significant day job. I talk a little bit about that more in here in a second. Along the way, as you've seen thousands and thousands of sick kids, you have seen some things that are broken in the health care. You seen people die unnecessarily and you went out and decided to do something about it.

Dr Mark Piehl: Right.

Henry Kaestner: Tell us about that.

Dr Mark Piehl: Obviously, we live in a broken world and we see a lot of that in health care. And within health care itself, there's things we could do better. And so I noted that there was a type of patient that I felt like we inadequately cared for, and those were the sickest patients who were dying or bleeding to death and dying of things like sepsis. And I never thought I would be an inventor or entrepreneur, but did have an admiration for friends like Henry Kaestner, who had just had an idea and went out and made it a reality and made something out of it. I thought man, that would be so cool if I could be in that space. But surely doctors can't do that and kept witnessing patients that I felt were inadequately resuscitated, meaning we didn't provide the care to them in the minutes that mattered between life and death, as we should have. And so over a number of years and through partnership with a number of friends and brothers, thought up an invention that would help us provide that care more quickly. And we'd get into the details of that later. Henry, if you want. But that was, let's say, ten or more years ago. That journey began just thinking, wow, there's got to be a better way to care for the sickest of our patients and sure wonder if I could be involved in creating that way. And so that's the journey I've been on. In addition to being a clinician, is trying to be an entrepreneur in that space.

Henry Kaestner: So I want to hit on that. And yes, I do want to talk about the device and we're not going to spend a ton of time going down memory lane. People will tune out and we'll keep talking about the times we ran off an island together. We talk about time where you tried to kill me on a run. We're talking about a whole bunch of things. But one of my favorite stories is when you came to visit us in the very, very early days at bandWith, and I remember walking out in the parking lot, I remember where we were on Western Parkway, this is almost 20 years ago and said, I can't believe it. What you do is so cool. And I remember at the time thinking and saying to you, Wait a second, you're saving people's lives every day. We save people money on their telecom bill, but it's something which just astounded me. It's been amazing to see how God has probably well before 20 years before that conversation had given you this sense, because maybe he's given it to everybody about wanting to innovate and create because you're created his image and you're able to take that and apply it back to your field. So you're able to take this entrepreneurial ambition that you kind of get in glimpses at, because he had different friends that were out there that you thought were entrepreneurs and then end up going ahead and solving something to be able to develop a device that saving thousands of people's lives. I want you to. So first off, what is that device? How does it work? And then tell us a bit about the entrepreneurial journey.

Dr Mark Piehl: So the problem we were trying to solve was the patient who is in shock, which means you do not have enough blood supply to getting around to your vital organs brain, heart, kidneys, lungs. And that can occur because you are shot or run over or otherwise have hemorrhage from some injury or illness, or you have a bloodstream infection when bacteria have gotten loose in the blood. This happens after COVID, interestingly, sometimes where the heart is not able to circulate the blood and oxygen adequately and things begin to die. And often the first line treatment is, in the case of trauma, is getting blood into that patient or in the case of sepsis, getting fluid into that patient quickly enough to to restore the blood supply to the organs. That's called reversing shock or treating shock. And there are lots of ways to do that, but none are precise or easy or efficient, and most can't be used well in places like ambulances and helicopters and on the battlefield. I mean, this, interestingly, particularly affects children where we have a lot more trouble. Precisely. And quickly resuscitating with the proper amount of fluid in blood. And so all life flow is a little manual device that lets a nurse, paramedic, battlefield medic, doc, anesthesiologist identify the problem and say, I'm going to get some blood into this patient immediately. In fact, this happened. Henry I just got a text before we started today in Florida. There was a young woman hit on the side of the road on her moped and was profoundly, badly injured. And the paramedics arrived, identified that she needed blood and were able to give it to her quickly on the street and in the ambulance in a way that never before has been possible. That's what life flow enables us to get enough of that product that they need blood fluid plasma into them quickly and intuitively, basically anywhere that you would provide medical care. So that's the problem life flow is trying to solve and is solving.

Rusty Rueff: Is it an injection?

Dr Mark Piehl: It is. So basically what we want to do is get imagine a half a liter of blood. A unit of blood is about 300 500 milliliters or about half a liter. And we're trying to get that blood into that woman through a small I.V. in her arm, or as crazy as it sounds, through a needle in the arm or leg into the bone or someone super sick and in shock, you often can't find a vein. And so you have to drill a needle into the bone of the leg or the arm. As gross/gruesome as that sounds, it's what we do on a regular basis in patients who are critically ill, and we then need infused blood or fluids through that portal of entry and life flow enhances the ability to do that well. So it's basically an injection of blood or fluid into the body when patients need it the most.

Rusty Rueff: Yeah, that's good. Because the name of the company is 410 Medical, and that's some calculation of amount of fluid you're trying to get into.

Dr Mark Piehl: Absolutely. So the company is 410 medical. And I'll tell you a couple of the origins of that name. The first was back when I was training. Our goal in a child with sepsis was to get about 40 milliliters per kilo into the patient in 10 minutes, which almost never happened. That's 40 milliliters per kilo of body weight in 10 minutes or for ten milliliter per kilo doses in 10 minutes, basically an unattainable goal. And I wanted to make that attainable because I felt like we were providing inadequate care, life flow enabled that in the child readily. And at the time when another good friend of mine and Henry's name Luke Roush we were thinking up the name for the company, I happened to be reading first Peter and came across first Peter 4:10, which paraphrased as. Each one should use the gifts you have been given to serve others. And if anyone serves, you should do it with the strength God provides so that in all things, God may be glorified through Jesus. So that day I literally is reading my Bible. 410. Four, ten. That's the name of the company called up Luke, and we agreed on. So it had to do with a calculation of the volume of fluid in the speed with which we want to give it, which the device could achieve, and that of scripture, which is actually a map for how we live our lives as Christians. So by God's grace, those two things came together and that's what the name of the company came.

Rusty Rueff: That's very cool. That's very cool. And the company's mission statement, I'm just going to read it for everybody because I think it's so simple, practical, straightforward to take care of sick kids, teach others how to do it, and think about new ways to do it better. I mean, it can't really get any clearer than that.

Dr Mark Piehl: Yeah, and that's actually Rusty my personal mission statement. You may find that on our website. Just to clarify, it's not our official company mission statement, but as I've kind of thought through, what do I do? What is my life to be about? It's those three things. And so it's kind of distilled it down into those three and try to measure the things I'm doing in my work life against those three principles.

Rusty Rueff: Okay, so let's take it apart for a second, because obviously it means a lot to you. So to take care of sick kids, you became a doctor.

Dr Mark Piehl: Yep.

Rusty Rueff: When did you get to the point where you said, Now it's about teaching others how to do it?

Dr Mark Piehl: It's such a good question. And by the way, I interestingly, I always thought I'd be a primary care doctor in a rural area of the US or somewhere overseas and kept getting drawn to the sickest patients in the ICU in the ER. And that's what ultimately led me down the path of becoming an intensive care doctor, but maybe always had a hunger to improve what we were doing. I always saw there's the stuff that we just kind of do because that's what we are taught and that's what's in the textbooks and that's what it's always been done. Surely there's a better way. And so I think it was probably a ten year journey of thinking. I wish I could just make this process better and that process better, never really tying together that I might create an innovation out of it, but it was a long evolution. Rusty Over probably ten years of practice.

Rusty Rueff: Well, in Bremner, I applaud you because, I mean, when you say, yeah, it's one thing to come up with new ideas. Yeah, it's another thing to take care, but to want to teach others that service.

Dr Mark Piehl: Good point. Yeah. And I found myself one having a hunger to teach other people to care for the very sick patients that I was drawn to. So how do I replicate that? How do I scale that so that other people can do it? As I'm learning lessons, I want to pass them on. And I also found through that teaching that I became a better clinician in that I was teaching others. And it made me have to become smarter to teach groups of residents and other docs and nurses and paramedics. I have a special obligation to understand what it is that I'm practicing and teaching and having to get on a stage and teach or teach a small group of practitioners or one doc in the middle of the night in the ICU with me, another resident with me. It's a task that is a privilege and it's made me become a better physician because I'm teaching. So I think it's just that's also been a slow evolution from practitioner to teach and from practitioner to innovator.

Rusty Rueff: I always use the adage and I forget who told me obviously was probably a teacher that he or she who teaches learns twice, right? Every time we teach somebody else, we learn twice. And I think it's a really powerful thing. But I'm guessing because I don't know the medtech space as well. You also have had to influence a lot of people, including policymakers. I mean, did you need FDA approval? Do you have to go through all of that?

Dr Mark Piehl: Yes. So I was naive at the beginning thinking, ah, here's a better way. Everyone will loved us not understanding that there were many, many, many hurdles to overcome between concept and marketable idea on the path to commercially successful and clinically successful company. And I'm not saying we're there yet. So FDA number one, and convincing the FDA that our product is worthy of approval is a long, expensive, difficult process. So yes, absolutely. They're probably more the medical kind of establishment. So academic physicians and hospitals influencing policy within them and within ambulance agencies to say, hey, we have guidelines out there for the care of these sick patients that we rarely meet. And why is that? Is it possible that a new tool or new technique could help you better meet the standards that we say we should be meeting and better provide for your patients? And so I'm still on that journey of trying to convince the world that what we have produced and what we create is actually truly is life changing. And some of that is through anecdote and intuitiveness. Someone sees the device and says, I get it, that works. That makes a lot of sense, and some of it is through data. So we are engaged in. Multiple clinical studies demonstrating the value of what we have created so that policymakers, academics, physicians, hospitals will say, hmm, I think they're right. That doesn't prove outcomes, that doesn't prove mortality, that doesn't prove patient care. This is something we should implement, even though it costs more many times than our current standard of care. So there's a lot of influencing Rusty that goes on for sure.

Rusty Rueff: Entrepreneurs. We're problem solvers, right? So why do so many of us ignore the biggest problems we face? Most of us? Well, we feel isolated and we feel alone. Our mental health suffers. Our relationships suffer. We get bogged down by the pressures of running a business. But say, hey, it's just part of the job. Well, it doesn't have to be that way. You see, we're not meant to be siloed. God designed us to do good work alongside others. And you can experience that kind of community with other like minded entrepreneurs on the same mission as you. Through our Foundation Group series. This eight week course helps connect you with people who understand your struggles because they've been through them too. There's no cost and no catch. You can meet online or in person and then continue gathering with our monthly entrepreneur groups. Don't let this problem go unsolved. Find out more at Faith Driven Entrepreneur dot org backslash groups. Now back to the show.

Henry Kaestner: Mark, I'm interested in having really seen your journey and going through it about what you're feeling that God is teaching you about Himself through this journey. What do you now know about God that maybe you didn't know ten or 11 years ago?

Dr Mark Piehl: One There's joy in creating. He's the ultimate entrepreneur, right? God is the ultimate innovator, and there's a special joy in us when we are able to create and to help push back the darkness in a broken world. And so I have found joy in doing that, and I think that's a God given gift. So use the gifts you've been given. So honoring the resources, the talents that I've been given and handing them back to him and saying, here's what I made of that one talent. There's joy in that. Number two, I've had to trust him more through this journey, probably more than any other endeavor in life yet because it's been so difficult, risky, and remains an uphill climb to get us to that commercial success point. It has caused me to continue to put my trust in God as having given me this path, led me on this path and give me the skill and the ability to do it. I don't know where it's going to end up, but I've had to trust him more than probably I ever have. Henry As you know, Meghan and I prayed about whether we should go down this path in the first place, and we both felt led, for me to do it. But there have been many, many, many points along the way where I've said, this is too hard. I can't do it. But God didn't promise us ease. Paul did not have an easy journey of spreading the gospel throughout difficult lands either, and yet he felt that God had called him to do and he did it in the midst of multiple barriers and hardships. And so I've had to realize that that's part of the Christian life, is finding joy in all circumstances, even when they're hard and even when there are barriers that we encounter. So yeah, it's helped me to trust him and probably understand God's grace more and humility more than I have in any time of my life.

Henry Kaestner: That's fascinating to hear from a guy that through the grace of God, has seen people saved on our emergency room, operating tables and seen people die. And yet it's this entrepreneurial process that has stretched you the most, or am I putting words in your mouth?

Dr Mark Piehl: Absolutely. No, no, it is. I mean, I love, love, love the care of critically ill kids. I love it. I look forward to it being able to help in those situations. And there are a lot of hard things about it. But the entrepreneurial journey starting and helping lead and grow a medical device company in many ways has been a much more difficult mountain to climb and remains still for sure. And getting them to do them together, Henry and Rusty is also a joy that they feed each other as I have to get out in the world Rusty and try to convince policymakers and hospitals and physicians there is a better way. Then I'm back in ICU in the middle of the night and think, am i right. Oh yeah, in this situation, this is where we need our device. This is where we need to improve resuscitation. I think God led me on this path. I think I am right, it gives me then, the energy to go back up the next day and convince the next person. Yeah, let me tell you what happened. Let me tell you what happened last night and how we improve the care of that patient. So both dovetail nicely.

Rusty Rueff: It's got to come with a lot of patients, too, right?

Dr Mark Piehl: Absolutely.

Rusty Rueff: I mean, in this area, you're running a marathon, right? Because I mean, I have yet to run into a person who says, you know, let me just tell you, you know, doctors and hospital systems, wow, boy, they're fast moving. They are so efficient, you know? I mean, so, yeah.

Dr Mark Piehl: It's a test of patience for sure. A test and one of the important virtues.

Henry Kaestner: So, Mark, you're one of most thoughtful people I know about the integration of faith in the work and what you do it in your name with 410, it occupies much of what you and I get a great chance to talk about on runs or and join an occasional adult beverage together. Tell us a bit about what that complete spiritual integration looks like, and you fall short too and I fall short and we try to help each other do better. But yet you also have this incredible opportunity being in the care of very sick kids and with families in crisis. And yet you have brought your faith to the hospital in a winsome way. Not perfectly, but in a winsome way. Talk to us a little bit about that, because many of us listening to this are parents and have kids. And that's our worst fear, having a, as you call it, a really sick kid. And what if kids come in the emergency room? They're really, really sick. What does that look like? And as you ministered to these families.

Dr Mark Piehl: Yeah. So first I'm inadequate, completely inadequate in that. And do pray about it every day how I will glorify God in my work and one way we all can and is just doing whatever we have been given to do, whatever task we're being given to do with excellence. And again, not in our own strength, but with the strength you provide so that God's glorified. It's just a great framework for thinking, okay, you do this well, care for people will care for people patiently and humbly. And then it just happens that in my line of work there are opportunities where people are at their most vulnerable and I can pray with and share truth with them, share the gospel with them. Do I do that in every situation? No. Maybe not in every situation, even where I probably should or could. But there are distinct opportunities in the care of critically ill patients and their families. When I have the opportunity to share truth or just try to be as excellent as I can. And I feel like. back to Rusty question teaching, writing, speaking and innovating have in turn helped me be better at the very patient care that I love in the first place. So I think it's first Henry doing what you do and what God has called you to doing it well, trusting Him for the skill and the strength to do it well and praying that he would, by his grace, allow you to reflect his glory back to the people that you're interacting with or caring for.

Henry Kaestner: You've seen at times, haven't you, where the faith of a family in crisis has been an encouragement to you and your faith?

Dr Mark Piehl: Absolutely, Yes. Absolutely. The way folks handle death and dying and critical illness who are believers is often remarkable and humbling and amazing for me to watch that folks can go through the actual death or the potential death of a child and nevertheless, trust God with that situation has been a fascinating and privilege to be able to witness. So, yes, I have. And I'm not saying it's unique to Christians, but there are, I would say is predominant so that folks who I either know are believers or discover in the journey certainly have been able to witness amazing peace in the midst of chaos, as the doctors in there in the room with with their child and with the family. So that's a good question. Henry.

Rusty Rueff: So, Mark, we have a lot of listeners who come from different disciplines and backgrounds and then became entrepreneurs. And obviously you came from a very intensive learning background being a doctor, right? You don't just get to be a doctor. And then, you know, you became a pediatric intensive physician. What do you wish you would have been taught even within that vertical of discipline or wish you would have learned along the way that would have gotten you maybe even readier earlier to become an entrepreneur?

Dr Mark Piehl: Hmm. That's such a good question. Well, one, I wish that the environment was conducive to it. Historically, there's not been an environment in which commercial entrepreneurship thrives within academic medicine. It was something that I was flying blind on for a long time. So even having the ecosystem within which that is possible would be something I wish for and Rusty, a lot of hospitals now are creating their own innovation centers, including my own here at [WakeMed] as a result of some of the work I've done and other docs. We've created that space within which there are advisors, there's funding or other mechanisms to help a naive clinician with an idea negotiate the multiple minefields that are on the path between concept and reality. So I wish that that had existed. I don't think it did. I didn't know anything about intellectual property or FDA or fundraising or any of the many, many challenges that you encounter on the way to creating a medical device. Should that be part of our curriculum in medical school or residency? Maybe. So that would have been nice, I think, interestingly. Does the church have a role in promoting entrepreneurship? And I think you guys would have a special expertise to speak to this question. But I think yes. And interestingly, through the church that Henry and I were a part of for many years together, I engaged in a study, a Bible study on caring for the least of these, caring for the poor. And that, in a way, led to another path of entrepreneurship and the creation of a clinic for the uninsured and homeless. And I think maybe that was my first. It was like Tim Keller interpretation of Scripture helping me interpret Scripture and how I should use my gifts and skills and led down the path to that original innovation. And I think.

Rusty Rueff: Is that The Samaritan Health Center?

Dr Mark Piehl: Samaritan Health Center. Yeah. And then probably that was the spark that led to this smoldering ember in me back at the hospital and like, wait a minute, is there something else I can do here? And that need, in fact, that one patient who died in my hands, who bled to death on my hands, I left the hospital that evening thinking, there's got to be a better way to fix this problem. Who knows what the exact sequence was? But I think a group of us at church studying together. How do we use our gifts in the world? How do we best glorify God with our each unique individual gift we have been given probably helped lead me down that path. And so to the extent you guys as Faith Driven Entrepreneur as an organization can help people see catch a vision for leaving it all on the field, finding your gift and going out there and using them for God's glory, I think that's maybe what if I had gotten a hold of that earlier, Maybe I would have been further down the path Rusty. But it happened in God's timing, and thankfully it happened at all.

Rusty Rueff: Why don't you tell us more about the Samaritan Health Center? Because I think this is really cool.

Dr Mark Piehl: Yeah. And Henry, I can't remember what stage you and I met in relation to that, but we had our church in Durham, North Carolina, a little bit for the local outreach committee, and we just sat and studied scripture together and thought, how do we as a church, as a group of believers, make a difference for the kingdom? How do we glorify God in our world, where there are needs and where we have special gifts? That was as simple yet. And one thing that kept coming up over and over was there's not a lot of good health care for folks who can't afford it. And we happened to develop a relationship with a homeless shelter. And one of the leaders there one day in the midst of this said, hey, I heard you are a doc, I heard you are a pediatrician. Can you come see some of our patients, all of our kids over here once in a while? And that just kind of again, was a spark to say, I could do that. I could show up on Mondays and see some of their sick kids. But why don't we just start a whole program for that that would invite others in who have similar needs? And so that led to a group of folks at our church praying for and planning and raising the funding for actually creating an actual functioning clinic, which has now become a larger health center, serving immigrants and the homeless and the uninsured all together. So that was a long evolution of social entrepreneurship that I'm thankful for. I'm not as involved Rusty right now. I pivoted to the business for a while, but I still love that organization and help fund it and feel like God kind of taught me a lot through it.

Henry Kaestner: I want to pivot over to Lightning Round. I want to talk about just a bunch of different things about just discipleship and how you've come to know God. You've been really intentional about it. And while some number of our audience is going to want to know what your favorite pizza places, your favorite ice cream places in North Carolina, we do like doing those questions when we go to different places.

I can answer that.

Okay. Yeah, go.

Dr Mark Piehl: Well, I just got I just got to praise Pizzeria Toro in downtown Durham. It's it has to be the best pizza that exists. I mean. Henry, what do you think?

Henry Kaestner: So Pizzeria Toro is phenomenal. We just were on with we had one last podcast was with a really neat couple in Charlotte, North Carolina, and it made me think about brixx because brixx pizza is also.

Dr Mark Piehl: Yeah, yeah, it's fun.

Henry Kaestner: Brixx is great, but Pizzeria Toro is better than pizzeria toro like burn down like three times. It just kept on bouncing back. Apologies to the guys at the brixx pizza. But Pizzeria Toro is better.

Dr Mark Piehl: That's analogous to that to the entrepreneurial journey. There are devastating challenges and, you [....]

Henry Kaestner: Way to bring it back.

Dr Mark Piehl: To them.

Henry Kaestner: Yes. Way to bring it back, absolutely. All right. So you and I spent some time going through Romans together and something I appreciate you went even deeper than I did. We both listened to the JD Greear sermon series on Romans. You turned me on to that. And then you were doing that at the same time that you're going through John Piper's sermon series on that. Just looking through all of his notes. Tell us about what are you doing right now? What are you doing right now to get deeper into God and his word and just help us?

Dr Mark Piehl: Yeah. Not enough. Number one, I'm reading through the Bible and back to reading the Bible in the year I did go through Romans, Henry, as you mentioned. And that was if you did.

Henry Kaestner: What do you do? Are you doing an app? I'm doing a Nicky Gumbel.

Dr Mark Piehl: ESV, ESV every day in the world on my phone.

Henry Kaestner: Mark introduced me to ESV and helped me understand where the NIV was inadequate. I'm still in NIV, but I'm doing the Nicky Gumbel Bible in one year app I'm loving it. So what are you doing? The ESV?

Dr Mark Piehl: however you do It, it's worthwhile. God teaches you something every day to His word, whatever you're reading. And so what I miss is diving deep into each passage. What I love is seeing the whole breadth and depth of the Bible. And my wife has been a great actually mentor in that way. She's a student of the Bible. She teaches she helps lead a big women's Bible study. And just seeing her faithfulness and being in the word every single morning has helped me realize the value of that. So that's number one. Almost every morning begins with reading scripture and praying for the day and for my family and for my friends and for you. Henry. And then not every day. I can't promise you. I pray to you every day, but I do pay for you for the business. And then when a group of men in our church, we have a Bible study there as well, and then a small group of couples that I've been engaged in and now for probably over five years or so, a number of ways that we're trying to be faithful as believers, studying the word together.

Henry Kaestner: One thing that the three of us share is a joy of running. It's a darn shame, Mark, that this is not a video podcast because all of our listeners could see how incredibly fit you look. But talk to us about the role of exercise in your life.

Dr Mark Piehl: Yeah, I mean, I do feel that one exercise could be an idol, so I try not to overdo it, but I love exercise and I feel like it's just one of the ways that I clear my mind and keep my body strong for the next task is to devote at least 30 minutes to an hour when I'm mountain bike a little longer and exercise every day. And it's a time that I actually do my best thinking, unless I'm running with you, I do my best talking, my best listening.

Henry Kaestner: What do you mean by exercise can be an idol? I'm thinking that is it just the fascination of being able to beat me on some sort of like ten mile run in eastern North Carolina, which I'm only now just recovered from and had to have open heart surgery to fix?

Dr Mark Piehl: Exactly. No, I think if I had all the time in the world, I'd probably be running an Ironman. I'd love to ascend to the next David Mark in level of fitness, but I, I don't have that luxury. But yeah, so it's important and.

Henry Kaestner: That is not a slight on people who are listening to this, who are doing triathlons.

Dr Mark Piehl: It is not. I'm just saying I would be prone to making that my sole.

Henry Kaestner: So would I. So would I.

Dr Mark Piehl: So, yes. And I respect and love and I'm jealous of people who do ironman, by the way. But yeah, it's important, Henry. And you ask me often if I'm training for something and I say no, I'm just training for life. And I feel like God has given me good health and I want to keep that health going as long as possible. Though at 55, which I am now, you notice the strength, the endurance falling off. So I'm trying to prevent that, although it's inevitable. Outwardly we are wasting away, as Paul says, it's happening. So I guess that's the other place you could become an idol is if you're trying to reverse the effects of aging too much. But I do love exercise. Thanks for asking.

Rusty Rueff: All right. So I have one. And then we're going to come to close because we only have a limited amount of time. I wish we could talk forever. I think we could among the three of us. So at one time you said that your goal was to have 14 Twitter followers.

Dr Mark Piehl: That's an old goal. I don't know how many I have.

Rusty Rueff: You don't know how many have now?

Dr Mark Piehl: I don't, do you?

Rusty Rueff: I do You had 291, but now you have 292.

Dr Mark Piehl: Wow. Thank you. So I had to confess, I'm not on Twitter very much, and I could use you guys counsel, but I.

Henry Kaestner: You were my first friend on Twitter. You introduced me to Twitter.

Dr Mark Piehl: I did?

Henry Kaestner: Yeah, you did.

Dr Mark Piehl: And you probably have, like, 6 million followers. And I have 200.

Henry Kaestner: Oh, I'm sure. Don't. I don't. I don't post on Twitter.

Dr Mark Piehl: Yeah. I have generally been staying off social media most of the time. I find it drags me down into not always a healthy place. So I think some folks can manage it better than I. But yes, at the time Rusty, I was hoping for more than 14. Thankfully I got there. Thank you for joining me as a follower and I'll try to send out a tweet or two here in your honor.

Rusty Rueff: I think it's a good caution. Actually. I've over the years, I was one of the early Twitter guys just, you know, jump on and. It can suck you right in, you know, And the next thing you know, and actually, Henry and I had a conversation I don't know how many years ago, Henry, about the use of Twitter and politics and all of those kinds of things with good wise counsel from my brother. But I think any of these things that, you know, you think you're doing good because you're staying up to date, you're staying knowledgeable and you're staying. However, this also can become a place of a little bit of self-promotion and a little bit of self inflation. And then, you know, emotions that can get going. And so I think we should all, you know, guard against that. It's wise counsel.

Dr Mark Piehl: And for you guys and no, I'm often in controversial spaces in medicine. And so when there's a perceived conflict, meaning I have a company and I'm also advocating for a certain direction that medical care could go, there's opportunity to get into arguments in public spaces that I found are not really helpful. People have strong opinions and they express them more readily on social media, Twitter and elsewhere. So I've learned to try to have those conversations in different environments, speaking to groups in one on one, conversations through writing and research, and not try to make my point as much through social media. There's definitely a place for it. Oh, yes, there's a place for it. But I found for my personality and for the business I'm in, it's not as effective and maybe not as helpful.

Rusty Rueff: Yeah, I think that's why we can't be encouraging. We can be inspirational and people need that. People actually need that, you know?

Dr Mark Piehl: Yeah. And there are many encouraging posts and my company posts all the time. I love it, but I just personally have stayed out a little bit.

Rusty Rueff: So if William was here, he would, he would close us with asking the question that we ask all of our guests. And and you've already alluded to the fact that, you know, you're spending a lot of time in God's word. Is there is there anything that God has just sort of said to you, like in the last couple of days in his word, that is sticking with you?

Dr Mark Piehl: Yes. So being in a word every day, I just at a moment of that was kind of down there since difficult stuff in our business. And I came across first Corinthians 15, I happened to be in my daily reading. And at the end Paul says it's first Corinthians 15:58 Therefore, my beloved brothers, the steadfast, immovable, always abounding in the work of the Lord, knowing that in the Lord your labor is not in vain. And He's basically saying, I face tons of challenges. I've I've faced almost unbearable challenges as the Apostle Paul, and you will, too. But by God's grace, you are able to be steadfast, trusting him, immovable, not getting pushed back by those challenges, continuing to abound in the work of the Lord. Do lots of good God honoring work with the gifts He's given you. And that was just an encouragement to me. And I think that's what he's teaching me, is and even in the midst a challenge, there's joy in it. And learning to be content in every situation, whether we are thriving and succeeding or whether we are facing challenges. So I guess that'd be the best answer to what I'm learning right now. And I have a lot more learning to do. But you can pray for me that I would continue to learn and continue to trust in our business to continue to thrive and save more lives.

Henry Kaestner: Heavenly Father, we lift up Mark right now, along with all of our audience of Faith driven entrepreneurs around the world, and ask that you'll continue to teach them that they will trust you, to have faith. Dear Lord, please forgive us for our inadequacies in the time we don't trust you. But, dear Lord, give us your blessing. May we be faithful and obedient. May we be protected. Dear Lord, may we experience your joy as we go about doing the work under your power, for your glory as your kingdom comes about on earth, as it is in heaven. In Jesus name. Amen.

Dr Mark Piehl: Amen.