Random Thoughts from a Restless Mind

Dr. Darrell White's Personal Blog

Cape Cod

Thoughts About Kate Spade and Anthony Bourdain at 28,000 Feet

As is often the case when flying I was rewarded for offering a greeting to my row mate on the plane with a bit of insight and knowledge I’d have missed had I not simply reached out a hand and said “Hi, I’m Darrell.” My momentary companion (we each moved to more spacious seats) had been a schoolmate of the recently deceased Kate Spade. He confirmed her years-long struggle with a depression that defied logic and was thus a depression that was as pathological as diabetes or heart disease or cancer. Opening my Sunday papers brings stories from the friends of Anthony Bourdain, also deceased, and his decades long struggles with the same demon disease.

Like so many others, both Mrs. Spade and Mr. Bourdain were killed by illness, cause of death: suicide.

First, a couple of statistics. Suicide is presently the 10th most frequent cause of death in the U.S. currently responsible for taking roughly 45,000 lives each year. I am a physician. Doctors die from suicide at a rate 0f 40 per 100,000, the highest rate of any profession and twice the rate of Americans in general. Suicide is the second leading cause of death among teenagers (behind accidents), having surpassed homicide for the first time in 2017. [As an aside, the U.S. loses more young lives from all causes than any other developed country. This drag on life-expectancy should always be considered when you compare the health outcomes of various countries] A very large percentage of these deaths occur in those who suffer from some kind of mental illness, of which depression is far and away the most common.

It is time for us in America to reframe our conversation about suicide for the good of those who are at risk as well as those who have lost a loved one for whom the cause of death was suicide. Let us start, as we should in all serious discussions, with the language we use. For decades at least we have used the phrase “committed suicide” when describing such deaths. It is well past time for us to retire this phrase, at least for people like Kate Spade and Anthony Bourdain. To commit is to perform a willful act while under the full control of all of your faculties. Commitment implies the performance of an action that is the culmination of rational thought. Outside of war, the act of taking a life after rational thought is the purview of the psychopath; it bespeaks the presence of evil.

People like Spade and Bourdain who are killed by suicide are not evil.

We will all come upon well-meaning entreaties from those around us offering help should one be considering suicide. We will see headlines and the like proclaiming that “Suicide can be prevented”. Can it? Can suicide be prevented by addressing suicide and the thought of suicide itself? By and large suicide is an effect, not a cause. Some suicides do, indeed, follow the rapid appearance of dismay and despair, and these may very well respond to the well-meaning aid of those who offer a phone number, an ear, or a ride to a doctor or therapist. For some, especially the young, suicide is an impulsive reaction to an overwhelming emotion. For those left behind these are the hardest for we all surely ask “what if”, and we all as surely respond “if only.”

There is suicide that kills as the consequence of illness too long in development, even with the best of care possible. Depression, Bi-polar Disease, Schizophrenia and their ilk sometimes prove untreatable in the exact same manner as cancer or heart disease. Suicide is the cause of death in the same way that liver failure might take someone with widespread cancer that began in another organ; the ultimate cause was neither the failed liver nor the suicide but the underlying disease. It is so very, very important for the family and friends and acquaintances of those who ultimately pass by suicide to understand and accept this, especially if their loved one was being actively treated. Here, in these circumstances, we the living must guard against “what if” and “if only” as if our own lives depended on it.

Because they do.

I have known you all, you who have lost and who are still here to remember. I am one of you. Friends and acquaintances, friends and family members of acquaintances–I, too, have losses. “What if” and “If only” haunt us all. For us, as it so often is, the solution lies in love and kindness extended not only to those who are suffering, but to those we have lost and most especially to ourselves. No one who loved us as we loved them would have chosen to hurt us in life; how they ultimately died was not a choice to hurt us in the passing. We will surely hurt but we must not allow ourselves to feel that we have been hurt on purpose. More so, in time we must forgive ourselves for that which we could not change as surely as we could not have saved the parent or the sibling or the friend who died from cancer. We must forgive ourselves, be kind and loving to ourselves and all of the others who share our loss, for the alternative for us is despair and dismay.

We can begin this cycle of kindness and love by choosing a different way to discuss suicide and calling it what it is: the cause of death. Do reach out to those you know who have been buried by despair and are drowning in dismay, for they might be saved. Fight for the right to do so. Do champion the recognition that mental health diseases that have no outward signs such as true depression are as real as an open fracture at the scene of an accident; they should be treated as seriously and with the same sense of urgency. Fight for the right to have these diseases treated the same way. Doing so will save lives. Love those you love as much as they will let you for as long as they are alive for the loving, and let them do the same for you.

Peace and grace be upon those who have lost loved ones who were killed by suicide. Joy and love to all who have stood with toes across the precipice and stepped back, and to those who were there to embrace them when they did.

 

Sunday musings 6/3/18: 40th Reunion Thoughts

2018 is the year of my 40th high school reunions (we moved after my freshman year so I have two). It’s a nice time to return to one of my frequent themes, identity. Who are you when you are all alone, just you and the mirror? Who are you when you are in any particular group of people? Do you feel that there is more confluence between those versions of you than not? How much confluence do you think there is between who you think you are and who it is that those around you think you are? As this is my 40th year away from my classmates, have you evolved from who you thought you were and who your classmates thought you were over the years?

First a couple of disclaimers. One should not be all that too terribly concerned about the thoughts of others since this gives all too much power to individuals who may not have your best interests at heart. Sorry, but our world is altogether too filled with people who will opt to climb over your downtrodden psychological carcass if you allow them to do so. Also, there is no reason for you to ossify as an individual at any stage of your life. Indeed, if you haven’t evolved since high school you’re probably doing it wrong.

Over the years I admit that I have not made much of an effort to remain in contact with the vast majority of my classmates in either of my childhood towns. I could certainly lay the blame for that on my Dad who held that true friendships were rare and the effort to stay in touch with acquaintances too arduous for the ROI. The truth is more that I’ve always done the deepest dive possible into whatever ocean of opportunity I happened to be sailing on at any given moment; those oceans have always been rather distant from the shores of my youth. It was simply too hard and too time consuming to maintain a large number of close contacts behind as I was ever looking ahead. Looking back there is no way to know if this was the best strategy. Like my Dad, though, I have tried to be the best friend I could be to those who were with me at any given time.

Today Facebook has made it rather easy to re-forge ties, however delicate the fibers may be. These tiny, tenuous connections have me very curious about my childhood mates in both towns. Much to the surprise (and amusement) of my family I have found myself moving all kinds of the chess pieces of my life so that I might attend both reunions. Who will I meet when I do? With the exception of a very few people I still do chat with, so many years have passed that literally everyone I see will be someone I am pretty much meeting for the first time.

40 years is a lot of years of growth and change.

Who will my classmates be meeting when they see me for the first time in at least 30 years (I went to one school’s 10th)? Judging by a post on our Reunion FB page in which a classmate unearthed some commentary about our class from graduation day I will be largely unrecognizable. You see (and this gets back to who you think you are and who others see you as being) what I once thought of as self-assurance and confidence came across (to some people at least) as self-centeredness and arrogance. This is not really a revelation mind you, nor is the re-appearnace of this item from Graduation Day distressing. I’ve long held that I was an arrogant putz when I was a young man, although that may have been a part of whatever successes I may have accrued over the years; I pretty much always assumed I was gonna turn out OK.

What does bother me though, at least the me of the last 20 or so years, is the possibility (probability?) that my younger self may have run roughshod over people who didn’t deserve anything rough out of me at all. That does make me sad, frankly. You see, a large part of my own personal development, the ongoing changes to the person I try to see in the mirror (and project for any and all to see in me) is a foundation of kindness in all that I do and in all that I am. It’s hard–no, impossible– to be good at all times, and I’m not sure at all that you can be truly kind always and everywhere. But you can try, and it is in the trying that I have evolved over the years.

Who will my classmates remember as they think about our upcoming reunions? Will our memories of the children we were be so strong that we will be prevented from seeing the adults we have become? Regardless it’s been an interesting part of the journey to be reminded of who people thought I was so long ago and to peruse the pages of each intervening “Yearbook” as I’ve gone from cocky teenage jock to whatever it is I am today.

Wow. 40 years.

Fitness or Sport? A Proper Place For High Intensity Training

The CrossFit Games Regionals were on ESPN yesterday afternoon. What? Wait. No? No, I guess you’re right. It wasn’t ESPN, was it. As it turns out the Games have shifted over to CBS Sports. Totally missed that memo. Of course, I only surf to the Games site once or twice a week anymore so I can be forgiven. Thankfully I was marooned at home with nothing left on either my Honey-Do list or my own Wish List, and ESPNU was all kinds of messed up so I couldn’t watch the D1 Lacrosse quarterfinals. Surfboring around cable I stumbled on the Regionals and received my annual reminder about what CrossFit is and who is supposed to do it.

In short the CrossFit Games as exhibited in this year’s Regionals is to CrossFit as the Indy 500 is to your daily commute: almost everyone needs to do the latter, but almost no one can, or should, do the former.

You could certainly say that I am treading on thin ice by proclaiming that you and I have no business doing anything but gawking at Regionals athletes doing full-on Regionals WODs here on .com. Fine. Here is why I feel this way; the incessant urge to emulate Games-level athletes and to turn every CrossFit WOD into a training session for competition risks the undoing of what makes CrossFit (and other high-intensity offshoots) a potential solution (or integral part of an irreducible Rx, to coin a phrase) in solving the population health problem in Western societies. It really could be as easy as eating fewer processed carbohydrates, being stronger, and training at relatively high intensity for periods of time in the 8-20:00 range. Stronger and leaner with greater aerobic capacity is all pretty much any of us needs.

Everyone who has ever owned a Box or coached a CrossFit class has seen the danger of extending the “you vs. you” competition outward into the “Sport of Fitness (TM)”. Clients who leave a gym because the trainer refuses to teach them how to do a CTB butterfly PU when they can barely do a single dead hang PU. Fledgling CrossFitters who insist on rebounding box jumps instead of stepping down because their times suffer when they do. “Linda” or “Diane” done As Rx’d with rounded lower backs, chins held high because, you know, you gotta Rx the Open WODs if you want to go to the Games. It’s really hard to exaggerate how disheartening it is to listen to a client say they are leaving a gym because they don’t feel like you are the best fit for them. Then you look at their data and discover that they are down 15% BW fat, have doubled their 1RM Deadlift, can now do “Fran” Rx’d in half the time they first did it with an empty bar and a green band, all injury-free.

Form, then consistency, then and only then intensity. This is what you need for fitness. The siren song of competition is strong, especially during our Games season. Shout out to those trainers, both within the CrossFit business universe and out, who continue to hue to this orthodoxy. Functional movements, irreducible exercises performed properly at a level of intensity that is high for an individual, coupled with a diet that is designed to fuel performance in the gym and in life is what we 99.9%’ers need. Distilling this prescription into a measurable and repeatable program is the essential genius of CrossFit. That some of us get to do it as part of a community is that much better; friendships formed through shared experiences, especially shared strife (and what is “Fran” if not shared strife), are also an integral part of being healthy.

After my (ca. 2006) WOD I sat down with some left-over steak and a handful of nuts to see how Dani Horan was doing in the East. A little sore and energized, the only thing that was missing was another CrossFitter there to join me in watching the spectacle.

Professor Dunbar Says To Call Your Mom

Professor Robin Dunbar poses that the maximum number of individuals with whom a human can maintain social cohesion is 150. Hence, “Dunbar’s Number”. Essentially “social cohesion” means that you have some degree of awareness of who another person is beyond simply their name and their Twitter handle. Further research seems to show that we can follow 500 acquaintances (we know a bit more than just their name; for example, we might know to whom they are married), and we can match some 1500 faces to names. As I’ve written before we then cone down through various circles (friendly acquaintances, casual friends or “buddies”, close friends, and best friends), and there is a nearly constant movement in and out of all but the closest inner circles. (HT NYT and Teddy Wayne for the reminder).

How has electronic communication altered this dynamic? It turns out that there is rather little change in the numbers involved. Weird, huh? You’d think that FB, Twitter, Snapchat, and Messenger would have increased the numbers but in fact Dunbar’s more scientific rationale–the size of the neocortex determines the number of contacts–holds true no matter what type of communication connects your network. Dunbar does have some thoughts on SM and its effect on relationships and they can be summed up thusly: remote connections maintained electronically crowd out the possibility of newer, closer friendships created locally and in real time.

My bet is that you can easily confirm this in your own groups as I did just the other day. A friendship 15 years in the making, one that was probably on the border between “buddies” and close friends, has been on the wane after a retirement and subsequent move south (and up), it’s gotta be 10 years ago now. A (very) brief interaction around a death in the family is the sum total of our engagement for a couple of years, yet I have managed to remain connected through occasional social media “engagement”. What remains of our friendship is my memories of times together, and perhaps warm feelings on both sides when those memories arise.

But Dunbar is right; mourning the friendship that was keeps the slot occupied and therefore unavailable for a more intimate, current, local friendship.

Key to all of this is the “how” of our interactions. Mrs. bingo and I organized a spur-of-the-moment Happy Hour at a local bistro that turned into a raucous up too late bacchanalia with our inner circle. Cell phones were pocketed throughout (with the tacit agreement that we could text if our kids reached out) and we hugged each other, punched shoulders, and shared all manner of concoctions through the night. Yes, it all started with a group text, but that was simply the flint struck to light the campfire for the evening. We were together in the realest sense of the word.

How can we further combat this “crowding out” effect of modern electronic communication brought on by the availability afforded by our ubiquitous, irresistible smart phones? Easy. It’s in the name of the tool: phone. Short for telephone. Initially “cell phone” after the towers that were first erected to transfer…wait for it…telephone calls. VOICE! Voice, once taken for granted, has now become so exotic that I have been informed that I must first make an appointment to call someone on the phone. Indeed, the voice call is only slightly less rare (at least between friends) as a handwritten letter.

Therein lies the solution my friends. Your handheld computer is a telephone. It’s not even all that retro: Captain Kirk famously spoke into his communicator (“Beam me up, Scotty.”) in the future of Star Trek. Call your friends. If that seems a bit too anachronistic or archaic indulge in a video call. Hear them/see them between those occasions when you can shake hands or hug. More voice, fewer posts/texts/messages/snaps/tweets, especially for anyone in the “buddy” circle or closer.

Now, get off the internet and go call your Mom.

Forgiveness for the Tiresome

“We forgive those we find tiresome, but not those who find us tiresome.” –Duc de la Rochefoucauld

The capacity for forgiveness is nearly bottomless in humans. One need only think of the indignities piled upon children by indifferent or self-absorbed parents (Mommy Dearest, etc.) that are barely remembered by adults who love and cherish those same parents. Best friends regularly forgive transgressions directed toward one another, often to a point of irrational amnesia. “Tiresome” could be a synonym for “difficult”, the fatigue implied being that which follows the effort necessary to be in the company of such an individual. We tend to be tolerant of all types of behaviors that could be so described in all types of folks for all types of reasons, don’t you think?

Ah, but if someone else let’s on that it is YOU who is the tiresome one at hand, that is quite a different kettle of fish, eh? To be found tiresome by someone else, especially someone else whose company you’d like to keep, is to be found undesirable. Not just wanting in some respect, lacking in some regard, but somehow not worth the effort. Something about your very essence is literally too difficult to deal with to even try.

There is a tiny little silver lining here, of course. Sometimes each of us may, indeed, be tiresome. This silver lining comes with a tiny caveat: if we have become tiresome through the development of some newer activity or belief, one who now finds us newly tiresome may actually be doing us the favor of alerting us to the effect of our new self. However hurtful the revelation might be we are afforded the opportunity to reassess the importance of our latest evolutionary change.

“Must we really talk about your post-WOD vegan recovery shake? Again?”

Unforgivable? Perhaps. It probably depends on who it is that has found you tiresome in your evolved state. We all, in some way and at some level, want to be liked by those who we find likable. What Rochefoucauld finds unforgivable is that some part of our very essence is tiresome to another. This likely occurs quite often, but another quite human trait shields us from the indignity: humans tend to shy away from cruelty at close quarters. They may not necessarily be kind, but at their core most people are not cruel. We understand that to say out loud that you find another person “tiresome” is to choose to wound that person. However tiresome we might find a particular behavior (e.g. dissecting your “Fran” performance with a non-CrossFitter), it is quite different to find and declare an entire person to be “tiresome”.

In my long and eventful life I believe I have been wronged on occasion. For the most part I have forgiven, or at least made an effort to forgive even those who have found the whole of my being to be tiresome. At that I have been mostly successful, though I confess I never forget. For any times I may have slipped and declared someone else tiresome I ask your forgiveness.

I understand if it is not forthcoming.

 

The Kids Are Alright

If you are of a certain age, and for sure I am of that certain age, you remember a time when young people were given the latitude to learn from their mistakes. More than that, though, is that young people were routinely forgiven for having made those mistakes. There was a kind of statute of limitations if you will. Stupid stuff you did or said as a teenager was wiped clean from your “record”. Heck, if you met a young person who seemed to have made it through without making any of those typical dumbass kid things you were a little skeptical.

Not so much anymore, eh? In this day and age of foreverness of every action and every uttering it sure seems as if we are no longer willing to let kids learn from their dumb kid mistakes.

Several of the boys who were drafted by the NFL last week are perfect examples. One of them said some stupid stuff on social media, got smacked for saying it, and has clearly expressed that he is aware that he was a knucklehead. Another chucklehead had a car accident, and yet a third had a beer or something, got caught and received the logical immediate consequence. There were a dozen similar stories. From the looks of it each one ended with lesson learned. Why, then, do I know about all of this when we are discussing 20, 21, or 22 year olds who did this dumb stuff when they were in high school?

Youngsters are impulsive and impetuous and they make decisions that are absolutely baffling to folks who are…ahem…less young. The elders on the ground are supposed to teach kids that all decisions have natural consequences in the hope that they will make better decisions. Once they start making better decisions it’s time for all of the rest of us to wipe clean the hard drive and stop piling on with punitive consequences that no longer make sense. Let’s let kids learn from their mistakes when they are young, like we did. Most of it is harmless if they do, indeed, learn the right lesson. Should you really have to account for that speeding ticket you got at age 18 during a job interview when you are 50? Your Dad took the car away for 6 months and you haven’t had a ticket since.

The kids are alright. Cut ‘em  some slack.

Remembering My Gama*

Admit it, you cried too. You found yourself in front of the TV for whatever reason at noon on April 21, 2018 and watched the Bush family say goodbye to their matriarch. My Mom turned 81 on April 21st, and quite frankly I am not ready to think of her being gone. Not even a little bit. So I watched the grandchildren. Rather than putting myself in the minds of Mrs. Bush’s children I channeled her grandchildren. Listening to Jeb Bush describe “Ganny” sent me back in time to the days when I was the best-loved grandson in the history of all mankind.

My birthday is January 7th, 1960. Gama was “born” about a year later–I couldn’t get my one year old tongue around the word “grandma” and it came out “Gahmmah”. Now, the White family is really big on precedent, and since grandchild number 1 called Mom’s mother Gama, Gama it was for everybody. Subsequent grandchildren, great-grandchildren, friends, neighbors, heck a few Romans who lent an ear for all I know, called Jane Knopf “Gama”. (This precedent thing turned out to be not so good in the next generation when my nephew, grandchild number three, called my parents “Bam” and “Bamp” and it wasn’t allowed to stick, but that’s another story.)

As the first grandchild in my Mom’s family I had the perfect set-up, and the fact that I was the first male in a generation didn’t hurt one bit. My brother was born 17 months after I was, and with the two of us so close together it was apparently a burden for my folks. Turned out to be quite a break for me, though, because my brother was born in May; at the end of June I was shipped out to stay with Gamma and Gramp at the Jersey Shore, the first of countless solo visits with my grandparents. Thus began a most privileged relationship with my maternal grandparents, especially with my beloved Gama.

It’s hard to describe, especially in these days of ultra mobility where extended families live apart, how critical it was to be loved by a family member without condition. Accepted and supported with no strings attached. Time spent with Gama was time spent in a guilt-free bubble. You behaved because it just felt so good to be in that bubble, and if you misbehaved forgiveness came in waves a very brief instant after any punishment. I visited my grandparents for weeks at a time, especially in the summer. My aunt Barbie, 16 years my senior, made it OK for the rugrat to be around even though I was clearly messing up her “only child” status in the house. Those were good times. I had a very special and unique relationship with Gama and Gramp. If I close my eyes and it’s very quiet I can still hear them…”Dar”.

Apparently everyone in my family saw what a special relationship I had with them and sought to preserve and protect it. It does no good to share any family secrets, but every family has some, eh? I was the last to discover any of the family’s darker secrets, long after my siblings, long after the cousins 10 and 12 years my junior. I was 30 when my aunts visited us in New York at the end of my residency years when I became aware of how much I’d been “protected” over the years, protection so effective that any present day revelations cannot dim or diminish the memories of my life with Gama and Gramp.

We lost Gramp when I was around 17  when he succumbed to his nth heart attack. That whole time is really just a blur, from the phone call I took in Rhode Island with the news from my uncle to the memorial service in Miami where I stood next to Barbie as she tried to read her farewells. What I remember–indeed all I really remember clearly–is Gama saying over and over, “I didn’t get to say ‘goodbye’.” I didn’t get to say ‘goodbye’ either. Maybe that’s why I can still hear Gramp every now and again…”Dar.”

Gama stayed in Florida at King’s Creek for a couple more years, living in the same apartment I’d visited so many times. I even made one last solo visit when I brought my new college buddy “Kid” for a week of spring break fun during freshman year. Every family seems to have one adult who’s cool, don’t they? Yours does. Admit it. There’s a parent or an uncle or a grandmother who’s just cooler than all of the other adults, right? Well, in our family it was Gama. My Gama was cool! As the years went by as more and more of our friends got to know her it seemed she just got cooler. Just ask Kid.

It turns our that Gama was ALWAYS cool. She entered college as a pre-med student in the days when women did not become doctors. Almost got away with it, too, until her mother found out and transferred her into education. She dated the gay boys when she was younger because they took her to the best clubs and they were the best dancers (and she didn’t have to worry about getting pawed on the train home from New York).  Yup, Gamma was cool.

After a few solo years in Miami Gama moved in with my folks in Rhode Island, spending several months each year with my aunts and their kids in Florida. She never called us just by name, it was alway “MY Dar”, my Ran, my Tracey, my Kerstin. My Jenny, Rick, Mike or Ed. All eight grandchildren now clearly had a unique and special relationship with Gama since she was now living with all of us. She was still my biggest fan, my brother Randy’s defender (Ran was the “black sheep” by choice when we were younger), Tracey’s cheerleader and Kerstin’s confidant. Even though I can’t describe them as well I know that each of my Florida cousins had some version of that same specialness.

Some time ago, I was in my early thirties, Gama fell and broke her hip. Word came from the hospital that she was failing–a broken hip is often the end for older women. Beth called me on the way to the OR to do cataract surgeries. Numb, stunned, I couldn’t think. I did what we have always done in my family, I went to work. It was Beth who knew better, who cancelled my patients and put me on a plane to Miami. Beth who let everyone know that I was on the way, alerting everyone in Florida when I was delayed in Greensborogh so that Barbie knew where to to leave the message. I sat sobbing in the airport after the  gate attendant told me Gama had died. I wouldn’t get to say goodbye.

My Mom and I spoke at the memorial service representing the children and grandchildren, Mom all icy control, me crashing, burning and choking my way through. I told one of my favorite stories, the one about the little girl who was standing in front of her grandfather’s casket, stomping her feet, clearly angry. “He can’t be dead. I wasn’t done with him yet!” That’s how I felt when Gramp died. I think if we’d had the chance to ask him Gramp would have told us that he wasn’t really all that done with US when he died, either. I definitely wasn’t done with Gama, either, but Gama was done with us. She was ready to go, so long after Gramp left, so long living alone among all of her special grandkids. I said then, and I still wish to this very day, that she hadn’t been in so much of a hurry. I would very much have liked to say goodbye.

Maybe that’s why even now, when it’s very quiet, if I close my eyes, I can still hear her…”Dar.”

 

*In our family there is some question about the proper spelling. Since she signed all of her cards and gifts “Gama” I’m going with that.

There Are No Small People

“But players don’t feel like bit players in their own lives.” –Richard Russo

Oh man…how good is that? Every life is just huge if it’s you who is living it. Every story suffers or soars depending on the frame of reference of the author. The eyes and ears of the storyteller only catch so much, and some of what is seen or heard never makes it past the “bit player” level in the story that is eventually told. This is what Russo refers to.

There are short stories, but there are no small stories. There are quiet lives lived with little or no acclaim, but there are no small lives. There are people who move as if shadows among giants, but there are no small people.

Thoughts on the U.S. Health Crisis

We are looking at a true health crisis in the U.S. In 2015 some 40,000 Americans died from opiate overdoses. This is more than the number of deaths by firearms by a factor of 4, and is similar to the number of deaths in automobile accidents. I recently read a startling statistic: 7 million working age men are out of the employment market, and 1/2 of them take painkillers on a daily basis. Crazy, huh? Add to that the ever-expanding waistline of the average American and we have a kind of Double Jeopardy.

We can agree that there is a general crisis of health in the American populace stemming from over-consumption of calories (most of which are high glycemic index carbs) and under-consumption of physical activity. This week has brought several long discussions about the “failure” of American physicians to prescribe physical activity or exercise as a treatment for this. An equally startling story in this week’s news is the growing acceptance of excess body weight fat as some kind of new normal, a normal that should somehow be institutionalized. In this discussion one must add the overconsumption of alcohol, because countless studies have shown that this legal substance is responsible for all kinds of negative health effects, both direct and indirect. (As an aside, it does give one pause when one considers the possibility of legalizing another neuro-depressant, marijuana, the association with lower opiate abuse rates notwithstanding). As if this isn’t enough, we now must add to this toxic recipe the ingestion by any route of opiates.

The U.S. is regularly taken to task for its failure to sit at the top of the world’s life expectancy leader board despite spending the largest amount per capita on healthcare in the world. This criticism becomes more and more unreasonable as we dive further into what it is that actually drives statistics such as life expectancy. Deaths from overdoses are illustrative of the folly of conflating health and healthcare: there is nothing in the healthcare system of treatment that drives this statistic, and the death of these primarily young people has a disproportionate effect on the life expectancy statistic in which it is years lived that we are counting (and losing).

What, then, is to be done, especially in this setting here of health-conscious individuals? It behooves each of us to take a bit of personal responsibility in the discussion and pledge that we will utilize accurate nomenclature, and in turn demand that everyone else in the conversation do likewise. Health and healthcare are not synonyms. Likewise, healthcare and health insurance (itself somewhat of a misnomer) are not the same; one does not lose healthcare when one does not have health insurance, and for certain the ownership of a health insurance policy does not guarantee one access to healthcare. Indeed, because the outcome was inconvenient to the majority of entrenched healthcare interests, the landmark study of Oregon Medicaid recipients that showed no improvement in health outcomes in those with Medicaid compared with those without has been mostly ignored and purposely forgotten. We need to engage in this conversation, but do so with strict fidelity to meaningful terms.

From there we should lead in whatever way we can. Despite the pejoratives leveled at my physician colleagues and their exercise prescribing habits, this effort is not at all about the treatment of disease, at least not as far as we here are concerned, but rather one of Public Health. There are quite specific areas to be addressed if we wish to effect change. Each one must be subjected to a root cause analysis. Overconsumption of low-quality carbs is near and dear to anyone concerned about public health, and the battle against “Big Soda’s” influence has been engaged. Other influences such as agricultural subsidies should have a similar bright light shined in their direction. How is it that the dramatic reduction of drinking and driving has failed to render deaths from drunken driving a statistical anomaly? Perhaps someone can convince one of those know-better do-gooder billionaires globe-trotting in search of a trendy problem to throw money at to look a bit closer to home when they apply their famous intellect to new thinking about old problems.

As to the tragedy that is opiate overdose deaths, can we please have someone with no skin in the game be given no-risk access to any and all applicable data and just turn them loose? Some guy did a deep dive into the issue of scrubbing the internet of all vestiges of child pornography using a combination of massive computing power and an outsider’s view. Give someone like that the ability to examine the entire opiate ecosystem to uncover some of the hows and whys so that we can make some decisions of the whats of our response with more than just our typical SOP of some self-designated, conflict-of-interest-infected expert who declares that his/her solution should work because of what they are sure must be going on. This seems to be a new thing, opiate overdose deaths, and of the rather young, too. Prior opiate societal infestations surely share some aspects with our present crisis, but I don’t recall the opium dens in the days of the Crusades so routinely offing their customers.

Anything that can be measured can be analyzed. Anything that can be analyzed can be altered utilizing the results of that analysis. What is needed is the double-edged sword of courage to uncover an unpleasant truth, and strength to set aside all manner of short-term personal gain in favor of a long-term solution for societal benefit.

We ought not let 40,000 lives representing hundreds of thousands of years not lived to be lost in vain.

Dial Tone

There are a couple of broad-brush themes I find myself drawn to, things I find myself visiting with some regularity. Communication is one of them, and this week the specific thing that came up several times was how you might choose to communicate with a particular person or group of people. There’s always a trigger for these ruminations, this time the jarring interruption of an examination in my office by a ring tone that my patient surely thought was quite clever and altogether appropriate for any and all occasions. Yeah. No. Especially not while sitting in the exam chair in front of a doc who pointedly does NOT carry his cell phone while on the job.

We all got to talking about what cell phones have become and how we use them. A bit later in the day a patient was lamenting the presumed need to carry a smartphone with all of the attendant capabilities and inferred responsibilities and demands. You know the drill: each text is mission critical and cannot be ignored. An answer must be on its way before the backlight on your phone dims. You no longer have the answer to any question literally at the tip of you fingers, you now have the obligation to GET that answer, right now, lest you end up with questions in a queue. Questions have rights, too, in the age of the smartphone.

It’s insidious and seemingly irresistible, even for a guy who hangs his cell phone on a peg in the office (like a gunslinger entering an old West saloon). The “gotta answer” text now more compelling than a phone call ever was before because you can answer that text so quickly, almost…ALMOST…without interrupting whatever you may be doing otherwise. Unlike a phone call, where you must break away both attention and voice in order to communicate with someone who is not right there with you. Texters are now to the point where you need to text and ask if it’s OK to call. I must admit that even though I am nothing short of terrible at the physical act of texting (my auto-correct is in therapy with self-esteem issues) I, too, have been seduced by the ease with which a thought/need can be sent off RIGHT NOW, saving me the angst that would occur if I somehow forgot to transmit that thought/need if I had to remember it for a later transmission. I found myself becoming annoyed that my Mom doesn’t text (or email, but that’s a whole ‘nuther thing) because if she did I would never, ever forget those mission critical things I was supposed to remember and report.

But then, of course, it hits me: some people are always worth the effort of a phone call, even if they DO text (or email). In the natural evolution of communication a phone call–a real, live, use your voice and your ears phone call–has become as significant a gesture as hand writing a letter once was. Some things you just have to say out loud, and some people you just have to call up and talk to. You don’t text your grandmother to tell her about your first big boy/girl job after college. Your grandmother is worth a call even if you’re just telling her you remembered to pick up orange juice. Your Mom and Dad, POSSLQ, doctor, the guy who’s fixing your toilet–if these people want or need a call, a call is what they should get. Some communication is nothing more or less than a transactional transfer of information, while other communication is much more personal. Truly effective communication occurs when both sides are in agreement about what type of communication is occurring. Every communication with my Mom, for example, is personal, and would be even if she had and used a Galaxy whatever. As a matter of fact, even a phone call with my Mom is a kind of compromise as far as she is concerned because I am not able to just drop by to catch her up on whatever it was that she tasked me with reporting. Indeed, face to face communicating trumps even the handwritten note for immediacy, engagement, commitment, and conspicuous effort.

I was able to communicate with my patient just how I felt about that phone going off in my exam room with one eyebrow tied behind my back.