Random Thoughts from a Restless Mind

Dr. Darrell White's Personal Blog

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Hugs, Kisses, and Cultural Norms

It takes very little effort to observe the intersection of cultural norms. Indeed, it takes a substantial effort NOT to notice them when they collide, as they must, in the polyglot that is the United States. Physicians, it’s been noted, are little more than paid observers; I see these collisions daily. What are we to do when cultures collide?

Now, I’m not talking about the “old as eternity” cultural divide between teenagers and their parents; in the end the teens will either hew closely to the cultural norms of their heritage or fall more in line with those of their present address. What I am interested in are those cultural norms that remain an integral part of the fully formed adult one might encounter in a rather typical day, and by extension whether and how one should respond to any cultural dissonance. Or for that matter, WHO should be the one to respond.

It’s the tiny ones that catch my attention. Personal space for example. The typical American personal space extends one arm length between individuals. Something shorter than a handshake, more like a handshake distance with bent elbows. The Mediterranean space involves an elbow, too: put your hand on your shoulder and point your elbow to the front and you have measured the personal space of a Sicilian. Asians on the other hand occupy a much larger personal space that can be loosely measured by a fully extended fist-bump. Something which would be anathema in polite Japanese company, but no matter.

My favorite little example of the variety of cultural norms that swirl in the soup of the great Melting Pot is the affectionate greeting. You know, what most fully acclimatized Americans would recognize as the “bro hug” shoulder bump and clasp, something that would be appalling to a Parisian or Persian, or indeed even to a Princess of the Antebellum South. Yet even here there are differences. The Princess, joined by legions of Housewives of Wherever and Junior Leaguers everywhere are ninjas in the practice of the single-cheek air kiss. It should be noted that ~90% of men are NOT ninjas in this particular art, and are expected by its practitioners to bungle the act.

Persians and Parisians, on the other hand, find the one-cheek air kiss to accomplish only half the job. They, and others who share centuries old cultures, warmly greet each other with a two-cheek kiss. I am sure that there are nuances involved here that remain unseen and unknown to both most men and certainly most (all?) who don’t share the heritage. (As an aside let me just say that I am a huge fan of this particular cultural norm because it means that one of my very favorite colleagues, Neda, always arrives bearing TWO kisses).

So what’s the point here? Two, I think. First, there is a certain boorishness in the failure to observe and recognize the existence of these cultural norms when they are encountered. Some, like those I’ve mentioned, are the relative equivalent of a soft breeze, neither strong enough to fill a sail nor de-leaf a tree. Recognizing them, even in the tiny manner that one tries not to trample on them even if they will be ignored, is a tiny gesture of kindness, respect, and courtesy.

The flip side, number two, is deciding which of these norms is the default setting. Here things get a bit stickier, especially when cultural norms run afoul of SOP on the particular ground they occupy. Think air kiss in Afghanistan, for example. Bowing in the boardroom of Samsung in San Clemente. There are more, and bigger examples, but you get the idea. Here I think geography holds the trump card: “when in Rome” should be your guide, especially with cultural norms where the collision may be substantially more impactful then whether or when you turn the other cheek, a tornado to the above tickling breeze.

If only we could agree on the universal appeal of the two-cheek kiss.

Sunday musings 10/9/16: Grateful

Sunday musings…

1) Camping. Recreational homelessness.

2) Enough. Perfection is finally attained not when there is no longer anything to add, but when there is no longer anything to take away.” Antoine de Saint Exupery

3) Khakis. As in the khakis that somehow didn’t make it yesterday morning on the way to the airport. Per Mrs. bingo they are right where the rest of the pile was before I crammed it into my backpack.

Did you know that Target is open at 0800 Sunday mornings?

3) Grateful. A quorum of the White family congregated in Rhode Island this morning to mark the 1-year anniversary of my Dad’s passing. Appropriately, the main event was Sunday mass in the tiny little Catholic church of my youth. Rock hard wooden pews with a 90-degree angle, just to make sure you suffer a little every week. We arrived 20 minutes early to make sure that Grambingo could sit in the front row.

Even the priest made fun of us.

Father is that (now) rare priest who reads far outside the lines and then brings his reading to the homily each Sunday. Today’s gospel was about gratitude, and Father’s take on the topic lined up perfectly with how we were all feeling about the day. You see, my Dad was a medical train wreck, a disaster just waiting to happen for about 3 decades or so. We, his family, were on borrowed time since a bypass surgery went off without a hitch in 1985.  Kinda like 30 years of extra time on a pinball machine. We were playing with house money.

Funny thing: not a one of us took any of that for granted. My siblings and I, our children, and of course Grambingo have been forever grateful for all of that time with Dad. No one was more grateful than he was, though. My Dad and Arnold Palmer were contemporaries. The great writer Dan Jenkins once said of him that no one was ever happier with his life than Arnold Palmer was with his. With all respect to both Messrs. Jenkins and Palmer my Dad was certainly at least as happy as Arnie.

When I read about Arnold Palmer, his life and his family, I see my Dad. Each day was a new and wonderful adventure, a unique gift that was as unexpected as a Depression era gift under a Christmas tree. Big or small, each daily victory was another reason to be thankful. Being grateful was the default setting for a man who began each day with enough. The lesson is very, very powerful.

Perhaps unconsciously channeling Saint Exupery Father finished by describing the most simple, elegant prayer yet written. “Thank you.” For all of the sadness that each of us has felt this past year without my Dad we are, each of us, grateful for the privilege of having had him in our lives for as long as we did. Each day he showed us what gratitude looked like. “Perfect” is likely unobtainable, but we can always choose to be grateful.

Thanks again, Dad.

I’ll see you next week…


Fall Weekends Free of Football

My son Randy texted me about the exciting finish to a Saturday college football game. It made me smile. Not the result, not even the topic, but the excitement. A parent is only as happy as his least happy kid, and at that moment one of my kids was very happy. Randy’s football playing days are long behind him, but the game still brings him joy.

Me? Not so much.

Oh sure, there was a time when football never seemed to be any lower on my list of wonderful things than number 2 or 3. I was a medium-sized fish in a puddle as a high school football player, but still I didn’t have the game out of my system when I graduated. Accepted at one Ivy League school and waitlisted at another, I turned down both because I was too small to have any chance of playing football at that level. Instead I went to a very old, very small school and played a some all 4 years. Now done as a player once graduation came, I was nonetheless still enthralled by all other things football.

Many of my closest friends were met on the freshly cut football fields of my youth. Wins and losses followed on those fields, most of which I’ve long forgotten. Indeed, I’ve written before that it is only the losses I remember, especially those that resulted from some personal failure in a game. A fumble, perhaps, or a blown coverage. And yet there is no escaping the fact that those countless hours at practice, in the locker room, and on the field are in large part responsible for who I am, the adult I’ve become.

It’s a powerful thing, football. The game itself is exhilarating to both play and watch. At least, it was. I find myself finding all kinds of reasons not to watch football games now. Not consciously finding “big picture” reasons so much as tiny reasons, like Beth wants me to tag along to the barn, or Abbie the world’s smartest (and most easily bored) dog would like an adventure kind of reasons. Football of all sorts played at any and all levels has sunken to a kind of triviality, easily trumped by a trip to the grocery store. Indeed, my fall weekends have been liberated.

No one thing is responsible for this falling out of love, as it were. This fall is different from the last, and the one before only in that it is now glaringly obvious that football holds for me no essential attraction by itself. Looking back my only surprise is that it took me so long. Why didn’t I begin to turn away as my friend the ER doc buzzed through my other son Dan’s shoulder pads with a saw in order to get him into the MRI? Or when I walked onto the field after Randy knocked himself out cold with a helmet-to helmet tackle to force a fourth down, his first concussion? I was still young, still sure that the game would bring my sons what I thought it had brought me.

I see them now, both of my boys, face down and immobile, and I shudder. I started to see them each time I saw a player go down in high school, or college, or the pros. I began to see that I valued those young men nearly as much as my own boys, and I started to notice that the game of football had become The Game. Those entrusted with The Game did not–do not–appear to share my feelings about the players. Any of them, at any level.

The junior high coach carries the star running back to the bench, there to wrap the sprained ankle in the hope of returning him to the game. In a high school freshman game, a rout, the first string defense is still on the field in the fourth quarter, the opportunity to play in a game slipping away for kids on the bench who may never get another chance, when the starting safety goes down with a severed spine on a play he should have been watching from the sideline. They were up by six touchdowns. SIX! They’re freshmen. What was the first string learning at that point in that game?

Alumni and athletic directors and coaches at colleges noted for academic excellence openly opine that they cannot win without lowering the admission standards for football players, and just as openly run those kids off the team and out of their scholarships when they are no longer needed to win. The game in the NFL becomes ever more violent, with ever more gratuitous violence magnifying the carnage wreaked upon the bodies of the players. Ex-pros roam the earth as a kind of walking dead.

When did football become The Game? When did the keepers of the game become keepers of The Game? When did football players as young as high school become little more than a modern stand-in for gladiators thrown into the arena for no more than the amusement of the many and the benefit of a tiny protected few? I’d like to think that there was such a time, an inflection point, when it did change, but I fear it has been ever thus. If that is so then I, too, bear some responsibility for what The Game has become. I did not turn away, or turn my own sons away, at the time of my own dawning awareness that The Game and its keepers cared naught for our sons at all, but only for themselves and their respective place and privilege.

There was a time when my playing days were long over when I still found myself on edge as the weather chilled and the smell of cut grass filled the autumn air. It was time to get ready to play football. Those days are long past, and I find that I no longer even think about watching, indeed can no longer see myself watching, except as a vehicle with which I might channel the joy of a child. And this is perhaps why: I can no longer watch a game whose keepers have lost sight of the fact that someone’s child plays in The Game. I am a man who consciously strives to live a life free of regret, but I regret that I lacked the courage to say “enough” when my own children played.

One wonders about the parents of gladiators past.

Population Health v10.0

There is a certain arrogance in the academy, that vaunted group of professors who opine righteously from afar about pretty much anything they study. Add to that the well-known arrogance of youth with its inherent disregard for any and all history which transpired before the youthful reached the age of cognition and you have either a toxic combination of ignorance and impetuosity, or simply a laughably vacuous collection of paper thin pontification. Such is the case with a series of statements quoted yesterday morning from a lecture given by a young academic physician on the state of population or public health in America. He posits that there is a new movement toward moving healthcare from inpatient to outpatient. There is an equally new and heretofore unseen effort to make people healthy rather than treat them when they are not. This young doctor is calling his observations Population Health v1.0.

I’m calling it Bullshit.

The lecture in question was being live-Tweeted, but that is probably the only thing about the subject matter that can reasonably be v1.anything. Instantly available dissemination of medical information to a general audience is a truly new phenomenon. With it comes the danger of the wider audience simply accepting the information since it comes from an “expert”. However, along with the relatively naive broader audience we thankfully have a small subset that is either a) informed enough on the topic to offer a “con” opinion, or b) simply old enough to remember that there is a deep and meaningful history that predates what the young expert is proposing as new. Count me as able to check c) both of the above.

Population Health is simply a better term for what historically has been known as Public Health. While Public Health typically connotes some sort of governmental involvement, Population Health is a more inclusive, more powerful concept because it includes not only government programs but also private initiatives of all kinds. Public Health typically equates to top-down implementation of global governmental policy, whereas Population Health covers everything from large for-profit publicly traded companies to the tiniest solo-practice pediatrician. In fairness to the speaker (and in a kind of peace offering for what is to come) I do think his choice of a label is spot on. The rest of his thesis and its development? Not so much.

There is literally nothing new in the entire exposition. How can you call anything v1.0, the first iteration of something that is truly new, if everything that is used as an example is simply today’s version of yesterday’s news. Let’s start with his primary assertion, that there is a new move afoot in which healthcare is only now being provided in the outpatient, rather than the inpatient, setting. This can’t be a doctor who is taking care of any patients in the real world. It is long been the exception rather than the rule that a majority of surgeries take place in an outpatient setting. Heck, 99.9% of eye surgeries have occurred in this setting since the 1980′s. So, too, for invasive testing like colonoscopy, bronchoscopy and cardiac catheterizations of all kinds. It would be much more accurate to state that we are in the end game phase of this transition, v10.0 if you will. For crying out loud, this is such a mature part of the evolution of healthcare in America that any essence of patient-centered care that would require an admission to a hospital is dismissed outright, one more nail in the coffin of that now meaningless label.

How about the assertion that we are only now engaging in a concerted effort to improve the health of our population as opposed to simply treating various maladies? This one kills me. Really? All of a sudden the entire healthcare/government/industry axis is only now finally seeking to improve the general health of our people by preventing illness? Now, in 2016, we have population health v1.0?! That’s laughable. If our young scholar is anything like yours truly, the last stop he made before making his way to the lectern was the loo. HeLOOOoh. Indoor plumbing anyone? You can make a sincere argument that v1.0 of population health efforts occurred a hundred hears ago with the introduction of the kitchen sink and the toilet.

If we confine our discussion to matters more purely medical any reasonable view must acknowledge the tremendous life-saving effect of mass vaccinations for childhood illnesses. Smallpox, polio, and measles each killed hundreds of thousands every year before the advent of widespread vaccination programs. Even efforts which we would now condemn like the sequestration of TB patients in sanitariums must be considered a type of population health program. Despite our modern day fetish with privacy issues, the near elimination of syphilis  in the Western world through mandatory case reporting and contact notification cannot be forgotten or ignored.

When we talk of Population Health in this day and age we are typically talking about mitigating the effects of modern society. Indeed, in cases such as nutrition, we are actually talking about undoing the adverse effects of prior Population Health efforts. The U.S. government either simply got it wrong, or was led awry by a cynical effort by food producers who surreptitiously funded self-serving research. No matter. We are now in possession of a sedentary, overweight population susceptible to once less common diseases that now run rampant. There is little argument that the healthcare community should engage in the effort to keep people healthy as well as treat them when they are not. The notion that this is something truly new is a fanciful notion bred of what must be purposeful historical ignorance.

So, Population Health v1.0? Hardly. A process that arguably began with the invention of the flush toilet cannot be labeled new, no matter how good this makes a speaker, a system sound, or a concept sound. Those who fail to study history may be doomed to repeat it, though in this case there really is no need to do so. Acknowledge the past, make a sincere effort to place your idea in its appropriate slot in that history, and then make a case for your proposal. Have a little humility. There’s nothing wrong with being v10.0. Especially if it works.






A Quick Thought on Measuring Health

Thoughts I’m thinking while following a vacuous, arrogant, self-congratulatory, and epically ignorant of history exposition on public health over on my Twitter feed…

It seems as if the entire world is in search for the magic metric that will allow us to measure, and then manipulate, health. Frankly, I’m stuck in my own search for a metric that combines Fitness (as defined by Greg Glassman), traditional western medical measurements (serum lipids, BP, waist/hip, etc.), and emotional well-being. Wouldn’t it be something if all you needed to do was accurately measure your pulse? What if your pulse, one of the easiest things to measure there is–all you need is a second hand and the ability to count–could predict everything about your health with the exception of bad karma stuff like depression or cancer? More than that, what if you then could be told what your pulse pattern needed to be and how to effect that?

In Scandinavia a long-term study was done on men looking at specific variations in pulse. Resting, peak, speed to peak, speed to recovery and the like were all recorded, and cardiac events/deaths were then analyzed against the data. The result of this research was a proprietary algorithm, the PAI (owned by a company called Mio Global) that posits a direct association between specific pulse patterns and longevity. Indeed, they boldly state that a PAI of 100 equals up to 10 additional years of life, presumably free of decrepitude (reflecting my CrossFit-affected view of life). Imagine for a moment how earth-shaking this would be. Having an actionable metric for health, especially one that is as easily accessible as your pulse, would allow us to critically evaluate a majority of health interventions available.

Nothing is that simple of course, but it is quite easy to envision a pyramid of health, not unlike our CrossFit pyramid of fitness, with a base that consists of your PAI. Layer on whatever you please, but the smart money is that something that looks an awful lot like CrossFit’s 100 words of fitness will be in there somewhere.

I’m off to take my pulse and then do a WOD.


Sunday musings (The Purge)…

Sunday musings…

1) Anniversary. It literally just occurred to me that Clan bingo moved to Cleveland 25 years ago this month.

2) Birthday. The Man Cub turned 1 yesterday. Massive party complete with the latest trend, the “smash cake.”

Still pulling icing out of his nose, and his ears, and…

3) Pro health. Outside mag has an interesting article on the pursuit of ultimate physical performance. Aside from the obligatory dig at CrossFit (“injury factory”), the author’s visit to the Exos group at the StubHub Center (of all places) was illuminating. My reading of the article is that upwards of 90% of what is happening at places like this is precisely what has been going on in the CF competition world for some 3+ years now. Dynamic W/U, an emphasis on mobility, programmed recovery, tightly managed nutrition. There is much more use of supplements as a primary element than traditional CF; I’m not sure if that is necessary for the masses, those of us who don’t compete. The author saw a real, measureable improvement in not only fitness but also applied fitness.

The mic drop, however obvious, came at the end of the article when the author described his slow, inevitable slide back to average. Why? Easy. While he was “in residence” at Ethos the entirety of each day was filled with nothing other than being a better athlete. Back home it was easy to revert to old habits. A missed workout here; too rushed to work on flexibility there. And beer. Beer is a problem.

Being at your peak physical capacity is a full time endeavor for the pro athlete. That, as much as anything, is what separates you and me from them.

4) Purge. In a couple of days we will be one step closer to completing “The Purge”. No, no…not THAT purge. I’m talking about completing the purge of all of the stuff that filled up our larger home with all of its modern storage spaces. Our new home, a tiny 1947 two-bedroom cottage, is 50% to the inch the size of our old home, but it has only 1/3 as much storage. Our purge has partially furnished at least 3 other homes, and the upcoming delivery to “Lovely Daughter” adds another home to the list.

Clothes, art, tchokes…you name it. We’ve been liberated from our stuff.

Have you ever seen George Carlin’s classic riff on “Stuff”? Truly funny stuff (Huh? Huh?), and easily available on YouTube. An entire cottage industry has grown up around the purging of stuff. That’s kinda funny, actually. The concept that you need someone to come in and tell you how to get rid of your stuff. In addition to a few minutes of belly laughs, Carlin gives you the place to look for low-hanging fruit: other people’s stuff! Set a timer, and if them others don’t pick up their stuff, off it goes.

The harder part, if it’s really all that hard at all, is when you are down to the stuff you think you might need someday. You know, like that really interesting, sure to be useful gadget you just had to buy at Sur La Table 10 years ago that’s still in its original packaging. Or those holiday dishes you’ve forgotten to use every Christmas since you got married 25 years ago. Stuff like that. When you literally don’t have a place to put ‘em, this category becomes not at all different from other people’s stuff: if you never used it, it was never really yours, right?

Before I get too self-congratulatory and get injured by patting myself on the back, I should point out that we DO have an attic, and also a tiny little vestigial cellar. Both are filled with unpacked, lovingly examined, and re-packed memories. Sure, I could digitize the photos and upload them to the Cloud. The 55 year old “Teddy Monkey” that hasn’t been cuddled for 2 decades would certainly fit better in an album than a box. It’s here where the line is drawn in our home, that place where “stuff” intersects with memories. Maybe I’m too old school, or perhaps just plain old, but the memories and the things that trigger the memories are safe from the Purge.

The whole exercise has been a helpful and useful one in my never-ending journey on the “want vs. need” highway. Stuff? Firmly on the “want” side of that equation. Every day in our cottage, more joy from less. Letting go of the stuff has also brought me closer to cherished memories, which in turn is bringing me closer to cherished people. Funny, eh? The less room I have for stuff, the more room I come to have for the people who helped me make the memories I’ve been saving. I’m off at the moment to round up a couple of those people, hopefully to create a few more of those memories.

After all, the size of your heart and soul need not be bounded by the kinds of walls that surround your stuff. There can always be room for your memories and the people who made them with you.

I’ll see you next week…


Sunday musings 9/11/16

Sunday musings…

It was a Tuesday. For sure. Tuesday is an OR day for me, and I was with my work people on what looked to be a pretty vanilla Tuesday morning. That’s how you like it in the OR: vanilla. A good day is no memory of the operations whatsoever. A great day is one where you remember some interaction with your teammates, something good or funny or nice.

9/11 was definitely a Tuesday. What I remember is being with one group of my people.

Everything about the day was going just like every other Tuesday. Fast cases with great results. Stories flying back and forth between doc, nurses and patients. Just a joy to be doing my job. Until, that is, one of the nurses came into my room and said a plane had hit a tower. To a person our collective response was something like “huh…that’s weird. How tragic,” and then back to work. Back to normal until that very same nurse came back and said a second plane had hit the second tower. We all stopped after that case and headed to the family lounge, a TV and CNN.

I remember being in a similar place when the Challenger blew up, surrounded by colleagues, patients and families. That’s where I was when the first tower collapsed. After that nothing was normal about the day at all. There is literally nothin in my memory banks about the rest of the morning. I know we finished the cases, but then everything came to a full and complete stop. Clinic hours were cancelled, schools let out, and the wheels of American life ground to a halt. The rest of the day was spent in tracking down my brother (traveling now by car from Chicago to Connecticut), and best friend (stranded in Brazil). The skies were empty for days.

Our new normal had just kicked in.

My parents worried about an attack on our soil from Germany to the east (U-Boats off the coast of New England) or Japan from the west (a friend posted the story of a Japanese pilot who actually fire-bomb Oregon!). As a child our politics and our lives were spent worrying about the specter of a communist attack. As an adult, a father and a grandfather, it is now the fear of Jihad unleashed. The post-Reagan/post-Berlin Wall years of relative peace and security seem so very long ago now, don’t they?

The reality, of course, is that we are far safer than we think we are. Yet our own personal realities are driven by the same psychology that led our parents to fear a coastal invasion, for us to fear Russian bombers. We march on each day, as we must. We march on so that each day’s completion becomes one more tiny victory in yet another long war fought for us mostly between the ears, so much like the Cold War before it. We seek victory once again in the daily act of living our normal lives.

We remember, though. Like I remember that it was a Tuesday. We never forget, nor should we try to forget. It is in the remembering and carrying on despite the remembering that we do our tiny part to honor those who were lost. Today is a day to take a moment away from normal to remember.

I remember.

I’ll see you next week…


Love For, and Loving From My Dog

Pets, dogs in particular, teach us some valuable lessons. We learn responsibility because they depend on us for the essentials of life. Every day we see what unconditional love looks like when we are smothered in puppy love upon awakening. Heck, we get it when we return from a 90 second errand. Some famous someone once noted that a dog is the only creature ever created that loves you more than in loves itself.

And we learn how to say goodbye. Our pets teach us that life is finite. Our love cannot change that, nor can theirs. Before we say goodbye to our people we typically have to say goodbye to one of our dogs. It’s a lousy, ouchy lesson; it’s a measure of their love for us that they typically handle it so much better than us. We are left with memories, and even here our dog teaches us about remembering our loved and lost.

Who, after all, really remembers anything truly bad about their dog?

Wellbeing Is Part of Being Healthy

Some time ago I wrote about creating a way to measure health. Real health. Health that encompasses every aspect of what it means to be alive and well. As a CrossFitter I definitely included Coach Glassman’s Disease -> Health -> Wellness continuum, and I also acknowledged the critical importance of his concept of “Fitness over Time”. As a classically trained physician/scientist there is clearly a place for more traditional metrics like blood pressure, serum lipids and the like, although they may, indeed, be a variable that is ultimately tied to fitness.

Where my thoughts on defining and measuring health seem to depart from most current trends is in the recognition that mental health–emotional wellbeing—is as much a part of being healthy as anything else we might examine.

Think about it for just a moment. Most of what we would classify as mental illness has as many outward signs that we can see as diabetes and hypertension. Which is to say, none. Yet we see nothing but the good in treating diseases like diabetes openly and aggressively. There is no stigma attached to seeking care for your hypertension or your elevated LDL. To the contrary, if someone who loves you discovers that you stopped measuring your glucose before you bolus your insulin, they are for sure gonna get in your grill.

For whatever reason, mental illnesses are looked at quite differently. No one is asking the person with chronic depression whether she is taking her life-saving medication, for example. We might notice an insulin pump on a friend or family member, but then it’s quickly forgotten. Everyone seems to be very uncomfortable around the young man who has very obvious hand tremors from the life-saving medication he takes for his Bipolar disease. We all seem to be so much more understanding when we have to wait for a response from someone suffering from Parkinson’s Disease than from the young women who has those same symptoms as a side-effect from the medicine that quiets the dangerous thoughts in her head from Schizophrenia.

It’s not necessary to look only at these kinds of severe mental illnesses when we are examining the importance of mental or emotional wellbeing as an integral part of being healthy. What good does it do to have a 5:00 mile, a 500 lb. deadlift, and a 1:59 “Fran” if it was self-loathing that drove you in the gym to get there? You may be quite accomplished, the envy of your peers, at the peak of whatever life mountain you wished to climb, and yet you cannot feel joy. How is it possible to be healthy without joy? I look at Usain Bolt and what I see is quite possibly the healthiest man alive. My friend Tim, the writer, tells me that Justin Gatlin has nearly everything that Bolt has—youth, fitness, wealth—but the combination of failure to knock off Bolt, and the public disapproval reigned on him as boos from the Rio stands has left him emotionally broken. It’s subtle, but if you look at his face in the blocks of the 100M Olympic Final it’s there.

Our complex and conflicted attitudes and feelings about mental illness are especially evident when the topic of suicide comes up. Just typing the word makes me uncomfortable. Even how we describe suicide is fraught with hidden meaning that reflects our discomfort: someone has “committed suicide”. Right? Someone committed an act that we simply cannot fathom, one that leaves the survivors completely without any understanding whatsoever. How could someone DO that? It’s as if every suicide is the same as the suicide of the crooked prison warden in The Shawshank Redemption. He looks out the window and sees his fate arrive in the front seat of a State Trooper’s car, and swallows his revolver.

In reality most of the time it’s simply not like that at all. Nothing about it is simple at all.

The outer walls at the periphery of my world have been breeched by suicide twice in the last couple of weeks. One of them, close to my age, actually does feel a bit like that prison warden. Frankly, I am too conflicted, too aware of the external circumstances involved and not enough aware of the internal life of the deceased to offer much right now. The other one, however, stopped me in my tracks when I heard. The loss was profound. It has also introduced to me a new vocabulary that I truly believe provides a starting line from which we can change how we think about not only suicide, but all of mental illness. A friendly acquaintance lost his wife when she was “killed by suicide”.

We don’t need to know all of the details of the story. Suffice it to say that in the face of a child’s illness she suffered quietly. Too quietly to be noticed. Perhaps she didn’t realize how badly she was suffering, or maybe she was like so many of us and couldn’t bring herself to see her illness for the life-threatening entity that it was. No one will ever know. What is clear, though, is that this was not anything about commitment. Kidney failure may be the cause of death in a diabetic, but it is diabetes that kills him. There is no difference here. The cause of her death was suicide. Her disease, her depression is what killed this young woman.

Each of us has a very few moments in our lifetimes that forever change us. On the second Tuesday of July in 2006, unbeknownst to me, one of those moments was transpiring in a lonely, dark corner. Joyfully, the moment was a hopeful beginning, not a tragic ending. Regardless, once learning of the moment I was changed forever. Now I knew. You cannot see any marks from mental illness, no swollen appendage or insulin pump to clue you in. But it is there all the same, and it must be acknowledged and accorded the same degree of care as any other disease that may take our loved ones from us. Mental illnesses are real, and they can be deadly. There ought not be any conflict or discomfort in treating them. There ought not be any conflict or discomfort in seeking treatment.

We may stop losing so many of our loved ones when start to see emotional wellbeing as part of being healthy. When treating mental illness is as much of a non-event as injecting insulin for diabetes.

“Proper English” and First Impressions.

In my day job I work with folks of various backgrounds, both in terms of education and upbringing. In all walks of my public life I come in contact with an even broader swath of humanity in all regards. I routinely travel up and down the social, economic and educational ladders at work and at play. For the most part, with everyone I meet the language we all speak is English. I live in Cleveland, Ohio, USA after all. Our English, however, is hardly the same.

While we cannot truly escape our origins, as we cannot truly escape our genome, we can choose how we interact in the daily mechanics of society regardless of origin. For better or for worse this begins with how we speak. That old saw, you only get one chance to make a first impression, is especially true when you speak, and especially important because for the most part you can choose not only what you say but also how you say it.

There’s nothing new or striking about this concept, either. You can think of it as verbal situational awareness. You would (hopefully) speak differently to a priest than you would the surfer sitting next to you beyond the break. On the phone with the cable company should sound very different I think than on the phone with your BFF. All speech is by definition qualitatively different that a text or an email because speaking implies hearing; speaking and hearing involve the inclusion of inflection, tone, and tempo. Really basic stuff.

Why, then, is it so brutally common to hear such poor English? Poor grammar, improper word usage, a situational tone-deafness. This doesn’t even begin to touch on the concept of working vocabulary (BTW, the person with the largest working vocabulary I’ve ever met is responsible for our little CrossFit thing). Once upon a time one heard much about “Proper English” or “The Queen’s English.” What happened?

In English we do not have the French equivalent of “Tu” vs. “Vous”. No lazy man’s way to “polite-up” our speech. A certain unearned familiarity is too often presumed. We take way too many liberties with grammar, and frankly we too infrequently make the effort at “polished” English when it’s time to do so. That first impression thing is incredibly affected when you open your mouth to speak, on the up and the down sides. It is equally jarring to hear the word “ineluctable” from a guy in faded jeans and a baseball cap turned backwards (up) as it is to hear “me and Joey are gonna go…” from a guy in a suit and starched collar (down).

The stark reality is that there are no barriers to the “up” version of English. There is no genetic, social, or economic barrier blocking the acquisition of the ability to speak well, and by extension to acquire the situational awareness to know when it is vital to do so. All that is required is the effort to learn that version of English that we know as “proper”, and the effort to learn when. It’s not necessary to speak like this all the time. You can choose to “let your hair down” so to speak–my love for the versatility of the “F-bomb” is well known in certain circles–but a lack of virtuosity in the English domain is a choice.

There are many aspects of a “first impression” over which we may have little control. Don’t choose to let your version of English be one of them.