Random Thoughts from a Restless Mind

Dr. Darrell White's Personal Blog

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Healthspan Recipe v2.0: Sunday Musings…9/25/22

How did I spend all of the spare time my hip “gifted” me with over the last several weeks? Well, I did do a little bit of stuff on the intellectual side of my day job. I spent a bit of time working formally as a consultant, helping companies with new product development and working on writing projects in areas that interest me. Much more enjoyable were the couple of opportunities I had to interact informally with colleagues who’d reached out and requested a bit of wisdom from the mini-silverback in their midst. Both versions of this part of my professional life are very satisfying.

Neither, it turns out, is enough to fill all of the hours that would normally be taken up by going to work. After my daily PT was accomplished I was left with 5+ hours of “free” time, and I just couldn’t see spending it all on bingeing TV. Even something as noteworthy as “The Wire”, which I still regret missing and am still promising myself I will watch (Beth has no interest). What I did, instead, was indulge my interest in the field of lifespan and longevity research, an area I’ve wanted to explore for some time.

Now, my little combination of whimsy and drivel here is not the place to do an exhaustive review of the science involved in extended your lifespan by adding healthy years of living. For that I will save you the trouble of trying to find resources and once again recommend “Lifespan” by Dr. David Sinclair of Harvard. I will be sending copies of this around to friends and family who wish to know more than what I’m about to share, or the “why” behind my suggestions. If you just want to read his conclusions yourself there are about 100 pages that will do the trick. More interested in the potential social and societal ramifications of having a meaningful percentage of our populations living actively for 20 or 30 additional years? Sinclair shares his thoughts on these as well.

In a nutshell we can distill Sinclair’s (and other’s) conclusions down to two straightforward strategies that work at the cellular level. First, in order to enhance cellular vitality it is beneficial to maintain cell processes that function during times of deprivation in an “on” mode. Second, while doing so, one must enhance each cell’s ability to identify and repair defects and errors in both our genes and the “epigenetic” mechanisms that turn those genes on and off. Again, if knowing what this means in a more granular fashion is your cup of tea, “Lifespan” is excellent.

How, then, do we accomplish these goals at macro level? The stuff we choose to do in our day to day lives? Some of this you likely already know, especially if you have spent any time here in my Restless Mind. Deprivation is in many ways a synonym for stress. Tactic #1 is eat less. At a cellular level this, in and off itself, turns on the “save for a rainy day” mechanisms that extend the healthy life of the body’s cells. Honestly, your macro dietary move could be just that. Eat less. “Eat to promote results in the gym, not fat.” Yes, all of the research showing the effectiveness of particular forms of fasting are largely correct. You can turbocharge the effect of eating less with pretty much any version of fasting that you can, or are willing to adopt.

Let me step outside of “stress” for just a moment to discuss what to eat. Sugar is still the enemy. Processed food high in added sugar, especially manufactured sugar such as high fructose corn syrup, is a pro-inflammatory agent that works at cross-purposes to our goals here. Attempting to get as many of your daily carbohydrates from non-grains and non-sugars is STILL part of the prescription. Sinclair and a litany of others have repeatedly shown the deleterious effects of eating mammalian protein. Meat, especially red meat, is associated with higher rates of both heart disease and cancers of all sorts. Do you have to become a vegan to increase your healthspan? Heavens no. Just realize that with the exception of post-intense exercise recovery, our need for gobs of protein is lower than we think. Obtaining that protein from plant sources and fish is easier than you think.

Returning to the the concept of “stress”, you gotta get up and move. The couch is STILL your nemesis. Literally anything is better than nothing. Brisk walking works, and by brisk I don’t mean meandering behind your pug as he ponders the placement of his, well, you know. Wanna run? Sure. Why not? Just remember that you don’t need to run 10 miles/day to increase your healthspan. Turns out the health benefit is probably the same if you run 3 miles, and you might get almost the same with that brisk walk. The key is to elevate your heart rate and get a little bit out of breath. Nothing seems to be more effective than high intensity interval training or HIIT. No matter what you think about CrossFit, done properly it is simply the most efficient and effective way to inject physical stress into your recipe.

Lastly for the macro stuff is the truly macro: you have to build some strength. Old fashioned, full-bodied functional movements during which you move meaningful (meaning heavy to you) weight. Sure, you can use all manner of exercise machines that produce resistance that targets individual muscle groups, but healthspan necessarily means the absence of decrepitude. Doing movements such as the deadlift, squat, or press that cannot be broken down into component parts, and doing them while moving a load that is meaningful without being dangerous, is what will make it more likely that you will be able to rise unassisted in (much) later life.

But you knew all, or most, of that already, right? What’s new, at least for me, is what we can do on a daily basis with supplements and a common medication to enhance our body’s functions on a cellular and genetic level. There are a ton of things that have been proposed to slow aging at a cellular level. Many of them have been controversial, at least in part because the research has been less than overwhelmingly positive. Sinclair takes far more of these things than I am comfortable suggesting. I’m going to make it super simple, distilling everything I’ve read about “what to take” down to 4 substances, 3 of which are over the counter.

Let’s start with the simple science of the one medicine that has a direct effect that counteracts cellular aging. The ends of your chromosomes are protected by structures called centromeres. The longer the centromere, the physiologically younger the chromosome, and therefore, the cell. Metformin is a medication that is routinely prescribed as a first-line treatment for Type 2 diabetes. Metformin has been called the closest thing to the Fountain of Youth yet discovered. One of its notable “side effects” is that is elongates those centromeres, presumably increasing the lifespan of the cells themselves. An older medication, metformin is available as a generic for, like, $5 a month. Sinclair takes 1,000mg per day.*

You may have heard about Sinclair’s next suggestion, resveratol. Sinclair and his labs became famous for the findings on resveratol in 2006 that formed the backbone of the so-called “French Paradox”. The French supposedly were living longer despite eating a diet high in saturated fat because of the liberal partaking of red wine with those “unhealthy” meals. While reading “Lifespan” I found it interesting that the people living in the Sardinian “Blue Zone” routinely drink meaningful amounts of a local red wine, Canonnau, that contains high amounts of resveratol. Not all of the early enthusiasm about resveratol has survived deeper testing, but it appears to have little or no downside when taken without the alcohol chaser in the red wine. Sinclair takes 1000mg/day*.

The last supplement is a kinda two-fer. Nicotinamide mononucleoside (NMN) is a potent producer of NAD, the energy source for the activation of the “stress genes” as well as the proteins that function in cell repair. Again, the science is cool and it is well-described in “Lifespan” if you wish to explore it in greater depth. Theoretically the production of NAD results in a depletion of methyl groups that are necessary for other significant basic cellular activities. Sinclair suggests that, if this is so, this can be counteracted by adding trimethylglycine (TMG or betaine) to your supplement cocktail. Sinclair takes 1000mg of NMN and 500mg of TMG daily*.

So there you have it. A recipe that, coming from me, begins appropriately with something that sounds an awful lot like the original CrossFit prescription, “Fitness in 100 Words”, found in the CrossFit Journal Vol. 1 #2 2003. Eat less. Eat better. Move in such a way that you get a bit out of breath and do that regularly. Get and stay stronger by doing full-body functional exercises where you move weight. Do your homework and consider taking some or all of the supplements that David Sinclair and his family and co-researchers are taking to extend the lifespan of the cells in their bodies.

In so doing you will also be joining me, and my family, as I add Sinclair’s regimen to the pescatarian diet suggested by my daughter, and head back to the gym after my rehab from hip surgery. May we all increase our personal healthspan, adding many healthy and vibrant years to our lives.

*Reporting on these findings is not a medical recommendation. Note that you need a prescription from a doctor for metformin. Discuss metformin with your medical doctor.

Onward Toward the More Useful Metric Healthspan: Sunday musings…9/18/2022

1 Quiver. A group of cobras. Normally a totally icky thought, but Beth and I finally started watching Cobra Kai, so…

Why isn’t this what the Cobra Kai kids call their team?

2 Announcers. I no longer really watch sports of TV unless they are spectacles. Super Bowl, NCAA championship games, Majors in sports such as tennis and golf. However, as I find myself at home, often alone, with hours to burn, I have had sports of some sort on in the background these last couple of weekends. The games are still not very impressive. Honestly, it seems as if the quality of play in all of the major sports leagues has declined over the years. The individual sports, on the other hand, continue to amaze as one GOAT after another arises to thrill us with their exploits.

One thing, though, is amazingly consistent: the teams of announcers who are not the top teams are uniformly terrible. As I write today’s musings I have our local team, the Browns, filling auditory background. They appear to be on their way to blowing a 2 score lead in the last 2 minutes, and the announcers are simply awful. Their banalities are entirely devoid of insight, provided without an iota of style. In what turned out to be a rather exciting game it sounds like a snoozefest. They add nothing.

I suppose I can sorta, kinda understand why I’m left to suffer at the hands of these end-of-the-benchers. The Browns are not exactly NFL royalty, after all. But the same thing was on tap yesterday for the Notre Dame home game. NBC has spent a fortune buying the rights to these games and they can’t find better announcers? Seriously. Snooze fest.

It’s enough to make you pine for the CrossFit Games feed, ca. 2015 or so.

3 Healthspan. Given the luxury of time to myself I’ve been doing what I’ve done each time this has happened: do a deep dive into something that has appealed to me but escaped me due to time constraints. This is how I spent my time during my recovery from carpal tunnel surgery in 2003 (resulting in the launch of SkyVision), the early days of my new practice in the 2000’s where I just wasn’t all that busy (the start of my CrossFit immersion), and my first hip surgery in 2019 (a re-set of my nutrition and sleep study). During my post-hip rehab I’ve been looking into the ultimate form of increased longevity.

Healthspan, the measurement of healthy, vibrant years lived with a relative absence of both disease and decrepitude.

This is really the ultimate expression of the quest I’ve been on since discovering CrossFit in 2005. The ultimate goal I’ve sought as I’ve tried to develop a single measurement of health that encompassed both fitness and traditional health measurements. Whether or not we decide to measure our true biological age (actually possible, albeit pretty expensive at the moment), we probably should be adding to our quiver (regular use!) of strategies some of the things that the pioneers in longevity research have already uncovered.

For a CrossFit OG this is really the next logical phase. Work capacity across time and modal domains extended across a longer lifespan unencumbered by disease or infirmity = healthspan.

Do your self a favor and pick up a copy of “Lifespan” by the Harvard professor David Sinclair. If you are of a scientific bent you will thrill to the explanations of the first section. If you lean toward the more social engineering side you will likely find yourself nodding along with Sinclair’s thoughts on not only the expected effects of more people living not only longer but better, but on why this is likely good for everyone and everything. Most of you, I suspect, will jump to the “what to do” sections in which Sinclair lays out what we can, probably should, be doing to apply the science right now as I did (going back to read the science afterward).

Allow me to save you some time. I actually read several other books on both longevity and maintaining one’s mental faculties as we age, but all you really need to do IMO is read Sinclair. “Lifespan” not only covers all of the meaningful ground, it lays out a playbook for the next part of the journey. If I get a little inspiration and set aside a little bit of time I’ll expand on both the “soft” and “hard” interventions available right now to almost all of us to expand something much more meaningful than just a lifespan.

It’s time to work on expanding our healthspan.

4 Stethoscope. So, how did I end up faring on the other side of the stethoscope? As you may recall I had my right hip replaced about 10 days ago by a surgeon and in a facility where I was known to no one. Just one more middle-aged ex-jock with a busted up hip and a big prostate. Short story: surgery was uneventful and my recovery got off to a great start despite the fact that no one bothered to listen to the sad, sorry story about my prostates efforts to spoil the party last time. No matter. I was out after about 30 hours total.

What came next is the indictment of our increasingly consolidated healthcare system I thought I’d escaped. After 5 days of simply all-world recovery spent on the farthest righthand side of the Bell Curve I suffered a bit of a setback. On Post-Op day 8 my IT band and abductors went into full revolt mode and I was thrown back to day 3. I didn’t feel comfortable calling or texting either the nurse of PA who sat between me and the surgeon, opting instead for the PT who’d been with me the day before the wheels came off. Is that because I “normally” would have been able to just pick up the phone and buzz my surgeon buddy? Sure. Of course. But the vibe of a large hospital system where the system protocols reign made me wait days before I eventually texted the PA.

That’s probably the lesson for your buddy the Eyeball Boy. If there is a psychological barrier that is effective against someone as confident and plugged in as I am, what must it be like if you really ARE jsut one more middle-aged guy with a busted hip and a big prostate? It’s the big system, not the location of the big system, that creates the distance between doctor and team, and patient. I’m left with the realization that my experience would have been largely the same had I been here in the neighborhood and cared for by either of the big systems in town.

In the end I will surely be just fine. The PA responded to my Sunday text and seemed nonplussed by my symptoms, a response that will eventually make me feel better I’m sure. The big system is able to see me on Thursday, four days from now, if I get worse (no information about what to do if I get worse in the mean time), something they don’t foresee. The reality that a 3 or 4 day delay in my recovery will upset hundreds of apple carts does not register at any level in a large healthcare system. Honestly, I never would have known this had my recovery continued on its early course. My “review” of my journey on the other side of the stethoscope would have been mostly self-deprecation at the notion that I would notice any difference at all.

What I learned is that it’s not the distance between your house and your hospital that matters.

I’ll see you next week…

Mercy At The Finish Line: Sunday musings…9/4/2022

“If not for the pain, how would we know that we were alive?”

Who uttered this profound statement? Was it Rousseau or Rochefoucauld? I confess that I can neither remember the answer, nor conjure up enough Google-Fu to find it online. Rochefoucauld is famous for “We all have strength enough to bear the misfortunes of others,” which seems somewhat inconsistent. Perhaps it was Rousseau, then. No matter.

A few weeks ago I wrote about my very short encounter with a man who cried “Uncle”. Injured at 20, kept alive by an implantable defibrillator for some 22 years of unremitting pain, Billy Ray had no one to live for. All he knew was pain. He was imprisoned by his pain. Truly an island, he shook the shackles of his torment when he turned off his defibrillator.

For several months now I have had near constant pain that has been bad enough to impose itself on my minute-to-minute consciousness. Not like Billy Ray, mind you, and it’s only been 3 or so months. I am reminded of my friend Steve, one of the nicest, kindest, friendliest humans I’ve been privileged to know. He suffered the same pain from the same cause, but for myriad reasons he chose to carry the burdens of others and did not address his own for many, many months. He, and those closest to him, say that the pain changed him. His general bonhomie declined along with his patience and good cheer. Thankfully, surgery cured his pain. More thankful, still, is that the removal of his pain returned to us the friend we’d come to know and cherish.

I’ve given a lot of thought to this over the last several months. What makes my situation different is that I have a finish line. I can see ahead to the date when there is a 99% chance that the pain will be alleviated and I will be able to return to a life that is generally free from that type of burden. My time in this bubble has been relatively short, many months shorter than Steve and years shorter than Billy Ray. The finish line has been close enough that I hope I have been able to avoid any change in who I am, with the exception of the physical limitations that I have had that will also be alleviated.

Seeing the finish line ahead has meant hope, which has been a balm to sooth the pain.

My part of the medical world is mostly filled with caring for people whose lives will improve because they received that care. Indeed, that’s part of why I chose ophthalmology in the first place. There is a very small subset of my Dry Eye patients for whom relief is not possible, at least not from me and what I have to offer. This short stay in the dark world of chronic pain has given me a different perspective on that part of my practice. While it is not the same at all, doing what it takes to work through and around pain that does not go away will likely allow me to bring more light to that small part of my practice world.

For me, though, the answer lies just ahead at the finish line. The date is set, and all that remains is a phone call confirming the hour. I have people to live for, people whose misfortunes I will once again be strong enough to carry. Relief awaits at the finish line, along with all of the friends and family members who have been strong enough to bear my misfortune and carry me there.

I’ll see you next week…

The Other Side of the Stethoscope: Sunday musings…8/28/2022

1 Chicago. Great little town, especially if you have a native friend to give you pointers.

2 Chicago. Great little band. Went to see a regional cover band last night with friends. Very good musicians, but as is so often the case the lead vocals are what separate the Major Leaguers from Triple A. Still, some music is just so good that you go just to sing along.

3 Whoop. As I sit on the porch at Casa Blanco there is an infomercial on the tube taking up space before the FedEx Cup begins. Whoop, as you may know, is the activity tracker that is the darling of professional athletes of all kinds. Unable to track activity-specific metrics (like a CrossFit WOD, for example), it is really little more than a steps tracker with a heart rate monitor, sleep tracker, and what looks like an HRV (heart rate variable) tracker. The schtick is that it provides you with a recovery “number” that you can use to determine your level of fitness and your readiness for the next work-out.

This particular informercial joins Justin Thomas, a PGA tour pro who is arguably at the top of his game, with Michael Phelps, the 20+ time Olympic gold medal swimmer. Phelps, like so many retired athletes before him, has used his newfound spare time to fall in love with golf. On the infomercial the two are playing a casual round of golf, goofing around in a hotel-like gym, and talking about the importance of recovery for all athletes. They are hawking the Whoop as the way to do so.

I have nothing against the Whoop. Heck, it may be the only stand-alone fitness tracker that I haven’t tried. There are a couple of points to be made after watching Thomas and Phelps talk about recovery. First, they are correct. Not only from the viewpoint of the elite athlete but also for washed-up ex-athletes and never-was newcomers to athletics of all kinds. I once wrote (although I’m sure it wasn’t original) that under-training and over-training both result in a reduction of your ultimate outcome. HRV-based recovery data is the best option I found in my 15+ year odyssey in the fitness tracker world.

The second point is that we have reached a point in the evolution of the tech that prices have fallen. Whoop is expensive. The business model is to pay a monthly subscription fee of $30 or so in perpetuity. I think that’s a lot of money. You can pay less than $360 once and get everything you need to track the same metrics with most trackers. I use one called a Biostrap which I like very much. As an aside it will also do an adequate job of tracking exercise specific activities if you add a shoe-worn monitor.

Bottom line: the pro golfer and the pro swimmer have similar needs when it comes to tracking sleep and recovery as do the amateur golfer and the CrossFitter.

4 Stethoscope. Everyone except the unlucky will eventually find themselves on the other end of a stethoscope. While my life has been filled as much as anyone with visits to that place, for the first time in my life I, a physician, am about to experience the entirety of what it feels like to be a patient in the U.S. healthcare system.

Let’s be super clear about the background for what comes next. Since entering medical school as a 22yo in 1982 I have been treated as a VIP at the very least. As the years have gone by it has been more akin to a B-list celebrity if I’m being honest. I’ve never waited for an appointment in my adult life. Obstacles of any and all types magically disappear when I need to see a doctor or get a test. When I’ve needed surgery my docs and their staff have bent over backward to make sure that it happened when and where it was most convenient for me. In return for taking care of our colleagues patients, doctors of my era and the one that just followed us took loving care of each other (and their families). We no longer get comped when it comes to fees, mind you. But when able the docs who have shared patients have taken a deep interest in not only our mutual care, but also how we feel while getting it.

So what’s different now? Well, first a bit of a preamble. My right hip, the good one, has failed me spectacularly over the last several months. Where once I had minimal pain in my left hip that accelerated with activity and prompted a replacement in 2019, this one hurts all day every day. Like the left hip it doesn’t keep me from doing my job, it just hurts this time. No big deal, right? Just get this one replaced just like the other one and go on about your life. Sadly for me, and wonderfully for him, the surgeon for my first hip retired 3 months before I needed him again. I would have to have someone else do this next hip, but my friend picked out the guy he planned to have do HIS surgery when the time came. A surgeon from another system across town who literally has no idea who I am, and wouldn’t care less even if he did.

Welcome to American medicine Eyeball Boy.

For the first time in my adult life I will be a regular patient. Number whatever, hip number X on the day of the surgery headed for Room Y. Show up at the appointed time. No, we can’t tell you what time that is before hand. Why? Because. Pre-admission testing WILL take place live and in person on this particular day at this exact time. No, we cannot change that because you have a full schedule of patients to see in your office that day. Did you reply to our daily reminder email? Did you? Hey, we’re talking to you. We don’t care that you’re a doctor over there; you’re not one over here. Reply or your slot can go to the next number on our list.

Has it really been like that? Well, in the beginning, sure. Why wouldn’t it? That’s what my patients complain about when we have to refer them out to large institutions because we have so few private practice referral options remaining. But to be honest, I understand the system very, very well, and as soon as I started to find my way to a live person on a phone stuff started to loosen up a bit. It surely helped a bit to be assigned to a PA who is an ex-college athlete raising elite athletic children; we’ve got tons to talk about, including her very strong thoughts on whether I should return to CrossFit after my recovery. And it surely made me feel a whole lot better when my cardiologist came in for a visit and scheduled me for a pre-op stress test on his phone before he left my office. When it came back suspicious he worked me in for a cardiac cath, and the cardiologist who would be doing it did my informed consent after we finished with HIS appointment in my office. (It was negative. Phew).

It may sound like I’m complaining, whining even, but I’m really not. It’s not that I’m worried that things won’t go well with the surgery. This is still the U.S., my surgery is one that is done hundreds of thousands of times each year, and the buddy who did my first hip handpicked my surgeon. Medically it will likely be a non-event. No, after all of this, the really crazy hard part about being just a regular patient will be not knowing a soul where I will have my surgery and where I will recover. No one. No nurses I’ve taken care of or physical therapists whose Mom I just did cataract surgery on. No one who has had a glass of wine at Casa Blanco is gonna be there if I have trouble with my bladder. I will be mostly alone in my room; Beth will be kept out like all family members because of the institutional madness around the Pandemic.

It had to happen someday. Despite years of medical attention directed at various and sundry stuff, ailments and health risks, with multiple surgeries along the way. After 40 years I finally find myself in the most usual and normal place for a 62 year old man. I am, for the first time in my adult life, fully and completely on the other end of the stethoscope.

I’ll let you know how it goes…

The Importance of Making the Choice. Sunday musings…8/21/2022

A couple of months ago my young buddy Blake, a rising rockstar in the world of my day job, asked me to co-host a series of episodes on the podcast he hosts called “Ophthalmology Off the Grid” (launched a few years ago by another young friend Gary). As the invited co-host it was my job to pick the topics for three episodes, and to suggest some guests that would make the podcasts interesting. Now, as anyone who has ever read my drivel knows, I am cut from a different cloth when it comes to your standard issue eye surgeon. The topics that Blake and I chose, and the guests who were invited, reflected my “out on the edge” perspective of our professional lives and life in general.

For reasons that I will explore next week, my brother-in-law Pete, the mad genius, brought up one of our favorite authors, Blake Crouch. Pete and I have long been exploring all kinds of esoteric stuff, lots of it involving deep, unsolvable questions, often through the lens of quantum physics. One of our favorite topics is whether something like an afterlife exists, or could exist. Quantum physics postulates that our universe may only be one among an infinite number of universes, all of which comprise the “multiverse”.

Our guests on one of the episodes of the podcast were two female ophthalmologists, close to me in age and both dear friends of mine, each of whom had made significant choices early on that had profound impacts on the arc of their careers. Like me, after the pivotal decision I made in my early 30’s not to travel to speak or consult, Lisa and Maria decided as young surgeons that they would make their careers priority 1A, a notch below the priority that they would assign to the health of their growing families.

Which brings me back to my brother-in-law Pete and one of our favorite books.

The book “Dark Matter” by Blake Crouch continues to provoke. A brilliant physicist and his girlfriend, a supremely talented painter, discover that she is pregnant. They have just begun dating. The pregnancy is a classic crossroad. Which way to go? End the pregnancy, go their separate ways, and pursue the limits of their individual gifts, or follow their emotions and make a go of being a family? In the novel they choose to have the child and marry, settling into a life dedicated to home, in which their respective brilliances are applied to the mundane work of supporting the family. They seem to be quite in love, and their little family of three appears to be well to the happy side of the Bell Curve. Did they make the right decision? A reviewer for the WSJ opines that they “settled for, well, mediocrity.”

Had they, though? It turns out that the young physicist is an expert in Quantum Physics, his specialty the study of “quantum superposition” (Google: Schroedinger’s Cat). His area of research is that of creating a portal to the “multiverse” of infinite possibilities, one of which, of course, is the one in which the couple did decide to choose their individual paths. He solves the riddle of Schroedinger’s Cat, gains access to the multiverse, and both versions of the physicist are able to examine the path not taken.

What do you think the physicist who chose his career over marriage and family discovered? The one who chose family over career and eventual fame? I won’t ruin the story for you by answering those questions, but I will hazard a tiny ‘spoiler’ by taking issue with the WSJ reviewer: the young couple who chose family over devotion to career settled only for mediocrity in their professions. They had simply applied other parts of who they were to their fullest expression in the pursuit of excellence at home, as a more careful reading of the early part of the book makes clear.

Like Maria and Lisa.

The point? Lots of them, actually. Each of us faces more than a few truly epic, life-altering decisions where we stand at the crossroad. Which way should we turn? The tragedy is not in choosing the wrong path; it is in not choosing at all. Simply drifting through that crossroad without committing to the decision is likely what sows the seeds of regret if things don’t turn out just quite so. In reality, we don’t get to observe what it looks like at the end of the road not taken. Certainly not like the physicist who managed to turn himself into the cat that lived.

“He had his life—it was not worth much—not like a life that, though ended, had truly been something. If I had had courage, he thought, if I had had faith.” –James Salter, “Light Years”.

Lisa, Maria, and I offered our experiences to our friend Blake as he approaches a similar crossroad in his young career. Like the physicist and the artist, we chose the path that led first to home; we have no regrets. The antidote to regret lies in the knowledge that one must have the courage to acknowledge the crossroad before you, and the courage to make a choice. What inoculates us as we continue down that path is an unwavering faith that we made the best choice we could at that time, at that crossroad.

Faith that lead us to commit to the best possible destination in our one, singular universe.

I’ll see you next week…


“They may say I can’t sing, but they can never say I didn’t sing.” –Florence Foster Jenkins.

I’m a bachelor this weekend. Beth is in Columbus at a horse show, just killing it, while I languish here in The Land with the dogs. Much of what a summer typically includes has been stolen by the traitorous behavior of my “good hip”. Where my left hip only announced its intention to desert my body when I was active, my right hip demands my attention during all waking hours. I am home taking call for our practice to clear the decks for my September surgery and recovery.

Because I was home and free of any real responsibilities I was able to attend the retirement party for a woman with whom I have worked since my very first day in the OR in Cleveland 31 years ago. Mary Kay was my first scrub nurse, and she went on to run one of the surgery centers where I operate for 18 years or so. All in all it was a lovely affair, held at an Irish pub in homage to Mary Kay’s heritage, and attended by about a hundred folks who also worked with her over the years. As an aside I had a number of funny encounters at the bar. Remember, we are a group of people who generally only see each other in surgical scrubs, and for 2+ years no one has seen anyone’s entire face under our masks. A couple of the youngsters were quite funny when they finally recognized me “wearing clothes”!

At 62, with 32 years as a working doc under my belt, it appears that I have reached a stage where retirement is kind of an expectation. At least on the part of those folks with whom I’ve worked for decades, and especially, I guess, at someone else’s retirement party. Almost all of the folks I’ve known for more than 10 years at the party asked about my own retirement plans. Having the good fortune to have several close friends who have had the good fortune to already be retired, and to have retired well, and having spent many an hour hashing this out with Beth, I’ve come up with a very honest answer, however frustrating to me, at least, it turns out to be.

Retiring FROM what I am doing now isn’t enough; I need to have something that I will retire TO.

Beth, the good looking, smart member of the couple, has made it quite clear that I am not going to be allowed to retire to HER. My wife is not going to be my hobby, my go-to activity. At least not 24/7. Nope, I’m going to have to come up with something that I wake up looking forward to doing each day, and fall asleep at night happy that I did it. I need to come up with some activity that I am passionate about. Funny, all of the men I chatted with last night had a kind of blank look on their faces when I gave them this answer. All of the women had a knowing smile and nodding heads, congratulating Beth on her perspicacity and resolve.

Which got me to thinking about Florence Foster Jenkins and the movie of the same name about her.

Mrs. Jenkins was a socialite in NYC, I believe, who was quite passionate about singing opera. She had the financial wherewithal to produce her own performances in a rather major way. A pivotal scene in the eponymous movie about her takes place at Carnegie Hall, for example. There was only one problem with that, at least as far as it went for the spectators: Mrs. Jenkins was a terrible opera singer. Actually, she was epically, brutally bad at singing opera. Yet, again and again, she went to the well and sang her heart (and her lungs) out in front of an audience.

My instant, deep emotional response to this story is jealousy. Jealousy followed by mad respect. Jealousy because Mrs. Jenkins has a passion, something about which she cares so deeply that she is willing to pursue it to whatever limit her abilities might impose. Respect because she is willing to devote time and resources to this pursuit in spite of the fact that she will never come anywhere near anything that even approaches proficiency, let alone excellence. More than that, she insists on sharing the fruit of her labor publicly, even though she is told time and time again that her particular fruit is inedible. No matter. Florence Foster Jenkins will sing.

Retired or not, everyone should have a passion like this. We should add a tiny disclaimer or two, of course. There are a few things that shouldn’t be done by amateurs or hobbyists, no matter how passionate they may be about them. Neurosurgery comes to mind. Or operating heavy equipment, even if you didn’t take any of those medicines that are advertised on TV where you have to choose between your health or, you know, driving a backhoe. If your passion is harmful to you or those around you it’s probably more psychopathic than passion. As an aside, this is why I have shied away from a deeper dive into wine. Short of that, though, the kind of passion shown by Mrs. Jenkins is to be envied, something to aspire to.

For many years now my own life has been missing this. Outside of my marriage and my family there isn’t really anything I burn for like Mrs. Jenkins burns to sing. The stuff that I might have pursued has either been systematically taken away by injury (golf) or circumstances beyond my control (CrossFit). I do get to watch this magical phenomenon on a daily basis though. Beth had long yearned to ride horses. When our kids had gone off to college she finally had her chance. The barn is her happy place. A funny thing happened for her that makes our collective experience very different from Mr. and Mrs. Jenkins. Somewhere along the way to a “time-filling hobby of a 50-ish homemaker”, Beth actually started to get good. I mean good enough that even a knuckle-dragging ex-CrossFitter spouse could see the difference. Good enough that she outgrew the ability of her horse, necessitating first an effort to breed a successor and then an epic trip to Spain to import her new partner.

Doing the work has never felt like work for her—that might define passion, eh?–and there has been a payoff: she is still getting better at riding. This weekend she achieved what 15 years ago would have been unimaginable: she earned a bronze medal riding at a level that is at least 5 above where she started (and higher than any trainer we can find for her to ride with in the winter when we visit Megan). As if that isn’t enough, she got her first score above 70 (trust me, a big deal) riding Hero to music in the discipline known as Freestyle. Again, a level higher than she ever expected to compete. 61 and still riding her passion to new heights.

I am equal parts awestruck and jealous.

As for me, as I shared with all who asked at the party last night, I will go on in search of that thing that makes me want to put everything aside and just do. That thing that I might “retire to”. That thing—singing for Foster Jenkins, riding for Beth—you think about when you are doing almost everything else. If you are one of the lucky ones who’ve already found yours, I extend to you the same jealousy and mad respect I have for Mrs. Jenkins and my wife. For those of you who are like me, I wish you good fortune in your search, and remind you that the search is worth the effort.

Never, ever, ever let anyone tell you that you cannot sing.

I’ll see you next week…

Cape Week: A Loving Memorial. Sunday musings…8/7/2022

As she headed out the door and off to the barn Beth looked over her shoulder: “What’s your plan for today?” I replied that it was Sunday, the Sunday at the end of Cape Week. I thought I should sit down and write a bit. The annual trip isn’t really over until I write about it.

Each morning as I sit and contemplate the night before and the day ahead, I peruse the memories on my Facebook feed. Around this time of year they are filled with thoughts about the Crossfit Games, and musings on both the front and back ends of what is universally known around me as Cape Week. To be fair, having drifted away from the Crossfit world these last few years, I only this morning discovered that one of my friendly acquaintances from here in Ohio placed second in the Masters 50-54 competition. In years past I would have watched every second of his quest. Now all that remains for me in August is what has been part of August for 31 years now:

What remains of Cape Week.

As I predicted 6 years ago when I wrote about Cape Week on the way home after Year 25, change has come for Cape Week. Have you been reading Random Thoughts for long? If so, then you know the story of Cape Week and I ask for your forbearance as I tell it once again for those who may be unfamiliar. Beth and I are both first-borns. More than that, among our siblings we ended up doing pretty much everything first. First to marry and so first to have in-laws. First to have children, and so first to receive all manner of “help” in parenting them. Long after the start of Cape week we were also first to have a child marry, gaining in-laws in law, and along with that the first to have grandchildren of our own.

In-laws bring with them the expectations and desires of another family. For sure there are all kinds of new “must attend” events, but it is the two great American holidays that become the flashpoints of discontent, especially in families that do not settle together. Who will host Thanksgiving and Christmas, and more importantly, who will be there? With the appearance of in-laws for my youngest sister we four siblings and our spouses realized that there were no easy options to make all 5 sets of our parents “holiday happy”. Our response? At least for the extended White Family, we would create our own holiday, a week together at the beach. My sister Tracey found a 5 bedroom house across a sand road from the beach, and in July of 1992 Cape Week was born.

For 25 years we had a kind of growing Groundhog Day week. We gathered in the main house (to which we added a spill-over cottage next door in year 4) for meals, games, and naps. Each day was spent almost entirely on the beach. Even Dad, not in any sense a beach guy, would fill up a beach chair and be at least a part of the scenery (as an aside, this is part of what informed my description of him, and my father-in-law, as “garden gnome” grandfathers: fun to play around, but they didn’t really play back). Eventually there was a total of 10 grandchildren, none of whom lived in the same town, and all of whom have become friends because for one week each year they were together on the beach.

It was quite rare for anyone to leave the compound in those first 25 years. Nor were visitors invited in, to be honest. During the years of “Cape Week Classic” it was the extended White Family, period. We are a family of habit, tradition. Comically so, in some instances. Saturday night dinner? Always barbecued chicken. Friday night finale? Pizza. The change from Joey’s to Paradise, years overdue, took one full week to bring about. No, while growth (we had young kids!) was occurring, change was not a part of Cape Week. With the exception of medical crisis, for 25 years we all came and we all stayed.

What does it take to pull off something that remained so much the same for 25 years? I’ve reposted my “musings…” from year 25 just below. Quite frankly no one can really say, and what I said 6 years ago is probably as well as I will personally ever be able to say it. Four couples committed to a week together with one parent/in-law, and then did whatever it took to make it happen for 25 years. It is now year 31, and as I predicted, our 25th year on the Cape was, indeed, the last of what I, at least, would call Cape Week.

The winds of change had blown through our week at the beach, as we all knew, or should have known they would, though each of us in our own way held out a tiny bit of hope that they wouldn’t. Dad passed away. Mom now only makes short “ceremonial” stays on the beach itself, and only a few at that. One sibling has a medical condition that for the most part keeps them off the beach. The daily walks together with my siblings and in-laws weren’t possible for me because I need a new hip. Only one grandchild remains in college; the rest hold jobs with little vacation to spare for their parents’ in-laws. Only two of five great-grandchildren have ever felt the sand of our sacred beach between their toes. In year 1 of Cape Week there were 10 adults and 5 children together for 7 days and 6 nights. For year 31 we had 9 adults and 3 children.

No one was left for pizza on Friday.

What a run it was, though! At the end of Year 25 I sobbed in the night before we left, as I kissed the beach goodbye, and while I wrote my “musings…”. What my siblings, our spouses, our children and I had come to know as Cape Week had, indeed, run its course at the end of that week, and if we never returned it was a run for the ages. 25 years! Everyone there all day, every day, every year. Although I did leave behind a tear or two during my annual kiss of thanks to our beach, these tears were not only tears of sadness as they were in the past. No, these were also tears of gratitude for what this beach, this Week has meant to our family and done for our family. For the friendships among the cousins. The love among the four couples. For my parents.

But they were also tears of joy. Some time over the week it finally came to me that another Cape Week tradition, a wholly new and different one, had actually started in year 26. Different, yes, but once I realized that, everything changed for the good. We had 25 years of Cape Week. As a family and as families we were blessed beyond reason. And for 6 years we’ve had something else. We can still call it Cape Week, of course, even though it’s different. But I didn’t cry on the way home, and I’m not crying while I write this. Each of the last 6 years has been unique, yet if you think about it–if you allow yourself to admit it–each of those years was just as lovely in its own right as all of those first 25 years were.

Some part of our family was together on “our” beach.

Winds of change have blown through Cape Week, but these last 6 years have shown that our love and fidelity to the goals we once had, and the memories we created over 25 years and will now share for eternity, need not be carried away by that breeze. Cape Week has changed. We have changed, all of us. But Cape Cod and our sacred beach remain, there for whomever may wish to gather for however long they wish to stay.

We will experience joyful change (graduations, marriages, births), and eventually loss and sorrow. We once chose to be together, and for 25 years we ritually did so. Have we closed the door on the house and driven away one, last, final time? I don’t know. I doubt it. While the ritual is gone, we may be fortunate enough to make the same choice we’ve now made 6 times, if not always, at least on occasion. We can choose. Cape Week, for all of its intensity over the years, has changed with us as we have changed along the way. The setting is the same; the story and the characters a bit different each time the book is opened. Who knows? There may be 25 more years, each one as unique and different from the last as years 1-25 were the same.

Year 25 actually WAS the last year of Cape Week as we first knew it. Cape Week has been reborn. It just took me 6 years to realize it.

A Memory: Cape Week Musings, Year 25

Sunday musings…

The beach was chilly, the water a boiling mass of foam, yet the sand was smooth and calm. Unaffected. Doubtless, it had seen this before. My eyes began to leak. It must have been the wind. Yes, that’s it. The wind. I stood there in silence, struggling to fix the image in my mind. I knelt down to kiss the sand of my beloved beach. With a shirtsleeve to stem the flow from my eyes I walked away from 25 years of family history and toward the beginning of a new story.

What does it take to bring together an entire family for 7 days under one roof, every year, for 25 consecutive years? Why even start in the first place? Once upon a time families were born, grew, and died in a single town or small group of neighboring towns. Getting together was a given. Holidays presented a challenge born of access: who would host whom for what occasion at what time and for how long? Your Mom or your spouse’s Mom for Thanksgiving or Christmas or whenever. A cousin’s graduation might be a life-or-death obligation, attendance mandatory. Proximity rendered this moot, but we moved away.

First borns both, Mrs. bingo and I married first and had the first grandchildren. We hit every adulting stage before any of our siblings. This meant encountering in-law issues first as well. Where would we go and when? Sticky wicket, that. The solution, at least for the White family was the creation of a separate holiday totally removed from any established American tradition. We would all go to the beach together, just like we did as kids. Thus began “Cape Week”.

How do you get 4 young couples, all of which had multiple children to return time and again to the same place at the same time to do pretty much the same stuff each year for 25 years? It could be having a parent everyone was afraid of, or another no one wanted to disappoint. For sure having BOTH was a key component. Through every milestone each little family plowed through and found a way to make it to Cape Cod each year to spend every waking moment together in our little compound. Only serious illness kept anyone away. Over the years change did eventually come in the way of summer jobs for the grandchildren, which led as such things do to real, live adult jobs with little vacation time. That and of course, another generation of in-laws for our children to now contend with. Whispers of change were on the winds these last couple of years, but still, almost everyone was there for almost the whole week each summer.

I know what you’re thinking. Somehow it must have been easy for us. There must have been some sort of massive bribe, or something. Nope. What it took was a ton of commitment and hard work by four (now not so) young couples to make Cape Week happen. One family came from California for several years, another from the Midwest. There were summer camps that were never attended, All-Star teams made but All-Star Games missed. The classic teen rebellions against family were quashed, all 10 cousins showing up many more years than not. Invitations to vacation alternatives were graciously turned down, and every “how come always your family” discussion always ended with some version of “we can do that, too, just some other week.”

Cape week itself took hard work and commitment. Four families, 10 kids, and two grandparents together for meals, beach games, TV at night, and forays en masse to the ice cream shop. It could be a little bit cramped, even with the addition of a second cottage in year 4. Those 10 cousins from homes scattered all over America have grown up to be friends who know an amazing amount about each other despite their age differences and lack of proximity. For instance, 10+ summers of having the “college talk” with their aunts and uncles is uniformly one of their WORST memories. Yet there they were as well, every summer in which there was no unavoidable conflict. Until this year.

Why now? Why this, our 25th year, are we now closing the book on the last chapter of Cape Week? The easy answer is the loss of one of those grandparents, my Dad. It really doesn’t matter whether he was the one we were afraid of or the one we didn’t want to disappoint, I think it’s more a matter of needing both to make something like Cape Week a forgone conclusion. That one singular loss seems to have opened the door for each family to consider the value of Cape Week to their individual families. To think the heretofore unthinkable: something is more important to our family unit than the annual assembly of the extended family.

Is that it then? Is it over, 25 years and out?

It’s been an extraordinary run. Not a one of us knows a soul who’s even heard of a family that pulled off something like this. What is clearly over is Cape Week written in stone, and while that has always been inevitable if any of us ever really gave it any thought, it is quite sad nonetheless. We will continue to rent the main house, installing Gram for a week in the same chair at dinner, on the same spot on the beach. A calendar will say that it’s number 26, but it will be different. A new Cape Week, year number 1, invitations soon. Who will come?

If I close my eyes I can still see my beach. See it, as it has been these 25 years. With my eyes closed I see my Mom and Dad, young and vibrant, surrounded by babies and toddlers covered in sand and seaweed. There’s my brother and his wife, my sisters and their husbands, my darling Beth. We’re all together. My eyes have begun to leak again and it’s all a blur. There’s a breeze in my house; there must be a window open. Yes, that must be it, an open window has let in the wind.

The winds of change have finally come for Cape Week.

I’ll Be OK: Sunday musings…7/17/2022

1 Open. Wow. What a golf tournament. Cam Smith holes out everything to spoil the feel good Rory story.

2 Wedding 1. Our closest couple married off their 3rd child last weekend. Nothing but smiles all around. There are few experiences more fulfilling than being treated like family at another family’s proudest and happiest moments, as we were so treated yesterday.

Congrats and bon voyage to Joey and Leslie. Fasten your seatbelts kids.

3 Wedding 2. Another couple with whom we are close married off their daughter yesterday. This one was quite an experience for both of us. Beth’s first Indian wedding (the mother of the bride is Sikh) and my first in 30 or so years. We both wore traditional Indian garb for the first ceremony, and then dressed up like the middle-aged Americans we are for the second, Christian ceremony. The festivities began on Thursday and only finished about an hour ago (we only participated on Saturday).

This one included a tiny little lesson in cultural respect. In all honesty, the effort that Beth and I made to show respect for the Sikh religion and traditions was really rather modest: we wore traditional clothing, took off our shoes, and covered our heads. Hardly worth mentioning, except that it must not be the norm, so effusive and sincere were the compliments and thank-you’s sent our way. Similar, but different (I was 31 or so) at my first Indian wedding.

All it takes to do the right thing with this kind of stuff is to ask a couple of questions and then make an honest and heartfelt effort. Heck, that should go for any situation where one is confronted with the opportunity to demonstrate your respect.

4 Clock. Nice little op-ed in this morning’s Plain Dealer by a former journalist honoring the memory of her recently deceased single Dad. Sounds like he was quite a guy. Union card-carrying auto worker who raised his daughter alone, gently guiding her away from danger while helping her find her way. When her marriage was over and she declared that she’d done all she coulde, he encouraged her to walk away and begin again.

“…life is too short to run out the clock.”

I love that. Just love it. I wish I’d read it before writing any one of my “seize the day” essays over the years. It’s just the kind of everyday poetry each of us needs to hear every now and again. RIP Mr. John F. Palfy. It would have been an honor to have known you, Sir.

5 Happiness. This is what happens when you don’t sit down to write every Sunday: lots of prompts back up in between your ears and you just have to put ’em all down to make sure you don’t forget them. Maybe come back and expand on them later, or maybe not. Whatever. At yesterday’s wedding one of my dear professional friends dropped this one on us at lunch:

Happiness is reality minus expectation.

Another 5 word poem. Think about it a minute. If you live your moments fully engulfed in them, without the “filter” of expectation, the wonderful among them are much more likely to generate happiness. How often are we disappointed by something which, from the outside, is nothing short of spectacular, but it wasn’t the exact spectacular we expected. Deepi was using examples from our specialty (we sat a a table of physician families), but it was clear that she meant pretty much everything.

This one I’ll come back to for sure.

6 Pain. Funny how two identical body parts can fail is such disparate ways, and along the way give you a totally different experience. When my left hip fell apart it did so rather slowly across several months. Even toward the end, when surgery was already scheduled, the degree of pain that was life-altering only occurred if I was particularly active. Pretty normal, un-extraordinary stuff like walking a couple of miles with Beth fell apart within 200 yards or so. Work, sit around, watch TV…no problem. It’s been 3 years since I had my left hip replaced and since the end of rehab it’s been a breeze.

This time it’s a totally different gig. Roll over just a bit too quickly? Yeah…zero to 8/10 in 2 seconds. I can’t stand still for more than 5 minutes without the same thing happening. Heck, I was getting a massage for goodness sake and had to cut it short because I couldn’t lie flat on either my back or my stomach. In less than 6 weeks this one is imposing itself on every waking minute.

Now, I’m not writing this seeking sympathy. Nope. With only a tiny bit of luck I’ll be just as well a month after surgery, and I only have 6 weeks or so to go before this other hip gets replaced. What’s of interest is this little glimpse into what a life with constant pain might be like. As far as I can tell the pain has changed neither my outlook on life or on the future. I’ve been pretty good at maintaining my sunny outlook (still Lake Dad, Mega!), but it has made me think about what a life with pain always there would look like. My level of respect–awe, really–for folks who soldier on despite debilitating chronic illness has tripled over the last few weeks.

How fortunate am I, are we, to live in a time when at least some of the pain can be cured.

7 OK. Honestly, the quick 90 degree turn in the conversation took me totally by surprise. I’d casually mentioned to Beth that one of my Williams email buddies had shut down his blog, an endeavor that he’d really seemed to be enjoying. It made me wonder if he was OK. If anything was going on. Instead of sending in a batting practice fastball and asking why I was concerned about Thunder (none of us have “real” names on that thread), she tossed a knuckleball:

“Are you gonna be OK? I’m worried about whether you are going to be OK if I’m not here.”

Not gonna lie, I wasn’t expecting that one. For sure we’ve talked about what it will be like to grow old together. Stuff like my recent pain, when we might need to leave Casa Blanco and what that may look like. Statistically it’s much more likely that I’ll shed the ties to this life long before Beth. We middle-aged men are definitely the more fragile version of the species, medical progress regardless. Still, it was, is, a fair question. I’ve made no secret of how much I love my wife. Love to be with her, even if it’s just in the same space while we do totally different stuff (like now while I write and she plays a game she loves).

It’s interesting, isn’t it, that she chose to ask if I’d be OK. Not if I’d be happy or sad, but if I’d be OK. Between our very brief conversation and sitting down to write I learned that my buddy Thunder was just fine; he just wasn’t getting what he wanted or needed out of his blog and decided it wasn’t worth continuing. “Just fine” is what he said. Would I be just fine without Beth? Nope. Not fine and not truly happy. Maybe not even content. No matter how much I try to make the integer “expectation” in my friend’s equation “zero”, in this case I can’t even visualize my world without Beth.

But what I WOULD be, what I’m sure of, is that I would be OK.

You see, I have spent a life, already quite long at 62 years, a life that has been grounded time and again by unconditional love. Love from people who time and again told me that I was OK. That I had it within me to be OK, even when other people might not have been. Same with Beth. Our parents loved us since I was old enough to know and remember, however much they may not have liked us at times along the way. So, too, my maternal grandparents, Gamma and Gramp. They are there in my earliest memories as well, always letting me know that I was, and would be, OK. Probably gave them fewer reasons not to like me I’m sure. The same type of unconditional love has been with me for all of the years Beth and I have been together. It grounds me, still.

So, happy? No way. Content? Fine, like my friend? Unlikely. Will I be OK though? Yes my Dollie, I’ll be OK. I promise. The unconditional love will still be there. Unconditional love will be there forever.

Living Is More Than Just Being Alive: Sunday musings…7/10/2022

“S/He’s living her/his best life.” Seems I hear some version of that phrase to describe someone pretty much everyday. Most times I just smile, or maybe chuckle if it was said sarcastically or if the speaker was aiming for irony, but hearing it usually leaves no impact of any significance. What does it even mean, you know? Best in what way? Best possible for them? For anyone? What does it take to live your best life, anyway?

I am home after sneaking away early from a conference this weekend. Among my professional colleagues I am famous for making all kinds of plans to stick around to the bitter end of a meeting and then pulling an “Irish Goodbye” a day or two early. This time was kinda funny because you could reasonably said the it was an example of me “living my best life”. Or at least one version of “best life”. I was among many professional friends, some of whom I’ve known for decades. They were happy that I was there, and I in turn was quite happy to see all of them. The topics covered were in my wheelhouse, and happily every question lobbed in my direction came in as straight and true as a batting practice fastball.

Yes indeed, professionally I was living my best life.

Among this group of colleagues is a smaller group of people who are, or are becoming, friends without a qualifier. People who I would try to see and hang out with every week if we lived closer. One of them–I’ll call him Mark because, you know, that’s his name–is someone with whom I’ve been exploring two of my pet themes: friendship and happiness. Mark and I are close enough in age and life stage that we cone to these topics, and the vocabulary necessary to discuss them, with a kind of ease and comfort. We’ve talked about the Harvard Class of ’55 study that showed that, outside of being married, the only thing that consistently results in happiness is the presence of three close friends.

Mark is a very successful executive who has moved around a bit during his career. Beth and I moved a bit during our younger years before settling in Ohio 30-some years ago. Despite this pattern deviation between us, Mark and I agree that our jobs and our commitment to family have made it difficult for us to cultivate those local friendships. I’m not sure how Mark views his situation, but I’m pretty sure that I bear more than 1/2 of the responsibility for mine. Since our dear friends Bill and Nancy decamped for Cincinnati I’m sure that my side of the effort equation has been lacking hereabouts.

And yet, despite that, I’m really quite happy at the moment, however much I may worry about what is to come, and I think Mark feels the same. Why? Well, we are both married for one thing, and anyone who reads my pabulum here knows that I am blissfully married at that. As much as I like my professional friends and colleagues, I do have a small tribe of buddies whose company I throughly enjoy, who have thus far continued to welcome me as a tribemate. As I flew home on my secret ninja express yesterday, thinking about Mark and our latest exploration of middle-aged mandom, I realized that not only am I not alone, not even remotely, but it is more likely than not that I will spend much more time with this tribe as we all leave our working lives behind.

Mark and I both have people we live with, and who we live for.

Flying home I realized how lucky I am to have these people. Beth, my kids and grandkids. Siblings and their spouses, all of whom I would love to see every week. My little tribe here locally and all of my professional friends I see over the course of a year. Bill and Nancy, who we still see every couple of months. It made me think of a man I once met at work who had no one, and what I wrote about him after we met.

Billy Ray (not his real name, of course) turned off his implantable defibrillator (ICD). Billy Ray is 44.

In my day job, in the days that I did in-house consultations, I was asked to evaluate Billy Ray for a problem in my specialty. I was told he was about to enter hospice care and assumed that he was much, much older and simply out of options. I admit that I was somewhat put out by the request, it being Saturday and the problem already well-controlled. Frankly, I thought it was a waste of my time, Billy Ray’s time, and whoever might read my report’s time, not to mention the unnecessary costs. I had a very pleasant visit with Billy Ray, reassured him that the problem for which I was called was resolving nicely, and left the room to write my report.

44 years old though. What was his fatal illness? What was sending him off to Hospice care? I bumped into his medical doc and couldn’t resist asking. Turns out that Billy Ray has a diseased heart that is on the brink of failing; without the ICD his heart will eventually beat without a rhythm and he will die. A classic indication for a heart transplant–why was Billy Ray not on a transplant list? Why, for Heaven’s sake, did he turn off his ICD?

There is a difference between being alive and living, having a life. It’s not the same to say that one is alive and that one is living. It turns out that Billy Ray suffered an injury at age 20 and has lived 24 years in unremitting, untreatable pain. Cut off before he even began he never married, has no children. Each day was so filled with the primal effort to stop the pain he had little left over for friendship.

Alive without a life. Alive without living. Billy Ray cried “Uncle”.

I have been haunted by this since I walked out of the hospital. How do you make this decision? Where do you turn? Billy Ray has made clear he has no one. Does a person in this situation become MORE religious or LESS? Rage against an unjust God or find comfort in the hope of an afterlife? Charles DeGaulle had a child with Down’s Syndrome. On her death at age 20 he said “now she is just like everyone else.” Is this what Billy Ray is thinking? That in death he will finally be the same as everyone else?

And what does this say about each of us in our lives? What does it say about the problems that we face, the things that might make us rage against some personal injustice? How might we see our various infirmities when cast in the shadow of a man who has lived more than half his life in constant pain, a man alone? The answer, of course, is obvious, eh?

The more subtle message is about people, having people. Having family, friends, people for whom one might choose to live. It’s very easy to understand the heroic efforts others make to survive in spite of the odds, despite the pain. Somewhere deep inside the will to live exists in the drive to live for others. The sadness I felt leaving the hospital and what haunts me is not so much Billy Ray’s decision but my complete and utter understanding of his decision.

Billy Ray gave lie to the heretofore truism that “no man is an island”.

Find your people. Allow yourself to be found. Go out and build your bridges. Build the connections to others that will build your will to live. Live so that you will be alive for your others. Be alive so that your life will be more than something which hinges on nothing more than a switch that can be turned off. Live with and for others so that you, too, can understand not only Billy Ray but also those unnamed people who fight for every minute of a life.

Be more than just alive. Living your best life means living with, and for, your people.

Thanks to my friend Mark for the inspiration. I’ll see you next week…