Random Thoughts from a Restless Mind

Dr. Darrell White's Personal Blog

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Memories and Remembering: Sunday musings…12/1/19

Not gonna lie, Thanksgiving this year has been a tough go for me. As you know Thanksgiving is far and away my favorite holiday. The coming together of family and friends for nothing but the joy of coming together as family and friends has always touched my soul. That we would or could continue to do so year after year has been a bit of a touchstone for a kid (and a couple) who moved away. For more than 30 years we have alternated in some way between extended families. Where once we needed only manage two generations there are now four in the mix. 2019 was an “off” year for us, a year when children would prioritize in-laws (if even that was possible). Beth and I neither hosted nor traveled to be hosted by family for Thanksgiving dinner (hugs and infinite thanks to the Taylors for folding us into theirs and to Randy and his little family for joining us for brunch).

I missed everybody.

Seriously, I was a mess. Just a great big blubbering mess. I missed everyone, those both simply away and those who are gone. This longing was occasionally just below the surface, and to my wife’s great amusement bubbled through at pretty much every tiny little emotional prompt. It goes without saying that I sprung a leak watching “Mary Poppins” and “A Beautiful Day in the Neighborhood ” (the Mister Rogers movie), but come on, I cried at the end of “Downton Abbey”. Everybody lived! Everybody was happy! And I still cried. Don’t even get me started about that new “E.T.” commercial. Sheesh.

For whatever reason, well, probably because we wouldn’t have a typical family Thanksgiving, I’ve been thinking quite a bit about family members who are no longer with us. It’s been a tough few years for the White and Hurst families, and for the families of our sibling’s spouses for that matter. I’ve found myself thinking of my Dad and my Father-in-Law, wishing I could chat about any number of things. We stumbled upon a lovely picture of Sandy, my Mother-in-Law, making Christmas cookies. So vibrant, so alive in that picture. My memories of those holiday moments came alive, too, a rush of color and smiles and scents and laughter. Bob’s puns. My Dad’s terrible palate that could nonetheless parse the provenance and price point of Chateauneuf de Pape. They are here with me as if we’d had dinner yesterday.

If I had the guts I would re-watch “Coco”, that lovely little Disney movie about the Mexican day of remembrance Dio de los Muertos. I don’t, and I won’t, at least not now while I seem to be just one raw exposed nerve, but if I did it would probably help a bit. Remembering, that is. Harold Bloom, the Yale professor of literature and societal scold, has given this some thought: “Our beloved dead live only as long as we absorb them into our daily thoughts and feelings. When we die, our own survival will be the extent to which we have changed the lives of those who come after us.” Very Mexican, that. Still, both Bloom and Coco are right; Beth’s folks and my Dad have been here with us this Thanksgiving.

Are they in Heaven? Boy, for as much thinking as I’ve done about that over the years I still don’t know where that is. Heaven, that is. Is it a place like what Disney depicted in “Coco”, where our dead live for as long as they are remembered by the living? Does the Heaven of my upbringing exist as a place of eternal joy for those whose lives were deemed worthy? Or is there some other, more rational explanation like the one that my genius brother-in-law and I have explored through quantum physics? The multiverse of infinite time going both forward and backward?

Or perhaps it is not our beloved dead who are in Heaven but us. Maybe it is we who are in Heaven. Mr. Rogers: “The connections we make here in the course of a life–maybe that’s what Heaven is.” Maybe Heaven is here, now, and those we’ve lost in the flesh are nonetheless here with us in Heaven for as long as they are remembered. Make no mistake it is easier and far more satisfying to be warmed by a hug than a memory. But still, the connections persist. That’s likely the important lesson for me this Thanksgiving. The rituals help us to remember, and the remembering keeps those we love and have loved close by. My beloved Thanksgiving, in every version, may be as close as I will ever come to understanding Heaven.

And that it’s OK for me, for anyone, to want a little more of Heaven.

 

Thanksgiving musings…

Thanksgiving musings…

For pretty much my entire adult life I have tried very hard to live by one of the core tenets of Taoism: the man who knows when enough is enough will always have enough. Through times both thicker and thinner, the more closely I’ve been able to hue to the intent here the happier I’ve been. For Thanksgiving Day I’ve come upon a companion piece that may very well bookend a philosophy for life.

“Gratitude turns what we have into enough.” (HT Mrs. Bill Livingston)

Enough is a truly powerful thing. Enough is the portal to satisfaction, if not happiness. Enough is the antidote to yearning, to wanting. Once you have enough there is no reason to covet. After enough anything else is a bonus, life’s equivalent of that overflowing Holiday cornucopia. Gratitude is a straight shot to enough. On this Thanksgiving Day I am grateful for all that I have, for as long as I have had it.

For a life where for so very long enough has been enough.

Happy Thanksgiving.

Holiday Rituals: Sunday musings…11/24/19

“The sign of a healthy ritual is one that can be changed.”

This is my favorite time of year. Thanksgiving, that is. I’m not so much a fan of the whole “Holiday Season” thing, given that it’s all about the commerce of Christmas. What I really love is Thanksgiving. It’s pure, or at least as pure as a holiday can be in our hyper market-driven American lives. For those of you who are now being launched out of your chairs with a knee-jerk response about the heinous effect of the Pilgrims on the indigenous natives here long before the westward move from Europe, save your breath. What I’m talking about is not in any way related to anything historical other than the traditional myth of generosity and comity I first learned about in kindergarten. Thanksgiving for me is simple and pure. We gather and break bread, the only reason to do so being that we are thankful for the opportunity.

We joke in the White family that our traditions, especially those around holidays, are set in stone. Do it twice and it’s as permanent as Stonehenge. While this is certainly true on average, looking back there have been some mileposts where a turn was made. Actually, more than a few. In the earliest of days my maternal grandparents hosted Thanksgiving in New Jersey. This went on until my Dad had enough of traveling with 3 and then 4 little ones. Turkey Day moved to our home for the next 20 years or so. I have to admit that I don’t remember whether or not Gamma and Gramp were there in the tiny house in Southbridge; I cannot remember a Thanksgiving without Gamma once we moved to RI, at least after Gramp died.

Why can’t I remember where she sat?

Take a moment and think about your family meal. What time did you eat as a kid? Do you remember why that was the time? And the meal itself; what did your family eat and how was it prepared? It was always the same, each year, right? We were a football house. In RI every high school has a Thanksgiving Day game. Same for Massachusetts. The annual rivalry with Bartlett (Webster) has been a thing in Southbridge for decades. I got to play in one as a freshman, but I can remember going to the game to see our childhood heroes, the gods who strapped on the pads for the Pioneers, from my grade school years. My first cup of coffee was at at Bartlett/Southbridge Thanksgiving Day game when they ran out of hot chocolate. We ate around 3 if memory serves. The games began at 11 and were done by 1:00. Long after I hung up my cleats in RI we all piled on our warmest outerwear and watched Lincoln High play its annual version of the game.

Stuff starts to change when you get married and the whole in-law thing enters into the Holiday equation. Beth and I are both first-born, first-married, first to have kids (and grandkids) in both of our families. Since our families lived 6 or 7 hours apart there was no way to pull off the double-dinner dance so delicately done by countless friends who married local. It’s funny how you notice the differences in family traditions so much more than that which is the same. The Whites and the Hursts all ended up with magnificent meals, both nutritionally and spiritually satisfying in every way, albeit by vastly different routes. Beth’s family sourced everything locally, each item plucked from the farm within days of Thanksgiving, every course and dessert made from scratch. In our house the turkey was frozen long before dinner, and the only things made from scratch were the mashed potatoes (Dad was very particular about them) and the stuffing.

And yet both meals were the best meals I ate every single year because they were baked in love and enjoyed in the company of those I loved and who loved me.

Change has continued to come to our Thanksgiving rituals as the next generation went to college and began to (yikes!) marry themselves. Two generations of in-laws to manage now. Whoa. Children living out of town with job schedules and travel logistics to contend with. Siblings who live close enough to give at least a passing thought to joining around a single table, and other sets of siblings just far enough apart that to do so would require a quantum computer and a Papal decree. Our little family alternates years as we did for so long when our kids were young. This is an “off” year for us. Beth and I will see one child and his family for a short time at brunch. That will be it for our family gathering, at least on Thanksgiving Day. Another family will fold us into the embrace of their ritual, a change for both of us.

The details change, but do the rituals of Thanksgiving change as well? I don’t think so. At least not enough to change how I feel about Thanksgiving or how I remember our Thanksgivings of yore. We will enjoy the rituals that have surrounded the signature ritual, the Thanksgiving Day meal, and for this year they will be enough. Pizza on Wednesday to usher in the Holiday, and the best steaks we can find on Friday. On Saturday I’ll try to find some way to serve lasagna; we always had Mrs. Cunniff’s ready to defrost after 3 days of leftovers. I’ll bring Cakebread Chardonnay (and think of my sister Tracey) to our friends’ house for dinner, almost 30 years of ritual in that little gesture alone. With those steaks we will drink Chateauneuf de Pape, the only wine my Dad could identify; he had the world’s worst palate and was subsequently the easiest wine drinker to please except on the Friday after Thanksgiving when only Chateauneuf de Pape would do.

The sweet sadness of change will be lightened for me by the strength of the rituals that persist. Each one has grown to fill the space created by inevitable change. By both loss and gain. The rituals that we have now have come from the same place as those they have replaced, a place of love, a place filled with thanks for that love. Yes, this is my favorite time of year. Thanksgiving is my favorite holiday.

Happy Thanksgiving to you and yours.

Mary Poppins and Politics: Sunday musings…11/11/19

Sunday musings…

1) Wit. “Mustard’s Last Stand”. Name of a hot dog stand at Northwestern.

2) Streaming. Lots of churn about streaming fatigue, overload, etc. So many/too many new options layered on top of shows and movies you still need to catch up on. What’s a body to do?

I’m gonna read a book.

3) Burberry. I stumbled upon several articles talking about the new creative director of venerable clothing brand Burberry. All of them talked about their plans to change stuff there. While I am not a regular customer by any means I have had a couple of pieces from Burberry that fit my style and stood the test of time. Which begs the question: why must Burberry, or for that matter any iconic brand known for a particular whatever, change? Evolution seems proper, maybe even inevitable, but the incessant demand for the traditional to change is confusing to me.

Why must change be considered as a mandate rather than an option, especially in a successful endeavor?

I admit that I poke fun at fashion with some regularity, typically timed by the semi-annual release of fashion issues of the big national newspaper magazines. My fascination with the absurdity of what is promoted as good, or even possible knows no bounds. Nobody wears that nonsense, yet lots of somebodies continue to wear garments that are instantly recognizable as Burberry. Does this not denote success? Is this not what a successful venture of any kind in any space would seek to perpetuate? I think of the pillars of healthcare delivery, known for excellence in certain spheres because of their ability to successfully treat the most complex cases imaginable. One of them here in town has a new “creative director” who has decided that change means the equivalent of mass market growth in fashion. Like Givenchy designing and selling volume in Kmart.

How long can a successful brand sustain change before what made it successful has been diluted to the point of nonexistence? How many places can the iconic Burberry plaid be placed before it’s just another color? How far from the classic pieces for which it is known can the new creative director take the Burberry style before it’s no longer Burberry?

These are questions that apply everywhere a traditional product, brand, or name means something.

4) Candidate. Much noise has been generated by Michael Bloomberg’s flirtation with a run for the Democratic nomination for president. He is a political chameleon, running now as a Democrat after a run for mayor of NYC as both a Republican and an Independent. Mostly a down-the-line progressive when it comes to social issues he nonetheless has a couple of positions that would appeal to conservatives; his record for law and order in New York appeals to conservatives while at the same time revolting progressives due to the tactics utilized to achieve the goal. A billionaire many times over he seemed to find a balance in NY between promoting business and the creation of wealth while simultaneously protecting those at the bottom of the economic pile. As much as anyone in New York can, anyway. He likely gets bludgeoned in the primaries even though it is equally likely that he would win the presidential election in a landslide.

As interesting and intriguing as Mr. Bloomberg may be his potential entry into the race makes me think of the most impressive national figure I can think of in my lifetime who should have run for President, Condoleezza Rice. Ms. Rice was Secretary of State under Bush and is now a professor at Stanford among other pursuits. Possessed of a nearly unmatchable intelligence among recent government officials both elected and selected, she checks every conceivable box both as a candidate and as someone prepared to govern. I think I can trace my dissatisfaction with both politics and government in part to her decision to withdraw from public life. Not since Paul Tsongas withdrew from the ’92 race due to illness have I felt like the right person was there to be chosen. Her absence from the national conversation borders on tragic.

I fear that we are thus doomed to at least 5 years of braying from the far Right and Left, or just plain old braying if we have 4 more years of 45. In the absence of someone like Ms. Rice, someone of substance who transcends the pettiness of our politics, I will spend another 4 years waiting. Waiting for someone of substance who will speak to me and the 10′s of millions of us who inhabit the center of American politics. Some a little left and others a bit right of center, but all of us clustered far from what it apparently takes to be nominated to run for either party. I will wait for someone who makes me think of Mr. Tsongas or Ms. Rice. Individuals of arching intelligence and substance who have lived lives that citizens of all political leaning can agree have been honorable. Ethical. Candidates who will take and hold principled positions without denigrating or dismissing those who disagree. Someone who can both campaign and govern.

Watching her leave her post as U.N. Ambassador after a successful run as Governor of South Carolina I felt like Bert, looking skyward as Mary Poppins flies away after saving the Banks children. So long Nikki Haley. Don’t stay away too long.

I’ll see you next week…

 

 

“Traditional CrossFit” Sunday Musings…11/3/19

1) Fall. As in fall back. Daylight Savings time is over. I will miss our sunsets.

That extra hour of sleep, though…

2) Toddler. We have been hosting our little Man Cub (and his Dad) while the Pipsqueak is away with her Mom. Nothing, and I mean nothing up to and including fusion, produces more energy over the course of a day than a male toddler.

Even that extra hour of sleep isn’t enough to catch up.

3) Goals. Mens Journal has a fluff piece about Michael Strahan in last month’s issue. Seems like a nice enough guy (though you’d like to see one of these whirling dervish success types manage to stay married). Got lots on his plates. It’s a fun peek into his work week. As is often the case there is a little gem tucked into the text, this one about how he sets goals: SMART.

Specific. Measurable. Attainable. Realistic. Time-Bound.

“Attainable” and “Realistic” are redundant, but the idea behind this little ditty is pretty good. After reading this I fired off an email to one of my teams at work about a service that we have not successfully integrated into our business. While we may still fail, putting my proposal in this format at least makes our process a better one.

As is so often the case it was worth reading about one more golf-obsessed retired athlete to get this one little pearl.

4) Traditional. Those of you (both of you?) who have been reading these Sunday missives for a bit will remember that “Sunday musings…” was  my way of giving back to the (much younger, earlier version) of the CrossFit community. I discovered CrossFit in 2005 and began to interact online in 2006. The website also had a Message Board back then; folks got to know one another in what I called the “cyber gym” both on CrossFit.com and the Board. Those free-wheeling, wild west spaces are long gone, replaced by a subscription/sign-in and monitored corporate locale befitting the grown-up business that CrossFit has become.

On Instagram, a place I do not visit, a pundit in the fitness arena opined that “Traditional CrossFit” is no longer, and that his version of “smarter” CrossFit was now what one should practice. What he is actually saying is that the practice of “CrossFit, the Sport of Fitness” is no longer what the masses should be doing, because so-called traditional CrossFit has really never gone away. The very best affiliate gyms have always used the kind of CrossFit that you found on CrossFit.com (with rational scaling options provided each night from BrandX)  from 2005 through around 2011 or 12.

While I no longer have any type of relationship with CrossFit, Inc. or a local affiliate gym (though I continue to be very friendly with the owners of the original Box here in Cleveland), I still work out much as I did when I discovered CrossFit in 2005 (interestingly in a Mens Journal article). There is still wisdom in the original version of “What is Fitness” published in the CFJ volume 2 ( the re-edited version is not of the same quality; I wish I’d saved a copy of the original). Constantly varied (do lots of different things) functional movements (do exercises that involve the whole body, not isolated parts) performed at RELATIVELY high intensity. That last part has always been key, and it is one of the parts that, if forgotten, leads to suboptimal outcomes and injury: intensity is relative to the individual on any given day. At 59 (and coming off a hip replacement) I am hardly going to have the same intensity I had when I started CF at 45.

Form, or technique (do the exercises properly), consistency (do the exercises properly all the time; adhere to a schedule of exercise and recovery), and only then intensity. This was once dogma that was unassailable. The “gamesification” of CF after 2012 prompted many a gym to lose this as they chased the competitor and as members chased competitions they had no business chasing. “What is Fitness” also introduced the masses to the 10 Characteristics of Fitness and the concept that a truly fit individual was equally competent in all 10. That IG opinionater  makes the classic mistake of stating that strength is more important than the other 9 characteristics. This  is as misguided as one of my other favorite reads, Outside Magazine, which consistently posits that cardiovascular endurance is the sine qua non of athleticism. Jeff Martin of The Brand X Method (who has no affiliation with CrossFit) should be credited with the real insight regarding strength: the vast majority of individuals are under-strong relative to the other 9 characteristics, and therefore supplemental strength training is necessary.

It’s not necessary to learn that IG opinionator’s name because he is just the most recent example of someone who almost gets it. Man, the conversations we had about this stuff in those halcyon days of CrossFit.com–scaling, strength, additional work, recovery–my kids called in “CrackFit” because we were all so into the intellectual side of this new way to approach fitness. Without a doubt “CrossFit the business” bears little resemblance to those early days, but the very particular way “CrossFit the program” applied classic HIIT principles was, and still is, revolutionary. Layering on traditional training techniques (periodization, supplemental exercises to address weaknesses) while remaining firmly committed to the original core principles (technique -> consistency -> intensity, etc.) is simply proper evolution.

With or without CrossFit, Inc. that particular era is far from over.

I’ll see you next week…

 

A Common Experience With Uncommon Disease

It really makes no sense. No sense at all. I live in a city that can be described as a mid-major, sure, but it happens to be a city that has a major league medical community anchored by two large research centers. Three if you happen to have a pediatric disease. And yet, with all of our local resources it can be absolutely maddening if you have a relatively rare disease, an unusual presentation of a common affliction, or if you happen to need highly specialized care at even the most mildly inconvenient time. There is a rent  in the very fabric of our medical system, the part of the general healthcare system where actual medical care is delivered to real, live patients by doctors and nurses and the like.

One of the main selling points of the Accountable Care Act was that it would encourage the creation of large vertically integrated organizations that would be so efficient that they would provide medical care to people with greater convenience at a lower cost. In reality, not so much. Where once a patient would call an operator sitting at the front desk of her doctor’s office to make an appointment, one now calls a large center that resembles the kind of place you call when you have a problem with your credit card. Your operator has no idea what’s going on in the office, and she has all kinds of rules that are in effect barriers to seeing the doctor. If you have an emergency there is only one answer allowed: go the emergency room.

Neither convenient nor cost effective, that.

What happens when you have a rare, unusual, or complex problem is even more maddening. Once upon a time institutions like the Mayo Clinic, Cleveland Clinic, and Cedars Sinai were willing recipients of referrals from doctors in the community (or from within their system) who had the very hardest medical challenges. Indeed, in my recollection that’s all they really wanted to see. They were so busy making brilliant diagnoses in the most confusing medical cases, and performing brilliant surgeries on the most difficult and rare diseases that they had no time to see the common, mundane diseases that make up the overwhelming majority of what most doctors see in their offices and the OR. More than that the doctors at these medical meccas were simply thrilled to have your referral if you, like me, were someone who saw the masses. The great professors were available 24/7/365.

Now? Not so much. The age of the Accountable Care Organization (ACO) is the age of the institution. What was billed as a program meant to return the patient to the center of the care experience has actually driven the patient to the bottom of the org chart. Where once the patient was truly the focus the most accurate description of the priority cascade is now institution (administration) -> government -> payer (insurance) -> doctor -> support staff -> patient. With few exceptions there is no such thing as A PATIENT; institutions (and payers, etc.) talk only about PATIENTS. Like customers at Target. An omnibus group to be assessed en masse, with conclusions drawn and then applied to a population, not a patient.

This works I suppose, at least it sorta works from a medical standpoint, if you are a patient who has a common problem that fits in the middle of the Bell Curve of presentations. Where once these vaunted institutions were staffed by a small cadre of truly elite practitioners, nothing but Generals and Colonels, there is now an army of  privates and corporals marching in lockstep. Like an army they are fed by a massive infrastructure that is unseen and uninvestigated, punching in and punching out, their output measured as precisely as that of a manufacturing company staffed run by a Six Sigma star chamber. But what if you, the patient or the parent of a patient, fall outside the limits of the Bell Curve? What if you are like the patients who used to constitute nearly the entire population of patients at what used to be called tertiary care institutions?

Let me tell you a couple of stories that seem to be representative of the law of unintended consequences. Unintended, that is, if we are being charitable.

While I was out of town last weekend one of my associates saw a patient in the office who we had inherited from one of the larger institutions in town. Inherited, that is, when our patients family had become exasperated by the barriers placed between them and the care they needed, especially when there were acute issues to be addressed. Although we are not a “mecca” our group is really very good, able to handle levels of complexity that are beyond the scope of a typical specialty practice in the community. Nonetheless, there are circumstances where care should be provided in a super-specialty setting, and such was the case for this poor patient. My associate was rebuffed by both institutions, never able to get by the second level of “civilian” phone bureaucracy at either institution to even discuss the case with a physician. One offered a visit at an associated local ER (with no specialty coverage), and the other refused to even offer that since our patient had once been seen in the other institution and was therefore “their” patient. When I intervened I did speak to an on call specialist who agreed to have our patient seen by their onsite (general) ER. I arranged care with a private subspecialty group.

Our patient got the care they needed because I have 30+ years of experience, and I have contacts I’ve built up along the way that I can call on in a pinch. What if you are a patient, or the parent of a patient, who needs something unusual, out of the ordinary, even if you don’t need it on an emergent basis? One need only look at the evolution of disease support groups on various social media platforms to understand the scope and character of the difficulty that this population faces when they need specialty care. Let me use our little family as an example (my son and daughter-in-law have been very open about their experience).

A child has a number of small but not inconsequential medical issues that don’t seem to be related, but there are just one or two too many to just chalk up to being a “little behind”. Mother and grandmother share their concern with the family doctor who agrees, but admits that it’s just a bit beyond their scope of practice. Mother used her considerable Google-Fu and discovered that there is a medical condition that explains everything that is going on, and she has spent some time in an online support group learning about it. She  has convinced both grandmother and family doctor that a rather rare but well-known entity is possible, so the family doctor arranges for the proper specialty consultation. The specialist agrees and orders the standard test, an MRI, and all hope for a quick confirmation so that a solution can be found.

So far, so good, right? A process that’s a little slow, but a process moving forward. Once the MRI confirms the diagnosis we will surely find an expert to do the surgery since we live in an area with not one, not two, but three world famous children’s hospital. Even if the MRI is equivocal the support group members assure our little family that the existence of the “occult” or hidden version of this condition is well known enough that we will be able to move forward locally. Until, you guessed it, the MRI was read by the infantry as “normal”, and the specialty surgeons declined to even see the little patient.

Mecca was closed.

In the age of the ACO this is such a common occurrence that the support group could not have been more blasé in its response. A dozen or more moms chimed in with carbon copy stories of large, prestigious institutions that no longer looked beyond one or two standard deviations from the mean. What has replaced the tightly nit and interwoven physician networks of trust in which a dogged pursuit by the family physician would carve a path to the necessary super specialist is the online support group. Where once a single doc could move the needle there was now a hive of collective knowledge and experience that sought out and then supported those few specialists who practice as if they were back in the era of the giants. And so it was that our little patient traveled from Cleveland, home to three world famous children’s hospitals, to Providence and the surgeon who would go on to confirm the diagnosis and perform the surgery that would lead to a cure.

What does it say about a healthcare system that has dismantled  the institutions that once cared only for the most complex and complicated medical problems, as our little patient experienced? It turns out that the MRI was misread; the diagnosis was obvious to the Rhode Island surgeon, and easily seen by mother and grandmother once it was pointed out. What does it say about division heads who are so consumed with acquiring market share in the most basic areas of a specialty or service that they allow the growth of a culture that is built around turning away these challenging problems at the door, as my patient experienced? Volume and margin have triumphed over the miracles that we once came to expect from great medical institutions.

What happens to the patient who doesn’t have an old, connected doc willing to get on the phone to find the right place and the right care? Or the child who doesn’t have a mother or grandmother who will doggedly pursue the diagnosis and care that was once pursued on their behalf as a matter of pride, a matter of course? What happens when Dr. House is too busy doing cash-pay executive physicals to see the patient he was trained to save?

Tiny Cultural Collisions

I just returned home from the largest of the annual ophthalmology meetings. At these gatherings I see my professional friends, and some 35,000 or so of us descend upon whatever city we are visiting. We bring all manner of customs and culture along with us, there to collide with those of the locals. Here is what I wrote about this a few years ago, still relevant today.

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 two of my very favorite colleagues, Neda and Carol, always arrive 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 than whether or when you turn the other cheek, a tornado to the above tickling breeze.

Perhaps we could all agree on the two-cheek greeting thing.

In Memoriam: Abby, the Wonder Dog

In Memoriam: Abby the Wonder Dog

This morning I was awakened by a text from Beth: “Call when you can.” That’s almost never good, and today was no exception. My beautiful, brilliant dog Abby had died. A tumor was wrapped around a major artery; there was nothing to do but comfort and love her after the artery burst. She died in her Mamma’s arms as my son Randy gently stroked her head.

May I tell you her story?

My older boy, Dan, shared an apartment with two friends and a very cool Border Collie named Dakota. When Tommy and Megan moved on Dakota went with them, leaving a hole in Dan’s heart that could only be filled by another dog. Did you know that farmers in central Ohio who raise working dogs don’t always spay or neuter their packs? Neither did we. While I don’t know how extensive this next part is, at least some of the pups that are not needed to work the farms are simply turned out onto the land to fend for themselves. It’s enough of a thing that there is an animal rescue in Tiffin, Ohio dedicated solely to these “extras” from the litters.

Abby and her sister were feral for the first 6 months of their lives. After being live-trapped they were brought to the Border Collie/Australian Shepherd rescue where Dan somehow discovered Abby’s picture. There must have been 3 dozen dogs in crates and running in outdoor pens when we arrived to see if they would let us adopt one. It was funny. We had to audition for the staff. They brought out 6 or 7 other dogs to see how we would handle them before finally bringing Abby out of her crate.

Abby, who promptly came right over and climbed simultaneously into Dan’s lap and all of our hearts.

Herding dogs like Abby, part Border Collie and part Aussie, are rightly famous for their intellect and their energy. Having one of these without a farm to run them is a special kind of crazy. As a college junior Dan’s apartment was hardly expansive enough to contain her energy. Was it boredom or anxiety that prompted her to tear the carpet in the apartment and eat down through the subfloor while he was in class? She never said, but shortly after her “redecorating” she came for her first extended stay with Mom and Dad.

We had quite the little pack, Beth and I. Haddie our English Setter was like Nana in “Peter Pan”, mothering dogs, children, and adults alike. Tiny Tim arrived looking more than a bit like a Beanie Baby, so tiny and fragile, velcroed to Beth’s side. And then Abby arrived, all energy and curiosity and mischief. Even with her canine buddies there was still something about being without her people that made her crazy. Nothing on a counter or in a closet was safe from her when we were out.

I’ve told most of these stories before. Like the time she ate about $200 in petty cash from the office. Pretty interesting poops in the backyard after that as you can imagine. The very best one was when she “ate my homework”. We’d gone out to dinner and apparently I didn’t put my surgical sheets for the next day’s cases far enough back on the counter. If that’s all it was I could have run up to the office and simply run off new copies. Nope. As it turned out I was also transporting a couple of special order lens implants from one surgery center to another. Implants for which one of my patients had paid about $1500. Oh yeah, Abby ate those, too. That was a pretty weird phone call, telling my patient why I was cancelling their surgery at 9:00 PM the night before. The OR staff still talks about that one.

Abby never really lost a kind of wariness around new people. It was there with all of us (except Dan) at the rescue and remained after she came to live with Beth and me while Dan was doing lots of traveling as he completed his studies. There’s a lovely fellow who worked for the boys at their gym who Abby never warmed to; he sent us a very nice condolence in which he shared that this had always made him sad. Beth and I had just one worry, that she would be skittish around little ones like grandchildren. No worries there. I will forever see her lying close to her newest littlest people, totally unperturbed as they tumbled on top on her in their travels.

Or the tiny little “drive-by” kisses, soft little licks she gave Landon or Lila or McKenna on her way by. Yes, those…those I will see through my tears forever.

Abby loved us from the minute she chose Dan right up until she died. The last thing she saw on this earth was her people Mom, Beth, and her little brother Randy. I’m still not sure if it was better to be away or not. All I know is that I loved my dog, and that the very last thing I did when I left the house last week before my travels began was to reach down, scratch her ears and tell her. For all of my sorrow I wouldn’t trade our years together for anything.

Fair winds on this last journey Abby, your sails full with the winds of my love. I did so love being your person.

Musings on When a Game Became “The Game”

Here is an update to an essay from a couple of years ago. I read it today, on a Saturday afternoon, when I will once again not be watching football.

 

Randy texted me about the exciting finish to the ND NCAA football game. Dan called and asked if I was watching the Browns. 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 those moments two of my kids was very happy. My sons football playing days are long behind them, but the game still brings them 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 2 or 3. I was a medium-sized fish in a puddle as a high school football player, but 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 bit all 4 years. Now done as a player 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.

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 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.

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 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. 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 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 little 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 can channel the joy of a child. And that 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.

One is left to wonder about the parents of those gladiators past.

The Purge: Re-Visiting the Process of Shedding Material Things in Our Downsize

Six years ago this month Beth and I downsized and upgraded to Casa Blanco, our tiny little lakeside “retirement” home. It took 3 years to let go of our accumulated “stuff”, not a little bit due to the fact that there was quite a bit of “stuff” that belonged to our kids. We have new neighbors moving in next door, also downsizing, and some of my friends around the country are starting the process. Here’s what I had to say about our experience when we finished our “purge” and as our grandchildren started ramp up the acquisitions of new stuff.

 

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.

 

And with that Beth and I are off to visit family in Rhode Island and friends we made on our Honeymoon 34 years ago!