Random Thoughts from a Restless Mind

Dr. Darrell White's Personal Blog

Cape Cod

The End of the Age of Volunteerism

Ladies and gentlemen, we are gathered here today to mourn the death of the Age of Volunteerism. While there exist tiny spaces where true volunteers live and thrive in a bilateral exchange of freely given goodwill, by and large volunteerism has been extinguished by the actions of its historical recipients. Sunday marks my last day ever of hospital ER call, the end of 2 years of receiving token payment for making my expertise available following 25 years of doing so for free. My experience is typical, as is this denouement.

Once upon a time all of your doctors were in private practice. We all had tiny little cottage businesses, did our work, and billed you or your insurance company for the work we did. Some of us worked in tiny little groups, but it was the rare doctor who was part of a large group or business whether in a big city or out in the country. Even the slickest Madison Avenue internist was basically a country doc, just with a better, more expensive wardrobe. In addition to having a greater familiarity with our patients we also enjoyed a very clubby relationship with all of the other doctors where we practiced. There was a collegiality, a sense that we were all in the struggle together. Folks who shirked their duties, foisting them off on other docs, were quickly educated about proper protocol or left to toil alone.

Hospitals were different, too. Local or regional, they were hardly the gargantuan mega-businesses they’ve become. The org chart was shallow, and most local doctors were on a first name basis with the few administrators on the hospital payroll. You took call for the ER as a volunteer; the ER respected that you were donating your skill and your time and handled everything it could before calling you. Same thing for consultations. Your colleague only called you if they couldn’t figure out a problem or ran out beyond their scope of practice. There was a faint air of apology with each request, and a definite unspoken appreciation for the help that would be given. You helped because you were appreciated.

This is really no different from all manner of volunteerism in America. Smallish, closely knit organizations depending on the goodwill and generosity of members of their community pitching in to ensure success. Think local memorial 5K races, or CrossFit Games Regionals in the days before ESPN or the Home Depot Center. Countless small private schools that depended on the largesse and time offered by the families who sent their children there. You gladly accepted the opportunity to volunteer because you knew that without you the organization would not be able to function. You also knew that the recipient of your generosity not only appreciated your contribution, they really had no other options. Not only that, but if that organization somehow existed in your professional space you knew that it would never, not ever, abuse the trust necessary for volunteers to continue.

What happened? Money. Money and size and the distance that they create between an organization and its volunteers. Let’s go back to the hospital and the ER for a minute. Where once your efforts as a volunteer were deeply appreciated and those efforts rewarded with respect and care for your time and your expertise, the growth of employment of doctors by hospitals opened a gap between colleagues. No longer was there the esprit de corps, the shared notion that the primary target of our efforts was the patient was replaced by so very many doctors by the reality that they worked first for a business as faceless and uncaring as GM. Work that was once done by your colleague was now pushed to the volunteers whenever possible. It’s cheaper that way. Worse, boxes to be checked by the employed (to maximize revenue and minimize risk) meant demands made of volunteers, not requests. Worse, still, were discoveries that some “volunteers” were more equal than others: they were paid.

Innumerable examples are there for the picking. Some times it was just a case of laziness. Other times the insult was a clear effort to dump work on the volunteer. A critical care fellow requested a consult for acute narrow angle glaucoma. For those of you not medical this is one of the few “drop everything and go” consultations in eye care. When I arrived in the ICU I found a young patient with a black cornea who was mildly uncomfortable. I did what every highly experienced specialist does when they start a consultation, I asked the patient: “Hey, what’s up with your eye?” Turns out they had a blind, painful eye as the result of a surgical mishap, and surgery to remove the eye was already scheduled. Their discomfort was because none of the eye medications had been ordered; the fellow never asked. No doctor (or nurse) would have allowed this to happen in the Age of Volunteerism.

While this is nothing short of tragic in health care, it was inevitable once medical businesses were incentivized to grow ever larger. It is not confined to health care by any means. How do you think that volunteer at a Spartan Race feels when he learns how much his “team leader” is being paid? Have you ever “discovered” how much the Executive VP of your favorite professional organization is paid? As a people we Americans are generous to a fault. That generosity usually continues right up until we discover that we have been duped, and even worse that we have been purposely duped by the people who run the organizations for which we volunteer.

And so we gather here to mourn the passing of the Age of Volunteerism. Like so many things of wonder and goodness there remain pockets of resistance, little oases where the goodwill, honesty, and appreciation beget the kind of ebb and flow that made things so much better, kinder, more collegial at the apex of Volunteerism. My friend Tom Gardner was just named the president of the Society of Alumni of our Alma Mater. Tom has given tirelessly of his “spaces”, his timespace, brainspace and emotionalspace to help shepherd tiny Williams College as it flows on though time. Is this truly different? A tiny refuge from the Zombie Apocalypse of corporatization of all things to which we once volunteered?

We can only hope. Hope that Tom and those like him who continue to find places and causes where their volunteerism is met with what we in medicine have had to bid farewell. We can only hope that there will be places where being a volunteer means receiving the respect and appreciation and even a kind of love in return for what we have given. We can only hope that there will continue to be places where the incessant drive to grow ever bigger, size measured on a spreadsheet rather than by heart, will be resisted. For if it can happen in medicine, if volunteerism can be killed in what is arguably the most noble of all endeavors, I fear that it is doomed everywhere.

We mourn the end of the Age of Volunteerism. We wait with equal parts sadness and fear for arrival of whatever comes next.

 

Sunday musings 10/14/18

Sunday musings…

1) Feral. Abbie the Wonder Dog was feral for the first 6 or 9 months of her life. I can’t remember exactly. She was live-trapped and rehabilitated by a Border Collie rescue organization in north central Ohio. When she frustrates me it is always helpful to remember this.

Having a formerly feral creature living in our midst is also a very good counter to the frustrations of modern life. I try to remember how far I am from true privation whenever I find myself railing agains the insanity and inherent indifference that the world clearly has toward my existence.

A quick thought of my clever (read: sneaky) pup is usually all it takes to quell my urge to explode when I encounter the tragedy of a poor internet connection…while hurtling through a mountain pass in a car going 80 MPH.

2) Test. Some 10 years ago or so I proposed that a true measurement of health should be possible. Something that combined the most basic of classic medical knowledge (weight, %BW fat, BP, Cholesterol, etc.) and the breakthrough notion that physical fitness could be measured and tracked. My theory included the necessity of including some sort of measurement of “well-being”, a mandate that was initially openly mocked but seems to have been rather meekly accepted as both logical and necessary.

Creation and launch of such a value, call it “Total Health” or something along that line, has fizzled due to the lack of consensus–nay, even interest–in coming up with a way to measure Fitness. Imagine, in a place like CrossFit where the very definition of Fitness was created, no one save me and a tiny group of equal obsessives has so much as let fly a tiny trial balloon. The original owners of CrossFit LA were the first to use a standard entry test. 500M Row/40 Squats/30 Sit-Ups/20 Push-Ups/10 Pull-ups. I suggested pulling from both traditional sources (The President’s Fitness Test) as well as CrossFit and the larger endurance communities: 2:00 each of PU/Push-Up/Sit-Up/Squat, 1RM Deadlift, 1 mile Run. We ran a competition once called the “Fittest Eye Doc” using this.

What is necessary is a test that is a) doable by the general public, and b) capable of creating a single value that can be measured and tracked. Once that is done mathematicians and statisticians can be let loose with the various factors and given the task of coming up with a formula that includes all three categories. Why bring this here, again, when thus far my previous dozen or so postings have been met with crickets? With the pivot to health and the rapid build-up of a cadre of physicians who are at least superficially interested in using high intensity exercise for the purpose of increasing health, I am hopeful of a broader dialogue that comes to an agreement on a test.

Challenge: create a test of fitness that is broadly accessible in all ways (scalable) that can be included in a definition of health. 3-2-1…Go.

3) Volunteerism. Ladies and gentlemen, we are gathered here today to mourn the death of the Age of Volunteerism. While there exist tiny spaces where true volunteers live and thrive in a bilateral exchange of freely given goodwill, by and large volunteerism has been extinguished by its historical recipients. Today marks my last day ever of hospital ER call, the end of 2 years of receiving token payment for making my expertise available following 25 years of doing so for free. My experience is typical, as is this denouement.

Once upon a time all of your doctors were in private practice. We all had tiny little cottage businesses, did our work, and billed you or your insurance company for the work we did. Some of us worked in tiny little groups, but it was the rare doctor who was part of a large group or business whether in a big city or out in the country. Even the slickest Madison Avenue internist was basically a country doc, just with a better, more expensive wardrobe. In addition to having a greater familiarity with our patients we also enjoyed a very clubby relationship with all of the other doctors where we practiced. There was a collegiality, a sense that we were all in the struggle together. Folks who shirked their duties, foisting them off on other docs, were quickly educated about proper protocol or left alone.

Hospitals were different, too. Local or regional, they were hardly the gargantuan mega-businesses they’ve become. The org chart was shallow, and most local doctors were on a first name basis with the few administrators on the hospital payroll. You took call for the ER as a volunteer; the ER respected that you were donating your skill and your time and handled everything it could before calling you. Same thing for consultations. Your colleague only called you if they couldn’t figure out a problem or ran out beyond their scope of practice. There was a faint air of apology with each request, and a definite unspoken appreciation for the help that would be given. You helped because you were appreciated.

This is really no different from all manner of volunteerism in America. Smallish, closely knit organizations depending on the goodwill and generosity of members of their community pitching in to ensure success. Think local memorial 5K races, or CrossFit Games Regionals in the days before ESPN or the Home Depot Center. Countless small private schools that depended on the largesse and time offered by the families who sent their children there. You gladly accepted the opportunity to volunteer because you knew that without you the organization would not be able to function. You also knew that the recipient of your generosity not only appreciated your contribution, they really had no other options. Not only that, but if that organization somehow existed in your professional space you knew that it would never, not ever, abuse the trust necessary for volunteers to continue.

What happened? Money. Money and size and the distance that they create between an organization and its volunteers. Let’s go back to the hospital and the ER for a minute. Where once your efforts as a volunteer were deeply appreciated and those efforts rewarded with respect and care for your time and your expertise, the growth of employment of doctors by hospitals opened a gap between colleagues. No longer was there the esprit de corps, the shared notion that the primary target of our efforts was the patient was replaced by so very many doctors by the reality that they worked first for a business as faceless and uncaring as GM. Work that was once done by your colleague was now pushed to the volunteers whenever possible. Worse, boxes to be checked by the employed (to maximize revenue and minimize risk) meant demands made of volunteers, not requests. Worse, still, were discoveries that some “volunteers” were more equal than others: they were paid.

While this is nothing short of tragic in health care, it was inevitable once medical businesses were incentivized to grow ever larger. It is not confined to health care by any means. How do you think that volunteer at a Spartan Race feels when he learns how much his “team leader” is being paid? Have you ever “discovered” how much the Executive VP of your favorite professional organization is paid? As a people we Americans are generous to a fault. That generosity usually continues right up until we discover that we have been duped, and even worse that we have been purposely duped by the people who run the organizations for which we volunteer.

And so we gather here to mourn the passing of the Age of Volunteerism. Like so many things of wonder and goodness there remain pockets of resistance, little oases where the goodwill, honesty, and appreciation beget the kind of ebb and flow that made things so much better, kinder, more collegial at the apex of Volunteerism. My friend Tom Gardner was just named the president of the Society of Alumni of our Alma Mater. Tom has given tirelessly of his “spaces”, his timespace, brainspace and emotionalspace to help shepherd tiny Williams College as it flows on though time. Is this truly different? A tiny refuge from the Zombie Apocalypse of corporatization of all things to which we once volunteered?

We can only hope. Hope that Tom and those like him who continue to find places and causes where their volunteerism is met with what we in medicine have had to bid farewell. We can only hope that there will be places where being a volunteer means receiving the respect and appreciation and even a kind of love in return for what we have given. We can only hope that there will continue to be places where the incessant drive to grow ever bigger, size measured on a spreadsheet rather than by heart, will be resisted. For if it can happen in medicine, if volunteerism can be killed in what is arguably the most noble of all endeavors, I fear that it is doomed everywhere.

And so we mourn the end of the Age of Volunteerism. We wait with equal parts sadness and fear for arrival of what follows.

I’ll see you next week…

–bingo

 

Good and Bad. Right and Wrong. Sunday musings 10/7/18

Sunday musings…

There is such a thing as right and wrong. Good and bad are different. My reminder came while reading about Dale Murphy, the retired baseball player most famously remembered for his days as an Atlanta Brave. Mr. Murphy was noted for his career-long insistence on doing the with thing. If you are a baseball fan you may remember that he retired 2 HR short of the magic 400 that likely would have guaranteed his election into the Hall of Fame; he could no longer stand to be the shell of his former self and so he went home rather then extend his career with PEDs.

Dale Murphy is a good man who did the right thing.

We have been living in an age of moral equivalence for a very long time. Certainly no less than 30 years. A time in which the ends justify the means. Something is not really wrong if it was done by or directed at the right people. Generations ago one could enunciate a coda of what was nearly universally recognized as good, as right. Be honest. Don’t steal or cheat. Work hard. Don’t cause harm to another on purpose. As a society Americans had an ethic of working together toward a common goal, a common idea of what was good. None other than de Tocqueville observed this and included it in his historic musings about America and Americans. As a people we had a sense of what was right and what was wrong, a clear understanding about the difference between good and bad for a couple hundred years. Sometimes we got it wrong, but in general we strove as a people to be better.

This is the place where naysayers jump in with comments about various types of discrimination, about groups for whom this ideal was simply not a reality. I fully acknowledge these facts. Racial discrimination was terrifically worse in previous generations, as was the unconscionable treatment of women (entire categories of people could not vote for 150 years). All true. Still true. But as de Tocqueville anticipated, there has been an inexorable (albeit painful and often excruciatingly slow) movement toward more of better. It has hardly been a straight line from bad to better, but that is the journey we have taken.

Dale Murphy is looked upon with a kind of wonder, as if he and his life are somehow not of this time. Marry someone you love. If you have a family prioritize raising your children to be good citizens who know the traditional difference between good and bad. Be honest. Don’t hurt people. Be kind and generous to those outside of your family whenever you can. Do these things in a quiet manner, not out loud in self-aggrandizement as you build “your brand”. There are certainly others who fit this mold; Denzel Washington and Neil Patrick Harris come to mind. Lots of no-name folks, men and women  you will never meet who will never be famous are doing the same thing.

You could say that what I bemoan about our present society has always been thus; that I, we,  simply know more about it now because of newer, freer information streams. I cannot argue against this possibility. Still, it seems as if even knowing this, that a return to an acknowledgement that there is a clear difference between good and bad, between right and wrong, can only strengthen the fabric of our society. Different, on its face, is neither good nor bad, it is simply different. Something that is unattractive or distasteful may be just that and nothing more. We can disagree in the great middle. Good and bad is bigger than taste or style or personal preference.

In the dark we are all the same. We live together unseen. We have the same dreams and the same fears. Though we cannot see we still feel. Right and wrong are different. There is such a thing as good and bad. These things do not change when the lights are turned on. Seek the good. Do the right.

I’ll see you next week…

–bingo

 

 

Sunday musings 9/30/18

Sunday musings…

1) JFK. So. Big.

2) NYC. So. Big.

3) Fact. Everyone is entitled to their own beliefs. However, everyone is not entitled to their own facts.

4) Homage. There’s a big ol’ plane sitting outside the window waiting to take me to Mexico. Beth, her sisters and their husbands are on the other side of this leg waiting for me. We are all spending a week in the time share that my father-in-law willed to his girls. As a financial move it’s hard to think of an “asset” that comes with more strings attached and is more difficult to enjoy. As a gesture, however, it was made out of the deepest well of love imaginable.

How will we use it? Meh, who knows? The details hardly matter, though. It appears that our girls and their boys will use this weekend to plot and plan how it is that we will use our little oasis as an excuse and an incentive to spend time together as a family. I can think of no better way to honor Bob’s memory.

Hang on Dollie…I’m almost there.

5) Tiny Tim. Beth has a little mutt that Megan named Tiny Tim. You see, Timmy was about 9 months old when he arrived, so emaciated that he looked like a little fluffy Beanie Baby with a bum leg. Hence, you know, Tiny Tim of Dicken’s fame. Part shitzu, poodle, and terrier, I decided we’d call him a “Shitpoo”. Pretty fitting if you know our pooch. Now 17 years old Timmy is half blind, mostly deaf, and dumb as a rock. He is also the happiest, goofiest, lovingest thing imaginable.

And boy, does he love his Mom.

We are coming to the end of his journey. Soon, though we don’t know quite how soon, we will bid him farewell as he precedes us into whatever comes next. There’s no message here. No lesson or teachable moment. No, Tiny Tim has been doing all of the teaching just like so many beloved pets. He has reminded us that love matters more than a carpet stain. That we should all wag our tails more often. There is nothing better than a random late morning nap. Important  stuff like that. He is home bringing smiles to his babysitter and my little granddaughter who has decided that he is hers and she is his.

Do hang on Timmy, just a bit longer so Mom (and Dad) can give you a little more love.

I’ll see you next week…

–bingo

Sunday musings 9/23/18

Sunday musings…

1) Autumn. Yep. Here it is. First day of Fall and it’s 55 degrees outside at Casa Blanco.

2) Movie. Mark Wahlberg perfectly captures the intensity and the desperation I would feel if one of my children went missing. The Lovely Bones is gut wrenching.

3) Chardonnay. Do you partake of the grape? My darling Beth has become physically intolerant of red wine (though she will choose to suffer for a special Zinfandel) and so we have been on a white wine quest for the last couple of years. Our first such journey was the classic rite of passage new wine drinkers all embrace as beginners before they are inevitably swept up in the “only red wine is worthy” stage. This has been fun because we’ve given ourselves permission to just enjoy whatever we find for whatever we spend.

Look for Goldschmidt “Singing Tree” from Cali. You’re welcome.

4) Non-Zero. In my travels, and those of my oldest friends and acquaintances, I have come across scores of people who are truly happy. Capable of feeling and giving in to joy. It’s such a special thing to see, and even better to in some way feel a part of that joy, wherever it may be from and whatever may have brought it to life. It’s out there, you know. Sometimes it’s subtle, as gentle and quiet as the proverbial footstep of a butterfly landing on a leaf. Other times it is raucous and riotous and simply blasts through your space like a runaway train.

That’s kinda cool.

Sadly, there are others out there who resent the joy in others. Whether they are themselves happy or not so much, the happiness of another feels to them like losing. It’s more than envy in the unhappy. For these folks it’s as if there is a finite about of happiness and joy in the world; no matter how much of either they may have at any one time they cannot see another’s joy without feeling as if it is somehow draining the reservoir from which they may drink some time in the future. Weird, huh? They sometimes seem more fixated on the blessings of others than on their own, so much so that their own joy slowly seeps away.

Happiness and joy are not limited resources. Quite the contrary. My happiness, my joy is not predicated on your unhappiness or your sorrow, and vice versa. Heavens, if one person’s happiness could come only from another’s despair we’d have long ago slipped into a rather dismal anarchy. No, joy is the ultimate non-zero sum measure. More than that, joy is an exponential multiplier. When you find or see joy in someone else and that vision makes you happy, the mount of happy you get is a full order of magnitude greater than it should be. If that joy and happiness should come to someone who has lately had little of either, well, that’s just that much better.

Life is pretty good around Casa blanco right now, and as much as I’d like to think that means it will always be thus that’s not how life works. Regardless, if I should stumble upon you in the midst of something joyous you can be sure that no matter what happens to be going on in my little world I’m surely not going to resent you or your joy. Quite the opposite.

Whether the skies be cloudy or eggshell blue, a glimpse of the sun always warms.

I’ll see you next week…

–bingo

Sunday musings 9/16/18

Sunday musings…

1) Sabbath. I read this week a proposal to reinstate the institution of the Sabbath, with or without religion, as a way to force at least one day each week without any work in the U.S.

This is an idea worth considering.

2) Bubble. Yesterday’s WSJ Magazine had something like 15 full page ads for really expensive wristwatches. Like, stupid expensive wristwatches. Says here that’s a sign of a bubble about to burst. If people have so much money they can be persuaded to buy a watch by a magazine ad then I’m saying the economy is overheated. Like the P/E ratio, the Wristwatch Index.

First offered on “Sunday musings”, 9/16/18.

3) Communication. My Mom needs a new cellphone. Her old one is apparently dying, and the service contract that covers the phone is so expensive that it borders on usury. Mom needs a new phone and this is turning out to be a rather fraught experience not only for her, but also for her 4 adult children and their spouses. As is the case with all things family, the “why” of this is complex because participating in the process of obtaining a new phone involves so much more than just the kind of financial and technical exercise that you, or your kids, go through when your iGalaxaPhone goes on the fritz.

Oh sure, the technical part is important here, too. Mom’s not all that good on using her 2003-level tech on a phone that doesn’t even “flip”. Think about your first cell phone and how it worked. Kinda like a “real” phone, wasn’t it? At least a real touchtone phone at least. You hit “ON” or “SEND”, tapped in a number on a standard 1-9+0 keypad, and waited for the phone on the other end to ring. If you were born before 1980 or so this was second nature. Texting was exotic and expensive, so most people didn’t do it. Interestingly, if you were born before 1950, it actually took a bit of doing to get used to having to hit “SEND” to make the call; your home phone just did the job after you dialed. My Mom has found this to be a problem. She is a phone caller and a talker, and still has 2 phones attached to a wall in her house  to supplement a “cordless” phone. How will she do with a password-locked screen, the swipes and touches of a state-of-the-art smartphone?

This brings up the first uncomfortable topic for her kids and their spouses: Mom is getting older. Make no mistake, Mom is still in full control of all of her faculties. She is whip smart and continues to be able to call into play everything she knows. Indeed, she is quite happy to share with all of us her thoughts on how what she knows squares with what we are all doing! But she will admit that she has changed as she has gotten older, and that some of those changes have made life a bit harder. She doesn’t really like to drive after dark or in the rain, for example, a couple of very common things that happen to everyone. Changes occurring around her over which she has little control make her more unhappy than they did when she was younger. Thank Heaven’s she is surrounded by so many wonderful folks who look after her! A few months ago her plumber figured out the software change to her TV cable remote so she didn’t have to, and got her all set up in time for Jeopardy.

As an aside, tech companies should be tasked with making all of their offerings geared to be usable by the LEAST technically savvy users in their markets. That would demonstrate real innovation.

Over my years musing on Sundays I have often thought about how people communicate. The differences in style between generations, and the changes that have occurred over my lifetime, for example. This is the hardest part for us in my generation as we tackle this issue for Mom; we must look through HER eyes, through the prism of HER needs and HER comfort as we seek to find the successor to her 15 year old cellphone. You see, we communicate much differently than Mom. When she wants to get in touch that means she wants to TALK to you. That’s right…old-fashioned verbal communication. This morning I have texted with Randy’s family  (pics of The Littles included!) and Beth (from an airplane!), emailed a colleague, Tweeted @ someone and answered a FB message. With all of that I am a comparative Luddite; I don’t Snap, Instagram, or WhatsApp. Mom dials up a call.

What my Mom needs is a phone. A telephone. What she wants is a phone that feels as close to a phone that is wired into the wall next to her fridge. She is emblematic of her generation; a phone call is in itself a compromise, because the person to whom she is speaking isn’t right there with her in the kitchen or on the couch. We want Mom to be available to us and we want her to feel that we are available to her, but what that means is terrifically different to each of us. I can’t tell you how many times I’ve wanted to just send her a quick text. It is at the same time the most loving, and yet the hardest thing to do for us to acknowledge our Mom is ready only for a new version of what for us is an old thing, a phone that can make phone calls.

There is nothing wrong with that.

In this day and age how we communicate with someone else is a sign of commonality, but it is also a sign of respect. I text Dan to make sure it’s OK to call for example. My daughters-in-law text me the photos and videos that they Snap to everyone else. My Mom wants to talk. When she has a problem or is in need of some help, being able to reach out and talk makes her more comfortable. My siblings and I so desperately want to believe that Mom is just like us, only now maybe just a little slower around the house. We want that to be more than we allow ourselves to think or say. Mom needs a phone to make phone calls. As hard as it is for us to be here and to think along these lines we need to show that we see her and love her as she is today. We need to help her get that phone.

We need to call her on it for as long as we have her here to call.

I’ll see you next week…

–bingo

 

 

 

Don’t Exist, Live.

After my first foray into Spinning my back seized up. Pre-CrossFit this was a rather common occurrence, but it’s been some 10 years since my last episode and I’ve been feeling a little sorry for myself. For as long as I have been writing these little ditties I have exhorted (both of) you to get out and actively live your lives; don’t just exist.  More than that I have tried to impress upon anyone who would listen how important it is to have people to live for. People who truly care that you are living among them. What follows is a re-posting of one of the saddest, most powerful stories I’ve ever heard.

 

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

In my day job I was asked to evaluate him 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 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 G0d 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”.

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 the 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 alive. Live.”

 

Sitting here in the airport with Beth, headed home after celebrating our Anniversary with Lovely Daughter Megan and her Handsomedon Prince, somehow my back doesn’t feel all that bad anymore.

Sunday musings 9/2/18

Sunday musings…

1) Eschaton. A final stage in social evolution. Proposed by futurists in Silicon Valley as the inevitable.

Likely to be as accurate as Marx commenting on the steam turbine and electrification. (HT George Gilder).

2) Refurbish. Mrs. bingo and I own a refurbished 1971 runabout. It took 11 months to be  returned to us. At the moment it is a lovely piece of lawn art because our 1999 pier is in the middle of a refurbishment.

Yup. It’s been 11 months.

3) Air Show. Labor Day Weekend means it’s air show time in Cleveland. It’s nothing short of awe inspiring to see the majesty of our nations’s air power parade by the North Coast of the U.S. Two A-10′s casually floated by Casa Blanco on their way to the fairgrounds. They. Fly. So. Slowly.

Why do people choose to mess with us?

4) Nest. My brother and sister-in-law are now officially empty nesters. Both children have graduated and are full employed. No one lives at home. Randall and Joanne chose to spend their first official trip with us. This is actually a pretty big deal; for 10 years they have spent literally 40 weekends per year following their boys’ collegiate teams. For 10 years I have waited for my bother, my best friend, to be free to hang with me again.

What’s the point? Simple. Sunday musings, indeed, all of my pabulum, is a luxury that I have taken for myself, and that all of you have gifted to me. It’s been a blast. A privilege. But it’s neither necessary nor is it mandatory. Here we are at 2042 and I am just now getting around to my laptop. I spent today doing pretty much exactly what I have exhorted each (both?) of you who read my stuff to do: spent my day in direct face-to-face contact with people I love, away from pretty much all forms of digital whatever. Arms length or closer, all day. We slept in while Mrs. bingo tended to her horses. We got a collective dousing from the Man Cub, who has apparently discovered how to turn on the back yard hose. The sunset over Lake Erie was epic.

I love writing for you, I really do. I hope that what I write occasionally gives you a moment to reflect on what it is we do and why. Today I just lived among my people. My whole day was spent with people I love who love me right back. I was busily in the act of loving and being loved all day long.

What a day!

I’ll see you next week…

–bingo

Dunbar’s Number and Your Cell Phone

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

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

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

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

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

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

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

Now, get off the internet. Go call a friend and make plans to get together for the Labor Day weekend.

Sunday musings 8/26/18

Sunday musings…

1) Vicissitude. Fancy word for weather, especially if you need a particular weather pattern at any given moment.

2)) Hero. To be a hero one typically demonstrates courage in the face of personal danger, usually involving the selfless decision to put others before self. As a young man I find it hard to argue that this doesn’t describe John McCain. One could certainly disagree with the positions Mr. McCain took as a politician in the second phase of his life, but one would be hard pressed to argue that he hadn’t done enough in the service of his country over 60 some years.

RIP John McClain. Citizen. Patriot. Hero.

3) Health. CrossFit, Inc. has pivoted. Some among you will rejoice, for the direction that appears to be taken is in line with your own philosophy and goals. Those here who revel in the challenge of elite fitness will no doubt feel that this is a betrayal, a clear step backwards and toward mediocracy. I have a few friends who remain employed at CF, Inc. and they would doubtless like to hear me speak out in favor of this evolution. At the same time there are a few friends who are quite dear to me who would much rather I simply declare my days living in CF nation over and move on. CrossFit in all of its iterations has changed, and so, too, have I.

For many years I have written around this time of the year, just after the completion of the Games, about the peculiar and poorly understood triad that has comprised what we all know as “CrossFit”. It is a business, CrossFit, Inc., one that has as its charge the necessity to be self-perpetuating and to provide for the financial well-being of its owners. This should be self-evident, but over the years commentary has often come up that seeks to present CrossFit the business as some kind of public good. It is not, nor has it ever been. CrossFit, Inc. has succeeded over the years as a business, and in so doing it has made decisions that outsiders have both lauded and loathed. For many, how they interact with the company we call CrossFit is determined by who has been affected by these decisions and how. A pivot has occurred; you and I did not have a vote. CrossFit, Inc. will likely continue to prosper.

Second among the three traditional pillars of CrossFit is the Sport of Fitness. With the possible exception of aerobics competitions in the Denny Terrio age (the spandex!) and that old ABC series The Superstars (O.J. in a boat!), CrossFit likely deserved wears the mantle of the founders of fitness competition. Beginning with a friendly barbecue and leading up to a multi-day tiered competition shown on live network TV, there is no doubt that fitness competition is now here to stay. Early announcements suggest that the pivot will dramatically lower the direct involvement of CF in the competition season, but that CF will have the ultimate say at the highest level. No one you or I talk to has any real idea what this means, and supposition along those lines is wasted effort until we are all told exactly what CF has in mind by CF. The CrossFit Games have changed often over the years and they have changed again. Full stop.

Where most of us come in contact with CrossFit is in the third priority: fitness as a conduit to health. It surely seemed as if this was the least important of the three parts of CrossFit, at least until this past week, but it has always comprised the massively overwhelming majority of participants. Whether on CrossFit.com or in a local affiliate, almost everyone fell under this category;  most of those who thought they were part of the Sport of Fitness were fooling themselves at their own risk. With the creation of a CrossFit health movement and an L1 program for CrossFitting physicians, CrossFit, Inc. appears to be signaling that its public face will now be directed here. Note that I say “appears” because I am no more in the know about this than you or anyone else.

This is a good thing.  To de-emphasize the competitive aspects of CF is to re-emphasize the health aspects of CF that were outlined in “What is Fitness” in CFJ #2, the seminal thesis that brought so many of us here in the first place. I wish we could all go back and look at the threads on the old Message Board, 95% of which had to do with getting healthy. How will this affect the kind of CrossFit we see coming from CFHQ? Again, who knows. CVFMAHI has undergone countless lines of evolution outside of the direct umbrella of CrossFit. Individual trainers have gone out on their own and modified CrossFit in ways that reflect what they learned training people themselves (think James Fitzgerald, once known as OPT).  Entire movements with companies attached have been launched to provide clients with what they feel is a better way. A perfect example of this is The Brand X Method and the Martin family who are without a doubt the world leaders in youth fitness. Who will be right? Who will thrive?

Who knows?

In the end the entire conversation has changed over the last 10 years, and more people are sitting at the fitness table than ever. The line between healthcare and fitness continues to be a bright dividing line. Barriers continue to exist between the fitness world and both public health and public education. Will this pivot at CrossFit, Inc. start to blur those lines, or at least build bridges across them? Will we see some other organization, perhaps one that began within the CrossFit universe but now exists as a separate, growing galaxy like Brand X share the load or even take the lead?

The only constant in CrossFit in the years that I’ve been here is change. Change brings with it opportunity. My prediction: this turns out pretty well for CrossFit. The fitness world is much, much bigger than it was 10 years ago. One would do well to listen very carefully when CrossFit directly addresses this pivot publicly. This will also turn our pretty well for people who may have been part of the CrossFit world but are no longer associated with any of the 3 parts of CrossFit outlined above. One would also be well-advised to closely watch the direction taken by the Martins and others in the fitness world as well. There will be many benefits that come from that one, big original idea. They will come from many places.

After all the Theory of Relativity was simply the on ramp to what we now know as Quantum Physics. The highway of fitness progress is now fed by a growing number of on ramps that come from many directions.

I’ll see you next week…

–bingo