Random Thoughts from a Restless Mind

Dr. Darrell White's Personal Blog

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Archive for September, 2010

White Flags Waving in the Breeze

Uncle. I give up. Full surrender. Total capitulation. I cannot beat the takers.

It’s funny because my first three drafts of this missive started out “stop the madness”, but I can’t. It won’t stop. The “Do-Gooders” and “We Shoulders” who make the decisions because “they think” or “we feel” have beaten me. Beaten everyone like me. The white flag is up. Turns out the windmill is really a dragon, and contrary to what it says in all the fairy tales the dragon always wins.

You see I, Dr. Quixote as it turns out, thought that being right made a difference. I thought that data, precedent, FACTS would rule the day. Silly me. Silly, sorry sad little me. I thought it was about patients, patient outcomes, statistics, but all along it’s been about the system and protecting the system, protecting it from the very possibility of theoretic risk, protecting it from…patients.

Here I was looking at yet another cost being added to the experience of my surgical patients and asking why a change was being made. Why were we opening a new bottle of $13.00 eye drops for each laser patient, when each bottle held enough medicine for 100 patients? Why were we using a new vial of antibiotic to be injected into the infusion bottle of each case, when each vial held enough medicine for 5 cases? Why, indeed, when there had never…not once…been a reported case of acquired infection, ever, from using one bottle or one vial. Ever. When eye doctors in their offices use and have used, bottles of eyedrops until they can’t squeeze our a single extra molecule. Why?

I blanched at the waste. Plastic baggies of bottles full of drops carted to the trash. Vials of man’s best antibiotics less the microliters used for one surgery crowding the sharps buckets. It was unconscionable, an insult to Puritan and non-adherent alike. The amount of waste nothing short of vulgar.Did no one else see this? I mean, here we are in the supposed throes of a healthcare crisis born of excess and waste, and yet I, Dr. Quixote, flailed alone?

Data…surely data would prevail. Look at the cost, I cried. Never mind the insult to the Puritan ethic, simply look at the cost! You can’t bill the patient, though Lord knows you’ve “mistakenly” done so innumerable times. It’s a cost. It decreases “revenue in excess of expenses” (you’re a non-profit…I get it…we can’t call it profit). I even understand why you’ve spurned my entreaties about Pre-Admission Testing even though there was an article in the New England Journal of Medicine that said PAT is unnecessary. The NEJM is the only medical journal that God reads, and even SHE knew I wouldn’t win THAT one because you can get PAID for PAT. I get that one.

You’ve beaten me. Today I see it. You sent in the REAL decision maker, one of the people who make the decisions in this new age of medicine. I was still under the illusion that maybe I, a doctor, was a decision maker. That I, a doctor who looked at and liked real data, had a vote, some skin in the game. No, today you sent in The One From Pharmacy. I have seen the One With Power and now I know that I am beaten.

The One From Pharmacy has all the words. He has all the weapons. “It’s only fair that each patient receive the same freshly opened bottle/vial.” “What if we have an infection and we re-used a bottle? How could we ever face that patient?” “Here’s an article by a pharmacist that says you could possible have contamination of an open bottle.” “Should we ignore this article that discusses the theoretic possibility of infection?” I also know from prior conversations with The Hospital Administrator that The One From Pharmacy cannot abide not knowing the destination of each drop, cannot abide not having the option of charging each individual patient (if only he could) for each medicine, and that a new bottle must be opened and assigned to each patient for this purpose. This I know.

Oh, I tried. I really did. I tried to point out that each of the articles the The One From Pharmacy shared with me were nothing more than opinion pieces, essays that were little more than editorials sharing one author’s thoughts. His or her feelings. “I think,” therefore it must be. But…but…but…there’s no DATA. No evidence. Nothing to refute decades of experience in the operating room. No results or reviews showing that the status quo is dangerous, only some somebody who managed to get what “they think” into some non-peer reviewed journal.

“Doctor, are you saying that we should just IGNORE these articles? You would have us simply continue with business as usual? The governing bodies ALL say this COULD happen. Are you saying that we should ignore what they THINK?” I confess, I had no answer. I was paralyzed, caught between my horror at the thought that decades of success, as well as common sense so obvious it made stomach hurt, were to be tossed aside because of some someone’s feelings, and my fascination at the sheer revulsion registering on the face of The One From Pharmacy. Funny, he wasn’t anything at all like what I thought the dragon would look like.

I stood there for a moment, bleeding, as the realization slowly came to me that I was defeated. Vanquished. It’s a shame, really, because doctors of my generation are the last, best hope for all of us. We bridge the divide between the ancients who lived through the Golden Age of Medicine–the Giants who cured polio, discovered antibiotics, replaced joints–and the moderns, the nextgen who will live through the silicon age of medicine–Dwarfs who will serve a system, cure the economics, replace care.

I felt small, diminished, inconsequential, a failure, a disappointment. It was hard, frankly, to haul my carcass to the operating room to begin my work day. Yet that’s exactly what I did. I mounted my steed and raised my lance; slowly, ever so slowly, we rode alone to the operating theater.

A white flag, attached to my lance, waving in the breeze.

Tales from Bellevue Hospital: The Bellevue Death Ray

Man, what a place Bellevue Hospital must’ve been back in the day. It was crazy enough in MY day in the mid-1980′s. Bellevue is arguably the most famous hospital in the world, famous mostly for the treatment of psychiatric patients, and made all the more famous by the Christmas movie “The Miracle on 49th St.” in which Santa Claus was institutionalized in one of Bellevue’s top floors. For those of you who don’t know Bellevue Hospital, the top six floors of a 30 floor tower were (are?) reserved for psychiatric patients, at least one of them for psychiatric patients who hail from Rikers Island.

I’m not really sure why, but I’ve been thinking a lot about Bellevue recently. My experiences as an ophthalmologist in private practice in the suburbs of Cleveland, Ohio really have exactly nothing in common with my experiences as an ophthalmology resident on the lower East Side of New York City. Nonetheless Bellevue has been on my mind. I thought I’d share some stories about Bellevue and about my time as a resident at all of the NYU hospitals. This will also give me an opportunity to introduce you to some very special, very interesting characters whose lives crossed paths with mine.

Irwin Siegel was an optometrist with multiple roles at Bellevue Hospital. His most important role for me and my fellow residents was to teach us about optics and refraction, the science and technique of prescribing glasses and contact lenses. Dr. Siegel was also a noted researcher in the diagnosis and treatment of retinal diseases, specifically diseases of the macula or center of the retina; there is actually a syndrome named after Dr. Siegel and two of his partners.

Dr. Siegel was a fascinating man, especially fascinating to a child of suburbia like me. The prototypical New Yorker, Dr. Siegel lived his entire life in Brooklyn and Manhattan. He did not own a car, and used some form of public transportation for more than 95% of his travels. You got the sense that any forays outside the island of Manhattan were viewed as akin to a ride on the “Heart of Darkness” express. The guy simply reeked of New York, and he spent his entire professional career at Bellevue Hospital.

Recall that my life’s memories are wrapped up in eyecare, optics, and the optical industry. My father’s first job was at American Optical in Southbridge Massachusetts, at the time the largest ophthalmic manufacturing company on the planet. The very first lasers were actually developed in the laboratories of AO. In the early 1960s Dr. Siegel and his partners were doing research on lasers at Bellevue. Now, as you can imagine, something as powerful as the energy of the laser light had also come to the attention of the U.S. Military. So comes the story of the Bellevue Death Ray!

Dr. Siegel and Dr. Carr were doing laser work somewhere in the bowels of Bellevue. This would have been in the early 1960s, and the laser they were working on was an enormous mechanical monstrosity, a piece of equipment that took up more space than most upper East Side kitchens. Not only was it physically enormous, but the generation of a single pulse of laser took well over a minute, a minute filled with a crescendo of sound not unlike what one would experience when a jet engine is engaged . Imagine a room, half filled with this exotic piece of near–science fiction equipment, surrounded by white–coated scientists all wearing goggles that look as if they had been spirited away from a Mount Everest expedition. Add in a few very senior military officers in full dress regalia and the scene is set.

The officers visiting from the Pentagon really had no idea what to expect. They were intrigued by this new technology, interested to see if there might be some military application. Dr. Siegel noted that he and Dr. Carr were mostly bemused by the presence of the officers, although he did admit being a little bit impressed by the two-star general in their midst. The  experiment/demonstration was set up, on one end of the room the monstrous laser, on the other end of the room a rabbit in a box, his head poking through a hole, the laser aimed at his left eye. Goggles were donned and the switch was flipped.

The laser came to life, slowly building energy in the rudimentary laser tube, the whine and the clang and the clatter growing in intensity with each passing second. Dr. Siegel and Dr. Carr stood calmly to the side, ignoring the laser and concentrating on the rabbit. The officers, on the other hand, slowly crept back away from the laser, trying to melt through the wall, and failing that trying to become as small as possible. Two-dimensional, if possible. The wail of the laser grew… the sound filled the room… the wail, the clatter, a crescendo… BAM!

And then, silence. The doctors and the officers took off their goggles. They walked over to the  box and discovered that the rabbit was dead. Immediately one of the colonels started doing a jig. “We have a death ray! We have a death ray!” He began to run for the door, headed for the telephone (no cell phones or sat phones in those days). “Well, hold on a minute,” said Dr. Siegel. “Let’s just take a closer look.” It turns out that rabbits are not terribly bright creatures, and that when they are frightened they tend to forget how to move backwards. This poor bunny, the only creature in the room without Ed Hillary’s goggles, had been so frightened by the noise of the laser that he literally suffocated himself, pushing against the rim of the hole in the rabbit box in an effort to escape.

When Dr. Siegel looked inside the rabbit’s eye there was a single perfectly round burn, approximately 2 mm in size in the middle of the rabbits retina. There,  in the space of approximately 5 minutes, was born and died the Bellevue Death Ray.

The epilogue of this story is rather interesting, though. About 10 years later, after numerous refinements of both the production of laser energy and the focusing of that energy, one of the most important trials in the history of medicine took place using focused laser light to prevent vision loss from diabetic retinopathy. The Diabetic Retinopathy Study was the first prospective, double–blind, randomized clinical study done on a cooperative basis across the entire country, and the results of that study have saved countless individuals from a life of blindness due to diabetes.

This is where I trained, and men like Dr. Siegel who told this tale from Bellevue Hospital as part of our optics classes, is one of the men who trained me.

Sunday Musings 9/26/10 Remorse vs. Regret

From Crossfit.com.

Sunday musings…

1) “Art without Commerce is a hobby.”

2) Border Collie. The obvious inspiration for the Everready Bunny.

3) Rational Self-Interest. Have you read any Heinlein? If so you know exactly what I mean when I write TANSTAAFL. If we examine much (all?) of what we see or read about and drill down to the bottom, isn’t it fascinating how often we see the underlying self-interest that informed the action?

Much of modern Economics, especially Behavioral Economics of course, is centered on this essential premise, that events and behaviors can be understood or predicted based on the assumption of rational self-interest.

Altruism, behaviors that are truly counter to rational self-interest, if it really exists, is the fly in the ointment. How to explain altruism when so much else, indeed almost ALL else, can be so accurately explained by rational self-interest?

4) Sorry? It’s rather amazing how many apologies to which we’ve been subjected lately, eh? Famous athletes, movie and rock stars, politicians, all proffering “heartfelt” apologies for some indiscretion or another. But are they sorry? Sorry for what they have done? Or is it something more…I dunno…less? Regret, perhaps.

There’s quite a gulf between regret and true remorse. Remorse is a deep emotional response that touches on shame. Regret, not so much. Regret is a more superficial emotion, a sadness or maybe a disappointment, more closely attached to rational self-interest whereas remorse is more akin to altruism. Remorse is more outwardly projected: I’m sorry for the effect on the OTHER. Regret much more inward, more centered on self. Think about the last few very public “apologies” you’ve heard or seen recently. Any true remorse?

How does one apply this difference in every day life, other than as a determinant in how we feel about the news we read? Well, regret lends itself to strategy and tactics, a certain calculus or cost/benefit analysis applied to the road ahead, or applied to the fall-out of the road behind. Rational.

Remorse on the other hand seems to me to be purely reactive. Not amenable to planning because whatever we’ve done to prompt true remorse, to be truly sorry, to feel ashamed, is nothing one would ever make a rational choice to do. We FEEL sorry, we don’t think it. We feel the pain of the other and we feel truly sorry for our part in it.

And there, my Brothers and Sisters, is where the line between regret and remorse lies. That outward extension of ourselves toward the other, so easy (I think) to see it when it’s real and so obvious when it’s not. Just as regret could be seen as a form of rational self-interest (I’m sorry I got caught), we might think of remorse as emotional altruism (I’m sorry I’ve let you down).

To remember our remorse for actions in the past is to remind ourselves of the presence of others as we act now.

I’ll see you next week…

Time, Freedom, and Medical Emergencies

A message heard while calling to speak with a colleague at 5:01 on a Thursday afternoon: “Thank you for calling Waterworld Eye, a division of World-Class Hospital. Our office is closed. Our office hours are Monday through Friday 8:00 AM until 5:00 PM. If this is an emergency please hang up and dial 911, or go directly to the emergency room. This system does not take messages.” Something like that.

This is what has come to.This is how World-Class Hospital, held out as the beacon of hope, the shining example that all in medicine should follow, this is how they deal with emergency patients who are in need of specialty help. The same institution that took out a full-page newspaper ad touting  “same–day appointments” is not available to see emergency eye visits after 5:00 PM or on the weekends. This is the type of system that our federal government believes will bring better health care to all Americans.

Brings a tear to the eye, don’t it?

About a week ago my wife and I celebrated our 25th Wedding Anniversary. A part of our “gift” to ourselves was a four-day weekend, four days without any plans to visit the offices of Skyvision Centers, and four days where my partners would answer as many of the emergency calls that they were qualified to handle. My partners are optometrists, eye doctors who are trained in vision care, and at least in the state of Ohio eye doctors who are also trained and qualified to take care of medical diseases of the eye. I am an ophthalmologist, an M.D. I went to medical school, did a medical internship, and then did a residency in ophthalmology. I am trained in vision care, the care of medical diseases of the eye, and I am trained to perform eye surgery as well. As such even though my partners were the first line of “on-call”, and even though I was “off–duty” for my four-day Anniversary weekend, I still had to be available for any emergencies that might require my additional training, my special skills.

On Monday evening, day three of our four day anniversary gift, I sat next to Beth while finishing the last of the “Girl with the Dragon Tattoo” books. We enjoyed a magnificent dinner of lamb chops and all the fixings, accompanied by one of those rare finds at the wine store: a $20 Cabernet that tasted like 100 bucks! The bottle was still one third full; it sat just behind me next to my empty Reidel goblet. “You know what I miss,” I said. “When my face is already numb, I miss the freedom of being able to have another glass. Another glass of joy, another glass of goodness.”

Now, I’ve always taken ER call. Every practice I have ever been part of has always had doctors available to see emergency patients, pretty much 24–7, 365. No “nurse on call”, no call 911 or go to the emergency room. Nope, I have always worked in a place where an eye doctor was available to see you if it was truly an emergency. Makes sense, don’t you think? The eye is a pretty specialized area, so specialized that we actually have super–specialists who concentrate either on the front or the back half of the eye! Think about that… and organ roughly the size of a large marble that is so complex and whose care is so complicated that it has to be divided in half! Call 911 for this?!

I left my original Cleveland practice some 5 1/2 years ago to start Skyvision. Suffice it to say that it was not an easy or clean break. No, it was all kinds of messy and ugly, with very hard and uncompromising business and legal stuff before, during, and after. And yet, with all of the inconvenience, and all of the bad blood, and all of the hardships that we and I endured as Skyvision Center started from scratch, the only thing that really affected me, the only thing that really hurt, was when I was ousted from my emergency call coverage group because I left the other practice. That one hurt, and continues to hurt. (If anyone involved in my prior practice or in that call group decision reads my blog, and I certainly would if I were them, the score on this one is definitely you 1–Darrell 0).

Why is that, exactly? Why should such a seemingly minor part of an otherwise very hard experience be the only thing that hurt? Well, it’s rather simple and rather complex. You see, everything about the way we handled emergency calls in my previous practice, and everything about the way the other practices involved in our call coverage group handled emergency calls was exactly correct. Everyone, and I mean EVERYONE involved, routinely and regularly took the high road. Everyone answered patienT calls. Everyone went in to see a patient who had a true emergency, seven days a week, at all hours of the day or night. Emergencies, true emergencies, do not respect either the calendar or the clock.

Now some folks certainly abused our collective goodwill, calling after hours or on the weekend and manufacturing an emergency simply because it was more convenient for them as patients to come in during non–office hours. But this was really more the exception than the rule; all of our patients respected our personal time and personal space, and demonstrated their respect and gratitude for our collective availability by calling only when they had a real problem. (As far as I know, all of the doctors in all of the practices in that call group continue to do just this.)

So who’s right? Are we, the private ophthalmologists and optometrists who take the phone calls from our emergency patients and see them when it is necessary, are we right? Or is it Waterworld Eyecare and World-Class Hospital, and by extension our federal government and “health care reform”, dial 911 or go to the ER? Are they right.  Let me tell you a story and I’ll let you decide.

Just before my four day weekend I got a call at 10:40 at night, 20 minutes after I had retired for the evening. The father of my patient, a 10-year-old girl with a extremely high glasses prescription, had torn her contact lens when she was trying to remove it for the evening. Half of the contact lens ended up in the sink, and half of the contact lens was still in her eye, stuck way up underneath her eyelid and unreachable by either  young Maria and her parents. My phone was right next to my bed, 2 feet from my pillow as it is every night. I answered the phone, spoke with the father, got dressed and went to the office to remove the other half of the offending contact lens. Didn’t even really give any thought to any other options, to tell you the truth. What if they had been patients at Waterworld I? “Hang up and call 911, or go to the emergency room.” Your call.

So on that Monday night, day three of my four day weekend, wine in the bottle, glass empty, face not yet numb… I sighed, turned the page, and continued to read.

A 9/11 Epiphany

It’s been 9 years since the 9/11 attacks on America. One wonders what lessons have been learned in those intervening years, lessons that may be either personal or societal, or indeed lessons that might be so universal that they are both. This kind of stuff doesn’t happen all the time, a life-changing event that informs and transforms entire generations, a game-changer that sets the table, lays down the rules for all of the “play” to come. Looking back over the years it’s clear that I had an epiphany during those days right after 9/11, a personal insight that was so significant that it changed the very vocabulary I have used to discus my life since. How about you? Did anything like this happen to you?

I should set the table here I suppose. Where were you on that day? Where were you…what were you doing when the planes hit? When the buildings came down? It was a Tuesday. I was in the operating room when one of my assistants told us about the hits, and I was in the lobby watching as the first building came down. Everything shut down here in Cleveland; it was rumored that another plane had diverted and was on its way through our airspace. We shut down the offices, retrieved the kids from school, and set about hunting down friends and family all over the world. There was a little panic as we waited to hear from my brother (stranded in Chicago, eventually to rent a car to drive to Connecticut) and my closest friend Rob (safely at lunch on business in Rio di Janeiro), and then…nothing.

Remember? Remember how weird it was for a few days? Businesses closed, schools closed. All air traffic came to a full and complete stop. It was sunny in Cleveland, an odd stretch of bluebird days with nary a cloud in the sky. This, of course, only made it all the more eerie and obvious that the sky was empty, not a single airplane, not a single entrail to mark someone’s path from some here to some there. My kids begged me not to go on a business trip long planned for that Friday, their impassioned pleas rendered moot by the shut down of North American aviation. We all stayed home. Remember?

The world cautiously and gingerly re-opened for business that next week which allowed four of the White men to keep their golf date at  Kiawah Island. Not that the world had returned to business as usual, though. Not by a long shot. I flew out on September 20th I think it was, Cleveland to Charleston. Just me and a skeleton crew of workers at CLE for the departure and the closest thing to a private jet trip I’d ever taken. They weren’t closing the cockpit doors yet; I spent the whole flight chatting with the flight attendant and the pilots. They were very friendly, seeing as I was the only other living creature on board at the time.

The Kiawah resort had a 99% cancellation rate that weekend. That’s not a typo. NINETY-NINE PERCENT. We had the place to ourselves. I’ve never had better service. Walk in for breakfast and sit…anywhere. Stroll up to the pro shop at courses that typically have months-long waiting lists for tee times, and then proceed directly to the first tee. Lunch and a re-load? No problem fellas. What time would you like to play this afternoon? Unprecedented, and unlikely to be repeated short of the Apocalypse.

It was while playing the Ocean Course at Kiawah, the course made famous by the epic comeback by the American Ryder Cup team to re-claim the Cup after several pastings at the hands of the Europeans, that I had my epiphany. I hated it. I played poorly, but not as poorly as I scored. The course was so penal that shots little more than 2 or 3 yards off target begat unplayable or nearly unplayable lies. It’s not just that it was hard, either. Heck, the River Course at Blackwolf Run absolutely slaughtered me, but I enjoyed everything else about that venue. I hated the everything about the Ocean Course itself. If you are a golfer you understand what it means to say that a course “sets up well to the eye of the golfer”. Not there. Not for me. I never liked what I saw in front of me; the course never set up for my shot in a way that pleased my eye, let alone my game.  In the afternoon I played Panther quite well, and enjoyed everything about the walk, too.

We discussed our plans for golf for the rest of the weekend at dinner, a discussion that was made possible by the absence of any competition for tee times. My brother, brother-in-law, and Dad all wanted to play the Ocean Course again. Nope. No way. Why, I asked them, would I willingly return to some place or some thing that I knew I disliked? I then expressed my epiphany, my gut reaction to 9/11 and all that had come with it, identified and crystallized by a round of golf on the Ocean Course: the things that make me UNHAPPY make me feel worse than the things that make me HAPPY make me feel good. The bad feelings from the bad stuff are worse than the good feelings from the good stuff are… well… good. Furthermore, once identified, the bad things could very likely be avoided with greater accuracy and success than the good things could successfully be made to happen.

WHAT?! The table fairly exploded. Stuff like “glass half empty” and “not playing to win” flew around, a veritable carpet bombing of my revelation. I made a couple of half-hearted efforts to explain, to expand on my epiphany, to defend my position, all to no avail (which if you know any of the extended White family is not the least bit surprising). Nonetheless I stood my ground on the essential tactical decision that came from the strategy of avoiding things identified as “unhappy”–I continued to vote “NO” on another round at the Ocean Course.

Was I right? Am I right? Well, my partners definitely didn’t think so, and might still not agree if they were asked today. But here’s the rub: the epiphany was so clear, so obvious, so definitive and logical and right for me that it didn’t and doesn’t matter all that much what others think or if others agree. Given the game-changer that was 9/11 I was obviously open to this kind of revelation, though I was not in any way seeking this, or any OTHER sort of revelation. It arrived unbidden, and once there was like finding that thing you forgot you were looking for.

My epiphany? The things that make me happy can always be sought, can always be chased when they are visible, can always be welcomed if they arrive. Who wouldn’t fill their glass with that kind of stuff whenever they had the chance? The easy thing, I think, is to avoid the stuff that, once identified, you now know will make you unhappy. No matter how full your glass may be, THAT stuff always drains the glass.

Some times playing to win means playing defense.

Sunday Musings, 9/12/10

Originally posted on Crossfit.com, as I do most Sundays.

Sunday musings…

1) Butterflies. (From Wendy Keretz). It’s OK to have butterflies before something big, as long as you can get them to fly in formation.” Man, how good is THAT?

My friend’s daughter missed her bus to get to a CC meet. Anxious, nervous, scared, and angry, she ended up posting a PR on the 5K CC course. Got all of her butterflies in formation, she did. I really like this quote (wonder where Wendy found it); it makes me think of my preparation each time I do “Fran”.

2) Grace. Mrs. Bingo: “You know, of course, that if you had the pain in your back that I’ve had you’d have been in therapy months ago.” Truer words were never spoken.

There’s something about the varied and disparate ability to not only withstand pain or discomfort, but to do so with grace. To stand up to pain of any sort, physical or otherwise, and bear the pain without comment or complaint. You know people like this…we all do. I’m apparently just not one of them, at least as far as physical pain goes!

I messed up my knee on Friday. Landed funky on the dismount from my pull-ups in the warm-up (it’s amazing how far the butterfly kip sends you when you are new to it). All weekend I’ve been “commenting” on how my knee feels, what’s going on inside my knee at that particular moment. To one uninitiated in “bingo-speak” it might sound like a verbal newsreel, but Mrs. Bingo knows exactly what’s going on, that I’m whining about my pain and about my concern that I won’t be able to continue to be physically, I dunno, young.

Last night was spent in the company of my friend, the one who is dying. His body is fading; the cancer will win. Yet, the capitulation of body is not accompanied by a surrender of the mind or the spirit. The cancer will not spread to my friend’s brain; he will have the exquisite yet excruciating experience of knowing exactly when he will make that surrender. His intellect is fully intact, and he chooses to remain so. Chooses the pain over the retreat that will simultaneously end his intellectual engagement as it ends his pain.

What does this have to do with any of us, healthy and pursuing a longer life of health? Well, we need not aspire to the level of grace demonstrated by my friend; indeed, it may not be POSSIBLE to reach that level absent a similar pain, eh? No, what we can aspire to is a certain level of grace in which we address any and all of our pains as simply the cost of doing the business of life, as Mrs. Bingo addresses the chronic pain living within for some 10 years now. One doesn’t ignore it, nor does one embrace it. Who, in their right minds would choose the pain?

We can choose to persevere, with grace, however big or small our obstacle. Not to surrender. Not to capitulate. To say, as my friend is saying each waking moment: Not yet…

NOT YET.

I’ll see you next week…

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