Random Thoughts from a Restless Mind

Dr. Darrell White's Personal Blog

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Archive for January, 2011

TANSTAAFL And “Mommy-Track” Docs

Uh oh. Now they’ve gone and done it. Someone has gone and rained the facts down on what is generally considered a feel–good story in American medicine, the dramatic increase in female doctors in America. In response to Dr. Herbert Parde’s “The Coming Doctor Shortage” article in the Wall Street Journal, Dr. Curtis Markel pointed out that there is a difference between the raw, gross number of physicians in America, and the EFFECTIVE number of practicing physicians.  Not only that, but he had the audacity to point out that roughly 50% of newly–minted American trained physicians are women, and that many of them do not practice full-time.

The NERVE of that guy. I mean, how dare he bring facts into a discussion of physician manpower? Wait a minute… maby that’s it right there… MANPOWER. This must be just another incidence of the male–dominated world of medicine cracking down on those female party-crashers. Except for the fact that…no… this really isn’t a case of that at all. Just an illumination of a significant part of a more general trend. When we look at the economics of physician resources the more important statistic is NOT the number of physicians working, but the number of physician–HOURS that are worked. Physicians newly minted in the United States in the last 20 years work fewer hours per week and annually than their predecessors, and “mommy–track” docs work even less.

That, my friends, is a fact–based reality of healthcare economics in the United States. The fact remains that Heinlein was right: there ain’t no such thing as a free lunch. The facts do not care what you think. They do not they do not care how you feel about them. They do not go away and they do not change if you try to change the topic or bury them with obfuscation. Torn between self–righteousness (I’m staying home for my children) and righteous indignation (I work HARD), the mommy-track docs have fired back.

Unfortunately, their return fire has been little but emotion-loaded pellets, rather than fact–filled ordinance. An ER physician talks about choosing to work fewer shifts in order to tend to her family, or an ailing parent, or even to avoid “burnout”, and conflates the effects of these personal choices with her feelings about the effects of inequities between the compensation for so–called cognitive versus procedural specialties. Another talks about wanting to work part time with the thought that this will make her a more effective doctor. Still others try to shift the conversation from the “mommy–track” to general lifestyle considerations: I wish to “paint, or cycle, or just read.” All well and good, of course, but all also well beside the point. The fact remains that women physicians tend to work fewer hours than their male colleagues, those who have children take long stretches of time away from practicing medicine to do so, and both men and women recently trained tend to work measurably fewer hours than their predecessors did and do.

Sorry. You CAN’T have it all. Thinking that you can is a fantasy; it’s just not consistent with a fact–based reality. There ain’t no such thing as a free lunch. In medicine or anywhere else.

Please don’t get me wrong. I personally find absolutely nothing inherently wrong with working fewer hours or taking time out to have children. Back in the day there was often a terrible price to be paid because of the traditional work ethic of the American (mostly male) physician. The landscape is littered with the carcasses of medical marriages that didn’t survive this “profession first” rule. Substance abuse was rampant among these physicians, and the physician suicide rate was (and is) a multiple of the general population’s. Younger physicians, mommy–track and otherwise, are certainly onto something. The life balance that is so important to them is healthier in almost all respects, at least as far as the physicians themselves go. But in terms of our health care system as a whole? Nope. The facts say we either need more doctors, or doctors need to work more hours. To say that you, the physician, are making these choices for anything other than lifestyle reasons, to blame some reimbursement inequity or other external factor is disingenuous at best.  My mother used to call it “the consequences of your decisions”, but I prefer Heinlein. TAANSTAFL.

While there are some medical specialties that are very lucrative (neurosurgery, gastroenterology), the income that physicians take-home is generally reflective of how hard they work. How many hours per week they to spend doing clinical work. How much they actually do in each of those hours. General surgeons tend to make more money then family practitioners,  not so much because they get paid all that very much for any individual thing they do, but because they tend to work lots of hours, and they tend to do lots of work in each one of those hours. Nights, weekends, dinnertime, and long after Conan has called it a night, general surgeons are at work because the work needs to be done. The vast majority of primary care physicians work 40 hour weeks, hours that look more like the proverbial banker’s day than the surgeon’s. Nothing wrong with that, and neither is this always the case. I have a friend who is a very successful, family practitioner who is blessed and cursed with both ADD and insomnia. I think he works more than anyone I know, doctor or otherwise, and his income is consequently more like that of a general surgeon.

Perhaps an illuminating example would be the decision I made approximately five years ago to totally change the way I practice my specialty. Suffering from a severe case of professional and business dissatisfaction, I left an extremely successful practice (a practice that remains extremely successful in my absence) and started Skyvision, a very different type of eye care practice. (As an aside, when they finally got around to replacing me, it took TWO 30–something year-old physicians to do so.) At Skyvision I see many fewer patients each day, and consequently have a dramatically lower income. When presented with the Zen–like question “do you wish to be wealthy or happy” I chose happy. The decision has made me quite “UN–wealthy”, but I really am quite happy.

That is the fact–based reality of physician economics, my  little micro–economic example to explain the macro–economic effects of physician–hours versus physician numbers. There’s no one to blame. No government conspiracy. No specialty vs. primary care inequity. I am the sole bread–winner in a home with a “mommy–track” Mom. There are more eye doctors where I live because some of the eye doctors who are already here, mommy–track or otherwise, are now working less.

Are mommy–track docs the sole problem why we face a pending physician shortage in the United States? Of course not. We have a decades–long history of new physicians working fewer hours than their predecessors, a relatively static number of new physicians being trained, and an ever–expanding population of patients who need the care of these physicians. No matter how they might FEEL about it, and no matter how they might feel about having it pointed out, the fact remains that, on average, newly–minted doctors work fewer hours than their predecessors, and mommy–track docs, on average, work fewer hours than their peers. Wanna stay home with your kids? Cool. 12 weeks to bond with the new baby? Sure, who WOULDN’T want that. Just “man up” and face the facts–you can’t have it all. Nobody can. Be a grown up and accept the consequences of the choices that you have made, and accept this gracefully when someone else points that out in the Wall Street Journal or elsewhere.

There ain’t no such thing as a free lunch. Somebody, somewhere, always pays.

Sunday Musings 1/30/11

Sunday musings (feel free to scale)…

1) Secretariat. 31 lengths. Just saying.

2) Pro. The advent of the sponsored athlete is nigh. Mikko and the Rogue athletes. Jon Gilson’s Again Faster collection. Graeham picked up by Reebok. Did Coach foresee this? Did anyone? No idea.

It bears a little examination, though, to try to put it in perspective. Crossfit seems, to me at least, to have much more in common as a sporting endeavor with Track and Field, Skiing and Snowboarding of all sorts, and other individual sports such as golf and tennis. Team events like the Tahoe Throwdown, indeed the teaming of anything, seem to be more like those relatively rare times when athletes in individual sports assemble under some flag or another for an event that seeks to create a team ethos in an otherwise team-averse universe. Think Ryder Cup golf much more than think Olympics, for example.

My bet? The Track and Field analogy is closest, and we will see sponsorship activity more akin to that then, say, snowboarding; there’s just less STUFF to purchase, or need to purchase, to Crossfit. $22 for a pair of Chuck Taylor seconds, some socks and you’re good to go.

Think just for a minute what Crossfit has done for so many folks, business-wise, that is. 3000 gym owners. A few dozen sponsored athletes, sure to be a few hundred this time next year. Not one but TWO Crossfit-dedicated equipment companies, as well as non-CF companies who have seen an explosion in their sales due to their discovery by Crossfitters (Lulu Lemon, Innov8, Vibram). An entire business ecosystem has arisen in <2 years.

Did Coach foresee that? Did anyone?

3) Form/Function. I look good. I mean reeeaaaalllly good. I’m going on a beach vacation in a week or so, and I’m feeling just fine about taking my shirt off at the pool.

‘Cause I look GOOD.

Here’s the funny thing about that…I’ve made only the most cursory effort to look good. You see, for 5+ years I’ve been pursuing not so much form as function. The metric I have pursued, the measurements I’ve taken and the outcomes I’ve sought have all been performance related. What’s my “Fran” time? PR is Front Squat? Stuff like that. As a matter of fact, just for fun I’m going to go back to 2006 and do a few months of 2006 Main Page CF WOD’s to compare.

The point here is that form follows function with few exceptions. Want world-class marathon or triathalon times? You aren’t going to look like Mikko. Aiming for a podium in a power lifting competition? Likely the same thing. Chasing General Physical Preparedness, WCABTMD? Well now, YOU might look a little more like Mikko.

Let’s not get carried away, though. I look NOTHING like Mikko, and you shouldn’t expect any shirtless bingo pics on the Main Page (with or without a tire, PU bar, or KB), but the fact remains that form follows function, and I look good.

Bet you do, too.

4) Community. Made any friends recently? I have. Seems a week doesn’t go by in which I don’t “meet” someone new who could turn out to be a new friend. How? I’m a Crossfitter. I talk to people who Crossfit.

There’s an essential goodness that permeates the Crossfit community, whether it be here on Crossfit.com, Facebook, or in the Affiliate gyms. By and large we assume goodwill on the part of other Crossfitters (and are always taken aback when it isn’t there). The vibe is positive. Optimistic. There’s an enthusiasm about turning the next corner because what’s been around all of the previous corners has been pretty cool. It’s amazing when you think about how consistently this has been the case.

I’m a community kinda guy. Love this place, and love most everything about it. Communities are like gardens, though–they need care and feeding. We must tend to our community in ways big and small, as we would tend to a neighbors garden while tending to our own. We may choose to tend to Crossfit itself, or not, but we should always and ever choose to tend to the community that has grown up around Crossfit.

It’s a fertile garden, one from which friendship blooms, regularly and routinely, in ways as mysterious as they are wonderful.

I’ll see you next week…

Tales From Bellevue Hospital: The Blue Chair

Bellevue Hospital, and the Bellevue Hospital residents provide medical care for the New York City prisoners who are housed at Riker’s Island. This is actually quite an opportunity, especially for a child of suburbia like yours truly. It’s not as if I had never come across people in the criminal justice system prior to my Bellevue days, it’s just that I didn’t have such routine and regular contact.I don’t remember exactly, but there are at least three or four entire floors at Bellevue dedicated to the care of Riker’s Island inmates who have medical problems. One or two are for the criminally insane, and others who have some degree of mental illness. The remaining two floors house prisoners with problems as varied at coronary artery disease and pink eye. As disconcerting as it was for someone like me to enter a locked ward, the accommodations at Bellevue were at least a full order of magnitude nicer than those at Riker’s Island. This provided an interesting opportunity for Riker’s Island inmates to create a medical reason to leave The Rock, and created a very interesting learning opportunity for all of the residents  to discern real from not so real.

This  might have been the most fun part of my entire residency experience.

People who have something to gain from having an eye problem all seem to have the exact same complaint: “I can’t see.” Sometimes it’s “I can’t see out of my right (or left) eye,” and sometimes it’s simply “I can’t see.” The savvier the patient, the more subtle the symptom. The trick as the doctor on call is to simply demonstrate that their vision is substantially better than what they are describing. Oh yeah, it’s important to do so in such a way that you don’t make them too very angry; you don’t want to become a Bellevue Hospital “target” yourself!

Every resident develops a repertoire tricks that he or she will use, a go–to list that tends to work for the majority of the malingering patients. To be truthful, especially when caring for children, sometimes the patient is actually convinced that he or she really CAN’T see. The kids are really pretty easy, though. I found, and frankly continue to find, that even with my limited attention span (often described as being slightly shorter than that of your average gnat) that I have more patience than almost any child under the age of 18. Most eye charts will start with a 20/10 line, and then move through 20/12, 20/15, and then several to many 20/20 lines. If you start at 20/10, by the time you get the 20/25 or 20/30 that line looks absolutely enormous! I think I’m batting about .997 in kids with 20/400 vision in the ER who “miraculously” and up with 20/25 vision in the exam room.

Folks who have something to gain from being diagnosed with visual loss weren’t always wards of the state or city. Occasionally there would be people who stood to gain from being diagnosed with profound visual loss for other, less existential reasons than wanting a ticket out of Riker’s Island. My favorite was a Hispanic woman who came with an entourage of family members, her complaint being complete and total loss of vision in both eyes from some vague and poorly defined trauma suffered at the hands of a landlord who was trying to evict the her from a rent–subsidized apartment. Her examination was totally unremarkable. Everything about her eyes was so  normal it was eerie. My suspicions were high because she just didn’t seem all that distraught over her new blindness, you know? There’s an instrument called an indirect ophthalmoscope which is used to examine the peripheral retina. The light we use can be cranked up to a level which is quite frankly rather painful. I explained to my patient through her translator that I was terribly sympathetic, and very concerned about how she would ever be able to survive if she was  evicted, what with her being totally blind and all. I just had this one last test to do, to look at her retina. With phasersset on stun I started to examine her eyes with the light cranked up. She started screaming in Spanish. What’s she saying? What’s she saying? Remember, now, this is a woman who has no light perception, everything in her world is black. Her son grabbed my arm and started yelling at me. “Turn that light off. It’s too bright. It’s hurting her eyes!” Yup, just another satisfied patient.

The prisoners really were the most fun, though. You had to be on your toes because some of them were actually quite dangerous. If the corrections officers were chatting amongst themselves in the waiting room you could be pretty sure that the patient in your exam chair was nonviolent. If, however, there was a corrections officer standing roughly 1/2 inch from each arm of the patient, well, that was one you had to worry about. But the prisoners got it, they got that this was a game. If they could beat me they got a stay at the Bellevue Hilton. On the other hand, if I got the best of them, it was back to Riker’s Island. The guys who complained of decreased vision in just one I were actually not too difficult to fool. Again, all I had to do was prove that the vision and the supposedly “blind” I was normal. We quote discovered” all kinds of sight threatening needs for a new pair of glasses at two o’clock in the morning in the Bellevue consultation room.

The guys who complained of decreased or lost vision in both eyes were more challenging and therefore more fun. Can’t see anything at all? Piece of cake. All I have to do was prove that they had locked on to some image. There must be three dozen prisoners who complained of total loss of vision in both eyes who headed back to Riker’s Island one minute after entering my consultation room after they leaned over to pick up the $10 bill that I put on a footstool of the exam chair. Did you know that your pupils constrict when you focus on an image inside arm’s-length? You can imagine how handy that three-year-old Sports Illustrated bathing suit issue came in, and how many prisoners learned about accommodative pupillary construction after looking at THAT picture of Christie Brinkley.

There is one story out of all of my adventures with the Riker’s Island prisoners that stands apart. It was July, and I was doing my duty helping out the new first-year resident on one of his first nights on call. We got a call from the ER about this terrified patient who had lost vision in both of his eyes; he was defenseless. Dave, now a world famous pediatric ophthalmologist, was really unsure of how to proceed so I told him that we would do it together. We sat back and watched very carefully as the prisoner entered the room. He was totally on his own, not assisted in the least by the corrections officers. He managed to navigate around all of the little articles I had placed between the door and examination chair, not hitting a single one. He found the chair, turned just like you or I would, and sat down. His examination was perfect, naturally. After putting drops in his eyes to dilate his pupils this is what I said: “I can see that you are terribly frightened sir, and frankly I can’t blame you. I’m very concerned about your vision, and I’m going to do everything I possibly can to make sure that you are alright. I just put some drops into your eyes so that your pupils will dilate. Dr. Granet and I will then examine your retinas once the drops have worked. We are going to talk about what we’ve seen so far. Please go back into the hallway and take a seat in the blue chair, and we’ll come and get you in just a few minutes.” The prisoner left the room, once again navigating the “mine field” without incident.

Dave bowed his head, a little tiny twitch at the corner of his mouth as he shook his head. “There’s only one blue chair out there, isn’t there?” He smiled as he strolled over to the door. Sure enough, there was our patient, very calmly sitting in the single blue chair, surrounded by a dozen empty red ones!

We had to invite the corrections officers into the exam room when we explained our findings.

Sunday Musings, 1/23/11

Sunday musings (tip o’the hat to J-Bird!)

1) Oxymoron. Mature boy.

2) Vision. My dog, a border collie/aussie shepherd mix, climbed up on my kitchen table and ate my work project. That’s right…my dog ate my homework. As if that wasn’t enough she also ate my reading glasses.

The irony of that is simply too perfect for words.

3) Candor. Do you have any management responsibility? Any direct reports? How do you manage criticism? Do you reward candor? Honesty? I’m always looking for an expanded vocabulary to both understand and explain things I do, or would like to do. Here’s a good one:

“In order to promote honesty and candor among staff you must offer ‘umbrellas of grace’, reassurance that candor won’t be punished.” William Hubels.

I would add that candor leavened with kindness is an invaluable trait in people who work for you.

4) Marketing. I just read the Slate article on P90X and Crossfit. Pretty light fare, if you ask me. I also read through the comments that followed. Deja vu barely touches the ennui they provoked. Best quote: “Is it possible to be supportive of Crossfit without being ridiculed as a fanboy?” P90X is cool, even if you are a Crossfitter. Think about it. You are a Crossfitter and you understand the value of actually WORKING during your workout. Compared with what you see in most settings the folks who do P90X do waaaay more work than, what, 90% of other workouters? You should be fine with that. Really.

The fun part, I think, is drilling down into the business of P90X (not too hard since it’s pretty standard marketing stuff) and Crossfit. I have been a student of the Crossfit business model from day one, and an unabashed fan from the start. Really. The business started in pure “react” mode, Coach and L responding to their clients’ requests/ideas/demands near and far (make a website, give us something to study, come teach us this stuff). In contrast P90X was corporate marketing 101 from day 1. No knock there–it’s certainly successful. Just much less INTERESTING for my mind.

Crossfit is a virtual company, one without a central location, with growth initially and still mostly viral in nature. Now both reactive and proactive as it moves into adolescence, Crossfit Inc. still appears to be very much a work in progress. Nothing more than the marketing style is greater evidence than this. Crossfit has been marketed like Facebook has been marketed, just earlier and with more sweat involved.

These are smart people doing stuff that is really new and different in business. Do you run a business of some sort? What can you learn from Crossfit?

5) Need. Mrs. bingo and I watched a rather disturbing movie last night, “Winter Bone”. Very impressive acting by the lead. Hard to watch, what with all of the privation displayed, hardships open to view without airbrush. The movie instantly became a part of my ongoing education in the vastness between ‘want’ and ‘need’. Compare the stated goal of the 17yo heroine–I can’t keep this family together if I lose this house, with the bleatings of some Gen Y’er in the WSJ yesterday–”we face a bleaker investment future that our parents did”.

Seriously, he used the word ‘bleak’. We have ‘evolved’ as a people in North America where someone, presumably with a straight face and in all seriousness, uses the word ‘bleak’ in the context of his potential lifetime ROI. That type of navel gazing is part and parcel of a society displaced from the concept of “need”.

Food, shelter, and clothing. We’ve mostly licked those issues in North America. That’s why a movie like “Winter Bone” with its unsparing depiction of a life in America still focused on food and shelter is so disturbing. A former partner’s son took his life last week on the day that his house was re-possessed. And yet, his family had already been re-sheltered, the ‘need’ covered. I’ll not cast aspersions on this young man and his tragedy; I do not for a moment pretend to understand it, and please trust me that Clan bingo has had much too much close experience with this sort of thing to be dismissive or disrespectful. I only bring it up in order to marvel at those who persevere, when all seems lost and hopeless, in the pursuit of real needs.

Look around you today. What do you need? I’ll go out on a limb and say the truth is ‘nothing’. We have 20% or so of the income of 5 years ago, 5% of the net worth, and yet we live in abundance chez bingo. Heck, we have a washer, a dryer, and a dishwasher! Mrs. bingo and I always said that we would be grown-ups, we will have made it when we have a washer and dryer of our own! And yet even those are simply ‘wants’ that are closer to our needs, but are still ‘wants’, nonetheless.

Look around yourself today. See that all of your needs, your true needs, are more than covered. Want what you need. Need what you have. You have it all. You are blessed.

Everything else is just ROI.

I’ll see you next week…

The Role Of Adults In Youth Sports III: Fun

Do you remember playing sports when you were a kid? If not, if you are old like me, how about do you remember the last time you drove by a bunch of kids playing some sport or other in the absence of any adults? What I remember about both of those experiences is the sound. It’s a beautiful sound, and it cascades over any and all who are within earshot. It’s the sound of children having FUN!

Somewhere, sometime, there was a very significant change in what it meant to play a sport when you were very young. It used to be, at least when I was a kid, that sports were really just games, and the responsibility for playing a game rested with the kids who are doing the playing.  I distinctly remember neighborhood versus neighborhood baseball games, true nine on nine games played with wooden bats and a hardball, not a batting helmet or adult insight. We could play pickup basketball for literally hours any place we could find a hoop. To find this kind of scene nowadays, at least with children over the age of 10, you have to visit the bleached sand fields of South Africa or the barrios of Rio de Janeiro and watch the bearfoot urchins play their games with whatever they can find that will roll.

Here in America, though, it seems you can’t find any kind of game being played by kids of any age without uniforms, lined fields, and of course, adults. Think about it. When is the last time you drove by an open field and saw 10 kids chasing a soccer ball all by themselves? It couple of kids on a local tennis court whacking a ball back and forth? Or how about this one, a bunch of boys all dirty and muddy playing football without pads? Admit it… you can’t remember EVER seeing that, can you?

As long as we adults are going to be present there is one final role that we must play in youth sports: we must ensure that our children are having FUN! The younger the children involved, the higher priority this becomes. As offensive as it is to hear a parent screaming at his or her child during a high school soccer game, it’s borderline repulsive to hear the same kind of language directed at an eight-year-old.  It’s a game for heaven sakes! These kids are playing! Let’s have a little fun.

I know, I know, this is just one more example of some mamby–pamby,  soft in the middle American parent who doesn’t have the guts to push his kids to excel, right? The only problem with this, of course, is that this description couldn’t be further from the truth. I LOVE to win! I LOVED coaching when I had permission to try to win. Loved it. The whole “everyone plays the same number of minutes”, feel good, raise the self–esteem thing was really hard for me. I certainly got it, and certainly was on board when the children were really young, elementary school or junior high school, but I’m also of the mindset that it’s perfectly okay to try to win once you reach a certain age, probably high school.

But even there these are still kids, and they should still be having fun.

Let me indulge myself (as if this whole blog thing wasn’t self–indulgent enough) and share a couple of memories. There are all kinds of basketball games I remember from when I was a kid, but the one memory that came to me first while thinking about this was one of the very first practices after I made the JV basketball team in high school. We played “dribble tag”, with a towel tucked in our shorts and each of us dribbling a basketball. The object of the game was to pull your teammates towell, knocking him out of the game. Man, I just don’t remember laughing so much, or having so much fun on a basketball court before or since.

My sons each have a memory from junior high school football–the same one, actually just separated by three or four years. We live in Cleveland; in the fall it rains in Cleveland. Every year there is an opportunity for a mud practice, a session where pretty much no useful coaching is possible because it’s raining too hard and the field is too muddy. Cancel practice? Heck no! This is when the boys get to perfect their mudslides, mud dives, and mud flops. At the end of this particular session, and it happens just this way every single year, the young defensive coordinator brings the boys over to the garage and literally hoses them down with the church garden hose. He then piles them into the back of his pickup truck, refusing to allow the parents to befoul their cars with these muddy, wet, sloppy boys, and drives the kids home. The fun of this pracitce is what both of my sons remembered first.

Even playing sports in college it can be fun. I was a cornerback at Williams College. I’ve written before that I was good, but probably not nearly as good as I could have been or should have been because I didn’t work hard enough at the game. I was probably a “middle of the bell curve” defensive back for my day. When I was a junior the other starting cornerback was REALLY good. Despite that, the two of us had a rather poor week of practice one time, and the defensive coordinator, Coach Farley, gleefully pointed this out. “Ack… Look at my cornerbacks. One’s bad and the others worse!” Well, the next day every single defensive back rolled into practice with some sort of denigrating label on his helmet. Stu was “Bad”, I was “Worse”, and we were joined by our teammates “Terrible”, “Awful”, “Putrid”, etc. We got ahold of Coach Farley’s coat and taped “Tremendous” on the back. THAT was fun!

These are games, these sports. Always have been, and it’s really our responsibility to make sure that they always will be. We adults who are involved in youth sports need to make sure that our children are safe, and that they ( and we) take advantage of the life lessons that can be learned while playing sports. We must also accept the responsibility to make playing sports  fun. (If you want a great example of how to make fitness fun take a walk over to www.crossfitkids.com sometime. These folks make WORKING OUT again, fun.)

I think there’s a role for adults in youth sports, I really do. I’m convinced that the role has expanded too much, and the fact that most of us have never seen children playing sports without uniforms, or officials, or coaches is the most damning testimony to this fact. If we are going to be involved it is our responsibility to fully accept our three roles. Keep our children safe. Teach them through the vehicle of sports.

Help them have fun!

Sunday Musings 1/9/11: Your Last Tweet

It’s a sad day, Chez bingo. It’s a sad day, but also a day to breathe, to feel alive, to cherish a life. My friend has left, and today is the day he is memorialized.

We arrived early, Mrs. bingo and I. I’m not sure just why. The receiving line was already out into the entryway; it grew by the minute. It gave me pause, to be truthful, for my friend and his family are known for the quiet grace with which they conduct their lives. My friend grew up in a very reserved setting, and although he was capable of showing every emotion in the rainbow his show was was mostly with the volume on “low”, at least outside of his closest circle.

And yet, there it was, a line that was literally out the door and winding through and around the building. It really did make me stop and think. Here was a man who went through his (too short) life with a quiet grace, neither seeking attention nor courting fame, and yet his world of “one-degree of separations” grew by the minute.

I read something this morning that came back unbidened while waiting in line: what if your last Tweet (or FB post, or email, or text or voicemail…) was the last of you? What if? What if your last goodbye is, indeed, your last goodbye? Really anything, you know? Yesterday at work, today in the gym, lunch. Whatever. What if? How long would the line be, and more importantly what would your “one degree of separations” be thinking while they stood in that line?

As I write this my sadness begins to ebb, my mood lighten. Memories of my friend from months, years ago start to trickle in; they share space with my more recent memories, but something about how many of them are arriving, how quickly and confidently they come into my “memory room” gives me comfort. There will be more of them, the good memories, and they will be the ones just inside the door waiting to greet me every time I visit that particular room. So, too, will it be for everyone (still) in line.

And for you? Me? What will the line look like, and what will the memories look like to those in line when they are thinking of us? What were your last whatevers with your whoevers? What will fill their room of memories of you? If.

I’ll see you next week.

The Role Of Adults In Youth Sports II: Teach

At the news conference following a heartbreaking overtime loss, the head coach of Boise State had this to say: “one player can’t lose a football game all by himself. A player can WIN the game, but no one can lose it by themselves.” How good is that?! Seriously, after losing the opportunity to represent every underdog in the history of forever, in a football championship game for the ages, what does the coach do? He sees the situation for what it is, what it always is when you are an adult involved in youth sports; he sees this as just another “teachable moment.”

It’s gone so far beyond the cliché that they are life lessons to be learned by children playing sports that many of the adults who are involved in youth sports seem to have taken this for granted and just assumed that it will happen automatically. BZZZZZZT. Sorry. It doesn’t work like that. Never did. The second most important role that adults play in youth sports is to foster and facilitate learning among the children playing sports.

It’s pretty easy in the beginning. Heck, if you are coaching very little kids you actually have to teach them the rules of the game! I once tried to teach a bunch of kids in England play baseball. Piece of cake, you say. They play a game called “rounders” which is very similar to baseball, with a little bit of  Cricket mixed in.  Rounders doesn’t have foul lines, though, and English kids have no concept of what a foul ball is. I spent pretty much the entire game trying to explain why a perfectly good hit just to the right of first base didn’t count. In the beginning being an adult in youth sports is ALL about learning, ALL about teaching.

There’s a really cool phase in youth sports, whether you are a coach, booster, or simply an interested spectator, when the kids get the rules, they know how to keep score, and you are simultaneously teaching them technique and nuance while at the same time trying to win. Junior high school, Junior varsity in high school, times like this. This can be the most satisfying time to be an adult involved in sports. Somewhere in high school the “win mode” kicks in so strongly that teaching and learning can go by the boards, all teaching and learning geared toward just one measure, the one lighting up the scoreboard.

It’s not just about the game though of course. This would be a pretty trivial post if it was, eh? No, playing sports, especially team sports, leaves open all kinds of possibilities for learning. Even if you are the absolute star of a football team or basketball team or any other type of team, being part of the team means learning how to depend on your teammates. It means learning how to have other people depend on you. You have certain responsibilities, and the success of the team depends on you and everyone else doing exactly what they’ve been taught to do at exactly the right time. I’m going to my office in a very short time where I will be a member of yet another team. All of the lessons I’ve learned from all of my teams over the years come into play every time I go to the office. Same thing in the operating room this morning. Good outcomes depend on impeccable teamwork, with each team member doing exactly what he or she should be doing. Some may get more credit than others, at least publicly, but playing team sports should teach each athlete that he or she succeeds only if the team succeeds. The adults who are involved in youth sports have an obligation to teach this lesson to both the stars and the grunts.

Winning and losing are important measures, but it really DOES matter how you play the game. Did you play within the rules, even when no one could see whether or not you did? Did you cheat, break a rule that gave you or your team and advantage? Some of the individual sports are the best opportunities to learn these lessons. Have you seen those PGA commercials about the First Tee program for youngsters playing golf? Integrity and fidelity to the rules are mentioned by everyone. Adults should not only teach this but should also model these behaviors and attributes. What is your athlete learning if you use the “foot wedge” in the rough?

It’s possible to learn some very valuable lessons about how one might meet adversity in life simply by playing youth sports. How do you handle winning? Success that just can’t be hidden? Conversely, how do you handle it when life throws you an enormous curveball, and you look at terrible on a swing and a miss? Humility in victory, and grace in defeat are lessons that are there to be learned by our children playing sports. Sometimes all it takes is a gentle reminder, maybe even just setting a quiet example. There are other times when the designated adult must demonstrate a firm hand in teaching the lesson. I have visions of golf clubs helicoptering across fairways, tennis rackets splintering during fits of rage, trash talking and posturing under the basket or in the end zone. Failing to intervene and teach the PROPER lesson is nothing short of inexcusable if you are the adult present at those times.

It doesn’t sound easy, does it? I mean, that’s a lot of responsibility. It kind of sounds like… WORK! And it is, if you get right down to it. The adults who are involved in youth sports have great responsibilities, and they really have no right to expect a pass when it comes to fulfilling these responsibilities. This goes for coaches on the sidelines, officials on the field, parents in the stands, and boosters and administrators behind the scene. The opportunity to teach our children about fair play, following the rules, and being a good teammate are there for the taking. Even when it becomes time to win, as we saw in the example above with Boise State was on the verge of making history, there but for a missed 26 yard field goal, the imperative to teach our children, to foster their learning through sports, is one that we simply must seize as the adults involved in youth sports. Just like that head coach at Boise State.

They may not know it now, but every one of those Boise State football players walked off that field with a win because their coach played his role.

Sunday Musings 1/2/11

Sunday musings…

1) Resolute. The derivation of “resolution,” no? Should probably pick one that you can be the other about. Just saying.

2) Bowls. Is it just me or has New Year’s Day become something, I dunno, less? If you are of a certain age you remember January 1st as the day when you watched college football, even if you hated college football, because pretty much every family planned their day around exactly 4 games: Sugar, then Cotton, then Rose, then Orange Bowl. In that order. Meals, family visits, pretty much everything revolved around who was playing when, depending on who mattered the most to the family member driving the schedule. Remember?

It all started to fall apart with the Gator Bowl. I know…you want to blame the Fiesta Bowl, but before Tostitos or Doritos of whatevero’s got involved it was the Gator Bowl that crashed the party. We now have, what, 35 Bowl games, and even when the B(S)CS championship Game isn’t held in a traditional game we STIILL don’t have all 4 on 1/1. Can anyone tell my why the Sugar Bowl game is on a Tuesday? For real?

The “good old days” weren’t always good (props to Billy Joel), but in this instance, BCS or no BCS, New Year’s Day is just a cheap imitation of the holiday of my youth.

3) 21 months. It’s rather sad chez bingo today. My friend Ken will pass very shortly. Diagnosed 21 months ago with a disease that has a 95% mortality he will succumb at least 12 months later than predicted, but he like all the others will succumb. His passing at age 45 is quite sad, and I could (and probably will elsewhere) mine this for literally thousands of words, but I’d like to share just one little part of this with you, my Crossfit friends.

It took a fatal illness for two busy docs to make the time to forge a friendship that deserved to be. We have so very much in common and are so very comfortable in the company of one another. The small difference in our ages and family life stages meant that the friendship would not occur spontaneously, or organically, even though by rights it really should have. Nope, it took the specter of looming demise to make the two of us look at our lives, our days, our schedules and obligations and declare that we would be friends. For 21 months as it turned out.

Do I feel cheated somehow? Having made this decision to be a friend, carve out time I didn’t think I had to be everything a friend should be? I’m sad, but no, I don’t feel cheated or gypped somehow. How could I? A friend is such a precious and rare thing that even 21 months of real friendship is something to be cherished, its wonder and its splendor worth every bit of the pain and the emptiness of its loss.

Here’s the rub, a lesson learned time and again since that first time my Dad, Grampbingo first warned me: we get very, very few real friendships in this life. Very few people on whom we can depend, who can depend on us. Precious few who we are willing to make the time necessary to nurture the friendship. So few with whom everything is shared and score is never kept. So few.

For 21 months I had one more.

I’ll see you next week…

Posted by bingo at January 2, 2011 8:37 AM

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