Random Thoughts from a Restless Mind

Dr. Darrell White's Personal Blog

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Archive for January, 2012

The Lonely Athlete

My CrossFit INTERVIEW (you can find it on CrossFit.com) starts off like this: “I was bored and lonely in the gym.” 6 years ago I discovered CrossFit and now I am no longer bored. The CrossFit mantra, constantly varied, has seen to that. But the lonely part? That’s a little more complicated.

CrossFit has a couple other mantras that apply. We seek a type of “broad, inclusive fitness” that we define as “Work Capacity Across Broad Time and Modal Domains.” To achieve this the CrossFit programming utilizes “full-body functional movements performed at relatively high intensity”, and the order in which we engage the program is “form followed by consistency, and then intensity.” Here’s the complicated part: in order to achieve “consistency” I work out in a commercial gym that is exactly 2 miles from my office and 2 miles from my home. Smack dab in the center, it’s on my way to everywhere. It’s not a CrossFit gym, so I work out alone.

I’m still lonely.

For the longest time the online CrossFit community was where I found my gym “mates”. I’d log on, post my results, and check in on everyone else. I know…I know…it’s not the same as being there with everyone, but it was close enough in the beginning, and it was enough when the early gains of the programming came so quickly and reliably. Converging trends have combined to render the cyber-gym the pale substitute it probaby always was: 6 years in the gains come more slowly and at a much greater “price” without the support of collaborators, and the denizens of the online community have emigrated to real, live CrossFit gyms.

I’m alone, again, in the gym.

What makes a successful CrossFit Affiliate gym has little to do with the stuff in the gym. It has little to do with the address, the structure, or the decor. What makes an Affiliate successful is the manner in which it combats the loneliness that exists in most commercial gyms.

Think about it. What is it like where you are working out if you, like me, are working out in a commercial gym? You’re doing CrossFit, which almost certainly means that you are doing it alone. How many other solo exercisers are faithfully there? Not many, huh? It kinda explains the whole “personal trainer” thing to me, the “training” that goes on in the commercial gym. Most “personal trainers” are simply keeping the customer company, at least the ones I observe. They combat the loneliness.

The successful athletes I see in non-CrossFit gyms work out with one or several partners. This collaboration cuts the essential loneliness in half, at least. There’s a kind of sterile safety that loneliness confers, in the gym and elsewhere. It explains, I think, the endless plateau occupied by most exercisers.

Not in a CrossFit gym, though. No, Sir. Not even in a commercial gym where two or more CrossFitters work together. The essential collaboration of spirit inherent in the CrossFit group instills a tiny dollop of courage, of fortitude, a dash of valor to the spirit that allows one to forge ahead and beyond. It’s there, beyond the boundaries of loneliness, that we succeed. It’s there, lifted by the collective spirit of the group sharing our particular type of discomfort, that we break through.

The magic of CrossFit is in the movements. The genius of CrossFit is in the programming. The soul of CrossFit is wherever two CrossFitters collaborate to break free of the lonely athlete’s safety zone.

 

An EPIC Adventure II: Training

As I posted a few weeks ago, in order to continue to use an outpatient surgery center where I have performed surgeries for 15 years or so, I am now required to use the electronic medical record EPIC. My hope had been that I would be able to continue to run “under the radar” by utilizing my pre-–dictated notes and standard orders, signing the papers as I have done lo these many years. Tragically, this was not to be. Having come to this realization about a month ago I reached out to the IT department and asked for training on the system. Being the somewhat self–involved surgeon that I am, I naturally assumed that a single phone call or e-mail would see multiple individuals leaping into action in order to help me so that I might continue to use that surgery center and generate revenue for the hospital. Silly me.

Four weeks, a dozen conversations, several e-mails, and I am assured more than several telephone calls later, I finally received a call from IT and one of the physician–advocates/trainers. I explained that I had a back log of signatures (little did I know!), and that I would be taking ER call soon, and did he perhaps have some time available to show me how to use the EMR? In the first of several remarkably positive little things in this process, Andrew did, indeed, have some time available the very next morning when I, too, could sit with him for a little bit.

Andrew himself was one of those little surprises. And ex–cop who had put himself through nursing school with the intention of using his nursing degree as a springboard to management, he informed me that he was one semester away from an MBA. It was clear he was anticipating a hostile interaction; this had been his typical experience when teaching physicians the system, especially private practice physicians. I liked him instantly, we connected, which probably contributed to the speed with which we flew through phase 1 of my indoctrination.

This can’t be all good, of course, otherwise there would be no reason to do this series! After learning how to get into the system (no, you cannot change your username), we looked at my chart deficiencies, specifically op notes that needed to be signed tracing back to November. I cleaned up all the old stuff, and then we got stuck with all of the charts that were sitting there from last week. Apparently part of the efficiency of the system allows the medical records department to put you on the “bad boy” list as soon as the case is done! We agreed to ignore these deficiencies since these would still be paper charts needing to be signed and moved on to pharmacy orders.

This was rich. I looked at about 200 orders with a “signature required” tag. Things like IV orders, and medicine injected to into the IV. Some were anesthesia orders which have no business on my list, and essentially all of the rest had already been signed. Andrew told me he’d taken a look at my in basket before we met and deleted three or four months of the pharmacy orders. I think the number he used was 800,000 orders! Whoa, maybe this isn’t going to go as well as it looks like it might. There is no connection between the electronically entered pharmacy orders and the signatures on the order sheets! 30 some odd orders per patient, each one individually entered and requiring a signature. I did 22 cases yesterday! Are you kidding me? This is what my colleagues were talking about when they mentioned the four minute per chart rule.

Like I said, though, this was a surprisingly positive interaction. Andrew took a couple of screenshots and said that he was going to sit with the IT magicians and see if we might be able to figure this particular one out. Man, that’s gotta work. I mean, the whole exercise took me about 45 minutes, and I didn’t even learn how to ENTER an order.

I can sign one, though. I’ve got some ER call coming up, and I’ll have to do some–patient consultations as part of my responsibilities. I’d better polish up my “helpless look” and rehearse my supplications. Getting someone to take verbal orders is gonna be the key to salvation.

More to come…

Inflection Points

Beth and I had dinner last night at a local steak house. Primal paleoish. We sat at the bar next to an older couple who are regulars. I dunno why, but on the way home while thinking about how this 58 years of marriage couple ended up as regulars it came to me how few truly major inflection points there have been in my adult life.

You know, points where you will make a decision because everything has brought you to a place where you must do so, and what comes downstream will change because of that decision. Inflection points to me are somewhat less obvious than Frost’s “fork in the road”, and sometimes they are only visible in the rear view mirror. At the time you may not even be aware that you were there, or that you were making a decision. Indeed, sometimes the decision is to do nothing, to stay the course. After all, choosing not to act is a choice, too.

For me each of these inflection points has a commonality, at least insofar as outcome. As I look back the direction I chose at each of these very few points lead me to become some better version of the man I could be. Simple, yet not. Self-congratulatory perhaps, but there was loss involved in each decision, too. It’s only in the review that I can balance the gain agains the loss and see the net. It’s in that review, however, that the threads come together and where the possible lesson going forward may lie, for I will surely be faced with one or more of these inflection points should I be fortunate enough to survive a while longer. Thinking back, without knowing I was doing so, I always chose to be more rather than to have more.

Think back a bit and look for the inflection points in your life thus far. Which major ones brought you here? Is there a pattern to your choices? When you come to the next point should you hold true to that pattern, or should you learn from those prior inflection points and alter your pattern?

 

It’s Hard To Make It Look Easy

It’s really hard to make something look easy. Think about it. The best knee surgeon takes 1/2 the time and gets twice the good results of the average surgeon. It barely looks likes he’s working at all. The very best LASIK surgeon makes the most difficult case look like a piece of cake, just like the easiest and most straight forward cases done by the average surgeon.

None of this happens without an enormous amount of hard work, practice, study, and yes, a little bit of natural ability doesnt’ hurt either.

Think about double-unders, jumping rope with two passes of the rope under your feet for each jump. A CrossFit legend named Chris Spealer did a Tabata Double-Under set (20 seconds of exercise followed by 10 seconds of rest, repeated 8 times) and got a lowest score of 40, or something crazy like that. Looked like a snap, too.  My best is 10. TEN! If you are a CrossFitter and you’ve struggled with Double-Unders (and who hasn’t, eh Jeff Martin?) you watch and you say it’s easy for him. You gotta know, though, after watching all of the Speal videos, that there were countless hours of work behind that. He just makes it look easy. It’s not.

Samuel Beckett had a run of some 10 years or so where everything he published was nothing short of brilliant, and there was a ton of it. If you are a writer and you have stared at a blank piece of paper or a blinking empty screen (and who hasn’t, eh Daigle?), you might think that Beckett was simply gifted, that the words simply poured out onto the page fully formed and prepped for posterity. Reading Beckett’s letters, though, tells a different tale entirely, one of anguish and toil, brutal hard work. He just made it look easy. It wasn’t.

We tend to discount the hard work behind any skill-based endeavor when we only see the “game film”, so to speak. The untrained eye is often unable to discern the subtleties in some performance or job that the best of the best just blow through, making it look like an everyday, ho-hum whatever. In most circumstances we just don’t have an adequate frame of reference that allows us to see how an average or “regular” surgeon, or athlete, or debater struggles with the curveball, the surprise. We don’t even get a chance to compare how the true superstar handles a truly mundane “game” in comparison with the middle-of-the-Bell Curve guy, at least outside the realm of sports.

This lack of perspective, along with a lack of awareness of how hard the best of the best have worked to get there, leads us to minimize the excellence before us. The average cataract surgeon in the United States takes more than 20:00 to complete the surgical aspects of a case. The very best among my peers take 5 or 6:00 to do the same thing. No movement is wasted, and each tiny step is literally a microscopic ballet. The complication rates for average eye surgeons are 5-10X greater than that of the top surgeons, and the best surgeons routinely achieve better outcomes by all measures.

The best surgeons make it look too easy. Our response as a nation to this is criticism that eye surgeons are overpaid for such a “quick and simple” procedure; there is a palpable, barely hidden contempt for the highest achieving physicians among healthcare policy makers. This is just wrong.

It’s really hard to make it look easy, almost everywhere and in almost every endeavor. We should be MORE amazed and have MORE respect when we see something and think: WOW…she really made that look easy!

 

Down To One

One.

At some point it comes down to the number one. A single, solitary soul. In the end there’s only one person who will make the call, and that person is you. Whether everything lines up in your favor, or every single card in the deck is stacked agin ye, there will come a time when you, and only you, will need to step up.

Clan bingo has mentored one of Lil’bingo’s friends for many years. With few in-born or familial advantages he managed to get himself into a position where he had every resource necessary to succeed. All he had to do was step up and do that part of the job that he, and only he, needed to do. In round one he failed miserably, essentially ignoring all of the assistance sitting right there for the asking. Given a second chance with yet more help, he once again failed to answer the call. It’s painful to watch, all the more so because a third chance is not likely on the way.

In every life there is a point where no one can do what needs to be done but you. No amount of help will allow you to stay on the sidelines and be a spectator. It may sneak up on you and spring out like a bad joke, or it may sit there for what seems like a forever, a gnawing ache until it begins to fester. High born or low, the bell will toll, and it will be up to you. You vs. you, you vs. it, or you vs. them, whoever they or it might be, the only number that will count will be “one”.

One you to make it happen.

 

 

 

A Great Job!

For all of the whining, moaning, and kvetching, eye Doctors have really good jobs. Especially eye surgeons. Well, at least the eye doctoring part of our jobs.  Sure, the business part of running any medical practice is hard and getting harder every day; buried under the never–ending avalanche of new and existing regulations, it’s a wonder we ever get to practice any medicine at all. But when we do, we actually have a pretty good job.

Some of the stuff we do and the successes associated with that are really quite obvious. Take an older individual who is about to lose her drivers license because she can’t see, remove her cataract, and all of a sudden you might have a 75-year-old “Mommio Andretti”! I don’t care who you are, that’s pretty cool. Add in some of the extraordinary new advanced lens implants and we have retired people who started wearing glasses in the third grade running around with bare naked faces. Seriously, you could be Genghis Khan and if you take someone’s vision from 20/100 to 20/20, people are going to like you.

It used to be that retinal surgeons celebrated “anatomic success”, the achievement of a normal appearing retina. Nowadays, with the advent of advanced micro surgical techniques and injectable medications, retinal surgeons are not only are preventing vision loss but they are improving vision in everything from retinal detachments to wet macular degeneration. They don’t really have any refractive retinal surgeries yet, but I’m thinking it’s only a matter of time. Think about it–how good is your job if you take someone with a bleeding retina and 20/200 vision, and a few months later they can drive a car? Pretty good job.

Some of the mundane things that we all do, things that are profoundly uninteresting to eye doctors, have an outsized importance to our patients. The surface of the eye has more pain fibers per unit of area than any other part of the body. If you believe in evolution, and I do, this actually makes a lot of sense. We are such visual creatures that our sensory cortex devoted to vision is dramatically bigger then any other mammal. Those pain fibers prompt us to rapidly close our eyes for protection. Ever get anything in your eye? A piece of gravel, perhaps a tiny piece of metal while doing some grinding? How about a scratch? It’s amazing how many people are assaulted by their Christmas trees in December and January. Its bread and butter for us, but making that “jump off a bridge” searing pain go away makes for a pretty happy patient. Happy patients make it a good job.

Whenever I get a little down or blue, overwhelmed by all of the minutia of running a business, or borderline depressed at the thought of ever more government intrusion into the space between me and my patients, I remember just how good my job is when I can get to doing it. I don’t really think about all of the high-tech things, the LASIK, the cataract surgery, the fantastic medicines I have at my disposal to treat things like infections or glaucoma. No, what think about is the oldest, least fancy, most routine part of my job: prescribing that first pair of glasses to a kid who can’t see. Seriously, you should see the look on their face when they realize just how poorly they’ve been seeing. Even better, the “AHA! moment” when you put that prescription in front of their eyes and all of a sudden there’s a 20/20 line on the eye chart. I’ve been at this for 25 years or so, and that moment, that simple, low–tech moment never fails to make me smile. When the simplest, tiniest thing you do can make someone that happy, well, you’ve probably got a great job.

Like me.

Carpe Diem, The Irish Wake Is Tomorrow

Carpe diem. For tomorrow you die.

Life is short. How many times have you heard some version of that? Some kind of profundity inevitably follows. There’s been a bunch of death and dying around clan bingo of late, so we’ve been forced to think about this. But is it? Is life (in the developed world) really all that short? I’m not so sure.

My day job is medical, and I hang around older folks 8-10 hours a day all week long. They used to check out in their late 60′s and early 70′s back when I started out, but it seems like almost everyone is hanging on well into their 80′s now. Every now and again someone dies young, though, and those deaths resonate so strongly that we forget that they are actually the anomalies. The 52 yo father of a new friend, my 45 year old friend Ken…they represent the outliers now, not the 90 year olds who pass on “unexpectedly”.

The take home here is to be prepared, whatever that means to you, not solely for an early departure but also for a long, long journey.

I attended one of the most interesting funeral services the other night, the one for that 52 year old father of a new friend (brought to me, yet again, by CrossFit). I won’t go into all of the details, but one that struck me was the fact that the Pastor who officiated had a somewhat, how shall I put this, superficial knowledge of the deceased. Oh, he knew a couple of the big things, but it was notable how few details he knew about a man who’d been a part of the congregation for some 35 or 40 years; he was reading from the obit.

Made me think a bit. Who would officiate at my funeral? Should anyone? If so, would they know me? Who would eulogize? What would the atmosphere be like? Funny to be thinking about this, but I wonder.

It’s sad to lose a loved one, even a loved one you may not really like all that much. The loss of your remaining parent makes you an orphan, no matter how old you may be when that happens, and that;s some heavy stuff to carry to the funeral. It probably doesn’t really matter all that much if the person officiating knew you–you’re dead. Priests, Rabbis, and Imans have been pretending to have intimate knowledge about the shadow dwellers in their flocks for generations.

No, I guess it’s more a matter of style, of atmosphere. I really love the whole New Orleans jazz funeral and the Irish Wake things. A celebration of a life and a life’s stories. We ALL have stories, and they just keep getting better as we get older and polish them up a little with each telling. Heck, to hear a couple of my guys tell the stories, only Johnny Rogers was a better punt returner than me back in the day!

There’s The Reverend Mel in Indy whom I love, a Baptist firebreather who never fails to move a soul, but he may not be available. If anyone else cares, I’m preparing for both a very long and a very short life, and no matter how it turns out I don’t much care about who might man the pulpit. A party, though, a celebration of whatever highlights there might have been, however few, now that would very nice. A little music, a few glasses raised, tears only of laughter.

Until then, though, carpe diem.

 

 

Who’s In Charge?

Home doing admin work and writing. Among my couple of New Year’s resolutions is to figure out who’s in charge, me or FB/Twitter. Me or the Skyvision blog. Me or Random Thoughts.

It all comes down to ROI, return on investment. Look at CrossFit, for example: the hours I have invested there exercising, learning, and writing have returned an incredible “profit” in health, knowledge, and new friendships. ROI? Massively positive. Random Thoughts has allowed me to occasionally empty the internal hard drive of my brain, leaving room for new stuff to get in. ROI? Probably a wash; I get a little frustrated because some of the things I write about are still messed up and my voice is very small…few listen.

FB and Twitter, at least my personal ones are quite simply a blast. Just fun. Brain candy, kinda like a Lee Child novel. I’m a social creature, and they allow me a way to be a bit more social, although they create in me a longing for more face to face time with my friends and acquaintances. ROI? Can’t separate my personal from the professional here, I’m afraid. The social media “requirements” for work still seem nothing short of oppressive. Is the need for a new Skyvision website real? Is it really necessary for cutting edge medical practices and doctors to have a comprehensive SM presence? If so, how comprehensive? Does Skyvision need the same amount of work to lift it’s cyber-profile as, say, the Mayo Clinic or CrossFit? Don’t know. Frankly struggling with exactly that as we cruise into 2012. ROI thus far in terms of new business, increased contact with existing clients, or increased visibility with referral sources is unmeasurable in any meaningful way at present; the emotional “cost” of mandatory posting is high.

Tune in, sports fans…

 

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