Random Thoughts from a Restless Mind

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Archive for March, 2018

Reality

“Reality is that which, when you stop believing in it, doesn’t go away. –Philip K. Dick

A fact-based reality should be the easiest one in which to live. Presented with data your only challenges should be to either explain it, seek to change the underlying causes of it, or make your peace and live with it. Now to be sure I am one who has opined that one’s perception of the facts becomes your own slice of reality, but PKD’s quote above is the ultimate response to one for whom the data becomes inconvenient.

Comparative data that shines light on differences between relatively identifiable groups seems to be particularly uncomfortable for large swaths of Americans at the moment. Well, not only at the moment I guess. Daniel Patrick Moynahan is still persona non grata to some people for pointing out facts about groups of Americans in the 70′s and 80′s I think it was. The CrossFit world is presently in the midst of an exercise designed to gather larges amounts of data about a subset of the planet’s population. Adding additional data such as diet and nutrition would undoubtedly yield a reality that some version of high-intensity interval training, becoming physically stronger through lifting heavy objects, and limiting the consumption of processed carbohydrates creates a healthier human.

Reality check for the pizza and beer on the couch set.

In the end I think my philosophy is becoming that I want to see the data. For me a data-driven reality may be unpleasant but it is at least one that gives me those 3 options above so that I feel a sense of control over my reaction to the reality, at least. Grade differences among groups at “elite” U.S. law schools? Let’s see them and figure out why they exist. Daughters in a particular group tend to remain at the same or higher socio-economic level as their parents but their brothers slide backward? Shine a light on that data so that a root-cause analysis can be done and change attempted.

Daniel Patrick Moynahan:  a person is entitled to their own opinion but not their own facts. The reality is that I am not as fit as I thought I was. I scaled CrossFit Open workout 18.5 and still only got 100 reps. It’s up to me to decide how I feel about that, and what I will do about it, but it won’t change the reality of 100 reps.

 

Never Stop Trying

There’s a video that made its viral rounds on various social media places of a rather earnest-looking professor-like guy talking about the power of a tiny domino falling and hitting a bigger domino on its way to the ground. He starts the dominoes tumbling. The cascade of 15 ends with the fall of a domino weighing 100 lbs. and measuring >1 meter in height.

All from a domino so small he needs tweezers to place it.

The Professor ends the video with the observation that a similar 29 domino cascade would finish with the fall of a domino larger than the Empire State Building. Pretty vivid. As is so often the case on Sunday mornings I let the video rumble around in the space between my ears for a bit. What I saw first was a vast space filled with thousands, nay millions of those tiny dominoes, falling down over and over again, never striking anything but the ground. Every now and again a tiny domino would fall against a massive domino, either bouncing or slowly sliding off, eventually finding its way to the ground either way.

It was discouraging to think about. It made me a little sad, to tell you the truth.

But as I thought about it a little more, spent a bit more time in my imaginary vastness filled with tiny dominoes perpetually falling, it occurred to me that in order to fall over and over again it was necessary for each of those tiny dominoes to somehow rise up to stand. More than that, each time one fell it moved a little bit. Sometimes further into the vacuum of the vastness, but sometimes closer to another tiny domino. Another domino falling.

Another domino that kept getting back up.

It’s probably trite–some would say I specialize in trite–but what stayed with me in the end was not the image of the massive domino falling at the end, but that of the tiny, delicate, fragile domino in the front of the line. The one that started the whole thing. What most of us ever see is the last couple of dominoes falling, the last tumblers settling into place. Almost no one ever sees those first dominoes. Those tiny, fragile, tentative steps in the very beginning of the line when there is little more than an idea and a dream. Who knows how many times that first, tiny domino fell and struck nothing but earth?

And then got back up.

Optimization vs. Diminishing Returns

Some time ago I wrote about the Minimum Effective Dose (MED), the concept in which we seek to optimize our results with the smallest amount of whatever it is that we are using to achieve that outcome. The quest to find the MED is one that crosses quite easily between my day job (medical) and my own quest for health (CrossFit). A quick mention of Eva T in Outside magazine and the program she uses with her clients made me think a bit more on the MED. The Everyday Math column in the WSJ provided an enhanced vocabulary for the journey.

Sometimes the MED really is a “something” you take. Here one thinks of medicine or food, for example. More often is the case that we are looking at a dose of time or effort. Or perhaps both. In this case we are seeking to optimize the effort as it relates to the outcome, to make the value of outcome divided by effort as large as possible. The rate limiting factor here is the Law of Diminishing Returns, of course: at some point additional effort produces such a small incremental increase in the outcome that it becomes not worth making. This applies to everything from WODs/week (or day) to decorating a birthday cake. At a certain point you just have to feel you’ve succeeded.

How, then, to know when you have reached this optimal level? Eugenia Cheng, the mathematician who wrote the WSJ piece, offers the concept of the “minimal acceptable standard”. Once she has reached this outcome the additional effects garnered from more effort have moved beyond the point where Diminishing Returns kicks in and she simply accepts the outcome. We would call these “minimal standards” goals, but the concept is essentially the same. We want an outcome; setting a target or a goal is step one in optimization.

Cheng then goes on to refine optimization with a discussion about boundaries. One is your goal, of course. In real life others also exist, things like a 24 hour day and a 7 day week and the need to make a living. The dose you choose, both qualitatively (what it is) and quantitatively (how much you get) is unavoidably affected by boundary conditions over which you have less control.In the end no outcome worth getting happens without effort. Health, friendship, or the unraveling of a gnarly math problem–you’re going to put effort in to get your results out.

Maximizing your outcome-to-effort ratio is just another way to say you are seeking your Minimum Effective Dose, in CrossFit and elsewhere.

Mental Health is Part of Health

Some time ago I wrote about creating a way to measure health. Real health. Health that encompasses every aspect of what it means to be alive and well. As a CrossFitter I definitely included Coach Glassman’s Disease -> Health -> Wellness continuum, and I also acknowledged the critical importance of his concept of “Fitness over Time”. As a classically trained physician/scientist there is clearly a place for more traditional metrics like blood pressure, serum lipids and the like, although they may, indeed, be an variable that is ultimately tied to fitness.

Where my thoughts on defining and measuring health seem to depart from most current trends is in the recognition that mental health–emotional wellbeing—is as much a part of being healthy as any other thing we might examine.

Think about it for just a moment. Most of what we would classify as mental illness has as many outward signs that we can see as diabetes and hypertension. Which is to say, none. Yet we—all of us, not just CrossFitters—see nothing but the good in treating diseases like diabetes openly and aggressively. There is no stigma attached to seeking care for your hypertension or your elevated LDL. To the contrary, if someone who loves you discovers you quit measuring your glucose before you bolus your insulin, they are for sure gonna get in your grill.

For whatever reason, mental illnesses are looked at quite differently. No one is asking the person with chronic depression whether she is taking her life-saving medication, for example. We might notice an insulin pump on a friend or family member, but then it’s quickly forgotten. Everyone seems to be very uncomfortable around the young man who has very obvious hand tremors from the life-saving medication he takes for his Bipolar disease. We all seem to be so much more understanding when we have to wait for a response from someone suffering from Parkinson’s Disease than from the young women who has the same symptoms as a side-effect from the medicine that quiets the dangerous thoughts in her head from Schizophrenia.

It’s not even necessary to look only at these kinds of severe mental illnesses when we are examining the importance of mental or emotional wellbeing as an integral part of being healthy. What good does it do to have a 5:00 mile, a 500 lb. deadlift, and a 1:59 “Fran” if it was self-loathing that drove you in the gym to get there? You may be quite accomplished, the envy of your peers, at the peak of whatever life mountain you wished to climb, and yet you cannot feel joy. How is it possible to be healthy without joy? I look at Usain Bolt and what I see is quite possibly the healthiest man alive. My friend Tim, the writer, tells me that Justin Gatlin has nearly everything that Bolt has—youth, fitness, wealth—but the combination of failure to knock off Bolt, and the public disapproval reigned on him as boos from the Rio stands has left him emotionally broken. It’s subtle, but if you look at his face in the blocks of the 100M Final it’s there.

Our complex and conflicted attitudes and feelings about mental illness are especially evident when the topic of suicide comes up. Just typing the word makes me uncomfortable. Even how we describe suicide is fraught with hidden meaning that reflects our discomfort: someone has “committed suicide”. Right? Someone committed an act that we simply cannot fathom, one that leaves the survivors completely without any understanding whatsoever. How could someone DO that? It’s as if every suicide is the same as the suicide of the crooked prison warden in The Shawshank Redemption when he looks out the window and sees his fate arrive in the front seat of a State Trooper’s car.

In reality most of the time it’s simply not like that at all. Nothing about it is simple at all.

The outer walls at the periphery of my world have been breeched by suicide twice in the last couple of weeks. One of them actually does feel a bit like that prison warden. Frankly, I am too conflicted, too aware of the external circumstances and not enough aware of the internal life of the deceased to offer much right now. The other one, however, just stopped me in my tracks when I heard. The loss was profound.It has also introduced to me a new vocabulary that I truly believe provides a starting line from which we can change how we think about not only suicide, but all of mental illness. A friendly acquaintance lost his wife when she was killed by suicide.

We don’t need to know all of the details of the story. Suffice it to say that in the face of a child’s illness she suffered quietly. Too quietly to be noticed. Perhaps she didn’t realize how badly she was suffering, or maybe she was like so many of us and couldn’t bring herself to see her illness for the life-threatening entity that it was. No one will ever know. What is clear, though, is that this was not anything about commitment. Kidney failure may be cause of death in a diabetic, but it is diabetes that kills him. There is no difference here. The cause of death was suicide. Her disease, her depression is what killed this young woman.

Each of us has a very few moments in our lifetimes that forever change us. On the second Tuesday of July in 2006, unbeknownst to me, one of those moments was transpiring in a lonely, dark corner. Joyfully, the moment was a beginning, not an ending. Regardless, once learning of the moment I was changed forever. Now I knew. You cannot see any marks from mental illness, no swollen appendage or insulin pump. But it is there all the same, and it must be acknowledged and accorded the same degree of care as any other disease that may take our loved ones from us. Mental illnesses are real, and they can be deadly. There ought not be any conflict or discomfort in treating them.

We may stop losing so many of our loved ones when start to see emotional wellbeing as part of being healthy.

When “Team Player” Means It’s All You

“It’s better to full-ass one something than to half-ass a bunch of things.” Anonymous

Soon enough I will be living another week of on-call coverage for one of the largest hospitals in Ohio. When asked recently by colleagues why I still do hospital coverage I had to admit that I really didn’t have an answer. I don’t really have to do it, and yet it doesn’t really seem like it feels right not to. There’s a kind of “pay it forward” debt to the giants who came before me that still lingers, I suppose. That debt’s been paid, with a bundle of interest, many times over, and it may be time to close the ledger.

Why now? Well, it has very little to do with the work itself because that hasn’t really changed all that too very much over the years. No, it’s more about the work that’s NOT being done by others, work that they own and are responsible for and don’t do, that will ultimately drive me away from this part of my day job. It’s really no different than any other job or workplace anywhere. The lazy and the shiftless, the incompetent and the entitled all see it as just fine to kick the can downstream to whomever they can get away with kicking it to.

I’ll bet you just had a dozen images of this from your own life flash by, right?

Boy, there are a thousand reasons you will hear to explain and rationalize why they feel it’s perfectly reasonable to get you to do their work. After awhile it gets really old. The first thing you should do when you encounter this is to look within and make sure that YOU aren’t doing this anywhere to anyone else. Gotta make sure that your virtue is intact before you saddle up the high horse! Once you’ve ascertained that all is right and proper with your own work ethic you then have a bit of a choice to make: rock the boat or sail along. Sadly, though you know the consequences of the latter (you continue to do that slacker’s work), be prepared for the possibility of not being thanked for pointing out reality to bosses and co-workers. It’s entirely possible that you will be the one criticized. Totally fair, right?

In the end there is no best answer to this dilemma. All you can do is use the feelings generated in you by being on the receiving end of this work-shifting to make yourself a better worker, no matter who it is you do that work for. If you do, indeed, reach that point where you just can’t look at yourself in the mirror any more because the injustice is simply too much to accept, it’s OK to call it as you see it. That’s where I am today, and that’s what I’ll be doing while on call. To be sure, all of that “pay it forward” I’ve done will get me an audience, though it may not mean I will be able to effect change. Other than workload, that is. In this tiny part of my day job, I will continue doing the very best job I possibly can, as I always do, for each of my patients each time I see them.

What I won’t be doing is picking up the other half an ass that someone else missed before I full-ass my part of the job.

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