Random Thoughts from a Restless Mind

Dr. Darrell White's Personal Blog

Cape Cod

Archive for April, 2018

Remembering My Gama*

Admit it, you cried too. You found yourself in front of the TV for whatever reason at noon on April 21, 2018 and watched the Bush family say goodbye to their matriarch. My Mom turned 81 on April 21st, and quite frankly I am not ready to think of her being gone. Not even a little bit. So I watched the grandchildren. Rather than putting myself in the minds of Mrs. Bush’s children I channeled her grandchildren. Listening to Jeb Bush describe “Ganny” sent me back in time to the days when I was the best-loved grandson in the history of all mankind.

My birthday is January 7th, 1960. Gama was “born” about a year later–I couldn’t get my one year old tongue around the word “grandma” and it came out “Gahmmah”. Now, the White family is really big on precedent, and since grandchild number 1 called Mom’s mother Gama, Gama it was for everybody. Subsequent grandchildren, great-grandchildren, friends, neighbors, heck a few Romans who lent an ear for all I know, called Jane Knopf “Gama”. (This precedent thing turned out to be not so good in the next generation when my nephew, grandchild number three, called my parents “Bam” and “Bamp” and it wasn’t allowed to stick, but that’s another story.)

As the first grandchild in my Mom’s family I had the perfect set-up, and the fact that I was the first male in a generation didn’t hurt one bit. My brother was born 17 months after I was, and with the two of us so close together it was apparently a burden for my folks. Turned out to be quite a break for me, though, because my brother was born in May; at the end of June I was shipped out to stay with Gamma and Gramp at the Jersey Shore, the first of countless solo visits with my grandparents. Thus began a most privileged relationship with my maternal grandparents, especially with my beloved Gama.

It’s hard to describe, especially in these days of ultra mobility where extended families live apart, how critical it was to be loved by a family member without condition. Accepted and supported with no strings attached. Time spent with Gama was time spent in a guilt-free bubble. You behaved because it just felt so good to be in that bubble, and if you misbehaved forgiveness came in waves a very brief instant after any punishment. I visited my grandparents for weeks at a time, especially in the summer. My aunt Barbie, 16 years my senior, made it OK for the rugrat to be around even though I was clearly messing up her “only child” status in the house. Those were good times. I had a very special and unique relationship with Gama and Gramp. If I close my eyes and it’s very quiet I can still hear them…”Dar”.

Apparently everyone in my family saw what a special relationship I had with them and sought to preserve and protect it. It does no good to share any family secrets, but every family has some, eh? I was the last to discover any of the family’s darker secrets, long after my siblings, long after the cousins 10 and 12 years my junior. I was 30 when my aunts visited us in New York at the end of my residency years when I became aware of how much I’d been “protected” over the years, protection so effective that any present day revelations cannot dim or diminish the memories of my life with Gama and Gramp.

We lost Gramp when I was around 17  when he succumbed to his nth heart attack. That whole time is really just a blur, from the phone call I took in Rhode Island with the news from my uncle to the memorial service in Miami where I stood next to Barbie as she tried to read her farewells. What I remember–indeed all I really remember clearly–is Gama saying over and over, “I didn’t get to say ‘goodbye’.” I didn’t get to say ‘goodbye’ either. Maybe that’s why I can still hear Gramp every now and again…”Dar.”

Gama stayed in Florida at King’s Creek for a couple more years, living in the same apartment I’d visited so many times. I even made one last solo visit when I brought my new college buddy “Kid” for a week of spring break fun during freshman year. Every family seems to have one adult who’s cool, don’t they? Yours does. Admit it. There’s a parent or an uncle or a grandmother who’s just cooler than all of the other adults, right? Well, in our family it was Gama. My Gama was cool! As the years went by as more and more of our friends got to know her it seemed she just got cooler. Just ask Kid.

It turns our that Gama was ALWAYS cool. She entered college as a pre-med student in the days when women did not become doctors. Almost got away with it, too, until her mother found out and transferred her into education. She dated the gay boys when she was younger because they took her to the best clubs and they were the best dancers (and she didn’t have to worry about getting pawed on the train home from New York).  Yup, Gamma was cool.

After a few solo years in Miami Gama moved in with my folks in Rhode Island, spending several months each year with my aunts and their kids in Florida. She never called us just by name, it was alway “MY Dar”, my Ran, my Tracey, my Kerstin. My Jenny, Rick, Mike or Ed. All eight grandchildren now clearly had a unique and special relationship with Gama since she was now living with all of us. She was still my biggest fan, my brother Randy’s defender (Ran was the “black sheep” by choice when we were younger), Tracey’s cheerleader and Kerstin’s confidant. Even though I can’t describe them as well I know that each of my Florida cousins had some version of that same specialness.

Some time ago, I was in my early thirties, Gama fell and broke her hip. Word came from the hospital that she was failing–a broken hip is often the end for older women. Beth called me on the way to the OR to do cataract surgeries. Numb, stunned, I couldn’t think. I did what we have always done in my family, I went to work. It was Beth who knew better, who cancelled my patients and put me on a plane to Miami. Beth who let everyone know that I was on the way, alerting everyone in Florida when I was delayed in Greensborogh so that Barbie knew where to to leave the message. I sat sobbing in the airport after the  gate attendant told me Gama had died. I wouldn’t get to say goodbye.

My Mom and I spoke at the memorial service representing the children and grandchildren, Mom all icy control, me crashing, burning and choking my way through. I told one of my favorite stories, the one about the little girl who was standing in front of her grandfather’s casket, stomping her feet, clearly angry. “He can’t be dead. I wasn’t done with him yet!” That’s how I felt when Gramp died. I think if we’d had the chance to ask him Gramp would have told us that he wasn’t really all that done with US when he died, either. I definitely wasn’t done with Gama, either, but Gama was done with us. She was ready to go, so long after Gramp left, so long living alone among all of her special grandkids. I said then, and I still wish to this very day, that she hadn’t been in so much of a hurry. I would very much have liked to say goodbye.

Maybe that’s why even now, when it’s very quiet, if I close my eyes, I can still hear her…”Dar.”

 

*In our family there is some question about the proper spelling. Since she signed all of her cards and gifts “Gama” I’m going with that.

There Are No Small People

“But players don’t feel like bit players in their own lives.” –Richard Russo

Oh man…how good is that? Every life is just huge if it’s you who is living it. Every story suffers or soars depending on the frame of reference of the author. The eyes and ears of the storyteller only catch so much, and some of what is seen or heard never makes it past the “bit player” level in the story that is eventually told. This is what Russo refers to.

There are short stories, but there are no small stories. There are quiet lives lived with little or no acclaim, but there are no small lives. There are people who move as if shadows among giants, but there are no small people.

Thoughts on the U.S. Health Crisis

We are looking at a true health crisis in the U.S. In 2015 some 40,000 Americans died from opiate overdoses. This is more than the number of deaths by firearms by a factor of 4, and is similar to the number of deaths in automobile accidents. I recently read a startling statistic: 7 million working age men are out of the employment market, and 1/2 of them take painkillers on a daily basis. Crazy, huh? Add to that the ever-expanding waistline of the average American and we have a kind of Double Jeopardy.

We can agree that there is a general crisis of health in the American populace stemming from over-consumption of calories (most of which are high glycemic index carbs) and under-consumption of physical activity. This week has brought several long discussions about the “failure” of American physicians to prescribe physical activity or exercise as a treatment for this. An equally startling story in this week’s news is the growing acceptance of excess body weight fat as some kind of new normal, a normal that should somehow be institutionalized. In this discussion one must add the overconsumption of alcohol, because countless studies have shown that this legal substance is responsible for all kinds of negative health effects, both direct and indirect. (As an aside, it does give one pause when one considers the possibility of legalizing another neuro-depressant, marijuana, the association with lower opiate abuse rates notwithstanding). As if this isn’t enough, we now must add to this toxic recipe the ingestion by any route of opiates.

The U.S. is regularly taken to task for its failure to sit at the top of the world’s life expectancy leader board despite spending the largest amount per capita on healthcare in the world. This criticism becomes more and more unreasonable as we dive further into what it is that actually drives statistics such as life expectancy. Deaths from overdoses are illustrative of the folly of conflating health and healthcare: there is nothing in the healthcare system of treatment that drives this statistic, and the death of these primarily young people has a disproportionate effect on the life expectancy statistic in which it is years lived that we are counting (and losing).

What, then, is to be done, especially in this setting here of health-conscious individuals? It behooves each of us to take a bit of personal responsibility in the discussion and pledge that we will utilize accurate nomenclature, and in turn demand that everyone else in the conversation do likewise. Health and healthcare are not synonyms. Likewise, healthcare and health insurance (itself somewhat of a misnomer) are not the same; one does not lose healthcare when one does not have health insurance, and for certain the ownership of a health insurance policy does not guarantee one access to healthcare. Indeed, because the outcome was inconvenient to the majority of entrenched healthcare interests, the landmark study of Oregon Medicaid recipients that showed no improvement in health outcomes in those with Medicaid compared with those without has been mostly ignored and purposely forgotten. We need to engage in this conversation, but do so with strict fidelity to meaningful terms.

From there we should lead in whatever way we can. Despite the pejoratives leveled at my physician colleagues and their exercise prescribing habits, this effort is not at all about the treatment of disease, at least not as far as we here are concerned, but rather one of Public Health. There are quite specific areas to be addressed if we wish to effect change. Each one must be subjected to a root cause analysis. Overconsumption of low-quality carbs is near and dear to anyone concerned about public health, and the battle against “Big Soda’s” influence has been engaged. Other influences such as agricultural subsidies should have a similar bright light shined in their direction. How is it that the dramatic reduction of drinking and driving has failed to render deaths from drunken driving a statistical anomaly? Perhaps someone can convince one of those know-better do-gooder billionaires globe-trotting in search of a trendy problem to throw money at to look a bit closer to home when they apply their famous intellect to new thinking about old problems.

As to the tragedy that is opiate overdose deaths, can we please have someone with no skin in the game be given no-risk access to any and all applicable data and just turn them loose? Some guy did a deep dive into the issue of scrubbing the internet of all vestiges of child pornography using a combination of massive computing power and an outsider’s view. Give someone like that the ability to examine the entire opiate ecosystem to uncover some of the hows and whys so that we can make some decisions of the whats of our response with more than just our typical SOP of some self-designated, conflict-of-interest-infected expert who declares that his/her solution should work because of what they are sure must be going on. This seems to be a new thing, opiate overdose deaths, and of the rather young, too. Prior opiate societal infestations surely share some aspects with our present crisis, but I don’t recall the opium dens in the days of the Crusades so routinely offing their customers.

Anything that can be measured can be analyzed. Anything that can be analyzed can be altered utilizing the results of that analysis. What is needed is the double-edged sword of courage to uncover an unpleasant truth, and strength to set aside all manner of short-term personal gain in favor of a long-term solution for societal benefit.

We ought not let 40,000 lives representing hundreds of thousands of years not lived to be lost in vain.

Dial Tone

There are a couple of broad-brush themes I find myself drawn to, things I find myself visiting with some regularity. Communication is one of them, and this week the specific thing that came up several times was how you might choose to communicate with a particular person or group of people. There’s always a trigger for these ruminations, this time the jarring interruption of an examination in my office by a ring tone that my patient surely thought was quite clever and altogether appropriate for any and all occasions. Yeah. No. Especially not while sitting in the exam chair in front of a doc who pointedly does NOT carry his cell phone while on the job.

We all got to talking about what cell phones have become and how we use them. A bit later in the day a patient was lamenting the presumed need to carry a smartphone with all of the attendant capabilities and inferred responsibilities and demands. You know the drill: each text is mission critical and cannot be ignored. An answer must be on its way before the backlight on your phone dims. You no longer have the answer to any question literally at the tip of you fingers, you now have the obligation to GET that answer, right now, lest you end up with questions in a queue. Questions have rights, too, in the age of the smartphone.

It’s insidious and seemingly irresistible, even for a guy who hangs his cell phone on a peg in the office (like a gunslinger entering an old West saloon). The “gotta answer” text now more compelling than a phone call ever was before because you can answer that text so quickly, almost…ALMOST…without interrupting whatever you may be doing otherwise. Unlike a phone call, where you must break away both attention and voice in order to communicate with someone who is not right there with you. Texters are now to the point where you need to text and ask if it’s OK to call. I must admit that even though I am nothing short of terrible at the physical act of texting (my auto-correct is in therapy with self-esteem issues) I, too, have been seduced by the ease with which a thought/need can be sent off RIGHT NOW, saving me the angst that would occur if I somehow forgot to transmit that thought/need if I had to remember it for a later transmission. I found myself becoming annoyed that my Mom doesn’t text (or email, but that’s a whole ‘nuther thing) because if she did I would never, ever forget those mission critical things I was supposed to remember and report.

But then, of course, it hits me: some people are always worth the effort of a phone call, even if they DO text (or email). In the natural evolution of communication a phone call–a real, live, use your voice and your ears phone call–has become as significant a gesture as hand writing a letter once was. Some things you just have to say out loud, and some people you just have to call up and talk to. You don’t text your grandmother to tell her about your first big boy/girl job after college. Your grandmother is worth a call even if you’re just telling her you remembered to pick up orange juice. Your Mom and Dad, POSSLQ, doctor, the guy who’s fixing your toilet–if these people want or need a call, a call is what they should get. Some communication is nothing more or less than a transactional transfer of information, while other communication is much more personal. Truly effective communication occurs when both sides are in agreement about what type of communication is occurring. Every communication with my Mom, for example, is personal, and would be even if she had and used a Galaxy whatever. As a matter of fact, even a phone call with my Mom is a kind of compromise as far as she is concerned because I am not able to just drop by to catch her up on whatever it was that she tasked me with reporting. Indeed, face to face communicating trumps even the handwritten note for immediacy, engagement, commitment, and conspicuous effort.

I was able to communicate with my patient just how I felt about that phone going off in my exam room with one eyebrow tied behind my back.

You are currently browsing the Random Thoughts from a Restless Mind blog archives for April, 2018.