Random Thoughts from a Restless Mind

Sunday musings…

1) Feckless. Who would have ever thought that our country would look to a 73 yo mensch from Yellowstone, OH to lead us in the Age of the Pandemic. Or that the mayor of NYC, arguably the most important city in the Western Hemisphere, will forever be married to the single most derogatory term I have ever seen attached to a politician.

2) Answers. “I don’t have any answers at all.” Sabrina Ionescu, University of Oregon

Ms. Ionescu suffered a much more personal loss when the helicopter went down. Kobe Bryant had become an in-person mentor, schooling her not just on her game but on life as a leader. And now the crowning moment for the nation’s best college basketball player (not, it should be noted, best women’s basketball player) has been snatched from her grasp by the pandemic.

Like so many of us in so many other walks of life, a leader is left with no one to lead and nowhere to lead them if she could.

It’s hard to put into words, but at this moment in time, unbeknownst to this very special young woman, I have more in common with her than she could possibly imagine.

3) Endings. It is nothing short of heartbreaking to read the stories about people saying goodbye to a spouse, children, parents without knowing if it’s just a regular “see you later” or a real at-the-end goodbye. Just one example: so many stories about the agony of family members who have placed loved ones into hospice care only to learn that they cannot be there at the very end due to the all too real need to put physical distance between our bodies, no matter how much we need to bring our souls together.

Thinking for just a tiny moment about that, about the very specific question of hospice care and the intense desire to be there to shepherd a loved one to the beyond, the sage advice of my dear friend Bill, the surgeon, is there once again to guide us. It’s so much more important to be there just before the end. Before our loved one has begun their final journey. Before they are unable to hear us. Feel our hand in theirs, our tender caress. Bill has long said that the rush to be at the deathbed side has always confused him. What should we have left to say, he wonders. Peace is there to be made, love to be professed each and every day. For those entrusted with our loved ones under hospice care let Bill’s gentle guidance show you the way.

Allow, nay encourage, peace to be made and love to be professed, heartfelt goodbyes to be made upon entering your gentle care.

For the rest of us, those of us who need not address death at the doorstop just yet, allow me to return to the lovely advice offered by Ira Bock M.D., a doctor from Dartmouth who spoke at a conference held in memory of my late friend Ken a year after his passing. The talk was surprisingly moving, not only because it brought back memories of Ken but also because I would go on to lose my Dad and both of my in-laws in the not too distant future. I thought of my folks throughout the talk. What the speaker discussed as end of life care and end of life preparations also offered a very important take-away that I will try to apply now, today, as if the end of life was nigh.

One should say 4 things often and with ease, not only in the course of completing a life’s work or concluding a life’s relationships, but in the course of living a life:

Please forgive me.
I forgive you.
Thank you.
I love you.

Sounds simple, huh? Maybe even a little trite. But each one of those little phrases is a bit of a minefield, each one laden with a hidden meaning and a back story, each one the mid-point in a little journey with a “before” you know, and an “after” you can’t possibly predict. There’s a little risk in that “after”, too, and that’s why those 4 little phrases aren’t really all that simple, and why considering this is not at all trivial. All 4 of those little phrases make you look outward, look at another, and in the saying they force you to put yourself at the mercy of that other. Each one of those phrases is a little opening in our guard, an invitation for someone to accept or reject not only the sentiment but the sender.

I’ve spent several years thinking about those 4 essential things and about how they fit in a life that is not necessarily concluding, even today in the midst of the Great Covid-19 Pandemic. We are, each of us, part of a tiny little ecosystem; thinking about using these phrases encourages us to look outward and see the others in our own worlds whether we are approaching the conclusion of a life, or smack dab in the middle. How will my Mom react if I approach this when I visit? Does she know it’s now the 5th act, that we are tying up all of the loose ends in the story?

How about my friends, my kids, my darling Beth? Actually, without really knowing it I’ve been on this path for some years now, probably guided by Beth and her inherent goodness. Friends come and go; either way I’ll likely feel a sense of completeness in the relationship if I remember these 4 things. Patients and staff do, too. Come and go, that is. I think I’m a pretty good boss and pretty user-friendly for patients as far as specialists go. Bet I’ll be better at both if I’m thinking about these, even just a little bit, even now.

Please forgive me.
I forgive you.
Thank you.
I love you.

Don’t wait for the conclusion of your life to think about these. Don’t wait for the end of a life to say these things.

I’ll see you next week…

Sunday musings…

1) Pace. None.

2) D. As in Vitamin D. Get outside and get you some.

3) Mask. For whatever reason we are in the midst of a national shortage of highest quality protective masks. As an ophthalmologist, an eye doctor, I am not in any way a front line, at-risk specialist. I do, however, get very close to my patients during an examination. Like 6 inches close. As such my staff and I could really use at least a little bit of a barrier.

Enter Beth, stage left, to the rescue. After about an hour of Google-fu she discovered how to make cloth masks that can hold a filter liner (originally quilt batting, soon HEPA filter paper) and can be washed after a day’s use (replacing the HEPA filter if necessary). I am living with one of our Better Angels.

But you already knew that.

4) Non-essential. You always know where you really stand in the food chain of life; the pecking order of importance, where you fit individually and where what you do fits in collectively. You can imagine it differently, behave as if what you do has greater meaning, but deep down you know where you stand. Where you fit. Although I already knew this any doubt about my own little place was erased this past week.

What I do is non-essential.

Along with dentists and perhaps dermatologists, eye doctors were among the first medical specialties to be so informed. My largest national organization, the American Association of Ophthalmology, sent out a letter demanding that all ophthalmologists immediately cease providing all but emergency care. Not suggest, not request, but demand. Patients were continuing to come to our door. The phones continued to ring. No matter. It is rare for a cataract and LASIK surgeon to do emergency surgeries. 15,000 ophthalmologists now sit idle. While their national organization held out for a week or so, 47,000 optometrists are now also mothballed.

Thus I was brought to the most agonizing decision of my professional career. After days of internal strife and nights of ceiling gazing it became clear that in order to save our practice, a business that supports some 20 families, we would have to shut our doors and close. My staff was almost entirely furloughed. We provided assistance in applying for unemployment, and we will continue to fund health insurance premiums for as long as there is cash in the till. On Wednesday I chaired the most difficult meeting of my life; on Thursday we turned out the lights.

It’s a rather sobering thing, to be told that what you do is non-essential. Let’s be honest, it’s a particularly bitter pill for a physician of any sort to swallow; we are, as a hole, rather impressed with ourselves. All work (that is legal) is honorable. All work has value. Saving, restoring, or improving sight certainly does. But times like this reinforce that some jobs are simply more equal than others, at least for the duration of our crisis. Think airplane, 36,000 feet, passenger down with chest pain. You want the 25 yo EMT in row 30, not the 60 yo ophthalmologist in row 10.

The longer this goes on the more we will be needed. What we do, what dentists, etc. do, will rise to ever greater levels of essential over time simply because there are very real problems that exist in our specialties that cannot be ignored forever. Our patients will determine what becomes essential and they will demand (not suggest, not request) that we re-enter the arena. My prayers will go out to my staff and their families. Not being there to provide for them is my greatest burden.

Until then I take my place on the bench, stay loose, and watch as the game unfolds. Like the proverbial back-up quarterback I will do what I need to do to be ready when I am called back to the field. When I am, once again, essential.

5) Dominoes. There was a video making 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 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 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. Who knows how many times that first, tiny domino fell and struck nothing but earth?

And got back up.

That’s the message, isn’t it? Always. Get. Back. Up.

I’ll see you next week…

Here is a reprint of “Sunday musings…” from the weekend of my little Buggie’s baptism. In these strange and challenging times it is helpful to reflect on our faith. Whatever that may mean to us.

“I don’t believe in an afterlife, but just in case I’m bringing along a change of underwear.” –Woody Allen

Funny how stuff seems to come in waves. This week brings together parts of the White Family for a Christening, the death of the great physicist and atheist Steven Hawking, and a preview of an encyclopedic take on the five years of Pope Francis’ papacy and the controversies therein. We have an affirmation of faith, an implied revelation of whether or not faith should have been present (although the rest of us will remain unaware of the outcome), and an evaluation of the challenges inherent in attempting to alter 2000 years of the administration of faith.

Scientists from the time of Archimedes have struggled with the challenges of faith versus science. Hawking dismisses the afterlife out of hand: “[T]he brain is a computer; once its parts wear out it is simply done.” John Polkinghorne, Professor of Physics and former Anglican priest, offered a learned and respectful (to both sides) examination in the delightful (if challenging) “Quarks, Chaos, and Christianity”; he clearly aims to find the intersection of science and faith. My brother-in-law and I have been sorta, kinda exploring the possibility that an afterlife lives in the multiverse, that infinitely possible infinite number of versions of our own little slice of reality (see “Dark Matter”) that is implied in quantum physics.

At the moment I am just back from the Baptism of my youngest granddaughter, witnessed by the family member who has the greatest degree of faith in the classical sense, my Mom, Grambingo. Introspection and critical analysis is not necessary, nor even really something to be considered by one who is so faithful in the traditional religious sense. Mind you, this is not a bad thing at all. Indeed, classical religions all seem to share a commonality of decency, a moral code that is at its core one of kindness and consideration. Pope Francis is popular in part because the “optics” of his papacy all point toward this part of Catholic doctrine. This imagery, which it is reasonable to believe, is heartfelt and real. It is said to be attracting drifting congregants back to the fold. Controversy is only present when the details are laid out, the rules of the religion still as unwavering as they’ve been since Vatican II.

Still, it is the faith, and more than that the real desire (bordering on need) of human kind to have some sort of faith that there will be something at the end. Something more. Whether it is a trip forward or backward, at some point we simply run out of the real estate of time and we are left with a choice: faith, despair, or madness. We can only go so far back in time before we run into the Big Bang. What came before? When we depart that which we are calling life we run into, well, we don’t really know. If we do seek to know what came before or what comes after we run into an absolute road block.

For me, a casual scientist brought up in a very traditional religious environment, I have decided to leave behind both the angst that comes from the need to know, as well as the trappings of religion, in favor of faith. Just faith. Somehow, deep inside, I am comforted by the belief that there was something before and there will be something after, despite the fact that I, like everyone else, am incapable of knowing for certain what that is. There is an inherent comfort in the thought that I might live on in a state of some form or another, perhaps even one that is part of my granddaughter’s Christening today. One thing I know for sure is that without that faith the path for me is one that leads straight to madness.

Indeed, one wonders, especially after the lovely occasion this afternoon, if Mr. Hawking packed a spare pair of underwear. Just in case.

Steven Pinker’s breakthrough, at least from a commercial standpoint, was a book about human nature entitled “Our Better Angels”. It’s a few years old and I confess that I’ve skipped over it and instead have started his newer book, “Enlightenment Now” at the suggestion of Bill Gates and his annual reading list. (Gates calls it his favorite book of all time). As an aside I’m also reading “Fewer, Richer, Greener” by Siegel, a similar data driven thesis about our world being better than popular, perhaps prevailing sentiment.

Anyway, in “Our Better Angels” Pinker describes a world in which there has been a dramatic and meaningful decrease in violence (wars, uprisings, genocides, etc.) despite sentiment to the contrary. He posits that exceptions to this trend get disproportionate coverage in the press and on social media, creating a false reality that the opposite (that the world is more violent) is true. Further, he points out that at the most personal level the entirely human traits of reason and empathy have made the world kinder and safer at both the 3 and 30 foot level.

For quite some time now I have observed this in my daily travels, both at work as a physician and around the various towns of my “civilian” life. We cannot discount the effect of “othering”, the process by which the bitter and the bigoted seek to make their targets something less than fellow humans in order to justify their prejudice. But this, too, is likely far less prevalent in reality than it seems it is given the reporting we see (although “othering” and prejudice in all of their forms are loathsome and have no place in our societies). No, what I see as I move through a life that brings me into contact with people of all walks of life is a people who bear no ill toward their fellow travelers. Indeed, a people who, given the chance, choose to do acts of kindness both large and small.

What will we see over the next weeks and months in the time of Covid-19? Well, we will surely see silly, even stupid stuff judging by my Twitter feed this morning (people in bars, cattle-car crowding in airport Customs lines). There will be folks who will say stuff that will make you roll your eyeballs right out of their sockets (too many examples to pick one). Some will seek to profit from the pandemic (how about that knucklehead who bought 17,000 bottles of disinfectant and jacked up the price? Got his comeuppance he did. Maybe we should let Amazon/EBay handle the insulin market). Even more distasteful will be those who choose to use the pending upheaval for political gain (Really? Somehow we’re gonna use this global emergency to win an election?). Even our Best Angels cannot avoid the tiny number of folks who see only themselves, even when doing so is so much more damaging than it might have been last week, or last month, or last year.

But these will not be the majority of who and what we see now, regardless of what we see and read and hear from whatever sources we use to gather information about our worlds. No, the majority of who and what we will see is people who do the right thing. People who choose to be kind and understanding, who offer gestures of both in ways big and small that may be visible but will as often go unobserved. For sure there will be more of these acts of kindness now in a time when they are needed; our Better Angels will respond now because now is when we need them. We will find that things like watching a child or dropping off some groceries have been going on under the radar for, like, ever; the Better Angel within all of us will simply be more aware of the chance to help, to provide. It could be a tiny as opening the minivan door for the Dad carrying groceries and a toddler in the grocery store parking lot, as subtle as not buying toilet paper because you are set for a couple of weeks at home, or as grand as learning that you have recovered from the virus, you are at least temporarily immune, and you take every extra shift they’ll give you at work, wherever work may be.

9/11 showed Americans that we can rally around a common cause. Rally around each other. Looking back, with the exception of the greater NYC area, rallying as a nation did not require a terrific degree of sacrifice. Certainly not like those borne by our nation during our great wars or times like the Great Depression. Now, when it’s hard, when sacrifice will be asked of all, now is the time to seek the Better Angel within each of us. I’m getting to be an old guy now, and maybe I suffer from a kind of sentimentality brought on by my stage of life (rather than the cynicism of so many of my Dad’s buddies at a similar stage), but the more I look the more Angels I see around me. The more closely I look the more of what I see is kindness. Understanding. Caring. Now is the time to seek the Better Angel within.

I see you. I know you. I see the Angel within you. I know that Our Better Angels will prevail. Our Better Angels will triumph.

I’ll see you next week…

Every child is special. Right? I mean, that’s what we’ve been told our entire lives. Every child is not only special but equally special. It makes sense, really. How can you possibly label one child special and another one somehow less so, or not.Regardless of the details, the individual circumstances in which you might find any given child, each child really ought to be accorded the label “special” at the outset, and then each child should be cherished and loved as such.

I really do think that’s a pretty decent baseline position for every other human to adopt when thinking about any child. Especially parents. Each child is special. A gift. Each one deserves to be cherished and loved as such. In reality that’s often pretty much all that’s necessary once you’ve helped your child attain the status of “housebroken” and have imparted in them the basic ingredients to survival in society. You know, the Golden Rule and some version of the Ten Commandments is probably the barest minimum set of social survival skills you’d be remiss if you didn’t pass them on.

In reality once you’ve done this, as long as you continue to provide food, clothing, shelter, and the “cherish and love” thing, kids out in the wild usually turn out pretty darned well without much more in the way of prepping. At least in the developed West with public schools to pick up the pace around age 5. Sure, encouragement to aim for success, a shoulder for the occasional cry, and the odd re-direction if they drift off course might be helpful. But kids have been managing the growing up jungle gym in the face of all manner of benign neglect for well over a century, the overwhelming majority of them turning out really well.

Is that it? Am I just gonna say kick ’em outside if the sun’s out, unplug their screens occasionally, and don’t let them dine on nothing but Cheetos and Cheez Whiz? Of course not. What all of this is leading up to is that, while every child deserves to be loved and cherished, and almost every child who is will turn out pretty close to as well as they possibly can turn out, there really does exist something that can only be described as a “very special child”. Let’s abbreviate that VSC so I don’t have to type it all the way through. An VSC deserves just as much in the cherish and love category as every other child, but the stark and harsh reality is that more is required from pretty much everyone for that child to be OK, let alone blossom.

You don’t really need me to tell you what might constitute a VSC. In your mind’s eye right now you have at least a couple of kids in view. There are the obvious ones, the kids who are born with genetic defects or who have some kind of medical challenge that they just can’t handle without help. Some kids have hidden problems that you can’t see from the outside. Think Diabetes. Nothing you can see on the outside tips you off to this challenge. Or abuse. You can’t see the internal scars that affect the young victim of abuse, and yet they are there just like any other medical problem.

On the other side of the spectrum there are children who are gifted. Exceptional in a way that is simply not normal. Super smart kids. Not “gonna be valedictorian” smart but “ready for Yale at 13” smart. A musical prodigy whose talent is so blaring and obvious that they debut at Carnegie Hall or the Grand Ol’ Opry before puberty. Michaela Schiffrin’s coach in Vermont told her parents that she was destined for greatness at 10. Kareem Abdul-Jabbar (then Lew Alcinder) was recruited as an 8th grader. Kids like this are not just special, they are a VSC.

So what? Love ’em, cherish ’em, and just throw them outside, right? Nope. Whether or not you knowingly signed up for the VSC cruise, in almost all cases you willingly signed up for the kid cruise in general. Once on board that ship there is always a chance that you will become the parent, grandparent, or guardian of a VSC. Good, bad, or indifferent, the arrival of a VSC brings with it a level of commitment that is simply greater than that of parents who have a regular, ol’ special kid. It may be good and fun or really terrible, but it’s always much, much harder.

Always harder.

Again, what’s the point? Two, I think. First, as the parent (or other responsible person) of a VSC there is unavoidable sacrifice. Maybe only one parent can work. A smaller house. Less sleep. Someone has to take their VSC to the doctor or shuffle the chess prodigy to that tournament in Chicago. There’s blocking and tackling in parenting of every child. Paying the bills, making the time. With a VSC there is much, much more of everything. No matter which side of the spectrum they fall on, raising a VSC means sacrifice that most of the rest of the world just never needs to make.

The second thing is for the rest of us. Those of us doing our best to raise special kids. We should realize that no matter how hard it is for us to feel like we are doing the right thing by our kids, to make the sacrifices that we all make so that our kids have their best chance to have a happy life, there are parents out there who have it much harder than we do. They could sure use our help and support, but really all they need is for us to be kind in the face of the challenges they face. Not only the Mom who has to stop everything in the grocery store to calm her child who has autism, but yes, even the frazzled Dad trying to figure out how to manage the up-do that came undone just before the floor exercise at the Junior Olympics. Our role in the lives of those raising a VSC is simply to offer kindness.

Every child is special. Some, for reasons that may be good or not so good, are more than that. There really is such a thing as a Very Special Child. If in some way he or she is yours you have an outsized burden that you cannot walk away from, that you must shoulder every day. The rest of us owe you and your child kindness in both thought and deed.