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Archive for January, 2021

First, You Need a Boat: Equality is Not the Proper Goal

“Life’s not fair.” –Scar

What does equality mean? What does it mean to be equal? I caught the tail end of a discussion on equality on NPR this morning. Unlike most of these discussions in that particular space this one was calm, measured, and came to a reasonable conclusion: only after a basic level of things like food, shelter, and safety has been met is it reasonable to consider disparities above that level.

This has come up in my day job. A study was done that proports to show that male and female eye doctors are paid unequally. The conclusions are false at the outset in this particular case because by law, services in this particular arena are paid exactly the same no matter who performs them, when or where. Unfortunately, the sensational lede taps into all kinds of notions of fairness, and all kinds of perceptions about what people assume must be true, that women always make less than men for equal work. There is no question that this is the case is some walks of life, but interestingly the data (some of which the authors ignore in their quest to prove their preconception) proves otherwise in medicine.

An opportunity to examine real differences in how men and women practice medicine is thus lost in the pursuit of an examination of the spiritual quest to combat inequality, even where none exists. Is this the unicorn of equality? Is payment under government programs the only place where equality actually exists? Heck if I know. What interests me is the fact that the first assumption is that inequality is present. Inequality is the default setting. That there is an inherent degree of unfairness in pretty much any and every setting.

Know what I think? Equality doesn’t exist. It cannot exist if we are to have an ever-improving world. There is nothing unfair about that in the least. Just like the conclusion reached this morning by the NPR panel, a just civilization establishes a floor below which allowing people to live is ethically wrong. For example, in healthcare it is my contention that we have a moral obligation to see that every citizen has access to care when they are sick. Inherent in this contention is that there is a basic level of care that meets this moral obligation by ensuring the same outcome as any other level of care. One could apply this same concept to food, clothing, and housing without missing a beat. We can think of the rights enshrined in the U.S. Declaration of Independence as a proxy for this baseline if you’d like. Life, liberty, and the pursuit of happiness make a very fine baseline.

One’s right to “life” necessarily includes a right to be fed, would you agree? Equality would mean that if one among us dines on Beef Wellington, than each among us must do so as well. This is where unthinking and unquestioning fidelity to “equality” brings you. In so doing it forces everyone to expend energy protesting “inequality” better put toward fulfilling the moral obligation to see that no one goes without protein. In healthcare we see all kinds of protests againts the inequality of care demonstrated by the horror of a VIP of some sort or another recuperating from a procedure in a luxury suite, while the proletariat must recover in the equivalent of a Hotel 6. The reality is that the outcomes will be equal; the moral obligation has been fulfilled.

Above a basic level in pretty much any domain you wish to examine, equality does not exist. Sorry. Scar is right. Life’s not fair.

Is he really though? Saying that it’s not fair is the same as saying that inequality above that level at which everyone has a right to live is wrong. Here is where I part company with those who hew to this viewpoint. What does it matter that someone drives a Cadillac while another drives a Kia? Do both not get you to work on time? Or that Beef Wellington again: do you not get the same amount of protein from a hamburger? The example I am presently using in another conversation about equality in healthcare is similar: if a medicine is effective taken 4 times a day, is the fact that someone can pay more for a version that must only be taken once a day a measurement of unfair inequality? I vote “no”.

My strong feeling is that energy spent in some way protesting “equality” is energy that is not expended on the much more important task of fulfilling the moral obligation of raising everyone to that acceptable basic level. In may, in fact, work against that effort. That constitutes unfairness in my opinion. Advocacy and protest should be directed there, toward making sure that everyone has that most basic obligation covered. One of this morning’s NPR panelists politely disagreed with Former President Obama’s dictum that a rising tide lifts all boats: it doesn’t work if you haven’t got a boat.

Once universal entry is accomplished across all applicable domains, the next task is to continually raise that basic level for everyone, no matter how far the gulf may be between that level and whatever the “sky’s the limit” level might be. Everyone needs a boat; no one “needs” a yacht. One need only look at “poverty” or “hunger” and how the bar has moved ever upward there to see how this might work. We have a moral obligation to see that true rights are available to all. It is unfair to those who have not yet achieved that most basic level when efforts to help them are diverted to the pursuit of an unachievable conceptual goal that neither feeds nor clothes nor cures those in need: equality.

Cape Week Lives! Sunday musings…1/24/2021

Sunday musings…1/245/21

1 Grey. Color of the Cleveland sky from October 1st through May Day. 

2 Vaccine. Got shot #2 on Thursday. Felt pretty punk for a day or so. Now? 

Hopeful. I feel hopeful. 

3 Electric. As in electric car. Why are the ones that are affordable so darn fugly and the ones that are even a little bit pretty so darned expensive? Or uncomfortable. The front seats of a Tesla have the same specs as the benches in the stands at any high school stadium anywhere.

‘Splain me that Elon. 

4 Mirror. I made the mistake of taking a look in the mirror this morning. There’s nothing really special about this particular morning since I have to peer at present day self while shaving pretty much every day. Today, though, I happened to also look at pictures of myself from 5 or 6 years ago. Pictures taken when I was very happy to be sure, but still, the “picture” gazing back at me in the mirror this morning was striking. 

That guy really got old over the last 5 or so years. 

I did a tiny thing this morning.

Beth: “That was nice.”

Me: “I’m a nice guy!”

Beth: “That’s why I married you!”

Me: “I thought you married me for my cute butt, and now that’s pretty much gone.” 

Beth: “Hmmm…right. Good thing you’re nice.”

Me: “Funny girl. That’s why I married you ;-)”

Old, apparently aging rapidly, but still happy. 

5 Cape. Cape Week lives! 28 consecutive years of our annual family gathering on the beach fell to the Pandemic last year. Last night my siblings and I all gave the thumbs up to resume our annual gathering. To our great relief my brother took over the admin duties from my Mom. Understand, she was never meant to have them in the first place. My sister Tracey handled stuff for a few years in the early days before Mom muscled in. 

Who is going to be there? I don’t think it really matters to be honest. Everyone is invited from every generation. Well, every human that is. As always, dogs are not on the guest list. We are clearly all going under the assumption that everyone will have had their second shots (or a single blast from J&J) by then (my brother has the world’s tightest bubble going on at the moment). Once there we never really go anywhere other than the grocery store and perhaps Sundae School for ice cream. The beach is private so it comes with built-in crowd control. 

To be quite honest I was very pleasantly surprised by the enthusiasm on our little family text thread last night when my brother confirmed our reservation. After a year off it would have been pretty easy to just let Cape Week drift off into the netherworld of family lore, living on in our hearts but no longer in our calendars. It was really more than a little exciting to be having that little side conversation. Now we are all in that rather blissful stage where our anticipation and joy pretty much overshadows anything else. 

Like, you know, will we still have a matriarch to fuss over? If so, how do we get her across the street and onto the beach? Can any of the cousins make it? Where will they all stay? Will anyone have to work while they are there? Oy…bandwidth…

But those are questions for another time. Not for today. Nope, today is for letting the glow of hope flow over our family. Today is for giving Gram her calendar goal. A little flag on the horizon to march toward. Today is for all three generations to look back over our 28 years of memories and be warmed by them like we are by the noontime sun on the beach. To scour our closets for folding chairs and bocce balls. A day of reminiscing as we sit with photo albums filled with pictures of babies on the beach, my Mom and Dad young and healthy, beaming, happy. Pictures of me with a butt!

For today, at least, Cape Week lives.

I’ll see you next week…

Medicine, Celebrity, and Responsibility: Sunday musings…1/17/2021

I made it! I’m on the B List! After years of describing myself as a C List celebrity with B List aspirations in my day job I have finally reached that milestone. Say it with me: “B List celebrity!” In all of my years behind the scenes in the original CrossFit community I never scaled such heights. C Lister all the way. But not my day job. B List big time baby!

Just kidding. There’s no “B” or “C” list in eye care. There’s only a very small group of “A” listers to whom we all turn for advice on all things professional. Some are young, others not so much. Men and women, with the next wave looking to be more women than men, actually. Still, though they may be celebrities in my work world, the rest of us look to them only for advice and guidance as eye doctors. At least as far as their public pronouncements go.

There’s a temptation here to veer of on a rant about celebrities elsewhere offering opinions of varying degrees of ignorance about subjects on which true experts struggle to find consensus, but I think I’ll leave that for another time. Or perhaps another, more talented or better informed writer. The “A” List celebrities in my work world are who they are almost uniformly because of an outsized degree of excellence in our tiny little sliver of medicine. They’ve by and large earned their stature and their slot on the list.

The temptation to take a shot at celebrities who are “A” List in the social sense, who are famous simply for their ability to be famous, is nearly irresistible. While I confess to a striking and complete ignorance of what it is that makes literally anything Kardashian worthy of being influential in any sphere whatsoever, this temptation I will also let pass. Well, maybe someone could help me understand Paris Hilton. Could she really do the DJ thing well enough to get that famous and make that much money from her fame, or was she just a slightly earlier evolutionary step in the Kardashian genus?

Nope. Where I’m going here is celebrity that grows from true excellence in some sphere where, having demonstrated excellent performance in some venue or another, one then goes on to become famous. I mean big time, “A” List, “Bo Knows” kind of famous. Face it, as much as my colleagues and I would love to have our outstanding performances in the OR recognized with the occasional listing on People Magazine’s Best Looking list or with a cover treatment in Vogue, “real” celebrity comes from excellence in much different venues. Excelling in the arts–movies, theater, literature–is surely a route to “A” List fame as is the rendering of awe-inspiring feats of athletic legerdemain in professional sports.

And if you somehow pull off being noteworthy in both? Well, there isn’t enough red carpet in the world to accommodate your footprints.

What’s got me thinking about this is some of my recent reading in the “auxiliary office”. I got caught up with the NYT Sunday Magazine “The Lives They Lived” Issue while also staying abreast of the comings and goings of my college buddies on our email list serv. As I’ve noted in the past we are a group of middle-aged men who attended a small liberal arts college in the Northeast who were there at some point along with the Class of ’79. As such we are encountering all of the typical illnesses and infirmities of every group of 60-somethings in America. Notably, we lost one of our most beloved members a little over a year ago to prostate cancer.

It was him about whom I was thinking as I read the very poignant essay written about Chadwick Boseman by Ismail Muhammad. Boseman, you may recall, is quite rightfully and properly famous as an actor of considerable talent, most recently in “Ma Rainey’s Black Bottom.” Or, I sadly should say, was famous. Mr. Boseman passed away from colon cancer this past year, a diagnosis that he and his family managed to keep a closely guarded secret until his death. I found this fascinating. That an individual so very famous chose to keep such a dire illness a secret, and then managed to do just that.

Why would this surprise me? Why would I even care? Well, with the exception of a very tiny group of his closest friends, my college buddy did the same thing. Hardly famous in the “Hollywood A List” kind of way, he was very much a “Hollywood A List” kind of famous in our group. His passing has kind of “permissioned” the rest of us to talk more or less openly among ourselves about screening, testing, monitoring and treating cancer. One can’t help but remember Katie Couric after she lost her husband to colon cancer, famously submitting to a live-streamed colonoscopy in an effort to raise awareness of a cancer that can be better treated if caught earlier rather than later.

There are celebrities, both capital and lower case “c” celebrities, who choose to be very public about their diseases. I guess that either happens so frequently or is so widely publicized that it feels like almost every celebrity deals with their illnesses as if they were simply another opening night or playoff game. It’s rare that an “A List” celebrity takes the opposite route, the route taken by my college mate, dealing with illness as the private ordeal it is for the rest of humanity. Not gonna lie, on first blush one is left to wonder if doing so, at least for the very famous, is an opportunity to help that is lost.

That’s kind of where I thought I was heading when I sat down to start this a couple of hours ago. But as I’ve been ruminating on this, all the while chatting with close family members and as luck would have it several members of that college email group, I have come to a rather different conclusion. In the throes of the ordeal of illness one really owes nothing to anyone outside of those closest to you. And to them most of what they really want is for you to do nothing other than try to overcome. To survive so that they may continue to have you among them, living. If you do survive it’s still up to you whether your ordeal becomes part of your mission or not. Celebrity at large or only within your tiny sliver of the world, there exists no quid pro quo attached to your celebrity in this. No Owesies or obligations.

For the rest of us these passings actually are an opportunity, whether or not the departed wished for their celebrity to play such a role. Among my friendship groups in addition to my college email string we have all spoken more openly about what it means medically to be a middle-aged American male. Our friend’s passing has made some of us much more open with each other if it turns out we share not only the good but also a bit of the not so good. Mr. Boseman’s passing reminds me of my own family history; I’m sure it’s not completely accurate but it sure seems as if everyone in my Dad’s family either died with or from colon cancer. Sadly, relative youth (Boseman died at 43) does not inoculate you against genetics.

Very few ever become “A List” celebrities of any type, either world-wide owing to achievements in the arts or athletics, or in a smaller, more contained world like ophthalmology. Still, in our own tiny circles almost all of us are blessed to be on the “A List” for our families and our very close friends. Whether during the ordeal of illness or after its conclusion, each of us enjoys a tiny bit of, I dunno, let’s call it “micro-celebrity”, that will hopefully influence those we love to take just a tiny bit better care of themselves. I’m sure this is happening around the Boseman family, and it is certainly happening in a tiny corner of my buddy’s world.

Don’t let the passing of Mr. Boseman or my friend be in vain. Let their celebrity, whether writ large or small, be useful. Learn a bit about yourself and use that knowledge to do some very basic investigation of any risks you may face as you get older. Breast self-examination (look up the “Feel Your Boobies” foundation), PSA testing (Michael Miliken’s foundation), and the various tests for early colon cancer detection (I think Katie Couric has a foundation). Even with all of the strum und drang of our American health system it’s remarkably easy to get some pretty basic screening done.

Remember, even if you never show up on Entertainment Tonight or ESPN, in someone’s life, you are the biggest “A List” celebrity in their world.

I’ll see you next week…

Sunday musings…1/10/2021

1 Larper. Live action role player. One who enjoys acting out fantasy adventures. New word for me. I came across it on 6 January.

So much meat on that bone.

2 Pescatarian. Welp, it’s been almost 4 months. How’s it going? To be honest, I feel great. Haven’t lost an ounce (because: bagels), but my energy levels are high (see also: bagels). Of greatest importance my sleep has been nothing short of fantastic (as long as I avoid mixed drinks).

Do I miss anything? Beth and I were chatting about this last night. She misses stews during the cold winter months, and maybe chicken. Beth really likes chicken. Me? Mostly I just miss red wine. There’s not a whole lot of stuff in the vegetarian/pescatarian world that cries out for a massive Cab or Zin, and Pinot just doesn’t move me like they do.

Still, on balance, it’s been a good call.

3 Bills. The Buffalo bills won a playoff game! How about that?! Oh sure, the octogenarian helming the Bucs won too, but just for a moment let’s let all of those long-suffering Bills fans have their day in the sun. Have they won a playoff game since Jim Kelley retired? If memory serves (Beth can fact check me, something she finds incredibly fun to do), didn’t both the Bills and the Vikings lose 4 Super Bowls with a single quarterback under center (Tarkington, Kelley)?

Who cares? Congrats to Steve Bu and all of my Williams cronies from Buffalo on “their” victory.

4 Measure. While thinking about health and fitness (and really, who doesn’t in January) I dug into the drawer where I keep all manner of fitness trackers accumulated over the years. I’d stumbled on PAI (Physical Activity Index) again and thought it would be fun, or maybe helpful, to track my HR and how it reacts to exercise as a measure of health predictably. You may recall that I have been “working on” a comprehensive health metric based in part on how CrossFit measures fitness (WCABTMD).

As it turns out all of my older trackers are either kaput or, if still working, need to be connected to an app that comes from a company that is kaput. On first blush that was pretty disappointing. However, thinking a bit deeper about the tracking thing, it occurred to me that the factors that will determine my training going forward are wholly independent of what a tracker might tell me about variations in my HR, or for that matter pretty much any other measurement other than sleep.

All I’m gonna get from measuring them is additional stress if it turns out my activity isn’t producing life-extending numbers.

So, will I (finally) abandon all tracking? Nah. Just the serious stuff. There’s really very little to learn now about sleep, too. I’m better rested with 8 than 7 hours of sleep, and I sleep better if I don’t drink any liquids at all after 7:00 or so. Sleep quality is driven by sugar consumption in the evening, whether in the form of mixers in a cocktail or dessert. Bummer, for sure, but highly reproducible results confirm the findings. I’ll stay on the lookout for a way to measure how well I’m actually moving when I do work out (perhaps the latest from PUSH), but that’s just for fun.

The gym is supposed to be fun.

5 Care. As in care facility. What an interesting label we’ve adopted to denote what almost everyone called a nursing home until they became kill zones in early 2020. Care facility. Greg Glassman once said that the goal was not longevity in and of itself, but longevity that outpaced decrepitude. Indeed, over the years, and especially in my most active CrossFit years, I was continually asked why, for Heaven’s sake, did I push my body so hard in the gym. The answer lies just around the corner of that weak sauce term above, “care facility”.

The battle is waged so that I can get my own ass up off the toilet, without anybody’s help, for as long as possible.

In the prevailing vernacular “care facility” denotes a dwelling in which the elderly or otherwise infirm live in a congregate setting. Nursing homes, senior living facilities in which the residents spend time in a communal area, or even group homes in which dwell people who for whatever reason cannot completely care for themselves. What turned these places, at least for the elderly, into kill zones was a virus that was more deadly to older individuals and those with certain types of compromise to their immune systems. 75 seems to be the “over/under” for the virus, give or take. It doesn’t much matter where you get it as much as it matters how old you are when/if you do.

How does this follow from thoughts on fitness trackers? Oh come on…you know where this is headed. I’m not remotely mysterious enough, or good enough at this writing gig to create an elegant or unexpected segue. I spend my working days in the company of older people who by and large get themselves in to my office on their own. They are not under the care of anyone, in a facility or otherwise. For whatever reason and through whatever route they took they arrived at a place where they can cart their 70 or 75 or 80+ year old asses not only up off the toilet seat but out the door. For sure some of that is nothing more noble than genetic kismet. But still, a continual desire to move on one’s own seems to be a common thread for those who are blessed to not have an uncontrollable condition that cannot be overcome.

I confess that I peeked at CrossFit.com this morning, curious to see how, or even if, the new owners were addressing the annual onslaught of New Year’s Resolutionaries who have begun a CrossFit program on New Year’s Day. No, this is not my announcement that I am either jumping back into formal CF training or in some way re-joining some part of the greater CrossFit community. “bingo” lives abroad now. Still, it was heartening to see one OG offering up his 13 year summary of WOD’s for those who wanted a copy. To see a couple of the “Usual Suspects” offering encouragement to a Newbie. No longer fitness “infidels”, CrossFitters are now firmly a part of the mainstream.

No, what I was doing there was reminding myself that if I want to avoid a “care facility” longer into life, some things remain unchanged even if what we call them changes. The enemy remains the couch. The goal is still to retain the ability to get up, from the toilet or a fall, at a very advanced age. The competition remains “you vs. you”, with the ultimate victory to be slightly better tomorrow than you are today.

And, in time, to hold onto the “you” of today for as many tomorrows as possible.

I’ll see you next week…

Hope for the New Year

I came across my New Year’s musings from 2017. Let’s take a look, shall we, and see if there might be a little evergreen peaking through the soil of 2020 into 2021…

Chief Justice John Roberts gave a commencement speech to a group of 9th graders this year in which he wished them “bad luck”. Now, lest you think ill of the Chief Justice, that he was being churlish and mean-spirited, what he meant was that he wished that these young people would experience some degree of hardship in their youth so that they would develop tactics to persevere as adults when those same hardships inevitably arose.

“I hope you will be treated unfairly, so that you will come to know the value of justice. I hope that you will suffer betrayal, because that will teach you the importance of loyalty. I hope that you will be lonely from time to time so that you don’t take friends for granted. I wish you bad luck from time to time so that you will be conscious of the role of chance in life, and understand that your success is not completely deserved and that the failure of others is not completely deserved either.

And when you lose, as you will from time to time, I hope every now and then your opponent will gloat over your failure. It is a way for you to understand the importance of sportsmanship. I hope you’ll be ignored so that you know the importance of listening to others, and I hope you have just enough pain to learn compassion.”

My hope for each of you is encapsulated in Justice Roberts’ conclusion: I hope that you will have the ability to see the message in any of your misfortunes, and that you will express appreciation for the people who help you overcome them.

Let me leave 2017 with a final thought, inspired by Ben Reiter’s review of the movie “I, Tonya”. “Each of us, “I, Tonya” suggests, is more than the worst thing we’ve ever done–or, in Tonya’s case, the worst thing she might have done.” In our present days of instantly available and infinitely scalable opinion, we should add what someone says we did.

Let us, each of us, resolve that in 2018 we will look first to that which is good about each other, and endeavor to see that each of us is more like the best thing we’ve ever done than not.

2021 me is back. What do you think? For me it seems as though our poor children have gotten a lifetime’s worth of Chief Justice Roberts’ wishes this year, wouldn’t you say? Still, my wish in 2017 is, indeed, evergreen: see and appreciate those who helped, especially those who did so without being asked.

The year 2020 seemed so very hard while we were in the midst of living it. For those who became ill, who lost loved ones, it can only be the worst year ever. But for the rest of us, those who survived, when we look back we will likely see things gained as much as we see things lost. At least I hope that’s the case. All of those trips “lost”? They are still there for the taking. You may have learned, as I did, that the trips weren’t really the important part though; it was the company you would have kept on those trips that matter. If you are fortunate you spent 2020 with those same people (I was more with my closest people than not), or if not, are just itching to do pretty much anything, anywhere, just to be with them.

We are, as a people, more like the best thing we’ve ever done than not. Yes, let us go forth into 2021 and eventually out of the shadow of 2020 holding this evergreen thought close to our hearts. May 2021 be the year that you and I meet if we’ve not yet done so, the year that we reunite if we have.

Happy New Year to you all.

I’ll see you Sunday…

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