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Archive for April, 2021

You CAN Have It All (Some Restrictions Apply)

In my weekly reading I came across an updated version of a classic. Life is like juggling as many balls in the air as we can. All of the balls are made of rubber; drop one or two or whatever and you just pick ’em up on the bounce. All of the balls except for family. The family ball is made of glass.

Drop the family ball and it shatters.

Some years ago I wrote an essay that pretty much said that you CAN’T have it all. It was accurate for the times, not because it was harder to have it all back then but because having it all actually meant having EVERYTHING. Man, was I attacked for saying that. One Academic ER doc, a woman, came at me with a classic ad hominem attack. Not a word about what I wrote (the only thing she actually knew about me), but plenty about the person who wrote the piece. Not very helpful, frankly, or conducive to productive dialogue. Wonder what she’d have said if she’d known about my advocacy on behalf of my younger colleagues, particularly women. In any event, it’s time for an update.

My daughter and I have had a brilliant ongoing discussion about what most people label “work-life balance”. Megan and I agree that no such thing exists because the whole concept is built upon a false construct. “Work” is a part of “life”. It is inextricably a part of life and therefore cannot be carved out as something that is inherently separate and equal to whatever it is that one calls “life”. My old CrossFit world provides a very nice analogy in the discussion of functional movements like the squat. A squat is a movement that is a unified whole. You cannot break it down into pieces/parts and train them separately.

Doing leg extensions, hamstring curls, and leg pushes does not train the squat.

What Megan and I have settled on is “Harmony”, a state in which all of the aspects of life ebb and flow into and out of play. Think of the various instruments in an orchestra playing a complex composition. It is as obvious when a life lacks harmony as it is when a single instrument is out of step with the rest of the orchestra. Too much or too little, too fast or too slow, you always “see” it when harmony is lost.

What, then, is different in our understanding of “having it all” today compared with 9 or 10 years ago. As always my understanding, and consequently my ability to enunciate my understanding, has been enhanced by a better, more accurate vocabulary. You can, indeed, have it all, but you must think long and hard about what “it all” means to you. The misperception then, and now, is that “having it all” means having EVERYTHING. You can’t have everything. No one can have everything. Whatever you think “it all” means, for sure it doesn’t mean “everything”.

There’s more to it, though. Once you have taken the measure of what belongs in your own “all” basket, harmony comes when you realize that you can’t have it “all” at the same time. All of the things in your “all” basket take the lead at times, and fade a bit toward the background at others. Again, the metaphor of the orchestra is apt: there’s an oboe there somewhere but it’s not always playing. You simply can’t have it “all” all at the same time.

You can have it all, but all doesn’t mean everything. Even if you have it all, you can’t have it all the time. So where does my little juggling epiphany fit in? We all know people who we admire for keeping many balls in the air while spinning a dozen plates on sticks. When they occasionally drop a ball here or there we uniformly react with something like “of course you drop one every now and again.”

But what if it’s the family ball? The one that’s not even a little bit rubber but actually the thinnest glass imaginable? Each of us also knows that career-driven person who always puts family second (or lower). Takes every assignment. Works when they’re home, by choice. What of them? (And don’t @me about those true heroines/heroes who work 2 or more jobs just to keep a roof over the family’s heads and food in their tummies; I’m clearly talking about people who have choices to make).

Family, like work, isn’t really a “stand alone” part of life either. However, as I get older, as I watch another generation raise their families while simultaneously watching the generation that raised us leave the arena, it becomes clear that harmony is much more difficult to achieve if you don’t handle the family ball as if it is, indeed, the fragile element that it is. “You’re only as happy as your least happy child.” How often have you heard that one? Pretty accurate, that. For those of us “managing” the lives of elderly parents and relatives it often seems as if we are only as happy as our least happy elder, too. Do you wonder what, or more accurately who will be there when it is you that is on that final glide path?

I can’t help feeling as if the place of family in one’s own experience of harmony will determine how that final flight goes.

I dunno. Maybe the juggling quote weakens my thesis about life and work and harmony, but I think not. Whether you buy into Megan’s and my concept of harmony or continue to feel that “balance” is the better construct, “work” is not the other side of the teeter totter from “life”. Family is. Without adequately caring for the family part of whichever equation you wish to use stuff just doesn’t work. There is no balance. Harmony is unachievable.

You CAN have it all, as long as the well-being of your family is the first part of “all” you create and take care of.

Sunday musings…4/11/2021

1 Crowd. What you call a herd of rhinos. Pretty good word. Still not the coolest name for a group of animals, though.

A group of crows is called a “murder”.

2 Simulacrum. “sim-you-LAY-crum”. An image or representation of someone or something, usually unflattering or denoting something unsatisfactory.

No reason. Just came across it and had to look it up.

3 Paak. The rapper Anderson.Paak: “You need the mojo of the stage”. This from a man who has been incredibly productive over the course of the last year, creating astonishing music in the fanless vacuum of his home. This quote reminds me of how pretty much all of my professional colleagues viewed their time in lockdown, home, away from their patients. It makes me think about how much we all wish to come together for in-person meetings despite the evidence that shows we are able to learn remotely.

There is an energy in the doing on stage thing. There is a creative spark that simply never lights when you do what you do behind the curtain, so to speak. For me, at least, there is. Paak says it out loud. In healthcare can you provide the same level of care “behind” a screen, without the presence of co-workers? Without the physical connection of in-person care? No idea. Will the possibility of enhanced access, along with what everyone assumes will be lower cost, trump the spark that occurs “on stage”?

For now the answer lies just far enough back stage, off screen, for us to truly see it.

4 Healthspan. Ooooo, I really love this one. As opposed to lifespan, of course. Your healthspan is that part of your life where you are not only not dead (duh), but in good health. Functional. Still winning the fight against decrepitude (you can still get your ass up off the loo without help). As a sorta, kinda, still a CrossFit guy the appeal of this term is obvious. Especially today as I sit here having “broken” my ass after hitting a measly 40 balls on the range yesterday.

Aging is a bitch, but seriously? I hit 40 shots with a wedge and I have a broken ass?

In yesterday’s WSJ there was a cool essay by a guy who wrote a book on the science of fighting aging. Not the diseases associated with aging, but the process of aging itself. At a cellular level there is a lifespan. Once the cells die their lifeless husks apparently remain, gumming up the works for the cells still living. Why does a tortoise live so long? As it turns out it actually ages more slowly at the cellular level. Not only does a tortoise live longer, but it also doesn’t age as rapidly; a 100 year old tortoise is as vibrant as a 50 year old tortoise (if any tortoise could be described as vibrant). In a similar vein there are species of rats, I believe, where it is not possible to distinguish between a 3 year old rat and a 23 year old rat.

Although they live a long time these animals do not age, per se.

Imagine what this would mean for developed societies (the only kind I’ve lived in so the only kind I feel comfortable commenting on). Even without any significant increase in lifespan, if you increase the healthspan of the population you alleviate massive amounts of late-in-life suffering, thereby reducing the cost of caring for elderly infirmed. If older people are only older in time, not age, you preserve the resource that is their collective life’s experience. Mentorship remains available for decades longer, and productivity during their years of employment remains high.

There remains the need to continue to develop cures for disease, of course. This is especially true for those diseases that take out the young. Public health remains neither more nor less important; protecting the population from preventable deaths where better policy is the cure (vaccination, accident prevention, etc) is probably even more important when you have a population that remains “young”, or “not-aged” well past mid-life.

What will bring us to a human version of tortoise-hood? In my rather obsessive reading on this over the years there does not appear to be any one, single thing that could be universally applied across humanity. At least not yet. It appears that literally every diet/nutrition strategy works best in a particular genetic setting, and that no one, single diet works across the board. This stings a bit if you have forced yourself to adhere to something extreme and it turns out it doesn’t fit your genome, a phenomenon that cuts both vegans and carnivores equally. Even if your diet does match up with your genetics, so far it would only seem to keep you alive longer, not keep you “young” longer. Some suggestions to fight aging run afoul of the “less fun” barrier. As in “is it really worth not aging if I can’t have a beer” barrier. Is it really better to have a longer healthspan if you each day is emptied of fun?

Still, even here there is less than conclusive evidence, let alone a consensus of evidence.

It appears that the battle against decrepitude, the quest to be older without aging, will require something that we do not yet posses. Some kernel of knowledge, some discovery that will allow us to be simply more experienced versions of our younger selves without suffering the aging process. Whatever it is will also have to be acceptable. Suffering some puritanical intervention to achieve a long life without aging seems like a recipe for some sort of societal disaster. Still, I’m convinced that it’s possible to find a solution that will allow us all to enjoy a glass of wine, eat in a manner that we find pleasing and comfortable, and still remain youthful in all ways except the number of candles on our birthday cakes.

Which means we should be able to swing a golf club 40 times without injuring our ass.

I’ll see you next week…

Wearing a Bow Tie to Honor a Friend: Sunday musings…4/4/2021

Tomorrow I will wear a bow tie to work for the first time in more than a year. Actually, it will be the first time I wear a bow tie outside of my house since mid-March 2020. When my world got locked down by fiat from multiple aboves, all of the doctors in my practice transitioned to scrubs for the office. You know, so that we could launder them every night. One of my docs went so far as stripping down in the entryway to their home and showering before changing into civvies. No bow tie meant I could launder everything I wore to the office.

Since med school I have pretty much always worn a bow tie to work. Certainly since I began practice. What started out as convenience (a bow tie doesn’t hang down into all of the yucky stuff you encounter in a hospital) turned into a professional signature (Dr. Bow Tie). Not wearing a bow tie was universally noticed. Greeting patients prior to surgery in scrubs never failed to elicit a “where’s the bow tie, Doc?” The only time I wore what my kids called a “grown up tie” was for wakes and funerals. Bow ties sometimes denote a sense of whimsy and fun; I never wanted anyone to feel I wasn’t being properly respectful.

Last week I lost a colleague from work, someone with whom I worked side by side for the better part of 25 years. Tomorrow, at their funeral, I will wear a bow tie.

That my colleague died suddenly and alone makes my loss, our loss, so much more painful. Separated from each other for 9 or 10 weeks our work family actually bonded. Reached out to one another. Cared for one another. I recorded a video on the effects of the entire COVID experience on our small private practice in early March, and one of the marvels was that each and every person who worked together in our little place came back to continue the journey. Every. Single. One. Other than being able to stay open that fact, that we all came back to pick up where we’d been stopped, was the most amazing, wonderful part of an otherwise very hard year.

That’s what I will be thinking about on my way to the funeral tomorrow. We’d made it. Or at least I thought we’d all made it. Looking back my colleague had started to change a few months ago. A little less bounce in the walk. Slower to laugh. More time spent alone when the option to be together was there. Still, they’d always been very private. We knew something was wrong. We gave space because space was requested whenever we asked if we could help. Safe, we thought, in the knowledge that our colleague had always bounced back from setbacks large or small.

Indeed, they joked with me that the bow tie needed to make a return.

I find myself thinking about my colleague, my friend of 25 years, at odd moments. My efforts to put them in a little closet, a tiny shrine somewhere in my mind, perhaps, where I can visit when I’m strong enough…well…that’s been a miserable failure. I know that there was nothing that I, or anyone, could do for our friend. There was more pain than they thought possible. Intellectually, I know that we were all powerless. Still, dark, sorrowful tears tinged with the bitterness of “why?” and “if only” come without warning, unbidden, staining my cheeks on their way to the ground.

Tomorrow, to honor my friend, so that they will recognize me as they’d known me these many, many years, I will wear a bow tie in public for the first time in over a year. Just in case they are watching from above, to make sure they know I’m there, I will wear a bow tie to a funeral for the first time ever. There will be many of my work family there. We are all feeling the same. There’s an ache, a hole where our friend should be. Where our friend once stood so stolid, so supportive and loving, we will have to find the strength to make our friend proud of us as we hold each other up. As they once did for us. I must remember to bring tissues for everyone. For myself. That will be very helpful.

When you wear a bow tie there is nothing there to catch the tears.

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