Random Thoughts from a Restless Mind

1 Flow. Sort of the opposite of “block”. You know, like the writer’s block I thought I had until I sat down and looked over some notes I’d jotted down and the words started to flow so fast I can’t get a handle of which ones go where.

Is this what it’s like to be Steven King sitting at his keyboard?

2 Euderimonia. From Aristotle. A deep sense of well-being in which one feels that a life has meaning and purpose.

Think pre-EMR, pre-Meaningful Use, pre-Affordable Health Care Act private practice physician.

3 Brand. Why do vaccines have brand names? Wasn’t there just, like, one vaccine at a time back when we dinosaurs were the first wave of kids to get MMR, Polio, DPT and the like? Were there brands that were marketed to your friendly neighborhood pediatrician back then?

Sorry. Just seems super weird.

4 Book Report. My daughter in law Tes (TEZ) has this huge book club. Like a couple of hundred women reading books together huge. I should pay closer attention sometimes; she might be the admin member of her group, which would be a pretty big deal (I’ll ask when she arrives tonight to tipple with her hubby and her in-laws). Anyway, I’d started to read rather than have my books fed to me primarily via Netflix et al, and people ask about what I’ve read. So here’s another report: “A Monk Swimming” -Malachi McCourt.

Those of you who know me know that I spend an awful lot of time with “brain candy” like The Grey Man and the Jack Carr “Terminal List” series, alternating with Sci-fi that skews hard toward quantum physics and the multiverse. But every now and again I stumble across a book that latches onto my funny bone and just won’t let go. “A Monk Swimming” is one of those. Invariably I end up with one of these books while on a plane, usually while in the company of Beth, much to her chagrin. I am infamous for snorting when I laugh out loud, and this was one of those books that Beth literally made me put away while we were flying.

Malachi McCourt was the black sheep of the McCourt clan that also included Frank, author of “Angela’s Ashes”. Not a funny book. Malachi, on the other hand, made quite a life for himself by being the funniest guy in a room filled with all manner of people. He quite famously was one of the unnamed crew that aided and abetted the original Rat Pack (Sinatra, Martin, Davis Jr., Lewis, etc.). The guy’s stories are side-splitting funny, whether or not you are on a plane. He turned 91 last year and is probably pouring Manhattans at the retirement home this afternoon.

Do yourself a favor and pick up this gem. Be careful though. You want to drink your coffee or whatever while you are not actually reading. The book starts off hilariously with an explanation of the title (I snarfed on the plane) and just gets funnier from there.

5 Bedside. As in “Bedside Manner”, the antiquated term once used to describe a physician who had an easy way about themself while they communicated with their patients. It’s a term that’s been relegated to the historical junk heap, tarred by incriminations that it was little more than paternalistic and patronizing pulled off with panache. Of course, unlike days of yore during which so much of healing actually took place at the side of a sick bed, there’s not a whole lot of bed going on in modern healthcare.

I digress…

Bedside manner really means nothing more than openly showing that a physician cares about how a patient is feeling. Yes, sure, there was always that little bit of shade attached, an implication that the doc with a great bedside manner was actually hiding the fact that their medical acumen was rather thready, like describing your date as “a really good dancer”, but the reality is more likely that a “good” doctor with a “good bedside manner” was just like anyone else whose job made it necessary for them to be outwardly focused, focused on the patient/customer more than inwardly focused on what would ultimately lead to personal benefit.

In last week’s weekend edition of the WSJ there was a long piece on so-called “supercommunicators.” These individuals did something that I’ve translated as “active listening”: fully concentrating on what another is saying, and then validating that other’s thoughts/position/feeling by repeating the gist of what they said back to them. Even more so, after doing so they intuitively then ask if what they received was at least close to what the other person was sending. The front side of this is really nothing that your grandmother didn’t teach you when your were a kid: listen without interrupting when it’s not your turn to talk. It’s the second part of the equation, paraphrasing and confirmation, that elevate these folks to the “super” category.

Now this article was discussing communication in general, not focusing on the nuances of medical communication. Still, I kinda paid attention to my own habits in the exam room this last week when it was my time to “listen”. There’s a little caveat, of course, because a patient typically tells their story to a nurse or technician first, but paraphrasing the story obtained by another and seeking confirmation that your take is accurate is legit. Being a medical supercommunicator takes a bit more, though. There is an inherent information inequality due simply to the nature of the experience; no matter how much time you’ve spent with Dr. Google or messing around with ChatGPT or other AI’s, it is overwhelmingly more likely that I still know more about why you are in the office than you do.

The crux of having a good Bedside Manner is in how you take the next step in the conversation. How you demonstrate that you care about what your patient has told you. That you heard how much a problem is affecting them, and that you are committed to finding a solution. You, the doctor, may feel this deeply; your Bedside Manner is how you now project this. It is my contention that both House and Marcus Welby cared equally about the patients who presented themselves to be healed. Both were appreciated for their brilliance and the successes it wrought; only one was beloved.

I wish I had a newer, better term to describe a supercommunicator in healthcare. It’s my opinion that “Bedside Manner” has gotten a bad rap, honestly, but I get it. In the rest of the world’s non-medical communications there are some lessons to be learned from those docs who did/do have a “good Bedside Manner” for sure. Be an “active listener”, offering your communication partner the floor when it’s their turn to speak, paraphrasing and seeking confirmation so that they know that they’ve been heard. Like a doctor who sometimes has to prescribe a solution that is not really what a patient wants to hear, confirming that you’ve heard another does not require that you agree with them. Your response, agree or disagree, simply affirms that how they feel has value, too.

In the end we could all use a little bit of Marcus Welby’s manner at any “bedside”.

1 Upstander. Better than bystander.

2 Tare. To zero a measuring instrument. I was today year’s old when I learned this.

3 Patrick Adams. While flying home from a meeting I struck up a conversation with my row mate (I routinely talk to strangers), a gentleman named Patrick Adams. Seems Mr. Adams is semi-famous in the general way, but rather genuinely famous among the music cognoscenti of Nashville where he is a songwriter and performer. We shared the last leg of his trip home from performing.

Do yourself a favor, look this guy up on Spotify or wherever you do such things. Listen to his lyrics. Maybe choose, as I did, a playlist of others playing music he wrote. Think of it as talking to strangers by proxy.

4 Book Report. “We get given our faces, but we inherit our lives.” Michael Robotham, “Life or Death”.

Often, when I finish a book, something that happens with some frequency I’m glad to say, I think that perhaps I should have a little space in “Sunday musings…” or “Random Thoughts” that serves as a kind of book report. I dunno, might be a bit presumptuous but when has that ever stopped me, eh? Anyway, a fair portion of what shows up here comes from stuff I’ve read, including the above-mentioned “Life or Death.” It’s a fantastic story, a thriller, and honestly I just couldn’t put it down. A guy has spent 10 years in prison and on the day before he is scheduled to be released at the end of his sentence he escapes from prison.

It’s a story about fortitude. About single-mindedly doing the right thing, no matter how often or how violently you are thwarted. Asked about the wild swings of luck he experiences the hero answers with a bit of southwestern poetry: “I guess I broke a mirror and found a horseshoe on the same day.” While not as filled with the invitation to deepest thinking I enjoyed in “Dark Matter”, it is nonetheless one of the better reads of the 20’s.

5 Holiday. The one, true universal holiday in the United States is Super Bowl Sunday (SBS). Seriously. Is there truly another day in which a super majority of our nation’s citizens unite more completely, with a greater cross-section of the population engaged than the championship game of the National Football League? Seriously. It supersedes Christmas, New Year’s Day and the Fourth of July (which I’ll bet most people do not know is really called Independence Day) for participation. Some 130 million folks tuned in to watch it live, if only to see the commercials (at $7 Million for 30 seconds) they would talk about even more than the game itself.

Some folks tuned in solely for the commercials, using the action in the game as a bathroom break.

“Did you see The Game?” “Where did you watch The Game?” “How about that commercial for XYZ? Wasn’t it awesome/awful?” For days on end both pre- and post-SBS these questions were never more than 30 seconds in to any conversation in my decidedly middle-class world. Man or woman, young or old. Didn’t matter. I’m still processing what it means for such an event to be the singular thing on which a country agrees. It doesn’t matter which team you rooted for, or this year if you were rooting for a team at all.

You know EXACTLY what I’m referring to.

What really struck me, convincing me that SBS is, indeed, that one single universal commonality was reading a couple of newspapers and watching the network morning shows on Monday (I was on vacation, chilling with Beth and Hero as they trained in a more horse friendly clime than Cleveburg in February). The topic at hand was whether the Monday following SBS should be a national holiday. Really. Folks were having serious conversations about whether the nation should cure SBS flu by simply declaring the day a holiday. In a country that can’t somehow find a way to make Election Day a national holiday, shutting down on the Monday after SBS was fodder for serious discussion.

I found myself counting up the national holidays we do have. Days when schools, government offices and the financial markets are closed. Heck, maybe we even celebrate some of them. Christmas and Thanksgiving. New Year’s Day. Independence Day, Memorial Day and Labor Day. Veteran’s Day, President’s Day and MLK Day. Did you know that VE Day (Victory in Europe) and VJ Day (Victory over Japan) were once national holidays? No one remembers VE Day, and Rhode Island is the only VJ holdout remaining. Where once we lived under the umbrella of “Blue Laws” that forbade commerce on Sundays, you can now buy a sofa on Easter.

Do we need another national holiday? Beats me. Looking at our list of holidays we have now they all seem to have, I dunno, maybe a tiny bit of nobility, or something to that tune. Maybe that’s a stretch, the nobility part. I guess I’m thinking that collapsing Washington and Lincolns’ birthday celebrations into a single day while adding MLK Day contains at least a whiff of nobility, no? Anyway, the days we DO have all seem to be backed by long-standing, almost eternal significance (looking at you, New Year’s Day), national impact, or the like.

Like Easter, Super Bowl Sunday does not require that we set aside a day off work for the celebration. Is SBS itself a holiday? Sure. Any day that brings together almost half of the country is some way, shape, or form fits the definition, at least my version of the definition. Indeed, Super Bowl Sunday and all that goes along with it may be the single thing that we can all agree on. That we can all congregate around without major conflict or controversy. Those who celebrate the day pretty much have a live and let live attitude toward those who don’t and vice versa, and really, how many things in our modern America can you say THAT about.

As I talk myself through this I think I’m cool with Super Bowl Sunday as quasi-national holiday. But the Monday after? Nah. Not buying it. In a country that de-holidayed the day commemorating Columbus and the “first” Europeans to set foot in the Western Hemisphere we’re gonna shut down City Hall, local schools and the nation’s banking system so that SBS “celebrants” can suffer their hangovers at home? I’m afraid that I just can’t find the nobility, reverence, historical or civic significance, necessary to make that call.

I’m willing to keep an open mind, though. I mean, if a certain guy had dropped to one knee and you-know-who said “yes”, well, maybe just that once.

I’ll see you next week…

“When you decline to create or to curate a culture in your spaces, you’re responsible for what spawns in the vacuum.” –Leigh Alexander

Nature abhors a vacuum. In all ways and in all places. While I have never seen this immutable law applied to group culture that only speaks to my own lack of imagination and insight, and by extension Alexander’s surfeit of both. I use “spaces” a bit differently, preferring the term as a reference to internal or personal geography (timespace, brainspace, emotionalspace). Alexander’s choice of “space” rather than “place” adds to the brilliance, the “aha”-ness of the insight in that it specifically includes the virtual as well as the physical.

Some people exert, or could exert, enormous influence over very large spaces by either actively tending to the culture or by standing aside and simply observing what fills the vacuum. The CEO of our local medical behemoth has imposed his will at a very granular level on an organization that employs 10’s of thousands. Rules and regulations abound there. In the CrossFit world, the culture arose primarily from the founder’s philosophy and worldview. Greg Glassman is a classic libertarian: your business starts and everyone else’s ends at the tip of your nose. Pretty freewheeling, rough and tumble culture for the entirety of Greg’s reign.

My present location is a folding chair off to the side at the Florida horse barn where Beth is enjoying the life of a full-time equestrian. One of her barn mates, a younger woman who occasionally engages me in deeper thoughts, asked about the cultures in the spaces that make up my life. Think for a moment about your own spaces, maybe looking initially at the ones over which you might have a bit of control or influence. Work. Home. CrossFit Box or horse barn, whether owner or member. What has your role been in the creation and ongoing curation of the culture of those spaces? It’s a rather Taoist proposition, I think: to act is precisely equal to not acting, because one or the other course must be chosen. At my day job we actually did go about the task of creating a culture (A Tribe of Adults), and we knowingly curate that space by culling the tribe of those who don’t, won’t, or can’t acculturate.

In the end this is probably just another entreaty to consciously examine your own spaces, your world, and seek to exert whatever control you can wherever you can in order to live well. Whatever “well” means to you. Again, Lao Tse and the Tao te Ching gives us some useful vocabulary, imagery we might reference. In the end we are all more like the pebble in the stream than the reed in the field. We may aspire to live as the reed, flexible and ever able to flow with whatever breeze may blow through. The reality is that an untended culture surrounding us flows so powerfully that it, like the water in a stream, eventually reshapes us as it inevitably sculpts the stone in the stream.

The difference, as both Lao-tse and Leigh Alexander teach us, is that you have within you the ability to control the flow.