Random Thoughts from a Restless Mind

Dr. Darrell White's Personal Blog

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The Lifelong Bond Between Caddies. Sunday musings…6/9/19

1) 27. Happy 27th Birthday to my doppelgänger Randy. Never fails to make me laugh when he laughs (or sneezes, or talks) and someone expects to see me.

2) Mom. Boy, my Mom and I made a spectacle of ourselves this weekend! I really wonder what folks thought about the wacky, age mismatched couple laughing uproariously at the bar on Friday night. The only one who “got” us was Cecelia, a ridiculously precocious 4 1/2 yo, a bat savant, who chatted up Mom at The Ice Cream Machine.

You had to be there.

3) Hip. Couple of milestones this weekend as I continue to recover from my total hip. I just finished my longest walk, 30 minutes, and I feel great. The lack of “athleticism” is weird, though. You know, that ability to just move on demand. Yeah, not there yet. The other milestone was setting off my first airport metal detector. Funny, it didn’t happen on the way out. Of course I left everything in my pockets (TSA pre-checked) and ending up getting the full, up close and personal experience when I went through the particle detector with my wallet in tow.

Air travel is not for sissies.

4) Sasha. What a gem our new little Aussie Shepherd is turning out to be. Our border collie Abby loves her, and Sasha is equally in love with her new big sister. You can’t help but feel great about coming home when your dog wags her (sorta) tail so hard her feet come off the ground.

Rescue your next dog so that it can rescue you.

5) Caddy. My caddy partner for the day was having a rough go of it. A bit older than the high school and college kids who filled the benches in the caddy shack, he was there to make a little extra cash while hanging out with his people, other caddies. His golfer was a handful. He’d been having a tough round and was not handling it very well. By the time we got to the 14th tee he’d thrown his club a dozen times. Of course, he duck hooks his tee shot out of bounds to the left and sends his club helicoptering 50 yards and into the gorse. The caddy looked at the gorse; he looked at the golfer. “I think you’re going to have to throw a provisional club Sir. I don’t think I’m going to be able to find that first one.”

Pretty sure that was his last loop, maybe ever.

Were you ever a caddy? In one of my older essays about my requirement that young physicians should spend time in their training working in an intensely personal customer service job I suggested that being a caddy would be an excellent assignment for interns before you let them take care of patients on their own. As a caddy you may be a better golfer than your boss, and you may very well know much more about the golf course than they do, but the only thing that matters is that you contribute to the enjoyment of the game for your boss that day, the golfer for whom you tote the bag.

Training for the ultimate consumer service job: doctor.

There is a very special bond between caddies who have worked together. Yesterday I had the pleasure and honor to connect with three men with whom I plied the links as kids, Christopher, Chris, and Michael. The brothers Bohac (Christopher and Michael) were two of three Bo’s who caddied when my brother and I were caddying, and Chris one half of a twin set who took their seats in the caddy shack alongside us. C Bo is now the director of course operations and assistant pro at the club we all worked for. The White brothers and the Bohac brothers were also junior members of the club as well. Chris, Christopher, and Michael were joined by a buddy for 18 and I rode a cart with them for a few holes of visiting.

If you think golfers are bad about telling the same stories over and over, hang out with a bunch of ex-caddies some time. Laugh? I don’t know how any of the guys got a ball airborne we were laughing so much for those 3 holes. You see, we caddied in a different time. A more innocent time, and frankly a less pretentious time, at least at our Dads’ club. We were famous for “caddy pranks”, stuff that the poor kids nowadays would never dream of trying. You always needed to keep a close eye on the caddies in the groups in front of and behind you lest a key club in your golfer’s bag go missing. I wish we had cell phone cameras back in the day just so we could have recorded a fellow caddy doing a front flip when his crossed straps caught him in the knees as he picked up his bags! Or a picture of Christopher’s bags hanging about 8 feet up in a fir tree when he was a junior caddy and made the mistake of leaving them right where his brother and I would be forecaddying on the next hole.

Poor “Chrissy” was only about 4’10 at the time.

So many caddies went on to become golfers. For sure the White and  Bohac brothers did. Both Chris and his bother Pat play. I like to think that all ex-caddies are as good to their caddies as my three buddies are. The fiercest ribbing came when a team hit their drives on the opposite sides of a fairway, a set-up that would make a caddy carrying double work extra hard. Indeed, what we learned on the golf course as caddies was not only how to provide service to a very particular individual, we also learned very valuable lessons about what kind of adult men we wished to be (note: there were no female caddies at our club; women golfers only rarely used caddies). Golf tends to accentuate essential characteristics of the golfer. Honor, or lack thereof. Courtesy and respect, or not. The difference between confidence and arrogance. Men for whom respect came naturally and men who tried to buy it. We saw it all. Being a caddy prepared me for pretty much all manner of adult male behavior as I moved through the stages of my education and career.

Many thanks to my old caddy buddies Christopher, Michael, and Chris for the warm welcome, the memories, and the laughs yesterday. For better or for best, I am who I am at least in part because my brother and I were caddies with you once upon a more (or less) innocent time.

I’ll see you next week…

Four Star Treatment

The Windsor Court Hotel in New Orleans is one of my favorite places in all of the world. Tucked into a corner across the street from the casino, equi-distant from both the convention center and the French Quarter, it is an oasis of genteel service surrounded by a kind of institutional crassness. Just walking through the gate and seeing the fountain in the courtyard always makes me comfortable, makes me smile.

What I really love about the hotel, though, is that it is a place of exemplary service in which I can just act like myself. Do you ever go to a new restaurant or hotel that has a reputation for excellence, a place inhabited by a clientele with whom you might not regularly consort, and feel like you (and your behavior) are being judged by the staff? You find yourself trying to “live up to” the expectation of a waiter or concierge, inverting the service continuum because deep down you’re not really convinced you belong there. Somehow you have to “live up” to the place. You are there for them, rather than the other way around.

In my 30′s and 40′s I never, not for a single minute, had that sense in any situation whatsoever. I owned every room I walked into, no matter who was there or who was yet to arrive. Several major life events occurred in my 50′s which not only humbled me a bit, but also shook my core sense of worthiness. It’s as if those setbacks and challenges had somehow negated what my family and I had accomplished as we climbed out of the bitter poverty of my Dad’s youth. Even my wardrobe, classic and conservative almost by genetic decree, felt uncomfortable for a time. Funny, to find myself trying to impress a waiter, let alone another guest, as if I needed to prove I was worthy enough to be served.

The quiet, comfortable service given me as soon as I stepped out of the cab and was welcomed back to the Windsor Court has brought order back to the service continuum for me. In my day job I provide the service, and each of my clients deserves to assume that they are worthy of my very best. When I close up the shop at day’s end and head out I am now the client. Whatever room I enter is now once again mine. Tuxedo or tee shirt, my clothes fit me like a glove. Wherever I end up, I belong.

You do, too.

Bucket List Trips: Sunday musings…5/26/19

Anyone who has read any of my stuff will remember my angst filled year of turning 50, memorialize in “The Hard Turn at Mile Marker 49″. Last week, for whatever reason, it dawned on me that next January I will turn 60. No, this is not another whiny, self-absorbed description of my angst at that rather non-interesting discovery (of course, pretty much every entry here is, at the very least, somewhat self-absorbed). 2009 was a rather challenging year for me in many respects, but 2019 is actually pretty OK, thank you very much. I’m actually enjoying the vast majority of the minutes of my regular day-to-day life, way too much so to allow the thought of finishing another decade to intrude on the fun.

Beth and I have been talking quite a bit over the last little while about Bucket List travel. Hers, at least insofar as I understand it, is really pretty straightforward and logical; Beth would like to visit North Dakota and Alaska and thereby check off all 50 states in her lifetime of travel, and she would like to visit Scandinavia since that part of Europe is also a hole in her travelogue. We’ve talked about that quite a bit and have at least a rudimentary plan starting to take shape. I, on the other hand, have spent so little time even considering that I might maybe even HAVE a Bucket List of trips that I am literally and figuratively all over the map. Since my darling wife really and truly would like me to find happiness and joy around my 60th, my random and thus far totally unfocused “planning” is once again causing her to stress over my silly birthday.

Again, so not fair.

In my defense there are a couple of structural and logistical issues (I hesitate to call them barriers) that are involved in any discussion of travel around my birthday. To begin with, it’s in January. That would be winter in the northern hemisphere, and we have largely lost our love for wintery activity. We seek to leave our cold, dark and dank hometown each winter in search of blue sky sunny.  Sounds like a layup you might say. All of those classic south of the equator Bucket List destinations like Australia and New Zealand, Costa Rica and Belize are just there for the pickin’. Machu Pichu here we come, right? But I feel about these pretty much the way I feel about almost every other possible draft choice in the Bucket List lottery. They’d all be cool and all, but none of them make my heart skip a beat.

Our little slice of Heaven at Casa Blanco is simply lovely from June 1st until well after Labor Day. Treating myself to staycations of varying lengths has been one of the nicest gifts I’ve been able to give myself (might actually be a Bucket List item checked off). Taking trips away from home in the summer in many ways makes little sense since each day at home is like a tiny vacation during the summer. And yet there are destinations and trips that do interest me quite a bit that make all the sense in the world during the summer and the fall. I’ve never been to Italy or the French countryside. For 35 years or so I have been carrying on a passionate love affair with all things wine. The vineyards and wineries of the American Pacific Northwest have long been on my target list.

Is it still a milestone Bucket List birthday trip if you take it 9 months after your birthday?

My old college buddy John Starr has been on a fun little quest he has labels “Drinks Around the World”, regaling us all on Facebook with pictures of all manner of libations consumed in places both high and low. It looks like he’s having an absolute blast, and I will freely admit to more than a touch of envy when I see each of his Captain’s Log Entries from the field. This morning over our weekly bacon indulgence Beth suggested shorter but much more frequent, smaller trips, perhaps tied to late-published airline fare sales. As I’ve mulled this over (and over, and over…) this morning perhaps this idea (and John’s inspiration) is where my Bucket List actually comes to life.

In my mind I’m a great traveler. Even my choice in watches reflects this romantic notion of myself: I only buy dual or multi-timezone watches. You know, because at any moment I might up and hop on a plane and travel several time zones away and need to know what time it is at home. Silly, I know, but still, it always makes me smile when I look down at the face of a GMT watch and think about that. Maybe that’s the answer. Maybe it’s the act of travel and the freedom to be able to travel that’s actually the Bucket List item I am supposed to be checking off as I turn 60.

Yes, I think that might be it. I suppose it’s such a cliche that it’s almost painful, but my Bucket List may not be about the destinations at all, but about the journeys.

I’ll see you next week…

It’s Better Than You Think: Sunday musings…5/18/19

1) Cassowarrie: Enormous flightless bird from Australia. Possessor of a 4th claw which makes it the most dangerous bird in the world.

Run away, Forrest.

2) Toe-tagged. Another absolutely delightful phrase coming on the heels of last week’s “Furballed”. Means dead, or as good as dead. As in “toe-tagged Pimlico” where the ancient plumbing gave new meaning to the term “sloppy track” at yesterday’s Preakness. (HT Tim Layden)

The runs, Forrest.

3) Bodexpress. In this year of danger in horse racing what the sport needed was either a simple, clean race run at the Preakness, or a hero of some sorts. What it got was both. War of Will was once again ridden brilliantly by its jockey, guided tight to the rail and sprung through the opening that never materialized at Churchill Downs to win in 1 1/4 lengths. No fouls; no harm.

Yet the story is all about the number 9 horse, Bodexpress, who dumped his rider at the gate (the jockey was unhurt) and then proceeded to not only run the entire race alone, but also to take a “victory lap” before being corralled by an outrider. Thoroughbreds run because they love to run. One of the risks of having a riderless horse is that sometimes the horse gets in the thick of the race and tries to win. For a few moments it sure looked like Bodexpress was going to be that horse. Again, no fouls, no harm.

Someone should have wiped down his face, just to see what a horse smiley face looks like on the towel. Run Forrest, run.

4) Better. Our world is much better off than you have been led to believe by the media. Yes, a cursory look at incomes relative to inflation appears to show that we have “stagnated” since 1972. That our “buying power” is at best unchanged since that time. But if you look even a tiny bit closer at the economics involved you see that not only has our financial health actually improved, almost everything around us has, too.

Let’s take a quick look at where we live. In comparison with 1972 all but the most squalid of habitats in the U.S. have not only running water, but also have a dishwasher. Some 80% of homes are now air conditioned compared with something like 15%, and almost no abode is without not only a TV, but almost always a high definition flat screen TV. The percentage of homes in which there are 2 or more rooms for each person living there has increased something like 100X. While homelessness continues to be a maddeningly complex problem resistant to a solution, those who do have homes live in dramatically more hospitable circumstances than in 1972. Deaths from non-lifestyle disease continue to fall. If you avoid the dangers associated with various consumptive diseases (alcohol, obesity, opiates, etc.) your life-expectancy continues to rise.

Food has become less and less expensive, regardless of quality (whatever that may mean). Where once families spent upwards of 20% of their income on food it is now closer to 8 or 9%. We now have access to out of season fruits and vegetables year round, regardless of our zip code. Hunger, while not eradicated by any means, is now a very small problem in America. It has been replaced by something called “Food or hunger anxiety”, the fear of being hungry. We have more nutritious options at a lower cost relative to 1972. Functional clothing is another example of the same phenomenon.

What have we been purchasing with the money we are not spending on food and clothing? Well, you are reading this on an internet connected something or other that did not exist in 1972. The internet did not exist in 1972. You likely bought that something or other on line from a vendor that did not exist in 1972. In doing so you did not have to use your car, a car that by the way almost certainly is safer, pollutes less, and is more comfortable than all but the most exotic options in 1972; you cannot buy a car without air conditioning unless you are buying a race car. Those phones we are all attached to have more computing power than that used to land on the moon, even those that cost as little as $200. Some of your former food budget is now spent “connecting”.

We are continually told that we are falling behind. That we somehow can’t afford what we need. Somehow our current world is not as good as that in 1972 or 1955. Yet we actually have more. Much more, actually. Our baseline has risen magnificently in all ways for almost all Americans. By and large each one of us has what we need. More than what we need, actually. This prevailing angst that what we do for a living is somehow not adequate if it doesn’t feed our soul, or some such, is new in only the aspect that there is so much public kvetching and caviling about it. Do you really think all those men in gray suits and blue ties felt “fulfilled” by their job selling mainframes in the 60′s? Come on.

You have what you need. Step one toward happiness, and perhaps fulfillment is to want what you have. There is absolutely nothing wrong with wanting more of anything. For sure there is nothing wrong with wanting and working toward more happiness. No one has a right to anything other that those needs necessary to live freely such that they may pursue that happiness. We have not gone backwards. We have not stagnated. It is easier in 2019 than it was in 1972 to pursue happiness.

You have what you need.

I’ll see you next week…

Mother’s Day 2019 Sunday musings 5/12/19

1) Furballed. Choked. Best new word in a long time.

2) Keanu. “I’m very fortunate. I’m glad to be here.” –Keanu Reeves

Me too, Brother. Me too.

3) Vineyard Vines. You know, Lands End for the “can’t spend my money fast enough” crowd.

Until it shows up in Target.

4) Presence. My Mom lost one of her closest friends yesterday. Frank, or hilariously “Honey” to those in the know, passed away peacefully in his sleep after kissing his beloved wife Mag goodnight on her way to her third shift nursing supervisor gig. Frank and Mag were the dearest, truest of friends for my Mom and Dad, and after Dad passed they continued to be incredibly generous and supportive of Mom. Everyone should have friends the way my folks and the Detorie’s had each other. My heart breaks for both Mag and my Mom.

Frank was a bit more than that for me. My brother and I often caddied for him on Wednesday afternoons when he and the other doctors in town took time off to hit the links. Like pretty much all general surgeons in that era Frank was literally larger than life. He was big in every way. Tall, booming voice, and as with all surgeons of the day, he possessed boundless confidence in his ability to be right. He’d even been in the Navy if memory serves. Think Hawkeye Pearce and Trapper John all in one. Being in the OR when he walked in was to be ringside when Ali came through the ropes. Very impressive for a young buck who desperately wanted to be a doctor.

Thank you Dr. Detorie, for all of that. Fair winds and following seas Sir.

5) Mommy. It’a Mother’s Day in America. Here at Casa Blanco we’ve heard from all of the kids and grandkids. Only my Mom and my sister’s mother-in-law remain for us to call. All bases have been touched. We will share the end of the day and dinner with one of our little families. It’s gonna be great. All of the mothers in our family are “Mommies”.

To be a mother is to give birth. There is nothing trivial about that. Carrying a baby for 9 months is the set up for the privilege of childbirth. It’s all a big, big deal. Being a mother never ends; you carried them and gave birth. Once labor is done presence is no longer necessary. Being Mommy, on the other hand, is an ultramarathon of being present. There is literally no amount of time, attention, or energy that a a Mommy can give to her child that will be enough. It’s an ongoing, every minute of the day endeavor, even if she isn’t in the room, or the house for that matter. Mommy is there in spirit, always. Mommy teaches and she plays and she loves. One chooses to be Mommy. Mommy never really leaves.

So here’s to all the Mommies who are being celebrated today. My professional colleagues who manage to do the same job I do AND be someone’s Mommy are awe-inspiring to say the least. Happy Mother’s Day to you all. To my Mom, still very engaged in the act of teaching and playing and loving. Make you a deal, Mom: I’ll keep being a “work in progress” if you’ll promise to stick around doing the Mommy thing. Happy Mother’s Day Mom. A big shout out to the two women who are Mommy to my grandkids. Thank you for being the terrific Moms you’ve been, and thank you for sharing your babies with us; they are so very lucky to have you. Happy Mother’s Day Katelyn and Brittany.

And finally, Happy Mother’s Day to the woman who has been Mommy to my little brood, my darling Beth. I always chuckle when someone compliments me on what a great job I’ve done as a parent. It’s mostly reflected glory, but thanks! It’s been such a great privilege to be a Dad alongside you as Mom. How cool that you get to be Mommy and Grammy today?!

We are all so lucky to have you.

I’ll see you next week…

Old Friends: Sunday Musings 5/5/19

1) Hip. 3 1/2 weeks out from surgery I forgot my cane this weekend and made it through unscathed. Mistake or milestone?

2) Dayton. In town for a wedding (see below). We spent almost all of our time in and around the campus of the University of Dayton. I’ve always loved college campuses, and Dayton was another campus to love. 4+ years there must be a very nice way to grow up.

3) “You can’t make old friends.”

Beth and I are cruising home following the wedding of a young man we’ve known essentially since birth. Billy is the middle child of our oldest, closest local friends, a couple we met in graduate school in 1982. Over drinks at the Rehearsal Dinner on Friday the topic of friendship came up (out of town guests had been invited to attend). Beth recalled the song lyric above, pretty much stopping conversation in its track when she did. Assembled at that particular table were the parents of the groom, two couples they’d met when they moved to Cleveland in 1991, and us. That’s a lot of years of friendship for that couple.

It takes much more than time to make an old friend, though time is certainly a major part of the recipe. Friends share not just time but also time together. Real friends share experiences, and more than that they openly share how those experiences made them feel. There is a trust in friendship, and you can’t have an old friend unless that trust has been tested over time and repeatedly made the grade. An old friend is one you turn to when times are both good and not so good; they are equally able to share both your sorrows and your joys, and they will forgive you for both. You don’t need to be anyone other than yourself, your truest self when you are in the company of old friends. No masks, no posturing, no playing position. Friendship of this kind is the ultimate nonzero-sum game.

That Beth and I have old friends is among our greatest accomplishments. You can’t make old friends, you have to earn them.

I’ll see you next week…

Follow-Up From the Other Side of the Stethoscope

So, how did everything end up? You know, my little side-trip to the other side of the stethoscope, doctor becomes patient thing. If you recall my beaten up old dude’s body is wearing out starting with my hips. What’s it been like since my last report filed the day before I headed to the OR to pick up my new left hip?

You’re never going to believe how surgery day started. The hospital where my buddy the orthopedic surgeon operates was undergoing one of those massive EMR transitions that is one of the unspoken traumas that result when a smaller hospital is “upgraded” by being absorbed into a larger, usually brand-name hospital system. How ironic that my own personal medical journey should include an EMR transition. If you’ve read any of my drivel you know that my little practice has had a recent government “encouraged” change of EMR, and one of the surgery centers where I ply my art seems to be in a perpetual state of epic upgrades that mess with my routine on a weekly basis. And now I show up at the outpatient sign-in desk and I’m confronted by a couple of clerks with a “deer in the headlights” panic manning the computers.

As if that wasn’t bad enough the “hired guns” sitting in and helping the staff manage the transition had literally no sense of what we, the patients, were experiencing. I almost–ALMOST–made it through the entire process without comment. Woulda done it, too, if it weren’t for the line of questions about my employment. This is a silly thing to be asking someone who has been pre-authed for surgery, been through PAT, and pre-registered, but to make those poor clerks take that particular detour when they were already 45 minutes behind on the first cases of the day was simply too much for me to handle. To my credit it was the only time I stepped back around the stethoscope and pulled the “I’m a doctor card”, telling the hired gun that maybe she should let her charges skate on that bit of misery on day one.

For the most part the rest of the hospital experience went pretty smoothly. Since I was the only my guy was doing that day (as you remember he and his wife were hopping on a plane to more friendly weather a few hours later) he was around a bit more than expected. Consequently there was a little extra awareness of my doctor-as-patient status in the OR. But once I got up to the floor I was pretty much just another hip in a long line of hips to come through. Oh sure, there was a bit of enhanced attention when I had a little post-spinal issue with my bladder and the nurses discovered that I was texting the chief of urology for advice…

Ok, maybe they really did remember that I was a doctor after all.

Which brings up an interesting twist on the 2-way stethoscope street: sometimes it’s NOT an advantage when folks know you are a doctor. It’s pretty common for medical staff of all types to assume that doctors know way more than we really do about the blocking and tackling that takes place outside of our own specialties. The best example of this was without a doubt my physical therapy. My entire team was fabulous, both inpatient and at home. Each of them started our encounters with some version of “well, of course, you know that…” something. At that point it became glaringly obvious to me that, no, in fact, I did NOT know whatever, and I asked each of them to treat me like a moderately intelligent 8th grade jock who was confused by his non-cooperating glutei, etc. It was way better just being on the patient side of the stethoscope, for sure.

Now here I am, precisely 3 weeks out from my surgery and preparing to head back to the office in a couple of days to begin my journey back to my regular side of the stethoscope. As expected I’m a bit ahead of the typical total hip replacement patient, not because I’m a doctor but because I’m a solid 10 years younger, 10 times closer to my ideal weight, and 100 times more physically fit. Still, it’s amazing how far I still have to go before I can consider myself anywhere near normal. There’s still pain, there’s a ton of weakness, and boy, do I get tired easily. All normal stuff. My surprise is doubtless a side effect of my lifetime of athletic activity and what my mind recalls of recoveries in the past. Really, typical bonehead aging athlete stuff. Thankfully the patient in me listened well enough to my doc and his people and took that extra week off to recover.

In the end two things stand out when I look back on this experience. The first is that we are all human. Your doctor is human, too. We all enter the “patient zone” with one very important thing in common: we all have fear. I’m not exactly sure which fear is going to turn out to be worse, the fear of the unknown you have before the first time you have a surgery, or the fear you have the second time because you know what’s coming. Either way, it’s natural to be nervous and to be afraid. No one wants to be sick. No one wants to need surgery. Doctors who travel to the other side of the stethoscope are no different from anyone else. Those kind thoughts extended from my patients pre-op came from a place of knowing, and the care that they extended was all the more appreciated because of that.

There were no epiphanies for me, and that’s the other take-home from this experience. Ever since the landmark 1980′s movie “The Doctor” starring William Hurt as an arrogant putz of a cardiac surgeon who has a near religious transition after being hospitalized, people have just assumed that every doctor is shocked to discover what their patients experience. Not me. I’ve spent the last 20+ years of my career plumbing the experiences of my patients and those of my colleagues in and out of eye care in an effort to improve the patient experience. For sure there were a couple of things that could have gone a bit better for me, but there was no choir of angels singing moment when I realized something about what it means to be patient that I would instantly apply to my practice.

That’s probably a good thing, though, right?

Reporting from a Hopeful Place: “Sunday musings…” 4/21/19

1) Faith. Happy Easter! Happy Passover! Happy Ridvan!

2) 82. Happy 82nd Birthday to my Mom, our last remaining parent. Many happy returns!

3) Letter. Hope vs. Hype. A single letter separates the two, and yet the gulf that exists between them is too large to begin to measure. One is a journey without end and the other is over in the blink of an eye. One could end in joy, while one might bring little but sorrow. Money often changes hands with either; sometimes it ends up in the hands of someone who has it.

Which is which?

4) Kindness. Accepting kindness is a type of kindness itself. Giving brings joy to others. Allowing them to offer you kindness brings them a type of joy.

Sometimes the most sincere act of kindness is to simply say “thank you”.

5) Inchstone. If I use the term “milestone” pretty much everyone would know what I was talking about. A milestone is a major move along  some continuum, usually one that is well-established and understood by most of those who would witness it. They are usually pretty large changes. Decisively different from a most recent baseline. Crawl to walk. Solo flight. The first time you sign a medical order and no one looks over your shoulder and makes it official with a  co-signature. Your first house. Milestones, all.

There are other times when progress is slow, sometimes painfully so. Still, anymovement  forward is an achievement and probably needs to be acknowledged, too. What to call these smaller moves along the continuum that deserve to be noted? I’d like to propose “inchstones”. It’s a bit cutesy, I admit, but you have to agree that it kinda fits the bill. Maybe someone or something just isn’t on the same timeline that we would all agree was normal or typical. What we would consider a barely perceptible advance might have taken the effort and had the same effect as achieving a more common milestone. Cheer the inchstone! Really complex problems of massive scope often move in great leaps and bounds until they approach completion. Here, so close to success, progress slows to a crawl. Celebrating each inchstone that moves you closer to the finish line in the same way you cheered those earlier big jumps might be what it takes to propel you to the finish line.

Be ever kind when you encounter what looks to you like an inchstone being celebrated. What might look like an inchstone to one of us may very well be a milestone as monumental as scaling Everest to another. Achieving them may be what it takes to keep hope alive.

I’ll see you next week…

The Other Side of the Stethoscope: Sunday musings…3/31/19

A physician is no more or less human than any other person.

It’s comical to watch the reactions when a doctor calls in sick for whatever reason. A lovely minority of patients rally to the side of the physician, offering words of caring and affection. Of course that means that the majority of others who share a particular doctor’s professional orbit exhibit some degree of displeasure, at least on first blush. Annoyance at the inconvenience of one fewer hand on deck from the co-workers all the way to personal affront on the part of some patients. It’s an extension, at least in part, of the well-known (to healthcare workers) phenomenon whereby patients and non-provider workers such as insurance operatives and various managerial types feel permissioned to treat medical staff members of all levels as if they were some sort of lesser version of the species.

The stuff people say to a medical receptionist laboring under the added challenge of being short-staffed due to illness would be considered hate speech if directed at the cashier at a 7-Eleven.

With this in mind I’ve been trying to observe and feel every bit of my experience now that I find myself on the other end of the stethoscope. As I’ve gotten older I’ve had all manner of run-ins with the world of medicine as a patient. Most of them have admittedly been pretty short trips over which I’ve been able to exert quite a bit of control as a physician myself. Even my carpal tunnel surgeries in 2003, potentially career-threatening for a micro-surgeon, didn’t really seem like all that big of a deal. Maybe it was my relative youth (43) at the time. I don’t know.

A couple of years ago I had a triple hernia procedure performed by a hot-shot 30-something general surgeon who could have been my time-traveling surgical soul twin. Literally every step of the way was choreographed by the docs and nurses in such a way that I was barely even inconvenienced. I was escorted to a private area pre-op where I was visited by pretty much everyone I knew as if we’d just happened upon each other at a restaurant. Back at work after a long-weekend off. In all honesty the only time I felt like a patient was when I woke up to some incisional pain.

Perhaps that’s why my upcoming hip replacement seems so different. I’m older, and unlike both my carpal tunnel surgeries and hernia repairs, a hip that’s worn out from a lifetime of use can’t be shrugged off as genetic misfortune like you can do with, say, a family history of weak pelvic floors. Nope, for whatever reason this particular medical adventure is the first time I’ve really felt like a regular patient. This is as close as I’ve ever come to being just another person putting on one of those ridiculous gowns that hang open in back.

My age-worn old man’s flat ass looks just like anyone else’s in one of those stupid gowns.

Because I am the only surgeon in my eye group choosing the date of my surgery was a pretty big deal. I’ll be out of the OR for about a month. The date made the best sense for us as a group and I made sure to vet it with my orthopedic surgeon, a personal friend. Our entire year’s schedule for all 4 doctors was now tied to April 8, 2019. My first clue that I was now more or less a regular patient came a couple of weeks ago when the surgeon’s office called to let me know that he’d changed his schedule and would be out of town during the week of my surgery. My first reaction went something like “NO NO NO! It’s GOTTA be THAT day”, among other (non-profane) strong statements about why.

But I’ve done that a ton of times over the course of my career. Changed an OR day or week that is. My friend would never have done that if he’d remembered that he and I had chosen that particular day, and just like me it never occurred to him to check his records to see who might be on the schedule that morning. I can’t ever remember doing that when I’ve made a change in my schedule; why would anyone else do that just because it’s my date? Is there really any difference between the effect of a schedule change for surgery between a doctor and anyone else? Of course not. Such a change, for whatever reason, is hard on a patient and everyone around him who will be affected by his need for care and his hiatus from whatever it is he will not be doing because of the surgery.

But my doc is human, too. He needs a bit of a break and saw a window of opportunity. Trust me, once I got over the shock of the potential upheaval in my own schedule I totally understood what had happened and what was going on. In my case a little bit of creative manipulation of the calendar will make everything turn out as it should. My surgery will go off as planned and my surgeon will jet off to care for his own well-being as he should. My lesson is two-fold. First, I am a patient and as such I won’t control the process. Second, all of the efforts that my colleagues and I have made to improve how being one of my patients feels are more than worth the time and expense we have dedicated to them.

Little stuff is interesting. Although I’m pretty healthy for a middle-aged guy I still had to go to the hospital for Pre-Admission Testing or PAT. Everything could have been handled by mail or on line, with a quick trip to the lab to have some blood drawn. The likelihood that anything would be uncovered that would derail the surgery is really, really small, but one must always remember the two-pronged priority of hospitals in the U.S.: mitigate any risk possible, and maximize the payday. A hospital gets paid for PAT and makes a profit on it. So there I was on a Thursday morning meeting a series of quite lovely people, all of whom could not have been nicer or more efficient. In and out in an hour, much to my surprise and delight.

So where am I now? A week out from surgery with standard issue instructions on how to clean my buttox before reporting to the OR at 0Dark30 and a promise of meeting the PT wizards who will visit my home and shepherd me back to functionality. There are still some questions floating around, but I’m kinda reluctant to call my buddy, or even his staff, to ask. I have this little nagging feeling that a lot of folks probably have similar questions (for example, can I poop before surgery that occurs so close to my pooper?), and I know that because I’m a doctor all I have to do is pick up the phone. Still, it seems like if I did I’d be invoking a kind of privilege that any other patient might not have.

Then again, maybe not. It’s Sunday and I just got off the phone with a patient of mine who’s had a concern for 4 or 5 days. They “hated to bother me at home on Sunday” but knew that there’d be nothing between me and them but a good story told to the answering service. While this kind of thing doesn’t happen to a lawyer, accountant or stockbroker, it does definitely happen in healthcare. No, I won’t be calling my surgeon to ask him my silly questions, and I won’t be calling anyone at all on a Sunday to ask them, either. But I’ll for sure ask someone sometime this week, because that’s what I’d want one of my patients to do, and I want to be a good patient.

As I spend a week being mostly a doctor in preparation for a few weeks as mostly a patient I’d very much like to thank my surgeon, his staff, and the folks at the hospital for making my journey to the other side of the stethoscope a pleasant ride. A thank you as well to all of my patients who have wished me well, and to my own staff for not telling me any stories about those folks who forgot that their eye surgeon is gonna have to be human, too, for a little bit.

I’ll see you next week…

 

 

Unsought Solitude: Sunday musings…3/17/19

1) Irish. Happy St. Patrick’s Day to all, Irish or otherwise. Legends abound about Patrick of Ireland. Was he a monk as told by the Church? A heathen who did so much good that he was beatified regardless? A scholar who was in the vanguard of scholars who escaped the Dark Ages and “saved civilization” by decamping to Ireland?

Who cares? Slainte.

2) Gueridon. The little table upon which rests a basket, candle, and decanter to be used when decanting older (usually red) wines. Confession: I do not own one, nor do I own a random wine bottle basket or candle holder for decanting.

Who cares? Slainte.

3) Luddite. A young author was quoted in yesterday’s WSJ as preferring to read and write on various electronic utensils. No biggie, really, until she tossed shade at those of us who prefer pen, paper, and the various reading materials that come in the form of ink on stock of some sort. Something about not “offending luddites” by her comments. Does my preference for holding a newspaper or turning the pages of a real, live book when consuming the written word make me a luddite? At the moment I am typing on a ludicrously powerful laptop and bemoaning the fact that the best voice recognition software is not supported on my digital platform of choice. Two days ago I did laser surgery utilizing a couple million $$ worth of ridiculously complex software and hardware. Can you be a luddite if your daily existence is intertwined with tech that is just a tiny bit shy of quantum computing?

Who cares? Slainte.

4) Sears. Yesterday’s WSJ also included a lengthy treatise on the demise of the once dominant Sears company and brand. If you are of a certain age Sears was as important to your family’s commercial life as any bit of the internet is today. The Christmas Catalog was informally known far and wide as the “Wish Book”; as a kid you looked at the catalog and dropped hints (along with turned down pages) as the Holidays approached. Without knowing so, Sears was the Amazon of its day. Every small town had a little storefront Sears on main street long before the advent of the strip mall mega-store. You ordered your merchandise by phone and picked up up at the delivery store. Pretty much anything other than groceries could be bought that way, including your house.

So what happened to Sears? The catalog was shut down in 1994, right when the internet was getting its start. All it would have taken was a single visionary to see that moving the catalog online would have protected the singular power of Sears to define what it meant to be a department store in the internet age. Instead Sears remained mired in the old-school business model of bricks and mortar behemoths, merging and cleaving along various entity lines with a plethora of like-minded companies that will in all likelihood share its fate. Kmart, Ames, and others are but a memory. How long before they are joined by the likes of Khol’s and J.C. Penney?

All for the want of a single visionary in a company that employed hundreds of thousands of people. It makes one wonder about other bricks and mortar businesses. At least it makes me wonder. What of education, specifically college education? Will we have all of these colleges and their campuses in the future? Do we need all of those administrators whose ranks have swelled in response to a government regulating the physical space occupied by 18-22 year olds? Who knows. What of healthcare? Having just had a totally new way of delivering eye care shot down by an organization whose administrators could not see past their new bed towers, could not see past how the bricks and mortar paid their salaries, I wonder how long it will be before an internal visionary makes a move. Health care is the biggest rent seeking economic sector in the U.S. (with education not too far behind), one in which lobbying the government to maintain the status quo appears to be the most important job of senior administrators. Will this save healthcare from a Sears-like fall, or are we just one visionary away?

Slainte, indeed.

5) Solitude. Beth has been away this week tending to her filly on the winter show circuit and fitting in a bonus visit with “Lovely Daughter”. While she is away I have been mostly at work or traveling for work, and thus have been surrounded by other people for the bulk of my mid-week waking hours. Indeed, weekdays are easier on my soul because the alone hours can be shortened by simply going to bed early and sleeping them away. No, it’s the time off, the weekend time that I otherwise so cherish that is hard. Beth knows this, and so these trips are fewer and further between than they should be; she enjoys her barn and horse time immensely. Even typing these words makes me feel a bit guilty.

There is an “uncle” in the Hurst family, one of those people who has been around the family in a lovely and loving way for decades and is such a part of the scene that all of the grandchildren were astonished to discover some years ago that he is not a “real” uncle at all. Jay is an artist, a sculptor, and by necessity his has been a life of mostly solitude when he was working. This always seemed a bit odd to me because Jay was always such a full participant in all of the family dialogue at holidays and the like. How could it be that such a social creature spent so much time alone while creating? As much as I enjoy writing I couldn’t imagine hours upon days sitting alone at a keyboard. Indeed, my favorite writing times are when I am cocooned in a corner surrounded by the activities occurring just outside my sight. I know they are there if I need to jump in for a fix.

Jay has retired with his wife to a thriving community of like-staged folks and is thriving in the bustle of a little micro-society. His is a tale to sow optimism in the face of the lonely later life of another of Beth’s (real) uncles, also an artist, whose illness drove a wedge between him and most everyone else. Much, much later in life the solitude that he sought and which sought him began to ebb. His presence at family gatherings both sad and gay brought enjoyment to all of us, himself included. Both men lived decades in which they spent the majority of their hours alone. There is a significant difference however, and it is the difference that makes my little sojourn in solitude bearable: Jay emerged from solitude at the end of the work day into the embrace of a loving wife with whom he shared his evenings and weekends.

He wasn’t truly alone, he only worked alone.

Beth’s uncle, The King, passed away this week. He suffered a catastrophic stroke a few months after losing his sister, my mother-in-law, and gaining a daughter-in-law. While still more alone than not he was nonetheless close to two grandchildren, and seemed to be moving closer to his children and their varying degrees of happiness. There had been a rapprochement with his brother, words of kindness expressed between the two older men after decades of estrangement. The King had lived a mostly solitary life for years. Unlike Jay (and me) he seemed to be lonely for many of those years. How wonderful that he was able to shrug off at least some of that cloak in his last months, to replace it with the embrace of children, grandchildren, nephews and nieces.

I am lonely this weekend and I confess that it is a selfish loneliness because I know that it will be short lived. Beth will return tonight. My Man Cub and his sister The Nugget might be healthy enough for me to drop by, or their little family might swing by for a sunny dip in the hot tub. There will be corned beef and cabbage tomorrow night at dinner for us all regardless. Solitude for me is partly the side effect of obligation (I have a job) and partly choice (the kids were sick and I stayed home).  Jay and The King teach us the lessons that there is a difference between being alone and being lonely. One can be alone if one has love to look forward to when the solitary hours have passed.

Long live The King. Slainte.

I’ll see you next week…

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