Random Thoughts from a Restless Mind

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Sunday musings 3/29/2020…

Sunday musings…

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

I’ll see you next week…



Love in the Time of Covid: Sunday musings…3/22/2020

Sunday musings…

1) Pace. None.

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

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

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

But you already knew that.

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

What I do is non-essential.

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

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

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

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

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

5) Dominoes. There was a video making its viral rounds on various social media places of a rather earnest-looking professor-like guy talking about the power of a tiny domino falling and hitting a bigger domino on its way to the ground. He starts the dominoes tumbling. The cascade of 15 ends with the fall of a domino weighing 100 lbs. and measuring >1 meter in height.

All from a domino so small he needs tweezers to place it.

The Professor ends the video with the observation that a 29 domino cascade would finish with the fall of a domino larger than the Empire State Building. Pretty vivid. As is so often the case on Sunday mornings I let the video rumble around between my ears for a bit. What I saw first was a vast space filled with thousands, nay millions of those tiny dominoes, falling down over and over again, never striking anything but the ground. Every now and again a tiny domino would fall against a massive domino, either bouncing or slowly sliding off, eventually finding its way to the ground either way.

It was discouraging to think about. It made me a little sad, to tell you the truth.

But as I thought about it a little more, spent a bit more time in my imaginary vastness filled with tiny dominoes perpetually falling, it occurred to me that in order to fall over and over again it was necessary for each of those tiny dominoes to somehow rise up to stand. More than that, each time one fell it moved a little bit. Sometimes further into the vacuum of the vastness, but sometimes closer to another tiny domino. Another domino falling.

Another domino that kept getting back up.

It’s probably trite–some would say I specialize in trite–but what stayed with me in the end was not the image of the massive domino falling at the end, but that of the tiny, delicate, fragile domino in the front of the line. The one that started the whole thing. What most of us ever see is the last couple of dominoes falling, the last tumblers settling into place. Who knows how many times that first, tiny domino fell and struck nothing but earth?

And got back up.

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

I’ll see you next week…

Revisiting Some Musings on Faith

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


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

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

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

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

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

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

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

Our Better Angels: Sunday musings…3/15/2020

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

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

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

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

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

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

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

I’ll see you next week…

A Very Special Child

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

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

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

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

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

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

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

Always harder.

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

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

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


Sunday musings…2/23/2020

Sunday musings…

1) Metrollectual. A city dwelling intellectual. Implies a coastal home address (i.e. not Cleveland). Likely the owner of at least 3 social media accounts. Highly in tune with the zeitgeist but woefully out of touch with the nitty gritty of everyday reality.

Should be a word.

2) Courtesy. “Punctuality is the courtesy of kings.” Louis XVIII. Paul Newman to Fay Vincent who was surprised to see Newman precisely at the time of their appointment

I like that. Reading interviews of celebrities of all sorts you always take note when the author tells you that the celeb showed up on time and prepared. Harrison Ford brought muffins to a Parade Magazine interview.

Makes me vaguely uncomfortable to think of how low the bar is for kings.

3) Miracle. 40 years ago this week. Do you remember where you were when a bunch of college kids took down the best professional hockey team in the world? I can. There was a bunch of us gathered in the little TV room at my Dorm, Tyler House at Williams College. It was pandemonium as you can imagine. I was 20, after all; those guys could have been my classmates.

Last night I watched “Miracle” for the umpteenth time, catching my breath at all of the same places and leaking tears at the end. How hard it must have been for Herb Brooks to cut kid number 21 on the roster. Don’t I remember that Brooks was the last kid cut from the 1960 team that also won the Gold Medal? Such powerful moments.

This particular showing of “Miracle” had a postscript in which Bob Costas interviewed Al Michaels, he of the famous “Do you believe in miracles? YES!” call in that game. Of all the games Michaels has called in his storied career he is clear that the U.S./USSR hockey game was the top memory. I actually know a guy who was in the booth, Pharoo, an acquaintance from Williams who was Michaels spotter for the game. Can you imagine? Not only being there, at the rink, but in the booth with Al Michaels and Ken Dryden?

The very best that sports has to offer. A miracle, indeed.

4) Sportsmanship. “It doesn’t matter whether you win or lose, it’s how you play the game.” Anonymous

How many times have you heard this phrase? Whether or not you are/were an athlete. When did you first hear it? Probably like me, super early in your life, maybe even before you picked up a ball or a racket or a whatever. Might have been playing “Go Fish” with my Mom for me, but for sure I first heard it as a 10 year old playing Biddy Basketball at our local YMCA. Respect the game. Play the right way. There are probably as many versions of that old saw as there are old coaches. I vividly remember being dressed down after a Biddy League game that we won because half the kids didn’t touch the ball enough. The right way.

A respect for the rules of any game is instilled in the young in almost every family and on almost every youth team. “Winners never cheat and cheaters never win.” Right? You wouldn’t use loaded dice to beat your grandmother at Monopoly, would you? Of course not. You learn about sportsmanship pretty early, too. About respecting your opponent. Being both a good winner and a good loser. Respect is bestowed upon both beginning at a very young age.

But as soon as you start to play to win, to really try to win, selecting and giving more playing time to the players in your sport who increase the likelihood of victory, you introduce the concept of gamesmanship, and with it the essential tension that exists between sportsmanship and gamesmanship. T-Ball and Dad Pitch baseball gives way to Little League where the score is kept and the standings are published. “Good swing!” from both sides of the field gives way to “Hey Batterbatter. Heeeey Batter. SWING!” Winning matters, and you do whatever you can do to the letter of the rules to win. The only thing wrong with taking advantage of a loophole in the rules is if someone figured it out before you did. This is partly why so many folks dislike Bill Belichek and the Patriots.

People despise Bill Belichek and the Patriots because they not only push the limits of the rules of the game but they also crossed the line. They cheated. They clearly worked under the philosophy that it’s only cheating if you get caught. This, of course, is the reason that the Houston Astros as an organization and the players on the Astros roster during the 2017 season face such universal reproach. At some point they crossed the line between gamesmanship and lawlessness and broke the rules. That they are seemingly without adequate remorse, that they mostly regret that they were caught, makes them that much less in the way of sportsmanship in the eyes of most, including their professional peers.

Did Vince Lombardi really mean it when he said “[w]inning isn’t everything, it’s the only thing”? Did he mean that winning by any means, even cheating? Heck if I know. Those Astros are learning that there is a price to pay for cheating. Did you really win that high school tennis match if you cheated on line calls whenever you needed a point? Do you deserve your title if you and your partner sent each other secret signals about what you had in your hand in a Bridge tournament? Whether or not you were caught, at the end of a day or a life you know you cheated.

As a kid I played sports at a mid-level. Medium size schools in high school and Division 3 in college. We wanted to win, for sure. It doesn’t matter whether you have 200 students or 2000, you still want to win. I never remember cheating at anything. I’m not sure I ever wanted to win anything more than a member-guest golf tournament I played in with my brother after the club pro insinuated that we would fudge our handicaps. We played angry, fire in every step over 3 days, but we played at our legit handicaps as the rules demand. Not only did we not break a single rule on the course we also putted out on each hole, sinking even 6″ putts so that there was no possible chance that we would be accused of bending, let alone breaking a rule.

Winning is important, but how you win in games is still more important.

The lesson to be learned from the MLB Astros fiasco (and the never-ending Patriots imbroglio) is that the rules matter. Gamesmanship is OK but only to a point. How you play still matters. Sportsmanship still matters. It is not necessary to like your opponent, not even a little bit. But one should respect an opponent who also plays within the rules and respects both the game and you. These are the things that my Dad, my Grandfather, and all of my best coaches taught from the beginning. What I told my kids when they began competing. These are the things we need to hear from MLB.

This is what I will tell my grandchildren if I am blessed to have the chance.

I’ll see you next week…

Apocalyptic Thinking: Wrong Again

It’s astonishing how negative young people’s worldview has become. Let’s say under 35 or so is young. If you chat with them about the world we live in today it’s the rare young one who can bring up more than one or two things positive to say. Get them talking about the future (not a terribly difficult task) and the only variability you are likely to encounter is how bad the apocalypse will be and perhaps when it will arrive. Doom and gloom abound. I really can’t remember any talk about the future with someone under 35, even those who are generally happy, in which they didn’t tumble into hopelessness and despair.

Breaking news: the apocalypse isn’t nigh.

How do I know this? Well, of course I have the distinct advantage of having lived 60 years. Some of them without too very much in the way of income, most of them in relative comfort, but none of them in anything that could be construed as hopeless or a state of despair. Even after my “genius moment” business plan succeeded only in reducing my salary by 80% and wiping out my retirement account in my 40′s, the worst case scenario never included an apocalyptic demise. Yet what I hear from young people at an age at which Beth and I spent our last nickel each pay period is just that: despair and hopelessness.

In our age of blaring headlines always in our face it is impossible to avoid hearing the braying of all types of doomsayers. What we hear is how much better it was before, well, before pretty much everything. And yet everything that has happened in the world basically adds up to a powerful and direct repudiation of all things apocalypse. Deep down I’ve known this, but I’ve been at a loss to describe why I know this in a way that would convince, or would comfort, the young who are so distressed by what they think they see in our world.

In my search for a narrative that would convincingly combat the braying of the apocalyptic prognosticators I recently came across an interview with a gentleman by the name of Laurence Siegel. Mr. Siegel has written a book titled “Fewer, Richer, Greener” in which he proclaims “We are on the verge of the greatest democratization of wealth and well-being that the world has ever known.” I’ll share some highlights from the WSJ interview (with Jason Zweig), but I’m sure that I will have much to share after I read the book itself.

Let’s start with capitalism, at the moment the hoariest villain around. Capitalism has been roundly criticized for creating a historically huge degree of income and wealth inequality. In truth inequality of at least this degree has been with us since humans came together in groups larger than families. While it is certainly the case that the richest among us are far, far richer than the poor and middle class it is also inarguable that it is capitalism that has raised up the majority of humanity from crushing poverty. In the past year alone more than half of the world’s population has now become middle-class or wealthier. The defining level of income for extreme poverty continues to rise, and despite that the percentage of the world’s population that can be so described has plummeted. Wealth inequality is real; it’s effect on the daily existence of typical Americans is infinitesimal.

And yet like climate change it is the sheer magnitude of the issue coupled with the absolute impossibility that any one individual can have any significant effect on changing either that seems to be causing the despair I witness. “Young people can’t afford to buy a home” seems to be all the more cause for despair if you truly believe that the world will be near the end before you can scrape together a down payment. But just like in the 50′s when everyone was building fall-out shelters and every grade school kid was taught what to do when the air raid siren went off, life doesn’t come to an end, it just continues to get inexorably better.

Are there huge things out there that really could derail civilization as we know it? Sure. But every one of them is as likely to do so as every one that has come before.What about the environment?  In every country that has come up from poverty the process has, indeed, resulted in a dirtier environment. We’ve certainly seen that in Western Europe and the U.S., and for sure you are seeing it in places like India and China. Siegel: “…as they continue to become wealthier, people start to be willing and able to sacrifice some of those gains to get a cleaner environment. As the world gets richer it will continue to get greener. Switzerland is probably the most environmentally clean country in the world, and it is one of the richest.” As time goes on newly richer countries will behave more like Switzerland.

What matters when in comes to income and wealth is not so much what someone else has, but what you have and what it allows you to do. Mike Bloomberg’s wealth is unimaginable to me; his wealth came from the creation of a business which has created several other layers of wealth, and below those layers still more of middle-class comfort and security. So, too, the wealth of people like Bill Gates. His company is arguably responsible for much of the ease in your life brought about by the modern use of the microprocessor. I don’t choose to communicate with my refrigerator with my cell phone, but thanks in part to stuff that started with Microsoft I could. Bill Gates income and wealth is meaningless to those who type into Word documents like I’m doing right now; wealth inequality between Gates and anyone else is meaningless. Because of the source of his wealth our lives are immeasurably better because we can.

Climate change, wealth inequality, and the other macro issues that cannot be fixed on an individual level have always been with us. It is the fact that one literally can do nothing to change them that seems to be the cause of the sense of hopelessness and despair we hear so much of. But these macro issues have yet to come anywhere near reversing centuries of human progress. Again, Siegel: “Apocalyptic thinking is a neural mistake based on our need to survive in a cruelly hostile environment that doesn’t exist anymore. Apocalyptic thinking has always been wrong, and it will continue to be wrong.”

The world is a beautiful place that actually may be getting more beautiful by the year. It is safe, and getting safer for almost everyone every year. Fewer and fewer people live in poverty, as more and more people achieve a middle-class life or better each year. While we as a species must always strive to continue doing those things that have brought us this far, our lives would be far, far happier and more enjoyable if we directed our attention toward those things close to us that we control. Do some recycling. Buy an electric car. Vote.

To my young (and not so young) friends out there please don’t despair. We’re gonna be ok. The world is still gonna be there when you finally scrape up that down payment, and you’re gonna find a house you’ll like. There’ll be air to breath and water to drink, and we’re neither going to burn up nor freeze. You may not drive the same car as Jamie Dimon but, you know, the way things are going none of us are going to have to drive ourselves after Elon Musk makes all of our cars autonomous so they drive themselves. You’re still going to arrive on time.

Life is good. Despite all headlines to the contrary the world isn’t coming to an end. It just keeps on getting better.

Sunday musings…2/9/2020

Sunday musings…

1) Pickle. As legend has it the name of a dog after which the relatively new game of Pickleball is named. About 1 in 4 courts in Florida are now lined and set up for this instead of tennis.

With apologies to my buddy Ralph the tennis pro, this looks like the next adventure for yours truly.

2) Season. As in “high season” and seasoning, the act of moving lock, stock, and barrel to someplace other than home during that place’s high season,.

Beth and I headed to the southwest coast of FL to see what the big deal is. Many of our friends and acquaintances have headed there over the years, primarily the west coast and particularly the area around Naples. It was pretty nice. Lots of varied choices for how you live. We were particularly taken with Sanibel Island and its low-key style.

Still, all in all, there is too much for us here in our little NE Ohio home, even in winter, to consider “seasoning” for weeks at a time anywhere, even during the teeth of our winter.

3) Decline. I wrote an essay some years ago about my Dad and how he had become physically smaller as he aged. He was so big, big in all ways both physical and metaphysical. You know, big like you were always safe in his shadow big. Remember? As he got older everything about him go so much smaller. Mom, too, but you always notice it more with your Dad, I think.

Do you remember that famous poem “To an Athlete Dying Young”? “Rage, rage against the dying of the light”. Visiting an area that is famous for its retirement communities and amenities is to visit a bit of your own future. It begins as you step off the plane and see 5 or 10 or 15 wheelchairs lined up in the jet way awaiting their passengers as they deplane. Restaurants and shops are all “accessible”. Decline is on display. Beth: “It’s as if you can see your future.”

Ah, indeed. But which version of the future is yours? We saw some folks who had aged very quickly. Again, Beth: “It’s almost embarrassing, like we are intruding just looking at their decline. Like we’re invading our own space, they’re so close to our age.” Yet there are others like our hosts Beth and Steve and my close friend from high school Tom who push back against age and infirmity. They meet each aging milestone or setback not with quiet resignation but with firm resolve. Perhaps not “raging” but rebelling. Not today, not this year, not yet.

Those who seem to do that best, push back at the inexorable pulls of time and gravity, seem to do so not so much from plotting and planning as they do from a kind of purposeful daily pattern. A bit of movement, whether it be what one could call exercise or not, but enough to battle both gravity and gravy. Something that makes the neurons move a bit, too (I learned how to play American Mah Jong), enough to fight off the pull of the familiar. The folks we watched who seemed to stay the youngest did both in a way that seemed altogether natural. Less rage and more routine. A routine of physical and mental movement.

One need not “season” to adopt the lessons of those who season well.

4) Mature. “I love the way you two talk to each other.” Our friend as Beth and I worked through the complexities of a little family crisis.

When you think of love what almost always comes to mind first is that fiery, fierce love in the beginning of the affair. I don’t have to describe what that is, right? After all, this is a PG blog and my Mom reads it, too. Any movie about love seems to be mostly concerned with that early stage, no matter what age the characters may be at the time. Some folks never get past that stage, always and ever chasing the next endorphin rush in the barrel at the expense of the tranquility and beauty that lies just behind the breaking wave.

It’s a shame, really. There is so much beauty in the quiet, tender acts of a love that has been years in the making. The quick squeeze of a hand as your loved one walks by. A tiny, knowing smile you share when you both have the same exact thought at the same time and you just know that he was going to be in the same exact mind space you were right then. You communicate with a gentle honesty that allows for complete understanding. Your happiness is magnified if she is happier.

Love over time seems to be about space. Sharing enough space so that there is no room for loneliness, and yet leaving enough space for each of you to continue growing. It’s a cliche, often a hilarious cliche, the couple who find themselves struggling when one retires and takes up too much of the other’s space. No room to grow if your recently retired husband Velcro’s himself to your hip. On the other side Beth and I saw the sorrow in the solitude of friends who are alone, no matter how it is that they’ve come to that place. All the more poignant when you saw that loneliness in a crowd. To a person each says it’s not the fire or passion they miss but the shared passage leading to those quiet, tender acts of a love that’s grown over time. Riding the waves. Flowing with the tides. A love that’s growing, still.

As we age, growing smaller by the day, it’s that quiet love shared over a lifetime that pushes back against the decline. The love that lives on in the eddies behind the surf. A love that continues to grow. One that will carry us home.

I’ll see you next week…




Sunday musings…2/2/2020

Sunday musing…

1) Palindrome. 02022020. Apparently the first time in 900+ years.

Just thought you should know that.

2) Unwind. Pretty sure this is a synonym for fart.

If not it certainly should be.

3) Super Bowl. Pretty sure it’s today. Right?

Admit it, you’re just like everyone else…it’s really all about the commercials. You don’t GAS about who wins.

4) Lanai. At the moment I am sitting next to Beth x 2, a gentle sea breeze kinda sliding over me as we gaze out over the Gulf in southwest Florida. Frankly we’ve never really gotten the whole “head to Florida” thing. Seems like half of our age group just up and emigrated to the Naples area around January 2nd each year. Since we are not in Mexico (long, boring, self-indulgent story I won’t bore you with) this seemed like the  perfect time to accept Beth and Steve’s invitation to come hang out.

Super glad we did.

After a walk to the oldest continually active lighthouse in America we are slowly sliding toward a leisurely lunch as we prepare to watch commercials. Sanibel Island may also have one of the oldest bike trails in America, our next activity. Seems you can pedal pretty much anywhere here. So it’s off to the farmer’s market just because.

Is this how it is behind the scenes of all those fancy travel posters advertising the island life? I doubt we will ever know for sure. But at least for the moment it’s terrific fun to pretend that we are retired pirates, putting up our feet on tables made of wood from reclaimed shipwrecks, now only doing battle with various sea birds over the day’s catch. The best writing seems to come from some sort of hardship or misfortune.

I’m gonna write anyway. Given the circumstances I’m just gonna have to be ok with a mediocre “musings…” today.

5) Retirement. It’s interesting how often people ask me if I’m going to be retiring soon. Especially those who are aware that I just turned 60, but even patients who’ve just been in my care for a long time (usually right after remarking  on how young I look) are wondering. Lots of docs my age really are starting to bail. Heck, some of my buddies from college are already on their second stab at retiring. The topic comes up so often that I have to admit that it’s made me give it some thought.

What is it that makes some folks rush into retirement/out of the workforce, while others seem to be inexhaustible? What it is that one does for work doesn’t seem to be a factor. We all know doctors who have retired seemingly right after they finish training as well as those of all kinds who are still going strong at 70. Why are guys like Carl Icahn still in the game, striking fear in execs decades younger when they learn that they are in Carl’s bullseye? Ross Perot, or the guy who was forced out at AIG at age 90 or whatever, Sumner Redstone and all the rest. What drives these people to not only work but to work as hard as they did when they were in the process of “making it”? As I sit here with my Better 95% and our friends watching the neighborhood osprey “make” lunch I can’t help but wonder what’s missing from their lives that they don’t perceive the value in my present circumstances. Where are they finding joy?

On the other side of the ledger are people who make just enough, however much that may be for them, and walk away. The hedge fund guy who makes a killing and hangs it up at 30 or 40. Your sister’s best friend who has that one killer idea, turns it into a business, and then sells it all so that she can send the jet to pick up your sister for lunch. This weekend, heck right this minute on the lanai looking at the Gulf, it’s a little easier for me to understand these folks, the ones who literally don’t need to work in order to have what they need and do what they want. Still, I have this little bit of unease kinda gnawing at the back of my brain: what are they really doing all day. Where are they finding purpose?

As I work through this I can’t help coming back around to Lovely Daughter and the concept of “Harmony”. After all, life after we leave the workforce, or while we are leaving the workforce, is still, you know, life. There’s no real balance involved; the false construct of discrete entities put on and taken off the sides of the proverbial scale is as false later in life as it is in the teeth of your working life. Moving in and out of what we can think of as our “working lives” is in need of Harmony as much as any other stage of our lives.

So what’s the answer? Am I going to be retiring soon, as so many people seem to wonder? Well, my little taste of “retirement” as I recovered from my hip surgery in April leads me to believe that my life is much fuller, all my pieces parts in a much better state of Harmony, when I have as much unstructured times of greater leisure as I do times that are tightly structured and outcome directed. There was not enough work and too much free time on my calendar. Both seem to bring me joy, and neither on its own seems to be enough to fill me up. Harmony, for the moment, requires both. Pleasure and purpose.

Speaking of which, I’m about to hop on a bike along with”The Beths” for a little ride. We’re off to see some sights, sample some ice cream from an ancient island standby, and pick up some fresh vegetables at the Farmer’s Market for our Super Bowl dinner. More pleasure than purpose to be truthful, but likely to be a joyful experience nonetheless. Go whoever! Beat the other guy!

Enjoy the commercials.

I’ll see you next week…

Thoughts on Inequality

“Life’s not fair.” –Scar

What does equality mean? What does it mean to be equal? This came up this week 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 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.

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 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. 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. 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.

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