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Sunday musings 11/11/18

Sunday musings…

1) Veteran. “War is God’s way of teaching Americans geography.” –Ambrose Bierce

Happy Veteran’s Day to all who have served. I sit in safety because of your service, wherever it may have been.

2)  Riposte. To reply, as in fencing, to an advance. “L’esprit d’escalier”: the unfortunate tendency to think too late of the perfect verbal riposte to an affront or attack.

Likely more the rule than the exception I’d say.

3) Risk. None other than Michael Joyner of Mayo Clinic fame is now calling for the inclusion of “fitness testing” as a distinct variable when assessing health risk in adults. Of course he is talking about aerobic, “cardiovascular” fitness only, having chosen as his metric some form of VO2 Max. It is entirely possible that he and other adherents to the tenet that fitness is completely described by endurance in any domain that can be measured through a proxy like VO2 Max are correct. The absence of data, any data whatsoever, in support of the notion that physical decrepency is the actual cause of early mortality leaves scholars such as Dr. Joyner with no choice but to use endurance as the definition of fitness. When designing risk models they have no other options.

Some weeks ago I included a RFP of sorts here and elsewhere for a measurement of fitness that includes other factors such as strength. I specifically reached out to the CrossFit and functional fitness communities asking for a test or a measurement that could be used to apply a broader definition of fitness (e.g. work capacity across broad time and modal domains). Crickets.

You can’t out train bad nutrition. Fitness is going to be measured and included in cardiac/all-case mortality risk profiles. In order to be relevant in health, public health, and healthcare the functional fitness community (which is arguably led by CrossFit) must step up sooner rather than later and join the conversation in a meaningful and measurable way. As one with a foot in both sides of the conversation (who admits to his inability to conjure up the requested measure) it is my firm belief that it will be far better to engage in the welcome evolution of thought in the healthcare community than to hope to lead an insurrection.

All of the necessary elements are in place.

4) Loss.  Half-blind, deaf, and dumb as a rock, Beth’s little mutt lived one of the happiest lives I’ve ever been privileged to witness. Tiny Tim died this week in his beloved “Mom’s” arms just a few days after his 17th birthday. It was quite a run for our little “shitpoo” (shitzu, terrier, poodle). Timmy was named after the famous Dickens character when he arrived in our home looking like a Beanie Baby with a broken leg. His bond with Beth was cemented when she broke her leg falling off a horse and they convalesced together on the couch. Though he was a perfectly sized lap dog he would only allow Beth to hold him for any but the quickest moments.

Like when he would go out in the snow and forget to come in before his little toes froze and he was “stranded” in the yard. As I said, dumb as a rock.

We are in our 50′s, Beth and I. We are surrounded by death. Friends and acquaintances pass unexpectedly and tragically in the middle of life, or lose children to any manner of mishap or misfortune. Our fathers are gone, each the victim of a terrible and agonizingly slow demise that left them but shells of the men we’d grown up with. Along with our siblings we were a powerless audience, spectators with a front row seat to their suffering. Like Tiny Tim both men lived lives far, far beyond what could have been imagined in their childhood. Both men, when they had control of their faculties, could look back with a smile at the lives they’d lived. We miss them both terribly. In the missing it is the men in full we remember as time blurs the final chapters of their lives and we turn the pages to our favorite parts of their stories rather than the end.

Some losses are expected; they are simply a part of living. The death of my 91 year old former partner. Our little Manster Timmy. We sit in a kind of “pre-Shiva” as my mother-in-law dances her last dance hand-in-hand with daughters who have loved her as we loved our fathers. Our sadness stems from the knowledge that what remains will be only the memory of that love. The last bedtime story has been read. The last ball has been tossed. The last pre-dawn wake-up alarm has been barked.

The last goodbye kiss has been exchanged.

I miss my Dad and Beth’s Dad. I will miss Beth’s Mom. I miss my dog. How fortunate am I, are we, that we had them for so long, knew them so well, were so well loved by them and allowed to love them so well. I asked for and offered forgiveness for any hurts that may have been occurred. I have been openly thankful for all of the gifts that they have given me. In the end I am comforted in the knowledge that I told each of them how much I loved them.

How fortunate am I, are we, to have loved so long and so well that we are so deeply saddened at our loss. How fortunate are we all to have one another, still, here to love so deeply for however long we may be so blessed.

I’ll see you next week…

–bingo

 

Sunday musings 10/28/18

Sunday musings…

Old is as old does. Kinda Forrest Gumpian there, I know. Sadly, even a relatively minor injury or degenerative issue can turn even the fittest of individuals into an older version of themselves. So I’ve been learning after a tiny little jolt to my hip while doing a power clean that was just enough to make a heretofore unknown degree of degenerative arthritis become an every minute part of my life.

As they say, getting old ain’t for sissies.

While the discomfort is certainly noticeable for a significant amount of my day, it’s really what it keeps me from doing that brings on that oldish feeling. All of my usual fitness activities are curtailed. In no way am I attempting to be any type of super version of the middle-aged dud I am, but feeling as if I was physiologically 10 years younger was a really big part of who I’ve been for some 12 years. That’s slipping away as I find more and more stuff I need to avoid in the gym. For sure, modern medicine (sick care) is all over this, and I certainly have any number of friends and acquaintances who have already crossed this bridge.

Was it CrossFit that did in my hip? Nah. Some of my less fit colleagues are almost delighted to tell my about what their doctors and PT friends say about CF. But my buddy Dr. Bones pointed out all of the miles I ran in my 30′s, the pounding I took as a rather small guy playing a big guy’s game. Is there some kind of little injury from that power clean making stuff worse? Who knows. The X-rays show the effects of decades of heavy use on both sides.

That first step to a fix, though, is as daunting as the first time you walk through the front door to a new gym. No matter; having spent 12 years doing high intensity exercise that included a heavy dose of lifting heavy stuff, the guy who will put humpty dumpty back together is kind of excited to get to work. Why? Well that’s the lesson here this week: prepare for whatever tomorrow may bring. Your work in the gym makes you stronger, more resilient, and more able to bounce back from adversity of all type. In the end only my hips are old. At least at the moment. More work now while I figure out when I go into the repair shop should have me street-ready afterward that much faster.

The fountain of youth flows freely in the gym.

I’ll see you next week…

–bingo

Sunday musings 9/16/18

Sunday musings…

1) Sabbath. I read this week a proposal to reinstate the institution of the Sabbath, with or without religion, as a way to force at least one day each week without any work in the U.S.

This is an idea worth considering.

2) Bubble. Yesterday’s WSJ Magazine had something like 15 full page ads for really expensive wristwatches. Like, stupid expensive wristwatches. Says here that’s a sign of a bubble about to burst. If people have so much money they can be persuaded to buy a watch by a magazine ad then I’m saying the economy is overheated. Like the P/E ratio, the Wristwatch Index.

First offered on “Sunday musings”, 9/16/18.

3) Communication. My Mom needs a new cellphone. Her old one is apparently dying, and the service contract that covers the phone is so expensive that it borders on usury. Mom needs a new phone and this is turning out to be a rather fraught experience not only for her, but also for her 4 adult children and their spouses. As is the case with all things family, the “why” of this is complex because participating in the process of obtaining a new phone involves so much more than just the kind of financial and technical exercise that you, or your kids, go through when your iGalaxaPhone goes on the fritz.

Oh sure, the technical part is important here, too. Mom’s not all that good on using her 2003-level tech on a phone that doesn’t even “flip”. Think about your first cell phone and how it worked. Kinda like a “real” phone, wasn’t it? At least a real touchtone phone at least. You hit “ON” or “SEND”, tapped in a number on a standard 1-9+0 keypad, and waited for the phone on the other end to ring. If you were born before 1980 or so this was second nature. Texting was exotic and expensive, so most people didn’t do it. Interestingly, if you were born before 1950, it actually took a bit of doing to get used to having to hit “SEND” to make the call; your home phone just did the job after you dialed. My Mom has found this to be a problem. She is a phone caller and a talker, and still has 2 phones attached to a wall in her house  to supplement a “cordless” phone. How will she do with a password-locked screen, the swipes and touches of a state-of-the-art smartphone?

This brings up the first uncomfortable topic for her kids and their spouses: Mom is getting older. Make no mistake, Mom is still in full control of all of her faculties. She is whip smart and continues to be able to call into play everything she knows. Indeed, she is quite happy to share with all of us her thoughts on how what she knows squares with what we are all doing! But she will admit that she has changed as she has gotten older, and that some of those changes have made life a bit harder. She doesn’t really like to drive after dark or in the rain, for example, a couple of very common things that happen to everyone. Changes occurring around her over which she has little control make her more unhappy than they did when she was younger. Thank Heaven’s she is surrounded by so many wonderful folks who look after her! A few months ago her plumber figured out the software change to her TV cable remote so she didn’t have to, and got her all set up in time for Jeopardy.

As an aside, tech companies should be tasked with making all of their offerings geared to be usable by the LEAST technically savvy users in their markets. That would demonstrate real innovation.

Over my years musing on Sundays I have often thought about how people communicate. The differences in style between generations, and the changes that have occurred over my lifetime, for example. This is the hardest part for us in my generation as we tackle this issue for Mom; we must look through HER eyes, through the prism of HER needs and HER comfort as we seek to find the successor to her 15 year old cellphone. You see, we communicate much differently than Mom. When she wants to get in touch that means she wants to TALK to you. That’s right…old-fashioned verbal communication. This morning I have texted with Randy’s family  (pics of The Littles included!) and Beth (from an airplane!), emailed a colleague, Tweeted @ someone and answered a FB message. With all of that I am a comparative Luddite; I don’t Snap, Instagram, or WhatsApp. Mom dials up a call.

What my Mom needs is a phone. A telephone. What she wants is a phone that feels as close to a phone that is wired into the wall next to her fridge. She is emblematic of her generation; a phone call is in itself a compromise, because the person to whom she is speaking isn’t right there with her in the kitchen or on the couch. We want Mom to be available to us and we want her to feel that we are available to her, but what that means is terrifically different to each of us. I can’t tell you how many times I’ve wanted to just send her a quick text. It is at the same time the most loving, and yet the hardest thing to do for us to acknowledge our Mom is ready only for a new version of what for us is an old thing, a phone that can make phone calls.

There is nothing wrong with that.

In this day and age how we communicate with someone else is a sign of commonality, but it is also a sign of respect. I text Dan to make sure it’s OK to call for example. My daughters-in-law text me the photos and videos that they Snap to everyone else. My Mom wants to talk. When she has a problem or is in need of some help, being able to reach out and talk makes her more comfortable. My siblings and I so desperately want to believe that Mom is just like us, only now maybe just a little slower around the house. We want that to be more than we allow ourselves to think or say. Mom needs a phone to make phone calls. As hard as it is for us to be here and to think along these lines we need to show that we see her and love her as she is today. We need to help her get that phone.

We need to call her on it for as long as we have her here to call.

I’ll see you next week…

–bingo

 

 

 

Time Affluent

Time is the most valuable commodity. For each individual it is a finite item. Precisely 24 hours in each day, thank you very much, at least a couple of which you must spend sleeping. It has been called the ultimate luxury, spawning a new class of individuals for people to be jealous of: the time affluent.

It seems that there are two diametrically opposed camps when it comes to time. There are those who feel that the proper approach to the finite nature of time is efficiency; one must develop the ability to utilize each waking moment to its fullest, most productive limits. This group includes both multi-tasckers who try to do lots of things simultaneously, and power workers who have preternatural powers of concentration and just motor through one task after another. For the record, bosses love this kind of producer, right up until they crash that is.

On the other side of the coin is a group that cherishes the freedom that unassigned time provides. Time, that is, in which one can choose to be “productive” in a way that can be measured (e.g. practice bending notes on a harmonica) or not (play along to Wammer Jammer). Knowing the difference between the two is the first step toward this type of freedom. I have professional friends who simply can’t get enough of our particular medical specialty. They work all week, every week, and in their “free time” they attend conferences at which our specialties nuances and science are discussed and debated. Some of them are very serious about all of it. They have each day mapped out to the minute and race from one session to another. They are productive. Others approach it differently; they are exploring.

Each of us has that same 24 hours each day, and we all have some version of the same things that must be accomplished over the course of those hours. The aforementioned sleep, eat, earn a living…almost all of us have this going on. One can choose to “invest” in time, though. If someone else mows your lawn that frees you up to go to the gym, for example. Cooking, cleaning, shopping, stuff like that can be offloaded or batched so that extra aliquots of time are available for other stuff. This is what it means to be “time affluent”. There are choices that can be made, sacrifices in one area that gives you more time in another.

As is my wont I will offer an example from life Chez bingo. Many of my close professional friends spent last weekend in the mountains of Utah at a conference. All of the stuff that I like to do and all of the colleagues I like to hang out with were there. Me? Stayed home. The lake was flat and the Man Cub was available to hang out. Going to the conference would undoubtedly have brought me consulting and writing gigs, but I have more of those than I have minutes to spend with a water-loving 2yo. A really interesting business opportunity is circling my day job, looking for a place to land in my schedule. Frankly, it’s great business. But it will take time. Time that I have gotten accustomed to using in other ways.

While I have more freedom than most I am not “time affluent” enough to walk away from that joint venture; Monday morning will find me in meetings about how to make it fly. It’s actually interesting and intellectually engaging enough that I might have done the same thing even if I didn’t have such a compelling business prerogative involved. Still, the thought did cross my mind that maybe, in the end, I was actually better off letting it pass me by in favor of owning those minutes that will now be jointly owned by our venture.

Like money, no matter who much you have, someone always has more free time than you do.

 

 

Thoughts on the U.S. Health Crisis

We are looking at a true health crisis in the U.S. In 2015 some 40,000 Americans died from opiate overdoses. This is more than the number of deaths by firearms by a factor of 4, and is similar to the number of deaths in automobile accidents. I recently read a startling statistic: 7 million working age men are out of the employment market, and 1/2 of them take painkillers on a daily basis. Crazy, huh? Add to that the ever-expanding waistline of the average American and we have a kind of Double Jeopardy.

We can agree that there is a general crisis of health in the American populace stemming from over-consumption of calories (most of which are high glycemic index carbs) and under-consumption of physical activity. This week has brought several long discussions about the “failure” of American physicians to prescribe physical activity or exercise as a treatment for this. An equally startling story in this week’s news is the growing acceptance of excess body weight fat as some kind of new normal, a normal that should somehow be institutionalized. In this discussion one must add the overconsumption of alcohol, because countless studies have shown that this legal substance is responsible for all kinds of negative health effects, both direct and indirect. (As an aside, it does give one pause when one considers the possibility of legalizing another neuro-depressant, marijuana, the association with lower opiate abuse rates notwithstanding). As if this isn’t enough, we now must add to this toxic recipe the ingestion by any route of opiates.

The U.S. is regularly taken to task for its failure to sit at the top of the world’s life expectancy leader board despite spending the largest amount per capita on healthcare in the world. This criticism becomes more and more unreasonable as we dive further into what it is that actually drives statistics such as life expectancy. Deaths from overdoses are illustrative of the folly of conflating health and healthcare: there is nothing in the healthcare system of treatment that drives this statistic, and the death of these primarily young people has a disproportionate effect on the life expectancy statistic in which it is years lived that we are counting (and losing).

What, then, is to be done, especially in this setting here of health-conscious individuals? It behooves each of us to take a bit of personal responsibility in the discussion and pledge that we will utilize accurate nomenclature, and in turn demand that everyone else in the conversation do likewise. Health and healthcare are not synonyms. Likewise, healthcare and health insurance (itself somewhat of a misnomer) are not the same; one does not lose healthcare when one does not have health insurance, and for certain the ownership of a health insurance policy does not guarantee one access to healthcare. Indeed, because the outcome was inconvenient to the majority of entrenched healthcare interests, the landmark study of Oregon Medicaid recipients that showed no improvement in health outcomes in those with Medicaid compared with those without has been mostly ignored and purposely forgotten. We need to engage in this conversation, but do so with strict fidelity to meaningful terms.

From there we should lead in whatever way we can. Despite the pejoratives leveled at my physician colleagues and their exercise prescribing habits, this effort is not at all about the treatment of disease, at least not as far as we here are concerned, but rather one of Public Health. There are quite specific areas to be addressed if we wish to effect change. Each one must be subjected to a root cause analysis. Overconsumption of low-quality carbs is near and dear to anyone concerned about public health, and the battle against “Big Soda’s” influence has been engaged. Other influences such as agricultural subsidies should have a similar bright light shined in their direction. How is it that the dramatic reduction of drinking and driving has failed to render deaths from drunken driving a statistical anomaly? Perhaps someone can convince one of those know-better do-gooder billionaires globe-trotting in search of a trendy problem to throw money at to look a bit closer to home when they apply their famous intellect to new thinking about old problems.

As to the tragedy that is opiate overdose deaths, can we please have someone with no skin in the game be given no-risk access to any and all applicable data and just turn them loose? Some guy did a deep dive into the issue of scrubbing the internet of all vestiges of child pornography using a combination of massive computing power and an outsider’s view. Give someone like that the ability to examine the entire opiate ecosystem to uncover some of the hows and whys so that we can make some decisions of the whats of our response with more than just our typical SOP of some self-designated, conflict-of-interest-infected expert who declares that his/her solution should work because of what they are sure must be going on. This seems to be a new thing, opiate overdose deaths, and of the rather young, too. Prior opiate societal infestations surely share some aspects with our present crisis, but I don’t recall the opium dens in the days of the Crusades so routinely offing their customers.

Anything that can be measured can be analyzed. Anything that can be analyzed can be altered utilizing the results of that analysis. What is needed is the double-edged sword of courage to uncover an unpleasant truth, and strength to set aside all manner of short-term personal gain in favor of a long-term solution for societal benefit.

We ought not let 40,000 lives representing hundreds of thousands of years not lived to be lost in vain.

Offloading info/Work

Why do I write? Why do I sit down and use time that could otherwise be put to use in the gym, or in the office, or even just hanging with the Man Cub? As a long-standing lover of language I am always on the lookout for the best vocabulary to explain concepts I sometimes struggle with. Offloading is a term that is used in this case to describe what it is that humans do with information that they do not need to keep on hand in “useful memory” space.

This is what I do with ideas when my “wetware” memory is full.

This is hardly new. Indeed, the sturm und drang associated with the mega-trends in education, etc. associated with our massive information/recall apparatus that is the internet actually has its origin in the Greek era of Socrates and the transition from an oral tradition to one in which teachings were written. (HT to Frank Wilczek). Prominent adherents to the oral tradition such as Socrates and Simonides argued forcefully that the advent of the written transfer of information would weaken the mind and produce an inferior type of intelligence. In a fascinating and delicious ironic twist, all we know of either of these men we know because someone else wrote down what they recalled hearing.

In my day job we are still encased in a paradigm in which information is transferred from teacher to student and then tested to see if that information has been committed to memory. Imagine, with the explosion of data now available in the world of medicine we test (and test, and test…) both new doctors and established ones to see if they remember a certain percentage of facts, regardless of how often those facts come into play in the act of practicing medicine. The CrossFit analogy is to test a trainer on the precise moment that the obturator engages in the deadlift. One neither needs to know this to teach the deadlift, nor does one need to have memorized this in order to have it on hand in the gym. So, too, in medicine.

Please don’t get me wrong, I still enjoy knowing a bunch of stuff and being able to call up that stuff without needing to use my Google-Fu. The reality is that we have made a move from memory in written form to memory in digital form that is just as profound and disruptive as that from oral to written. We have only to remember where it is we have stored our memories, our books and our music and our musings.

And our passwords. We still need to remember our passwords.

Is There an Optimal Age?

Last week I got a bit sidetracked with the main focus of Sunday musings. Nuclear attacks will do that to a body. I’d run across an article on WSJ.com in which a fascinating hypothetical was proposed: If you could stop the aging process at a particular point in time, at what age would you do that? At what age do you feel that you are close enough to your physical peak that you are comfortable balancing that against your intellectual capacities and maturity? Great question, that.

My physical fitness has been slipping for at least several years. Despite this I remain generally stronger than I was at any time other than my years as a college football player. When did I peak? At what time was my overall physical fitness, when my capabilities across the 10 general characteristics of fitness at its highest level? Although I didn’t know it at the time I probably peaked somewhere in medical school. My buddies and I managed to cram in marathon hoops sessions, round robin squash fests, and an admittedly conflict of interest laden exploration of 1980′s aerobics classes (most of my friends were single) while we finished up school. I supplemented this with pretty standard issue weight training (Mrs. bingo like lifting, even back then). Make that peak age 25 or 26.

Believe it or not, from there the slow age and career inflicted decline began in earnest. Had it not been for that Men’s Journal article in December 2005 I’d likely be a typical 58 year old desk jockey, broken by my job and the various and sundry weekend warrior injuries I would have doubtless suffered. Ah, but this CrossFit thing not only saved me from that but also gave me another peak somewhere around age 48. To be truthful I’m back on the descent now, but at least summited another (slightly lower) peak before starting the slide.

How about the other half of the equation? The part where you have a certain amount of intelligence, experience, and maturity? Well, for sure I was whip smart at 26. Every doctor is simply brilliant on med school graduation day; we have no idea what we don’t know, and no idea how to actually be a doctor, but hey, we just crammed for 4 straight years and our brains are busting at the seems with, you know, smart stuff. You know where this part is going, of course. At 26 I’d yet to acquire the maturity and experience that is necessary to create what I’d like to call “actionable intellect”. Such a thing could also be called “judgment”, and in short the ingredients you add to the mix are mileage and the accumulated humility that one acquires “on the road”. Like every other 26 year old I was pretty sure I knew it all already, but we all know how much longer the story is at that point, don’t we.

So it must be age 48 then. Another physical peak achieved. lost of miles under my belt including the humility of a struggling business and the grounding effect of nearly losing a child. Must be 48, right? Well, to be quite honest, I would really love to return to age 48 in a physical sense. My 58 year old bones are more than weary, and I’ll admit right now that I’m slow-rolling writing this because I’m dreading the WOD that’s gonna happen right after I hit “comment”. A funny thing happened on the way to my “final answer” though: I realized that my non-physical growth over the last 10 years has been extraordinary.

It’s not that you have to forgo all of the wonderful things in life at your chosen “stop age”, but the proposal in the exercise is to choose an intersection where the combined peaks were some kind of best. The truth is that my non-physical fitness has continued to grow at a rate which is far, far greater than the rate at which my physical prowess has declined. I have learned, and become so much better at things like empathy, acceptance, caring and the like that there are times that I wonder how anyone ever put up with my younger version. 10 more years of loving and being loved by Mrs. bingo. Of learning how to continue to love other people in my life despite their (or my) faults.

And joy. Oh my, learning that there is joy to be had out there if you can spend just a moment and let it come to you. My little Man Cub has taught me that. At 48 I really had no idea just how much joy there could be. No, for me at least I don’t think I’ve hit that magical intersection of mental growth and physical decline at which I can say I’m at the optimal point. So it’s off to the gym for me so that I can stave off decrepitude just a little bit longer, to give myself a chance to enjoy whatever non-physical growth I have in me yet.

The Man Cub is bringing his family over to play later on and I’ve gotta be ready.

 

Full-Ass

“It’s better to full-ass one something than to half-ass a bunch of things.” Anonymous

At the moment I am living day seven of another week of on-call coverage for one of the largest hospitals in Ohio. When asked recently by colleagues why I still do hospital coverage I had to admit that I really didn’t have an answer. I don’t really have to do it, and yet it doesn’t really seem like it feels right not to. There’s a kind of “pay it forward” debt to the giants who came before me that still lingers, I suppose. That debt’s been paid, with a bundle of interest, many times over, and it may be time to close the ledger.

Why now? Well, it has very little to do with the work itself because that hasn’t really changed all that too very much over the years. No, it’s more about the work that’s NOT being done by others, work that they own and are responsible for and don’t do, that will ultimately drive me away from this part of my day job. It’s really no different than any other job or workplace anywhere. The lazy and the shiftless, the incompetent and the entitled all see it as just fine to kick the can downstream to whomever they can get away with kicking it to.

I’ll bet you just had a dozen images of this from your own life flash by, right?

Boy, there are a thousand reasons you will hear to explain and rationalize why they feel it’s perfectly reasonable to get you to do their work. After awhile it gets really old. The first thing you should do when you encounter this is to look within and make sure that YOU aren’t doing this anywhere to anyone else. Gotta make sure that your virtue is intact before you saddle up the high horse! Once you’ve ascertained that all is right and proper with your own work ethic you then have a bit of a choice to make: rock the boat or sail along. Sadly, though you know the consequences of the latter (you continue to do that slacker’s work), be prepared for the possibility of not being thanked for pointing out reality to bosses and co-workers. It’s entirely possible that you will be the one criticized. Totally fair, right?

In the end there is no best answer to this dilemma. All you can do is use the feelings generated in you by being on the receiving end of this work-shifting to make yourself a better worker, no matter who it is you do that work for. If you do, indeed, reach that point where you just can’t look at yourself in the mirror any more because the injustice is simply too much to accept, it’s OK to call it as you see it. That’s where I am today, and that’s what I’ll be doing this week. To be sure, all of that “pay it forward” I’ve done will get me an audience, though it may not mean I will be able to effect change. Other than workload, that is. As of tomorrow, in this tiny part of my day job, I will be doing the very best job I possibly can, as I always do, for each of my patients each time I see them.

What I won’t be doing is picking up the other half an ass that someone else missed before I full-ass my part of the job.

Contentment, Complacency, and My Fitness Tracker

Where does being content end and being complacent begin? As an older athlete this question is just dogging me. The parallel question might be where is the line between being content and capitulating? These are both, of course, extensions of some of my recent thoughts on balancing the effects of relatively high intensity workouts with the countervailing effects on recovery, plus or minus injury.

There might be a more scientific answer to these, at least in so far as fitness is concerned, and it would come from of all places the fitness tracker world. As it turns out my latest tracker(s) have the ability to measure the beat-to-beat variation in heart rate (HRV). This measurement is a proxy for autonomic nervous system activity. A lower HRV means autonomic stress. If correlated with the previous day’s workout that would argue for either a lower intensity session or rest.

Is HRV ready for prime time? Well, world class endurance athletes and many professional athletes in other sports certainly think so. How about for us, the regular folks hoping to improve our fitness and along with that our health? Dunno. I’m impressed and frankly a little depressed to find that my HRV responded so classically to what was for me an intense WOD yesterday. For this to work one must have the discipline to dial it back if your HRV is low on a particular day (be content with your work), but also the discipline to ramp it up when your HRV is high (fight complacency and go to work).

In a busy life it is likely the second part that will prove the more difficult.

Guidelines for Life

Sleep was late in coming. I stayed up texting with a West Coast friend and professional colleague, thinking and reminiscing about the 3 core guiding principles that helped me (and in many ways him) make it through our training and early professional careers. All 3 have stood the test of time, have continued to inform my best decisions both professional and personal, and over the 30 years now since I first said the out loud I’ve only needed to add one additional guideline.

“Knowledge is power.” One is at such a profound disadvantage if there is asymmetry in the amount of information they possess relative to those with whom they interact that at a certain point those not “in the know” cease to be independent entities. Without knowledge, awareness of the ground as Sun Tzu would say, you are at the mercy of another. You must depend upon their kindness for, well, almost everything.

“Perception is more important than reality.” The explanation of this, of course, is that perception is the reality of perceiver. While you could say that this is simply an extension of the first guideline–creating the perception is in some way controlling the knowledge–I would simply say that one need only look at the deeply held worldview of some of the U.S. voting public, their perception of what is real and what is important, to illustrate that perception comes from within. This is all the more so when dealing with “one issue” voters. Understanding this should inform your approach to any situation whatsoever. What does this individual perceive at this moment? That becomes the reality with which you will be dealing, your version notwithstanding.

“Evolution is better than revolution.” Funny to have initially stated something like that  on CrossFit.com, the home of a truly disruptive revolution in fitness, eh? Again, this CrossFit that I have so wholly embraced must be the example that renders this guideline moot. Here is where my conversation with Dave that night was so helpful, for Dave was (and still is) a man in a hurry to effect change for the better: evolution involves a conscious attempt to minimize unnecessary collateral damage. Sometimes that damage is directed at oneself, and thinking more along the lines of the “long game” is also sometimes a very reasonable approach to self-preservation. After all, the fire of revolution burns brighter the nearer it gets to the revolutionary. My friend Dave now seeks change in the cool contemplative glow somewhat removed from the fire, conscious always of the need to care for, and be careful for, the growing flock that surrounds him.

To these 3 I have added a line from the Tao te Ching: “The man who knows when enough is enough, will always have enough.” While this particular guideline has not been particularly helpful in my outward looking life, it has done more to aid in my inward looking experience than anything otherwise has (the exception being my 35 year quest to be a better husband). Those of us who live in the West are under a constant sensory barrage that demands that we submit to the need to acquire. More. More and more of everything. More because it’s, you know, more. To be honest, I gave this little more than lip service until I actually lost quite a bit of  stuff. Being reminded that almost all of it was something I wanted, rather than needed, allowed this guideline to bring an internal peace that was missing.

These 3 original guidelines have served me well lo these 30 years or so. Adding and committing to the fourth has brought me peace in the bargain. They may or not work for you; they may be nothing more than tinder to light the fire of your own guiding principles. Some day perhaps I’ll share the epiphanies of 9/11 and Heinlein that underly the tactical application of these 3 strategies, but there’s plenty to think about in these simple suggestions. “Knowledge is power.” “Perception is more important than reality.” “Evolution is better than revolution.” “Enough is enough.”

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