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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.”

Musings on “Exercise as Medicine”

The “exercise is medicine” movement is kind of a confusing thing. On the one hand we in CrossFit are the uber example of how exercise as an independent variable can enhance health. On the other we have the “Big Sugar” industry funding research and promoting the notion that exercise is all that you need, that there is no effect of nutrition on health. Train your way out of any kind of diet, if you will. This has led to the toxic effect of “BS” industry money supporting academic research that is in effect little more than marketing for their products. (Visit TheRussells.CrossFit.com for details). Indeed, the soda industry in particular has come in for some very pointed criticism which includes being accused of acting like the tobacco industry ( https://blogs.scientificamerican.com/food-matters/if-soda-companies-don-t-want-to-be-treated-like-tobacco-companies-they-need-to-stop-acting-like-them/ ). Pretty harsh, but probably deserved.

Here’s the rub: exercise really is a medicine equivalent for a very large number of medical problems. Heck, if it were only to work for cardiovascular health and Type 2 diabetes it would be considered, or should be considered, a miracle treatment. Not only that, but exercise very well might work independently of diet. While exercise should not be used as an excuse to consume a poor, dangerous diet, you may actually be able to at least partly out-train a poor diet to at least some degree.

In 2009 a study was published in the International Journal of Epidemiology (http://m.ije.oxfordjournals.org/content/39/1/197.full) examining the effect of aerobic exercise on longevity (hat tip to Michael Joyner, MD at Mayo). Mind you, the study was enrolled prior to the creation of the CrossFit fitness program (completed in 2003), so the definition of fitness (aerobic health) will be viewed as incomplete by CrossFitters since it includes only aerobic fitness. In addition, what is defined as an unhealthy diet would only partially pass muster here; we would agree that simple carbohydrates (sugars) are unhealthy, but there is a plethora of more recent data that strongly suggests that red meat and healthy fat do not render a diet worrisome in the least.

A careful reading of the study revealed a couple of nuggets that should not surprise even a little bit. Eating the unhealthiest diet was associated with a 40% increase in all-cause mortality in comparison with the healthiest diet. Those who ate that worst diet and reported that they did moderate or greater levels of exercise had a 13.5% decrease in mortality. That group of bad eaters who exercised and were proven on a modified cardiac stress test to actually have greater aerobic fitness levels had a 55% decrease in mortality. Let that sink in for a minute: people who ate a shitty diet who exercised to the degree that they were fit by the testing criteria in the study were half as likely to die in any period than those who were unfit.

Boom.

Frankly, I don’t care who funded this study. Eating a shitty diet that is high in sugar increases your risk of death by 40%. Proof. Exercise that produces improved fitness, even fitness that I would view as partial or incomplete, reduces all-cause mortality in people who eat a diet high in sugar by more than half. Proof. Yeah, sure, I get that this could be used to justify or excuse eating that way, but the reality has always been that most people don’t exercise at all. Nada. Bupkis. Those who do certainly don’t achieve much in the way of any kind of fitness because they don’t exercise effectively—saying you exercise only got you a 15% decrease in mortality, after all. These results only apply if you get fitness results, and let’s face it, working hard at exercise is not the default setting in the developed world. By comparison eating better is a breeze.

Studies such as this one are mint, man. Especially to people like me, people who follow the CrossFit Rx and other programs that ask you to work hard. It’s exercise AND nutrition. Says so in the study. Sure, we can pick at this one if we want, like I did above, but my bid is that we use studies such as this one as talking points to prove that our worldview is the gold standard by which all public health initiatives ought to be compared. We can turn the cynical “exercise is medicine” campaign of “BS” on its head and use their own data against them. Eat like a CrossFitter (protein, nuts and seeds, little starch, no sugar). Exercise like a CrossFitter (functional movements performed at relatively high intensity). Seek ever-higher levels of fitness (work capacity across broad time and modal domains) like we do.

“Exercise is medicine” is just fine as long as we continue to call BS on “BS”. Health requires both exercise AND nutrition. People who are fit, especially physicians, are just the right people to tell that story.

 

Transference from the Gym to the Street

What have you done, or what are you doing, to make yourself better? Not just in the gym, not just more fit, but in general.

We talk about the transference of the stress response from the WOD to life, how our willingness to put ourselves under significant physical duress teaches us that we can, indeed, perform at times of stress. This really happens; your neuro-endocrine stress response really does require a bigger stimulus to fire in that way that makes you “freeze up” after you’ve been dosed with the CrossFit prescription.

There is more to be learned in the Box or wherever you do your own version of CrossFit, of course. We learn to look at people differently once we’ve done CrossFit side-by-side, or once we’ve shared our results on CrossFit.com. It becomes less “what do you look like?” and “what did you say?” but more “what did you do?” and “how did you do it?”. This trait has gone with me out of the gym, been transferred to the larger and more inclusive domains of my non-CrossFit worlds. In general, I’m more interested in what folks do and how they’ve done it.

Every day, in countless CrossFit Affiliates, commercial gyms, and garages, folks who do CrossFit are engaged in the active pursuit of “better.” A thinner band, a first Pull-up, a kip, a butterfly…an endless pursuit of ‘better’ at what we do in our pursuit of fitness. This, too, should transfer, eh? We should be ever on a quest to be a little bit better in everything we do.

There is a willingness to try new things in CrossFit, often things that are at first glance simply unimaginable. “You want me to do WHAT with that Kettlebell?!” It’s a kind of knowing fearlessness, a faith in self and a belief in self that comes from choosing to enter that dark place where we know it will be hard, but we’ve learned it will be worth it. This openness to trying new things, to learn new stuff in the pursuit of a generally better you should transfer outside the gym, too.

The concept of transference from gym to life is one more of those things which was discovered after the fact of CrossFit. In my day job I deal with neuroplasticity, the re-wiring of the adult brain in response to purposeful stimuli. Al!ison Be!ger’s work shows us that our pre-wiring for connection in response to shared experience explains the CrossFit community. My experience with neural training to enhance vision explains in part the transference of the stress response.

Our willingness to try new things, to learn new things in the pursuit of greater fitness, can also become ingrained. Wired. It can become just one more example of transference. “Constantly learn” need not apply only to “new sports”, nor does “and play” necessarily have to apply only to “new sports”. I’ve found not only an increase in my curiosity about things far removed from my knowns and knowables, but also a willingness to brave what it takes to learn and play new ones in the pursuit of some better version of me.

So, what are you doing outside the gym today to apply what you have learned there in the pursuit of a better ‘you’ everywhere tomorrow?

Alive Without a Life

Billy Ray (not his real name, of course) turned off his implantable defibrillator (ICD) yesterday. Billy Ray is 44.

In my day job I was asked to evaluate him for a problem in my specialty. I was told he was about to enter hospice care and assumed that he was much, much older and simply out of options. I admit that I was somewhat put out by the request, it being Saturday and the problem already well-controlled. Frankly, I thought it was a waste of my time, Billy Ray’s time, and whoever might read my report’s time, not to mention the unnecessary costs. I had a very pleasant visit with Billy Ray, reassured him that the problem for which I was called was resolving nicely, and left the room to write my report.

44 years old though. What was his fatal illness? What was sending him off to Hospice care? I bumped into his medical doc and couldn’t resist asking. Turns out that Billy Ray has a diseased heart that is on the brink of failing; without the ICD his heart will eventually beat without a rhythm and he will die. A classic indication for a heart transplant–why was Billy Ray not on a transplant list? Why, for Heaven’s sake, did he turn off his ICD?

There is a difference between being alive and having a life. It’s not the same to say that one is alive and that one is living. It turns out that Billy Ray suffered an injury at age 20 and has lived 24 years in unremitting, untreatable pain. Cut off before he even began he never married, has no children. Each day was so filled with the primal effort to stop the pain he had little left over for friendship.

Alive without a life. Alive without living. Billy Ray cried “Uncle”.

I have been haunted by this since I walked out of the hospital. How do you make this decision? Where do you turn? Billy Ray has made clear he has no one. Does a person in this situation become MORE religious or LESS? Rage against an unjust G0d or find comfort in the hope of an afterlife? Charles DeGaulle had a child with Down’s Syndrome. On her death at age 20 he said “now she is just like everyone else.” Is this what Billy Ray is thinking? That in death he will finally be the same as everyone else?

And what does this say about each of us in our lives? What does it say about the problems that we face, the things that might make us rage against some personal injustice? How might we see our various infirmities when cast in the shadow of a man who has lived more than half his life in constant pain, a man alone? The answer, of course, is obvious, eh?

The more subtle message is about people, having people. Having family, friends, people for whom one might choose to live. It’s very easy to understand the heroic efforts others make to survive in spite of the odds, despite the pain. Somewhere deep inside the will to live exists in the drive to live for others. The sadness I felt leaving the hospital and what haunts me is not so much Billy Ray’s decision but my complete and utter understanding of his decision.

Billy Ray gave lie to the heretofore truism that “no man is an island”.

Go out and build your bridges. Build the connections to others that will build your will to live. Live so that you will be alive for your others. Be alive so that your life will be more than something which hinges on nothing more than the switch that can be turned off. Live with and for others so that you, too, can understand not only Billy Ray but also those unnamed people who fight for every minute of a life.

Be more than alive. Live.

 

The Value of Work

All work has value. Well, all legal work of course. Every job has value. There is a certain dignity that can be found in every job. Mop the floors? Someone’s gotta do it, and the rest of us should be thankful that someone did it. Digging up coal? Man, that’s a dangerous job. I think I read that 90% of Ohio’s electricity comes from coal. I’m warm today because someone went deep and came up with that coal.

Heck, even used car salesmen perform a job that has value. Seriously.

More to the point, especially at this time of year, is the value that is conferred on the person who has the job. Almost any job. You’ve got a reason to get up in the morning (or evening if you work graveyard). You have folks you are responsible for, and you are taking care of them. You are taking care of yourself. Taking responsibility. FWIW I would go to work on Wednesday if I had the magic lottery ticket on Tuesday.

In the Great Depression what everyone asked for was a job. Will work for food. I truly believe that this is still true for the most part today. People feel deep down that they need to work. When they have a job by and large most people work as hard as they can to do a good job. I live and work in the second most highly regulated industry in the U.S. (bonus points for knowing the first), and my income has been halved over the last 10 years or so. I still go to work, though, and I still work for the people who “buy” my services just as hard and in the same good faith that I did 10, 15, 20 years ago.

That’s my job.

Which brings me to the point: if you have a job for Heaven’s sake do your best. Work hard. If someone has given you a job work hard for her. Don’t’ let any resentments interfere with doing your best work. Everyone is underpaid; your boss thinks he’s underpaid, too. It may or may not be true, but when you are on the job it doesn’t matter. When you are at work is not the time to harbor or act on anything other than the job at hand. If you work for someone, WORK for him. Do whatever it takes to do the work well, to get the job done.

It’s not just that you owe it to her, you owe it to yourself.

 

What Do You Remember and Why?

Memory is a funny thing, isn’t it? My Dad has been sick; his short-term memory is now approximately 30 minutes, give or take. It’s exhausting to be the “reminder”, but worth the effort to quell the terror at the forgetting.

Did you watch any college football on Saturday? Ohio State vs. Michigan perhaps? The unprecedented ending of Alabama vs. Auburn? Memorable doesn’t quite seem to be adequate, but that’s surely what they were. Imagine for a moment you were there, on the field of play. Imagine the memories you’ll have.

Given my Saturday’s activity (glued to TV watching football) it’s not too surprising that I dreamed of football last night. It was a recurring dream, one that comes to me often, and one from which I always seem to awaken to start my day. My dream is like a classic NFL Films pastiche of all of my football FAILURES. That’s right, all of my lowlights in one continuously running loop, endlessly spooling until I finally, mercifully, wake up.

I never remember the good plays. From any sport at any time. Is it like this for you guys? Seriously, there is literally only one play from college I recall where it all turned out OK. Ah, but the misses? Those plays where I got burned, fumbled, missed the free throw, failed to get it up and down for the win? Those are burned into my brain as if by some cosmic branding iron. I wonder why that is…

Memory is a funny thing, isn’t it?

In my Inbox the other day I received a request to participate in a concussion study of Div. III football players. Some of my teammates received the request while others seemingly have not. This set us to the task of deciphering who did get the request and why. Opinions differ, swinging between GPA (those above a certain grade were solicited) and athletic prowess (those below a certain grade were solicited). All of which made for a spirited back and forth between men of a certain age who share…wait for it…memories.

Men over the age of 30 are well-known to have difficulty making new friends, at least friends as significant as those they made in their youth. I get this, especially when I realize that I really DO have good memories from my days as whatever version of athlete I might have been. They just don’t happen to be from the field of play, but rather from the locker room and the bus. Pre- and post-game meetings and gatherings. Watching the “big boys” play on Saturdays with teammates after our all too short season had ended. Gathering to parse the mysteries of the concussion study, so much like being back on a stool contemplating a new day’s fresh undergear, musing on the next generation telling their own stories of bonding and wondering if they will have what we had. What we have.

Indeed, I remember very little of yesterday’s CrossFit WOD. Little other than what the aches in my body tell me I must have done. Like in my days as a team sport athlete I do not remember a particular rep or the weight I used or my score. No, just like always and ever before what I remember from yesterday is what I remember from last week and last year and all the way back to 2006: I remember who I was with. I remember that being with them felt like winning.

I hope that they, as I do with teammates of yore, will remember it the same.

A Friend Who Will Tell You The Truth

Everyone should have a friend who will tell them the truth, specifically the truth about themselves. At least the truth about how the world views them. It’s impossible to accurately observe our own footprints; we need someone to show them to us.

This is not to say that one should form an opinion of one’s self or one’s self-worth solely on the basis of some external view. Hopefully our friend speaks kindly to us out of love and caring in the hope that the truth will lead us to a better version of ourselves, or allow us to feel better about the present version.

I have such a friend, and we recently had such a talk. It turns out that my doubts about the man I am now are unfounded, that I have grown into the type of man with whom others genuinely wish to gather, despite my fears to the contrary. It can be hard to sit still for such a compliment, uncomfortable to hear it no matter how lovingly it is offered, the urge to demure nearly overpowering.

How I have arrived here is quite another story, and a painful truth that my friend offered as well. In my younger years, a time filled with the external measurable trappings of success, I thought I’d already reached a place where people of all shapes and sizes were comfortable and happy in my company, and I in theirs. Hmm..turns out, not so much. No, it turns out that I was much too pleased with myself, too pleased myself with having achieved that visible success. I held myself apart, above. I was liked, but mostly because those to whom I would be compared were less likable. Ouch.

Would I have heard my friend if she told me this back in the day? I don’t know. I doubt it. A massive dose of humble pie was probably necessary, not only to hear and listen, to be ready to hear and listen, but certainly to have become who I am today. The details of my humbling are not really relevant, it was the lessons taught by humility that matter. Chicken? Egg? Does it matter? I do wish that she, someone, had told me then, though. Just in case I might have listened, gotten a head start on getting where I’ve gotten.

Why does it matter now? Why is this not simply a case of a friend congratulating me on growing up to be a better adult than I once was? Some times we get a mulligan. A do-over or a re-start. I may once again achieve a kind of success with all of the visible trappings. Man, I really hope so! If I do the truth my friend shared is not just a pat on the back but also a kick in the pants. A warning that I should do a better job of it if I get a this time around.

Everyone should have a friend who will tell them the truth. Each of us should care enough to listen.

 

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