Random Thoughts from a Restless Mind

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Easter Sunday musings…4/12/Pandemic

Sunday musings…

1) Indicator. The Sunday paper circulars are interesting. 2, 3, 4 weeks ago the Sunday paper was stuffed with the usual ads from drug stores, Home Depot and the lot. I couldn’t figure out if that was a hopeful sign. Typically there are 15 or more circulars; today there were 3. No mystery here; not hopeful.

The economy has capitulated.

2) Masters. It’s Masters Sunday. Each year I ask that it be ok for me to be allowed to check out from any responsibilities, take command of the TV, and watch the final round of the Masters. Not gonna lie, not having a Masters to follow this year was by far and away the strangest sports non-event for me. Bigger than no Opening Day, no Final Four. CBS has come to my rescue, showing the epic final round of the historic 2019 Masters. It’s almost normal. Beth is doing something useful, I’m bloviating via keyboard, as useless as can be, sitting on my keister watching Tiger.

For the first time in a couple of weeks it feels almost normal.

3) Lockdown. How long can our largest medical institutions in cities not yet “surged” remain at 50% census? I am told that the ophthalmology division at the Cleveland Clinic is down 80% in the clinic and 90% in the OR. In the community taking its lead from CCF it is 90% and 99%. The Clinic (and others such as the Mayo Clinic) are predicting annual losses exceeding $1 Billion at their institutions. Countless patients have seen carefully planned medical care disrupted, further inconveniencing them and their families, and in many cases causing significant financial hardship layered on top of that which everyone else is suffering.

Why the big draw downs in care? So-called “non-essential care” has been shut down, pushed out in order that supplies of equipment (e.g. ventilators) and material (e.g. PPE) be warehoused so that it would be available when the inevitable waves of sick patients are blown in on the winds of COVID. Again, I’m not gonna lie, this particular rationale is a bitter pill to swallow. Enormous institutions with the power to simply float their own loans and cover a loss are complicit in the egregious denial of the coming disaster, failing as fully as the federal government to stockpile what was necessary to be ready. My patients, my staff, and I are direct victims of their lack of vision.

What prevents me from being engulfed by bitterness at this particular aspect of the pandemic is the real reason that “non-essential” care was reasonably shut down and pushed out: medical offices, clinics, and operating rooms working under standard operating procedures are quite simply incompatible with any form of physical distancing. If I go to work and work is normal nearly a hundred patients move through the office in a typical day. Along with them come all manner of family and friends. On my days in the OR 15-20 patients will have surgery, again accompanied by family or friends. It’s not just the patients who are at risk due to the nature of busy offices and OR’s, but all of the staff and doctors as well. And trust me, an eye doctor’s office isn’t the place that all of those missing masks and other layers of PPE have been hiding out. We have been out of masks at our office for weeks. I could protect neither my patients nor my staff.

How long?

4) Compassionate. Again, Twitter is the double-edged sword of my quarantine life. There are some really super smart people hanging out there, and in the spirit of general goodwill most of them have been on their best behavior when “talking” with smart folks who aren’t necessarily smart in their particular area of, you know, smartness. Others, on the other hand, have been just as arrogant and dismissive as ever.

Yesterday I was engaging in one of many discussions of using medications that are either not yet approved for, or whose use for treating COVID-19 would be off-label. Newer medicines without a clear-cut history from which to judge safety pose one very specific problem: can their use in cases of last resort, so-called “compassionate use”, be justified while the option of enrolling randomized, controlled trials (RCT) is available. On the opposite end of the spectrum, is it OK to use older medications with a known track record that includes a very strong safety record in the hope that theoretical benefits will be proven to be actual benefits, again when the option of enrolling patients in an RCT is available.

No less that Dr. Anthony Fauci, the DC biocrat (my term for him coined last week) advocated for what he called the parallel course of doing both, enroll RCT’s and provide medications on a compassionate use basis, when he was faced with another new virus that was killing people at an alarming rate in the 1980’s. When the AIDS crisis was new he realized that waiting for the definitive proof available (though sadly not always forthcoming) from an RCT would mean that people afflicted with HIV and suffering from AIDS would die while the academicians calculated. Safer, older medicines where likewise studied as prophylactic medications in much larger study groups while at the same time being given to large numbers of individuals outside the trials.

When I posted that our present crisis, that includes both the terribly ill at high risk of death as well as the barely afflicted who may or may not end up in the ICU, was analogous to the 1980’s and AIDS I was insulted and belittled by the academicians. Not willing to engage on the ethical and moral grounds of the “parallel course” they instead played king of the hill on the head of the pin of RCT dogmatism. The use of unapproved medications in the most dire circumstances without clear proof that they are not harmful was declared immoral; those willing to even discuss the use of new anti-virals outside of an RCT were labeled naifs without the mental chops to even be given a seat at the table. Likewise the off-label use of an older medication with a sterling safety profile for prophylaxis. There was a barrage of condescending straw man arguments and outright ad hominem.

Why post this here, today? Listen, there were two important conversational threads to be had on this issue yesterday. One on the how and why of RCT’s in both the very ill and those who might become so. The other, no less important, was whether a “parallel course” of compassionate use originally discussed during the AIDS tragedy of the 1980’s by no less than Dr. Fauci, was appropriate. One conversation is cut and dried,  mathematical in nature and wanting only the mechanics to implement. The other is an ethical discussion, one that requires a different vocabulary and one that is open to a wider group of conversant, the insular and dismissive instincts of the academicians notwithstanding.

There will be endless armchair quarterbacking in the months to come. Dismissing people like me, with or without the backslap of insults and derision hitting my backside like the proverbial door as I exited the conversation, will not likely make it any easier for those who demanded the pulpit resting on the head of that pin. It will be hard to offer much in the way of understanding after the fact to those who have extended so little now, in the heat of the battle, to those of us seeking only to understand.

I’ll see you next week…

Sunday musings…1/19/20

Sunday musings…

1) Hiatus. Been a couple of weeks. Miss me? Lots to catch up on.

2) Spotify. I love Spotify.

That is all.

3) Dragon. At the moment I am awaiting the delivery of a new laptop that will allow me to “talk” my writing. I have long known that I am much more creative when I speak than when I type (my fingers can’t keep up with my brain, especially with this gawd awful new Mac keyboard).

With the likely exception of travel this may be the last “musings…” I type.

4) Wax. To increase or grow. To thrive

Wane. To decline or shrink. To wither.

Admit it, you always have to pause for just a moment to remember which is which. You’re welcome.

5) Narrative. Pretty much just means story. Like “my story” instead of “my narrative” except that narrative has been adopted by the precious consulting/media class to upgrade the seriousness of whatever they may be discussing. It’s all so very pretentious if you ask me. “Narrative correction” is simply changing the story, usually to one that makes the changer look better or gives them some sort of edge. For some reason it just seems more acceptable, rational, and proper if you are changing the “narrative” rather than your “story”.

Remember, the folks who insist on using “narrative” are the same folks who have so brutally abused the word “so” through such massively unthinking overuse that it makes “Um” look like a comparative slacker in public speaking. I still wonder why every declarative sentence uttered when changing the narrative ends in an uptick, a verbal question mark.

If you have questions about every sentence in your narrative why should I believe your story?

6) Judy. For the life of me I don’t know why I suggested that Beth and I watch the new Renee Zellwinger movie about the late singer Judy Garland. Man, it was 2 hours of relentless beat down of both Ms. Garland and anyone watching. What a sad story. Judy was psychologically abused from her earliest teen years, emotionally abandoned by her parents and apparently physically abused by power figures (read: men) in the studio system that made her a star. Dead at 47 but by the looks of it without living for many, many years prior to that.

Ms. Zellwinger is a revelation in the title role. If you are a movie buff (and I admit, I am starting to enjoy the exploration of movies as I enter my last 3 innings) her performance is riveting. If not this is probably one to steer clear of.

The end was a relief.

7) Trifle. My day job is one that has one of the highest suicide rates of any jobs in the U.S. Physician, that is. Don’t worry, this is not any kind of plea for help as I do not suffer from what is commonly known as “physician burnout”, the umbrella term for the myriad psychological stresses felt by practicing doctors that leads to the kind of beat down felt above by Ms. Garland. (As an aside a recurring theme around Judy Garland was a kind of incredulity by people with whom she worked that anyone like Ms. Garland could have any reason to be unhappy, let alone depressed). In fact I recently gave a speech about the quest for happiness in doctors in which I state early and often that I am actually quite happy.

But as I look around at my colleagues I see so many of them succumbing to the continual micro-assaults they suffer in silence until eventually the cumulative wounds add up to a hemorrhage of the spirit that is as unstoppable as a single slash to their emotional carotid artery. As is my wont I have been searching for some vocabulary help, some phrasing, a metaphor to use that would help me to both understand and explain what I see. Reading “The Ethicist” in this morning’s Sunday Times I came across this gem:

“De minimus non curat lex.” The Law does not care about trifles.

Eureka. Every doctor is taught that nothing is a trifle when it comes to the health of their patients. Especially the patient sitting in front of them. And yet 90+% of the changes in the provision of medicine over the last 2 decades have been precisely that, the introduction and proliferation of trifles into the sacred space between doctor and patient. “Non-combatant” narrative correctors have piled trifle upon trifle into the life of your doctors. Things that have no meaningful positive impact on your health. These, in turn, have bled much of the joy from the exam room for those same doctors. Making matters worse is the fact that more and more power has been vested in those OUTSIDE the exam room, OUTSIDE the operating room. Think administrators, government functionaries, insurance and pharma executives.Those who brought you the abuse of “so”, the question mark at the end of declarative sentences, and “narrative” want your doctor to be accountable to them, not to you and your individual health.

Fidelity to HIPPA rather than the Hippocratic Oath.

Despair over the injuries of a thousand pin pricks can be hidden until the psychological blood loss is the equivalent of a head on car crash. Judy Garland was “Judy Garland” on opening night in London. No one in that audience could see the scars from her years of abuse. No one knew how much “blood” had been lost until her injuries added up to a stumbling, bumbling and mumbling catastrophe on stage. Doctors, like Judy Garland, are looked upon as pampered creatures of privilege. Generally well-paid and with at least the veneer of social prominence and deference, it is inconceivable that they could be suffering from the very thing that has given them their station. To complain, nay even to offer the observation that such a thing could be, is met with at best incredulity, at least as often with scorn and ridicule. It’s just a trifle; what’s your problem?

Each trifle is in itself trivial. Yet trifle upon trifle leads to discouragement. It is discouragement that leads to despair, despair that can lead to death. To be damaged by being buried under a ton of pebbles is no different than the damage that occurs from the strike of a a single, massive boulder.

Just this morning the solution came to me thanks to The Ethicist and my new vocabulary word, “trifle”. We physicians are more important to our audience than Judy Garland was to hers because we possess the ability to prolong life, to cure, to make well. And like Ms. Garland who could not resist the stage, we desperately want to to this, to prolong life, to cure, to make well. During a brief conversation with my colleague Barry this morning it became apparent to me that our “narrative” has been stolen, or at least our right to own and tell our narrative, and with it I fear our ability to save ourselves is gone as well.

Think about this a little bit, won’t you? My epiphany this morning was equal parts simple, straight forward, and stunning. That part of our healthcare system that that most deserves saving is the part where a doctor sits with a patient with the sole responsibility and goal of making them healthy; call it the Hippocratic Space. Saving that sacred space won’t  come from us, your doctors. This morning it became clear to me that saving that space, and along with it saving doctors, will be done by patients. All of us are patients, and it is as patients that we have the most to lose if the avalanche of trifles drives doctors as we’ve known them off the mountain.

8) Dragon 2. If I had dictated “Sunday musings…” today I would not only have been done long ago, but at the time I type these last words I would also be done with my workout, taken a shower, and finished the laundry.

I’ll see you next week…

Thanksgiving musings…

Thanksgiving musings…

For pretty much my entire adult life I have tried very hard to live by one of the core tenets of Taoism: the man who knows when enough is enough will always have enough. Through times both thicker and thinner, the more closely I’ve been able to hue to the intent here the happier I’ve been. For Thanksgiving Day I’ve come upon a companion piece that may very well bookend a philosophy for life.

“Gratitude turns what we have into enough.” (HT Mrs. Bill Livingston)

Enough is a truly powerful thing. Enough is the portal to satisfaction, if not happiness. Enough is the antidote to yearning, to wanting. Once you have enough there is no reason to covet. After enough anything else is a bonus, life’s equivalent of that overflowing Holiday cornucopia. Gratitude is a straight shot to enough. On this Thanksgiving Day I am grateful for all that I have, for as long as I have had it.

For a life where for so very long enough has been enough.

Happy Thanksgiving.

“Traditional CrossFit” Sunday Musings…11/3/19

1) Fall. As in fall back. Daylight Savings time is over. I will miss our sunsets.

That extra hour of sleep, though…

2) Toddler. We have been hosting our little Man Cub (and his Dad) while the Pipsqueak is away with her Mom. Nothing, and I mean nothing up to and including fusion, produces more energy over the course of a day than a male toddler.

Even that extra hour of sleep isn’t enough to catch up.

3) Goals. Mens Journal has a fluff piece about Michael Strahan in last month’s issue. Seems like a nice enough guy (though you’d like to see one of these whirling dervish success types manage to stay married). Got lots on his plates. It’s a fun peek into his work week. As is often the case there is a little gem tucked into the text, this one about how he sets goals: SMART.

Specific. Measurable. Attainable. Realistic. Time-Bound.

“Attainable” and “Realistic” are redundant, but the idea behind this little ditty is pretty good. After reading this I fired off an email to one of my teams at work about a service that we have not successfully integrated into our business. While we may still fail, putting my proposal in this format at least makes our process a better one.

As is so often the case it was worth reading about one more golf-obsessed retired athlete to get this one little pearl.

4) Traditional. Those of you (both of you?) who have been reading these Sunday missives for a bit will remember that “Sunday musings…” was  my way of giving back to the (much younger, earlier version) of the CrossFit community. I discovered CrossFit in 2005 and began to interact online in 2006. The website also had a Message Board back then; folks got to know one another in what I called the “cyber gym” both on CrossFit.com and the Board. Those free-wheeling, wild west spaces are long gone, replaced by a subscription/sign-in and monitored corporate locale befitting the grown-up business that CrossFit has become.

On Instagram, a place I do not visit, a pundit in the fitness arena opined that “Traditional CrossFit” is no longer, and that his version of “smarter” CrossFit was now what one should practice. What he is actually saying is that the practice of “CrossFit, the Sport of Fitness” is no longer what the masses should be doing, because so-called traditional CrossFit has really never gone away. The very best affiliate gyms have always used the kind of CrossFit that you found on CrossFit.com (with rational scaling options provided each night from BrandX)  from 2005 through around 2011 or 12.

While I no longer have any type of relationship with CrossFit, Inc. or a local affiliate gym (though I continue to be very friendly with the owners of the original Box here in Cleveland), I still work out much as I did when I discovered CrossFit in 2005 (interestingly in a Mens Journal article). There is still wisdom in the original version of “What is Fitness” published in the CFJ volume 2 ( the re-edited version is not of the same quality; I wish I’d saved a copy of the original). Constantly varied (do lots of different things) functional movements (do exercises that involve the whole body, not isolated parts) performed at RELATIVELY high intensity. That last part has always been key, and it is one of the parts that, if forgotten, leads to suboptimal outcomes and injury: intensity is relative to the individual on any given day. At 59 (and coming off a hip replacement) I am hardly going to have the same intensity I had when I started CF at 45.

Form, or technique (do the exercises properly), consistency (do the exercises properly all the time; adhere to a schedule of exercise and recovery), and only then intensity. This was once dogma that was unassailable. The “gamesification” of CF after 2012 prompted many a gym to lose this as they chased the competitor and as members chased competitions they had no business chasing. “What is Fitness” also introduced the masses to the 10 Characteristics of Fitness and the concept that a truly fit individual was equally competent in all 10. That IG opinionater  makes the classic mistake of stating that strength is more important than the other 9 characteristics. This  is as misguided as one of my other favorite reads, Outside Magazine, which consistently posits that cardiovascular endurance is the sine qua non of athleticism. Jeff Martin of The Brand X Method (who has no affiliation with CrossFit) should be credited with the real insight regarding strength: the vast majority of individuals are under-strong relative to the other 9 characteristics, and therefore supplemental strength training is necessary.

It’s not necessary to learn that IG opinionator’s name because he is just the most recent example of someone who almost gets it. Man, the conversations we had about this stuff in those halcyon days of CrossFit.com–scaling, strength, additional work, recovery–my kids called in “CrackFit” because we were all so into the intellectual side of this new way to approach fitness. Without a doubt “CrossFit the business” bears little resemblance to those early days, but the very particular way “CrossFit the program” applied classic HIIT principles was, and still is, revolutionary. Layering on traditional training techniques (periodization, supplemental exercises to address weaknesses) while remaining firmly committed to the original core principles (technique -> consistency -> intensity, etc.) is simply proper evolution.

With or without CrossFit, Inc. that particular era is far from over.

I’ll see you next week…


The Purge: Re-Visiting the Process of Shedding Material Things in Our Downsize

Six years ago this month Beth and I downsized and upgraded to Casa Blanco, our tiny little lakeside “retirement” home. It took 3 years to let go of our accumulated “stuff”, not a little bit due to the fact that there was quite a bit of “stuff” that belonged to our kids. We have new neighbors moving in next door, also downsizing, and some of my friends around the country are starting the process. Here’s what I had to say about our experience when we finished our “purge” and as our grandchildren started ramp up the acquisitions of new stuff.


In a couple of days we will be one step closer to completing “The Purge”. No, no…not THAT purge. I’m talking about completing the purge of all of the stuff that filled up our larger home with all of its modern storage spaces. Our new home, a tiny 1947 two-bedroom cottage, is 50% to the inch the size of our old home, but it has only 1/3 as much storage. Our purge has partially furnished at least 3 other homes, and the upcoming delivery to “Lovely Daughter” adds another home to the list.

Clothes, art, tchokes…you name it. We’ve been liberated from our stuff.

Have you ever seen George Carlin’s classic riff on “Stuff”? Truly funny stuff (Huh? Huh?), and easily available on YouTube. An entire cottage industry has grown up around the purging of stuff. That’s kinda funny, actually. The concept that you need someone to come in and tell you how to get rid of your stuff. In addition to a few minutes of belly laughs, Carlin gives you the place to look for low-hanging fruit: other people’s stuff! Set a timer, and if them others don’t pick up their stuff, off it goes.

The harder part, if it’s really all that hard at all, is when you are down to the stuff you think you might need someday. You know, like that really interesting, sure to be useful gadget you just had to buy at Sur La Table 10 years ago that’s still in its original packaging. Or those holiday dishes you’ve forgotten to use every Christmas since you got married 25 years ago. Stuff like that. When you literally don’t have a place to put ‘em, this category becomes not at all different from other people’s stuff: if you never used it, it was never really yours, right?

Before I get too self-congratulatory and get injured by patting myself on the back, I should point out that we DO have an attic, and also a tiny little vestigial cellar. Both are filled with unpacked, lovingly examined, and re-packed memories. Sure, I could digitize the photos and upload them to the Cloud. The 55 year old “Teddy Monkey” that hasn’t been cuddled for 2 decades would certainly fit better in an album than a box. It’s here where the line is drawn in our home, that place where “stuff” intersects with memories. Maybe I’m too old school, or perhaps just plain old, but the memories and the things that trigger the memories are safe from the Purge.

The whole exercise has been a helpful and useful one in my never-ending journey on the “want vs. need” highway. Stuff? Firmly on the “want” side of that equation. Every day in our cottage, more joy from less. Letting go of the stuff has also brought me closer to cherished memories, which in turn is bringing me closer to cherished people. Funny, eh? The less room I have for stuff, the more room I come to have for the people who helped me make the memories I’ve been saving. I’m off at the moment to round up a couple of those people, hopefully to create a few more of those memories.

After all, the size of your heart and soul need not be bounded by the kinds of walls that surround your stuff. There can always be room for your memories and the people who made them with you.


And with that Beth and I are off to visit family in Rhode Island and friends we made on our Honeymoon 34 years ago!

Harmony, An Introduction: Sunday musings…9/22/19

Sunday musings…

1) Cat. I’m allergic. Pretty sure the barn cat is aware of that.

The barn cat who insists on sitting on my lap while I type “musings…”

2) Fashion. Happens every year around this time. All of the large national papers have a big, glossy magazine filled with the latest creations from the world of fashion. The stuff for women is wacky enough, but have you seen the garbage they have created for men?! Seriously, have you ever seen anyone wear an asymmetric suit larger than the one the guy from the Talking Heads wore in the “Stop Making Sense” tour video?

That trees were felled or energy created to send the electrons over the internet for this crap is criminal. Sheesh.

3) Emmys. Tonight we here in Cleveland will have to choose between the televised spectacles of the Emmy Awards and the Baker Mayfield Show. Both will feature suspense of some sort; it’s a done deal that something or someone will go off the rails in both. With the Browns seemingly on the brink of relevance and the Emmy Awards stepping back from the brink of irrelevance by acknowledging so-called “new media” productions, one of the side effects is that there is a renewed interest in the historical excellence of both. I’ll not bore you with tales of Jim Brown or Otto Graham; it’s really more fun to talk about historically important TV shows IMO.

Parade Magazine listed 20 of the top TV shows of all time. Pretty good list, actually. You probably have seen a bunch of similar lists if you are a TV watcher. Not much to quibble about on a list of 20. I would have added something like Happy Days. Maybe subbed out “Friends” for Seinfeld. Still, pretty good list. What are your favorites? Pretty easy question for me, as is the “favorite movie” question (Shawshank Redemption): Hill Street Blues (medical school) and M*A*S*H (college and med school).

What I love about TV now is both the current “binge-worthy” shows that I can watch like a really long movie (or a non-Stop “Roots”) as well as re-runs and anthologies of classic shows, especially comedies and variety shows. Like Carol Burnett. I am convulsed in spasms of laughter each time I see Tim Conway and the “Elephant” skit that cracks up the entire cast. Another treat with the Emmy Awards and nostalgia is trivia. Did you know that only one person ever turned down The Carol Burnett Show? Bette Midler.

Betting she wishes she had that one back.

4) Harmony. My day job, as you may know, is medical. I am an eye surgeon. My side gigs involve a little bit of creativity and communication. I write both as release/escape and as a service to my colleagues who spend the lion’s share of their work time in front of patients or in the OR. Same thing with speaking; I am either speaking as an educator (sponsored or not), or working behind the scenes representing my fellow clinicians.

This weekend was a bit different, though. My colleague Alice graciously invited me to be the Keynote speaker at the annual educational meeting put on by her group’s foundation. I gave two clinical lectures on topics I am known for and know very well. It was the third talk, though, that was different. At the end of the long day of very technical lectures I gave a talk about the challenges of being happy, especially (in this group) for physicians. This was a talk born out of discussions that Beth and I have had with Megan over the last several months, and the joy of putting it together is that I have been privileged by the inspiration that Megan has given me through her insights. Here, then, is a small introduction to our thoughts as I prepare a “long read” version for a later post.

We have been bombarded with the conflicting impacts of a need to “have it all” and what we are told is the need for something called “work/life balance”. What is implied, if not outright declared, is that happiness can only be achieved if one is able to achieve, or acquire, both. Having it all and a work/life balance, that is. In reality there is no such thing as a work/life balance. It is a false construct. Work is a part of life. It’s all “life”. In a similar vein, what is implied by “having it all” is actually “having everything”. This is, of course, impossible. No one can have everything. You can have it all only if you recognize and accept two tiny little “buts”:

You have to choose what “All” is, and you can’t have it “all” at the same time.

Your choices have consequences, not only in terms of what you choose to include in your “All” but also when you choose to include those things. Happiness occurs not when you have balance because balance never occurs; something is always underweighted (or not chosen at all) so that something may be chosen and emphasized. Happiness occurs when your choices flow into and out of one another in a way that they do not conflict. Think of your favorite song, sung or played in key, each or the pieces parts moving in and out of the spotlight, sometimes leading and other times simply supporting. Megan and I like the image of a fountain, it’s shape and size built by you to reflect the choices you’ve made about what will be part of “All” for you. Water flows up and over, around and through, it’s speed and volume and direction the result of what you need and want at any given time.

Too much flow and you run out of water; you tried to have everything, or you tried to have it “All” at the same time. Too little flow and you wither; life and living is an active pursuit of both mind and body. Harmony occurs when every surface of your fountain is bathed in flow at some point, neither overflowing nor draining away. Your fountain rests in the larger body of water that is humanity, the fountains of friends and family nearby, sharing the collective stream.

Happiness is possible when there is harmony between the choices you have made. You can’t have everything. You can have it all, just not at the same time. You have to choose what “All” is and when you will have each part of it.

I’ll see you next week…

Youth Sports: Sunday musings…8/25/19

Sunday musings…

1) Westbrook. Russell Westbrook was traded to Houston?! When did that happen? Reunited with Hardin. How is that a better idea now?

2) Luck. As in Andrew Luck. As in lucky to have his wits enough about him to realize that the near-constant reality of injury-rehab-repeat as an NFL quarterback was making  him unhappy to the point of being unhealthy.

Ans so he has retired at 29.

He will re-pay the Colts for either $12MM or $25MM depending on the reading of his contract, but will leave the NFL having made at least 40 or 50MM, so money is not the issue. Disaffected Colts fans are unhappy because he waited until 2 weeks prior to the season to make his decision, putting the team in a difficult personnel position. I can honestly sympathize with that feeling among hardcore fans, but ultimately Luck worked in a meat factory where he was just one more piece of meat. And he said no more.

Fair winds Mr. Luck. I walked away from amateur football at 21, the game done with me before I was done with it. Not you. May you be at peace.

3) Sport. The retirement of Andrew Luck comes on the heels of a series of events and subsequent opinion pieces on those events regarding the state of youth sports in the U.S. You’ve doubtless heard all of this before. Single-digit aged athletes who are single-sport specialists and all of the pitfalls therein. Participation in sports overall is apparently in the midst of a decline. Something like 45% to 37%, or numbers to that effect.   Did you know that the average age at which this cohort retires is 11? No, not 11 years of participation (I hesitate to call it “play”), but age 11. Washed up before they get to try out for a Junior High JV team.

What was your youth sports experience like? Mine was strongly influenced by the times of my upbringing. The 60’s and 70’s when I was playing local league and school sports had yet to spawn the tyranny of youth travel teams (except for hockey) and all of the havoc they wreak. I’ve written on this here on Random Thoughts at length (search “Three Sport Athlete”), but this latest news about the corrosive effects of early hyper-competition prompt me to spend a few more moments on the topic.

Among the many benefits I accrued from being a team athlete was learning how to both lead and be led. At least as important was learning how to sublimate my ego, my own need to not only excel personally but also be singled out for excelling, in favor of the more generalized success of my team. Tough, tough lesson, that. As a genetically programmed early achiever I certainly would have been selected for any number of teams that were filled through scouting, recruiting, and try-outs. Looking back I can hardly imagine a worse outcome for me as a kid. You see, I wasn’t really all that good, or at least it turned out that whatever gifts I may have been given at birth only made me look good in the earlier stages of an athletic career. With the exception of a little mini-peak as a college sophomore (and that only occurring due to an injury to the player who beat me out for the position), my reign as a standout talent was probably over as a high school sophomore.

What if I’d been on some sort of elite travel baseball or basketball team, all of my efforts (and likely substantial family assets) devoted to the singular pursuit of some sort of athletic achievement? It wouldn’t have been my choice to leave the games, someone would have escorted me out.

Kids who are true athletes, who will be capable of having some kind of advanced career in college or beyond, will find their way even if they aren’t put on a one-sport super highway at age 7. Andrew Luck is actually a pretty good example; I think he played pretty much everything well into high school. Heck, LeBron James was a heckuva wide receiver through 10th grade. Now we have personal quarterback coaches recruiting 8 year olds, parents being led on like so many sheep9ii. Not kidding. 8 years old and being taught how to read coverages in the secondary when you’re supposed to be learning how to spot bubbles in the sand so that you can dig up those cute little crabs that live 2 inches deep at low tide.

Please don’t get me wrong; this isn’t a missive about participation trophies and not trying to win. I am all about the lessons to be learned in preparing to win, and those you hopefully learn about how to comport yourself as both winner and loser. Ya gotta keep score to learn those lessons. The world keeps score for everyone eventually. It’s just a much better way, and time, to learn that lesson by playing youth sports. But playing on teams with kids who are both better and sometimes much worse at playing the games than you might be is in itself also a very worthwhile lesson to learn as a kid. How much better would I have been at life in general if I’d been a little aware of that part of the sports curriculum when I was a kid.

While I’m talking mostly about team sports I truly believe that many of these lessons are there to be learned in the individual sports as well, especially those in which you compete as an individual in a team setting. Think swimming, track and field, and any number of high school sports like tennis and golf. My buddy Chuck was number 1 on the tennis team from the minute he set foot on campus as a freshman, and yet he was arguably the most beloved member of that Williams team for all 4 years. Why? Well, partly because he never lauded his excellence over a single teammate, but mostly because he openly reveled in the TEAM outcomes, not his own W-L. Although he certainly entered his share of USTA Junior tournaments he never left his high school team in so doing.

Youth sports at their finest are played locally on teams consisting of kids who grew up together. Kids who spent lazy summer days touring their town hunting salamanders or hanging out at the city’s local Boys and Girls Club, away from harm. I can’t begin to count the number of boys who matriculated at one of our local Catholic boys’ schools specifically to play their chosen sport, only to be washed out of the program before 10th grade. How much more fun might they have had if they had gone to their home town high school and continued to play one or several sports with the kids they grew up with? My oldest son, Dan, went to school with a boy who went to St. Somebody as a 3-sport athlete and by the time he got to Junior year he was down to being an afterthought on just one team. It was heartbreaking because on a talent-basis he should have been starting on at least two varsity teams. His response? Well, he transferred to his hometown public school, played two sports, and had a ball. Got a D1 scholarship, too.

It’s time for a re-birth of local sports. Town leagues where kids get to play with their friends. A chance to learn a bit more about a sport, maybe even to excel, but more so a chance to be a kid having fun playing a game. At least at 8, no? At least until they begin to mature in adolescence, or at least until we start making cuts in high school. Play with your buddies. Learn how to be a good teammate, to win and lose with equal grace. To coexist, perhaps to thrive, with teammates who may not be quite as good at the game as you might be.

The average age at which children retire from organized sports is 11. That is a far greater tragedy than Andrew Luck retiring from the NFL at 29.

I’ll see you next week…

Taking Stock: Sunday musings…8/4/19

1) Crafty. Lovely Daughter’s term for the charting of a co-worker. Seems to mean equal parts clever and devious.

2) 28. This year marks the 28th consecutive summer vacation for the extended White family on Cape Cod. Same house, same beach, same neighbors. And yet, like so many years before, it was hardly the same trip. If memory serves this is the third Cape Week without my Dad (he passed in the fall almost 4 years ago), and it was one that saw for the first time less than 100% beach attendance by my Mom. Like the last 4 or 5 our children’s generation was sparsely represented as they pursue their early adulthoods. In fairness to them it should be noted that all four in my generation were out of college and married in the earliest years of Cape Week, 3 of us also already parents.

What is this year’s take home from our week? I’m afraid it was a bit too new and different, and it’s a bit too fresh for me to say. It was peaceful and free of rancor, but also awfully frenetic with the addition of my whirling dervish Man Cub; Beth and I had him solo for a few days. Being in the active pursuit of grand parenting without parents present does not lend itself to introspection of any kind, and since we flew home the internal dialogue of a 12 hour drive of years gone by has not yet taken place.

It was different. We were, all of us, different. It’ll take a little bit to sort through it all.

3) Goals. An Op-Ed in this week’s WSJ caught my attention. A daughter entering college asks her Dad at breakfast if he’d accomplished the goals he’d set out when he was a young man her age. It’s the kind of question I could easily see my own daughter asking me in any of a dozen scenarios. As I meander toward my 60th, in stark contrast to the year I spent careening toward my 50th, what little time for quiet thought I enjoyed this past week was devoted to this question.

Of course, like the author of the WSJ piece, in order to reflect on whether I’d actually met my goals I would have to reach back and try to retrieve some sort of memory of what those goals may have been. In doing so what strikes me the most is how few goals I seem to have had as a young man. At least when one thinks about large, grand, life-long goals that are significant enough that you actually express them in some way, shape or form. In retrospect most of mine appear to have been strikingly short-term, with a pretty complete lack of any deeper considerations of the longer term impact of those goals. I wanted to continue to be a football player as long as I could, and I wanted to be a doctor.

As far as I can see that pretty much covers it for goals as I exited adolescence.

What goals I remember setting and what accomplishments I’ve made seem to have arisen from the ground along the paths I’ve walked since my last moment on a football field and the milestone moments in the journey of becoming a practicing physician. We all start out believing that we will do something great. Something that will have a greater meaning with an impact that reaches far beyond our closest environment. At least the groups I was part of early in my life did. We’d just left the 60’s, a time of momentous change effected by seemingly out of nowhere leaders. Looking back I can see that I just assumed something like that would happen to me if I simply kept moving forward.

But it didn’t. Those great big goals and accomplishments that the author’s daughter was asking her Dad about never materialized for me. Each time the chance to choose that kind of path arose it was blazingly clear that doing so had consequences locally. All of the bigger, broader worlds fell away as the smaller, more intimate world around me became my focus. Our family. My modest, local practice. My role  model, Dr. Roy the pediatrician in Southbridge, was a very important man, but the reach of that importance was decidedly local. Each time an opportunity arose to extend beyond my own locale I chose, instead, to follow the lead of man whose life made me choose medicine as a career.

Looking back now I guess my goals were always rather modest. In the end what I wished to achieve was a family like the ones my wife and I grew up in, and a small measure of what Dr. Roy meant to our little mill town in Massachusetts: to be important in my own village. To be someone who had earned the respect of his fellow villagers. As I travel the slow, easy curve at mile marker 59 the journey is smooth because I’ve tried my very best along the way to achieve those two things. In the beginning and during the journey they seemed to be the only goals that I remember saying out loud.

After that I would just keep moving forward.

I’ll see you next week…

Sunday musings…6/2/19

1) Nature. It’s messy. The Avon Lake eagles dined on duck this morning. Hoping it’s not one of the mallards who routinely dine at Casa Blanco.

2) Equus. I continue to marvel that the horse, in all of its various forms, has survived its introduction to humans. Indeed, one of the equestrians I accompanied to a show this weekend shares my amazement.

“We’re talking about a 1200 pound prey animal with a tongue bigger than its brain. How are they still here?”

3) Mookie. Bill Buckner, unfairly cast as one of the greatest goats (as opposed to GOATS) of all time for his error in game 6 of the 1986 World Series, passed away this week at the age of 69. He accepted his fault in the game changing error that allowed the Mets’ Mookie Wilson to reach first base and thereby drive in the winning run. Buckner handled the situation with grace and humor, at least publicly, for the rest of his life.

Mookie for his part held from the beginning and never wavered from his position that he would have beaten out the grounder even if Buckner had cleanly fielded the ball. Buckner you see was injured. “Of course I would have been safe; I had two good legs and he only had one.” I wonder, was Wilson offering Buckner an out? Allowing him space to shed the burden of prolonging the Red Sox Series jinx? Baseball is known not only for its characters but also for being the home for men of great character. Think Hank Aaron or Jim Rice in the latter category. Could it be that Mookie Wilson was an example of both?

That’s gonna be my take from now on. That Mookie Wilson offered a lifeline to a worthy competitor, one who was too proud to take it when he was alive. I hope Mr. Wilson never changes his story.

4) Loyalty. On Wednesday this week my long-time practice partner hung up his spurs. Scott and I worked hand-in-glove as eye doctors for 20 years. Ours was an amazing team. When I zigged so did he; when he zagged, so did I. No one had to tell me what he said to a patient we were sharing, and he knew without a shred of doubt exactly what I was going to say when it was my turn to address someone who’d come to see us. It took about 2 days to figure out that our partnership would work, and neither one of us gave a moment’s thought to the possibility that it wouldn’t for 20 years.

Everyone should have someone who works with them in whom they can bestow unquestioning trust. Scott was 100% loyal to the success of our enterprise. He treated me and each of our co-workers as if we were friends he’d had since grade school. If you laid the “extra miles” he went end to end you’d circle the globe a few dozen times. In world where business search, often in vain, for some sort of secret sauce to motivate their workers at all levels, the only time I ever gave any thought to motivation Scott was when I tried (in vain) to figure out some way to convince him that it wasn’t time to retire. No one ever worked harder with me or for me.

So it’s off to a well-deserved retirement for my friend Scott and his wife Bonnie, one likely filled with extended trips to visit their basketful of grandchildren and following their beloved Buckeyes. Years ago I dubbed him “the nicest man since Ghandi.” He stayed that way every day for 20 years. You never let yourself think what your day-to-day work life will be without someone like that bouncing through the door each day. Monday starts a new chapter for all of us at our little business.

A little bit of each of our hearts have been retired as well, wrapped around the heart  of the man who was the soul of SkyVision in a lasting, loving embrace.

I’ll see you next week…


Eyecare Out Loud Episode 8 EMR Follies Part 2: Reclaim the Stories in Medicine

Episode 8 of my Ocular Surgery News  podcast. There is hope, however slight and far into the future. I think that hope lies in physicians and their patients reclaiming the stories that are the underpinnings of our relationships.



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