Random Thoughts from a Restless Mind

Dr. Darrell White's Personal Blog

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A Brief Father’s Day Visit from my Dad

Today, Father’s Day, my Dad would have been 89. I think of him often, as I do my Father-in-Law who passed away in 2017. Here is what I wrote after visiting my Dad on Father’s Day, the last time I visited him for his Birthday, re-printed as I’ve done each year since:

 

My siblings and I only need to remember one weekend each year when it comes to celebrating my Dad. His birthday almost always falls within a day or two of Father’s Day. So it was that I found myself in Rhode Island the past couple of days, in the company of my Mom and a guy masquerading as my Dad, a guy who was very curious about the new fella who’d dropped by for a visit.

Getting old is not for sissies, my friends.

Somewhere inside, deep inside, there’s still some of my Dad in the jumbled up connections of his mind, carried by the body that failed him in such spectacular fashion 2 ½ years ago. Dad is extremely intelligent, the only family member in his generation to have gone to college. Quite the athlete, he used football and the GI Bill to pay for school. Like so many in his generation he then worked, raised a family, and put himself through grad school. He won his club championship in golf twice at the ages of 50 and 60. No typo. Beat the reigning RI State Amateur champ on his home course for the first one.

As we sat on the porch of his house overlooking the par 5  14th hole, I had an ever so brief visit from that guy. From my Dad. Like a citizen of Brigadoon he came slowly through the mist of his mind to join me for a bit. We’d always bonded over golf. My brother and I never turned down an invitation to join him on the course, either as partners or as caddies for him and his buddies. It was quite a privilege to do either; my Dad’s most elemental essence was expressed on the golf course.

A light breeze was blowing through the forest in the back yard just beyond the rough. We chuckled at the golfers who failed to take the wind into consideration, sheepishly trying to sneak into our yard to retrieve their out-of-bounds second shot. Dad talked about caddying as a kid in the Depression. We both noted the absence of caddies as the foursomes passed in and out of view. It was really very nice.

I quite like the Dad of my adulthood. Quick to smile, slow to anger, unfailingly loyal and kind. It’s hard to imagine now how distant he was when I was a boy, his friendship as an adult is so easy. I’m not sure how long we sat there to be honest, nor when I noticed that he was slipping away. As surely as the village of Brigadoon disappears, the mist had returned to claim him. I got up, walked over to his chair, held his hand and gave him a kiss. I wished him a Happy Birthday and a Happy Father’s Day, hoping that I’d made it on time. That he was still there. That he knew it was me, Darrell, his oldest child. I told him I loved him.

He smiled and gave my hand a little pat as he disappeared into the mist.

 

I really miss my Dad.

Two Tiny Experiences as “Other”

Only twice in my life have I ever noticed that I was different. That I was, or could be identified, as “other”. Now to be sure, at neither time did this realization make me uncomfortable. That’s probably because I was in a relatively familiar setting, just among a rather homogenous group of people where I was the guy who stood out. Being the only person in church or on the basketball court who is NOT of color was for me, a non-large very white male, more a case of “huh, that’s different” than a case of ” be on guard”.

More than anything else, that is likely part of the core of what is meant when we hear talk of “white privilege”: I am only at risk if I actually do something wrong.

Sitting here in suburbia, in middle-age, it’s instructive to look back at how I’ve arrived at such a place. A place where I always feel like I could belong no matter where my place takes me. The town of my earliest youth is probably most responsible for this. Southbridge was a dying mill town in Central Massachusetts, although none of us kids new it was dying at the time. Settled initially by French-Canadien ex-pats, a second wave of migration from Puerto Rico occurred before I went to grade school. 10 or 15 percent of my classmates were children of Puerto Rican immigrants, but I knew them only as kids in school or teammates on the various fields of our youth. We fought side-by-side 100 times more often than we ever fought facing each other. Sure, they were different. Their grandparents spoke Spanish while most of ours spoke French.

Home since childhood has been driven more by economics than any other factor; the job has chosen the towns.  Most of my life since then has been lived in worlds that roughly track the Southbridge of my youth, roughly 80% White/20% Black or Brown. People of color were either there when I arrived (and so belonged as much as I), or arrived the same way I did (and so belonged as much as I). At this point I should confess that I’ve never given too very much thought to the color mix of my surroundings. This may also constitute “white privilege” I suppose, the privilege of not needing to be aware of color at all. What makes that kind of funny is that until the very last major move of my life, each time I’ve moved to a new place, many people assumed that I was Black prior to my arrival. Darrell White the presumably Black football player arriving at a new high school or at college? Nope. Short, skinny white guy. Darrell White the first ever Black med student or Black resident at my respective schools? No again. Still, short skinny white guy. Only my voice is 6’5″, and with no accent whatsoever my voice is colorless.

How about those two instances where I did feel different, in church and on the basketball court? In church it was mostly humorous since the other congregants made such a huge effort to make me feel welcome. Indeed, as the only White family among the churchgoers at the Black Baptist church one Christmas it was more than comical when the pastor, my friend the Rev. Mel Woodard, introduced us from the altar (over my gentle objection) to the congregation. “Please welcome The Whites!” With a twinkle in her eye “Lovely Daughter” leaned over to me in the pew: “Duh!” No, other than the obvious pointed out by Megan, in that setting the group made sure that only the most superficial differences existed for me in that room. I would only be “other” if I chose to be.

The basketball court just down the street from Wills Eye was a bit of a different matter, and because of that more instructive when examined through the magnification of the retrospectometer. The rules of pick-up ball are clear, and they are largely consistent in every park in America. There’s a line-up of who has “next”, and if you are not a regular you just call “next”, wait at the end of the line, and hope that you can assemble enough talent on your team to last more than one game. Here, like in church with Mel, mine was almost the only White face, but here I was “other” in every sense of the word. My turn as “next” kept getting lost on the list, the wait for that one game almost 2 hours before one of the park leaders acknowledged the tiny injustice and put my team on the court simply by joining us as our fifth guy. The other White guy was on the team, of course, and he was a stud baller. I was a bit to the right of average for that park; that game was the first time in my life when I was more conscious of what my game looked like than how I was playing. Who do I pass to? Do I take the open shot?

We lost the game, of course. Not so much because of anything I did or didn’t do during the game as that the other team had Joe “Jelly Bean” Bryant and no one could stop him (NBA vet, pretty decent player; his son Kobe had quite a run in the NBA). In the comfort of not needing to be the least bit introspective, of not needing to learn anything at all from that morning, all I got until these past weeks from my encounter with Philadelphia inner city hoops was pissed off that I only got a single run after waiting two hours for my “next”. It’s only now as I look back that I realize my sense of being scrutinized, of being conscious of how I looked while playing rather than just playing, needing to be much, much better than the other “average” ballers there that day because I was White. This lack of perspective in the moment at hand is also likely an example of White privilege.

The events–church, a pick-up basketball game–are trivial, but the fall-out, however long in coming, is not. The fact that it is now 35 years since my non-battle with Kobe’s dad and I am just now aware of how I felt may be part of what is called “White privilege”, but moments like this are to be encouraged however long they are in coming, don’t you think? My oldest friends of color, roommates and groomsmen, as well as friends of more recent vintage will likely welcome this sense with little more than a playful “what took you so long” wink, and begin the dialogue. They are, to a man, kind and generous people. The Rev. Woodard’s congregants didn’t even need the comfort and cover of friendship to offer a wink (and in their collective case, countless hugs), so aware were they of how it feels to be “other” until proven otherwise.

Sympathy, my friends, is not enough. Sympathy is situational and episodic, and is therefore also transient. After all, who among us but the most hardened bigots or the most unreachable psychopaths cannot find sympathy for the family of the man killed while instinctively reaching for his wallet, or the families of the officers gunned down while on duty? No, sympathy is not enough because it is only something that we feel, and not something that we are, or even choose to be. Empathy is the magic elixir because empathy cannot be set aside. Empathy is to feel with, not simply to feel for, because it is a part of who we are. But empathy is hard, and empathy takes time. No one would wish the loss of a loved one on another in order to feel “with”. Sometimes empathy is little more than a spark, and sometimes that spark is so small that it goes unnoticed or ignored.

There is a bridge, though, between sympathy and empathy, and it is understanding. Like a physical bridge one must look to the other side and seek to be there. Like any bridge one must have the faith that over the crest in the middle, beyond the road you can see, there lies ahead not a gap through which you will plummet to a certain doom, but a clear path to the other side. The trip may be a difficult one, but as with all trips, it will pass much more easily if in the company of others who either seek to understand as well, or better yet, others who already do. Like all those men and women who came up to me in church and hugged me after Mel’s introduction. Like the guy at the park who joined my team, made sure I got “next”, and told me to come back for a run the next Saturday.

Like my old friends Sheldon and Steve, Rasesh and Mel, as well as newer friends like my colleague Quentin. They will hold my hand and guide me as I traverse the bridge of understanding.

Whither CrossFit: Sunday musings…

Sunday musings…

Oh my.

This morning my first outside interaction was a quick note from one of my sons: “CrossFit shit storm”. Though it has been several years since I have had any meaningful association with official CrossFit I did a quick perusal of social media and up popped the story. CrossFit founder and CEO Greg Glassman had replied to an Instagram post about the death of George Floyd and the public health implications of systemic racism with a rather flippant statement combining the two great mega-issues before us today: COVID-19 and the national unrest that has followed Mr. Floyd’s death at the hands of a police officer. Already under fire for not “adequately” publicly responding to the devastating economic effects of the corona virus lockdowns on CrossFit Affiliate gyms, Coach Glassman essentially ladled accelerant on the flames.

Like so many things “CrossFit” over the years, this episode has multiple layers that touch on much more than what we see on the surface. My own CrossFit journey began in 2005, a time in which CF was little more than a tiny underground movement with a equally tiny group of nearly underground fitness “rebels” fighting what felt like a righteous enemy in the entrenched fitness (and nutrition) community, led by a brash iconoclast who reveled in conflict. Conflict that he routinely initiated, mind you. While I have never been employed by CrossFit, Inc. in any manner I was certainly an “insider”, comfortable in the “halls” of CF HQ as well as in the spaces CrossFitters call Boxes, CrossFit Gyms. My role such as it may have been, was to speak as a friendly fellow traveler to those in the CF community. Kind of a “Goodwill Ambassador” to both insiders and outsiders alike.  It was a role that I created, one that was by turns encouraged and barely tolerated by Mr. Glassman and others in HQ, until it wasn’t. A few years ago it was time to step away.

It’s been quite awhile since “CrossFit” has been mentioned in Sunday musings or Random Thoughts. Why now? As a longtime participant and observer who now has literally nothing invested in anything CrossFit (with the exception of several life-long friendships made in my earliest years there) I thought I might add a bit of perspective to what is happening at the moment for the benefit of those who are relatively new to the movement and the business known collectively as CrossFit. In particular I am hopeful that this perspective will be helpful to my fellow physicians, especially those who have recently come to the CrossFit world as part of their personal battle on the front lines of healthcare, fighting one person at a time to keep their patients alive and healthy. Again please note that I am speaking for myself; I do not speak on behalf of CrossFit, Inc.

In order to begin to understand how to interpret this week’s events in the CrossFit world one must first understand and acknowledge that “CrossFit” is not an omnibus term that means or encompasses one single thing. Rather, CrossFit is and has always been three interrelated entities. It is first, and foremost, a fitness methodology. “Constantly varied functional movements performed at relatively high intensity” designed to enhance and increase fitness. “Fitness” in the CrossFit sense is further defined as “work capacity across broad time and modal domains”: how far can you move how much, how fast. Countless trees have been sacrificed and electrons unleashed in debating whether there is anything unique, or even new, about the first part, the methodology. I’ve long counted myself in the camp that the “how” of CrossFit the system is indeed different and new; very smart, kind and considerate people both agree and disagree with me on that, which is more than OK.

Defining fitness was arguably a true “first”, and in so doing Mr. Glassman created a platform of a sort. More than that, by defining fitness CrossFit created a way that fitness might be measured. The CrossFit “Curve” of fitness attributes theoretically gives us the opportunity to measure an individual’s level of fitness by calculating the “area under the curve”. While this has proven to be more challenging than originally thought, this measurement gave birth to the second of the three distinct entities under the CrossFit umbrella: The Sport of Fitness. If you can measure something you can turn it into a competition. With what can only be described as a barbecue at which a bunch of folks engaged in friendly games from the gym was born what we’ve come to know as The CrossFit Games (note: I foolishly turned down a personal invitation to attend, thereby missing what is arguably the most pure expression of the “CrossFit Community” before or since).

While my view of the Games and the “Gamesification” of CrossFit was originally quite contrarian (conventional stance: the Games did more to bring awareness to CF than anything before or since), it was clear to me that the emphasis on competition drove CF away from  what was clearly its early drive to improve health. Indeed, the loud introduction of the CrossFit definition of health (Fitness over time) was drowned out by all things “Games”. As far back as 2010 I publicly (here on my blog) and privately encouraged a re-dedication to the kind of fitness and health discussions and emphasis seen on the CrossFit Forum in the earlier days of CrossFit. The introduction of CrossFit for Health along with a seminar program specifically aimed at practicing physicians was a welcome pivot by CrossFit, Inc. back to its roots.

Which brings us to the third leg of the three-legged stool that is “CrossFit”: CrossFit, the business. CrossFit, Inc. is a combination of an educational business and an affiliate business in which independent gym owners pay a fee to use the “CrossFit” banner as a part of their brand. In return for a relatively modest fee (in comparison with franchise fees) a CrossFit affiliate is enabled to operate with rather minimal rules (in comparison with the franchise model) regarding the actual practice of “CrossFit” the fitness modality. CrossFit the business is a one-man shop when it comes to corporate direction. The face of CrossFit was, is, and will be Greg Glassman until such time as he decides otherwise.

Nothing that transpired this week is new or unique. Mr. Glassman marches to his own drum. More than that, once he has chosen his particular beat he pounds that drum loudly, regardless of how his audience responds. On occasion even his good intentions are drowned out by his drumming; it is often tone deaf and off-key, (if asked my bet is that he truly felt he was being supportive of protesters against racism). Many in the CrossFit universe feel that Mr. Glassman’s views on the national protests about racism and police brutality are flat-out wrong. Disappointment and anger are the public sentiments. A wish to separate from CrossFit expressed. This has happened before, albeit on issues much less global and at times when CrossFit was much tinier in all ways. Mr. Glassman is nothing if not consistent. When his views run counter to prevailing views he has typically doubled down rather than withdraw. I have never seen him back down, no matter how tiny the corner that he has backed into may become. Expecting anything different this week is as fruitful as expecting the sunrise to hold off because you got to bed a bit later than usual and need a few more hours of sleep.

And so, whither CrossFit? It is not my place to suggest to CrossFit, Inc. how it should proceed. It never was. Nor is it my place to suggest to any of you who might read my drivel how you should respond to what comes from Mr. Glassman or CrossFit, Inc. CrossFit, and Mr. Glassman, will address the issue of systemic racism and associated mistreatment of Black Americans by a faction of the police force, or they won’t. Both are incomprehensible to me, a middle-aged white man who has acknowledged (and written) about a lifetime free of the concerns of racism and the likelihood of harm at the hands of a police officer. Like white bread I am of no particular distinction in the eyes of those who would judge one by how one looks. I am bland; I don’t register. I can not empathize, I can only be as sympathetic as possible. And so, like most of White America I struggle with how to actionably express my dismay at such things. To in some way give not lip service but be of real, actionable service in the hard work necessary to effect change here.

As for CrossFit, my views on the gamesification of CrossFit (not a great thing) and the recent pivot back to emphasizing health (a good thing) have been consistent over many years now. CrossFit, the methodology is still, when followed according to its original spirit and intent (and perhaps even better,  how it has evolved in the hands of several OG’s no longer affiliated with CF), the best overall fitness program I have encountered in a lifetime of fitness and athletics. This is the part that I do want to suggest. Constantly varied functional movements performed at relatively high intensity following the progression of form, then consistency, and then intensity, is still transformative, especially if it is accompanied by a diet low in processed foods and sugar, also encouraged by the CrossFit modality. This is separate, and separable, from the business of CrossFit and the public (and private) missives of the founder and CEO of CrossFit, Inc.

Understanding what “CrossFit” is will hopefully assist you in evaluating what it means to you and how you will choose to interact with all three of the very distinct entities that in combination constitute “CrossFit”. One can simultaneously, honorably, both do and disavow “CrossFit”.

I’ll see you next week…

St. bingo of the Sweaty Angel (ret.)

Strategy in the Age of COVID-19: Just Assume You Are Wrong

“I” before “E” except after “C” and when sounding like “A” as in neighbor or weigh, and on weekends and holidays and throughout May, and you’ll always be wrong no matter what you say!!” –Brian Regan

Not surprisingly this came to mind as Beth and I were talking about the best, or right, or acceptable way to start to resume life outside of our houses. How to return to the office, go to the grocery store, visit a family member or a friend. Fantastically superistically smart people who spend their entire lives thinking about this kind of stuff haven’t been able to find even the tiniest kernel of agreement, and yet we poor intellectual peasants are out here picking at their intellectual crumbs as we try to do the right thing. Go out/stay in? Hug the grandchild or wave? Mask/no mask? You get the idea.

The issue of testing is a great example of the conundrum faced by both the intelligentsia and the hoi polloi. It’s not even as easy as test or don’t test. Nah, that’d be altogether too easy. You gotta decide which test. Do you have the virus now? 4, 5, maybe 6 tests to choose from, all of which are substandard when it comes to accuracy in a normal world. Which one do you choose? How many times must you be tested? How long between? Have you ever had the virus? Meh, same issues. All but the most recently pseudo-approved tests in both categories take days to return a result. Does it really matter, that result, after it’s been a couple or a few days? Is it better to choose a slightly less accurate test in order to get the result within minutes, or wait for a slightly more accurate result arriving soon come? Now decide if you should venture out based on your decision.

See? No matter what you do you’re wrong.

We have all lost sight, at least a super majority of our government officials and many of our non-governmental experts have lost sight, of what “flatten the curve” was meant to do. It all made so much more sense, and the resulting overshoot on stuff like saving PPE for the tip of the spear workers was more tolerable, when we had a clear mandate that could be graphed accurately: prevent the surge of infected individuals from flowing over the level at which our acute care facilities would run out of space and materials necessary to provide the highest levels of care. Easy. Easy to be right. There were no extrapolations necessary to see if you were succeeding; you used real data. The line below which you succeeded was a known number: ICU beds + respirators. Nowhere in the U.S. have we seen the tragedies of Lombardy where doctors had to decide who made it into the ICU and who did not. We saw the curve, we understood the curve, and we successfully flattened the curve.

So what’s been lost? It’s a little more difficult to understand the concept of the AREA under the curve. How many people either get sick with the virus or die from the virus. Very few of our experts showed the far right side of their graphs. Fewer still gave any explanation regarding the dirty little secret of “flattening the curve”: all you are doing is pushing out the infections and resultant deaths from the virus. Pushing them out further in time. Flattening the curve simply means that you are not having EXCESS deaths caused by insufficient acute care availability in an overwhelmed  system. Without either a vaccine to prevent infection or a medication that treats the virus such that people don’t die, the same absolute number of people will eventually become infected, same number of people will become sick, and the same number of people will die.

Let me say that again so that it is clear: flattening the curve saves only those excess lives lost to insufficient hospital resources during a surge. Over time it does not save lives unless a vaccine and/or treatment arises.

Once again, no matter what you do, just like “I” before “E”, if you persist in flattening the curve edicts you are wrong unless you have a hard arrival date for a vaccine or a treatment/cure. You see, lockdown policies such as those in place in much of the world now are not entirely benign when it comes to health. Or death. Lockdown policies that mandate isolation, especially those that make it difficult to take care of what would otherwise be well-controlled chronic medical problems, actually cause EXCESS deaths. How many? The cold reality is that not a single model is capable to telling us that. Or at least telling us with enough degree of certainty and accuracy that we could titrate the “flattening” policies in such a way that the EXCESS deaths caused by the lockdown are more tolerable to a society than the excess deaths caused by system overload. No flattening of the curve? Excess deaths from system overload. Extend the curve? Excess deaths caused by solitude, reduced access to typical medical care, and the well-known health effects of an economic recession or depression.

Are the experts saving lives by insisting on these draconian lockdown policies across the country? Sure. Today. They are saving the lives of those who would not survive a viral infection should they become infected today. Are these lives that will ultimately be saved from being ended by the virus entirely? As of today the answer is a resounding “No” despite the earnest pleas and declarations from the various governmental pulpits. Absent a vaccine or a treatment/cure the math is as inescapable as math can be: the area under the curve, flattened or not, remains the same if you look far enough to the right. Deaths from the virus will be equal over time.

The REAL curve, the one we’ve yet to see and the one we are unlikely to see from those same pulpits, is one that adds the deaths from the virus to the excess deaths caused by the lockdown policies. Preventable deaths from untreated or inadequately treated cardiac disease or cancer for example.  That curve will show that no matter what you do, at home or behind the desk where you sign the lockdown edict, you will be wrong. That’s what makes this all so discouraging for me. What makes it all so dark. You can’t be right. Like “I” before “, be it May or just any old today, no matter what you do you’ll be wrong. Literally the only thing that changes that is a vaccine or a cure, two highly elusive solutions, the  achievement of which historically takes years, not months. Only then does the curve flatten to zero. Only then can we say that lives in the absolute have been saved.

There is only one thing left now, and that is a vaccine or a cure. Whatever light remains in the shadow of the virus, it exists here. Will it be months as we’ve been told? Will this virus fall to a vaccine in months where prior scourges took years to defeat (HIV), while we still await victory over others (Ebola)?  We must all pray that in this one single instance the people who are leading us are not wrong. For if they are wrong, if the area under the curve is the same no matter what shape the curve takes, it will upon the souls of our Government, our elected and appointed leaders, that each excess lockdown death will weigh.

“I” before “E” as directed by “G” means that the weight of being right falls on them, not on you or me.

Sunday musings…5/17/2020

Sunday musings…

1) Lockdown 1. One of my annual meetings, some 15,000 typically in attendance. Cancelled weeks ago. Somehow they managed to transition the whole shebang to a virtual setup. How’d it go? No idea. After 8+ weeks of nothing but online Zoom-type “meetings” I just couldn’t make myself log on to yet another one no matter how many friends were watching.

Sasha took me for a walk instead.

2) Lockdown 2. “[F]acts and data are independent of your credentials.” Aaron Ginn

Some of the most educational (and educated) pieces on the corona virus have been published by a few of my ophthalmology colleagues. You read that right; the so-called “eye dentists” have done excellent work both fishing out interesting ideas for treatment and testing and assimilating available information to form some sort of coherent whole.

You may remember that the first doctor to sound the alarm in China was an ophthalmologist.

The point? There are all kinds of degreed and pedigreed experts who have been belittling and lambasting very smart people outside of their little professional circles for having the audacity to opine on facts that are available to anyone to parse. The possession of a degree or an appointment does not confer upon you an exclusive right to set policy, or advise those who set policy, in your area of study. It certainly doesn’t inoculate you from having your conclusions questioned by other smart folks who may see something different in the data.

Data are what they are. Ideas sprout from data. It is those ideas that should be addressed, not who it may be who proposes them. Lofty credentials do not entitle one to an exclusive on the ideas.

3) Leadership. Have you been watching the  epic 10-part series on the 6th NBA championship won by the Michael Jordan/Scottie Pippin Bulls? It’s fascinating for dozens of reasons, none the least of which is the insight we have gained into the leadership style of Jordan. MJ comes across in episodes 7 and 8 as, there’s really no way around this, kind of a jerk. He bullies, berates and belittles his teammates, pushing and pulling them to heights most of them were wholly unaware that they might reach. No one, it seems, was immune from his attacks, though they took on terrifically different forms when applied to different teammates.

We’ve seen this type of leadership before in otherwise lauded and revered leaders. Steve Jobs comes instantly to mind. Jobs was infamous for how badly he treated subordinates at all levels. His impatience with underlings who failed to deliver was matched only by the vigor and venom with which he made his displeasure known. Now you could surely say that Jordan spent his career in a perpetual zero sum setting; winning was the only acceptable outcome and there would only ever be one winner. Jobs, it should be noted treated every market his company entered as if it, too, was a zero sum game. It wasn’t enough to simply succeed, to be profitable. Nope. The goal was to win so completely that the competition left the game.

Was Jobs an asshole? During his career was Jordan? I have to admit that I simply don’t know enough about the rest of Job’s life, how he treated people who were not in his chain of command, to opine of his overall asshole quotient (though it is rather common knowledge that he was quite unkind to his daughter from his first marriage). Jordan, too, was private enough that one can’t really say what his non-winner life was like. Did he treat Bulls staffers (other than the GM) better than his teammates? The guy who parked his cars, did the laundry in the locker room, mopped the gym floor? If he did does that lower his asshole quotient? There are some who say that it was the naming of Bill Cartwright as co-captain that catalysed the dynasty. Does a toxic leader need a consoler to be effective?

One thing you can say about MJ and his leadership style is that there was no subterfuge involved.

4) Unlocked. We finally cracked. Just a tiny bit, but crack we did. Not being able to force myself to log on to a national meeting with my peers was the first little leak in the dyke. A couple of videos of the grandchildren we usually see several times a week and hadn’t for 6 or 7 days, the announcement that our closest friends here in town were moving. Yet another series of announcements that our “new normal” was going to be around for 18-24 months. It all just became too much. One tiny bit of good news–it turns out that asthma is not the high risk problem after extensive research–and we took stock of what it would mean to live for another year or two without a vaccine. In the end one must accept that up to 50% of our nation will contract the virus (though medical technology will inevitably reduce the % of people who die because of that).

Without putting others at risk the question one must now ask is what part of your life, which of your loved ones can you accept the risk of seeing because not seeing them is more a case of not dying rather than living?

All around us similar cracks are opening up for similar reasons. Mind you, this is not “we love to go out to dinner” so we’re putting ourselves out there to visit our favorite restaurants. No, as much as I pine for Veal Picatta served with a side of smiling snark on “Tina Tuesday” at one of our locals, this is much more personal. As close to need as can be. This is about seeing our children and their spouses, even if it’s 6 feet away, instead of viewing them on FaceTime. It’s a running, jumping hug from my Man Cub and a kiss on the cheek from his sister the Pipsqueak. A very special bottle of wine, 22 years in the waiting, shared across a ludicrously huge table for only four people, but around a real table pouring from the same bottle with cherished friends. No hugs or handshake there, but THERE.

There is an energy that exists in love extended and received in person, even if in person means 6 feet apart, maybe even a mask or face shield. That energy is real, and at some point being walled off from that energy is to be walled off from what it means to be alive. In no way am I telling anyone what it means for them to feel alive. It would be unforgivably presumptuous to tell anyone that they cannot live behind an impenetrable curtain of seclusion, or which of their people they can accept as so essential to living that being with them may be the source of acquiring the virus.

We may escape an interminable pandemic. A vaccine may be on the way along with all of the other blessings we each receive. Until then we must accept that we each have a responsibility to protect our fellow travelers from whatever risk we might personally represent. For ourselves we will all eventually need to come to terms with what it means for us to be living, and who it is we need to have along with us as we do.

“The Last Word” Credit: Men’s Journal

Anyone who knows me well knows that one of my very favorite drinks is called “The Last Word”. It’s also a huge source of frustration because so few bars, however hifalutin and pretentious, can make a decent one. But this is not an essay on drinking. Far from it. “The Last Word” is the running series on the last page of each issue of Men’s Journal in which an older male celebrity is asked to answer a series of questions about life. There’s nothing particularly unique or imaginative about either the endeavor or the questions asked. Still, it makes me think, and I thought it might be a fun thing for us to think about together.

Herewith, the most frequently asked questions. I’ll offer up my own answers in a follow-up post. Perhaps you might answer either here in the comments, on Facebook, or somewhere else I might find you.

 

Who were your heroes growing up?

What is the best advice you ever received and from whom?

Who had the biggest influence on you when you were younger?

Was there a life-changing book you read? Movie you saw? Adventure you had?

What is the trait you most admire in other people? Least admire?

How should one handle getting older (if you are, indeed, older)?

How should one handle criticism?

If you could select the guests for your dream dinner party, attendees living or dead, who would you invite?

Do you have any advice you’d like to have given to your younger self?

How do you want to be remembered?

 

There’s a whole lotta ground you could cover there. Pick a few or pick ’em all. No rules here, just an opportunity to take a little stock, draw a few lines in the sand, look both forward and back. Write it down somewhere I might see it. Or not. Incorrigible naval-gazing bloviators like yours truly might turn each question into a an essay of its own, filling pages in the process. The poets among us will tell epic tales using fewer word than a Haiku.

That’s all part of the fun, eh?

 

 

 

 

Friendship in the Time of Corona

In a gentler time Beth and I were out to dinner with another couple. Mutual friends came up in conversation. They’d moved away a couple of years prior. Moved a couple of times, actually. “Have you heard from so-and-so?” “No. You?” “Uh uh.” “Huh. That’s funny. We thought maybe it was just us.” “Yah, I call every now and again. Text every so often. Crickets.” In an odd way it felt a bit better, for all four of us, that we weren’t the only ones who’d been left behind, as it were. Better, but still a bit sad and still a bit hurt. While we’ve all been home these many weeks we’ve thought about friends from the past. The longer our isolation goes the further back in the past we seem to go. Wondering, where did our friendship go.

Friendship is a bit of a journey. That’s not really news, though the journey evolves not only as one gets older but also in relation to societal evolution. T’was a time when the maintenance of a friendship forged on the battlefields of youth was almost expected to fade away, with only the faintest embers of memories still burning. It was natural. Common to the point of being expected, especially if friends moved far afield.

In order to keep the fires of friendship burning you need to stoke them. We marvel at the long-distance friendships of our forebears, brought to light in the letters they sent to one another. Can you imagine? Friendship maintained at the whim of the postal service? And yet, maintain they did, at least those friendships that were meaningful enough to make the effort. The dawn of the telephone age made it somewhat easier to do this, but expense was a barrier often too high to surmount, trumping the immediacy and intimacy of hearing a friend’s voice.

Friendships at the mercy of distance and time were friendships most often destined to become little more than memories.

Ah, but the world is so very different now. We have, each of us, a device that allows us to talk to anyone we have ever known, right now, for pennies. A text can be sent with an effort so trivial that we have laws to regulate when we should know better than to fire one off. As if that’s not quite enough, Facebook and Twitter are there for the asking, and the original “reach out and touch someone” revolution that is email will alert you when someone has messaged you on either of them. And now, in the age of Corona, we have all learned how to use Zoom. It is now so easy, the effort necessary to remain in contact is now so minimal, that what it means to stoke the flames of friendship has been turned on its head. Along the way it seems that our expectations of what will become of our friendships has changed as well.

We will have to re-order that, I think.

Beth and I have a number of friends with whom we shared many, many things, who have moved away from the little burg we call home. In truth, most were little more than friendly acquaintances, people with whom we were thrown together because of stage of life stuff like schools or sports or jobs. “Moving away” for these friendships is simply another way of saying the calendar has flipped, and these fade just like friendships in the days of the Pony Express. That’s OK, too; they are meant to fade because they weren’t really friends, people in whom you confided, people who confided in you, counted on you. They were “friendlies”.

Our new world of easy access to one another changes how we feel about people we really did consider friends if and when they move away. It takes only time, well, time and desire, to stay in touch. To stay friends. Ah…there’s the rub, eh? It’s so easy now–no hoping that they will pick up the phone, return the voicemail, reply to the email/text/PM/jump on Zoom or Facetime–that our expectations have changed. That resignation inherent in the historical timeline of all but the deepest, most meaningful friendships has been replaced with some kind of new expectation that we don’t have to let go, let the friendship go, simply because someone has gone somewhere else.

And it hurts, doesn’t it, when friends who were friends in person make it clear that moving away is actually just the same today as it was in the days of the letter and the rotary dial telephone. All but the truest of friends move on, and what we have now is not a gentle resignation and wistful sadness about our mutual loss, but rather a more acute and personal type, especially if we’d decided that the friendship had been worth the effort necessary to keep the fire burning. Moving means we are no longer friends. It is only natural to wonder, then, if we ever really were.

There’s a story here, of course, from days long before the Pandemic, but I won’t trouble you with it. You’ve got one too I’ll bet; only the details are different. There’s also a lesson I think, one that is grounded in the wisdom of yesteryear. Our world has changed in ways that were unimaginable to our parents and grandparents. Heck, even my Mom is now on Facebook (yikes!) and has participated in group FaceTime visits with her children and their spouses. Friendship, however, has not. It doesn’t matter even a little bit that it takes so little effort to connect in today’s world. What matters now is the same as what mattered when connecting meant eagle feathers and inkwells: having a friendship that was meaningful enough to make the effort. Friends reach out, and they reach back when you reach out, whatever reaching means on any given day in any given era. Friendship requires effort, and the effort required is most often more than can be mustered to carry a friendship over a lifetime. The arc of a friendship still ends most often as nothing more than warm memories, like the tiny embers of even the most magnificent bonfire in a dawn to come. Slowly, but ever so surely, only the memory of warmth remains.

We are all happier when we accept that most of our friendships will still be like this. Lucky are we if we have even a single friend who feels just the same about our friendship, whether we stoke our fire face-to-face,  side by side, or cross-country. Friendship was, is, and will always be about the desire to remain friends, not how easy it might be to express that desire. Remember this, and we steel ourselves a bit more against the sadness of a friendship which has been lost to time and distance.

Remember this, and we can still allow ourselves to be warmed by the memories that remain of the friendship that once was.

Mark Twain and Memory

“I used to remember everything, but now I only remember the things that never happened.” –Mark Twain.

Twain never disappoints, does he? There’s all kinds of meat on that bone. Is he saying that he no longer remembers things that really happened, only those things he imagined at the time, or imagines now? Or is he rather saying that looking back on his life he only remembers those things that SHOULD have happened, but didn’t?

Knowing Twain, my bet is that his answer would be:”yes.”

Memory is a funny thing. Partly accurate reportage, one’s memory is leavened by equal parts wishful thinking and regret. At least according to Twain. Think of your own narrative, the telling of your story. How much is fact, how much is embellishment (never let the facts interfere with a good story!), and how much is what you wish had happened? We were telling stories at dinner the other night, stories we all knew, ones we’d all taken part in creating and ones we’ve told countless times. Each time they are told they get a little better. Does this happen with you? Some of the stuff in our stories probably never really happened, but we remember it just the same.

But Twain also touches on regret in this quote, don’t you think? Things that could have been, or should have been, but for one reason or another, never were. Dangerous ground, that. Regret can turn the urn of happiness into a sieve. In his later years Twain was said to be increasingly bitter. One wonders if his regret fertilized the weeds in the garden of his memory.

Ticking time bomb, or soothing balm over time. Memory serves.

High Standards

A helpful thought as I prepare to reengage as a practicing physician and surgeon, opening my office and welcoming both my staff and patients.
There will doubtless be plenty of folks with an opinion of what I do and how I get it done. Here is a re-post of how I will try to carry myself.

 

“When you go out that front door be the best version of you that you can possibly be.” Lisa F., MD.

My good friend and colleague Lisa says this to her son when he leaves the house each day, but this is applicable to each and every one of us every one of our days. Whether you are a kid trying out different versions of who you are while eating breakfast, or a fully formed adult off to work, what better goal can one have than to be your very best you?

“I have such high standards for myself, and I’m so hard on myself because of that, I have no room inside left over for someone to come in and judge me.” Again, Lisa F., M.D.

I think this is really, really important. There is a subset of humanity that just simply holds itself to an unimaginably high standard. They feel that they must not only do more, but they must do it best. Because of this they are frankly harder on themselves than is really fair. Indeed, if they saw someone berating another person the way their internal voice talks to them they would probably lead an intervention. It probably doesn’t matter what you do, there are people in your world who wake up every day knowing that they have set nearly impossible goals for themselves.

What sets my friend Lisa apart is her incredibly healthy ability to realize that she is already under the burden of living up to nearly unachievable standards, and that the outcomes she seeks are often outlandishly ambitious. Because of that she need not surrender to the tyranny of someone else’s opinion, “what they think of [her]”. Now to be sure Lisa is of unassailable character and moral fiber; such an approach is not healthy if utilized by a narcissist, for example. Nor does it mean that she is incapable of seeking advice or learning from another. No, what she is able to do is pre-forgive herself when her best effort may not reach her own very high standard, and thus inoculate herself against uninvited external judgement.

This is a powerful lesson for anyone who sincerely gives their best when they walk out that front door.

Funny, whether you are attending a medical conference or a CrossFit seminar, sometimes the most powerful, actionable, and lasting lessons are not necessarily those that are taught from the podium. Be always and ever open to all of the learning available to you. Hat tip to my friend Lisa for being my teacher today.

Contact Tracing: Lessons from the AIDS Era for Our World Today

“Harvey told me to find a bow tie for a preppy. I hope you like it. Thank you for taking care of him. He really liked you.” –Mrs. K. May, 1987.

90,000 died in the U.S. 90,000 Americans died of AIDS before life-saving treatments became available. First it was gay men, then people who were addicted to injectable drugs who shared needles, and finally people requiring transfusions who were unknowingly infected by blood contaminated blood products. All from a novel virus that seems to have “jumped” to humans from another primate. 100% mortality.

90,000.

Now to be sure, AIDS is a manageable chronic diseases treatable with a pill in the U.S. (and most developed countries), but it still kills–what?–a million people worldwide. Some of that is due to a lack of access to a diagnosis, and in those 3rd world countries where the diagnosis can be made there is a lack of access for a number of reasons to the effective treatments. In those cases AIDS is still 100% fatal. If a diagnosis can be made an AIDS “hotspot” can be cooled, if not extinguished, through a variation of something we are now all becoming quite aware of, contact tracing and physical distancing. Sadly, in many of those 3rd world countries where AIDS is still endemic, these very basic public health interventions contravene unalterable societal norms and culture; the virus spreads and people die.

What does this have to do with us today as we address a new, novel virus that as of yet has neither cure nor medical prevention in the way of vaccine? I’d like to share a little history from the earliest days of the AIDS crisis in America, and a little story about my own experience as a young doctor just starting my career in medicine. Let me first be very clear about my place in that history. I am a straight, cis, white male born at the tale end of the Boomer generation. At no time in my life have I felt the sting of real discrimination based on either something I am, or something I am presumed to be based on what I look like, what I do, or who I am (my father did face discrimination as a Catholic, something which was largely a historical remnant but the time I came of age). As such my story and my thoughts about both what it meant to be gay in the 80’s and the possible impact of contact tracing in an epidemic or pandemic are sympathetic, based on observation, only.

Looking back my first encounter with anyone I could say I knew was gay was in the first week or so of my freshman year in college. The phone rang in my dorm room (landline, rotary dial, no caller ID), and the caller addressed me by name and asked if I was gay. As I recall I laughed a little, thanked him for asking, and said that no, I liked girls. That was it. He said thanks and hung up. Now of course as a child of the 60’s and 70’s I had most certainly come across many gay men by the time I’d made it to college, I was just clueless to this fact. There was a teacher in high school who was “outed” by a couple of kids from school after I graduated; they saw him coming out of a gay bar in Providence one night. That was pretty much it.

For the most part I just ignored the fact that there were gay men (and looking back, women, of course). Without really thinking about it I guess I figured that if I was indifferent to this part of my college mates’ lives then pretty much everyone else must be, too. It never dawned on me that being gay might have very real, very serious consequences when it came to very normal stuff like getting a job. I was totally clueless, in reality to most things that didn’t have any direct impact on stuff happening inside my own personal little navel-gazing bubble. Like everyone I kinda knew who might be gay, but again, I was indifferent. Even during a year when what it meant to be gay on campus was the year’s issue the only time I really paid attention was when one gay male student was interviewed on the college radio station about being attacked for being gay by a fellow student chasing him with a machete. And only then because the machete-wielding student was one of my close friends taking out his anger at being dumped by a girlfriend by swinging his sword at the squirrels along the driveway.

For the record neither the shaken (but mistaken) young man nor a single squirrel was harmed in the “attack”.

And then came AIDS. Those of us of a certain age recall that the initial publication was titled something along the lines of “Acquired Immunodeficiency in Homosexual Males”, I think first in JAMA if memory serves. I remember reading it in the med school library. Heck, I may not have even been out of the classroom yet. My presentation at the conclusion of one of my “away” rotations in ophthalmology was on the ophthalmic manifestations of this disease, soon to be re-named AIDS. As an aside I wrote that hemorrhages and focal areas of ischemia (cotton wool spots) were the signature signs of the disease, a statement that was shot down as incorrect by the retinal attending in the room. Turns out that I was technically right; hemorrhages and cotton wool spots DO result from HIV, while the entities that the professor pointed out were actually secondary opportunistic diseases. During my residency at NYU/Bellevue 50% of the inpatients on the medical floors would have full-blown AIDS. Every resident would become an expert in all things AIDS-related in and around the eye.

But it was in my internship in medicine at Rhode Island Hospital (RIH, a Brown University affiliate) that I would learn what it meant to be a gay man in America in the 70’s and 80’s. There were very few AIDS patients on the floors at RIH in the summer of 1986. I had one very special patient, Harvey K, who was on my service each time he was admitted that year. Openly gay, Harvey had been one of the earliest activists in the gay community, speaking out initially on issues of discrimination in general, and then as his life was upended by AIDS, speaking out while he could on the plague that had descended on his community. Harvey was unfailingly kind, generous, and understanding of his rather unworldly intern, cloistered as I was in my cis-straight world. He answered all my questions about what it was like to be a gay man in those days; he was  brutally honest about everything, including some of the activities that  led to rapid spread of HIV from a relatively small number of initial individuals who harbored the virus but did not yet have the disease.

This is the part of what Harvey taught me that applies, at least superficially, with where we are today. In its earliest phases AIDS was a disease transmitted almost entirely through sexual contact. Public health strategies to address this kind of disease propagation had been pretty standard for decades by the time AIDS arrived. Once a diagnosis was made a detailed list of contacts was then assembled. These people were in turn tested to see if they had the disease, were treated, and their contacts were similarly identified for follow-up. Similar tactics were used in the early days of TB as well, even though TB (unlike diseases transmitted by sexual contact) was not as easily and successfully treated with antibiotics. Harvey gently pointed out that yes, contact tracing could indeed prevent an infected individual from passing on the virus, and it could also alert his contacts that they were at risk to acquire the disease. The disease was fatal, but that was only one part of the issue.

Since only one small segment of society was affected AIDS at that time, being identified as a contact meant being identified as being gay.

Remember, this was in a time when being identified as a gay man had very real consequences. Not only could it affect your employment, but it is reasonable to say that the majority of gay men were not “out”, either publicly or privately. Nearly every major religion openly rejected these individuals, and more than half of the states in the U.S. still had laws on the books essentially making it illegal to be gay. One of the very first protest movements organized by the new gay activist organizations was to stop AIDS contact tracing before it started. As a newly minted physician, enthralled with science and quite sure that standard public health initiatives were mandatory to treat this new epidemic, it was left to my patient Harvey to teach me about the reality of large-scale medical intervention on vulnerable populations.

As we fast forward to our world in these days of the Corona virus and the varying degrees of societal “treatment” applied at the federal and state levels it is first necessary to be very clear that being told that you cannot go to work if you had contact with someone who is  test positive is not the same as being told that you have been in contact with someone who had AIDS in the 80’s. Not by at least one or two orders of magnitude, not. That’s kinda like saying being Catholic in the 70’s was the same as being Black. Again, not the same.

But one thing that Harvey taught me is the same. People who are in the contact strand are afraid of more than just the disease itself. They are also afraid of what having the disease, or even being associated with the disease will do to their life. Will they be able to go to work? Feed their family? Whether or not they do get the disease will someone tell them who they can see, where they can go, and what they can do? For better or for worse there are an awful lot of misunderstandings about COVID just like there were about AIDS. If they are are identified as a possible COVID risk will people think differently about them? Remember, unlike the gay men of the 70’s and 80’s who had decades to thicken their skin and steel their psyche against these kinds of feelings, the people who will be tracked now (most without the knowledge that they are being tracked, or have triggered a tracking tract) are experiencing this for the very first time.

Again, the true consequences are small, one or two orders of magnitude less than that faced by gay men in the earliest days of AIDS. But I’m sure that Harvey, as gentle and kind and understanding as he was despite his reputation as a fiercely powerful activist before he became ill, I’m sure Harvey would suggest that we seek to understand why people may rebel against contact tracing today. Just as surely as he would then go on to teach anyone who would listen (and eventually those who came after Harvey taught everyone to listen), that this is different. That we do not have the same concerns that Harvey and his friends did back then. While we can certainly discuss how it would be done and how consent would be given, Harvey would say that in this instance the population that is vulnerable will only be helped by “by the book” public health measures.

Harvey and I became friends of a sort. He needed some really terrible things done to him while he was in the hospital and forgave me each time I had to do one of them. I spent a lot of time just hanging out with him when I was on call. He was very, very smart, and every story he told was one that I would never have heard in my life to that point. As I said above, he was very understanding and kind. I’ve written many times that I’ve tried to live a life without regrets, never looking back at decisions and wishing that I’d done something differently lest my life be altered today by that change long ago. You know, the Butterfly Effect. When Harvey was discharged for what we both knew would be the last time I told him that I wouldn’t visit him at home; I wanted to remember him as he was that day. Still handsome. Smiling. Well enough to be happy he was leaving. I told him I didn’t want my last image to be what we both knew was coming. In retrospect I wish I’d had more courage, for I’d very much have liked more time with Harvey. I know I shook his hand, but I can’t remember if I hugged him.

I still have the tie.