Random Thoughts from a Restless Mind

Dr. Darrell White's Personal Blog

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“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…

 

A Common Experience With Uncommon Disease

It really makes no sense. No sense at all. I live in a city that can be described as a mid-major, sure, but it happens to be a city that has a major league medical community anchored by two large research centers. Three if you happen to have a pediatric disease. And yet, with all of our local resources it can be absolutely maddening if you have a relatively rare disease, an unusual presentation of a common affliction, or if you happen to need highly specialized care at even the most mildly inconvenient time. There is a rent  in the very fabric of our medical system, the part of the general healthcare system where actual medical care is delivered to real, live patients by doctors and nurses and the like.

One of the main selling points of the Accountable Care Act was that it would encourage the creation of large vertically integrated organizations that would be so efficient that they would provide medical care to people with greater convenience at a lower cost. In reality, not so much. Where once a patient would call an operator sitting at the front desk of her doctor’s office to make an appointment, one now calls a large center that resembles the kind of place you call when you have a problem with your credit card. Your operator has no idea what’s going on in the office, and she has all kinds of rules that are in effect barriers to seeing the doctor. If you have an emergency there is only one answer allowed: go the emergency room.

Neither convenient nor cost effective, that.

What happens when you have a rare, unusual, or complex problem is even more maddening. Once upon a time institutions like the Mayo Clinic, Cleveland Clinic, and Cedars Sinai were willing recipients of referrals from doctors in the community (or from within their system) who had the very hardest medical challenges. Indeed, in my recollection that’s all they really wanted to see. They were so busy making brilliant diagnoses in the most confusing medical cases, and performing brilliant surgeries on the most difficult and rare diseases that they had no time to see the common, mundane diseases that make up the overwhelming majority of what most doctors see in their offices and the OR. More than that the doctors at these medical meccas were simply thrilled to have your referral if you, like me, were someone who saw the masses. The great professors were available 24/7/365.

Now? Not so much. The age of the Accountable Care Organization (ACO) is the age of the institution. What was billed as a program meant to return the patient to the center of the care experience has actually driven the patient to the bottom of the org chart. Where once the patient was truly the focus the most accurate description of the priority cascade is now institution (administration) -> government -> payer (insurance) -> doctor -> support staff -> patient. With few exceptions there is no such thing as A PATIENT; institutions (and payers, etc.) talk only about PATIENTS. Like customers at Target. An omnibus group to be assessed en masse, with conclusions drawn and then applied to a population, not a patient.

This works I suppose, at least it sorta works from a medical standpoint, if you are a patient who has a common problem that fits in the middle of the Bell Curve of presentations. Where once these vaunted institutions were staffed by a small cadre of truly elite practitioners, nothing but Generals and Colonels, there is now an army of  privates and corporals marching in lockstep. Like an army they are fed by a massive infrastructure that is unseen and uninvestigated, punching in and punching out, their output measured as precisely as that of a manufacturing company staffed run by a Six Sigma star chamber. But what if you, the patient or the parent of a patient, fall outside the limits of the Bell Curve? What if you are like the patients who used to constitute nearly the entire population of patients at what used to be called tertiary care institutions?

Let me tell you a couple of stories that seem to be representative of the law of unintended consequences. Unintended, that is, if we are being charitable.

While I was out of town last weekend one of my associates saw a patient in the office who we had inherited from one of the larger institutions in town. Inherited, that is, when our patients family had become exasperated by the barriers placed between them and the care they needed, especially when there were acute issues to be addressed. Although we are not a “mecca” our group is really very good, able to handle levels of complexity that are beyond the scope of a typical specialty practice in the community. Nonetheless, there are circumstances where care should be provided in a super-specialty setting, and such was the case for this poor patient. My associate was rebuffed by both institutions, never able to get by the second level of “civilian” phone bureaucracy at either institution to even discuss the case with a physician. One offered a visit at an associated local ER (with no specialty coverage), and the other refused to even offer that since our patient had once been seen in the other institution and was therefore “their” patient. When I intervened I did speak to an on call specialist who agreed to have our patient seen by their onsite (general) ER. I arranged care with a private subspecialty group.

Our patient got the care they needed because I have 30+ years of experience, and I have contacts I’ve built up along the way that I can call on in a pinch. What if you are a patient, or the parent of a patient, who needs something unusual, out of the ordinary, even if you don’t need it on an emergent basis? One need only look at the evolution of disease support groups on various social media platforms to understand the scope and character of the difficulty that this population faces when they need specialty care. Let me use our little family as an example (my son and daughter-in-law have been very open about their experience).

A child has a number of small but not inconsequential medical issues that don’t seem to be related, but there are just one or two too many to just chalk up to being a “little behind”. Mother and grandmother share their concern with the family doctor who agrees, but admits that it’s just a bit beyond their scope of practice. Mother used her considerable Google-Fu and discovered that there is a medical condition that explains everything that is going on, and she has spent some time in an online support group learning about it. She  has convinced both grandmother and family doctor that a rather rare but well-known entity is possible, so the family doctor arranges for the proper specialty consultation. The specialist agrees and orders the standard test, an MRI, and all hope for a quick confirmation so that a solution can be found.

So far, so good, right? A process that’s a little slow, but a process moving forward. Once the MRI confirms the diagnosis we will surely find an expert to do the surgery since we live in an area with not one, not two, but three world famous children’s hospital. Even if the MRI is equivocal the support group members assure our little family that the existence of the “occult” or hidden version of this condition is well known enough that we will be able to move forward locally. Until, you guessed it, the MRI was read by the infantry as “normal”, and the specialty surgeons declined to even see the little patient.

Mecca was closed.

In the age of the ACO this is such a common occurrence that the support group could not have been more blasé in its response. A dozen or more moms chimed in with carbon copy stories of large, prestigious institutions that no longer looked beyond one or two standard deviations from the mean. What has replaced the tightly nit and interwoven physician networks of trust in which a dogged pursuit by the family physician would carve a path to the necessary super specialist is the online support group. Where once a single doc could move the needle there was now a hive of collective knowledge and experience that sought out and then supported those few specialists who practice as if they were back in the era of the giants. And so it was that our little patient traveled from Cleveland, home to three world famous children’s hospitals, to Providence and the surgeon who would go on to confirm the diagnosis and perform the surgery that would lead to a cure.

What does it say about a healthcare system that has dismantled  the institutions that once cared only for the most complex and complicated medical problems, as our little patient experienced? It turns out that the MRI was misread; the diagnosis was obvious to the Rhode Island surgeon, and easily seen by mother and grandmother once it was pointed out. What does it say about division heads who are so consumed with acquiring market share in the most basic areas of a specialty or service that they allow the growth of a culture that is built around turning away these challenging problems at the door, as my patient experienced? Volume and margin have triumphed over the miracles that we once came to expect from great medical institutions.

What happens to the patient who doesn’t have an old, connected doc willing to get on the phone to find the right place and the right care? Or the child who doesn’t have a mother or grandmother who will doggedly pursue the diagnosis and care that was once pursued on their behalf as a matter of pride, a matter of course? What happens when Dr. House is too busy doing cash-pay executive physicals to see the patient he was trained to save?

Tiny Cultural Collisions

I just returned home from the largest of the annual ophthalmology meetings. At these gatherings I see my professional friends, and some 35,000 or so of us descend upon whatever city we are visiting. We bring all manner of customs and culture along with us, there to collide with those of the locals. Here is what I wrote about this a few years ago, still relevant today.

It takes very little effort to observe the intersection of cultural norms. Indeed, it takes a substantial effort NOT to notice them when they collide, as they must, in the polyglot that is the United States. Physicians, it’s been noted, are little more than paid observers; I see these collisions daily. What are we to do when cultures collide?

Now, I’m not talking about the “old as eternity” cultural divide between teenagers and their parents; in the end the teens will either hew closely to the cultural norms of their heritage or fall more in line with those of their present address. What I am interested in are those cultural norms that remain an integral part of the fully formed adult one might encounter in a rather typical day, and by extension whether and how one should respond to any cultural dissonance. Or for that matter, WHO should be the one to respond.

It’s the tiny ones that catch my attention. Personal space for example. The typical American personal space extends one arm length between individuals. Something shorter than a handshake, more like a handshake distance with bent elbows. The Mediterranean space involves an elbow, too: put your hand on your shoulder and point your elbow to the front and you have measured the personal space of a Sicilian. Asians on the other hand occupy a much larger personal space that can be loosely measured by a fully extended fist-bump. Something which would be anathema in polite Japanese company, but no matter.

My favorite little example of the variety of cultural norms that swirl in the soup of the great Melting Pot is the affectionate greeting. You know, what most fully acclimatized Americans would recognize as the “bro hug” shoulder bump and clasp, something that would be appalling to a Parisian or Persian, or indeed even to a Princess of the Antebellum South. Yet even here there are differences. The Princess, joined by legions of Housewives of Wherever and Junior Leaguers everywhere are ninjas in the practice of the single-cheek air kiss. It should be noted that ~90% of men are NOT ninjas in this particular art, and are expected by its practitioners to bungle the act.

Persians and Parisians, on the other hand, find the one-cheek air kiss to accomplish only half the job. They, and others who share centuries old cultures, warmly greet each other with a two-cheek kiss. I am sure that there are nuances involved here that remain unseen and unknown to both most men and certainly most (all?) who don’t share the heritage. (As an aside let me just say that I am a huge fan of this particular cultural norm because it means that two of my very favorite colleagues, Neda and Carol, always arrive bearing TWO kisses).

So what’s the point here? Two, I think. First, there is a certain boorishness in the failure to observe and recognize the existence of these cultural norms when they are encountered. Some, like those I’ve mentioned, are the relative equivalent of a soft breeze, neither strong enough to fill a sail nor de-leaf a tree. Recognizing them, even in the tiny manner that one tries not to trample on them even if they will be ignored, is a tiny gesture of kindness, respect, and courtesy.

The flip side, number two, is deciding which of these norms is the default setting. Here things get a bit stickier, especially when cultural norms run afoul of SOP on the particular ground they occupy. Think air kiss in Afghanistan, for example. Bowing in the boardroom of Samsung in San Clemente. There are more, and bigger examples, but you get the idea. Here I think geography holds the trump card: “when in Rome” should be your guide, especially with cultural norms where the collision may be substantially more impactful than whether or when you turn the other cheek, a tornado to the above tickling breeze.

Perhaps we could all agree on the two-cheek greeting thing.

In Memoriam: Abby, the Wonder Dog

In Memoriam: Abby the Wonder Dog

This morning I was awakened by a text from Beth: “Call when you can.” That’s almost never good, and today was no exception. My beautiful, brilliant dog Abby had died. A tumor was wrapped around a major artery; there was nothing to do but comfort and love her after the artery burst. She died in her Mamma’s arms as my son Randy gently stroked her head.

May I tell you her story?

My older boy, Dan, shared an apartment with two friends and a very cool Border Collie named Dakota. When Tommy and Megan moved on Dakota went with them, leaving a hole in Dan’s heart that could only be filled by another dog. Did you know that farmers in central Ohio who raise working dogs don’t always spay or neuter their packs? Neither did we. While I don’t know how extensive this next part is, at least some of the pups that are not needed to work the farms are simply turned out onto the land to fend for themselves. It’s enough of a thing that there is an animal rescue in Tiffin, Ohio dedicated solely to these “extras” from the litters.

Abby and her sister were feral for the first 6 months of their lives. After being live-trapped they were brought to the Border Collie/Australian Shepherd rescue where Dan somehow discovered Abby’s picture. There must have been 3 dozen dogs in crates and running in outdoor pens when we arrived to see if they would let us adopt one. It was funny. We had to audition for the staff. They brought out 6 or 7 other dogs to see how we would handle them before finally bringing Abby out of her crate.

Abby, who promptly came right over and climbed simultaneously into Dan’s lap and all of our hearts.

Herding dogs like Abby, part Border Collie and part Aussie, are rightly famous for their intellect and their energy. Having one of these without a farm to run them is a special kind of crazy. As a college junior Dan’s apartment was hardly expansive enough to contain her energy. Was it boredom or anxiety that prompted her to tear the carpet in the apartment and eat down through the subfloor while he was in class? She never said, but shortly after her “redecorating” she came for her first extended stay with Mom and Dad.

We had quite the little pack, Beth and I. Haddie our English Setter was like Nana in “Peter Pan”, mothering dogs, children, and adults alike. Tiny Tim arrived looking more than a bit like a Beanie Baby, so tiny and fragile, velcroed to Beth’s side. And then Abby arrived, all energy and curiosity and mischief. Even with her canine buddies there was still something about being without her people that made her crazy. Nothing on a counter or in a closet was safe from her when we were out.

I’ve told most of these stories before. Like the time she ate about $200 in petty cash from the office. Pretty interesting poops in the backyard after that as you can imagine. The very best one was when she “ate my homework”. We’d gone out to dinner and apparently I didn’t put my surgical sheets for the next day’s cases far enough back on the counter. If that’s all it was I could have run up to the office and simply run off new copies. Nope. As it turned out I was also transporting a couple of special order lens implants from one surgery center to another. Implants for which one of my patients had paid about $1500. Oh yeah, Abby ate those, too. That was a pretty weird phone call, telling my patient why I was cancelling their surgery at 9:00 PM the night before. The OR staff still talks about that one.

Abby never really lost a kind of wariness around new people. It was there with all of us (except Dan) at the rescue and remained after she came to live with Beth and me while Dan was doing lots of traveling as he completed his studies. There’s a lovely fellow who worked for the boys at their gym who Abby never warmed to; he sent us a very nice condolence in which he shared that this had always made him sad. Beth and I had just one worry, that she would be skittish around little ones like grandchildren. No worries there. I will forever see her lying close to her newest littlest people, totally unperturbed as they tumbled on top on her in their travels.

Or the tiny little “drive-by” kisses, soft little licks she gave Landon or Lila or McKenna on her way by. Yes, those…those I will see through my tears forever.

Abby loved us from the minute she chose Dan right up until she died. The last thing she saw on this earth was her people Mom, Beth, and her little brother Randy. I’m still not sure if it was better to be away or not. All I know is that I loved my dog, and that the very last thing I did when I left the house last week before my travels began was to reach down, scratch her ears and tell her. For all of my sorrow I wouldn’t trade our years together for anything.

Fair winds on this last journey Abby, your sails full with the winds of my love. I did so love being your person.

Musings on When a Game Became “The Game”

Here is an update to an essay from a couple of years ago. I read it today, on a Saturday afternoon, when I will once again not be watching football.

 

Randy texted me about the exciting finish to the ND NCAA football game. Dan called and asked if I was watching the Browns. It made me smile. Not the result, not even the topic, but the excitement. A parent is only as happy as his least happy kid, and at those moments two of my kids was very happy. My sons football playing days are long behind them, but the game still brings them joy.

Me? Not so much.

Oh sure, there was a time when football never seemed to be any lower on my list of wonderful things than 2 or 3. I was a medium-sized fish in a puddle as a high school football player, but I didn’t have the game out of my system when I graduated. Accepted at one Ivy League school and waitlisted at another, I turned down both because I was too small to have any chance of playing football at that level. Instead I went to a very old, very small school and played a bit all 4 years. Now done as a player I was nonetheless still enthralled by all other things football.

Many of my closest friends were met on the freshly cut football fields of my youth. Wins and losses followed on those fields, most of which I’ve long forgotten. Indeed, I’ve written before that it is only the losses I remember, especially those that resulted from some personal failure in a game. A fumble, perhaps, or a blown coverage. And yet there is no escaping the fact that those countless hours at practice, in the locker room, and on the field are in large part responsible for who I am, the adult I’ve become.

It’s a powerful thing, football. The game itself is exhilarating to both play and watch. At least, it was. I find myself finding all kinds of reasons not to watch football games now. Not consciously finding “big picture” reasons so much as tiny reasons, like Beth wants me to tag along to the barn, or Abbie the world’s smartest (and most easily bored) dog would like an adventure kind of reasons. Football of all sorts played at any and all levels has sunken to a kind of triviality, easily trumped by a trip to the grocery store.

No one thing is responsible for this falling out of love, as it were. This fall is different from the last, and the one before only in that it is now glaringly obvious that football holds for me no essential attraction by itself. Looking back my only surprise is that it took me so long. Why didn’t I begin to turn away as my friend the ER doc buzzed through Dan’s shoulder pads with a saw in order to get him into the MRI? Or when I walked onto the field after Randy knocked himself out cold with a helmet-to helmet tackle to force a fourth down, his first concussion? I was still young, still sure that the game would bring my sons what I thought it had brought me.

I see them now, both of my boys, face down and immobile, and I shudder. I started to see them each time I saw a player go down in high school, or college, or the pros. I began to see that I valued those young men nearly as much as my own boys, and I started to notice that the game of football had become The Game. Those entrusted with The Game did not–do not–appear to share my feelings about the players.

The junior high coach carries the star running back to the bench, there to wrap the sprained ankle in the hope of returning him to the game. In a high school freshman game, a rout, the first string defense is still on the field in the fourth quarter, the opportunity to play in a game slipping away for kids who may never get another chance, when the starting safety goes down with a severed spine on a play he should have been watching from the sideline. What was the first string learning at that point in that game? Alumni and athletic directors and coaches at colleges noted for academic excellence openly opine that they cannot win without lowering the admission standards for football players, and just as openly run those kids off the team and out of their scholarships when they are no longer needed to win. The game in the NFL becomes more violent, with ever more gratuitous violence magnifying the carnage wreaked upon the bodies of the players. Ex-pros roam the earth as a kind of walking dead.

When did football become The Game? When did the keepers of the game become keepers of The Game? When did football players as young as high school become little more than a modern stand-in for gladiators thrown into the arena for little more than the amusement of the many and the benefit of a tiny protected few? I’d like to think that there was such a time, an inflection point, when it did change, but I fear it has been ever thus. If that is so then I, too, bear some responsibility for what The Game has become. I did not turn away, or turn my own sons away, at the time of my own dawning awareness that The Game and its keepers cared naught for our sons at all, but only for themselves and their respective place and privilege.

There was a time when my playing days were long over when I still found myself on edge as the weather chilled and the smell of cut grass filled the autumn air. It was time to get ready to play football. Those days are long past, and I find that I no longer even think about watching, indeed can no longer see myself watching, except as a vehicle with which I can channel the joy of a child. And that is perhaps why I can no longer watch a game whose keepers have lost sight of the fact that someone’s child plays in The Game.

One is left to wonder about the parents of those gladiators past.

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…

Honeymoon Weekend #34: Sunday musings…9/1/19

Sunday musings…

1) Fly. A young climate activist sailed across the Atlantic rather than fly to a conference to prompt a discussion about the environmental cost of air travel. She hopes to encourage the “climate woke” to fly less.

Sorry. Any trip over 3 hours is torture for me. If it takes longer to drive, pedal, or sail I’m on a plane.

2) Nashville. Pretty cool little city ya got here, Tennessee. Myriad options for drinking and dining layered on top of a truly magnificent music scene. I know that’s no real news to pretty much anyone, but being here to experience it is a tiny revelation.

Shame about the outcome of the Georgia/Vandy game, but still…

3) Connected. The good news: I am able to see pretty much all of my clinical data from the office including notes and tests. The bad news: ditto. Friday was my first full day on our Annual Honeymoon (more in a minute); it was filled with texts and emails and calls about patient issues that were convenient for those not on vacation to have handled during a Friday work day. Unlike many “always on” businesses my staff is largely off on the weekends so I am now somewhat inoculated from contact in all but the most significant emergencies. Also, unlike so many people who cannot turn off their connections lest the boss reach out and their availability to her/him be measured, I am traveling with the boss.

She just has to tell me what she needs and when!

4) Small. As in small world. As crazy small as the world turns out to be without any real effort on my part, the tiniest of friendly gestures can make it downright tiny. When I was an active participant in the Crossfit community, especially in the early pre-2012 or so days, wearing a shirt from CrossFit.com or a Box I might have visited was a guaranteed conversation starter. Heck, I once had a pilot who saw my tee shirt ask to see the Games videos I had on my iPad; the flight attendant brought it up to him in the cockpit while we were in the air. All it took was a noticing what I was wearing and offering a brief, friendly comment or question.

I had one of those moments this morning in our Nashville hotel. A gentleman who looked about my age was wearing a Middlebury Lacrosse tee shirt and I asked him about it. Turns out his son was a 4-year teammate of my nephew, and the two sets of parents had become great friends. We could have chatted for a couple of hours if they didn’t have wedding activities to attend to.

Smaller world moments are only a smile and a friendly question away. They are worth the tiny risk of approaching a stranger.

5) Honeymoon. Beth and I are in Nashville for our 34th Annual Honeymoon trip. What a ride! Without a doubt our marriage is the single most important endeavor we’ve ever undertaken, and so far the most successful thing we’ve ever done. I wish I could tell you that we had a super detailed plan that we laid out and followed all those years ago, but really, there were only two really simple things we did starting in the very beginning. We agreed that we would always talk to one another about everything we were thinking and feeling. No simmering and stewing over whatever might bother us. And we bought into Beth’s brilliant observation that marriage is not a 50/50 proposition, but rather 100/100.

Each of us has committed 100% of who were are and what we have to our marriage.

What does that mean in practice? In the briefest possible explanation what that means is that even when considering something that is vitally important to you, be it your job or some passion you have for whatever, you stop to consider what your decisions mean for your partner. Are you one of those people for whom job and hobby are one and the same? Can’t wait to get to work? Spend all of your non-office time dreaming about your career? Or are you rather that freer spirited soul who works only so that you can walk some other path, one at which you can’t really make a living? No matter. 100/100 means that you consider the effects of your career or passion activity decisions on your partner and your partnership, in our case our marriage.

Of course, all of this requires a huge amount of honesty and generosity, with a healthy dollop of tenderness and empathy. It takes effort. Over time it may become a bit easier simply because you become that which you practice, but in the early years most of us need to learn how to look outward, to hear and see how our personal choices affect that one person with whom we are closest. How do you get there? Well, it certainly helps to be crazy in love, right?! Each time you choose your two over your own one you get a little bit better at understanding how powerful those tiny little gifts to the marriage become as they build over time.

We’ve each been committed to each other, to our marriage, 100%. Two is so much bigger than 1+1.

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…

Musings on Home

Sunday musings…

1) Hero. Beth’s new horsey partner has finally arrived from Spain. Christened “Hortalano” but nicknamed “Hero” by the Man Cub (after Hiro, the protagonist in Big Hero 6), he is now home.

The latest actor in a long-running passion.

2) Drip. Street for “fashionable wear”. As in “LeBron was wearing crazy drip when he got off the bus.” Makes about as much sense as calling a high maintenance person “extra”.

3) Twee. Affectedly or excessively quaint, pretty, or sentimental. Never yet applied to any room decorated by Beth.

4) Bolt hole. A safe or restful place; one where you can hide from something unpleasant. Pretty much describes every place I’ve lived with Beth, especially Casa Blanco.

5) Home. What becomes of a place once it is no longer occupied by the people who made it a home? It is certainly changed. Can it remain home to those who are still there to make it one? Of course. Until, that is, it can’t.

My Gramp was so very smart in so many ways. He and Gamma could very well have stayed in the little ranch I remember as their home after my Aunt Barb went off to college. I’m pretty sure it was paid for, and it was certainly user friendly for a couple entering what we would now call middle age. But Gramp saw no advantage in the history of place, nor could he find a use for the extra room in even so small a dwelling once all three daughters had fledged the nest; he and Gamma decamped to a modest 2 bedroom apartment in Newark where he worked as the assistant superintendent for Newark schools.

They took along their living room furniture, and as luck would have it they also managed to take along (or had been taken along by) a few of their close friends at the time. Gamma and Gramp seemed to be about as social in Newark as they’d been in Glen Ridge. In all of my visits to their house I never remember any interaction with the neighborhood or the neighbors. In the Newark apartment it seemed that everyone knew my grandparents, and by extension, me.

In the late 60′s and early 70′s the great diaspora of retired north easterners to southeast Florida had begun. My two aunts had already moved to Miami, and Gamma and Gramp followed shortly after Gramp retired (the race riots in Newark prompted him to hang up his spurs at the earliest opportunity). I should note that in both Newark and Miami my grandparents became renters. Just another example of Gramp’s genius because neither they as a couple, nor Gamma as a widow, would be encumbered by place.

Like a spiritual tortoise, home would travel with them.

Gramp died when I was in high school. My memory of that time is kinda fuzzy. Maybe I was a junior. Gamma stayed in the King’s Creek apartment alone for at least a couple of years. She hosted my buddy Kid and me for a spring break visit during my freshman year in college. Her days seemed to be filled by time spent with friends in the apartment complex, usually centered around the pool. With two daughters and four  grandchildren only a few miles away she also had their activities to attend if she wanted to. I remember watching my cousins baseball games with my uncles and my Gramp. Did Gamma use their games (and Jenny’s tennis matches) to fill the hours of her days?

It’s been almost 4 years since my Dad died. Unlike Gramp there was so much of what constituted home for my Mom and Dad in the house where I was raised that they remained in place. Mom still lives there, moving through that big space like a ping pong ball in a gymnasium. With the exception of Thanksgiving and other family gatherings the house at 30 Kirkbrae Drive has been much too much for the 30 years it’s been since my youngest sister graduated from college, the last of the four of us to fledge. Mom and Dad stayed so long that home and place became one and the same for them.

After a couple of years alone in her apartment in Miami without Gramp Gamma either decided or was convinced that it was no longer home. Or at least that it wasn’t not enough home to stick around. My folks and my aunts were clearly on board because all three sisters built homes that had spaces ready for Gamma; she was welcomed into each of their homes for varying periods of each year, the specifics changing as she got older and the northern winters became more of a challenge. What changed for her? What had been there at King’s Creek in the first couple of years after Gramp died that was no longer there after a few years?

Or was it more that something had changed in Gamma herself? Even the tiniest of spaces can feel awfully empty when they aren’t really home. Without the rest of whoever made up “home” I imagine that the loneliness makes everything seem simply massive. And empty. The comfort of the familiar gets lost in the emptiness. When do you try to make that emptiness smaller? Gamma left in her late 60′s I think. Having already moved at least twice she simply moved with whatever she had left in her little tortoiseshell of home and began residing with her daughters and their families.

While we 8 grandchildren all considered her a part of our homes, I wonder now if Gamma ever really did feel at home in all those years lived without Gramp. Untethered to place she’d moved early at each stage. Probably not the first in any of her groups to do so but most definitely not the last. Blessed to have options she (and Gramp) seemed to grasp the reality that someone else would make decisions for them if they didn’t make them for themselves, even about something as fundamental as home.

There is certainly an aspect of place to home, but home is more than place. Leaving a place does not need to mean leaving home, or even leaving behind what made a particular place a good home. How do you know when it’s the right time to leave? Sadly I don’t think you ever really do. Gramp made moves which, looking back, seem to have been brilliant. Prescient. I think what you do realize all too often is that you probably stayed in place a bit longer than you should have. That the natural attachment to place that is part of the home equation has lasted longer than what really made that particular dwelling a home.

Home can be terribly difficult to leave unless we believe, like Gamma and Gramp, that home is not really where we dwell but where we live.

I’ll see you next week…