Random Thoughts from a Restless Mind

Dr. Darrell White's Personal Blog

Cape Cod

The Kids Are Alright

If you are of a certain age, and for sure I am of that certain age, you remember a time when young people were given the latitude to learn from their mistakes. More than that, though, is that young people were routinely forgiven for having made those mistakes. There was a kind of statute of limitations if you will. Stupid stuff you did or said as a teenager was wiped clean from your “record”. Heck, if you met a young person who seemed to have made it through without making any of those typical dumbass kid things you were a little skeptical.

Not so much anymore, eh? In this day and age of foreverness of every action and every uttering it sure seems as if we are no longer willing to let kids learn from their dumb kid mistakes.

Several of the boys who were drafted by the NFL last week are perfect examples. One of them said some stupid stuff on social media, got smacked for saying it, and has clearly expressed that he is aware that he was a knucklehead. Another chucklehead had a car accident, and yet a third had a beer or something, got caught and received the logical immediate consequence. There were a dozen similar stories. From the looks of it each one ended with lesson learned. Why, then, do I know about all of this when we are discussing 20, 21, or 22 year olds who did this dumb stuff when they were in high school?

Youngsters are impulsive and impetuous and they make decisions that are absolutely baffling to folks who are…ahem…less young. The elders on the ground are supposed to teach kids that all decisions have natural consequences in the hope that they will make better decisions. Once they start making better decisions it’s time for all of the rest of us to wipe clean the hard drive and stop piling on with punitive consequences that no longer make sense. Let’s let kids learn from their mistakes when they are young, like we did. Most of it is harmless if they do, indeed, learn the right lesson. Should you really have to account for that speeding ticket you got at age 18 during a job interview when you are 50? Your Dad took the car away for 6 months and you haven’t had a ticket since.

The kids are alright. Cut ‘em  some slack.

Remembering My Gama*

Admit it, you cried too. You found yourself in front of the TV for whatever reason at noon on April 21, 2018 and watched the Bush family say goodbye to their matriarch. My Mom turned 81 on April 21st, and quite frankly I am not ready to think of her being gone. Not even a little bit. So I watched the grandchildren. Rather than putting myself in the minds of Mrs. Bush’s children I channeled her grandchildren. Listening to Jeb Bush describe “Ganny” sent me back in time to the days when I was the best-loved grandson in the history of all mankind.

My birthday is January 7th, 1960. Gama was “born” about a year later–I couldn’t get my one year old tongue around the word “grandma” and it came out “Gahmmah”. Now, the White family is really big on precedent, and since grandchild number 1 called Mom’s mother Gama, Gama it was for everybody. Subsequent grandchildren, great-grandchildren, friends, neighbors, heck a few Romans who lent an ear for all I know, called Jane Knopf “Gama”. (This precedent thing turned out to be not so good in the next generation when my nephew, grandchild number three, called my parents “Bam” and “Bamp” and it wasn’t allowed to stick, but that’s another story.)

As the first grandchild in my Mom’s family I had the perfect set-up, and the fact that I was the first male in a generation didn’t hurt one bit. My brother was born 17 months after I was, and with the two of us so close together it was apparently a burden for my folks. Turned out to be quite a break for me, though, because my brother was born in May; at the end of June I was shipped out to stay with Gamma and Gramp at the Jersey Shore, the first of countless solo visits with my grandparents. Thus began a most privileged relationship with my maternal grandparents, especially with my beloved Gama.

It’s hard to describe, especially in these days of ultra mobility where extended families live apart, how critical it was to be loved by a family member without condition. Accepted and supported with no strings attached. Time spent with Gama was time spent in a guilt-free bubble. You behaved because it just felt so good to be in that bubble, and if you misbehaved forgiveness came in waves a very brief instant after any punishment. I visited my grandparents for weeks at a time, especially in the summer. My aunt Barbie, 16 years my senior, made it OK for the rugrat to be around even though I was clearly messing up her “only child” status in the house. Those were good times. I had a very special and unique relationship with Gama and Gramp. If I close my eyes and it’s very quiet I can still hear them…”Dar”.

Apparently everyone in my family saw what a special relationship I had with them and sought to preserve and protect it. It does no good to share any family secrets, but every family has some, eh? I was the last to discover any of the family’s darker secrets, long after my siblings, long after the cousins 10 and 12 years my junior. I was 30 when my aunts visited us in New York at the end of my residency years when I became aware of how much I’d been “protected” over the years, protection so effective that any present day revelations cannot dim or diminish the memories of my life with Gama and Gramp.

We lost Gramp when I was around 17  when he succumbed to his nth heart attack. That whole time is really just a blur, from the phone call I took in Rhode Island with the news from my uncle to the memorial service in Miami where I stood next to Barbie as she tried to read her farewells. What I remember–indeed all I really remember clearly–is Gama saying over and over, “I didn’t get to say ‘goodbye’.” I didn’t get to say ‘goodbye’ either. Maybe that’s why I can still hear Gramp every now and again…”Dar.”

Gama stayed in Florida at King’s Creek for a couple more years, living in the same apartment I’d visited so many times. I even made one last solo visit when I brought my new college buddy “Kid” for a week of spring break fun during freshman year. Every family seems to have one adult who’s cool, don’t they? Yours does. Admit it. There’s a parent or an uncle or a grandmother who’s just cooler than all of the other adults, right? Well, in our family it was Gama. My Gama was cool! As the years went by as more and more of our friends got to know her it seemed she just got cooler. Just ask Kid.

It turns our that Gama was ALWAYS cool. She entered college as a pre-med student in the days when women did not become doctors. Almost got away with it, too, until her mother found out and transferred her into education. She dated the gay boys when she was younger because they took her to the best clubs and they were the best dancers (and she didn’t have to worry about getting pawed on the train home from New York).  Yup, Gamma was cool.

After a few solo years in Miami Gama moved in with my folks in Rhode Island, spending several months each year with my aunts and their kids in Florida. She never called us just by name, it was alway “MY Dar”, my Ran, my Tracey, my Kerstin. My Jenny, Rick, Mike or Ed. All eight grandchildren now clearly had a unique and special relationship with Gama since she was now living with all of us. She was still my biggest fan, my brother Randy’s defender (Ran was the “black sheep” by choice when we were younger), Tracey’s cheerleader and Kerstin’s confidant. Even though I can’t describe them as well I know that each of my Florida cousins had some version of that same specialness.

Some time ago, I was in my early thirties, Gama fell and broke her hip. Word came from the hospital that she was failing–a broken hip is often the end for older women. Beth called me on the way to the OR to do cataract surgeries. Numb, stunned, I couldn’t think. I did what we have always done in my family, I went to work. It was Beth who knew better, who cancelled my patients and put me on a plane to Miami. Beth who let everyone know that I was on the way, alerting everyone in Florida when I was delayed in Greensborogh so that Barbie knew where to to leave the message. I sat sobbing in the airport after the  gate attendant told me Gama had died. I wouldn’t get to say goodbye.

My Mom and I spoke at the memorial service representing the children and grandchildren, Mom all icy control, me crashing, burning and choking my way through. I told one of my favorite stories, the one about the little girl who was standing in front of her grandfather’s casket, stomping her feet, clearly angry. “He can’t be dead. I wasn’t done with him yet!” That’s how I felt when Gramp died. I think if we’d had the chance to ask him Gramp would have told us that he wasn’t really all that done with US when he died, either. I definitely wasn’t done with Gama, either, but Gama was done with us. She was ready to go, so long after Gramp left, so long living alone among all of her special grandkids. I said then, and I still wish to this very day, that she hadn’t been in so much of a hurry. I would very much have liked to say goodbye.

Maybe that’s why even now, when it’s very quiet, if I close my eyes, I can still hear her…”Dar.”

 

*In our family there is some question about the proper spelling. Since she signed all of her cards and gifts “Gama” I’m going with that.

There Are No Small People

“But players don’t feel like bit players in their own lives.” –Richard Russo

Oh man…how good is that? Every life is just huge if it’s you who is living it. Every story suffers or soars depending on the frame of reference of the author. The eyes and ears of the storyteller only catch so much, and some of what is seen or heard never makes it past the “bit player” level in the story that is eventually told. This is what Russo refers to.

There are short stories, but there are no small stories. There are quiet lives lived with little or no acclaim, but there are no small lives. There are people who move as if shadows among giants, but there are no small people.

Thoughts on the U.S. Health Crisis

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

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

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

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

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

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

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

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

Dial Tone

There are a couple of broad-brush themes I find myself drawn to, things I find myself visiting with some regularity. Communication is one of them, and this week the specific thing that came up several times was how you might choose to communicate with a particular person or group of people. There’s always a trigger for these ruminations, this time the jarring interruption of an examination in my office by a ring tone that my patient surely thought was quite clever and altogether appropriate for any and all occasions. Yeah. No. Especially not while sitting in the exam chair in front of a doc who pointedly does NOT carry his cell phone while on the job.

We all got to talking about what cell phones have become and how we use them. A bit later in the day a patient was lamenting the presumed need to carry a smartphone with all of the attendant capabilities and inferred responsibilities and demands. You know the drill: each text is mission critical and cannot be ignored. An answer must be on its way before the backlight on your phone dims. You no longer have the answer to any question literally at the tip of you fingers, you now have the obligation to GET that answer, right now, lest you end up with questions in a queue. Questions have rights, too, in the age of the smartphone.

It’s insidious and seemingly irresistible, even for a guy who hangs his cell phone on a peg in the office (like a gunslinger entering an old West saloon). The “gotta answer” text now more compelling than a phone call ever was before because you can answer that text so quickly, almost…ALMOST…without interrupting whatever you may be doing otherwise. Unlike a phone call, where you must break away both attention and voice in order to communicate with someone who is not right there with you. Texters are now to the point where you need to text and ask if it’s OK to call. I must admit that even though I am nothing short of terrible at the physical act of texting (my auto-correct is in therapy with self-esteem issues) I, too, have been seduced by the ease with which a thought/need can be sent off RIGHT NOW, saving me the angst that would occur if I somehow forgot to transmit that thought/need if I had to remember it for a later transmission. I found myself becoming annoyed that my Mom doesn’t text (or email, but that’s a whole ‘nuther thing) because if she did I would never, ever forget those mission critical things I was supposed to remember and report.

But then, of course, it hits me: some people are always worth the effort of a phone call, even if they DO text (or email). In the natural evolution of communication a phone call–a real, live, use your voice and your ears phone call–has become as significant a gesture as hand writing a letter once was. Some things you just have to say out loud, and some people you just have to call up and talk to. You don’t text your grandmother to tell her about your first big boy/girl job after college. Your grandmother is worth a call even if you’re just telling her you remembered to pick up orange juice. Your Mom and Dad, POSSLQ, doctor, the guy who’s fixing your toilet–if these people want or need a call, a call is what they should get. Some communication is nothing more or less than a transactional transfer of information, while other communication is much more personal. Truly effective communication occurs when both sides are in agreement about what type of communication is occurring. Every communication with my Mom, for example, is personal, and would be even if she had and used a Galaxy whatever. As a matter of fact, even a phone call with my Mom is a kind of compromise as far as she is concerned because I am not able to just drop by to catch her up on whatever it was that she tasked me with reporting. Indeed, face to face communicating trumps even the handwritten note for immediacy, engagement, commitment, and conspicuous effort.

I was able to communicate with my patient just how I felt about that phone going off in my exam room with one eyebrow tied behind my back.

Reality

“Reality is that which, when you stop believing in it, doesn’t go away. –Philip K. Dick

A fact-based reality should be the easiest one in which to live. Presented with data your only challenges should be to either explain it, seek to change the underlying causes of it, or make your peace and live with it. Now to be sure I am one who has opined that one’s perception of the facts becomes your own slice of reality, but PKD’s quote above is the ultimate response to one for whom the data becomes inconvenient.

Comparative data that shines light on differences between relatively identifiable groups seems to be particularly uncomfortable for large swaths of Americans at the moment. Well, not only at the moment I guess. Daniel Patrick Moynahan is still persona non grata to some people for pointing out facts about groups of Americans in the 70′s and 80′s I think it was. The CrossFit world is presently in the midst of an exercise designed to gather larges amounts of data about a subset of the planet’s population. Adding additional data such as diet and nutrition would undoubtedly yield a reality that some version of high-intensity interval training, becoming physically stronger through lifting heavy objects, and limiting the consumption of processed carbohydrates creates a healthier human.

Reality check for the pizza and beer on the couch set.

In the end I think my philosophy is becoming that I want to see the data. For me a data-driven reality may be unpleasant but it is at least one that gives me those 3 options above so that I feel a sense of control over my reaction to the reality, at least. Grade differences among groups at “elite” U.S. law schools? Let’s see them and figure out why they exist. Daughters in a particular group tend to remain at the same or higher socio-economic level as their parents but their brothers slide backward? Shine a light on that data so that a root-cause analysis can be done and change attempted.

Daniel Patrick Moynahan:  a person is entitled to their own opinion but not their own facts. The reality is that I am not as fit as I thought I was. I scaled CrossFit Open workout 18.5 and still only got 100 reps. It’s up to me to decide how I feel about that, and what I will do about it, but it won’t change the reality of 100 reps.

 

Never Stop Trying

There’s a video that made its viral rounds on various social media places of a rather earnest-looking professor-like guy talking about the power of a tiny domino falling and hitting a bigger domino on its way to the ground. He starts the dominoes tumbling. The cascade of 15 ends with the fall of a domino weighing 100 lbs. and measuring >1 meter in height.

All from a domino so small he needs tweezers to place it.

The Professor ends the video with the observation that a similar 29 domino cascade would finish with the fall of a domino larger than the Empire State Building. Pretty vivid. As is so often the case on Sunday mornings I let the video rumble around in the space between my ears for a bit. What I saw first was a vast space filled with thousands, nay millions of those tiny dominoes, falling down over and over again, never striking anything but the ground. Every now and again a tiny domino would fall against a massive domino, either bouncing or slowly sliding off, eventually finding its way to the ground either way.

It was discouraging to think about. It made me a little sad, to tell you the truth.

But as I thought about it a little more, spent a bit more time in my imaginary vastness filled with tiny dominoes perpetually falling, it occurred to me that in order to fall over and over again it was necessary for each of those tiny dominoes to somehow rise up to stand. More than that, each time one fell it moved a little bit. Sometimes further into the vacuum of the vastness, but sometimes closer to another tiny domino. Another domino falling.

Another domino that kept getting back up.

It’s probably trite–some would say I specialize in trite–but what stayed with me in the end was not the image of the massive domino falling at the end, but that of the tiny, delicate, fragile domino in the front of the line. The one that started the whole thing. What most of us ever see is the last couple of dominoes falling, the last tumblers settling into place. Almost no one ever sees those first dominoes. Those tiny, fragile, tentative steps in the very beginning of the line when there is little more than an idea and a dream. Who knows how many times that first, tiny domino fell and struck nothing but earth?

And then got back up.

Optimization vs. Diminishing Returns

Some time ago I wrote about the Minimum Effective Dose (MED), the concept in which we seek to optimize our results with the smallest amount of whatever it is that we are using to achieve that outcome. The quest to find the MED is one that crosses quite easily between my day job (medical) and my own quest for health (CrossFit). A quick mention of Eva T in Outside magazine and the program she uses with her clients made me think a bit more on the MED. The Everyday Math column in the WSJ provided an enhanced vocabulary for the journey.

Sometimes the MED really is a “something” you take. Here one thinks of medicine or food, for example. More often is the case that we are looking at a dose of time or effort. Or perhaps both. In this case we are seeking to optimize the effort as it relates to the outcome, to make the value of outcome divided by effort as large as possible. The rate limiting factor here is the Law of Diminishing Returns, of course: at some point additional effort produces such a small incremental increase in the outcome that it becomes not worth making. This applies to everything from WODs/week (or day) to decorating a birthday cake. At a certain point you just have to feel you’ve succeeded.

How, then, to know when you have reached this optimal level? Eugenia Cheng, the mathematician who wrote the WSJ piece, offers the concept of the “minimal acceptable standard”. Once she has reached this outcome the additional effects garnered from more effort have moved beyond the point where Diminishing Returns kicks in and she simply accepts the outcome. We would call these “minimal standards” goals, but the concept is essentially the same. We want an outcome; setting a target or a goal is step one in optimization.

Cheng then goes on to refine optimization with a discussion about boundaries. One is your goal, of course. In real life others also exist, things like a 24 hour day and a 7 day week and the need to make a living. The dose you choose, both qualitatively (what it is) and quantitatively (how much you get) is unavoidably affected by boundary conditions over which you have less control.In the end no outcome worth getting happens without effort. Health, friendship, or the unraveling of a gnarly math problem–you’re going to put effort in to get your results out.

Maximizing your outcome-to-effort ratio is just another way to say you are seeking your Minimum Effective Dose, in CrossFit and elsewhere.

Mental Health is Part of Health

Some time ago I wrote about creating a way to measure health. Real health. Health that encompasses every aspect of what it means to be alive and well. As a CrossFitter I definitely included Coach Glassman’s Disease -> Health -> Wellness continuum, and I also acknowledged the critical importance of his concept of “Fitness over Time”. As a classically trained physician/scientist there is clearly a place for more traditional metrics like blood pressure, serum lipids and the like, although they may, indeed, be an variable that is ultimately tied to fitness.

Where my thoughts on defining and measuring health seem to depart from most current trends is in the recognition that mental health–emotional wellbeing—is as much a part of being healthy as any other thing we might examine.

Think about it for just a moment. Most of what we would classify as mental illness has as many outward signs that we can see as diabetes and hypertension. Which is to say, none. Yet we—all of us, not just CrossFitters—see nothing but the good in treating diseases like diabetes openly and aggressively. There is no stigma attached to seeking care for your hypertension or your elevated LDL. To the contrary, if someone who loves you discovers you quit measuring your glucose before you bolus your insulin, they are for sure gonna get in your grill.

For whatever reason, mental illnesses are looked at quite differently. No one is asking the person with chronic depression whether she is taking her life-saving medication, for example. We might notice an insulin pump on a friend or family member, but then it’s quickly forgotten. Everyone seems to be very uncomfortable around the young man who has very obvious hand tremors from the life-saving medication he takes for his Bipolar disease. We all seem to be so much more understanding when we have to wait for a response from someone suffering from Parkinson’s Disease than from the young women who has the same symptoms as a side-effect from the medicine that quiets the dangerous thoughts in her head from Schizophrenia.

It’s not even necessary to look only at these kinds of severe mental illnesses when we are examining the importance of mental or emotional wellbeing as an integral part of being healthy. What good does it do to have a 5:00 mile, a 500 lb. deadlift, and a 1:59 “Fran” if it was self-loathing that drove you in the gym to get there? You may be quite accomplished, the envy of your peers, at the peak of whatever life mountain you wished to climb, and yet you cannot feel joy. How is it possible to be healthy without joy? I look at Usain Bolt and what I see is quite possibly the healthiest man alive. My friend Tim, the writer, tells me that Justin Gatlin has nearly everything that Bolt has—youth, fitness, wealth—but the combination of failure to knock off Bolt, and the public disapproval reigned on him as boos from the Rio stands has left him emotionally broken. It’s subtle, but if you look at his face in the blocks of the 100M Final it’s there.

Our complex and conflicted attitudes and feelings about mental illness are especially evident when the topic of suicide comes up. Just typing the word makes me uncomfortable. Even how we describe suicide is fraught with hidden meaning that reflects our discomfort: someone has “committed suicide”. Right? Someone committed an act that we simply cannot fathom, one that leaves the survivors completely without any understanding whatsoever. How could someone DO that? It’s as if every suicide is the same as the suicide of the crooked prison warden in The Shawshank Redemption when he looks out the window and sees his fate arrive in the front seat of a State Trooper’s car.

In reality most of the time it’s simply not like that at all. Nothing about it is simple at all.

The outer walls at the periphery of my world have been breeched by suicide twice in the last couple of weeks. One of them actually does feel a bit like that prison warden. Frankly, I am too conflicted, too aware of the external circumstances and not enough aware of the internal life of the deceased to offer much right now. The other one, however, just stopped me in my tracks when I heard. The loss was profound.It has also introduced to me a new vocabulary that I truly believe provides a starting line from which we can change how we think about not only suicide, but all of mental illness. A friendly acquaintance lost his wife when she was killed by suicide.

We don’t need to know all of the details of the story. Suffice it to say that in the face of a child’s illness she suffered quietly. Too quietly to be noticed. Perhaps she didn’t realize how badly she was suffering, or maybe she was like so many of us and couldn’t bring herself to see her illness for the life-threatening entity that it was. No one will ever know. What is clear, though, is that this was not anything about commitment. Kidney failure may be cause of death in a diabetic, but it is diabetes that kills him. There is no difference here. The cause of death was suicide. Her disease, her depression is what killed this young woman.

Each of us has a very few moments in our lifetimes that forever change us. On the second Tuesday of July in 2006, unbeknownst to me, one of those moments was transpiring in a lonely, dark corner. Joyfully, the moment was a beginning, not an ending. Regardless, once learning of the moment I was changed forever. Now I knew. You cannot see any marks from mental illness, no swollen appendage or insulin pump. But it is there all the same, and it must be acknowledged and accorded the same degree of care as any other disease that may take our loved ones from us. Mental illnesses are real, and they can be deadly. There ought not be any conflict or discomfort in treating them.

We may stop losing so many of our loved ones when start to see emotional wellbeing as part of being healthy.

When “Team Player” Means It’s All You

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

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

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

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

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

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

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