Random Thoughts from a Restless Mind

Dr. Darrell White's Personal Blog

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The Enemy is the Couch

One of the repeating themes in all of my writings on fitness is that it is exponentially more important that one gets off the couch than it is what one does after getting up. To be sure, we in the CrossFit community have been reasonably and accurately accused of being zealous in our support of our chosen post-couch activity. Unlike “Fight Club” it has been observed that the first rule of Crossfit must be that you ALWAYS talk about CrossFit. Fair dinkum. Still, while we may be proven more right than not in the end, there exist other effective fitness options.

My nephew, a retired hockey and lacrosse player, has found his post-collegiate sweet spot in one of the cycling/spinning communities. His preferred version is “Soul Cycle”, but that’s probably more like saying Ben & Jerry’s when you really mean ice cream. You and I know all kinds of folks who swear by Pilates, Barre, various and sundry types of Yoga, and the legions of people who lace ‘em up and run at all kinds of levels at all kinds of times in all kinds of places. In the end even the most zealous among us has to admit that each and every one of these non-CF activities are substantially better than continuing in an unhealthy relationship with your couch.

Fitness, and by extension health, are profoundly complex entities. Hence my own personal difficulty in arriving at a single integer that can be used to measure relative health. It also explains the abject failure of the collective whole of the health wearables industry to come up with a single meaningful, actionable measurement. Still, we ought not dismiss the wearables industry entirely if for no other reason that putting on that Fitbit, or launching Health on your Apple Watch more often than not is like magic; it levitates your ass off that couch.

Simplifying our discussion about fitness and health along the straight line between relatively high intensity exercise versus what could be called long-slow aerobic exercise blinds us to both the essential value of forsaking the couch, while at the same time limiting our ability to explore why it is that there doesn’t seem to be that one, single best approach. Part of the genius of CrossFit is that it starts with a definition and then demands measurement. CrossFit proper has enjoyed explosive growth, growth which is now also occurring in a parallel universe of derivative programming offered by trainers who got their start owning a Box. Is it, are they, better than everything else out there?

Does it matter?

Zero sum games require that someone lose in order that another wins. Likewise, a zero sum grading of ideas means that one eventually must become axiomatic at the expense of the demise of another. Zone/macro quantitative strategies of nutrition vs. Paleo and similar qualitative strategies, for example. A complex system demands that we constantly assess not only the “games” themselves, but also the relationships between the various “games”. Perhaps the greatest gift that I have received from my discovery of CrossFit and the CrossFit community is my ongoing curiosity about all things fitness, and by extension my willingness and desire to pursue the inquiry. By extension I have learned that what works for me may not necessarily work for you.

Is it better to do my CrossFit Rx or my nephew’s Soul Cycle? The answer of course is ‘yes’. Should one do the “Taking Back Eating” macro program or find health in “The Paleo Solution”? Likewise: ‘yes’. Broad acclimations await better measurement followed by the evaluation of those measurements across very large groups of people. However, you and I need not await those conclusions because we can embark on a highly actionable study of our own, n=1.

All it takes is getting off the couch.

 

Meaning in an Indifferent Universe

“The most terrifying fact about the universe is not that it is hostile, but that it is indifferent.” –Stanley Kubrick

Man is the only species, on Earth at least, that seeks meaning in life. Once food, clothing, and shelter are secured, Man then turns his attention both inward and outward, in the quest for for some understanding of why we exist, a quest to make our existence meaningful. Alone among all creatures, we do not subsist (I eat, therefor I am) so much as insist (I think, therefore I am).

The great Religions of the Near East and Near West define a meaningful life in terms of fealty to a deity and His edicts. Further East and meaning is acquired by coming ever closer to enlightenment. New World religions assign meaning to the achievement of harmony among all life forms. But what of the emerging worlds in which the great Religions hold little sway?

Death is immutable, and it is death against which all meaning is measured. What came before can be ever and always dismissed as abstract, but what comes after is inextricably tied to what constitutes a meaningful life. Again, Kubrick: “If we can accept the challenges of life within the boundaries of death–however mutable man may be able to make them–our existence as a species can have genuine meaning and fulfillment.”

How is this necessarily so? Why would it be so? Is it because Man as a species can and does sit down to think? If the universe is indeed indifferent and it is Man who introduces meaning, must it not be that our universe is man-made? Whether through acts of omission or commission, consequences intended or unintended, it’s hard to escape this conclusion. Herein lies the essential challenge of seeking meaning in life: meaningful for whom?

Adherents to the great Religions are set here. Meaning is parsed by some higher being. For the rest of us an epic societal tug-of-war exists externally. The furthest to one side posits that meaning ends at the tip of a nose, while the other extreme holds that it knows better and will tell you what you should find meaningful. The truth, at least the actionable truth, lies as always somewhere in between.

Once more, to Kubrick: “However vast the darkness, we must supply our own light.” Herein, I believe, lies the lesson. Meaning, writ small or large, can only be created within. The light of meaning is self-generated, but like all light it can be shared. Must be shared. It is in sharing whatever light we might have or create, however dim we might find it, that makes a meaningful life. What light we create is what separates us from all other life, for Man is alone in his ability to shine that light for others, then see and act upon that which is illuminated.

In the end, the Universe may very well be indifferent, but we need not be. Meaning, in life, may be as simple as the absence of indifference.

Let’s Drop the Hyphen

Have you dipped a toe into the whole 23 and Me world? You know, the company that will analyze your DNA and tell you about your heritage. What percentage you are of this or that. Think for a moment about how your answer the question “what are your?” when someone is asking about your nationality. How do you respond? It’s a terrifically important question, more precisely your answer is terrifically important, especially in these fraught times of machine gun-toting police officers in airports.

How do you respond?

Confession time first, or course. Up until yesterday I typically answered with something along the lines of “I’m a mutt, but I’m mostly Irish.” Accurate enough, at least in terms of heritage back some long time ago, if just the tiniest bit dismissive of my maternal grandfather who was a first generation American of 100% German lineage. And there, in that last word–lineage–we find the linguistic accuracy necessary for each of us to begin to structure a better answer. Better for us, and better for everyone who shares a country to begin to think about how we answer the “what are you?” question.

Henceforth I shall interpret that as a question about my nationality and my answer shall be “I am an American*.” Full stop.

To be sure I will be happy to engage in a conversation about lineage because there are some pretty neat stories about my grandparents and their parents to be told. But me? It’s been many, many generations and much more than 100 years since my ancestors left whatever shores and became Americans. As soon as they married outside of their ancestral tribe they became, and more importantly identified, as American. Isn’t it time the rest of us follows suit?

Put me down as a vote to drop the hyphen. You know, the ( – ) between “X” and “American” we so often hear when “what are you, what nationality are you?” is floated. Wether born here or bourn and chosen, you are an American. This is not a “my country right or wrong” or “love it or leave it” kind of thing. Not one bit. It’s about how you identify, and then by extension how you support. I am an American. I live here, work here, vote here, and pay taxes here (boy, do I pay taxes). Sure, it’s a big country, and the experience of being an American is certainly different in NYC where I am sitting, Cleveland where God willing I will dine at home tonight, or in LA. But Americans we are, one and all. I hope for and will work for a better America, as I hope you will, too. We can keep the entire spirits and coffee industries afloat discussing what “better” means.

As Americans.

*Or Irishman, or Pakistanis, or Canadiens if the shoe (or skate) fits. Rejoice in what is good about your country. One need not disavow one’s lineage to embrace one’s nationality.

The Solo System: Friendship and their Orbits

Friend: a person who has a strong liking for and trust in a another person. –Miriam-Webster’s

This weekend my wife and I will visit my closest (non-family) friend. Friendship has been on my mind of late. Truth be told, some version of that sentence accurately describes some part of my day pretty much every day, just a bit more so of late. You can never have enough friends and all. True enough that, but one should reflect a bit on what it is that constitutes friendship, and what it means to be a friend.

Once upon a time in college I embarked on an adventure, a hitchhiking journey to meet up with mates from college, eventually landing on the beach in North Carolina. My Dad was dead set against it. It was time for me to go to work for the summer, and quite honestly the itinerary was more than a little “skinny” on details.

Me: “But Dad, these guys are my friends!”

Dad: “Probably not. In 10 years you may not even know a single phone number for one person who was there. You are lucky if you have a single friend in the world.”

Man, I hated him for that. I left angry and returned triumphant (God watches over fools and Irishmen). Sure enough, only one among that group remains, and he only a warm afterthought. My Dad, of course, was spot on.

Each of us lives in a galaxy of people who swirl around us as if we were a pre-Galilean Earth. Think Brian Regan’s famous “Science Fair” bit: “The big yellow one is [me].” This very center of this solo system is made up of our friends, however few. They are close enough to touch, always in view. Surrounding this inner circle is a slightly larger one filled with friendly acquaintances, people who may once have been friends or may yet become friends, but at present a group of people we are genuinely happy to see but don’t necessarily go out of our way to do so. Next is that mass of people we’ve met, a group not notable for anything; we don’t think of them at all. There are enemies, too, but for now let’s leave them be. All of this floats in a universe of beings we’ve yet to, or will never meet.

What is it that moves one from the orbit of friendly acquaintances into that innermost sphere of friends? The mechanics of it are really quite banal: shared experiences, a kind of proximity (geographic or in our modern world electronic), enough values held in common that you can forgive those that are different. It’s subtle, the difference between a friendly acquaintance and a friend. Heck, you may have some friendly acquaintances who like you, like who you are just as much as your friend. Maybe more. The difference, I think, is not so much in the liking as it is in the trusting and the caring.

Your friend cares about you. Cares what you think. He pauses before he acts or speaks and takes a moment to think about you before he does either. Someone with whom you are friendly might meet you halfway on something, but your friend will go way beyond that toward you because he cares a bit more about what you think than maybe even what he might. While your friendly acquaintance will likely never hurt you your friend will protect you from hurt. Might even take the hit for you and suffer so that you might not.

Because of this you trust your friend in a way that you trust no one other than your closest family. In a sense you’ve pre-forgiven him because you know…you just know…that he not only will he not hurt you, but he will be ever vigilant against doing so even by accident. My Dad was right. You don’t get very many of these. Indeed, most are fortunate to get one at a time.

Your little solo system is ever-changing; people move in and out of orbits, sometimes inward and sadly occasionally out. People grow differently. They change or they move. The work of friendship is hard because it requires looking outward at the same time you allow another to look in. It’s a high wire/high risk enterprise, being someone’s friend. In many ways it’s as if your very soul is in the harness, and your friend is on belay. And in your hand you hold the rope that allow’s YOUR friend’s soul to soar.

Right beside yours.

Yours ever in friendship,

Tone Across the Service Line

Ever listen to how people address folks on the providing side of the customer service continuum? Do you ever stop to listen to yourself, or think about how you will sound before you speak? Fascinating. In North America we are moving ever more swiftly to an economy that is majority a service economy; we don’t really make stuff so much anymore, we help people use stuff someone else made, or provide assistance based on a knowledge base or skill set. Listening to people on the receive side of the equation is fascinating.

We have been forced to change our EMR at SkyVision. Our office is running behind schedule because of this. My ears are on high alert for how our patients are reacting. I’m prompted to this line of thought by three interactions in the office that happened while I was loitering at the reception desk. Three individuals not so much requesting a service but demanding it, doing so with a tone that implies not only a deep sense of entitlement but also a deeper lack of regard for the individual who will provide that service. Both in tone and content the to-be-served make it clear to the service provider that he or she is there to serve only them. In fact, the servers only reason to exist is to serve, as if the to-be-served were some kind of different, superior version of the species. It’s loathsome, actually.

I spend every waking moment of each working day on the “serve” side of the equation, whether I am a SkyVision plying my profession or CFB coaching. Having achieved some measure of expertise in both it’s very rare that I am on the receiving end of this type of behavior, but it does happen. More often is the case that it is someone lower on the org chart who gets this. The receptionist, phone operator, or check-out person who gets this “lower life-form” treatment, not the doctor or business owner.

Life can be hard for these front line people in a service business. There’s not only a “customer is always right” mentality on the other side of the interaction but also a sense that being a customer who will get what they want is as much as human right as Life or Liberty. That’s what it sounds like, anyway, if you are off to the side listening. No matter how frustrated one might become from a service situation gone wrong it’s important to remember that there is no continuum in the relationship when it comes to the inalienable rights, nor is there any evolutionary hierarchy across that desk or over that phone line.

Danny Meyer, the great NYC restauranteur, is probably closest to correct when he says “the customer is not right all of the time, but mostly right most of the time. A customer [only] has the right to be heard.” How you express yourself when you are on the “receive” side of the customer service experience is not only an important measurement of how you value the person across from you providing the service, but frankly is probably also a predictor for how likely you are to be successful in being heard. It’s instructive that none of the three SkyVision clients who made difficult (bordering on unreasonable) requests in an unpleasant manner were accommodated because doing so would have required an extraordinary effort which may not have been successful in any event.

Sorry, no pithy statement to wrap it up this week. In the end we all want what we want, and we all need to be heard. It helps to look at the person on the other end of the service divide as if you were looking in a mirror. Would you say that, like that, to the person in the reflection?

Someone Is Keeping Your Receipts

Once upon a time records were kept prospectively in order to support some sort of existence. Transactions of some sort or another would be the most common example. Of course, if one wished to avoid or deny the existence of some sort of transaction, or indeed to deny the existence of some event, one simply had to avoid the creation of a “paper trail” which documented some part of that event. Receipts involved commerce, and if you spent just the tiniest bit of time thinking about it you could limit the number of receipts that were out there.

Now? Not so much. A “receipt” is now any type of irrefutable documentation of some event. Sure, that credit card receipt puts you in that Uber at 0200 in SoHo, but so does the Tweet that mentioned you in passing. Or the pic your companion SnapChatted and was saved as a screenshot. The ultimate, all-time greatest receipt was a certain dress that never made it to the dry cleaners, but nowadays scandals as great or orders of magnitude tinier are rendered factual by the seemingly banal.

Thinking back it’s funny, how I got to be “bingo” here and elsewhere. In those early days of online communication one gave reasonable thought as to whether it was prudent to use your own name online. Heck, my prenup consists of a single line: “Darrell will not run for elected office” so that the family would be spared the scrutiny of an election. To be anonymous in today’s world it takes either herculean effort (try to find something about the family that owns Perdue Pharma, for example), or a complete indifference to that which seems to drive western societies (think bridge troll). What was once the “paper trail” became the “digital footprint” and is now a ubiquitous “universal map” of your life. Does it even matter? One wonders in this day of Alexa and Siri and paying for the privilege of placing the equivalent of Big Brother v1.0 in your own home.

I have endeavored, here and elsewhere, to make kindness the currency of my transactions. Indeed, CrossFit.com (and my blog) have been little “behavioral gyms”, if you will, where I have practiced making kindness the irreducible movement in my interactions. The on-line world in its earlier days was kind of a mulligan for folks of my generation. Not a day goes by that one or another of us sighs in relief that cellphone cameras and social media had yet to be invented when we were young. Now? Now it’s a running tab, a veritable windfall for the social accountants who tally up the score. They are everywhere, and it matters not how many degrees of separation they are from you and Kevin Bacon.

Someone always keeps the receipts.

 

Pygmalion

In the big city, in a big meeting, both teeming with swarms of humanity, in the same location but not necessarily in the same space…

‘Twas a time not so very long ago when phrases such as “proper” and “polite company” had very specific and essentially universally understood definitions. Forming a foundation for this proper behavior were equally well-understood, nearly universal concepts like “private” and “reserved”.

Neither “proper” nor “polite company” was confined to a specific economic stratum or other social circumstance, although both had a certain aspirational aspect. Whether “low born” or “high born”, one was taught the meaning of each. Both were considered essential elements for a functioning society. One needn’t have a mentor or sponsor to behave in a proper manner so that one could travel in polite company, one only needed to have a grandmother.

The concepts of “proper”, “polite company”, “private” and “reserved” have no less a place in a society dominated by social media and cell phones than they once did in one of salons and stationary. I could certainly provide you with examples and definitions, but that seems to smack too much of what it is I protest. You should know this, no matter how old you are, without either me or Buzzfeed offering you a link to the Top 10 Lessons from “My Fair Lady”.

If you need a refresher course remember this: it’s not proper to text or to PM your elders on Facebook or Twitter to talk about it.

Cost + Quality + Convenience = Value

My wife Beth and I had a rather spirited discussion about how we in the U.S. might be able to pay for the healthcare of our citizens. Being ever practical, and also owning the job of writing the checks that pay for the “health insurance” our company offers its associates (including us), Beth in effect is arguing for a national consensus on something we might describe as a baseline ‘value’ for healthcare. Others would label her concept a ‘floor’, but you get the idea.

What Beth intuitively understands is the tension between cost, quality, and convenience. You pick a baseline or a floor level of value and offer that to everyone. With training as a nurse and 15 years in healthcare administration, her idea of what constitutes the sum of cost, quality, and convenience naturally overweights the integers for cost and quality: outcomes should be essentially equal across the board at the baseline or floor level, and the costs of achieving that should be in some way equitably shouldered by something we could describe as “society”. Very practical. A strategy that lends itself to being observable and measurable.

What’s the rub? Well, only two of the three elements that make up value are covered. To obtain an agreed upon level of medical outcomes (mortality, morbidity, longevity, etc.) the cost is covered. Ah, but HOW you obtain those outcomes is still a variable. It is the FLOOR of value that is guaranteed. Our family is experienced a bit of this recently with Beth’s Mom. After a hospitalization she was living in a setting that ws providing excellent care at a reasonable cost, but it was a setting that did not provide any extras; it was old, not very pretty, and she could  have had a roommate. Her (and her daughters’) experience, what we might call “convenience” or  in our formula, was found to be lacking. The girls opted to move her to a nicer setting, one that will eventually involve a higher cost because of the enhancements to the experience, with no change in the already best possible outcome, or quality.

Therein lies the problem with any discussion about literally anything that we might discuss as a “right”. Is everyone entitled to anything other than the minimal amount of convenience/experience necessary to obtain the best outcome at an affordable cost?

If we examine food, we find something quite similar. No one among us would say that X Million people should go without food. Indeed, we don’t even really talk about true hunger in the U.S. anymore, we talk about “food insecurity”, the concern that we may become hungry. By the same token, though, no one asserts that everyone is entitled to the same quality of food. Not even a little bit. No, quite the contrary, all that is discussed is cost and convenience (access).

Now, of course, we in the CrossFit world (and to a degree in the medical world) argue that quality is an ineluctable part of nutrition, that one must extend the equation outside of food alone so that an explicit choice is made that prioritizes quality calories over other purchases (cell phone, cable, fancy car, etc.). While this is accurate and proper I believe that we can reasonably quarantine nutrition and keep it separate from other needs, at least for the purpose of our discussion. The universal concept of the interplay between cost, quality, and convenience holds true in nutrition/food on a global, grand policy making level:

You can pick any two, but only two, when you are declaring what is the minimally acceptable level.

My formulaic approach to the coverage of needs has a little wrinkle that should be mentioned: quality cannot be increased ad infinitum. In all examples we might evaluate there is a practical limit to the ability to improve quality or outcomes. The law of diminishing returns arrives in the form of the asymptote as quality rises. On the other hand, cost and convenience are unbound and can rise almost infinitely. It is the alcohol in a drink that confers the health benefit; the same outcome occurs no matter what you drink. One person’s jug wine from Costco is another person’s Chateau Lafite served in the Gulfstream V. You get the picture.

What will become of our conversations about issues such as healthcare? Will we arrive at a similar juncture to the one we have now in food, clothing, and shelter? Where quality (outcomes) and cost issues are addressed and everyone is left to make their own call on convenience/experience? Beth can’t see how it can be any other way. Me? I’m much less optimistic. That old “want vs. need” thing just keeps popping up. Confusion arises when a truly generous people confuse what people want with what they need. Need is measurable and therefore finite, whereas want is neither. We can, and should, all work to pick up the check for the needs of each. “Want”, on the other hand, is the proverbial “free lunch”, and we as a society will need to agree on that before we can even begin to discuss begin to talk about the mechanics of paying the bill.

TANSTAAFL. Heinlein was right.

 

Succeeding Through Effective Failure

The secret to success just might be failure. Not abject failure, of course (although it’s always cool to use the word ‘abject’), nor consistent failure. But failure while pushing one’s limits or while exploring the new and the unknown might be the magic ingredient in the success recipe.

Why? Success is not simply the absence of failure, it is the defeat of failure. Success is over-coming failure. Indeed, without having failed at something some time, how do you know what success is? How do you know what it’s supposed to feel like?

Neither success nor failure need be any particular size. Small successes build confidence, and smallish failures teach. It’s important to qualify acceptable failures, though. Failure caused by sloppiness or laziness is ALWAYS bad. On the other hand, failure encountered while stretching beyond one’s limits, while reaching for something new, large, important…well…that’s the type of failure from which lessons are learned.

It takes a certain chutzpa to put one’s self at risk to fail while in the act of reaching further. I like Churchill’s take on it: “Success is never final. Failure is never fatal. It’s courage that counts.”

Be a little brave while failing.

Full-Ass

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

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

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

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

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

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

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