Random Thoughts from a Restless Mind

Dr. Darrell White's Personal Blog

Cape Cod

Posts Tagged ‘bingo’

Sunday musings 8/19/18

Sunday musings…

1) Bollocks. Testicles. Who knew? The whole kerfuffle over the Sex Pistols album title makes a ton more sense now.

2) Directed. “Use as directed.” I’m not sure who is more surprised. Mothers when their offspring open up some something or other and just fly into using it (and it works), or said offspring when they fail to check the directions and whatever it is they opened doesn’t work.

For the record this is also a problem in areas that are a bit less trivial than a tiny drone received as a birthday gift. Like medicine.

3) Knots. “Miles per hour plus the glamour of the open sea.” –Mark Childress.

Not terrifically accurate, but who’s gonna argue with that little bit of poetry?

4) Despair.  Why is it that so-called “great literature” always ends in despair? The boy never gets the girl and vice versa. Every family is rendered asunder whether or not they deserve that particular fate. Why?

Lettie Teague wrote about her summer reading, all of her books centered in some way around wine as a pivotal character. Upon reading the headline I was excited to have some fun, happy reading for a change. Yah. About that. Even the consumption of epic wines was spoiled by the despair that prompted the binge or that which ensued.

Jeez. Winston Churchill managed to help save the world when he drank. How come no one can write literature with a happy ending?

5) Change. Inspired by by near lifelong friend Bob.

I watch the ripples change their size
But never leave the stream
Of warm impermanence
And so the days float through my eyes
But still the days seem the same.  –David Bowie

Grand baby birthdays. Siblings and their offspring passing milestones. 40th high school reunions. There is no escaping the passing of time. Along with the ebbs and flows there has been but one, single constant: change. Each day seems so much like the one just passed, and yet a glance ever so slightly further back brings an awfully quick reality check. Change has been afoot. “You haven’t changed” is such a lovely thing to hear, yet it, too, cannot withstand even a passing glance in the mirror.

There is nothing new or even remotely weighty about noting change. What is significant, though, is the importance of both acknowledging and accepting change, however disruptive it may be physically or emotionally. One must be able to see change and react accordingly, no matter how difficult it may be for either an individual or for those who may be highly interested spectators. I think of my good friends from California, true pioneers in both the CrossFit movement and subsequently independently in the larger fitness world. They have looked at how their world, their lives have changed, and they have accepted the need to change as well. For them it begins with the closing of a beloved, iconic gym which is rightly famous worldwide, the loss of which has been met with an international tsunami of tears. Yet they have seen the change and have accepted that the time had come.

Some changes are so disruptive that they turn lives upside down even when you know they are on the way. Our friends Bob and Kathy begin the journey toward an empty nest as their only child begins his senior year in high school. So, too, my brother and sister-in-law must adapt to the changes brought by college graduation and their sons’ retirement from competitive sports. No longer will Randall and Joanne plan each week around their boys’ games. My sisters and their husbands are soon to follow. Will those changes be any less impactful given foreknowledge?

Someone, I’m not sure if they like me or not, once asked at what age I would choose to be frozen if such a thing was possible. How old would you choose to be, with all of the attributes of that age but no prospect of any further growth or development? It’s an impossible question, a cruel koan which cannot be solved. How can one possibly choose between the youthful feet attached to the running shoes that are so joyfully and maddeningly soaked by your child and the archless soles doused by a grandchild? Which is better, to have the agility to dance away from your son’s aim lest your shoes be ruined, or to happily submit to the realization that the laughter of your grandson is more than worth the fact that you can no longer save the shoes regardless.

Besides, the shoes have changed, too. They’re waterproof now.

Changes are happy and sad, big and small. We lose parents and friends. Special places like our friends’ gym close taking with them any chance they may change us for the better. Heck, it looks like I’ll be changing hips sometime soon, a change I for some reason thought I’d be the only one to escape. It makes me sad to hear parents tell a child “don’t change; stay like this forever” because that is one wish that will never be granted. Nor should it. After all, there is only one way to assure that change will never come.

I am not done changing
Out on the run, changing
I may be old and I may be young
But I am not done changing   –John Mayer

Change is life. To change is to be alive. Embracing change is to live.

I’ll see you next week…


Sunday musings 8/12/18

Sunday musings…

1) Krispies. All of my snaps and crackles now have pops.

2) Relevant. “Who wants to be relevant? It just takes a lot of work.” –Andie MacDowell

In this day of social media driving said relevance I think Ms. MacDowell is spot on. When relevance is measured by something as ephemeral and lacking in any type of substance as retweets and follows, her take is prescient.

True relevance is substantive. Or should be.

3)  Games. What are we to make of the massive gap between the top 5 men and women and everyone else? What is it that separates them so completely from the rest of the very best? Is it just me or is this fundamentally different from all of the other truly individual athletic sports?

4) Summer. For anyone with school-aged kids summer if officially over. August 1st has come and gone, the CrossFit Games are over, and football camps are open all across America. Heck, school starts in parts of Ohio on Wednesday, and didn’t I see kids heading to school last week on FB?

Sorry, that’s all wrong. School is meant to start after Labor Day. Too much work too soon for kids who aren’t taking part in feeding a family.

5) Screening. It appears that I am a health tracker recidivist. Why? Well, it certainly has nothing to do with the truly actionable nature off the information a tracker gives me, because to date only heart rate variability (HRV) has any value and at that it appears only in elite athletes. No, I’m just having some fun with mine, playing around to see if my little n=1 studies might come up with something that might move my needle for some reason or other.

That, and they are fun to write about.

Screening for health risks is potentially a big deal, the across the board lack of success thus far notwithstanding. The most recent best example of that coin is an article published this month in the NEJM on cardiac testing of elite soccer players in England. Performed at age 16 between 1996 and 2006 the screenings were undertaken to see if an EKG and Echocardiogram could predict cardiac events that led to early death in athletes who compete in sports with “strenuous exertion”. In all more than 11,000 athletes were tested, the vast majority of whom were declared healthy.

1 in 266 were found to have an underlying, silent abnormality that put them at risk for sudden cardiac arrest. Most of these were Hypertrophic Obstructive Cardiomyopathy (HOCM), the same entity that was responsible for the tragic death of Boston Celtic Reggie Lewis. 2/3 of those who were found to be at risk had surgical procedures which allowed them to safely return to play; it appears that they are all alive and well. Of the originally screens players 8 did in fact die from cardiac arrest, but here’s the kicker: only 2 of those 8 were assesses as being at risk. The other 6 went through the screening and passed. Overall the results equal a risk of 6.8 deaths per 100,000 athletes.

What does this mean in the greater context of health screening? In general the problem with health screening of all kinds (remember, I am in the midst of a classic American cardiac health risk screening process at the moment) is the combination of inaccuracy as noted above, coupled with a fraught cost/benefit ratio in almost all instances. Believe it or not, though, the cost of screening relative to the accuracy and ultimate effect may be the lesser of the problems inherent in screening. Two of the athletes screened and found to be at risk refused to give up soccer and were among the cardiac deaths. You might ask if they were mad to have continued to play, but I would counter that it is quite likely that all they had as a means to provide was soccer; to not play was to choose to go hungry. Imagine an inner city kid destined to be a Lottery Pick in the NBA screened and told they could no longer play the game that would surely set them up financially for life on their rookie contract alone?

Not to mention the deep psychological issues inherent in being told that you are no longer the one, single thing that you have self-identified since early childhood. That’s rough.

One of the very first diseases one used to learn about in med school was Huntington’s Chorea, an inherited disease in which the afflicted exhibit violent, uncontrollable movements (chorea) before eventually dying a rather unpleasant death  (any med students here? Is that still true?) Why? Well, partly because it’s such an interesting tale, equal parts detective story (the original cluster is in a tiny town in England) and history lesson (many of the townsfolk in England emigrated to Salem and were on the wrong end of the Salem witch trials). What makes this interesting in the context of screening is that Huntington’s Chorea is the first disease for which a single gene defect was identified, making it possible to screen with 100% accuracy to determine if you, like Woodie Guthrie and his siblings, would be so afflicted.

Would you want to know? Remember, even in this age of SPLCR technology there is still no cure for Huntington’s. Is there a difference between this and the cardiac risk of HOCM in athletes? How about the rather mundane and ridiculously common risk associate with elevated serum lipids? Given that there are things one can do to mitigate the risks in the latter one should probably answer “yes”, there is a difference. But emotionally, on an individual level, is there? That’s a really hard question to answer. I personally know families with Huntington’s and HOCM. Some family members get tested as a matter of course. Others, for any number of reasons, choose not to do so. In your life you know dozens of people who really need to be screened for diabetes and cardiac risk from elevated serum lipids who prefer the relative comfort of ignorance.

Who is to say who’s right?

In the end this is a question that is going to become more and more common as testing becomes both easier and less expensive. We are soon to see a lab test for HOCM which will be less expensive than an EKG/echocardiogram and more accurate to boot. The calculation will change as well because on the heels of this test is the likely approval of a gene therapy that will reverse the abnormality and presumably remove the risk. For some reason Huntington’s Chorea has defied this happy ending, but it has to be just a matter of time before it, too, is curable. Before any universal agreement is reached on screenings in general you can depend on tons of controversy which each new development. I shudder to think of the coming shit show that will be wrist-worn trackers that can detect afib in real time.

Who knows what kind of mischief I will manage to get into with my little HRV monitor?

I predict I’ll see you next week…




Babies on the Beach

Babies on the beach.

It’s been 15 years since the extended  White Family last had babies on the beach. Really, is there anything more wonderful than being witness to a toddler’s first dunk in the ocean? Up he comes, blinking and sputtering, the brine streaming out of his mouth and his nose and his ears. “Grammy! It tastes like salt!” As if it is a discovery as earth shaking and consequential as Magellan or Columbus.

We are back on Cape Cod for the 27th consecutive year. The White Family has assembled once again for a week of sunshine and sand. Gram is still with us, and that means 4 generations gathered to celebrate family. It’s equal parts Groundhog Day (everyone knows exactly where to sit for dinner) and the 8th day of the Universe (Grandchildren! In-laws!). Our neighbors, summer locals, expressed their amazement once again. “You’re back!” Like so many Monarch butterflies we have arrived right on schedule.

What does it take to pull something like this off. I gave this quite a lot of thought the first year we were here after Gramp left us when I wasn’t quite sure I’d ever see this particular beach again. We have been blessed with mostly good fortune, and our family has a couple of generations of beach history before ours. We are a family that thrives on consistency; do something twice and it’s a tradition. It’s almost as if we were wired to make this happen. Add to that a strong matriarch and patriarch, siblings who had more in common than not, and not inconsequentially 4 spouses who were willing to play. Don’t forget to pinch of good luck (only one rainy day per each week) and tons of hard work (hey, it’s family!) and you have the recipe for success.

Like our oft-offered advice for marital success (never stop dating!), Beth and I wish for any of you who might have a few of the ingredients above the courage to try something like this with YOUR family. A day, a weekend, a week…whatever might work for you. My kids know their cousins even though they’ve never lived in the same state. They know their aunts and uncles. They revere their grandparents. 27 years might be a bit much to expect, but you never know!

Man, babies on the beach again. How good is that?!




Having Passion

“They may say I can’t sing, but they can never say I didn’t sing.” –Florence Foster Jenkins.

Mrs. Jenkins was a socialite in NYC, I believe, who was quite passionate about singing opera. She had the financial wherewithal to produce her own performances in a rather major way. There’s a movie about her starring, I think, by Meryl Streep. A pivotal scene in the movie takes place at Carnegie Hall. There was only one problem with that, at least as far as it went for the spectators: Mrs. Jenkins was a terrible opera singer. Actually, she was epically, brutally bad at singing opera. Yet again and again she went to the well and sang her heart (and her lungs) out in front of an audience.

My instant, deep emotional response to this story is jealousy. Jealousy followed by mad respect. Jealousy because Mrs. Jenkins has a passion, something about which she cares so deeply that she is willing to pursue it to whatever limit her abilities might impose. Respect because she is willing to devote time and resources to this pursuit in spite of the fact that she will never come anywhere near anything that even approaches proficiency, let alone excellence. More than that, she insists on sharing the fruit of her labor publicly, even though she is told time and time again that her particular fruit is inedible.

No matter. Florence Foster Jenkins will sing.

Everyone should have a passion like this. We should add a tiny disclaimer or two, of course. There are a few things that shouldn’t be done by amateurs or hobbyists, no matter how passionate they may be about them. Neurosurgery quickly comes to mind. Or operating heavy equipment, even if you didn’t take any of those medicines that are advertized on TV where you have to choose between your health or, you know, driving a backhoe. If your passion is harmful to you or those around you it’s probably more psychopathic than passionate. Short of that, though, the kind of passion shown by Mrs. Jenkins is to be envied, something to aspire to.

For many years now my own life has been missing this. Outside of my marriage and my family there isn’t really anything I burn for like Mrs. Jenkins burns to sing. I do get to watch this magical phenomenon on a daily basis though. My wife Beth had long yearned to ride horses. When our kids had gone off to college she finally had her chance. The barn is her happy place. A funny thing happened for her that makes our collective experience very different from Mr. and Mrs. Jenkins. Somewhere along the way to “time-filling hobby of 50-ish homemaker”, Beth actually started to get good. I mean good enough that even a knuckle-dragging ex-fooball player spouse could see the difference. Good enough that she outgrew the ability of her horse. Doing the work has never felt like work for her—that might define passion, eh?–and there has been a payoff: she is still getting better at riding.

As for me, I will go on in search of that thing that makes me want to put everything aside and just do. That thing—singing for Foster Jenkins, riding for Beth—you think about when you are doing almost everything else. Might be writing; we’ll see. For those like me I wish you good fortune in your search, and remind you that the search is worth the effort. If you are one of the lucky ones who’ve already found yours I extend to you the same jealousy and mad respect I have for Mrs. Jenkins and my wife.

Never, ever, ever let anyone tell you that you cannot sing.

Time Affluent

Time is the most valuable commodity. For each individual it is a finite item. Precisely 24 hours in each day, thank you very much, at least a couple of which you must spend sleeping. It has been called the ultimate luxury, spawning a new class of individuals for people to be jealous of: the time affluent.

It seems that there are two diametrically opposed camps when it comes to time. There are those who feel that the proper approach to the finite nature of time is efficiency; one must develop the ability to utilize each waking moment to its fullest, most productive limits. This group includes both multi-tasckers who try to do lots of things simultaneously, and power workers who have preternatural powers of concentration and just motor through one task after another. For the record, bosses love this kind of producer, right up until they crash that is.

On the other side of the coin is a group that cherishes the freedom that unassigned time provides. Time, that is, in which one can choose to be “productive” in a way that can be measured (e.g. practice bending notes on a harmonica) or not (play along to Wammer Jammer). Knowing the difference between the two is the first step toward this type of freedom. I have professional friends who simply can’t get enough of our particular medical specialty. They work all week, every week, and in their “free time” they attend conferences at which our specialties nuances and science are discussed and debated. Some of them are very serious about all of it. They have each day mapped out to the minute and race from one session to another. They are productive. Others approach it differently; they are exploring.

Each of us has that same 24 hours each day, and we all have some version of the same things that must be accomplished over the course of those hours. The aforementioned sleep, eat, earn a living…almost all of us have this going on. One can choose to “invest” in time, though. If someone else mows your lawn that frees you up to go to the gym, for example. Cooking, cleaning, shopping, stuff like that can be offloaded or batched so that extra aliquots of time are available for other stuff. This is what it means to be “time affluent”. There are choices that can be made, sacrifices in one area that gives you more time in another.

As is my wont I will offer an example from life Chez bingo. Many of my close professional friends spent last weekend in the mountains of Utah at a conference. All of the stuff that I like to do and all of the colleagues I like to hang out with were there. Me? Stayed home. The lake was flat and the Man Cub was available to hang out. Going to the conference would undoubtedly have brought me consulting and writing gigs, but I have more of those than I have minutes to spend with a water-loving 2yo. A really interesting business opportunity is circling my day job, looking for a place to land in my schedule. Frankly, it’s great business. But it will take time. Time that I have gotten accustomed to using in other ways.

While I have more freedom than most I am not “time affluent” enough to walk away from that joint venture; Monday morning will find me in meetings about how to make it fly. It’s actually interesting and intellectually engaging enough that I might have done the same thing even if I didn’t have such a compelling business prerogative involved. Still, the thought did cross my mind that maybe, in the end, I was actually better off letting it pass me by in favor of owning those minutes that will now be jointly owned by our venture.

Like money, no matter who much you have, someone always has more free time than you do.



DNA Always Wins

DNA always wins.

In the fitness world, and sometimes even at that tiny intersection where fitness and health or healthcare cross paths, there is a recurring theme: you can’t out-train a bad diet. For whatever it’s worth, I think that’s true. Having said so there is a dangling little assumption that hangs off the back end of our axiom, that if you are fit and follow an evidence-based nutrition program that you will inevitably be healthy. Indeed, every worthwhile fitness program I’ve ever encountered pretty much says just that. “Fitness in 100 Words” on CrossFit.com was my first exposure to this as a mission statement. Loads of folks from the substantive (The Brand X Method) to the frivolous (The Biggest Loser) support this logic as the foundation of health-based fitness. For the most part it is true, and for most people the combination of general physical fitness and solid nutritional strategy results in health.

Except, you know, the whole Jim Fixx thing.

For all of you puppies and kittens out there Jim Fixx was the original running guru in the United States, the author of The Joy Of Running. You could make a case that only the late, great Jack Lalanne was a more influential historical figure when it comes to promoting health through exercise in the U.S. Jim Fixx was responsible for the surge in interest in running as both exercise and as sport, and his writing launched an era in which U.S. runners were competitive on the international stage in ALL distances from the mile all the way to the marathon.

As it turns out Jim Fixx may also be the single most influential non-medical individual in the history of the cholesterol theory of heart disease. You see, Fixx had hereditary hyperlipidemia. Despite his epic running history he was found one day in his running shorts at the side of the road, dead from a massive heart attack. Blood work at the time of his autopsy revealed a cholesterol of 750 or something like that, as well as other elevated serum lipids. His healthy diet, his outsized VO2 Max, and his prodigious training schedule were no match for his DNA. He died with epic fitness numbers, a single-digit bodyweight fat %, and coronary arteries that were so clogged red blood cells had to pass single-file. You can trace many of the USDA dietary guidelines and literally billions of dollars in research to the death of Jim Fixx.

Why bring up Jim Fixx now, in 2018, when we know that hyperlipidemia is a significant part of the cardiac risk story, albeit not the whole story? Well, we should harken back to the beginning of my thoughts: DNA always wins. While you can reduce your health risks by adopting a healthy, evidence-based diet and couple that with an exercise program that produces a comprehensive degree of fitness, you cannot escape genetics. Why at this particular moment? Yours truly just got all of his lab work back and despite 13+ years of a clean Zone diet and varying degrees of devotion to functional fitness, most of my serum lipid numbers have continued on their ever-upward march and have now reached a level where they simply must be addressed by modern medicine.

To do else wise would be madness.

I must confess that this is deeply disappointing. Quite frankly it feels like failure. At 58 I am relatively lean and strong, albeit a bit under-trained in the aerobic domain. Why didn’t this inoculate me from the need to take medication to lower my LDL? In the last couple of days I have chatted with my docs locally (both of whom are close friends who care about me) as well as really significant, nationally recognized experts in the science of health and cardiac risk mitigation. There is a consensus; nay, the voting was unanimous across the board. Don’t be stupid. Continue my program of fitness and nutrition and take the meds. We’ve now moved on the the minutia of choosing which one, a not-trivial discussion to be sure, but one that is less than earth-moving, you know?

Some years ago while proposing a unified theory of health on my personal blog I received an advance copy of Coach Greg Glassman’s definition: if fitness is WCABTMD then health is Fitness Over Time. As a physician and scientist I readily saw the value of this concept. However, I also saw and pointed out the deficiencies inherent in such a narrow definition. For example, any definition of health must explicitly address mental health. Over the years I have championed the term “well-being” and have suggested several metrics that can be used to measure this state of mental and emotional health. Mind you, I was openly mocked at the time for this, here and elsewhere. If you have followed the conversation in the CrossFit world since you will see an evolution of thought along this line, though. “Well-being” has been openly discussed in various ways as an integral part of health in most medical, health, and fitness communities. I like to think I played a small role in that.

I wrote before, then, and subsequently over the years that any definition of health must be more than a snapshot of how “healthy” you may be at any given moment. You may have a 2.5X body weight deadlift and squat, run a sub 5:00 mile and do “Fran” in under 3:00, but can you truly be declared “healthy” if you also harbor a malignant tumor in your gut or are running around with an LDL of 175? Like it or not, any comprehensive definition of health must be able to provide some degree of probability that you will remain healthy in the future. It must have some predictive value. Traditional health metrics–blood pressure, lipid levels, family history, etc.–added to a measurement of fitness and well-being do just that.

In practice such a value has proven elusive for a number of reasons, none the leasts of which is the difficulty in designing a truly measurable variable for fitness that would be accessible to the masses. Once such a measure exists the rest is just math, right? It will be necessary to determine the relative value of our three variables–fitness, well-being, and risk predictors–and then plug them into a formula to kick out something that we might call “True Health”. While this is still “pie-in-the-sky” stuff I am convinced that it is only a matter of time before it is a reality. To do my part I have tried to enlist new “partners” like my brother-in-law Pete, the cardiology savant, and others.

But for now there are lessons to be learned from Jim Fixx, and yes, once again there is a teachable moment in my little epiphany and “Sunday musings” this week. You can’t out-train a poor diet. A healthy diet of any type combined with a program of functional fitness meant to produce general physical preparedness that includes both strength and metabolic conditioning is the optimal strategy. Even here, though, you cannot escape genetics. DNA always wins. Good, bad, or in between, your DNA talks to you in the language of traditional health risk metrics.

Your DNA doesn’t care how fast you can run a mile or how much you can bench. I start my new meds tomorrow.


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.

Offloading info/Work

Why do I write? Why do I sit down and use time that could otherwise be put to use in the gym, or in the office, or even just hanging with the Man Cub? As a long-standing lover of language I am always on the lookout for the best vocabulary to explain concepts I sometimes struggle with. Offloading is a term that is used in this case to describe what it is that humans do with information that they do not need to keep on hand in “useful memory” space.

This is what I do with ideas when my “wetware” memory is full.

This is hardly new. Indeed, the sturm und drang associated with the mega-trends in education, etc. associated with our massive information/recall apparatus that is the internet actually has its origin in the Greek era of Socrates and the transition from an oral tradition to one in which teachings were written. (HT to Frank Wilczek). Prominent adherents to the oral tradition such as Socrates and Simonides argued forcefully that the advent of the written transfer of information would weaken the mind and produce an inferior type of intelligence. In a fascinating and delicious ironic twist, all we know of either of these men we know because someone else wrote down what they recalled hearing.

In my day job we are still encased in a paradigm in which information is transferred from teacher to student and then tested to see if that information has been committed to memory. Imagine, with the explosion of data now available in the world of medicine we test (and test, and test…) both new doctors and established ones to see if they remember a certain percentage of facts, regardless of how often those facts come into play in the act of practicing medicine. The CrossFit analogy is to test a trainer on the precise moment that the obturator engages in the deadlift. One neither needs to know this to teach the deadlift, nor does one need to have memorized this in order to have it on hand in the gym. So, too, in medicine.

Please don’t get me wrong, I still enjoy knowing a bunch of stuff and being able to call up that stuff without needing to use my Google-Fu. The reality is that we have made a move from memory in written form to memory in digital form that is just as profound and disruptive as that from oral to written. We have only to remember where it is we have stored our memories, our books and our music and our musings.

And our passwords. We still need to remember our passwords.

On the Beach 2018

(Surely you knew this was coming) This weekend begins the Royal Hawaiian Eye Meeting, an annual gathering of eye surgeons that I have thus far managed to avoid attending every year of my career. Why, you ask? Meh. 6 time zones for 3 days of work is the best answer. If that doesn’t do it I’ll add that Mrs. bingo won’t join me for the trip, and I really dislike most travel without the company of Mrs. bingo.

As you may have heard there was a bit of excitement in Hawaii yesterday. Seems a rather fumble-fingered employee jabbed the “alert all” button when taking his turn at the helm of the Emergency Response Center and sent off a 1960′s style, death from the air is coming, curl up under your desk kids and kiss your ass goodbye nuclear attack warning. Funny (funnier?), the doof figured out what happened when he got a text on his own cellphone.

Note to Expedia: this guy needs his own “Wanna get away” commercial.

What was your reaction? Mrs. bingo is away visiting her ailing Mom so I was alone chez bingo to contemplate what I would have done (interestingly, I would have been alone in Hawaii as noted above for real). The good folks of Hawaii and their 10′s of thousands of weekend guests were handed the dubious privilege of contemplating, if for just 30 minutes or so, how they would spend the last couple of hours of their lives knowing that they were about to spend the last couple hours of their lives. Did this occur to you, too?

Yesterday also brought me a couple of articles in a similar vein. One, from the WSJ, was not quite so stark. It asked when you would take a pill that arrested the aging process. At what age would you decide that the balance of physical prowess and age-begotten wisdom was optimized? (N.B. this was going to be the main topic of “musings”…) I also stumbled across a review of a book or a movie or something in which 3 siblings are told as young children the precise date of their deaths. What followed was the decisions these young children made based on that knowledge. Gotta admit, I went right to that place when I heard about the Hawaiian modern air-raid siren.

T’was a time when this type of inquiry was a rather commonplace occurrence. You could do worse than reading Neville Shute’s novel or the Stanley Kramer movie “On the Beach” based on it to get a sense of what a nuclear fraught world felt like. Both the novel and the movie depict a world destroyed by nuclear war, and life in Australia as the end-of-life nuclear cloud approaches the continent. How and what normal people decide to do in the face of an unavoidable expiration date some weeks ahead is central to the story. Yesterday’s equivalent would have been some hours ahead it seems.

What would you have done? Would you have sought shelter, as suggested, and hoped to somehow miraculously escape incineration if you were at ground zero? (As an aside, can you even imagine the horror of taking part in the effort to get off the islands to escape the radiation? We’d learn what savages we actually are, I fear) Would you go all Sartre or Beckett and choose an earlier “departure” of your own making as did so many in “On the Beach”? If it were real, what do you think you would have done?

As it turns out this kind of hypothetical is not solely the enterprise of the nuclear age. In fact a Parisian newspaper asked essentially the same question of its readers in 1922, long before the dawn of the nuclear age. Marcel Proust, the famous philosopher, offered perhaps the most lovely response I’ve heard before or since. “I think life would suddenly seem wonderful to us if www were threatened to die as you say. Just think of how many projects, travels, love affairs, studies, it–our life–hides from us, made invisible by our laziness which, certain of a future, delays them incessantly. But let all this threaten to become impossible forever, how beautiful it would become again!”

I surely know not what came before, as surely as none of us truly knows what, if anything, comes in the end. Questions that arise from the (usually) hypothetical “what if you knew when” scenarios lack the urgency to force an honest appraisal. Again, Proust: without the cataclysm “we find ourselves back in the heart of normal life, where negligence deadens desire. And yet we shouldn’t have needed the cataclysm to love life today.” It will be interesting for me to have a chance to chat with folks I know who are in Hawaii right now (a couple are close friends), but for now it was enough for me to have undergone this thought experiment for the umpteenth time and come to the same conclusion: I would have sought my people. Some how, in some way, with my last dwindling moments I would do whatever it took to be with my people.

Greater personal meaning will come from Proust: I will seek my people every day, for it is with them where lies joy. It is for others to seek the greater societal and geopolitical meaning and impact of yesterday’s blunder.


As We Turn the Page on 2017

Chief Justice John Roberts gave a commencement speech to a group of 9th graders this year in which he wished them “bad luck”. Now, lest you think ill of the Chief Justice, that he was being churlish and mean-spirited, what he meant was that he wished that these young people would experience some degree of hardship in their youth so that they would develop tactics to persevere as adults when those same hardships inevitably arose.

“I hope you will be treated unfairly, to that you will come to know the value of justice. I hope that you will suffer betrayal, because that will teach you the importance of loyalty. I hope that you will be lonely from time to time so that you don’t take friends for granted. I wish you bad luck from time to time so that you will be conscious of the role of chance in life, and understand that your success is not completely deserved and that the failure of others is not completely deserved either.

And when you lose, as you will from time to time, I hope every now and then your opponent will gloat over your failure. It is a way for you to understand the importance of sportsmanship. I hope you’ll be ignored so that you know the importance of listening to others, and I hope you have just enough pain to learn compassion.”

My hope for each of you is encapsulated in Justice Roberts’ conclusion: I hope that you will have the ability to see the message in any of your misfortunes, and that you will express appreciation for the people who help you overcome them.

Let me leave 2017 with a final thought, inspired by Ben Reiter’s review of the movie “I, Tonya”.

“Each of us, “I, Tonya” suggests, is more than the worst thing we’ve ever done–or, in Tonya’s case, the worst thing she might have done.” In our present days of instantly available and infinitely scalable opinion, we should add that we are more than the worst thing that someone says we did.

Let us, each of us, resolve that in 2018 we will look first to that which is good about each other, and endeavor to see that each of us is more like the best thing we’ve ever done than not.