Random Thoughts from a Restless Mind

“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.

The Extras. OUR Extras. That’s what Dilly (my daughter-in-law) calls all of the kids who were not our natural born children but who nonetheless lived a substantial percentage of their lives in our house. All three of our own had several friends who became Extras. Over time Beth and I morphed from Mr. (or occasionally Dr.) and Mrs. to Mama and Papi for these kids. Many of them are still very much a part of our lives, reunited with our odd little extended family by weddings, christenings, holidays and the like.

Tragically, one of our favorites is now no longer.

My oldest son Dan and I attended Bobby’s memorial service yesterday afternoon. Bobby was once so close with my two older kids and so comfortable in our home that I vividly remember coming home one day to find him at our kitchen counter doing his homework. All alone. No one else in the house. He lifted his head, smiled his trademark goofy smile and flicked the largest, heaviest bangs in the history of banghood out of his eyes, said “hey Papi”, and went back to his books. Neither one of us thought there was anything remotely odd about it at all. Bobby was not one of the Extras who stayed in touch. He drifted away from us as he fell further and further into his addictions and died of an accidental overdose last week.

It’s hard to describe how awkward, how awful the service was yesterday. We recognized almost no one. Dan only knew Bobby’s parents, and I’d never met either one of them. What could I say to them at a time like this? I was really only there for Dan (and by proxy “Lovely Daughter” Megan). There is not a single language in the world that has a word or a name for what we would call a parent who has lost a child. Nothing like “orphan” for the parentless, or widow/widower for the surviving spouse. I’m not sure if either of Bobby’s parents even know that he was our Extra, or knows how much we cared about him once upon a time.

Have you been to a funeral or a memorial for a young one who succumbed to his addiction? To the great credit of everyone in Bobby’s family they didn’t evade the issue at all. Three significant figures from his unsuccessful attempts to leave that life spoke. All of the happy memories were of his very young childhood, as if the Bobby who’d lived so much of his life at Casa Blanco had died at high school graduation. What can you say about a life that was 10 years shorter than the number of years one had lived? The other funerals of youngsters who have died have been filled with the lament of potential left behind. There was none of that for Bobby, only the memories of the child and the struggle of having watched 10 years of pain.

What is it about opiate addictions in our country now? We have had other substances that have been a scourge on our society, notably crack cocaine in the 80’s and 90’s, but this is different somehow. For one thing, while crack destroyed lives it didn’t end them. 30,000 people died from inadvertent opiate overdoses in the U.S. in 2016, most of them under the age of 30. For whatever reason 1/9 of them occurred in Ohio where we live. It seems like rather a bad business model–don’t you think?–to pump up the purity and strength of your product to the point that you kill off a meaningful percentage of your customer base. And yet here we are, more and more people dying each year from overdoses.

What is in the news on a daily basis is the problem of addiction created through the prescription of opiates by physicians, addiction which must then be addressed on the street if or when the prescriptions end. While that scenario is certainly real and needs addressing, we hear more about it because of the irresistible angle of big Pharma companies and their profits, and the equally irresistible urge to find someone or something to blame and punish. This is not Bobby’s story. Bobby, like so many, many of his peers today and for literally centuries of todays, fell prey to an illness that could only have been treated by prevention. There are those among us who cannot resist the siren song of any number of substances once they’ve had their first taste. I do not know what gateway drug it was that walked Bobby into that world; it was an opiate that escorted him out of our world in the end. A pox on the cretins who opened the exit door.

I am left grasping at straws. What can we do to prevent these senseless deaths? While I am a physician and a student of health policy, nothing in my training or experience is helpful here. Why is there so much “hot” product out there on the streets? What is it about this substance that makes it so difficult to leave behind once the addiction sets in? Our society is one in which we are convinced that someone is always to blame, hence the vitriol directed at the manufacturers of the legal version of the opiates that so many young people are abusing. I’m sorry, but it’s not intuitive to me that going after them is going to help the Bobbys of the world stay alive. The feeling I have is one of utter helplessness.

Message? Lesson? Sadly, I’m afraid, I have neither to offer. Bobby is gone and I am sad. Had he not been lost to us, had we remained a part of his life would there have been a different ending? Well, the story arc would likely have been different, but history has shown that the ending would likely have been the same. You never know, though, and that makes me sadder, still. You never really know, right? We would have tried, Beth and I, because he was one of ours. He was one of our Extras. For many years, he was one of mine.

It seems only yesterday that he’d found us, and we, him. Now his is lost to all of us. Forever.

My gentle, sweet, and much beloved father-in-law is now on his final glide path. As sad as we all are to be witness to this last landing we are equally joyous at this bonus year we’ve all enjoyed. What a gift it has been. You see, Bob was told he had a scant few months to live almost 1 1/2 years ago. Through a combination of good fortune, excellent modern medical care, a strong foundation of fitness (Bob’s trainer used CrossFit principles in his training!), and his drive to thrive, he has graced us with innumerable moments of love and joy we had no expectation of sharing.

Nothing focuses your attention on what matters in life so completely as imminent death. It’s quite a shame, actually. What we as an extended family have done over these last 15 months or so has come to seem quite natural and, while not easy, not terribly difficult to pull off either. Our efforts have centered on love and kindness. Full stop. We have all made an effort to connect so that we might express and share our love. That we might give ourselves extra opportunities to be kind to one another. It has certainly taken a bit of work, and for some of us it has tasked us with looking carefully at how we prioritize our lives. In the end, though, we all discovered that the effort/outcome equation has fallen squarely on the good side: we got more out of the effort than we ever thought we could.

Listen, it’s never the same before you see the glide path beginning. To conclude this little snippet by imploring you to totally re-order your life as if you, or someone special to you, is soon to land their flight forever is so trite it’s little more than drivel. It’s not natural, and none of us can do it. What is possible, though, is to inject just a bit more of that love and kindness into your everyday thoughts and actions with your loved ones now. If you get the same kind of optimization of your effort as we all in Beth’s family have received (and as an aside, what my family achieved during my Dad’s illness) perhaps you can try to add just a little more of each over time. It’s very CrossFitty, that. A little more love and a little more kindness offered today in the hope that tomorrow you and your loved ones will be a little bit closer, a little bit happier together than you were yesterday.

As for us, all that is left is to fasten our seatbelts as we hope for fair winds and the gentlest of landings.

There’s been lots of loss around the White house of late. Lost parents, parents soon to be lost, lost innocence, lost friends, lost trust. Tons of loss. Some of those losses are inevitable of course, but others are sadly losses born of the choices made by others. Whatever. We–you and I and our loved ones–do not get to make choices for those who come in and out of our lives. While that knowledge provides little salve for the sting of loss it at least allows us to make a clean break, to leave behind a loss after a proper amount of legitimate, honest mourning.

A problem arises when mourning is tinged with regret. This is made all the more problematic when the regret is not honest regret, when it is disingenuous, the result of a conscious decision made without any consideration of anyone other than oneself. You know how this goes. “I wish I’d visited Papa more after he got sick.” “My best job was the first one I ever had; I should have gone back and asked if I could start again.” “Man, I can’t believe ABC is closing. No place was ever as good that.” “I wonder if it would be different if I’d gone and had that beer with XYZ.”

Some regret is real. I get that. You’ve got a crappy job and you need it, and you just can’t get on a plane to see your Dad/Mom/sibling. Deep down you think you were wronged in some way at some time by somebody, that your boss/family member/friend could have been better to/for you and you had no choice but to leave the job/business/friendship. Heck, there are some families where so much toxicity is directed toward you that the only way you can remain healthy is to separate from the family. I get that, but let’s face it, stuff like that is not the norm. In most cases everyone could have tried harder, done better. Including you.

You, and I, can legitimately regret that, not trying harder.

What’s the lesson here? Well, as I said some losses are unavoidable. Death comes for us all. Miss that chance and it’s gone forever. Suck it up and spend the time BEFORE it’s time to mourn. The person who departs gets no satisfaction from your regret, they simply left saddened by your absence.

All the rest? Well, your choices have consequences for everyone involved. Bad or sad things are at least partly on you, and protestations of regret (Oh I wish I’d; Oh I should have) make it infinitely worse. Suck it up and own your decision. Suck it up and own the consequences. A business that depended on you folded because you left? A friendship ended because you gave up? A family less close because you were all “Cat’s in the cradle” all the time? You chose one of your ‘wants’ over some meaningful someone’s ‘need’? Saying you miss this or that about any or all of these only makes it worse. You chose to miss it.

Listen, I’ve done all of the above and properly suffered because of it. Some things are too valuable to take a chance on needing to mourn them. It’s much less painful, and much more believable, when you’ve made every effort possible to prevent a loss. Then others will believe you when you say “I miss…”

More importantly, you’ll believe it yourself.

(With thanks to Ira Byock, M.D.).

I attended a talk yesterday on end of life care, the first in a lecture series honoring the friend I lost to cancer earlier this year. The talk was surprisingly moving, not only because it brought back memories of Ken but also because I will likely lose my Dad in the not too far future, and I thought of my folks throughout the talk. What the speaker discussed as end of life care and end of life preparations also offered a very important take-away that I will try to apply now, today, as if the end of life was nigh.

One should say 4 things often and with ease, not only in the course of completing a life’s work or concluding a life’s relationships, but in the course of living a life:

Please forgive me.
I forgive you.
Thank you.
I love you.

Sounds simple, huh? Maybe even a little trite. But each one of those little phrases is a bit of a minefield, each one laden with a hidden meaning and a back story, each one the mid-point in a little journey with a “before” you know, and an “after” you can’t possibly predict. There’s a little risk in that “after”, too, and that’s why those 4 little phrases aren’t really all that simple, and why considering this is not at all trivial. All 4 of those little phrases make you look outward, look at another, and in the stating they force you to put yourself at the mercy of that other. Each one of those phrases is a little opening in our guard, an invitation to accept or reject not only the sentiment but the sender.

I’ve spent the better part of 24 hours thinking about those 4 essential things and about how they fit in a life that is not necessarily concluding (at least I hope not!). We are, each of us, part of a tiny little ecosystem; thinking about using these phrases encourages us to look outward and see the others in our own worlds whether we are approaching the conclusion of a life or smack dab in the middle. How will my parents react if I approach this when I visit? Do they know it’s now the 5th act, that we are tying up all of the loose ends in the story?

How about my friends, my kids, my darling bride? Actually, without really knowing it I’ve been on this path for some years now, probably guided by Beth and her inherent goodness. Friends come and go; either way I’ll likely feel a sense of completeness in the relationship if I remember these 4 things. Patients and staff do, too. I think I’m a pretty good boss and pretty user-friendly for patients as far as specialists go. Bet I’ll be better at both if I’m thinking about these, even just a little bit, even now.

Please forgive me.
I forgive you.
Thank you.
I love you.

Don’t wait for the conclusion of your life to think about these.