Random Thoughts from a Restless Mind

Dr. Darrell White's Personal Blog

Cape Cod

Posts Tagged ‘sunday’

Sunday musings…6/30/19

Sunday musings (lots to catch up on)…

1) Fonder. Absent last week. Never got to the keyboard. Miss me?

2) Timmy. Our little manster Tiny Tim passed away last fall. He was a great dog. Attached as if by velcro to Beth. He visited me last night in my dreams so vividly that when I awakened it was if my arms and my lap were still warmed by his soft, fuzzy body. It was a happy awakening.

I really miss our little floofball.

3) Savage. Did you know that Fred Savage from The Wonder Years is 42 years old? Not a typo. 42! I’m not really sure why this is so striking; I didn’t really watch the show and all.

Still, Fred Savage is 42 years old. Whoa.

4) Washing machine. Fun little article on hanging clothes to dry outside in this weekend’s WSJ. I can’t remember the last time I actually saw that outside of the beach. The whole washing and drying of clothes is yet another part of “the world is way better than we admit” thing I’ve touched on in recent months. For the price of a little electricity households are freed from the chore of washing and drying their clothes by hand.

Admit it. Unless you’ve done much travel in 3rd world countries or the whole bohemian backpack thing, you haven’t washed anything by hand in years. Maybe your whole life.

This does bring into play a few 1st world problems. Our washer drum is putting rust spots on our whites. Beth just ordered a new one to be delivered and installed on the 4th (in the middle of our party!). Top or front load I asked. Answer: “Top. The whole front load thing is annoying.”

There you have it.

5) PT. I threw on a backpack and took a walk to our local liquor store yesterday afternoon. Crazy good place that store. Anyway, I loaded up the back pack with “provisions” weighing ~20 lbs and walked on home. Only 2.5 months out from my hip replacement the extra load was actually pretty noticeable. Now when people ask what I’m doing for PT I have a new, and utterly perfect answer:

I’m a rum runner!

6) Words. How we express ourselves in the words we choose can make a difference in what others hear if we do, in fact, have the ability to choose. Those hearing us should extend  goodwill in that the vast majority of people speak with honorable intent. Still, when it is obvious that a choice has been made to alter a common speech pattern or phrasing it is heartwarming; the effort should be called out and those who made the effort applauded. A very important example, one that I have mentioned often, is to describe a suicide as “death by suicide” or killed by suicide”, opting to drop “committed” and all it carries.

So here’s to MLB and its tiny but meaningful gesture of changing the name of the list of players unable to play from the “disabled list” to the “injured list”, removing a possible cause of discomfort from affecting a vulnerable population. Bravo.

7) Equality. As I approach 60 I am frequently drawn back to times, places and people from the past. White privilege is a theme that is quite in the news of late. Other than being white it’s been rather hard to see how I’ve been otherwise privileged. Certainly I have never felt the sting of real discrimination based on the color of my skin; if privilege is simply the absence of discrimination then I have been thus privileged. But as I’ve written in the past my Dad grew up quite poor, and our very lower middle-class life in the earliest days of our family was remarkably similar in almost all ways to that of a super-majority of the families in the town where I was born.

Why was that? Southbridge was notably short of not only the truly rich, but even the upper-middle class. As far as I can remember there was only really one rich family (the Wells family owned American Optical, the big employer) who literally no one ever saw, and precisely one neighborhood that stood out. And that only because the lots were a little bigger. My memory is that the houses themselves were pretty much just like those in the rest of the town. Nobody took fancy vacations or traveled to exotic locations. Little League shut down when AO closed for 2 weeks in July, and everyone went to the local lakes. In my memory almost every family in town who wanted to belonged to the little 9 hole country club if Dad played golf.

What was really extraordinary was how it felt to be a kid in school. I have no memory of anyone standing out based on any type of affluence or wealth. The kids who had cars had them because they were car-centric families. Those of us who did not (my siblings and I were not allowed to own our own cars in high school and college) didn’t because our families just didn’t have cars for the kids. There are no memories of stratification based on the clothes we wore in school. In fact my only memory about clothes was how I felt because of our own family’s very strict dress code for school. No bellbottoms or blue jeans in school, and we could only wear sneakers on Friday. My hair never touched my ears or came within hailing distance of my collar. Remember, we’re talking the 60′s and 70′s here.

Although there was a regional Catholic high school in town almost no one went there despite the fact that at least 90% of us were Catholic. We all took French in school, even the children from Puerto Rican families for whom Spanish was the language spoken at home. Kids were “tracked” academically in those times; I spent each school day with pretty much the same 25 or so kids. In the hallways between classes you couldn’t distinguish which track a kid might be in, though. I was just as likely to be hanging out with a neighborhood buddy or a teammate with whom I never shared a classroom as I was to be walking with someone from math class. As I look back it seems remarkable.

For the boys at least, we all seemed to share our rites of passage on similar timelines. Sign up for Little League at 8. Basketball leagues started at the Y at age 10. We all played Pop Warner football in 7th and 8th grades. It surely seems like everyone I knew did all of that at the same time (girls sports were different in those pre-Title 9 days so my memories are skewed male, for sure). It seems like we all had our first beers and our first kisses within 12 months of each other, max. Despite obvious genetic differences in academic or athletic prowess we all seemed so much alike. There seemed to be so little that separated any of us from one another. I’ve often noted that the difference between the “good kids” and the “bad kids” may have been simply that the “good kids” didn’t get caught.

The White family moved on, moved to another state and another school system, and another way of life as my father became more and more successful. It was obvious that we now had more of at least some stuff, not least of which was house. There was a vast range of housing in our new town. Consequently there was a greater awareness of neighborhoods among everyone, including the kids. High school in the 70′s largely broke down this awareness and never let it be a barrier, but looking back that new town and new school were different. And I am left to wonder not why the new school was different (because I see now that it was actually more realistic and probably normal), but why my first school was really the one that stood apart.

In the end I believe that Southbridge in the 60′s and 70′s was different because of all the things that were the same. Everyone went to public schools. Most Moms stayed home. The only difference between Dads seemed to be whether they took their daily shower in the morning before work or at night after. Pretty much every household had the same philosophy on child raising, and consequently you were kinda parented by every parent in town. School was safe. We had only to behave there as we behaved at home and we were free to learn. Mostly we all had the same amount of nothing extra. Nothing that set us apart from one another. It seems that we only kept score in class and on the playing fields and had nothing to measure and to compete for otherwise.

Is this simply the rose-colored memory of a kid who was mostly successful in school? Maybe, but as my old school friend Jan pointed out yesterday I wasn’t really as successful socially as I was in the classroom and on the field. One wonders if anyone else who was there at the time has a similar memory. My sense from our conversation is that Jan might. Still, as someone who has since traveled  way up and way down the economic and social ladders, there was something there that I’ve not found anywhere else. It’s not obvious to me why that was.

My hope is that, having lived there and having experienced what I remember as an equality that was so natural and unexplored that it seems extraordinary and rare, that the greatest lesson I learned there is that it is always what we have in common that matters. And that we almost always have much more in common than not. Our default setting should always be set on “equal”.

I’ll see you next week…

Santa Will Always Be Real

“Santa is the Spirit of Giving. He is always real.” –Beth White

Once again my darling wife Beth knocks it out of the park. We have a couple of little ones again in the White house, and because of that we will have a healthy dose of Santa in our lives. While I realize that Beth and I will not really have a say in whether or not the whole Santa Claus story plays out in our grandchildren’s houses, what he stands for is important. Important enough for us to have had him in all his splendor and glory when The Heir, Lovely Daughter, and Lil’bingo were growing up. Important for us to draw out the time before Lil’bingo came to the realization that Santa was not a real person for as long as possible, so deep was his love for the furry fat guy he called “Key Klaus”.

Rest assured, the parental units in Clan White did struggle with how to handle the inherent subterfuge that is necessary to have the Santa Claus story as part of our children’s upbringing. From the very beginning, though, the message was about the giving, about generosity and caring enough about someone else that you not only gave them a gift, but you gave them a gift that let them know how much you cared about them. You know, the “spirit” in the Spirit of Giving, if you will.

No matter how you massage it, that day of reckoning when your child finally realizes that the character Santa Claus is nothing more than the figurative representation of the giving concept can be fraught with all kinds of emotional trauma. For sure you might get a dose of “you lied to me”, but in my now decades of experience being around parents it’s actually rather rare for this one to pop up. What you generally face is sadness, with maybe a touch of disappointment and even mourning tossed in just to add a little sting to the moment. Like so much else about parenting, or even just about kindness, these are times when you get to talk about and teach really important lessons. Here the lesson is about giving of yourself, with or without a physical gift to actually give.

While thinking about this we stumbled upon a lovely little story about how one family handled both the “Santa isn’t real” revelation and the “Santa is real” in spirit thing. Heck, the story may even be true! A Dad sensed that his son was pretty much on the cusp of discovering that the guy in the red suit wasn’t really the real deal. His approach? He talked to his son about how he sensed that he, the son, looked like he was not too sure about the Santa Claus character. The Dad complimented his son on being a caring young man: “Everyone who cares, who is generous can be a Santa. I’m very impressed by how kind you are. I think you are ready to become a Santa, too.”

The Dad went on to ask his son to think about someone in his world who looked like they were sad. Maybe a bit lonely even. He tasked the boy with thinking very hard about what that person might really like as a present. Something they needed, and something that would express that whoever gave it to them realized this need, and cared enough to give them a present that helped to meet that need. There was a catch, though: the recipient was never to know who gave them the gift. For the son the satisfaction was in the caring and in the giving, not in the recognition and praise that might follow.

It doesn’t really matter who the child chose or what he gave; you can trust that the story–true or not–is just lovely right to the end. What matters is that this very young boy is escorted through what can be a very sad stage in a young life by a caring and thoughtful parent. On the other side of this journey emerges a young man who has learned the true meaning of Santa Claus in the secular Christmas story. He has learned that what matters about Santa Claus is real indeed, and always has been.

Santa Claus is the Spirit of Giving. He will always be real.

Sunday musings 11/4/18

Sunday musings…

1) Fall. As in “fall back”. I slept 10.5 hours last night. I. Feel. Great.

2) Digital. As in watch. At the moment I am wearing an $11.00 Casio digital watch. It took 2 beeps to reset 2 time zones, and I know it’s November 4th by looking at a watch purchased 2 years ago.

$11.00. Is this a great world or what?

3) Techquake. Term used to describe the advances that have come to our digital world that began with the opening of the internet to regular folks like you and me by Netscape (among others).

I think that fits quite nicely, thank you very much.

4) Historic. “…for the growing good of the world is partly dependent on unhistoric acts; and that things are not so ill with you and  me as they might have been, is half owing to the number who lived faithfully a hidden life, and rest in unvisited tombs.” –George Elliot* (HT to my friend Bruce K.)

We in the U.S. have been bombarded of late with missives that declare that we are living in “historic times”, that we have a “historic opportunity” to participate in an election that will “determine our fate as a country in historic ways.” But is that really so? Are we truly at an altogether unique inflection point, one so different from all that have come before that our fate, our daily experiences to come will be affected in ways that we cannot miss or ignore? Or is this particular upcoming election simply the next in an unbroken series of political or governing evolutionary steps that has been unbroken since the end of the Civil War? Is the excitement and the drama simply an extension of the “Techquake” and its always on firehose of information?

Seriously now, if you are one who is on your soapbox (facing in either direction), are you really telling us that Election Day is going to change our nation to a greater degree than the one that brought us 4 years of LBJ and the Great Society?

As a people the citizens of the developed world have been swept along in the great rivers of effluent poured forth from that firehose of information that was spawned by the internet. Have we forgotten the accuracy and truthfulness of Elliot’s words? If so is it because we simply cannot get even a single pupil above the torrent of information to see what he saw? Or is it more that we have lost the ability to paddle even the tiny amount necessary to do so? No matter, the result is the same.

Literary fiction is taught as the study of quiet acts of desperation and the fall-out that follows. Life, on the other hand, is made up of quiet acts made out of sight of nearly everyone. Anonymous acts carried out with neither malice nor benevolence. These are what constitute the reality of life. It seems to me that at least a (very loud) portion of our people have lost the appreciation of this reality. For them each act is either an affront or a tiny step toward canonization. I do not believe they are correct. Elliot is only wrong in that he underestimates his object; that  things are not so ill with you and me, is not half but mostly owing to those who lived that faithful life.

To what, then, is this anonymous majority faithful? This is quite simple, and because this is so it is all the more painful that it must be pointed out: they are faithful to one another. They live lives that are faithful to the belief that it is another person with whom they are living, not an opinion or a belief. This anonymous mass lives lives that are intertwined with other people, not other opinions. When they look to their left or to their right what they see is not a position or a platform, but a person. It is this, the acknowledgement that we are surrounded first by other people, that leads to salvation in this life.

You are surrounded by people who are faithfully living quiet lives, anonymous to all but a handful of others, whose lives will be remembered by even fewer, if at all. Unbeknownst to one another they likely crossed paths with someone with whom they would find little common ground in belief, someone who is close to you, about whom you care very much. Despite this lack of commonality the crossing was uneventful. It was peaceful. On balance it was marked by quiet goodwill, if it was marked at all. It was a moment that will have passed directly into an unvisited “tomb” in the memory of each of these individuals.

And yet it was that quiet faithfulness that behind whatever disagreement might exist between the two there lived much more than another opinion or belief. There lived another person. Another person living a life largely unnoticed, hopefully a quiet one with less desperation than more, on their way to an end noticed by few and mourned by fewer still. Lives that were lived in the faith that there exists much, much more good in others than not.

A faith that we, the living, must endeavor to keep.

I’ll see you next week (which will surely arrive, regardless)…

–bingo

*George Elliot is the pseudonym of a woman. In order to write and be read she felt the need to write as a man. That most women who write today can do so using their own name is “unhistoric” is yet another indication of how wonderful are our times.

Smaller, As Time Becomes Shorter

This weekend was spent in Chicago at the annual meeting of men and women with whom I share my day job. As I noted in “Sunday musings…” I’ve been suffering a bit from some sort of degenerative issue in my hip. Traversing the longest indoor “bridge” outside of the Providence airport rental car connector, my discomfort made me think of my Dad and the back pain that grew to consume him as he aged. Mind you, my discomfort is minimal in comparison, and my particular problem is quite amenable to a surgical fix with a high success rate. Still, it made me feel older, and it made me think of my Dad, gone these 3 years.

Below is what I wrote some years ago when I started to notice the changes in Dad.

 

When did my Dad get so small? Close your eyes. Think of your Dad. What does he look like? How old is he with your eyes closed? He’s younger, isn’t he? And bigger. MUCH bigger.

I spend most of every day in the company of people decades my senior. I’ve watched some of them age over 20 years or so. There are a few with whom I’ve bonded, who I remember and can conjure up an image if asked. I never appreciate the change in size in them, though.

It’s a strange phenomenon. It’s uncomfortable, no? There really IS a physical change that occurs as we age; we really DO shrink physically. No, it’s more than that when you look at your Dad, more than the physical decrease in size, the loss of vigor and all that goes along with it, the stuff I might actually notice in my patients. What makes it so striking when it’s your Dad is that it’s more than just physical, but a diminution in all dimensions and domains including the one inside your head.

He WAS strength when I was a kid. Literally, a rock. Immovable and unshakeable at all times. Unmoved by excuses or explanations when he knew he was right, or if he MIGHT be right. The final arbiter of discipline (“wait ’til your FATHER gets home…”) in a very traditional family, every thing about the guy was just huge.

When did he get so small? It’s almost scary, you know. He was the guy who stood between me and everything that might be dangerous, at least figuratively. At least in my mind. It’s hard to reconcile the guy I just put on a plane back to RI with my Mom, and the guy who’s there–right in front of me–when I close my eyes. So small now, almost frail. That classic love/fear thing now replaced with something more like love/protect. Does he see it, too? How small?

Will I see it, when I’ve become small?

The End of the Age of Volunteerism

Ladies and gentlemen, we are gathered here today to mourn the death of the Age of Volunteerism. While there exist tiny spaces where true volunteers live and thrive in a bilateral exchange of freely given goodwill, by and large volunteerism has been extinguished by the actions of its historical recipients. Sunday marks my last day ever of hospital ER call, the end of 2 years of receiving token payment for making my expertise available following 25 years of doing so for free. My experience is typical, as is this denouement.

Once upon a time all of your doctors were in private practice. We all had tiny little cottage businesses, did our work, and billed you or your insurance company for the work we did. Some of us worked in tiny little groups, but it was the rare doctor who was part of a large group or business whether in a big city or out in the country. Even the slickest Madison Avenue internist was basically a country doc, just with a better, more expensive wardrobe. In addition to having a greater familiarity with our patients we also enjoyed a very clubby relationship with all of the other doctors where we practiced. There was a collegiality, a sense that we were all in the struggle together. Folks who shirked their duties, foisting them off on other docs, were quickly educated about proper protocol or left to toil alone.

Hospitals were different, too. Local or regional, they were hardly the gargantuan mega-businesses they’ve become. The org chart was shallow, and most local doctors were on a first name basis with the few administrators on the hospital payroll. You took call for the ER as a volunteer; the ER respected that you were donating your skill and your time and handled everything it could before calling you. Same thing for consultations. Your colleague only called you if they couldn’t figure out a problem or ran out beyond their scope of practice. There was a faint air of apology with each request, and a definite unspoken appreciation for the help that would be given. You helped because you were appreciated.

This is really no different from all manner of volunteerism in America. Smallish, closely knit organizations depending on the goodwill and generosity of members of their community pitching in to ensure success. Think local memorial 5K races, or CrossFit Games Regionals in the days before ESPN or the Home Depot Center. Countless small private schools that depended on the largesse and time offered by the families who sent their children there. You gladly accepted the opportunity to volunteer because you knew that without you the organization would not be able to function. You also knew that the recipient of your generosity not only appreciated your contribution, they really had no other options. Not only that, but if that organization somehow existed in your professional space you knew that it would never, not ever, abuse the trust necessary for volunteers to continue.

What happened? Money. Money and size and the distance that they create between an organization and its volunteers. Let’s go back to the hospital and the ER for a minute. Where once your efforts as a volunteer were deeply appreciated and those efforts rewarded with respect and care for your time and your expertise, the growth of employment of doctors by hospitals opened a gap between colleagues. No longer was there the esprit de corps, the shared notion that the primary target of our efforts was the patient was replaced by so very many doctors by the reality that they worked first for a business as faceless and uncaring as GM. Work that was once done by your colleague was now pushed to the volunteers whenever possible. It’s cheaper that way. Worse, boxes to be checked by the employed (to maximize revenue and minimize risk) meant demands made of volunteers, not requests. Worse, still, were discoveries that some “volunteers” were more equal than others: they were paid.

Innumerable examples are there for the picking. Some times it was just a case of laziness. Other times the insult was a clear effort to dump work on the volunteer. A critical care fellow requested a consult for acute narrow angle glaucoma. For those of you not medical this is one of the few “drop everything and go” consultations in eye care. When I arrived in the ICU I found a young patient with a black cornea who was mildly uncomfortable. I did what every highly experienced specialist does when they start a consultation, I asked the patient: “Hey, what’s up with your eye?” Turns out they had a blind, painful eye as the result of a surgical mishap, and surgery to remove the eye was already scheduled. Their discomfort was because none of the eye medications had been ordered; the fellow never asked. No doctor (or nurse) would have allowed this to happen in the Age of Volunteerism.

While this is nothing short of tragic in health care, it was inevitable once medical businesses were incentivized to grow ever larger. It is not confined to health care by any means. How do you think that volunteer at a Spartan Race feels when he learns how much his “team leader” is being paid? Have you ever “discovered” how much the Executive VP of your favorite professional organization is paid? As a people we Americans are generous to a fault. That generosity usually continues right up until we discover that we have been duped, and even worse that we have been purposely duped by the people who run the organizations for which we volunteer.

And so we gather here to mourn the passing of the Age of Volunteerism. Like so many things of wonder and goodness there remain pockets of resistance, little oases where the goodwill, honesty, and appreciation beget the kind of ebb and flow that made things so much better, kinder, more collegial at the apex of Volunteerism. My friend Tom Gardner was just named the president of the Society of Alumni of our Alma Mater. Tom has given tirelessly of his “spaces”, his timespace, brainspace and emotionalspace to help shepherd tiny Williams College as it flows on though time. Is this truly different? A tiny refuge from the Zombie Apocalypse of corporatization of all things to which we once volunteered?

We can only hope. Hope that Tom and those like him who continue to find places and causes where their volunteerism is met with what we in medicine have had to bid farewell. We can only hope that there will be places where being a volunteer means receiving the respect and appreciation and even a kind of love in return for what we have given. We can only hope that there will continue to be places where the incessant drive to grow ever bigger, size measured on a spreadsheet rather than by heart, will be resisted. For if it can happen in medicine, if volunteerism can be killed in what is arguably the most noble of all endeavors, I fear that it is doomed everywhere.

We mourn the end of the Age of Volunteerism. We wait with equal parts sadness and fear for arrival of whatever comes next.

 

Sunday musings 10/14/18

Sunday musings…

1) Feral. Abbie the Wonder Dog was feral for the first 6 or 9 months of her life. I can’t remember exactly. She was live-trapped and rehabilitated by a Border Collie rescue organization in north central Ohio. When she frustrates me it is always helpful to remember this.

Having a formerly feral creature living in our midst is also a very good counter to the frustrations of modern life. I try to remember how far I am from true privation whenever I find myself railing agains the insanity and inherent indifference that the world clearly has toward my existence.

A quick thought of my clever (read: sneaky) pup is usually all it takes to quell my urge to explode when I encounter the tragedy of a poor internet connection…while hurtling through a mountain pass in a car going 80 MPH.

2) Test. Some 10 years ago or so I proposed that a true measurement of health should be possible. Something that combined the most basic of classic medical knowledge (weight, %BW fat, BP, Cholesterol, etc.) and the breakthrough notion that physical fitness could be measured and tracked. My theory included the necessity of including some sort of measurement of “well-being”, a mandate that was initially openly mocked but seems to have been rather meekly accepted as both logical and necessary.

Creation and launch of such a value, call it “Total Health” or something along that line, has fizzled due to the lack of consensus–nay, even interest–in coming up with a way to measure Fitness. Imagine, in a place like CrossFit where the very definition of Fitness was created, no one save me and a tiny group of equal obsessives has so much as let fly a tiny trial balloon. The original owners of CrossFit LA were the first to use a standard entry test. 500M Row/40 Squats/30 Sit-Ups/20 Push-Ups/10 Pull-ups. I suggested pulling from both traditional sources (The President’s Fitness Test) as well as CrossFit and the larger endurance communities: 2:00 each of PU/Push-Up/Sit-Up/Squat, 1RM Deadlift, 1 mile Run. We ran a competition once called the “Fittest Eye Doc” using this.

What is necessary is a test that is a) doable by the general public, and b) capable of creating a single value that can be measured and tracked. Once that is done mathematicians and statisticians can be let loose with the various factors and given the task of coming up with a formula that includes all three categories. Why bring this here, again, when thus far my previous dozen or so postings have been met with crickets? With the pivot to health and the rapid build-up of a cadre of physicians who are at least superficially interested in using high intensity exercise for the purpose of increasing health, I am hopeful of a broader dialogue that comes to an agreement on a test.

Challenge: create a test of fitness that is broadly accessible in all ways (scalable) that can be included in a definition of health. 3-2-1…Go.

3) Volunteerism. Ladies and gentlemen, we are gathered here today to mourn the death of the Age of Volunteerism. While there exist tiny spaces where true volunteers live and thrive in a bilateral exchange of freely given goodwill, by and large volunteerism has been extinguished by its historical recipients. Today marks my last day ever of hospital ER call, the end of 2 years of receiving token payment for making my expertise available following 25 years of doing so for free. My experience is typical, as is this denouement.

Once upon a time all of your doctors were in private practice. We all had tiny little cottage businesses, did our work, and billed you or your insurance company for the work we did. Some of us worked in tiny little groups, but it was the rare doctor who was part of a large group or business whether in a big city or out in the country. Even the slickest Madison Avenue internist was basically a country doc, just with a better, more expensive wardrobe. In addition to having a greater familiarity with our patients we also enjoyed a very clubby relationship with all of the other doctors where we practiced. There was a collegiality, a sense that we were all in the struggle together. Folks who shirked their duties, foisting them off on other docs, were quickly educated about proper protocol or left alone.

Hospitals were different, too. Local or regional, they were hardly the gargantuan mega-businesses they’ve become. The org chart was shallow, and most local doctors were on a first name basis with the few administrators on the hospital payroll. You took call for the ER as a volunteer; the ER respected that you were donating your skill and your time and handled everything it could before calling you. Same thing for consultations. Your colleague only called you if they couldn’t figure out a problem or ran out beyond their scope of practice. There was a faint air of apology with each request, and a definite unspoken appreciation for the help that would be given. You helped because you were appreciated.

This is really no different from all manner of volunteerism in America. Smallish, closely knit organizations depending on the goodwill and generosity of members of their community pitching in to ensure success. Think local memorial 5K races, or CrossFit Games Regionals in the days before ESPN or the Home Depot Center. Countless small private schools that depended on the largesse and time offered by the families who sent their children there. You gladly accepted the opportunity to volunteer because you knew that without you the organization would not be able to function. You also knew that the recipient of your generosity not only appreciated your contribution, they really had no other options. Not only that, but if that organization somehow existed in your professional space you knew that it would never, not ever, abuse the trust necessary for volunteers to continue.

What happened? Money. Money and size and the distance that they create between an organization and its volunteers. Let’s go back to the hospital and the ER for a minute. Where once your efforts as a volunteer were deeply appreciated and those efforts rewarded with respect and care for your time and your expertise, the growth of employment of doctors by hospitals opened a gap between colleagues. No longer was there the esprit de corps, the shared notion that the primary target of our efforts was the patient was replaced by so very many doctors by the reality that they worked first for a business as faceless and uncaring as GM. Work that was once done by your colleague was now pushed to the volunteers whenever possible. Worse, boxes to be checked by the employed (to maximize revenue and minimize risk) meant demands made of volunteers, not requests. Worse, still, were discoveries that some “volunteers” were more equal than others: they were paid.

While this is nothing short of tragic in health care, it was inevitable once medical businesses were incentivized to grow ever larger. It is not confined to health care by any means. How do you think that volunteer at a Spartan Race feels when he learns how much his “team leader” is being paid? Have you ever “discovered” how much the Executive VP of your favorite professional organization is paid? As a people we Americans are generous to a fault. That generosity usually continues right up until we discover that we have been duped, and even worse that we have been purposely duped by the people who run the organizations for which we volunteer.

And so we gather here to mourn the passing of the Age of Volunteerism. Like so many things of wonder and goodness there remain pockets of resistance, little oases where the goodwill, honesty, and appreciation beget the kind of ebb and flow that made things so much better, kinder, more collegial at the apex of Volunteerism. My friend Tom Gardner was just named the president of the Society of Alumni of our Alma Mater. Tom has given tirelessly of his “spaces”, his timespace, brainspace and emotionalspace to help shepherd tiny Williams College as it flows on though time. Is this truly different? A tiny refuge from the Zombie Apocalypse of corporatization of all things to which we once volunteered?

We can only hope. Hope that Tom and those like him who continue to find places and causes where their volunteerism is met with what we in medicine have had to bid farewell. We can only hope that there will be places where being a volunteer means receiving the respect and appreciation and even a kind of love in return for what we have given. We can only hope that there will continue to be places where the incessant drive to grow ever bigger, size measured on a spreadsheet rather than by heart, will be resisted. For if it can happen in medicine, if volunteerism can be killed in what is arguably the most noble of all endeavors, I fear that it is doomed everywhere.

And so we mourn the end of the Age of Volunteerism. We wait with equal parts sadness and fear for arrival of what follows.

I’ll see you next week…

–bingo

 

Sunday musings 9/2/18

Sunday musings…

1) Eschaton. A final stage in social evolution. Proposed by futurists in Silicon Valley as the inevitable.

Likely to be as accurate as Marx commenting on the steam turbine and electrification. (HT George Gilder).

2) Refurbish. Mrs. bingo and I own a refurbished 1971 runabout. It took 11 months to be  returned to us. At the moment it is a lovely piece of lawn art because our 1999 pier is in the middle of a refurbishment.

Yup. It’s been 11 months.

3) Air Show. Labor Day Weekend means it’s air show time in Cleveland. It’s nothing short of awe inspiring to see the majesty of our nations’s air power parade by the North Coast of the U.S. Two A-10′s casually floated by Casa Blanco on their way to the fairgrounds. They. Fly. So. Slowly.

Why do people choose to mess with us?

4) Nest. My brother and sister-in-law are now officially empty nesters. Both children have graduated and are full employed. No one lives at home. Randall and Joanne chose to spend their first official trip with us. This is actually a pretty big deal; for 10 years they have spent literally 40 weekends per year following their boys’ collegiate teams. For 10 years I have waited for my bother, my best friend, to be free to hang with me again.

What’s the point? Simple. Sunday musings, indeed, all of my pabulum, is a luxury that I have taken for myself, and that all of you have gifted to me. It’s been a blast. A privilege. But it’s neither necessary nor is it mandatory. Here we are at 2042 and I am just now getting around to my laptop. I spent today doing pretty much exactly what I have exhorted each (both?) of you who read my stuff to do: spent my day in direct face-to-face contact with people I love, away from pretty much all forms of digital whatever. Arms length or closer, all day. We slept in while Mrs. bingo tended to her horses. We got a collective dousing from the Man Cub, who has apparently discovered how to turn on the back yard hose. The sunset over Lake Erie was epic.

I love writing for you, I really do. I hope that what I write occasionally gives you a moment to reflect on what it is we do and why. Today I just lived among my people. My whole day was spent with people I love who love me right back. I was busily in the act of loving and being loved all day long.

What a day!

I’ll see you next week…

–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…

–bingo

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…

 

–bingo

 

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?!