Random Thoughts from a Restless Mind

1) Olympics Fan. The White family, certainly my generation and that of my parents, is filled with Olympics fanatics. I’ve been home alone for 10 of the last 17 or so days without the Olympics to fill the vacuum. It’s a type of emotional and adrenaline withdrawal.

I can’t believe I have to wait two years for my next dose.

2) Olympics Spectator. Our little branch of the White family was in the middle of our life as a skiing/riding family when the Winter Olympics descended on our adopted winter towns of Salt Lake and Park City. Beth bought not one but TWO homes in response to my fear that we would have more trouble finding and affording housing for the 2002 Winter Olympics than we would finding and affording event tickets.

Like all things real estate she stuck the landing on that one.

We invited my Mom and Dad, the Olympics junky OG’s, to come along for a 10 day trip filled with a smorgasbord of events familiar to all (did you know the Czech hockey team had cheerleaders?!) and so obscure that we really didn’t know they existed (short-track speed skating relays!). Our experience mirrored Mom and Dad’s L.A ’84 trip on which they checked out almost 2 dozen different events. Including, in a fun kind of foreshadowing, equestrian! Mom had a foot injury which severely limited her ability to walk on hillsides; the image I see as I write is my 13 yo son pushing his Gram’s wheelchair to the front of the line at every event as we rode her coattails into each venue.

Those were good days. We have our sights on L.A. 2028 and the equestrian events.

3) Olympics Heroes. Each version of the Olympic games anoints a new group of heroes while simultaneously confirming the heroic status of multi-Games veterans. Milan/Cortina was no different. Who will ever forget the rings of color in Alyssa Leu’s hair? Has there ever been a more famous tooth than Chris Hughes left upper incisor? Heroes from Games long-passed re-emerge. Wasn’t it cool to see the quiet grace of Eric Heiden on display as he cheered on an heir-apparent? Or Ryan Cochrane-Seigel re-introducing us all to his Gold Medal winning Mom, Barbara Cochrane?

My personal favorite “remembered” Olympic hero is the 1960 figure skating Gold Medalist Carol Heiss-Jenkins, a friend here at home. How lovely to read about her, to hear true experts opine that she may have been the greatest of all the American figure skating greats. And to see her shyly smile and shrug it all off.

In a fortnight filled with both the creation and confirmation of hero status I found the stories of two American women skiers to be the most compelling. I admit to paying much more attention to Team USA. I also admit to being more than a little bit partial to those athletes that catch the attention of my friend Tim, a sportswriter who wrote about both. Mikaela Shiffrin conquered 8 years of grief to win the Gold Medal in women’s slalom 12 years after her triumph as an 18 year old. 4 years after skiing off course and a week after perhaps her slowest run in competition in years, Shiffrin lapped the field and won. Honestly, it was hard not to cry as she fell to the snow.

Then of course, Lindsey Vonn. Admit it, you were skeptical last year when you heard that Vonn, pain free after a partial knee replacement, had returned to the World Cup circuit after a year of under the radar training. Gobsmacked when she had a couple of podium finishes, and electrified when she won a Downhill. I sure felt all of that. And like me you were disappointed and sad when you heard that she had crashed and blown out the ACL on her GOOD leg two weeks before Snoop Dogg carried the flame around Milan. Because we honestly thought she had a chance. We wanted her to have that chance.

Why? Why did we care about Lindsey Vonn and her quest for one last shot at Gold at 41 years of age? Beth and I, Olympics junkies that we are, watched the story unfold with a deep sadness. Like everyone it seems, we were surprised and a bit skeptical when word reached us that Vonn would ski regardless. We are literally her parents’ age; our instinct was to reach out through the TV enfold her in a parental cocoon while we whispered “it’s OK, it’s enough.” But there we were a couple of days later, a little excited at a 5th fastest training run, a little pleased to hear there was no pain. Wary, nearly convinced on that one last run.

You know how this ended, of course. In her quest for speed it was not her knee or her technique that let her down, it was a tiny tactical error magnified by that speed that did her in.

It appears that Lindsey’s injuries, while much more catastrophic than apparent at the outset, will be overcome, and we collectively sigh in relief. There are lessons here for high achievers of all types in fields both athletic and intellectual, but those are Random Thoughts for another time. Which brings me back to my friend Tim and his thoughts on Lindsey Vonn and her quest: “She inspired fans and others who do not have her talent or courage, but who marvel at it–which is what sports do for us, even if they do not provide happy endings. It was historic, all of it, and it is a shame that Vonn did not make it to the bottom of the Olympia de Tofane, but it is a miracle that she made it to the top.”

We are grateful for the miracle that was “all of it”.

I’ll see you next week…

There’s been lots of loss around the White family 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. As they say, send the flowers today; the deceased never get to see them on the altar. Likewise, 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.

1) Memory 1. Music is a very powerful trigger for memories, isn’t it? Driving to the barn with Beth this morning and my brother calls with a challenge: when was the first time you heard “Close to You” by the Carpenters? With just the tiniest prompt (“it was summer”) I was thrown back to age 7 or 8 and the boardwalk amusement park on the Northern Jersey shore.

We “walked along” together past the “Win an Album” wheels, “Close to You” and “American Woman” back to back for miles.

2) Memory 2. Man, the White family is just a huge bunch of Olympics junkies. On that same drive this morning I was thinking about the massive “hangover” we will all have next Sunday when our fix goes on a 2 year hiatus. Skeleton on TV, leaning over the rail with Beth, the kids and my folks watching the sleds fly by in Park City in my mind. We saw almost everything in 2002.

It’s such a pleasure to see it all again.

3) Memory 3. Sonny, one of my teammates and good friends from college called out of the blue yesterday. Seems he has decided to write a biography of his Dad (note to self: this is a great idea) and was going through old letters as part of his research. In that printed pile of memories he came across a couple of letters I sent to him while he was in Japan teaching English while he tried to figure out what he wanted to be when he grew up.

Yup. Letters. Mind you, this was in 1982. Calling Japan was expensive. No cell phones, texting, WhatsApp or Signal. A postcard from Disney World reminded me of how much fun my closest friend Rob and I had that summer. We were jewelry display repair men, traveling all over the U.S. fixing displays in places like Zayres (RIP) and Eckert Drugs. We did 5 days of work in 3 and spent the remaining time exploring whatever city we parachuted into.

Best indoor summer job ever.

4) Memory 4. Sonny also sent me a picture of a full-on letter written on airmail paper (overseas snailmail was expensive, too!) in which I gave him the play-by-play of the 1982 Williams-Middlebury football game. Middlebury is about 45 minutes south of Burlington where I went to medical school. Sonny and I had dozens of friends still playing for Williams and the “good guys” won.

But the gold in that letter was my description of my guest at the game, UVM senior Beth Hurst. Yup, my very first date with the love of my life! John could barely get the words out as he read my description of how badly I burned the scallops I made for dinner after we got back to Burlington. Pretty sure the wine had more sugar than a 12 oz. can of Sprite, too. Thankfully Beth saw past my obvious culinary limitations.

Happy Valentine’s Day Dollie!

5) Free Skate. “I blew it. When I skated on to the ice my head was filled with negative thoughts. I just blew it.” –Illia Malinin, U.S. figure skater.

Man, there have been other Olympic athletes who were considered a stone, cold lock for gold as big as young Master Malinin–Alexiev in weightlifting, Gable in wrestling, the basketball HOF-packed Dream Team, Greg Louganis in diving, every German luge team, speed skater Eric Heiden–but the list of heavy favorites who underperformed in their final appearance so badly that they performed themselves off the podium entirely is rather small. Poor Illia went from first to 8th with a score <75% of his rather mediocre (for him) team score.

No one was more shocked than Malinin.

Before I get into the meat of this let me take a moment to send out massive kudos to the 21 year old Malinin for his grace and maturity, walking over to the gold medalist and immediately congratulating him, then while handling the onslaught of questions that followed his skate. Less than 10 minutes after his performance he was interviewed by NBC and uttered the words above. No excuses. He owned his performance and admitted that he had no idea why he entered the arena with those negative thoughts as he prepared to perform.

There’s no place to hide for the solo athlete. Tennis, golf, downhill skiing, equestrian, and many others. Out there competing pretty much alone. Circumstances exist in team sports that are similar. Think penalty shots in hockey or soccer, or perhaps playing cornerback in man-to-man coverage. I definitely relate to that last one. Win with grace or own it when you are beaten. All of them have much in common with Illia Malinin.

When you enter any of those lonely arenas it’s important to enter with visions of success. Until that fateful free skate I think that was one of Malinin’s strong suits; the kid expected not just victory but dominance in the process. Error free excellence at a minimum. Imagine bounding down the length of a 3-meter springboard and thinking about slamming your head on the board as you pass it on the way down instead of a perfect entry with no splash. Planning for and playing to the thought of success rather than, as Malinin described it, inexplicable thoughts of failure.

Do you know where else this is key? Surgery. Surgery of all kinds. There are no crowds watching. Certainly no one cheers at the end of a procedure. Why? Because the expectation isn’t the overwhelming favorite in the event, the acknowledged best-in-the-world surgeon is going to ace the performance, it’s that every single “athlete” in the tournament is going to ace it. Has to ace it.

Every. Single. Time.

Every surgeon enters the OR as if they are one of those solo athletes headed into the arena or onto the ice. The mental approach is like any other “event”: you have to bury any and all negative thoughts and visualize only success. It doesn’t matter what your “event” is. Neuro, eye, cardiac, transplant surgery, it doesn’t matter. The mental approach is the same: visualize only success. Nobody bats 1.000 in anything and surgery is no different. We sometimes don’t get the results we seek on behalf of our patients because of the very nature of surgery, the complexity inherent in performing surgery where every patient is singular and unique. But surgeons walk into every OR with only visions of success.

There are no games played in the operating room.

I’ll see you next week…

“The grains of sand that pass through the funnel of life’s hourglass are only dry and colorless if they are observed from afar; up close each one is as colorful as any rainbow, as full of energy as any thunderstorm. Poetry is there for the asking.” DEW 1/16/2017.

While everyone isn’t necessarily “A” somebody, everyone is somebody who matters. My Dad was heroic in this regard. He remembered everyone. The lower on the economic food chain someone may have been, the more he remembered them. Janitors, waitresses/waiters, maintenance workers…he knew all of their names. He’d ask you about your story, ask you to describe the grains of sand in your hourglass, and if you told him he remembered. Dad would be dumbfounded by the denigration of these and other physical jobs so prevalent on mainstream media and other outlets.

Dad had a way with frontline workers. It was natural, a gift for sure, but he obviously worked at it, too. Did you have a problem getting THAT gift this year? Turns out, that’s not a new phenomenon caused by “COVID-related supply chain issues.” My Dad had a coronary artery bypass graft surgery (CABG) in 1985 at the peak of the Cabbage Patch Doll craze. Somehow he found a Cabbage Patch Doll for every nurse in the Coronary ICU to thank them for their care.

So what’s the point? It shouldn’t take a pandemic that interrupts every aspect of everyday life for us to notice the folks who aren’t anywhere near the top of the economic food chain. CEO’s saved the world in the early parts of the pandemic (Sunday NYT)? Bullshit. Company X allowed the economy to survive because it made “stay at home” work possible? Yeah, that’s bullshit, too. The person who answers the phone in my office or the person driving the garbage trucks had just as much impact as that self-satisfied CEO who’s biggest sacrifice was skipping Davos this year.

There’s no such thing as a small life. Each life is full, vibrant, colorful, and important. Each little grain of sand flowing through the hourglass is as meaningful as the next.

It’s been years since my Dad died and yet I return to his lessons on a daily basis. I see him talking to the guy who swept the floors in the factory. There his is, sitting down to lunch with a banker. If I close my eyes and just listen to the personal banter it’s hard to figure out which is which. The sands of time that flowed for each looked the same to my Dad. He heard the poetry, saw the beauty. My Dad made every life he touched bigger.

Everyone was a somebody.

An imaginary letter to an imaginary advice columnist about something that may or may not have happened…

Dear Arthur,

Boy, does this feel strange. I’m the guy who folks of all ages, types and sizes come to for advice. My sole goal, the thing that approaches every conscious decision I make is to speak and listen, act and react from a place of kindness and, if possible, love. Yet here I am, silently frozen out of a friendship more than 20 years in the making for a presumed act of disloyalty. I got caught in a picture that I tried very hard to avoid being caught in, and before I could untag myself my friend caught sight of it on some social media thing or another.

Even the mailman was puzzled by the stamp on my returned Christmas card: “Delivery Refused”.

My sin was to do something kind for another friend entirely. I accepted their invitation to a gathering where I would know many people; my attendance would be very welcomed by everyone there, and the friend who invited me would likely garner some goodwill for having me there. One of the other guests who I once knew quite well but hadn’t really had contact with for more than 8 years had caused great harm to my out-of-town friend, someone who I try to be in touch with several times each year.

With the exception of the time I spent with my hosts, locals we try to hang out with, the gathering was rather awkward and uncomfortable for me. I left after a short stay; the only goodbyes I said were to my hosts. Still, just for being there it appears as if my long-time friend has decided to end our friendship over a picture on the internet. Our last interaction was a two sentence exchange on that social media site in which I explained the invitation.

Since I have enjoyed this friendship a part of me feels compelled to explain. At the same time the reaction to the picture seems so outsized I am left to wonder if doing so will matter.

Anonymous

Dear Anonymous,

What an odd world we live in! Once upon a time you had to almost work at it to offend someone face to face, or at least via a phone call or personal letter in order to get put in the eternal friendship penalty box. Now? Apparently all you have to do is show up in a random picture somewhere online without any context. Rough place, that internet.

I get it, though. Judging by your somewhat cryptic letter something really lousy must have happened to your out-or-town friend at the hands of the other invited guest. You accepted the invitation from your local friends because, well, they’re your friends, too. You seem to have made an effort to be electronically invisible but got photographed anyway. Perhaps you were momentarily distracted and didn’t want to cause discomfort for your hosts by more aggressively declining the photo. You say that you aim to be kind in your interactions. It is understandable that the “here and now” of the gathering was the stronger influence.

So what now? You feel badly. Your out-of-town friendship must be very meaningful. I mean, you and your mailman looked carefully enough at the returned letter to see the “why” on the envelope. As I see it there are two ways you can look at this. You can paraphrase the American philosopher Elbert Bubbard: “Never explain. Your friends do not need it, and [everyone else] will not believe it.” Do you think a more in-depth explanation than your quick SM interchange will make a difference?

Or we can channel another Philosopher, Reinhold Niebuhr: “No virtuous act is quite as virtuous from the standpoint of our friend or foe as it is from our standpoint. Therefore we must be saved by the final form of love, which is forgiveness.” Perhaps, upon reflection your friend will realize the value of your friendship, and upon doing so will recall your basic nature. Your tendency to kindness. And having done so will forgive you for the pain you unintentionally and unknowingly caused.

To each other.

With best wishes, Arthur

I’ll see you next week…

[Post below was originally the 5th bullet point in “Sunday musings…” 1/16/2022″. After engaging a bit with Mr. Cuban (who is very accessible for a man as famous as he is) about drug costs and generics I wrote and posted this in the hope that Mark would put his considerable intellect and influence to the task of drug costs as a whole. To start a front to attack all of the financially malignant players (health insurers, PBM’s, bloated government regulations etc.) that stand between patients and the care they need and deserve. Mark recently did just this on X.com and elsewhere.]

Mark Cuban has launched a website/business called “Cost Plus Drugs” (costplusdrugs.com) to much fanfare, especially on Social Media of all sorts (Cuban is a plays SM like Yo Yo Ma plays cello). The concept is quite simple: buy generic drugs at wholesale cost, mark ’em up 15%, add a handling fee of $5 and ship ’em off to a waiting patient. The fanfare part comes in the marketing on the website. Each drug is compared with the retail price of the branded drug from which it was spawned. For example, $41 for a chemo drug compared with $9,600 for the brand. Brilliant, right?

Meh…not so much. First of all, if a super expensive drug is off-patent and there is now a generic equivalent on the market, essentially no one prescribes the branded drug anymore (caveat: equivalent in potency, side effects, etc.). Secondly, there are several options out there already doing a very nice job of this, thank you very much, without the hullabaloo surrounding Mr. Cuban’s offering. GoodRx and Costco come to mind. There’s somebody out there, can’t remember who, offering hundreds of generics for $4.00 a month. To the extent that Cost Plus Drugs continues to pressure the pharmaceutical industry and its high prices I suppose Cuban’s entry is a net positive.

Let’s step back and look at the real issue here, though: groundbreaking, new treatments are too expensive. I’m not talking about the outlandish prices of these branded, patent-protected drugs that people like Mark Cuban bandy about to make the price of their generic look so virtuous. No, I’m talking about the amount of money that comes out of the pockets of the people who need the newer medications for which a generic equivalent is not available (or who for whatever reason cannot take a particular generic). For all of Cuban’s bluster and bravado, the bruises that he is getting from patting himself on the back are all for naught. With very few exceptions people aren’t struggling to pay for generic chemo drugs, they are breaking the bank on the newer, more effective drugs.

In general, new drugs come in one of two varieties: minimally changed versions of existing drugs/”me too” drugs from a competing company in order to be in the market space, or truly innovative and new drugs that are a measurable upgrade in all ways from existing treatments. Yes, to be sure, there are some newcomers into a therapeutic space that have a similar mechanism of action as legacy drugs but really do work better in that treatment pathway, but they are a small minority; most are the same drug with a slightly different concentration or secondary delivery ingredients, patented and priced as if they were groundbreaking, new developments.

Where we need someone of Mark Cuban’s intellect, entrepreneurial zeal and all-around chutzpah is when the very best treatments, standard of care treatments, are not available as generics. Here the unholy triumvirate of manufacturer/pharmacy benefit manager (PBM) and insurance company put profit before patient (and healthcare worker) welfare. New, innovative treatments are priced so that the manufacturer can give a handsome rebate (kickback) to the PBM. A patient is then charged a co-pay which is a percentage of that artificially elevated price. This co-pay reduces the financial obligation of the insurance company to pay for the medication. If you’ve ever wondered why a medicine which was priced at $100 ten years ago is now $1,000, this is it.

If the Mark Cubans of the world want to have a real impact on the healthcare costs that matter, the costs to the patient themself, let them turn their attention here. It does us no good to have another do-gooding middleman saving patients a few dollars on widely available generic medications. This is the equivalent of hitting a single when you’re down 10 runs in the ninth. In eye care we don’t need someone to shave off a couple of bucks from the cost of Avastin as the first-line treatment for the devastating, sight-stealing disease macular degeneration; it’s like $50, so patients drop 10 bucks in the bucket on the way out. At big places like the Cleveland Clinic they pay more to park.

No, what we need is someone to step in and figure out how regular folks can afford Eylea or Lucentis, the branded medications that a majority of these patients end up needing when the Avastin stops working (as it almost always does). At $2000 a pop that 20% co-pay can run into thousands of dollars each year for folks who need injections every few weeks, sometimes forever. Cancer treatments that cost $40,000 per dose or truly revolutionary, life-saving drugs like the hepatitis C drugs that came out a few years ago that are now “only” $10-15,000. 20% of that is meaningful to most folks. Step up to the plate and take a swing at these, Mr. Cuban. Figure out how people who have terrible diseases that aren’t really all that rare can afford their medicine. You’re not a singles hitter. Figuring this out is the equivalent of hitting a walk-off grand slam in the 7th game of the World Series.

You were made for this, Mark.

Here we are, almost 4 weeks into another new year. With the exception of a single resolution to endeavor to be more like some of my friends who I admire, to adopt one or two of the laudable traits that make up their character, I really didn’t make up a list of traditional “things I should do” in the new year. And here it is, almost February, and I’ve yet to sit down to ponder how I fared in the year just past. As a way to do this each year I return to a little thought experiment I discovered in the WSJ some 8 or so years ago that measures, at least for me, whatever declines I may have experienced, against those gains that I have (hopefully) made:

You are given the option of taking a pill that will halt the aging process. At what age would you decide that the balance of physical prowess, mental acuity, and age-begotten wisdom, was optimized? At what age do you take the pill?

After a certain point that is different for everyone, each human begins to experience an inexorable decline in their physicality. Strength, speed, endurance, balance. Pretty much all of our physical attributes will show a net decrease over time. My physical prowess probably peaked in medical school. My classmates and I somehow found time to play hours of pick-up basketball each week, and we organized countless squash round-robins in a school with 20 racquetball but only two squash courts. Beth and I had already discovered a shared love of strength training, and for wild reasons of all the wrong kind, a small group of us found joy in the back row of the aerobics classes then in vogue. Age 26 was my peak year in this domain.

In a similar way, we become less “sharp” mentally. We may still maintain possession of our memories, our internal hard drive if you will, but we begin to experience slower access to them. Our computational abilities decline as well. Now, to be sure, this is not a straight-line decline, not like an airliner on the glide path. It’s more like descending through a rolling hillside on the way to the valley below: both physical and mental prowess can be enhanced, at least temporarily, through purposeful action.

On the flip side of this we have what we would all understand as “wisdom”. Wisdom is something more than simply experience. It’s more like, I dunno, actionable experience I guess. It’s a kind of knowing, a confidence leavened by compassion, in the act of decision making. If you are fortunate your wisdom is a source of comfort for some of your people. Having you, and your wisdom, makes their lives better.

Along with this comes a deeper type of happiness that you hopefully gain by ever closer relationships with those same people. Family, for sure, but close, loyal friends as well. Another year has hopefully brought you deeper, more positive interpersonal relationships that result from your wisdom. Another year has brought you more joy as well as an ever greater ability to recognize and embrace that joy (read the latest findings from the famous Harvard study on happiness over a lifetime: The Good Life by Waldinger and Schulz).

One very important aspect of that age-begotten wisdom is the ability to take a gimlet-eyed view of the decline. Blake Crouch in “Upgrade”: “If we all had perfect memory, we would all grieve the older version of who we used to be, the way we grieve departed friends.” Grieve yes. Pine, no. To pine for that earlier version is to regret not figuratively taking that time-stop pill earlier. Our wisdom will hopefully allow us to take the occasional trip back in time for the pleasure of watching a less-wise but almost surely more exciting version of ourselves.

Physicality, mental acuity, and wisdom. As noted, physicality and mental acuity can be trained to a point. After discovering CrossFit in 2005, just before my 46th birthday, I enjoyed a kind of “mini-peak” in my physical fitness at age 48. For the first time in my life I got really serious about strength; I was likely as strong as I was as a 22 year old football player in college. Likewise, until a shoulder injury derailed me at 49, I was likely MORE fit from a cardiovascular standpoint than at any other time in my life. Still, I managed to stay within hailing distance of 49 for almost 10 years.

The failure and ultimate “departure” of my left hip in 2019 brought a rather rapid reversal of many of these mid-life gains. Alas, despite what looked like a promising road to retrieval of at least some of those gains was derailed by my right hip’s decision to follow suit. Adding injury to insult, months of post-op pain prevented me from returning to even my pre-op levels of physicality. Now, at 66, the fight is similar to swimming in one of those pools in which you try to stay still while you swim against, for me, a current set somewhere around age 61.

The last peak.

Like all doctors in my generation I probably contained more stored information in my brain at the time of my med school graduation at age 26. I was likely as smart as I would ever be, at least without the help of a Google search or guidance from Claude, one of my new best friends, when I graduated from my residency at age 30. Still, even with this in mind it is glaringly obvious that my overall mental acuity continued to expand and improve, not only in the ever finer prism of my professional acuity, but also as a thinking “machine” in general. I began to write in earnest some time around 2004 or 5, expanding the “fitness” of my language “muscle”. Looking back and reading my earlier stuff I got steadily better as a writer for many years, at least until 2019 or so when I “lost” my muse, CrossFit. I still write something pretty decent on occasion though, both here and in the tiny little “home” I’ve carved out in my professional spaces.

Has my mental acuity started to back up like my physicality? Man, that’s a really tough call to make from the “inside”, ya know? I find myself spending an extra heartbeat or two waiting for a name to arrive, and I admit to finding it easier to just Google-check myself for random factoids I might have just tossed out with confidence in years past. Still, from a functional intellect standpoint where one is tasked with evaluating the data on hand and coming to a conclusion or making a decision, I’ve probably been sitting on my peak for quite a few years.

Likely still sitting on a rather high altitude mesa, a long-lived peak.

Which leaves wisdom. There’s a lot that’s packed into wisdom, especially if we want to continue to think of this thought experiment as a three-legged koan without adding smaller, however meaningful subcategories. If we include things like the ability to discover and experience joy, or as I wrote in an earlier year the capacity to both extend and accept empathy under the umbrella of wisdom, we can make it work.

In the last couple of years I have learned that increasing wisdom is harder and involves more pain than what it took to gain greater physical prowess or mental acuity, or the tribulation inherent in fighting off the inexorable and inevitable decline in both. Wisdom is certainly there to be gained in joyful experiences like the Mulligan we get if we are lucky enough to have grandchildren and to relive childhood years without the pressure of parenthood. It is there to be found in witnessing joy in those we care about. Hopefully our wisdom can be put to use in the pursuit of joy in ourselves and in others.

But wisdom seems to be a bit of a double-edged sword, I think. It seems that a meaningful amount of one’s wisdom comes about from times of hardship, or pain, or loss. I’ve written that the months of pain I experienced after my second hip surgery changed me. I am so very grateful that the pain stopped; I find it easier to come to situations with a grateful mindset, a subtype of wisdom. Each episode of lost innocence when expectations are unmet, especially by those closest to us. Lost parents. Lost or misplaced friends or, Heaven forbid, children. Any or all of this seems to impart the kind of wisdom which, when imparted either to others or simply within, is gained.

Wisdom, and the growth of wisdom within me, is the greatest reason I have turned down “the pill” in our little thought experiment. Looking back, even way back, it is the reason why I wouldn’t have taken the pill if someone had given the option at my physical peaks at 26 or 48, or the last peak at 59. Why I would not have stopped the clock at 30 or 40 or 50, or even this lovely high plateau as my intellectual gains began to slow. This type of knowing, of knowing joy and empathy, of knowing that I can still find gains in the most elemental essence of those closest to me, to experience growth DESPITE what are the inevitable declines in physicality and acuity, seems too precious a possibility to decline.

And so once again, at 66, I will gaze upon the pillbox and wonder, as I slowly close its cover and store it for another year. Will I ever make the call? Will the unescapable slide in physical and mental prowess eventually outpace the growth of wisdom? Ah, how could one know? Maybe the best I can do is to have a little hope, perhaps make a tiny wish that I am granted a bit more wisdom, at least for a little while, with only a little bit of the pain or the loss to pay.

Maybe, if I may, only a tiny bit to pay.

I’ll see you next week…

“Eating healthy is too expensive.” How often have you heard some version of that phrase. Whether it be Zone, Paleo, Whole 30, or just “stay out of the middle of the grocery store”, this is uttered with some degree of exasperation and oppression with a kind of mind-numbing, self-fulfilling frequency.

How so? Per the folks at Whole Foods, regularly skewered for being too expensive (seriously, they sell fancy potatoes), on average we in America spend 7% of our disposable personal income–that’s SEVEN–on food. 50 years ago that number was 16%. We now spend less than 1/2 of our after-tax income on food compared with what we spent 50 years ago.

And eating well is too expensive.

If we dig deeper into that stat alone we see that modern food production has decreased the cost of food relative to both income and inflation. The cost of producing food of all kinds has risen much more slowly than income. Why? Partly because junk carb-laden food is cheap. High-fructose corn syrup costs a fraction of grain sugar. Corn-fed protein with or without pharmaceuticals is grown faster and cheaper than grass-fed. Stuff like that. Less expensive to produce/incomes risen at a greater rate across the entire spectrum, top to bottom.

How then is it too expensive to eat a more healthy diet. We have 9% of our after-tax income to play with, right? Is some other necessity (shelter, transportation, medical care, etc) eating that up? What are we doing with that 9% that we can’t find some of it to eat better? Ah, Grasshopper, now we begin to see. It’s a ‘Nando thing, superficial. It’s not how healthy you are, it’s how you look, or something like that.

Some stuff might be more expensive, but the seemingly obvious culprits are actually false targets (eg. healthcare which for this audience represents only a tiny % of new cost c/w 50 years ago because of insurance, govt. programs, etc.). Nope, it’s how we CHOOSE to spend that freed-up 9% .

Think about that household in the 1960’s or even the 70’s. One car. One TV. One radio. Once purchased all data was free. A pair of shoes and a pair of boots. Sneaks if you were a jock. You didn’t get your hair done if you were a guy, you got a haircut. You didn’t get your acrylics touched up every 2 weeks; if you wanted long nails you grew ’em. Stuff like that.

Fast forward to today and think about the stuff you’ve acquired, stuff you are convinced you can’t live without, stuff that costs money that you choose to spend every single day. The ratio of drivers to cars in a household is seldom less than 1.5/1. The ratio phones to people over the age of 10 is seldom less than 1/1. It’s not enough to have a phone, or even a phone with an unlimited text plan, nope, it’s gotta be a phone that will let you post your thoughts on today’s weather in Bimini to FB. Right now, from anywhere. If you don’t have Netflix available on each of the 4 flat-screen TV’s in the house you are considered a Luddite.

Listen, I certainly am not saying that all that stuff isn’t great, that it’s not a ton of fun and really convenient (as I type on one of the Apple products that literally litter our household, through my WiFi network, in front of my LightBright lamp), or anything like that. What I most certainly AM saying, though, is that people who whine about how hard it is to afford to eat better almost always do so via a FB post from their iPhone 5 while sitting in the salon having their hair done, hungover from too much Bellevedere they consumed last night while noshing on Doritos smothered in Cheez-Wiz.

9 %. The stark reality is that we have let our things become more important than ourselves.

1) Seagull. Why don’t seagulls walking around on the ice get cold feet?

My hands turn white just looking at them walking around on the ice.

2) Thanatophobia. Fear of death. William Shatner of all people thinks about death all the time. I mean, he’s certainly old enough to have it on his mind, of course. To be honest I’m not sure he’s really truly afraid, just reluctant.

“i’m surrounded by love. My life is fertile. I don’t want to go. Thoughts of leaving leave me sad. I just don’t want to leave.”

I get every bit of that.

3) Wealth. There are many types of wealth. All of them capable of eliciting envy. According to Sahil Bloom the important ones are financial, time, social, mental, and physical.

We all know what it means to be financially wealthy, and to at least some degree what it takes to become financially wealthy. The other four respond to investment as well, and investments in all produce measurable returns that are more likely to be measured in happiness than financial wealth alone.

What’s your investment plan?

4) Mattering. Lots of folks around me thinking about retiring. A bunch of my doctor friends. Folks of all ages I know who are in the military. I brought a “welcome home” gift to friends who lost their house to a storm disaster and had to re-build. Pretty much the same age we spent an hour or so talking about our plans for our next, likely last acts. Like me, my friend Frank has given a lot of thought to not only the “when” but also to the “what comes after” part of the decision. We both get the keep busy part, and we are both committed to being busy in the company of friends and family.

Yesterday’s WSJ added a bit of a twist to the conversation, at least for me. One of the things I have really enjoyed about my job is the opportunity I have had over the last couple of decades to interact with folks at all levels of the org charts in the industry that exists alongside the “caring” part of healthcare. These are the people who work for companies that make the drugs and devices that doctors and their teammates use to preserve and restore health. In this role my job has been to bring the realities of life at the exact point of healthcare delivery to industry execs, and bring back to my clinical colleagues a sense of what a company can do to help.

I’d kinda like to keep doing this for a while, at least as long as those executives think whatever I have to bring to the table remains relevant.

When you have a job or some type of calling you begin each day with a very particular incentive: you show up because doing so matters. You’ve likely been doing something that matters for many years. A job, for sure, but there are any number of other things that might have gotten you out of the door that wouldn’t be considered employment. Perhaps you were the primary parent running a household and raising a family. Or on the other end of the timeline you spent years as the primary caregiver for a parent or older family member. Any number of volunteer positions certainly fit.

When you retire it’s natural to wonder if you matter anymore.

Jennifer Breheny Wallace, the author of the article and a soon to be book on the subject, posits that mattering has four main components: feeling significant (seen and essential), appreciated (valued for your contributions), invested in (supported and cared for), and depended on (needed by others), encapsulated as “SAID”. As I think about it this is a very helpful corollary to the things that I have been examining as think about how it is that I will spend my time in retirement. I have been using the term “relevant”, but I now think that this is simply a “clock” or duration issue. In a small sliver of what I hope to do when I retire what I am really saying is I’d like to keep my little place at the intersection between commerce and care for as long as I matter.

Like everyone I know who is thinking about retirement I have endeavored to ensure that I have enough financial wealth to not run out of money before I “leave”. I have spent my working life in the company of retired people many years my senior and I believe they only come in two varieties, those who relax into the free time bounty they have graduated to, and those who are so busy they can’t figure out how they ever had enough time to hold a job. Kinda hoping that’s me! I’ve invested time and effort to build my physical and mental “bank accounts” in the hope that here, too, I will have enough wealth to avoid impoverishment for as long as possible.

Mattering speaks to social wealth, at least in part. Happiness is well-known to be highly dependent on having close personal connections, especially as you get further away whatever it was you retired from. That still feels like investment job number one as you build your retirement. To feel needed and wanted, significant and appreciated, to find that place where you matter seems like an awfully good investment strategy.

I guess I’ll keep doing all this as long as it matters, and as long as it does I’ll see you next week…

Lake Wobegone, where every child is above average. Remember that? It’s a joke, of course, but it’s funnier if you have even the tiniest bit of comfort with numbers, statistics, and probabilities. Every parent wishes for that, right? To have raised a child who rose even just a little bit above.

What does it mean to be average? It begins with the cohort, the population you are evaluating, and the particular variable that is to be measured. The average Division 3 cornerback is a decidedly different specimen than the average guy playing on Sunday. The average working vocabulary in a room filled with Pulitzer Prize winners is quite a bit different than that of, say, the Green Bay Packers booster club luncheon yesterday. On the other hand, the average VO2 max in those latter two groups is likely pretty similar.

Along with average comes a range in any curve. Some groups are tightly bunched around the mean, the average; being average is an expectation. On the line at Ford your performance has to be average at worst. If you are above or below the average in any other group it probably is helpful to know how big the range of differences is in that group. For example, if we are measuring 400M run times at the Olympics there’s a pretty skinny range beyond which below or above average makes you stick out, good and bad.

Average does not necessarily mean mediocre.

I got to thinking about this yesterday when I heard from a bunch of my college buddies sending along birthday wishes. In my life there have been two places where I’ve been average: Williams College and CrossFit. Both here in the CrossFit world and in my college years at Williams it has taken everything that I have just to be in the middle of the pack. This is a double-edged sword. It’s humbling to have to literally give it your all just to hit the mean. However, placed into a group or given a task in which you have the potential to excel, to bust the curve if you will, the experience of having to work so hard just to be middling should drive you to do the same when you have a chance to be the best.

My Mom and Dad did, indeed, raise kids who were above average. It appears that Mrs. bingo and I may have done so, too. If we are lucky, the Man Cub and his cousins will follow suit. The only way I will know is because I had the privilege of struggling to be average in the company of two very extraordinary groups of people.

My classmates and teammates at Williams and my fellow CrossFitters.