Random Thoughts from a Restless Mind

Dr. Darrell White's Personal Blog

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She’s in a Better Place: Sunday musings…6/9/2024

“She’s in a better place.”

At least that’s what all of my friends and acquaintances have been telling me since my Mom passed from this world on June 3rd. Presumably my siblings have been hearing the same. Is it true? Is that what happens when you die? Has Mom left our world and entered another, one in which my Dad has been waiting patiently for her to arrive?

If ever there was a time for faith, now is that time. You WANT to believe. You really, REALLY want everything that you learned as a child to be true. Especially when it comes to your parents, and especially if they were as devout in their belief as were my Mom and Dad. And it probably doesn’t really matter what version of an afterlife, a “what comes next” you, or for that matter they, believed. Reincarnation, a lifting of your spirit to join the mass of spirits who preceded, Heaven, or whatever it is that so many of the other great religions believe. With a belief in a thereafter there is peace in our new here and now.

Faith in something greater seems to be a uniquely human endeavor. Faith, and a near-rabid fascination with, and desire to understand and explain our world and our existence. Again, it’s all pretty simple when it comes to the Great Religions (probably need to capitalize that, eh?): everything started when whoever or whatever said it did (“…and on the seventh day…”) and it doesn’t look like it’s ever going to end (“…world without end…” and all). Each great discovery in physics brings us back closer to something that looks like a beginning, although no matter how large or meaningful that discovery may be, each subsequent one actually results in an ever-smaller step back in time.

Until even the most brilliant of physicists throws up their hands and exclaims “from here, nobody knows.”

It’s there, at that point in the “look back”, that faith is the only antidote to sure madness. How can it not be so? The Bosun Particle was nicknamed the “God Particle”, because even the proof of its existence was not enough to explain what happened in the beginning. At some point you go back and back and back, and to preserve your very sanity you must declare that SOMETHING started the whole thing off. It’s about as non-scientific a declaration as you can imagine. It is a declaration of faith.

How about on the other side? At the end? The physicists are pretty sure that the end is just that. The end. Stephen Hawking famously declared the human brain as nothing more or less than the greatest computer ever developed, capable of incredible, limitless feats as long as the current passed through the neural networks between our ears. At the end what remains is no more functional than the celestial junkyard overseen by Wall-E in the eponymous movie. Hawking was all so cut and dried, so distanced from any tiny bit of humanity. Perhaps that’s why he may have been the longest living ALS patient in memory; he couldn’t let go. Death for him meant the end.

But all the rest of humanity seems to have at least enough uncertainty about all things “after” that we wonder. Even Woody Allen, a self-proclaimed atheist once quipped “I don’t believe in an afterlife, but just in case I’m bringing along a change of underwear.” Again, not quite as far from faith as Hawking, but I always had this nagging sense that Allen was mocking those who had faith.

Which brings me all the way back to my Mom. And for me, while not any closer to religion, back to at least a little bit of faith. You see, faith brings with it hope, and hope is what has quietly kept one foot moving past the other for the last many weeks. Just like my Dad, Mom began to spend more and more time somewhere in the past. I hadn’t heard her talk about my grandfather in decades, and yet there he was with her, on the other end of a conversation only Mom could hear. She saw Dad everywhere and in everything. Her desire, her need to be with him was so very powerful. There was comfort for her there; she was happy there with him. She had hope. Mom believed and it made her ready to go. As much as I wasn’t ready for her to go, it made me want to believe.

Tomorrow we will lay Mom to rest, what remains of her earthly body will forever lay next to my Dad. Is there more for her? For us? For tomorrow, at least for me, the answer will be “yes”. Tomorrow I will have the same faith I find when I look so far back that I can’t look any farther, and I will allow myself the hope that faith in “something more” brings. I won’t say goodbye; I will simply tell my Mom that I love her, to say hi to Dad, tell him I miss him, and “I’ll see you later.”

And at least for tomorrow, I will believe.

Anne Lee White 4/21/1937 – 6/3/2024

A Sandwich at the Hospice Diner

You’re only as happy as your saddest child. You’ve heard that one before, for sure. There doesn’t appear to be an analogous version for how you feel in relation to your parents though. Not at any part of your life that I can think of at least. Maybe in your younger years it went something like you’re only as successful as your parents think you are. We Baby Boomers are famous for coming up with terms to describe our life stages, and then of course infamous for describing them as if we were the first generation in the history of mankind to experience them.

As if we are the first generation to ever find themselves the “filling” in the sandwich between our direct ancestors and our progeny.

With the exception of mass migration events (think northern movement of Black Americans from the Jim Crow south in mid-20th Century), it appears that we are the first generation to have chosen to follow our personal “destiny” and move away from our hometowns in numbers not common in prior generations. As such it’s kinda funny to listen to ourselves kvetch about how far away our children live from us. Especially once our children beget grandchildren! As an aside I like to think of my grandchildren as the “secret sauce” that makes my own little Sandwich Generation meal a bit more delicious. But in our present time, as we begin to exit the Sandwich when our parents take their ultimate leave, many of us face not only the emotions of watching ourselves become orphans, we also experience one more time the consequence of one of our great generational decisions: really leaving home.

In the past I’ve written countless words about how friendships and the blocking and tackling of maintaining a friendship have changed over the years of our lives. Sunday evening long-distance phone calls have become send a text and an ask if it’s OK to ring up a friend or family member. Letters and postcards migrated to email, and almost all long-form written communication was ultimately displaced by either the truncated convenience of text, Snap, and WhatsApp or the letters free images traded on Instagram. So very much easier, and yet so much less satisfying. The Chinese food of friendship: 30 minutes after modern communications are consumed you are “hungry” again.

Another quick aside: since it’s so very easy to connect with so little effort, if you don’t even make enough effort to order some Chinese takeout it stings. You don’t have to wait for Mother’s or Father’s Day to call your folks.

But that’s likely a rant for a different day. It’s the part of the Sandwich that’s going away that’s really on my mind today. My Mom, the last parent that Beth and I have left, transitioned from an assisted-living program to Hospice 2 weeks ago, a change that is at once both a respite and a clarion call for us all. I learned so very much about Hospice Care when I attended the first Ken Lee Memorial Lecture at my home hospital some years ago. What I learned, I have recently discovered, was only a small part of what Hospice means and what it is, and can be. The lecture was given by the head of Hospice Care at Dartmouth, an inpatient care paradigm provided within a large academic medical center. Subsequently we’ve known people who went “into” hospice–a literal move into a hospice facility–or had hospice care in the very last few days of life so that the passing might be peaceful.

What I’ve learned these last couple of weeks is that the concept of hospice care is much larger, much more inclusive, and consequently much more merciful to many more people. Mom simply moved 3 doors down, and family and staff welcomed a wave of additional support so that we might all, Mom and family, be more comfortable. At the same time I have learned of other family members and friends who are either in our shoes or on the cusp of lacing up to join us. It’s a good time to remind myself, and any of you should you so desire, that now is simply a time for love.

Allow me to once again channel my close friend Bill, the surgeon, to provide context for preparing for this stage, for the time when we are no longer the filling but have rather become the bread. Unlike me, an eye surgeon, Bill was a surgeon who operated on life-threatening illnesses and was therefore in a position to give counsel to both patients and families on end-of-life issues. Bill was surprised, always, at the heroic efforts family and friends made to be with the dying so that they might “make it right” before the end. He wasn’t quite sure which was the more heartbreaking scene, meeting those who didn’t make it “on time”, or those who did, only to find that the dying prevented any meaningful outcome other than “goodbye”.

The doctor from Dartmouth agreed. His counsel was that each of us should be prepared for either the departure of someone significant to us, or indeed, our own ultimate departure by saying at some point before the end these four things:

“I love you.”

“I’m sorry for anything that has hurt you.”

“I forgive you.”

“Thank you.”

If you have covered these bases there is peace to be found, for all of the things that YOU can say have been said. There may still be peace left unclaimed, of course, because those four statements are only half of the conversation. Someone may very well feel less at peace if they have not heard them back. If, for example, they have not heard a declaration of love. I have learned that peace in these circumstances my be a glass less than full, and I ache for those who find themselves with such a glass, one that they will seek to have filled until the very last moment that water may yet flow from the urn.

For me, for my siblings and our loved ones, for now we may each and all be comforted in the knowledge that my Mom is now under the care of lovely people who will see to it that however long is her remaining journey, her ride will be peaceful. Such is the gift of Hospice, for this will also bring us peace as we either ride shotgun or simply follow along. The menu is always the same at the Hospice Cafe. It’s always a sandwich, one that they handle with tenderness and compassion, hopeful that those who enter do so with as little hunger as possible.

It’s a place you can always come home to, no matter how far you’ve come, where love is always on the menu.

I’ll see you next week…

Sunday musings…Memorial Day 5/26/2024

I) Water. You just can’t go wrong with a day that stars on or in the water.

Says here that includes one of those little plastic baby “pools”.

2) Bloviate. My brother-in-law, the cardiology idiot savant, was flabbergasted that one of the nurses in the EP lab had never hear the word “bloviate”. You’ve all heard it here, of course, since that’s pretty much what I do each time I sit down to muse. Anyway, Pete defined it as “kinda like when a guy is talking just to hear himself speak.” To which the nurse replied “oh, like mansplaining”.

Pete: “Hm, not really. Mansplaining is more about the listener and how a mansplainer makes her feel. This is more like verbal ‘mansturbation.'”

I really like visiting Peter.

3) Memorial Day. I’m out of town with only a tiny window to sit down and muse. I came across this piece from 10 or 11 years ago, and with only a tiny bit of editing and updating it’s really appropriate for the three couples who have gathered in Vermont to share some time together. We’ve lost two of 4 Dads, and the two who remain are sadly not long for this world. We’ve spent quite a bit of time thinking about them all. I always think about my Dad on Memorial Day and Veteran’s Day. Think about him and the stories he never told.

“It’s the stories. The stories matter. Whether they died in the heat of battle or in the cold of infirmity, the warriors all have stories. The stories are all important.

It’s remarkable how difficult it is to get at those stories, though. The ones that were the most formative, the ones that turned that one soldier or that one sailor into who s/he became, they tend to be slow in coming, if they come at all. Yet those are the ones that matter most.

The warriors among us tend toward silence. It’s not so much a secret thing (although there is a small group who simply mustn’t tell their stories) I don’t think, as it is a continuation of the protector role our airmen, sailors, soldiers and marines assume. They don’t so much keep the stories secret as they shield us from the effects of the stories, so powerful were those effects on them when they happened. Yet again, to understand those who remain, and to try to know those who have departed, the stories matter.

I drive by a cemetery filled with the graves of those who fought, some who died while fighting, and I try to conjure their stories. It’s pure folly. Dead men tell no tales, eh? Humanity learns of conflict and war from the stories told about both, and humans learn about each other the same way. Asking to hear the stories is an act of respect. Listening to the stories can be an act of love. Telling the stories is a little of both.

The stories of the men and women who have fought our wars are important.

A friend from my youth, a coach not too very much older than I once broke down and cried over his story. A very junior officer, his story of leadership and loss comes to me every year on Memorial Day and Veteran’s Day. I know him so much better, understand who he is so much better because I heard his story. So, too, is my knowledge of the men and women younger than I who have served and fought and graced me with their stories.

Life is long unless you are unlucky, but even the lucky run out of time. We have no Civil War survivors, no one from WWI to tell their stories. Those few from WWII still here are reticent, and time grows short. Even Korea fades ever quickly to time’s passage. As I write Dad is marooned by his illness somewhere between 1947 and 1974; much of his “time” seems to be spent in Korea at the moment. The smallest of consolations for us, his progeny, is that we may learn his story.

This Memorial Day let us all remember not only those who served and those who died in that service, but let us all remember their stories as well. Let us ponder the lessons those stories teach about not only humanity but also about the warrior, the person we remember. Let us encourage those who still walk among us, especially those whose journeys have been long and must be soon ending, to tell us their stories, all of them, even the ones they wish to protect us from, while they still can. Let us listen to those who know the stories behind each headstone as we gather in their honor. We have much to learn from the stories, about war and conflict, about the people who fought, about ourselves.

The stories matter. Still.”

Grace and peace to the families of those who fought. May their stories continue to guide us. May their memory be ever a blessing.

I’ll see you next week…

How Far You’ve Come

1 IF. Imaginary Friends. A new movie titled “IF” will land this summer starring Ryan Reynolds in which his character and that of a teenage girl can see ALL of the imaginary friends of EVERYONE around them. Including, and this is the hook, the imaginary friends that have been left behind. It sounds really promising; I’m looking forward to seeing it.

A tiny little bit of reading today gave some insight into why John Krasinski, the actor and director, chose to make the movie. Did you know anyone with an imaginary friend or two? Or did you, perhaps, have one of your own? Krasinski does not appear to have had his own, but his curiosity led him to discover that imaginary friends do, indeed, befriend youngsters of all ages who are blessed with active imaginations to begin with. But his research led to the discovery that many, perhaps most of those imaginary friends are there to provide their physical friends respite from some type of trauma. Might be physical or emotional, but having discovered this, Krasinski shifted the tone of the move from vaudeville to virtue.

Years ago I “met” the imaginary friends of someone who is very, very close to me. I sensed at the time that this someone was hurting, a sense that was confirmed some time after the imaginary friends seemed to have taken their leave. Had I known that they’d likely faded into the background because they’d done their job, helped my person and allow them to carry on, well, I’d have sought them out to say thank you.

Perhaps they will join me at the movies this summer.

2 The D’s. Dementia, delirium, and decrepitude. These are the realities of the 3-D life we witness each time we visit my Mom. This is the kind of 3-D no one wants. Dementia is the disease in which some progressive trauma is inflicted on the brain and results in physical changes that alter brain function. The bitter irony is that Mom is in this Dimension of D’s for the same thing that sent Dad there, chronic vascular disease.

Delirium is the brain’s response to these traumas, the creation of a narrative to explain any event that is the least bit confusing or new. Delirium can be as tiny as a bit of confabulation or as intense as seeing your 9-years deceased husband interviewed on TV during an NCAA finals. Decrepitude, as we know, is the end-result of dis-use of our physical body resulting in the inability to perform the functional movements of daily life. Mom’s efforts at any type of preventative behavior that might stave off decrepitude ended when my Dad came home from the hospital.

Delirium may or may not be permanent; it is, after all, an adaptive reaction which, although negative, demonstrates the plasticity of the brain. The best one can do with Dementia is hope for a full stop, hope for the cessation of whatever insults are hurled at the brain. There is little one can do over a lifetime, at least little that we know, to steel oneself against the ravages of Dementia and Delirium.

But Decrepitude, ah now that’s a different story altogether. The battle against decrepitude starts as soon as you start to move in a purposeful, planned manner to train your body. To build strength, power, and endurance. These may actually be the magic elixir that pushes against Dementia and Delirium, but we know for certain that if we are more able physically we will be better able to persevere. Imagine how much more is the psychic trauma of Delirium if you cannot raise yourself up, cannot walk away. It’s frightening to watch when the realization that you are unable to help yourself becomes the only thing that you know is real.

Perhaps delirium exists to shield us from that realization. Perhaps delirium is simply an unnamed imaginary friend, sitting next to someone in need of respite.

3 Journey.”Mothers stay behind so that their children can look back and see how far they’ve come.” Ruth, the creator of “Barbie”.

What does my Mom see when she looks ahead toward her four children? Does she, or sadly more to our present circumstances, did she also look ahead to see if her 10 grandchildren have gone on yet further? It’s a bit different from pride, I think. Not exactly “is she proud” so much as if she has noticed how far each of us, and each of our children have come. This is a tricky question–it’s quite likely to always be a tricky question–because Mom, like every mother yet born and having given birth, had very clear ideas not only about how far each of us would go but also how we would get there. I once wrote an essay about this that might have been titled GPS or something to that effect.

For my Mom it wasn’t simply that you reached the expected destination, it was necessary that in doing so you took the exact route that she’d mapped our for you to get there.

How about us, then? We four children and our spouses. When we look back do we see how far we’ve come, or do we look back, take a look left and right, and measure whether or not we’ve come as far as Mom expected us to come? What defines, or will come to define our notion of our own success? It’s really just another version of the classic challenge of whether we are strong enough to own our own goals outside of anyone else’s external goals held on our behalf. Of course it’s also a bit more than “just” because it’s your Mom–OUR Mom–not just some external someone with an expectation.

For what it’s worth, when I look back it seems to me that I’ve come as far as I’d planned to, by and large. Without a single goal toward which to apply monomaniacal effort, the “length” of my journey was always going to require more of a “miles traveled” analysis than a simple “miles from origin”. I have placed varying degrees of emphasis and importance on not just one but several markers that could define a journey. Decisions that favor one domain cannot help but have an adverse effect on another. Spending the extra day at the conference might mean to miss being on the sideline for the conference championship game. Likewise, flying out early from the event to make sure to be there for a holiday with extended family might mean passing on dinner with the CEO who will decide between you and the other finalist for a gig that you really want.

It’s astonishing to finish watching a movie like “Barbie” and spend the next day wondering how far I’ve come. I look back at each step I’ve taken and try to remember how far I’ve actually traveled, not just how far I’ve come from where I started. Does Mom do the same? In the end, who’s to say?

By either measure we all really have come so very, very far.

A Mom Named Jim. Sunday musings…Mother’s Day 5/12/2024

Every year on Mother’s Day I think about a guy I know whose name is Jim. Once upon a time he was one of my lawyers during a particularly stressful part of my career. As such his was a daily presence in my life for the better part of 1 1/2 or 2 years. There’s actually a lot of dead air during legal stuff. Time when for one reason or another you and your attorneys aren’t really doing all that much of anything but waiting. Sitting around and waiting, mostly.

Most folks I know who have had a drawn out legal whatever come to associate their own lawyers so tightly with the experience that they cannot separate the man or woman from the outcome. Mine wasn’t all that great. The outcome. But during all of those quiet hours with not all that much to do, Jim and I ran out of relevant stuff to talk about and started to share a bit of our backstories. What’s that got to do with Mother’s Day? I mean, two men trying to keep one of them from being destroyed financially isn’t the typical jumping off point to discuss mothers.

I’d met Jim’s wife, but it was a while before I realized that she was his SECOND wife and not the mother of his children. To keep my spirits up Jim and his partner on the case took turns hosting me at their respective country clubs for a round of golf. We must have been playing in May because Jim mentioned that he’d just gotten a Mother’s Day card from his daughter, an annual event. Over 18 holes together he shared the details of a rough marriage that ended in a rougher divorce. The details are not mine to share. Suffice it to say that Jim became a single parent and did such a bang-up job at handling what we all typically think of as the Dad stuff AND the Mom stuff (of girls!), that at least the one daughter thanks him each year on Mother’s Day.

Whenever I am asked I make sure to note that the simple act of becoming a father is 2 or 3 orders of magnitude less commitment than that which is necessary to becoming a mother. We can start with the whole 9 months long thing where your body has been taken over by an alien being and my point is proven without even considering the whole giving birth part. To become a father one must simply deliver genetic material, something which can literally occur via FedEx.

All of this notwithstanding, we are not really talking about the generation of a child when we are talking about Mother’s Day. I mean, if we were, how could you explain Jim’s annual Mother’s Day card, right? Nope, on Mother’s Day we celebrate Moms. Women, and the occasional man, who wake up every day and do the kinds of things that prompt their children to call them “Mommy”. Whether they work outside the home or make their “living” as a homemaker, the women we celebrate are the women who are always and everywhere thinking about their children. Quietly or out loud they suffer and celebrate every bruise and battle won from day one until they are gone.

And that’s the point of today, isn’t it? I mean, we should be aware that Moms everywhere have been living and dying over most of what we did or are doing. I’ve yet to meet a Mom who, deep down, didn’t think their child would benefit from just a bit more parenting from their Mom. Job never done and all.

Where is all this going? I have no idea how often you talk to your Mom. I mean really talk. Pick up the phone or knock on the door talk to her. No matter how tough it may be to do so today you get a pass. You don’t have to think of any reason at all to reach out to your Mom so that you can hear her voice, and she yours. We should certainly do this a lot, right? But today you just gotta do it. For all but that tiny group among us who, like Jim’s daughter, had a mother but not a Mom, today you just find the time to call or drop by. It’s better than any card and sweeter than any chocolate you might send, the sound of a child’s voice on the other end of a Mom’s phone or knocking on the front door.

Because on your end of the call or the visit there is nothing sweeter than to tell your Mom “thank you”, tell her you love her, and to hear her say at least one more time “I love you too.”

Happy Mother’s Day Jim.

The Last Time

You never really know when it’s the last time.

Not gonna lie, I was more than a little bit salty that I was here, at home and on call this weekend, while my siblings and their spouses were gathered in the Low Country with Megan and Ryan. It was a lately scheduled get-together, dreamed up long after our office call schedule had been put together. Unwilling to pull the “I’m the boss” card, Beth and I were home with very little on our schedule save for the usual weekend stuff of early spring. Rather than a couples member-guest golf tournament to follow, the highlight on our calendar would be my first trip to watch two of our grandsons have a golf lesson.

Restless is the way Beth describes me on weekends like this. She is right, and if I’m honest with myself I really did want something to fill our weekend. Not that it would be the same as joining everyone, including Megan and Ryan, just something. Thankfully our friends R and C were up for a last minute dinner out, and my buddy Matt found us a spot at his fully booked restaurant, our favorite, with 24 hours notice. It was shaping up to be a really nice night.

Where do you sit on the “things happen for a reason” continuum? I’m firmly on the end that goes more like “things happen”, reasons or not. My Mom had been having what has become for her a pretty normal week. Days cycling around the dining room schedule, the time between meals spent now mostly in her wheelchair in front of random television shows, or snoozing upright with Alexa playing either Sinatra or Saturday Night Fever in the background. Mom is a big disco fan. Beth gets in to see her almost every day during the week. I try to get in once on a weekday, and then Saturday and Sunday mornings. For whatever reason we both missed Friday.

The first call came to Beth Saturday morning. Mom was really on the struggle bus. She was trying to eat soup with a knife. The staff on duty Friday and Saturday were mostly folks who’d just met Mom over the last few weeks. No one had really seen her in this state. They wanted to ask her doctor to send her to the ER, to do tests to find out why she had such a sudden decline. Now, going to the ER for something as amorphous as “she’s not doing well” almost always ends up the the “she” not doing very well. Tests beget tests, and older folks always have abnormal tests. Bright lights and alien noises create confusion where none exists; in the presence of a person no longer fully present anyway, the ER can be the final step from self which there is no return.

But Beth went in and walked the staff, and Mom, back off the ledge. Much of the discussion centered around uncertainty about Mom’s “final” wishes, questions that Mom and my sister had long ago addressed and handled quite nicely. Another call came later in the day, a few hours before our dinner reservation, and once again we were able to agree with the nurses that Mom was OK where she was. And so it was that we found ourselves at a cozy four-top with dinner on the way courtesy of a typically terrific waitress, telling stories about prior visits with Matt, the owner, settling in for what we all thought would be a typical 3+ hour visit. As our appetizers were being cleared Beth’s phone rang. Call number 3. Beth: “We really need to go in.”

This is where the “things happen for a reason” conversation really got started, and “the last time” thoughts began to tickle around the edges. The first was easy to process no matter where you are on my little continuum; if we’d been in South Carolina Mom would have already been sent to the ER. One or both of us would have been on a plane. We all would have been going to that “last time” place in our minds. But Beth and I were home, and whether or not we were home “for a reason”, we were nevertheless only a 40 minute ride to Mom.

As is so often the case this whole thing has been banging around in my brain since that first phone call. Like Brownian Motion, fragments of ideas, tiny thoughtlets moved through random synapses like so many molecules in a vacuum. Some about us, Beth and our siblings and the whole “Sandwich Generation” thing. But just like the focusing of those randomly moving molecules in a laser tube, everything really coned down to “the last time”.

Would tonight be the last time that I saw my Mom? Worse, was she really as sick as the nurses were telling Beth, and had I already for all intents and purposes seen Mom for the last time when we sat and chatted last Sunday morning?

We’ve already had a few last times. Thinking back you can see them. A few months before she finally capitulated, accepting the fact that she could no longer live alone in my “ancestral home” was the last time I saw the woman who was the driving force at the center of our family. Some time after that, I don’t really recall exactly when, I saw Mom as mostly herself, aware (and concerned) about everybody and everything, fully engaged in every waking hour of her days and nights, for the last time. Sometimes you can’t escape knowing exactly when the last time was. Someone is gone suddenly and unexpectedly, and the memory of that last time is seared in your mind. You are branded by the memory whether it was a good one or not.

This is not a story about regret, or regret avoided. Nor is it a case of the supernatural “things happen for a reason”, thing. Not at all. If we’d been in Bluffton it would have been a version of our Alaskan trip when Mom did, indeed, end up in the hospital while we were, all of us, incommunicado 4,000 miles away. This time, for whatever reason, I was here. I am fortunate to be the sibling who gets to be the one who will be “there” when Mom finally lands after this long, long glide path to the end of her journey finally arrives. Blessed to have such a loving and caring partner in Beth, who as always is carrying the bulk of the load.

And regret? No, I have followed the advice of my close friend Bill, the surgeon, who has counseled for so long that the time to say and do all of the important things is long before the last time, no matter how suddenly a “landing” comes after that last “last time” happened. If I am not there at the beside when her earthly plane lands and her soul

departs I won’t feel as if I’ve left anything unsaid. I have long ago begun saying those four special things I learned to say when the thought of a “last time” is but a notion. I love you. Thank you. Please forgive me. I forgive you. I have long ago begun saying versions of the same to the rest of my family and my friends. I hope, because I love them dearly, that my siblings will feel the same, at least when it comes to our Mom.

There have been many “last times”, and as a son there will be yet one more. I just may not know it at the time. You never really know then it’s the last time until it’s over.

15 Years of Navel-Gazing

Wow, that went fast! Through the wonders of the “Memories” tab on Facebook I was informed that my little slice of the internet just turned 15. For 15 years I’ve been sitting in front of a computer and sharing, well, stuff. So I’ve taken this as an opportunity to look back a bit. What prompted me to launch my own blog? What kind of stuff has made it onto these pages? Was any of it any good? How could any of it been better? Since this is just one guy’s view of his own belly button as it were, does being better even matter? And why, for Heaven’s sake, has anyone else been reading my drivel?

So I decided to take a little look back at the why and the what of what my “Random Thoughts” has turned out to be.

Without really knowing it I’ve probably always been sorta destined to write. Somehow or something, but writing. As I’ve said to anyone who ever asked, I am the son and grandson of teachers. Sticklers for the language, for grammar, in both the written and spoken word. Dinners at home were verbal free-for-alls. My Mom was famous as a younger woman for taking whatever position was on the opposite side of any issue just to spice up a conversation. Greg Glassman, the founder of CrossFit and a notable pot-stirrer was said to “like it a little rough” in the arena of ideas; growing up with two super intelligent parents and 3 equally bright (and argumentative) siblings probably did me well in comments section of the original CrossFit website.

Which, of course, brings up “Sunday musings…”, the original vehicle I used to exercise my writing “muscles”. After about a year or so as a moderately active member of the CrossFit “cyber-gym” I found the intellectual aspect of the community and the program as interesting and inspirational as the physical. I was introduced to what it meant to be a libertarian there, for example. My new business didn’t consume as much of my weekly hours as my prior one did. Sunday mornings were largely mine, the hours free of any real responsibility. I cut my teeth as a writer, found and refined my voice there writing my “musings…”

Why a blog? When I saw the FB “Memories” prompt I went back and read Post #1 and I posed that very question in the first paragraph. Do you ever find that your “internal hard drive”, your stream of consciousness running in the background, that it gets so full of ideas that you run out of space for new ones? I did. I do. An idea finds its way in and grows, sometimes crowding out other stuff I should be considering, or just expanding enough that another new, worthy something-or-other opens the door to your brain and simply can’t squeeze its way it. Just like a hard drive nearly full, or your ROM not up to the task of running your day-to-day tasks while at the same time processing the “big thoughts”. Writing it down, turning the words this way and that, allowed me to clear out the space needed to grow.

To be honest, every person who ever sat down to write secretly hopes that someone will read their stuff. Read it and like it, if we’re being fully honest with ourselves. This has been the case forever. Inkwell and quill or a computer capable of sending a man to the moon that fits in your back pocket, writers write in the hope that something they’ve written will matter. I was, I guess I am, no different. But from that very first post “Welcome to a Restless Mind” all the way up to this morning’s “Navel Gazing”, the main reason to write has been one part data dump and one part the simple joy I’ve found in the act of writing itself.

What have I been writing about? It turns out that my prediction on that very first post was fairly accurate. Healthcare, especially eye care, the topic of post #2 “Why Ophthalmology”. How our American healthcare system has slowly eroded over my career (“EMR and Underpants”), and how I have tried to fight that on a micro-level in my own practice (“A Tribe of Adults”). CrossFit, of course, but sports writ both large and small (“The Death of the Three-Sport Athlete I and II”). Athletes. The business of the sports world (“It’s Not About the Money”). Friendship has been a well to which I’ve returned time and time again. What is a friend? What it takes to make a friend and nurture a friendship. Being a good friend is important; I’ve done some of the work to be a better friend here. Lately, with the demise and subsequent “rebirth” of my hips there’s been a steady diet of thoughts on longevity, extending my “healthspan”, and a recent multi-part look at maintaining brain health as we get older.

Any writer has only to look to his family if he needs an idea or a little bit of inspiration when he sits down to write, and I am no different. Have you read the so-called “great writers”? In many cases the only topic they really address is family. Usually the darker aspects of their families, right? Their sun always seems to be in the shade of the dirty laundry they lay out. Not me. If writing about that kind of stuff in your family is what it takes to be a “great writer” then I’m never gonna measure up. I’ve tried really hard not to “go there”, and for the most part I’ve done OK. “Random Thoughts” has brought my beloved maternal grandparents back to life for me (“A Love Letter to My Gama”). It was a place for me to work through that pain of my Dad’s long goodbye (“A Father’s Day Visit From My Dad”), the loss of my in-laws, and sadly, the orphanhood lurking in my too near future. And Cape Week! 32 year of my family, you know, familying.

Was any of it any good? I dunno. Does it matter? Over the last couple of weeks I’ve gone back and read some of my posts and many of them (most?) have been rather pedestrian. Trite, even. I seem to try a bit too hard to be clever, to impress as a wordsmith. Still, every now and again a tiny bit of lightning strikes and a piece is pretty good. “The Genius Gene” and how I don’t got it. A couple on the difference between “Enemy and Other”, an older one about memories without the aid of a selfie or Instagram, of how I remember a dinner with my friend “The Dude” simply by the emotions I felt. “Shades of Gray”, still the best essay I’ve ever written, about the night when I knew that the very biggest thing was going to be OK.

Clearing my “internal hard drive”, writing down the things I’ve been thinking about, has helped me to be a better version of whoever I am, whoever I hoped to be. Will I keep writing? Sure. Why not? There’s always a little bit of better out there, just around the next bend, waiting to be found. My number one goal as an adult has been to be the best husband I could possibly be, a worthwhile thing I can strive to become every day. Writing has helped me there, too, and I am so very grateful to Beth for not only carving out space for me to write, but encouraging me to continue.

It’s been 15 years. I have enjoyed every part of them spent here, working through the random thoughts that bang around inside my brain. Honestly, it’s been a lovely surprise to find so many of you here, with me, still. Even though I am admittedly writing for an audience of one, I do so love it when you reach out and tell me that something I’ve written has been in some way meaningful to you or yours. What a privilege to have been a tiny part of your life. Thank you. I’ll be here, on and off, for as long as I can. My invitation in “Random Thoughts from a Restless Mind”, Post #1 stands:

Don’t be a stranger.

Sunday musings…4/7/2024

1 One way. As in street. I am back in Boston, the “big city” of my youth. Construction, weather, and the signature headache of traversing Beantown, the one-way street. Perhaps the only thing GPS hasn’t really, truly mastered.

Still the same brutal pain in the ass in 2024 that it was in 1974.

2 Leveler. Flight #1 cancelled, thankfully at 0400. Flight #2 postponed 2 1/2 hrs. Eventual arrival in Boston proper 0200 the next day.

Really, even a true snowbelt city is subject to the leveling effect of the wind.

3 Kalends, Ides, and Nones. “Beware the Ides of March.” Perhaps the most famous calendar reference in history. From the Latin calendar, the “Ides” fell on the 15th day of March, May, July, and October, and on the 13th of the other months. Did you know that? That the “Ides” wasn’t always the 15th of the month? No? Me either.

Turns out the Romans were into naming days. The first day of each month was known as the “Kalend”. Get it? Calendar. Ya, didn’t know that either. How about the “Nones”? The 7th day of March, May, July and October and the 5th of the other months. Any idea why?


4 Rearview mirror. This weekend I’ve been attending a conference being held in the “big city” of my childhood, Boston. Childhood home to my Dad. The first city out of which I ever flew. It’s been at least 10 years since this meeting called Boston home. After United took over Continental we began to fly in and out of Boston for our visits to Rhode Island. Now that my Dad is gone and my Mom has moved to Ohio, Boston has been turned into little more than a business trip and a rail stop.

What of our other cities and towns? Southbridge and Lincoln for me. Philly and the Lancaster area for Beth. Our ancestral “villages” if you will. The trip to Boston this weekend feels different now that my Mom is in Ohio. Each time I’ve been here for business over the course of my life I’ve either squeezed in a trip home or been squeezed by guilt because I wouldn’t be able to pull it off. My next opportunity may come in 2028 if it comes at all. After a final visit to to scatter their parents’ ashes, Churchtown may have seen the last of the Hurst girls. No opportunity appears on the horizon.

Honestly, this is weird. At no time in my life did it ever occur to me that the towns that domiciled my family, the towns that housed the halls of my education, that they would all cease to be destinations. Only memories, visited in daydreams.

Images that appear forever in the rearview mirror.

5 Ready? I guess this one could have been another “calendar” note. The years have passed and my days of visiting “home” have passed with them. Calendars are a measure of time, not unlike clocks or hourglasses, just a bit slower. This weekend I had the opportunity to share some advice with professional colleagues who are either surgeons like me, or folks who work for companies that make some of the tools and medicines we use. Much of the advice hinged on time and timing, the intersection of readiness and opportunity.

When is it your time? It always arrives. Your time, that is. Your “time” might be a problem, or an opportunity that arises. Your time either arrives when you are not ready, or you move as if it’s time but it really isn’t. Or it might be your time, maybe, but whether or not it is you just aren’t ready. And of course, sometimes the time is just right.

That even confuses ME, to be honest, even though I just wrote it!

Here’s what I mean by that convoluted koan: as I shared several times with my colleagues this weekend there is an intersection between readiness and opportunity, a coming together of the right thing at the right time such that something really good happens. For instance, you may have a singularly brilliant idea, something so far ahead of everything else in its space that it will be revolutionary. But the timing is off; you aren’t on the LEADING edge, you are so far out in front that you are on the BLEEDING edge. YOU might be ready, but it’s not yet time. Think the Apple Newton, the founding of a fully consumer-facing eyecare business just before the Great Recession or, you know, Crossfit ca. 1999.

On the other hand there may appear an opportunity which by all accounts is pretty much EXACTLY what you need right at that exact time. But you aren’t ready. A perfect job opens 2000 miles away, but the love of your life has 2 years to go for a degree. A trusted friend on the cusp of a success for the ages urges you to quit your “dead-end” job, the one that is paying you so much that you really can’t walk away from it just then to take what might be a dream job working with a friend. The culmination of your life’s mission is there for the taking, but reaching for it means leaving behind everything that you’d built AROUND that mission. Or it might be something as simple as not being ready for a “standard issue” life step like college right after high school or a job right after college.

Here I think, is the teachable moment, the guts of my advice: sometimes the hardest thing to do is to identify that one half of the equation has not reached a point of readiness, whether it’s the “you” part or the “opportunity” part. Several of my friends are sitting on one side or the other of this very thing. Failure to identify this almost guarantees that execution will fail, be only partially successful, or even very unsatisfactory. Once this mis-match has been identified, however, rational choices can be made. Strategy can be mapped out and tactics chosen.

Sometimes the best of these is to simply soldier on despite the fact that one part or the other isn’t ready (think Crossfit workout). Other times it’s best to drop back and re-group, prepare to re-engage at some time in the future if and when readiness and opportunity intersect (think Apple and the Newton, the re-boot of that consumer-focused eyecare company post-Recession). Either way, whether it’s you not ready for the world or the world not ready for you, the first step is to not ignore the fact that SOMEBODY isn’t ready.

And that once they are something really good happens.

I’ll see you next week…

Easter Sunday musings…

It’s Easter Sunday, the holiest day in the Christian year. This year is the 65th Easter for me. Many of the recurring themes that roll around the space between my ears seem to coalesce each year on Easter Sunday. Family and friendship. Faith, religion, the unbreakable connection, and friction, between them . Whether or not there is an afterlife, and if there is might it be explainable through the concepts of Quantum Physics. Role models; the essential nature of Christ as the ultimate role model (“as you do unto others…”). As Christians we “celebrate” the ultimate sacrifice, the ultimate expression of altruism in the “history” of mankind. Men and women are tasked with following Him as the ultimate role model for how we are to live our lives.

If one does, indeed, believe, and if one does follow Him as the role model in one’s life, then all other talk of role models is irrelevant. Like so many other goals and targets, though, the Lamb as role model is ultimately unachievable by any and all, and thus we have the all too human phenomenon of other, human role models.

What then constitutes a role model? Who is qualified to fill this role? Who would be willing to do so? How do we find these people, these role models? In a world that was much less heterogenous, where people of all stripes had more in common than not and acknowledged that fact, role models seemed to be a little easier to come by. Audie Murphy. Stan Musial. Jackie Robinson.

Heck, even a politician or two filled the bill, although we certainly seem to be rather bereft of those at the moment, don’t we? The wonderful writer Joseph Epstein wrote an insightful column in yesterday’s WSJ lamenting the fact that we haven’t had a President that we can feel good about, let alone emulate, in 50+ years. It is his contention that Ike was the last such President, although he admits to a fondness for Reagan that may not have been universal (more in a moment).

Every town had a teacher or a coach or a cop who everyone looked up to. Why then and not now? Partly because of that sense that we were all more the same than less, but partly because we only knew the good stuff about our role models, and on top of that we only really wanted to know the good stuff, ya know? Returning to Epstein, the last time I thought about this “out loud” a friend offered JFK and “ask not what your country can do…etc.” And yet now, in 2024, we know so much more about him that in hindsight, well, you know. But at the time, thinking of JFK and Gerald Ford and Reagan as role models, unaware of the brilliance of their speechwriters or any of their peccadilloes, for many they might have been candidates for the role.

On a local level, face to face (IRL as the digital natives describe it), once upon a time to be a role model meant to be always trying to do the right thing for the right person at the right time. We forgave the occasional slip because we saw the work it took and appreciated the ongoing effort. It inspired us to do better ourselves. We forgave the occasional failure because we knew how hard it is to always look to do that favor, to offer the helping hand, to put forth the best effort. Our sense of our own humanity was extended to our role models as a gift to them such that they would continue to lead us.

How different are our times now. The perceived lack of role models in society today says more about us than it does about any role models that we may have discarded. We accentuate our differences rather than our commonalities, no matter how far on either end of the curve lie those differences; someone with whom we share 80 or 90% of our opinions, of our guiding beliefs is no longer an ally or a potential friend but rather an adversary with whom we battle 100% of the time over that 10% delta.

We not only accept too much information about our all too human potential role models, we actively seek the “smoking gun” that will bury them. See above Epstein and Kennedy, or spend 15 minutes with the archives of any national newspaper during a Presidential election year. The marvelous baseball player Ohtani will now spend literally years having every non-competitive minute of his life dissected over the indiscretions of an employee. Any and all of the good things he does will be buried under whatever clickbait might arise. We are all the lesser for all of that, for we deny ourselves the potential that could come from having a role model just a little bit better than ourselves.

Today, on Easter Sunday, whether through true faith or simply the mechanics of religion practiced over a lifetime, in the Christian world we celebrate. We see in ourselves our faults and our failures. After 40 days of contemplation, we seek a better version of ourselves in the coming year. We seek role models near and far, and if we are so inclined we may seek to be, in some small way, a role model for others. If we do make that effort we hope for the grace of yesteryear extended to us for our efforts. For the only perfect role model continues to set an unachievable goal, however noble might be our effort.

And He has been dead for some 2000 years now.

Happy Easter. I’ll see you next week…

Brain Health, Bringing It Home: Sunday musings…3/17/2024

There’s really an awful lot going on today, St. Patrick’s Day, 2024. So much that I am finding it a bit daunting to narrow down my focus for todays musings. Why so much? Well, actually, that question feeds right into the final piece of advice for my friend who has been so concerned about their risk to develop dementia given a strong family history and the recent death of a family member so afflicted. I am writing as I watch the 4th round of the 50 edition of the Player’s Championship while I rest up for another evening of dinner with Beth and the couple we met almost 39 years ago on our respective honeymoons.

The final piece of the puzzle, the last tactic to bullet proof your brain as you age is to forge and maintain close personal relationships.

We had a free weekend earlier this year when Beth and I were plotting out our calendar. Nothing really special about the dates, we just knew that this weekend fell between any other commitments and work, and that we could sneak away for 4 or 5 days to someplace warm. Our friends Dave and Suzi were free, too, so off we’ve gone together. While Beth and Suzi have been flexing their photographic muscles all over our little seaside spot, Dave and I have been going over our efforts to improve and prolong our respective healthspans. Turns out Dave has spent a bit more time on the financial planning, and I a tad more on the longevity and health thing. Lots of numbers from Dave and a bunch of science from me.

We spent quite a bit of time on questions of testing. Full-body scans? Sure, if you can stand the claustrophobia of the tube. Genetic testing for cancers (Galleri)? Maybe. Gotta get a little better on the false positives since each positive test sends you off on a testing odyssey to find, and hopefully find an early cure, for whatever cancer you may have. Apropos of our brain health project, what about the APOE gene? This is a big one for Peter Attia the longevity doc. You can have zero, one, or two copies of this gene, with increasing risk for the disease as you have more copies. We are torn by this one. If you have done nothing to mitigate your risk for dementia taking this test and finding high risk gives you lots to work on (nutrition, sleep, exercise, alcohol consumption, etc.). But for Dave and for me the only thing really left would be abstaining from alcohol. Less joy, there. We tabled the test for the moment.

Which leaves the excellent research on health and happiness that began with a study of the men of the Harvard class of 1955 and the subsequent addition of high school boys in a lower economic area of Boston, now know as The Good Life Project. A book of the same name authored by the current custodians of the still ongoing study Drs. Robert Waldinger and Marc Shulz lays out the last piece of the puzzle that can be played: make and maintain close personal relationships. The original study on men of Harvard ’55 concluded that the presence of 3 or more friends (your wife did not count) was the key to lifelong happiness. It turns out that 3 (or more) is probably still a key number, but the updated research on the original subjects, their children, grandchildren and great-grandchildren has concluded that it can really be anyone. Friend, spouse, child, doesn’t matter. What you need is a deep, close relationship.

From the earliest results to the most recent, happiness has correlated most strongly with friendship. More than professional success or wealth. Fame. All of the things we think must certainly be the prime drivers. All of them are dwarfed by the positive effect of making, maintaining and nurturing close relationships. Men and women alike like longer and live better, and experience less dementia than those who aren’t so fortunate.

And that, my friends, is why I find myself banging away at my keyboard late on this Sunday afternoon, rushing to finish the task I promised my friend I would take on so that I can post this before Beth and I meet Dave and Suzi for another great evening at a killer restaurant in paradise. But that’s not what makes it all so great, right? What makes this weekend so wonderful is that I am with the most important person in my life, and we are with close friends with whom we have a deep, abiding bond, and we are enveloped in the embrace of our friendship.

We are, all four of us, happy.

To that friend to whom I promised this series on brain health, I hope this has all been helpful. I hope that you are at least a bit comforted having read it. I know that most of what I’ve shared is stuff that you already have covered, and I hope that knowing this eases your mind, at least a bit. To those like Dave and Suzi who have long surrounded me with their friendship and accepted mine in turn, thank you. I’ll be calling you soon.

And as always, I’ll see all of you next week…