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Archive for April, 2023

Smaller and Smaller. A “Sunday musings…” Trip to Visit Mom

Smaller and smaller. That’s all I could think about as we drove from Lincoln to Boston after a weekend visit with my Mom in her new home. So small.

Everything about Mom has become ever smaller. Someone snuck up and zapped her with some kind of shrinking ray. Never a big woman despite my brother’s teasing about her caboose, Mom looks incredibly tiny now. Lighter, thinner, shorter; even the good things about her are about small (a bit healthier, you can now see her ankles). Her apartment is less than half the size of the one she left a few months ago, which was itself about 20% of the size of the family home she left behind. Her very large circle of friends and acquaintances, once at least a couple of dozen strong with whom she had weekly contact, is now precisely zero. Outside of family (my siblings and our spouses), Mom’s world is encompassed within the four walls of her senior living facility.

There’s nothing really surprising about this. Not intellectually at least. We all certainly saw this happen to my Dad, both of Beth’s folks, and our brothers and sisters in-laws’ parents. It’s really just seeing it, and in my case seeing it episodically over intervals of months rather than weeks or days. Heck, Beth and I were lucky this weekend. Mom was feeling pretty well in comparison to recent weeks, and she was fairly easy to motivate toward movement. This is hardly a given as my poor sisters and brother have experienced over the last couple of months. But it was still striking to see it up close.

Everything has gotten so very, very small.

Once upon a time I wrote about this after visiting my Dad. He wasn’t a very big guy physically, but looking at him through the eyes of a son…boy…did he seem huge. He was a quiet man, at least around the house and certainly when we were all young. My son Randy was telling his fiancé about Dad sitting in his rocking chair and tipping the corner of his newspaper over just before he laid down the wood. I’m chuckling as I write as I think about the look on the faces of my sister Tracey’s dates when Dad looked over his reading glasses: “11:00 Tracey Jane.” A super-sized eye roll from Tracey and abject terror on the boy’s face. Seeing him diminished, so very small in so many ways toward the end, was simply gut-wrenching.

It’s sad. I’m sad. Despite the fact that I knew that it would be like this (again, my siblings have been terrific in both visiting and sharing updates), I’m just very sad about how very small both my Mom and her life have become. There are certainly lessons to be learned from what Beth and I saw in my Mom and the small group of women who have befriended her. For me, that is. In the process of finding places to live for both of our mothers Beth has visited quite a few senior living facilities, so what we are seeing now is what she discovered in her research. What I’m learning by seeing in real life actually reinforces and brings to life some of the things I have been researching at arms length.

Sorry, it’s a teachable moment and I’m gonna lay some, um, teachables on you.

All of the stuff that I’ve been reading about and observing about the importance of close relationships is true. Brutally true. In the book “The Good Life” by the researchers heading up the Harvard study on lifelong happiness there was an anecdote about a couple who had a lovely life. Really, quite lovely was the only way to describe it. The cornerstone of that life was their marriage, and from that the friendships that they’d forged both as a couple and as individuals. The husband had but one wish: “Please, don’t let me die second.” Man, it was just devastating to read that he did, indeed, die second, albeit only a couple of months after his beloved wife. I saw precisely two couples at my Mom’s place. Two. There were a handful of single men, but by and large the place was occupied by widows.

Maybe modern medicine will change this dynamic. Maybe there will be more men who survive long enough to be in senior living circumstances. Let’s hope so. Maybe that will make it easier for the single women who arrive without a tribe. Like my daughter Megan said so many years ago, the mean girls of high school don’t really graduate, they just move. Eventually they move to the last high school they will attend: senior living centers. Please let me live long enough to spare my darling Beth the pain of being single in “high school” again. Sorry for the rant; there is really no teachable moment to this part.

All of the teachable stuff comes straight out of the traditional CrossFit playbook, at least the physical stuff we saw. On the plane flying home I was reading Outside Magazine. The outdoors stuff really does speak to me, but for the life of me I can’t figure out why I insist on reading the fitness stuff. This is the magazine that persists on calling some skinny-fat ultra-whatever athlete the fittest person on the planet. A magazine published on a planet on which the likes of Lebron James lives, mind you, never mind Jason Kalipa and all 27 of the Thorisdottir’s. “Use It or Lose It” was the title of an article that cites researcher/trainer Alan Crouzen’s “Immortality Quotient”: the amount of aerobic fitness lost by endurance athletes due to age can be reversed by adding one hour of training time per month. I saw precisely no one at my Mom’s facility suffering from a lack of aerobic fitness.

Say what you will about Greg Glassman and the CrossFit Rx, ca. 2005-2015. Glassman and those who developed offshoot programs (e.g. Jeff Martin/Darrell White and CF Strength Bias) correctly identified the key, critical issue for aging humans: decrepitude. A broad, inclusive fitness that is NOT obsessively devoted to aerobic performance but is rather balanced in such a way that includes both strength and strength endurance is what is necessary in the real world of the aged. What Beth and I witnessed was countless individuals who were simply too weak to perform the blocking and tackling of their daily activities. We observed a cohort of men and women who struggled to stand up.

No matter how many friends you may retain as you enter the last couple of innings of your life, your world contracts if you can’t get your ass off the toilet.

This “musings…” began at Gate A2 in Boston. At the moment I am sitting at our only table at Casa Blanco, 40 minutes away from what promises to be an epic sunset and watching Beth mow the lawn while Bohdi assaults her lawn mower. At dinner I admitted that I was still sad. Sad about how small my Mom and her life had become. Sad because I was missing both of our parents when they were our age now. When their grand children were just getting started. Missing all that they were then, so unaware of the consequences to come from not planning for how they might find themselves in the decades to come. The glow of the sunset to come reflected off my darling wife as she maneuvers her lawnmower across our tiny backyard is a tiny beacon that might guide us both. Might signal that we both saw what might be before us if we don’t pay attention to what it was we were witness to this weekend.

Everything about my Mom had become so small. So very small. Some of that diminution is inevitable, of course, but the WHEN of that diminution is not. There are choices to be made, decisions over which we have control at the moment. Gravity will be victorious, but the timing of that victory may be partly in our hands. We will become smaller, too, but the speed at which we suffer that decline and the time at which that decline begins may be partly in our hands. There are many aspects of who our parents were when they were our age that Beth and I would be proud, thrilled, to possess, and we both are determined to do just that. The sun will set on us as surely as it did for our parents. No one escapes the sunset.

Unlike our parents, we need not face the sunset seated until help is at hand to help us stand.

Some very important things were learned about how we might be able to choose how we head to our own sunset. The lessons are there for the learning. Find your tribe and gather them close. Aerobic fitness may very well lead to a longer life, but it is strength that will lead to a better life. Run, walk, or bike as you will, but be sure to do what it takes to be able to get up and out of the loo on your own. We, too, shall be diminished in the end. Small is what waits for us all. It made me sad to see how small life has become for my Mom.

The lessons Beth and I are learning is that the when and the how fast our lives become small may very well depend on choices we make today while the sun is still high in our sky.

Burnout and Microstress: The Drips That Flood the Buckets. Sunday musings…4/23/2023

1 Time. For a guy who has been told, and who really does believe that he needs to find some hobbies so that he isn’t bothering the people around him who already have, I certainly seem to run out of time awfully frequently. Like, every day frequently.

Clue? It’s been three weeks since I’ve “mused”.

2 Spam. Not gonna lie, the bots are winning. Big time. It’s tough to filter out an email address when the bot has 50, or 100,000 or a million different versions of an address from which to bludgeon your email. My spam filters on email are nearly worthless.

It’s almost bad enough that you wanna find out just what it is that all of those “sexy Russian girls” find so fascinating about a slightly chubby, easily winded middle-aged man.

3 Fat. Man, I’m tired of being soft. Sure, there are a couple of very good reasons for these extra 8 or 10 pounds of marshmallow. 5 or so months of pre-surgical pain that prevented me from doing even the most minimal of physical activity, including walking. 4 months of post-op pain after I got my hip fixed. Not gonna lie, the miss-met expectations after surgery put me in a pretty dark and foul place.

Now? I am weak as a kitten and starting back at the whole fitness thing with less strength in my anything than at any time in my life with the exception of my teenage recovery from a broken back. While I am no longer in a dark place, let’s just say that this lack of fitness (and associated hurt caused by the pursuit to regain some modicum of the same) occasionally leaves me in a black mood. All exposed nerves and impatience. The sight of my well-cushioned navel unintentionally exposed when I reached up and my tee shirt ran out of cover almost cost me a full-length mirror.

Good thing I couldn’t bend down to grab a shoe.

4 Safety. “Keep children ‘safe enough’ rather than ‘as safe as possible’.” –Mikki Martin. Supportive reading: Outside Magazine article on raising children outdoors in Norway.

Mikki and her husband Jeff are the founders of the original CrossFit Kids program. There are many things tragic about the demise of the original company we knew as CrossFit, Inc., but for my mind none greater than the dissolution of the bond between the Martins and their creation, CFK. Fitness and the training of children in effective functional movement is fundamentally different than doing so in adults. Literally everything about it is different; the Martins cracked the code and brought what you could think of as Physical Fitness v2.0 to the masses. You can find them and v3.0 of their creation by looking for The Brand X Method.

Many parents would read Mikki’s quote and be appalled. Who in their right mind wouldn’t do literally everything possible to keep their children safe, right? But that creates more than a little bit of a problem if your ultimate goal is to raise a healthy, fit, creative and resilient kid. I mean, come on, the whole “as safe as possible” thing has brought us a couple of generations of kids who have no idea what “monkey bars” are. Climb a tree? No need to worry about some cranky old guy yelling “get off my lawn” when a panicked parent has hauled their budding climber off the maple tree before they were high enough to do a pull-up.

There is an extraordinary young woman, mother of 5 or 6 if memory serves, who was once one of my older son’s close friends. She would come over to our house, partly because she and Dan were buds but really, if she was being honest, because Beth let them play in the dirt. Or the mud, maybe with a little mudpie consumption. Or in a gently flowing stream, perhaps washing down that mudpie with a sip. All of which would be anathema to the “as safe as possible” crowd of course, notwithstanding the research showing that all of the above leads to healthier, happier kids.

Likewise, organized sports and other athletic activities. Here I will admit that I am conflicted, almost paralyzed in fact by my aversion to the wanton head trauma that seems so prevalent in all of the so-called “helmet” sports, including the beloved football of my youth. But even if we exclude them there are still risks involved in literally every physical activity in which our kids will participate. Do you know what the most dangerous sport is in terms of injuries? Hint: it isn’t a helmet sport. It’s actually baseball. More injuries, indeed, more deaths than any other junior sport. Care to guess what the safest is? Yup…a tie between strength training and functional fitness programs like TBXM in children as young as 8.

We should let our kids be kids. Explore. Try some stuff that may not turn out like riding a horse or trying to “ollie” a skateboard. Climb a set of monkey bars or see if you can traverse that horizontal ladder when your feet are hanging a yard or so above the ground. Ride your bike to school. Jump in that big pile of leaves that Mom or Dad dumped just on this side of the street. Grab that sunfish and try to get the hook out. Play in the dirt and dig up some worms.

Nobody ever died from tasting a worm to see why the fish seem to like them so much.

5 Microstress. Four clicks. That’s all it took. Four additional clicks added to the process of putting in a post-op order after surgery without any warning or explanation. 11 seconds of additional work on top of the tripling of the time taken to paperwork my way out of the OR necessitated by the advent of EMR. That’s all it took. Why? Why did we have to add this duplication of stuff that was already accounted for? Four clicks and I was literally enraged.

Four additional clicks pretty much defines the “micro” in “microstress”.

All of my reserves were depleted. There was no room for, well, anything else. I like to think of myself as possessing three distinct, finite “spaces” that encompass my daily lived experience. Timespace is easy: how many minutes I have over the course of my waking day to accomplish whatever it is that I need or want to accomplish. Brainspace is a little more complex: the amount of “carrying capacity” I have in my brain for the combination of accessible information storage and “computational” power to apply to the memory I am carrying in my RAM, so to speak. Lastly is Emotionalspace, the most complex of them all. This describes where I am on the proverbial “happy <-> sad” scale, my emotional resilience (how likely I am to be able to withstand negative events or vibes), and my emotional carrying capacity or empathy.

In my mind I see these three spaces as buckets, each a particular size at any given moment, and each filled to a level that corresponds to whatever state in which I find myself and the world around me. Timespace is mostly fixed of course; my bucket can never hold more than 24 hours worth of minutes. I only get to determine how many of them I’ll be awake to use. Both BrainSpace and EmotionalSpace are more elastic. There are some days when it seems like I can bring up any fact or notion I’ve ever acquired, and then work it effectively to carry out whatever task I’ve been presented. The BrainSpace bucket just seems a bit bigger sometimes. So, too, the EmotionalSpace bucket. There are days when I am just feeling on top of the world. I’m happy, and happy to spread some of my joy. I can withstand the emotional currents, both internal and external, that buffet each of us as we sail along. On days like this my EmotionalSpace bucket is as big as a swimming pool. On others it is quite the opposite; each tiny bit of negativity goes into bucket that shrinks with every passing minute.

Until four additional clicks, four tiny drops cause one or two or all three of my buckets to overflow.

That’s when stuff gets dicey, when the buckets overflow. It’s rather rare that you wake up with huge buckets, with all of your spaces sitting there and all kinds of volume available like so much space on a hard drive, and something comes along that floods one or more, producing what we might call “acute stress”. Chronic stress is what brings most of us down. The accumulation of tiny microtraumas, little moments of tension, discord or anxiety over time. A continuous flow of tiny drops filling up your buckets.

My Mom isn’t doing all that well in her retirement facility, a situation that produces a chronic drip that fills all three of my buckets. A kind of background stress. I barely know it’s there most of the time, but that’s a part of why stuff like that is so insidious and therefore dangerous. Unlike the tsunami that will ensue when Mom eventually passes away, the daily drip, the microstress of having her be less than well slowly fills my buckets and leaves less room for, well, everything else.

We each live our lives in a constant state of filling and emptying our buckets. “Burnout”, the inability to roll with the mundane in our lives, occurs when one or all of our buckets is so full that a single additional drop affects us as if it was that tsunami above. My buckets were so full from microstraumas like my Mom’s situation that the surprise addition of four clicks after surgery brought me to a place of injury no less hurtful than if I’d gotten there all at once; once there it doesn’t matter if it was four drops or from a veritable shower of challenge or trauma. Either way, you’ve entered the burn-out zone. I knew I was close; the “empty space” above the water in my buckets is where patience and empathy live and I’d been getting short of both. As it turned out, the surprise addition of four clicks on top of all of the other clicks it took to paperwork my way out of the OR was at least one drop too many.

Understanding burnout, understanding stress and stressors both micro and macro and how it all affects each of us, means understanding that the breaking point is more often a tiny drop into a bucket filled to the brim, with no space left above to breath.

Easter musings…

1 Vacation. Slept in yesterday. Took a walk. Had a drink. Declined to open up my laptop and type. The dogs napped.

We let them lie.

Here is a vacation edition of “Sunday musings…” with a couple of lightly edited entries from Easter weekends past.

2 Role model. It’s Easter Sunday, the holiest day in the Christian year, falling this year during both Passover and Ramadan. 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. 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?

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 effort 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.

The perceived lack of role models in society today says more about us than it does about any role models that we may have and ignore, or have and have discarded. We accentuate our differences rather than our commonalities, no matter how far on either end of the curve lie those differences. 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. 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. Someone to look up to, perhaps to guide us, or at the least provide us a living example of how we might be even just a bit better at the task of being human.

In our world of imperfect humans we will ultimately fail in any search for a role role model living unblemished among us, for the only perfect role model, at least in the Christian world, continues to set an unachievable goal, however noble might be our efforts today.

And He has been dead for some 2000 years now.

3 Death. Death continues to stalk our Clan. This makes us no different from Clan You; death comes for us all. Rare among us is the one who knows when the knock will come. Yet come it will. Beth’s Uncle, the last remaining of either side of the previous generation of her bloodline, resides at the moment in an ICU. It comes for those of every age. A year ago it came for a work world friend’s son. Seven years ago yesterday it came for a little girl who was a part of our horse world, taken at 12, alone in the gloaming, an unseen calamity leaving behind, well, everything and everyone. In this there is nothing special about our family. It is simply our time, our turn for Death to stalk our circle. Death takes us all, and we have very little choice about when it will inevitably come for us.

Life, though, is a very different thing entirely. Life, you see, can be taken by the reins and ridden for all its worth. We need not sit back and let life come to us like a horse at the far end of the field. It may, come for us that is, but it just as well may not. Like that horse, though, we can go right over and get it, hop on, and ride like hell. That’s the beauty of life. Of living. Being alive is a full-contact participatory sport. Every day you get to wake up is just chockablock filled with literally herds of horses just there for the riding. Some days you’re ready for literally anything and it’s off after that fire-breathing stallion and a gallop for the ages. Others, it’s all you can do to pull yourself into the creaky old saddle of an ancient herdy-gerdy pony barely able to put one foot ahead of the other. No matter. You’re alive. You woke up again and you looked into that pasture at all of those horses, chose one, and started to ride.

Death may indeed be stalking us, stalking you and me, but today is not our day. Uh uh, not today. Today we are alive. We are surrounded by our people, here and everywhere. Our circle is full. Today you have your people, and your people have you. This is not a day to be “not dying”, this is a day to be living. Choose a horse. Take the reins.

For today, we ride.

I hope you enjoyed my little vacation “look back”. I’ll see you next week…

Optimization; The Minimal Effective Dose: Sunday musings…4/2/2023

1 Fools. April Fools Day brought a very funny gag from my past. Supposedly Williams College and our arch rivals Amherst were merging, becoming Wamherst.

Easiest AFD joke to suss out in history.

2 Plural. Sometimes I struggle with spelling. English is an odd language, eh? Today it was the plural of “journey”. I kept trying to put an “ies” in place of the “y”.

Actually had to look it up to realize is was a simple “s”. Doh.

3 Offended. “Second hand offended”: to be offended on someone else’s behalf, whether or not they, themselves, are offended at all. Seems to be a major source of fuel for the interactive social media market. HT “Lovely Daughter” Megan.

There just isn’t enough time or energy to partake in this, at least for me. In my effort to optimize my various reasons to be offended (see below) I just can’t fit in any dose of offense on behalf of someone else at all.

4 Message. “Turn your mess into your message”. –Julie Walker, founder of the Peyton Walker Foundation.

My friend Julie lost her daughter to a cardiac condition almost 10 years ago. To honor Peyton’s brief but extraordinarily wonderful life Julie and the rest of the Walker family founded a charitable foundation dedicated to the twin goals of screening to diagnose cardiac conditions that pre-dispose to sudden cardiac death, and to donate AED’s to schools and other organizations so that they might have the means to save a life in one so afflicted. Very cool, very strong stuff, that.

A tip of the hat to Julie and her family. I’m gonna steal that quote but you can bet I’ll be giving attribution, Julie.

5 Optimization. Some time ago I wrote about the Minimum Effective Dose (MED), the concept in which we seek to optimize our results with the smallest amount of whatever it is that we are using to achieve that outcome. The quest to find the MED is one that crosses quite easily between my day job (medical) and my own quest for health. A quick mention of Eva T in Outside magazine and the program she uses with her clients made me think a bit more on the MED. Robb Wolf, one of the most knowledgeable nutrition experts on the face of the Earth, linked a Tweet today to another trainer who proposes that low-intensity aerobic exercise is the only thing that has ever been shown to postpone mortality. Big shift for Robb given his legacy involvement with CrossFit, the ultimate high-intensity program, and given the “slow” part of aerobic fitness programs, one that puts pressure on the quest for MED. The Everyday Math column in the WSJ provided an enhanced vocabulary for the journey.

Sometimes the MED really is a “something” you take. Here one thinks of medicine or food, for example. It is astonishing how many viewpoints there are on the topic of daily protein intake, for example. More often is the case that we are looking at a dose of time or effort. Or perhaps both. In this case we are seeking to optimize the effort as it relates to the outcome, to make the value of outcome divided by effort as large as possible. In healthcare “Effort” includes not only the number or test you get or pills you take, but also such things as time devoted to stuff like insurance forms and the figurative effort of reaching into your wallet to pay for medicine. The rate limiting factor is the Law of Diminishing Returns, of course: at some point additional effort produces such a small incremental increase in the outcome that it becomes not worth making. This applies to everything from workouts/week (or day) to decorating a birthday cake. At a certain point you just have to feel you’ve succeeded.

How, then, to know when you have reached this optimal level? Eugenia Cheng, the mathematician who wrote the WSJ piece, offers the concept of the “minimal acceptable standard”. Once she has reached this outcome the additional effects garnered from more effort have moved beyond the point where Diminishing Returns kicks in and she simply accepts the outcome. We would call these “minimal standards” goals, but the concept is essentially the same. We want an outcome; setting a target or a goal is step one in optimization.

Cheng then goes on to refine optimization with a discussion about boundaries. One is your goal, of course. In real life others also exist, things like a 24 hour day and a 7 day week and the need to make a living. The dose you choose, both qualitatively (what it is) and quantitatively (how much you get) is unavoidably affected by boundary conditions over which you have less control. In the end no outcome worth achieving happens without effort. Health, friendship, or the unraveling of a gnarly math problem–you’re going to put effort in to get your results out.

Maximizing your outcome-to-effort ratio is just another way to say you are seeking your Minimum Effective Dose, in fitness, health and elsewhere. Doing so in any one domain necessarily leaves you the resources/time to do the same in many more or the other domains in your life.

I’ll see you next week…

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