Random Thoughts from a Restless Mind

It’s really weird to spend an extended amount of time in the same house with multiple families while they are each actively pursuing the act of parenting. Have you ever done this? Done it when there was no escaping?

Beth and I are the oldest, first married, and first to create grandchildren. We are therefore also, now and evermore, the stupidest. No one is able to appreciate the difficulty and complexity of addressing any child developmental stage until they are knee deep in living it, although it’s amazing how much advice one receives from those not yet at any particular stage! Despite our shortcomings and obvious intellectual insufficiencies we have soldiered on nonetheless with good humor and grace…at least in the case of Beth.

After a week of (silent) observation of various parenting techniques and styles (silent because no one ever wants to hear “I told you so”, do they) I think I’ve come up with a general rule, or guideline, to the parenting thing. It seems that successful parents, those who manage to create useful, productive, mostly happy progeny who do not hate their parents, do so by setting clear and uniformly observed limits. Boundries within which the children live and learn. A sort of “silo” with virtual walls that exist both indoors and out. An open-ended silo is never successful because there is ultimately no clear limit established. A very skinny silo, bound up in rules and regs, with very little room for growth can be just as unsuccessful, and can be pretty tough to watch at that.

But it IS possible for even the tightest, skinniest silo to be successful in creating happy, successful, well-adjusted children. Why is that, if it’s so painful to watch a family silo that is so tight, so rigid, with so little room for growth? Ah, it’s because it’s not only the presence of parentally laid limits, the creation of the silo that is the ultimate source of parental success, it’s what ELSE you put in that silo that counts.

You gotta add love. It doesn’t matter whether your silo is looks like Old McDonald’s or a McDonald’s straw. Lots and lots of love. Fill every space in that silo that’s not already filled up with a kid with love.

There’s never enough of that in any family, ya know?

“Manic depression is touching my soul.”

You’re up;  you’re down. You’re happy; you’re sad. You have the best job in the world; thinking about going to work makes you sick to your stomach. You’re so good at what you do, everybody loves you; everyone is out to get you.

You are an American physician.

Recently I’ve been asked at least a dozen times why I became a doctor, or why I became an eye doctor. I’m not really sure why this has come up now, because most of the people who are asking have known me in some way for many years. Why I became an eye doctor is really rather simple, and I have written about it HERE. The question “why did you become a doctor” is much more complex, much more involved, and frankly I’m beginning to wonder about that myself.

“Why do you want to be a doctor” was at the same time the easiest and most difficult question for me to answer, especially during medical school interviews. I grew up in a small, dying mill town in Massachusetts. The happiest, most fulfilled, most IMPORTANT people in that town were the doctors, of which there were very few. The busiest surgeon in town, Dr. L., could possibly have been the happiest person in the entire town. Beautiful wife, attractive, intelligent, athletic children, really big house. He was even a decent golfer! I don’t think I ever saw him without a smile on his face.

It was Dr. Roy, though, my pediatrician, who really clinched it for me. There must have been another pediatrician in town–heck, there were 24,000 people there. For the life of me, though, I can’t ever recall any of my friends seeing any doctor other than Dr. Roy. He was confident. Secure. Always with a gentle smile whether in the office or on Main Street. My mom later told me that he was perhaps the most influential politician in town as well. Everybody looked up to Dr. Roy, no matter how young or old they might be. His was a happy, contented, full life, largely because he was a respected physician.

Can you name a single pediatrician now living and practicing in the United States whom you would describe like that?

Nevertheless, that’s mostly why I wanted to be a doctor. I want to be Dr. Roy. I wanted people to look up to me because I was good at doing something that was important, something that was meaningful to their lives. All of the doctors in town were like that.

Now? Well, I’m a 51-year-old eye surgeon and I am just like every other physician in the United States. I swing between the euphoria associated with a good outcome or a happy patient, and the bitter black hole that appears when a disease wins. My world is actually pretty good in this regard: for every defeat there are literally hundreds of victories. For every patient who is dissatisfied or unfulfilled there are hundreds who can’t wait to tell everyone in their lives how good their experience was. It’s just that there seems to be a couple more people who are less satisfied. A couple more each year.

Again, the success rate in my particular specialty is incredibly high, and these people who are less than satisfied have actually had an extraordinary good outcome if you look objectively. I think it all tracks back to the creeping consumerism in health care. It’s not good enough to have an outstanding outcome, it’s only truly even good enough if it meets the expectations of the consumer, the patient, no matter how outlandish or inappropriate those expectations might be.

I’m up. I’m down. The downs seem to hurt more because they are so much more, I don’t know, personal now.

I always got the idea that there was pretty much nothing to the business of being a doctor. All the docs seemed to have enough money, although none of them seemed wealthy. There was only one “girl” in the office and she made the appointments, gave you your bill, and took your payment. No back office or billing department. No special personnel responsible for charting, compliance, insurance communications. My “chart” was a couple of 5×7 cards stapled together.

Now? Oh man…the squeeze is coming from all directions. Private practice or big group practice, it doesn’t matter. You either deal with the external forces conspiring to make it more unpleasant to make a living as a doctor (insurance companies, the government, malpractice attorneys) or you deal with your boss (or more likely your boss’ secretary since you’re just another employee, after all). Your chart is now a legal document littered with land mines meant to ensnare even the most pious and dedicated among us.  Most docs do OK financially, maybe not 1%’ers but pretty well. It just seems like so many folks go so far out of their way to make us feel like we don’t deserve our pay. Any of us. Any of it.

I’m comfortable; you don’t deserve it.

Now, if you are not a doc you could sit back and rightly say “quit yer whinin”. I’d get it. I just can’t shake the feeling that Dr. Roy, and all of the Dr. Roy’s of the day, got and gave more out of what medicine could offer than any of us do now, despite the fact that those of us who practice now have so much more at our disposal on the medical side of the equation. It just doesn’t feel as good. There’s just too much that comes between doctors and that sense of service, of satisfaction in those bygone days. It just seems so much like work now. I don’t think Dr. Roy ever went to work. I believe he would have practiced pretty much the same way if he’d inherited a million dollars.

You’re up; you’re down. You have the best job in the world; you can barely make yourself open the office door. Everybody loves you;  you don’t deserve it.

“Manic depression is a frustrating mess.”

Someone posted on Facebook something about always wanting more. NEEDING more. Always striving for more. The sense I got from the post, and indeed the theme that ran throughout the comments, was that to NOT be ever–striving for more, to not EVER be satisfied, was to somehow settle. Settle for less. This was pretty much universally agreed to be a bad thing.

But where does happiness fit in here? If one never has enough, if one can never even be content, how is it that one can ever be happy? Frankly, I spent most of the day looking for the vocabulary to explain this. It’s just another version of the “want versus need” issue, complicated by a misunderstanding of the concept “ambition”.

I am ambitious. I have aspirations. Some of them are grand (reform organized youth sports, save the city of Cleveland), and some of them are quite trivial (own a home in Park city again, buy a watch). The difference, though, is that I’m really quite happy with what I have, who I am, where I am, and what I’ve done right now. I am thankful, openly and consciously thankful, for each one of those things.

Would I like more? Why, yes thank you. I’ve HAD more and it was really quite lovely. The only thing better than enough is more, eh? But there’s the rub: the man who knows when enough is enough will always have enough. We could say that one who is thankful for enough is living a life of gratitude. That certainly does not rule out ambition or aspiration, but it does leave a great big open door to happiness. People who are thankful for what they have, even those who constantly strive for more, tend to be quite happy.

I’m really quite happy. You?

Everyone should have a friend who will tell them the truth, specifically the truth about themselves. At least the truth about how the world views them. It’s impossible to accurately observe our own footprints; we need someone to show them to us.

This is not to say that one should form an opinion of one’s self or one’s self-worth solely on the basis of some external view. Hopefully our friend speaks kindly to us out of love and caring in the hope that the truth will lead us to a better version of ourselves, or allow us to feel better about the present version.

I have such a friend, and we recently had such a talk. It turns out that my doubts about the man I am now are unfounded, that I have grown into the type of man with whom others genuinely wish to gather, despite my fears to the contrary. It can be hard to sit still for such a compliment, uncomfortable to hear it no matter how lovingly it is offered, the urge to demure nearly overpowering.

How I have arrived here is quite another story, and a painful truth that my friend offered as well. In my younger years, a time filled with the external measurable trappings of success, I thought I’d already reached a place where people of all shapes and sizes were comfortable and happy in my company, and I in theirs. Hmm..turns out, not so much. No, it turns out that I was much too pleased with myself, too pleased myself with having achieved that visible success. I held myself apart, above. I was liked, but mostly because those to whom I would be compared were less likable. Ouch.

Would I have heard my friend if she told me this back in the day? I don’t know. I doubt it. A massive dose of humble pie was probably necessary, not only to hear and listen, to be ready to hear and listen, but certainly to have become who I am today. The details of my humbling are not really relevant, it was the lessons taught by humility that matter. Chicken? Egg? Does it matter? I do wish that she, someone, had told me then, though.

Why does it matter now? Why is this not simply a case of a friend congratulating me on growing up to be a better adult than I once was? Some times we get a mulligan. A do-over or a re-start. I may once again achieve a kind of success with all of the visible trappings, and the truth my friend shared is not just a pat on the back but a kick in the pants. A warning that I should do a better job this time around.

Everyone should have a friend who will tell them the truth. Each of us should care enough to listen.

It’s the end of November. In the United States we are just finishing the Thanksgiving holiday weekend, the purest of our national holidays in all respects. We are entering what is euphemistically known as the “Holiday Season”, a time once used to commemorate the intersection of family and faith, now b@stardized into a commercial org@$mic frenzy. Hidden in there, somewhere, alive against all odds, lie the rituals that bind us together, bind us to some version of our past.

Rituals are different from habits. Habits are trainable, repeatable, common activities we engage consistently in the hopes of some equally consistent, common outcome. They are largely personal and exist in a tiny personal domain. No, rituals are a shared endeavor, and choice is not always a part of the program.

We call these rituals by many names; in the extended White family they are traditions. We are a family that craves such things. Do it once it’s a precedent. Do it next year and it’s a tradition. Do it yet again and however it went is now inviolate ritual. Is this good?

Some rituals are gentle, almost whimsical. They tickle us and we smile little smiles as they come and go. Others are grand, some so outsized that “grandiose” is the only apt descriptor. There is weight to these, demands that must be met, plans that must be made. Some of this weight is real, usually born of history that stretches generations into the past. Some are even pleasant.

The power of ritual to teach and to bind is part of why they persist. The power of a ritual to resist a changing world, whether macro or micro, speaks to the inherent and personal resonance of that ritual. The more internal the effect, the greater the power.The longer lived the ritual, the more resistant it is to a changing world.

Church. The family meal. Travel. Gifting. All of the trappings that surround each. Why do we do what we do, especially at this time of year? Do our rituals remind us of a history that is warm, a legacy that bears propagating? Do they teach a next generation in a way that leads us to look forward with eager anticipation? Even painful rituals such as Yom Kippur end with optimism.

Do they rather simply reinforce some something that should have faded away, been allowed to die? Something that stands in the way of a better today or tomorrow, yesterday as the anchor that drags against full sails and a bright horizon? These we should have the courage to leave behind.

‘Tis the season in which most of us face the longest-lived, most deeply entrenched rituals in our lives. Most of them are likely that way because they bind us to a warm past, teach us, re-fuel and inspire us. Whether writ large or small, these are what we should return to as we face the bombardment of a world a’changing.

“What counts in sports is not the victory, but the magnificence of the struggle.”

There is more than a little merit to that quote. Have you played a sport? Been on a team, or stood alone in the crucible of game day? Everything you have done to prepare, every sacrifice you have made to arrive at that moment in that place now there for the realization. The struggle is not only that which lies before you in the match, but also that which lay before that you could be here, now.

You enter the arena, perhaps filled to the rafters with spectators, just as likely empty and near silent. It matters not; your struggle has brought you here, ready for the game. It’s you vs. them, or him, or her, but it’s just as much you vs. you. Will I commit fully to the struggle? Will I do anything and everything in my power within the rules of whatever game we play to emerge victorious? Aye, and if I have done so, and if the score at the end says I’ve lost, was my struggle any less magnificent? Any less worthy? I did what I could. I did ALL that I could.

Coaches from time immemorial have preached a gospel of lessons learned on the pitch applied to a life outside the sport. You play how you practice. It’s a 60 minute game, and you’ve got to play all 60. Call your own fouls. Be both a good winner and a good loser. It doesn’t matter if you win or lose, it’s how you play the game. I think it’s instructive to make a tiny little change in that quote, one that might have been said by any number of non-sports sages:

“What counts in life is not the victory, but the magnificence of the struggle.”

This fits. This fits in an infinite number of ways and an infinite number of places. Why? Because life has no clock, at least not a clock that we can follow, or a clock on which we can base “game strategy”. We can’t “run out the clock”, manage the shot clock, or make it to the TV time-out. The struggle is continual, and it is endless.

Everything else fits, too. The struggles of yesterday hopefully prepare us for the struggles of today. What will we bring to today? Am I ready for the struggle today? Will I fully commit to the struggle before me today, do all that I can within the rules, all that is asked of me, expected of me, required of me? Life, unlike sport, is not a zero-sum game. I win, if one can call it that, if I’ve done my best. In life, but not necessarily sport, others may win as well, but it is not necessarily so that others must lose so that I, or you, may win.

“Struggle” is a very good word in this context. One doesn’t read “struggle” and think “easy” or “soft”. The magnificence of the struggle lies there, I think, in the inherent difficulty of the endeavor. One is struggling. It’s hard to live well. It’s hard to do the right thing because the right thing is so often the hard thing. It’s how you play the game.

Isn’t it?

The struggle is indeed magnificent when you engage in it. When you don’t turn away from the struggle because it is hard but rather embrace it in an attempt to win. That in itself is rather a victory; failure to struggle, failure to try, failure to do what must be done because it is a struggle is a loss. It takes courage to do so. It takes integrity and honor to engage the struggle when no one is watching you, you are alone, and you must make the call. On the pitch and in life.

At some point, in the game or in life, we will be called upon. Take the shot. Make the call. Hold the line. Make the save.

When the game is over, when life winds down, each of us will look back on the struggle and ask these questions. What did I bring to the struggle? Did I fully commit myself to it? Did I do all that I could within the rules, all that was asked of me, all that was required of me?

How magnificent was my struggle?

“What counts in sports is not the victory, but the magnificence of the struggle.” –Joe Paterno

When I was a high school senior my football coach became my friend after the season had ended. Only 10 or 12 years my senior, Cat was still single and for the next 4 or 5 years we spent quite a bit of my at home time together. There are quite a few articles in the Veteran’s Day papers this morning, some of them about the difficulties encountered by our servicemen and women when they return from deployment; that’s gotten me to thinking about Coach Cat.

My friend Chris, Coach Cat, and I were having a couple (dozen) beers one summer night when out of nowhere Cat had a rather scary “flashback” to the jungles of Viet Nam. Turns out as a young 2Lt his squad got cut off from support and he was on his own, leading his men out of the jungle. I remember him sobbing that night, choking out “I can’t believe what I had to do, what I did to get us out.” Stunned, Chris and I gently steered him to bed at a buddy’s house and then we drove home in silence.

For after all, what can you say? What can someone like me, never a minute “in country”, say to someone at a time like that? Indeed, even in a non-crisis moment, how does one respond, how does one express understanding and gratitude to one who has done what needed to be done “there”? Papers this morning are awash with stories and commentaries on a nation’s citizens not at war. Of empty, meaningless gestures and expressions of “thanks” and “appreciation” and “support”. Is this true? Are we who are here, so safe and so far behind the line, are we that shallow and insincere?

I confess that I just do not know the answer to that question. Perhaps neither I nor anyone else ever will. Here’s what I think is different now, though, from those days of my youth spent drinking with a friend who’d done his duty and returned to face both his countrymen and his demons–now I think about this generation’s Coach Cats every day, and I think about how to express my understanding, my empathy, and my gratitude every day. I hope that I am not unique. I hope that the columnists are wrong.

CrossFitters will mark the day with a Hero WOD, “Murph”. We will express our gratitude and our respect in our own, special way, just as we did with “White” earlier. We will endeavor to remember EVERY day, not just on “Hero” days, though we will do so with a little more intensity, more conscious intent, with “Murph.”

In the end today is just a Friday off work for Federal employees if you think about it. When we are a country with men and women ON the line, Veteran’s Day is every day of the year.

I gotta find Cat’s phone number.

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

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

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

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

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

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

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

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

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

Sunday musings…

1) WOD repeats. Today’s scheduled WOD: Rake leaves, AMRAN (As Many Rounds As Necessary). Repeat X whatever.

2) Goals. I scaled a WOD on Friday, reducing the weight because my goal for that particular WOD was to not stop. I wanted to continue moving and maintain the “breathy” nature of the WOD. I could just have easily chosen to go as Rx’d and achieved a strength-endurance goal.

You vs. you.

3) Goals, again. I’m interested when I talk with a new CrossFitter to hear and understand his or her goals. Why do you want to do CrossFit? What do you hope to achieve? What will you do with the fitness you achieve? I’ve reevaluated my own goals a couple of times these last 6 years, and I’ve pretty much narrowed down my own desired outcomes and uses. How about you? What are your goals? Why are you doing CrossFit?

CrossFit is fun, whether you do it alone or in a Box. As a straight forward GPP (General Physical Preparedness) program I’m convinced it is superior to any and all other similar programs, but you may have a specific physical goal that extends beyond general fitness. Is CrossFit therefore not for you, or someone who shares your goal?

My bid is that an underlying foundation of GPP (upon which you layer your SPP) will make you better at whatever you do unless you are on the farthest extremes of the fitness Y axis, extreme strength or extreme endurance competition. Why there is so much gnashing of teeth and childish ad hominem about this escapes me.

I am especially befuddled when people who make their living teaching CrossFit, who are quite successful because of CrossFit, aid and abet those who launch such attacks.

4) 4 Things (With thanks to Ira Byock). I attended a talk yesterday on end of life care, the first in a lecture series honoring the friend I lost to cancer earlier this year. The talk was surprisingly moving, not only because it brought back memories of Ken but also because I will likely lose my Dad in the not too far future, and I thought of my folks throughout the talk. What the speaker discussed as end of life care and end of life preparations also offered a very important take-away that I will try to apply now, today, as if the end of life was nigh.

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

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

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

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

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

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

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

I’ll see you next week…

Posted by bingo at November 6, 2011 6:13 AM

Discipline vs. habit. Have you had those days when you trudge into the gym, the Box, with little to no desire to be there? Beaten down and on the verge of defeat, you simply show up, punch in, go through the motions, punch out. Had some of those? Yah…me, too. It happens elsewhere in your life, too, in other places and at other times when you don’t really ‘have to’ be there, doesn’t it?

Well then, why did you show up?

There’s a continuum, I think, along a line that includes discipline, motivation, and habit. It might be a circle or a feedback loop–I’m not sure yet. The end result is something like consistency. Was it some sort of discipline that prompted you to go to the gym and do that workout when you didn’t really have any too much desire to be there? Some sort of force of will, a conscious imposition of rational to overpower emotional? Or were you simply motivated by some end-goal long before chosen, a milepost toward which you travel no matter what because the destination is so compelling? Subtle, I know, and I confess that the subtle difference between discipline and motivation escapes my vocabulary and my understanding at this stage.

What I DO understand, though, is the concept of habit, and habit formation, and the consistency that arises from positive habits. You know, just like the Crossfit prescription of Form before Consistency before Intensity. Whether it’s the PULL of motivation to arrive at some wonderful destination, or the PUSH of discipline driving you there, it is the creation of habit, of consistency, that ultimately gets the job done. Similar prescriptions exist elsewhere, I’m sure.  CrossFit is just what I know.

Success is about building those habits, the ones that produce good outcomes. You went to the gym that day because going to the Box at that time is the habit you’ve developed; punching that clock on that day provides the consistency that will bring a giant forward leap on the next day when you show up with a spring in your step and fire in your belly. Any kind of habit that consistently moves you forward along a road to success is a habit worth creating. For example, I’m in the habit of assuming that every day in the office is gonna be a good day, unless it’s a great day, and I’ve noticed that this kind of habit is contagious.

Whether pushed by discipline or pulled by motivation, give yourself permission to create habits that move you.