Random Thoughts from a Restless Mind

The view where I write is of an inland sea. Today the sea before me melts, unleashing the power of water untethered as fully as it curbs the equally awe inspiring power of ice on the march. Indeed, the power of water is inexorable and undeniable in any form. After all, it was the glaciers of an epoch long gone that carved the great crevasses of the earth that we call canyons. Anyone with a flat roof can attest to the stealth of water as liquid, endlessly, tirelessly seeking the smallest weakness and pouring through once it does.

Water is the most valuable and least appreciated resource on our planet. Least appreciated, that is, until you are denied access to it. The water intakes of Lake Erie were frozen solid for some 24 hours this week, in some cases rendering indoor plumbing a concept of the mind only. In West Virginia all uses of all tap water are forbidden, a tasteless and odorless poison carried like a parasite on the back of the whale. Indeed, water lubricates the politics of states and nations, literally, as they fight in ways large and small over who controls the water.

In the end we will discover, to our inevitable surprise, that it is the water that controls us.

Registration for the CrossFit Open, the largest simultaneous participatory athletic event in the world, begins January 15th. Are you in? Of course you are! It only costs a few bucks (sorry Dave Castro, I haven’t actually been to the Games site yet so I don’t know the actual entry fee!), and you get to take part right alongside everyone. Even Rich, Annie, Julie, Sam, Jason, and, you know, EVERYONE.

Competing in CrossFit, CrossFit as a sport, is not really my thing. I have too many old injuries that take all of the fun out of “unknown and unknowable” as a game, but I totally get the whole “it’s fun to compete at my thing” aspect of CrossFitters competing . The Open is one cool way to compete, and for me it’s the only one that is enough fun for me to throw my hat into the ring, too. Even at that I will approach each event with safety as my priority. I want to be a part of the whole Open experience, but at the same time I don’t want to get injured and miss any training time in the gym because, let’s face it, I really like begin in the Box.

Injuries in competitions pitting CrossFitters against one another have been on my mind lately. Not crazy, freak injuries that are just bad luck, but injuries that appear to be predictable, at least to me. I’ve been a spectator at almost every CrossFit Games, multiple Regionals and Sectionals (when we had them), and many local competitions set up just for the fun of the competition and the gathering. I’ve been to a number of one’s locally very recently. There’s a trend in these non-HQ sanctioned events that I’ve noticed, and I think we need to talk about it. Now, with the Open almost upon us, is a really good time to do that.

The Open as you know, or are about to know, is one WOD per week posted each week for 5 consecutive weeks. That’s it. One WOD. Not 3 WODs with an hour between each, or a weekend’s worth of work that includes epics like “Elizabeth” followed by “Grace” followed by “Fran”, or a Sprint Tri followed by the BUDs obstacle course. One WOD per week. On top of that you will discover that the WODs chosen will allow for the maximum amount of participation; almost no one will be excluded by a movement or a load that is beyond them because of the structure of the WODs to come. This has been the signature of the Open and there is no reason to expect that the wide-open funnel at the entrance to the Games will be any narrower in 2014.

Yet, when I visit a Box or attend an event as a spectator, or even just look at the WODs posted for a competition, I invariably cringe at what I see. There might be enough volume to make even the hale and heartiest from the NC Lab blanch. The loads on familiar movements are so extreme that they are almost self-parody. To top it off there appears to be an “arms race” between competitions to see who can program the most obscure movements in our entire CrossFit quiver, stuff we do on only the rarest of occasions, and even then only for the unique training effects to be garnered more through mastering the movement than maximizing work with the exercise. Think heavy Turkish Get-Ups or ambushes with axel C&J. These competitions are supposed to be fun for Heaven’s sake!

The “Gamesification” of local competitions is a tragedy in the making. Looking at the events in some of them makes me think of some of the WODs I see posted in various places, long chippers with ever more clever names, each meant to out-do the last. These WODs as an Odyssey have been aptly called “Any Asshole” WODs, as in “any asshole” can put together a bunch of exercises and thrash a group of CrossFitters with them. Even worse is programming for regular CrossFitters that simply pounds away, day after day, with this kind of stuff, or pounds away at them in a local competition. People are getting hurt, missing work, missing time in the gym. It’s not OK.

I am confident that this year’s CrossFit Open will be like the last. It will include standard issue exercises and loads we can handle. Coach Glassman will see to that. For the rest of you who are holding “friendly” competitions around the world I am throwing down the gauntlet: stop hurting my people! Think CrossFit Open more than CrossFit Games when you program for your event. Be inclusive with movements and loads–you can very adequately test your competitors fitness with exercises and weights we use all the time. Save those weird and wacky events (100M backward sprints! One-arm barbell Cleans!) for the controlled setting of a training session under the direction of a trainer concentrating on technique.

It’s supposed to be fun, but as we say in my day job: it’s all fun and games until someone pokes an eye out.

Tons of random stuff banging around between my ears, so much that it’s a little difficult to wade through and make sense of any of it. One little thing keeps bubbling up to the surface, long enough at least to be noticed: the lowly comma. Mathew McConaughy describes himself as a “comma person”. I get that.

What with all of the New Year’s resolution action, here and, well, everywhere, it can get to feeling like there really is a discreet finish to a year. A ‘period’. Full Stop. Does it seem like that to you? Everyone gets all in a rush to finish off a year, in this case 2013, so that they can get started on the next one. All kinds of retrospectives, writ large and small, come cascading down at the end of the year. As if it really was an end. Capped by a ‘period’, you know?

The thing is, though, that I don’t really feel all that different. It doesn’t really feel like anything was all that completed on December 31st. Or, for that matter, like there’s any huge new start, re-boot, or even a mulligan just after that ‘period’. Sure, there’s a really convenient opportunity to take stock, maybe make some adjustments or even re-route, but the longer I’ve been at this New Year thing the less it seems like anything is ever really at Full Stop.

More like a pause. That’s it. Not a ‘period’ so much as a ‘comma’ leading into whatever comes next.

A sentence, a paragraph, a chapter, or the whole darned story ends with a period. The year is over and the last box has been checked, but the story continues on New Year’s Day. Even the most severe pivot is still connected to the other side of the angle, the beginning of the line. The line, the sentence, the story and the life do not really stop at all; New Year, Birthday, whatever. We may pause, indeed we do pause, sometimes quite often. Full stop? Nah. Not us.

That’s what’s got me thinking about the comma. The story goes on and on, one big run-on sentence with an occasional pause but never a stop. It’s connected front to back, side to side, and start to finish by those pauses, by the lowly comma. I think I get what McConaughy is getting at. New Year’s Day is a comma place for sure, but neither time nor life hits a ‘period’ there, either. We just keep on going. The comma means there’s more to come.

I think I might be a “comma person”, too.

Will you make any New Year’s resolutions this week? I probably will. Each year my list becomes smaller, but I am more successful in hitting the mark. Why? Probably because the list is small and therefore better thought out for one.

The other reason is “resolve”, the characteristic most necessary to achieving success in your resolutions. It’s a fancy word for commitment, or more precisely the conscious act of making and following through on that commitment. It’s infinitely easier to find  the resolve necessary to follow through on my resolutions if there are fewer of them for sure, but having taken a bit more time in coming up with them in the first place it also seems that my resolutions of late have been a bit more meaningful, too. Investing the time in the search for a meaningful resolution seems to reduce the time and effort it takes me to muster up the resolve necessary to see one through.

If you celebrate Christmas (or Hanukah for that matter) you probably did a bit of gift giving recently. Sure, some of it probably felt kinda like an obligation, but at least a bit of that gift giving was really more about the expression of love behind the gift. That’s the easy part, at least for me, expressing love. Whether on the gifting side or the giving side, once I gave myself permission to freely express love it really became pretty easy. Took a while to learn how to do it for sure, but with practice it became a natural thing, almost a default setting.  It was fun, too!

The receiving end of the gift thing is a lot of fun, too, of course. I mean–come on–who doesn’t like opening up gifts?! Lots of funny stuff around getting a gift, too. Think of all the funny “re-gifting” stories you have, or the last “White Elephant” party you attended. In the White house the philosophy of “it’s OK to say you probably won’t use that gift” became “REJECT THAT GIFT”! That got to be quite funny as we all tried to one-up each other in the outlandish ways we declined the gifts. Beth is still scarred from her first encounter, and she’s never had a single gift rejected!

Accepting a gift is really rather easy, it’s accepting the love behind the gift, accepting another’s love that’s a little more complex. Maybe you didn’t know how much they loved you. Maybe you are worried it’s conditional, the love, with strings attached. More often, though, the problem is that you aren’t really sure HOW to accept the love, or even if you are deserving of such a thing. That’s it, isn’t it? That’s really what you’re thinking. “They can’t possibly love me, love me that much. If they only knew the truth.” Or something like that.

Here’s the truth: they really DO know. And because of that they really, actually, truly DO love you. Most importantly there’s not even a little bit of a mistake here, and more than likely there’s not even the tiniest thread of a string attached. Not only are you loved, not only has someone in some way told you that, you deserve every little bit of that love. Really and truly. Resolve this year to believe that. Make your 2014 New Year’s Resolution to be openly thankful for that love, just like you are for that beautifully gift-wrapped present under the tree at Christmas, the one you would never reject.

Resolve to let yourself  be loved this year.

Happy New Year!

All work has value. Well, all legal work of course. Every job has value. There is a certain dignity that can be found in every job. Mop the floors? Someone’s gotta do it, and the rest of us should be thankful that someone did it. Digging up coal? Man, that’s a dangerous job. I think I read that 90% of Ohio’s electricity comes from coal. I’m warm today because someone went deep and came up with that coal.

Heck, even used car salesmen perform a job that has value. Seriously.

More to the point, especially at this time of year, is the value that is conferred on the person who has the job. Almost any job. You’ve got a reason to get up in the morning (or evening if you work graveyard). You have folks you are responsible for, and you are taking care of them. You are taking care of yourself. Taking responsibility. FWIW I would go to work on Wednesday if I had the magic lottery ticket on Tuesday.

In the Great Depression what everyone asked for was a job. Will work for food. I truly believe that this is still true for the most part today. People feel deep down that they need to work. When they have a job by and large most people work as hard as they can to do a good job. I live and work in the second most highly regulated industry in the U.S. (bonus points for knowing the first), and my income has been halved over the last 10 years or so. I still go to work, though, and I still work for the people who “buy” my services just as hard and in the same good faith that I did 10, 15, 20 years ago.

That’s my job.

Which brings me to the point: if you have a job for Heaven’s sake do your best. Work hard. If someone has given you a job work hard for her. Don’t’ let any resentments interfere with doing your best work. Everyone is underpaid; your boss thinks he’s underpaid, too. It may or may not be true, but when you are on the job it doesn’t matter. When you are at work is not the time to harbor or act on anything other than the job at hand. If you work for someone, WORK for him. Do whatever it takes to do the work well, to get the job done.

It’s not just that you owe it to her, you owe it to yourself.

‘Tis the season, eh? Indulgence at this time of year, at least in the Judeo-Christian world, is rather obvious. I WAM my nutrition all year so that I can eat pie at Thanksgiving and cookies at Christmas. Neither of which I weigh or measure, by the way.

There’s an aspect of guilt when it comes to indulgence. It’s more than just the occasional treat. An inch of dark chocolate on your Paleo Diet doesn’t really cut it, and if you consider that an indulgence it’s probably time to loosen up a bit. I was thinking that the ultimate First World indulgence is the un-timed hot shower, but anything that occurs on a daily basis probably doesn’t count either.

Uh uh…indulgence involves a certain sense of not only excess but also a bit of “I really shouldn’t”. Jay McInerney: “I find the shadow of guilt always adds piquancy to any indulgence. It’s almost more pleasurable, feeling slightly guilty.” As a boy raised Catholic by a mother who openly admired the way her Jewish friends raised their kids (producing what I’ve come to call “double guilt”), I definitely get the “shadow of guilt” angle to indulgence, especially with ones that only occur on rare occasions.

Others, though, indulge in ways both frequent and grand. Indulgence writ large, if you will. Take, for example, Lilly Bollinger and her approach to Champagne: “I drink it when I’m happy and when I’m sad. Sometimes I drink it when I’m alone. When I have company, I consider it obligatory. I trifle with it if I’m not hungry and drink it when I am. Otherwise, I never touch it–unless I’m thirsty.” Man, THAT woman knows how to indulge. Not much guilt evident, either. I’m sure my Mom wouldn’t approve, and I’m equally sure that Lilly wouldn’t care.

In a perfect world we would all be more like Lilly Bollinger, indulging on a daily basis in something that brings us pleasure with or without a side of guilt. The world, as I’ve said, is messy, no matter where it is you might live. Indulgence is what you make of it, and it’s probably a good thing that we have this Holiday Season during which we give ourselves permission to indulge a bit. Life is messy and hard–you’ve earned it.

[Raises flute]

The technology is fabulous. I mean, Femtosecond Laser Cataract Surgery (FLCS) is really, REALLY fabulous. It deserves a full roll-out. It is nothing less than the logical next step in a progression of medical treatments that extends back in time to the days of the Pharaohs and Cleopatra. Yet we debate its merits (Is it better? Is it safe?) in a sad and tawdry replay of the introduction of its predecessor technology, a chapter in the august history of ophthalmology that is still cringe-worthy among the vanishing actors still alive from that tragicomedy. That original sin, the denigration of the technique of cataract removal called Phacoemulsification (Phaco) by the establishment could at least stand on technical grounds;  Phaco 1.0 was rather rough stuff. Here we have no such ground on which to stand; the new technology of FLCS at launch is at LEAST as safe and effective, and promises to become more of both as it develops.

Why, then, my obvious angst?

The problem lies not with the technology but with the business model, and by extension how that is dividing the community of cataract surgeons. You see, what was really tragic about the the response of the ophthalmic community during the transition to Phaco for cataract surgery was the outright character assassination of those on the forefront of adopting Phaco by those still entrenched in the status quo. In my opinion the same is starting to happen now, only it is those who are adopting the new technology who are subtly smearing those who have yet to do so.

At the turn of the most recent century a company called Eyeonics (since purchased by Bausch & Lomb) and its CEO Any Corley ushered in a new era in cataract lens implants. With these new implants came an equally revolutionary new business model. Through the tireless work of Corley and his associates patients were given the option of paying an additional charge to add an UNCOVERED service on top of a medically necessary service that was otherwise fully covered by insurance. While the costs of the basic aspects of cataract surgery (remove the cataract; replace the removed natural lens with an artificial implant) would continue to be paid by health insurance (including, most importantly, Medicare), a patient now had the option of paying to add an additional service such as the treatment of astigmatism or presbyopia (the ability see up close as well as at distance) without the need to wear glasses.

Mr. Corley and Eyeonics did the grunt work of convincing the bureaucrats in what is now CMS that this was OK, and this  success launched some of the most vibrant technological advances anywhere in medicine. We now have no fewer than 6 “premium” lens implants, with at least another 6 in development. This is really exciting stuff and it is the direct result of the lobbying work done to create this new business model: extra charges for services that are beyond the basic, standard services necessary to accomplish the treatment of a medical necessity, in this case the removal of a cataract.

So what’s the problem? In a nutshell, the industry that has given us the FSLC is conflating this advancement in the fulfillment of the basic aspects of  cataract surgery (FSLC) with the provision of additional services that are not medically necessary (treatment of presbyopia). Indeed, such luminaries in my world as Eric Donnenfeld, Dan Durrie, and Steve Slade are on record as saying that FSLC is already safer than traditional Phaco, and that it already produces superior outcomes in ALL circumstances, specifically including the implantation of a standard lens implant. How then is this a “premium” service? Why is FSLC not being sold as the next development in the long line of successful improvements in cataract surgery for the masses? For Heaven’s sake, if FSLC is truly safer than what industry and industry consultants have taken to calling “manual cataract surgery” (despite the inconvenient fact that FSLC still involves some pretty tricky manual steps), how can one justify calling this a “premium, non-covered procedure” for which a patient must pay more? Seriously, pay more for safety? Pay more for better outcomes?

THAT my friends is the problem. In order to get what may turn out to be the safest surgery, for the first time in history patients must now pony up. Think about how this would play in, oh, heart surgery. “Well Mrs. Jones, your heart surgery can be done with the older technique and covered by your insurance, but for $2000 extra we can do the better, safer laser version for YOUR heart.” Nice, huh?

Our ophthalmic device manufacturers, including interestingly the same Andy Corley I previously lauded, have taken the easy route. Rather than “man up” and go before Medicare and the other insurers to justify a request for insurance coverage of the additional cost of what the podium speakers are calling a safer, better procedure, they have instead opted for the cynical, cowardly route of mis-applying the “Corley Rule” and having the patient pay. Worse than that, there is a very clear message coming from the podium (though not necessarily Donnenfeld, et al.)  and various editorials that those of us who have achieved stellar visual outcomes with spotless safety records are somehow now failing to provide our patients with the new “standard” if we opt to wait at this stage of development. Really. That’s what they are saying. Indeed, even some who are old enough to have been the targets of this kind of behavior in the 70’s and 80’s  say that out loud.

Listen, I get the excitement about a new technology that will probably win out as both better and safer. Heck, new often wins just because it’s new, or because people THINK it’s better and safer even if it’s not (read: Femtosecond laser LASIK  flaps vs. modern mechanical keratomes). I’m good with that. At 53 years of age I will almost surely perform FSLC for a significant part of the rest of my career once I begin. But don’t try to tell me that this is anything other than the latest step in a progression of procedures that began with “couching” in ancient Egypt. Don’t expect me to feel OK with the cynical decisions that everyone in the pipeline have made in order to avoid having the battle on insurance coverage for something they are already calling a “standard”. You simply can’t have it both ways. You can’t say that this is a safer surgery with better outcomes and then say that the regular Joe or Jane should reach into their pocket and pay EXTRA for the next better version of regular surgery that has always been covered by insurance, and then expect me to get in line and salute the “Jolly Roger” you’ve just hoisted.

The technology of the Femtosecond Laser Cataract Surgery is great. The cynical business model is not. Let’s not tarnish this wonderful new technology by repeating the bad behavior of the 70’s during the transition to Phaco by speaking ill of our colleagues who may not be as willing to jump on the bandwagon of a cowardly industry unwilling to do the right thing in support of of its own creation. It is our job as ophthalmic surgeons to demand that the device industry do the hard work to come up with a more appropriate business model if they want to sell their lasers.

As far as I’m concerned it is also our duty as colleagues to not forget the trauma we inflicted upon ourselves in the Phaco transition by smearing one group or another, however subtly or quietly that might be done. Both sides of this controversy must do whatever it takes not to repeat that tragic history as we move inexorably toward the universal adoption of the newest heir in the cataract surgery lineage. In general I’m a fan of our industry partners, but they created this issue by abdicating when it came time to support their invention.

It’s up to us to force them to own up to that and fix it.

Memory is a funny thing, isn’t it? My Dad has been sick; his short-term memory is now approximately 30 minutes, give or take. It’s exhausting to be the “reminder”, but worth the effort to quell the terror at the forgetting.

Did you watch any college football on Saturday? Ohio State vs. Michigan perhaps? The unprecedented ending of Alabama vs. Auburn? Memorable doesn’t quite seem to be adequate, but that’s surely what they were. Imagine for a moment you were there, on the field of play. Imagine the memories you’ll have.

Given my Saturday’s activity (glued to TV watching football) it’s not too surprising that I dreamed of football last night. It was a recurring dream, one that comes to me often, and one from which I always seem to awaken to start my day. My dream is like a classic NFL Films pastiche of all of my football FAILURES. That’s right, all of my lowlights in one continuously running loop, endlessly spooling until I finally, mercifully, wake up.

I never remember the good plays. From any sport at any time. Is it like this for you guys? Seriously, there is literally only one play from college I recall where it all turned out OK. Ah, but the misses? Those plays where I got burned, fumbled, missed the free throw, failed to get it up and down for the win? Those are burned into my brain as if by some cosmic branding iron. I wonder why that is…

Memory is a funny thing, isn’t it?

In my Inbox the other day I received a request to participate in a concussion study of Div. III football players. Some of my teammates received the request while others seemingly have not. This set us to the task of deciphering who did get the request and why. Opinions differ, swinging between GPA (those above a certain grade were solicited) and athletic prowess (those below a certain grade were solicited). All of which made for a spirited back and forth between men of a certain age who share…wait for it…memories.

Men over the age of 30 are well-known to have difficulty making new friends, at least friends as significant as those they made in their youth. I get this, especially when I realize that I really DO have good memories from my days as whatever version of athlete I might have been. They just don’t happen to be from the field of play, but rather from the locker room and the bus. Pre- and post-game meetings and gatherings. Watching the “big boys” play on Saturdays with teammates after our all too short season had ended. Gathering to parse the mysteries of the concussion study, so much like being back on a stool contemplating a new day’s fresh undergear, musing on the next generation telling their own stories of bonding and wondering if they will have what we had. What we have.

Indeed, I remember very little of yesterday’s CrossFit WOD. Little other than what the aches in my body tell me I must have done. Like in my days as a team sport athlete I do not remember a particular rep or the weight I used or my score. No, just like always and ever before what I remember from yesterday is what I remember from last week and last year and all the way back to 2006: I remember who I was with. I remember that being with them felt like winning.

I hope that they, as I do with teammates of yore, will remember it the same.