Random Thoughts from a Restless Mind

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 gone by 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. 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 that 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 discarded. We accentuate our differences rather than our commonalities, no matter how far on either end of the curve those differences may lie. 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.

As far as I can see, the only perfect role model continues to set an unachievable goal, however noble might be our effort. Sadly, He has been dead for some 2000 years now.

In the never-ending battle for supremacy on the countertop, my wife Beth and I are ever engaged in a tug-of-war over clutter. Though we were until very recently unaware that this is a THING. Like, with a guru thing, one that people engage in quasi-worship and for which they pay real money. Some “Kon Marie” or something like that. Totally news to us. You?

The anti-clutter thing, such as it is, is dramatically more than the comical little game that Beth and I have going on. Adherents think there is a true spiritual goal, an attainable endpoint that must be reached and then maintained. And not just on the kitchen counter mind you. No, no…on every counter, real or virtual, in every “room” of your life. Now, don’t get me wrong, there is certainly a place for a bit of order in a life, and we could all stand to be a little lighter when it comes to our stuff, but the fervor and the zeal with which adherents of this THING take it is spooky. Weird bordering on abnormal. It reminds me of the kitchen drawer in the house owned by Ben Affleck’s character in The Accountant: one fork, one spoon, one knife.

There’s only one person living there, after all.

Like everything else we can find merit on both sides of the clutter coin. For example, my workouts in the Casa Blanco garage gym have been of much higher quality since a little construction project was completed and the Men With No Last Names cleared out along with all of their stuff. My cleans have been much better now that they are performed in a clean garage. The pleasure that Beth gets from seeing a clean kitchen counter would be comical if it wasn’t so genuine, and frankly my pleasure at seeing her so happy is pretty significant, too. (Note to self: Beth will be home in 2 hours; get cracking at clean up).

There’s a flip side, though. Apparently there is research that validates my little slice of the countertop: people are more creative if they are surrounded by a bit of clutter. As I muse my computer peeks out from a pile of old newspaper clippings, magazines and books, and various chochkies from our life as it is today. Oh, and there would also be the Man Cub’s toys. They are apparently to Kon Marie what kryptonite is to Superman. Though we now live in a tiny cottage, a life that has us in a constant state of “purging” our things, what remains is not so much clutter as it is a measure of our lives and our loves. A clean surface around my keyboard leads to a blank screen. One woman’s clutter is another man’s muse.

I guess this is really just one more essay on the concept of “enough”. The monastic pursuit of any unreachable, unachievable outcome is one that must be accompanied by some degree of unhappiness in my opinion. What joy is there in the perfectly uncluttered closet complete with one pair of perfectly ironed and folded socks if all your eye sees is the possibility of going to work barefoot?

It all makes me think of an essay I read last month about clutter. Have you ever noticed, as did the author, that the arch villain in every movie you’ve ever seen lives in a perfectly ordered home, devoid of any clutter whatsoever? The hero, on the other hand, can hardly find her feet, let alone her socks, as she wades through the clutter of her tiny little hovel. That villain has a plan, meticulously laid out and ready to be put in play with single-minded zeal. Funny thing, though: the hero always seems to make her breakthrough with creativity, flexibility, and something she finds among the clutter, right where she knew it had to be. Every single time.

Now that I think about it, we do have pretty impressive swaths of countertop that are as devoid of clutter as the desert in Lawrence of Arabia. No villains around here, though. I have my tiny little corner of the kitchen table, and as long as you don’t move my “cheese” I know where pretty much everything is. That doesn’t make me the hero, though.

Can we talk about my wife’s closet?

This week I spent some time talking to a couple of folks who, unbeknownst to them, were talking about each other. Well, talking to them is not really accurate–they were having a discussion and I was having a listen. Both were talking about the effects of a particular happening on a particular person they both knew, effects that both could surely see if only they cared to remove their blinders and look.

They told wildly different stories. Their belief sets were so unshakable, so impervious to penetration by petty inconveniences like facts and reality, it was as if they wore not lenses to clarify but masks to obscure. The blind running from the blind, if you will. I’m fascinated when I see this; I see this almost every day when I am plying my trade as an eye surgeon. So much of what is “known” about medicine isn’t really known at all but “felt”. I constantly run up against an unshakable belief that is often expressed in a statement that begins “well, I think…” Indeed, I heard this from both folks telling me what was transpiring.

I’m fascinated and exasperated in equal parts by this because of how completely this unshakable belief nullifies the otherwise logical power of observable, measurable fact. If I step back and think a little more deeply about this phenomenon I am also terrified that I, too, may harbor similarly unshakable beliefs that blind me to the truths of a fact-based reality. This weekend brought me to a gathering of true experts in a particular field of my day job, one I was quite flattered to attend. There were a couple of points that I’m just convinced my colleagues got wrong, points of view it looks like I shared only with myself. Am I right? Is my insight so keen, my ability to analyze the data presented so much better, that I am just a full step ahead? Or is it rather that I am clinging to a point of view supported only by the virtual facts created by personal beliefs I am unable or unwilling to walk away from?

This simple awareness and acknowledgement–that I may suffer from “belief” bias–might be enough to inoculate me.  I certainly owe my patients (and my readers) an effort to investigate that.

“Life’s not fair.” –Scar

What does equality mean? What does it mean to be equal? This came up this week in my day job. A study was done that proports to show that male and female eye doctors are paid unequally. The conclusions are false at the outset in this particular case because by law, services in this particular arena are paid exactly the same no matter who performs them, when or where. Unfortunately, the sensational lede taps into all kinds of notions of fairness, and all kinds of perceptions about what people assume must be true, that women make less than men for equal work. There is no question that this is the case is some walks of life, but interestingly the data (some of which the authors ignore in their quest to prove their preconception) proves otherwise in medicine. An opportunity to examine real differences in how men and women practice medicine is thus lost in the pursuit of an examination of the spiritual quest to combat inequality, even where none exists.

Is this the unicorn of equality? Is payment under government programs the only place where equality actually exists? Heck if I know. What interests me is the fact that the first assumption is that inequality is present. Inequality is the default setting. That there is an inherent degree of unfairness in pretty much any and every setting. Know what I think? Equality doesn’t exist. It cannot exist if we are to have an ever-improving world. There is nothing unfair about that in the least.

A just civilization establishes a floor below which allowing people to live is ethically wrong. For example, in healthcare it is my contention that we have a moral obligation to see that every citizen has access to care when they are sick. Inherent in this contention is that there is a basic level of care that meets this moral obligation by ensuring the same outcome as any other level of care. One could apply this same concept to food, clothing, and housing without missing a beat. We can think of the rights enshrined in the U.S. Declaration of Independence as a proxy for this baseline if you’d like. Life, liberty, and the pursuit of happiness make a very fine baseline.

One’s right to “life” necessarily includes a right to be fed, would you agree? Equality would mean that if one among us dines on Beef Wellington, than each among us must do so as well. This is where unthinking and unquestioning fidelity to “equality” brings you. In so doing it forces everyone to expend energy protesting “inequality” better put toward fulfilling the moral obligation to see that no one goes without protein. In healthcare we see all kinds of protests againts the inequality of care demonstrated by the horror of a VIP of some sort or another recuperating from a procedure in a luxury suite, while the proletariat must recover in the equivalent of a Hotel 6. The reality is that the outcomes will be equal; the moral obligation has been fulfilled. Above a basic level in pretty much any domain you wish to examine, equality does not exist. Sorry. Scar is right. Life’s not fair.

Is he really though? Saying that it’s not fair is the same as saying that inequality above that level at which everyone has a right to live is wrong. Here is where I part company with those who hew to this viewpoint. What does it matter that someone drives a Cadillac while another drives a Kia? Do both not get you to work on time? Or that Beef Wellington again: do you not get the same amount of protein from a hamburger? The example I am using in another conversation about equality in healthcare is similar: if a medicine is effective taken 4 times a day, is the fact that someone can pay more for a version that must only be taken once a day a measurement of unfair inequality? I vote “no”.

My strong feeling is that energy spent in some way protesting “equality” is energy that is not expended on the much more important task of fulfilling the moral obligation of raising everyone to that acceptable basic level. In may, in fact, work against that effort. That constitutes unfairness in my opinion. Advocacy and protest should be directed there, toward making sure that everyone has that most basic obligation covered. Once universal entry is accomplished across all applicable domains, the next task is to continually raise that basic level for everyone, no matter how far the gulf may be between that level and whatever the “sky’s the limit” level might be. One need only look at “poverty” or “hunger” and how the bar has moved ever upward there to see how this might work.

We have a moral obligation to see that true rights are available to all. It is unfair to those who have not yet achieved that most basic level when efforts to help them are diverted to the pursuit of an unachievable conceptual goal that neither feeds nor clothes nor cures those in need: equality.

On Twitter a rather erudite retired surgeon posted the obituary of a 72 yo physician who died from cancer. She’d been sick and dying, knowing that she would die from her cancer, for some 2 years. Her obituary, obviously written herself, was funny and self-deprecating, an obvious attempt to soothe the sorrow of those she left behind. A women’s basketball player from Northwestern was killed by suicide last week. Who will write her obituary, and what will it say? One of my local colleagues died very suddenly and unexpectedly on Friday at the age of 50, roughly 24 hours after being diagnosed with cancer. Who will write his obituary, and what will it say?

2016 was notable for the number of rather famous people who died. This particular sector of humanity is famous enough that many media outlets pre-prepare obituaries so that they will have material ready to publish shortly after there announcement that the famous individual is deceased. It is unusual that someone not so famous, even someone of a degree of local fame, should have an obituary ready to go. More unusual, to be sure, for that obituary to be as light-hearted a read as that Minnesota MD. No, for the majority of humanity, at least here in the U.S., an obituary is a rather slap dash on-the-fly “just the facts, M’am” effort by whoever is at the desk at the local funeral home.

I know this, of course, because my Mom sent us the draft of my Dad’s obituary before she gave the OK to publish. Now, my Dad was a very good man, hardly great in the sense of, say, FDR or Red Auerbach, but he certainly deserved more than a rote regurgitation of his stats written in 6th grade English. Since I spend more time exercising my writing muscles than my siblings, or maybe just because I can type faster, the job fell to me to capsulize a man who was larger than life to his family, just like I’m sure is the case with my just deceased colleague and that Northwestern basketball player.

The grains of sand that pass through the funnel of life’s hourglass are only dry if observed from afar; up close each one is as colorful as any rainbow, as full of energy as any thunder storm. Poetry is there for the asking.

For most of us there is still a long journey ahead. The bulb atop our hourglass still holds innumerable grains of sand, a countless number of memories yet to create. We have years, nay decades of love yet to give and receive. Life is actually quite long for all but the unfortunate, unlucky few. Their lesson for us is simple, I think: Who will write your obituary? What will it say if it needed writing today?

Some time ago I wrote about creating a way to measure health. Real health. Health that encompasses every aspect of what it means to be alive and well. As a CrossFitter I definitely included Coach Glassman’s Disease -> Health -> Wellness continuum, and I also acknowledged the critical importance of his concept of “Fitness over Time”. As a classically trained physician/scientist there is clearly a place for more traditional metrics like blood pressure, serum lipids and the like, although they may, indeed, be an variable that is ultimately tied to fitness.

Where my thoughts on defining and measuring health seem to depart from most current trends is in the recognition that mental health–emotional wellbeing—is as much a part of being healthy as any other thing we might examine.

Think about it for just a moment. Most of what we would classify as mental illness has as many outward signs that we can see as diabetes and hypertension. Which is to say, none. Yet we—all of us, not just CrossFitters—see nothing but the good in treating diseases like diabetes openly and aggressively. There is no stigma attached to seeking care for your hypertension or your elevated LDL. To the contrary, if someone who loves you discovers you quit measuring your glucose before you bolus your insulin, they are for sure gonna get in your grill.

For whatever reason, mental illnesses, including addiction, are looked at quite differently. No one is asking the person with chronic depression whether she is taking her life-saving medication, for example. We might notice an insulin pump on a friend or family member, but then it’s quickly forgotten. Everyone seems to be very uncomfortable around the young man who has very obvious hand tremors from the life-saving medication he takes for his Bipolar disease. We all seem to be so much more understanding when we have to wait for a response from someone suffering from Parkinson’s Disease than from the young women who has the same symptoms as a side-effect from the medicine that quiets the dangerous thoughts in her head from Schizophrenia.

It’s not even necessary to look only at these kinds of severe mental illnesses when we are examining the importance of mental or emotional wellbeing as an integral part of being healthy. What good does it do to have a 5:00 mile, a 500 lb. deadlift, and a 1:59 “Fran” if it was self-loathing that drove you in the gym to get there? You may be quite accomplished, the envy of your peers, at the peak of whatever life mountain you wished to climb, and yet you cannot feel joy. How is it possible to be healthy without joy? I look at Usain Bolt and what I see is quite possibly the healthiest man alive. My friend Tim, the writer, tells me that Justin Gatlin has nearly everything that Bolt has—youth, fitness, wealth—but the combination of failure to knock off Bolt, and the public disapproval reigned on him as boos from the Rio stands has left him emotionally broken. It’s subtle, but if you look at his face in the blocks of the 100M Final it’s there.

Our complex and conflicted attitudes and feelings about mental illness are especially evident when the topic of suicide comes up. Just typing the word makes me uncomfortable. Even how we describe suicide is fraught with hidden meaning that reflects our discomfort: someone has “committed suicide”. Right? Someone committed an act that we simply cannot fathom, one that leaves the survivors completely without any understanding whatsoever. How could someone DO that? It’s as if every suicide is the same as the suicide of the crooked prison warden in The Shawshank Redemption when he looks out the window and sees his fate arrive in the front seat of a State Trooper’s car.

In reality most of the time it’s simply not like that at all. Nothing about it is simple at all.

The outer walls at the periphery of my world have been breeched by suicide twice in the last couple of months. One of them actually does feel a bit like that prison warden. Frankly, I am too conflicted, too aware of the external circumstances and not enough aware of the internal life of the deceased to offer much right now. The other one, however, just stopped me in my tracks when I heard. The loss was profound.It has also introduced to me a new vocabulary that I truly believe provides a starting line from which we can change how we think about not only suicide, but all of mental illness. A friendly acquaintance lost his wife when she was killed by suicide.

We don’t need to know all of the details of the story. Suffice it to say that in the face of a child’s illness she suffered quietly. Too quietly to be noticed. Perhaps she didn’t realize how badly she was suffering, or maybe she was like so many of us and couldn’t bring herself to see her illness for the life-threatening entity that it was. No one will ever know. What is clear, though, is that this was not anything about commitment. Kidney failure may be cause of death in a diabetic, but it is diabetes that kills him. There is no difference here. The cause of death was suicide. Her disease, her depression is what killed this young woman.

Each of us has a very few moments in our lifetimes that forever change us. On the second Tuesday of July in 2006, unbeknownst to me, one of those moments was transpiring in a lonely, dark corner. Joyfully, the moment was a beginning, not an ending. Regardless, once learning of the moment I was changed forever. Now I knew. You cannot see any marks from mental illness, no swollen appendage or insulin pump. But it is there all the same, and it must be acknowledged and accorded the same degree of care as any other disease that may take our loved ones from us. Mental illnesses are real, and they can be deadly. There ought not be any conflict or discomfort in treating them.

We may stop losing so many of our loved ones when start to see emotional wellbeing as part of being healthy.

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

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

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

Average does not necessarily mean mediocre.

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

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

My classmates and teammates at Williams, and my fellow CrossFitters.

Sunday musings…

Musing, whether today on my 56^th New Years Day or on any other random Sunday, is an entirely different proposition when done in the presence of my 15 month old Man Cub. He takes up an awful lot of space for such a tiny little creature. I’ll give it my best…

This is not going to be just another whatever about making or keeping resolutions just because it happens to be the first day in a new year according to the Western calendar. Hit up that intellectual workout if you please, for sure, but that’s not where my head’s at right at the moment. Nope, not detailed micro-resolutions like “exercise X times each week” or even more global ones along the lines of “get healthier”. At least for me, today is the day I tie the ruminations of prior days, weeks, months and years together into something which feels something like a common thread to which I can cling as I pull myself through the second half or so of this life.

Like so many of the stuff that leaks out of my inner hard drive onto my keyboards and into my life, this slow-cooked epiphany was prompted by a tiny little random thought I stumbled upon in something I was reading. “We spend most of our lives in a reactive trance, not really thinking about why we do what we do.” –Tara Brach. That, my friends, stopped me right in my tracks. How much of my life am I living on auto-pilot? How much of what I do each day is the equivalent of handing over my day to an internal self-driving program that, at best, reacts to not only what has just happened but what is by history likely to happen next?

It is time for me to remember that a purposeful life must be one that is lived proactively, and that in order to be proactive it is necessary for one to have a purpose.

No one can be expected to live every moment of a life in a fully proactive mode, at least not without risking certain insanity. No, what I think I’m feeling is a lack of thoughtful purposefulness in most of my life at the moment. It’s more than goal setting, more than having come through the serial apply-matriculate-graduate kind of purpose of a younger life. It’s not a case of just “going through the motions” of existence either. What I think this New Year’s Day reflection is really about is a need to articulate a 30,000 ft. purpose for at least a portion of my life, and in so doing to give me something about which I can be proactive for a portion of each day.

As I made the “hard turn at mile marker 49” my friend Hari suggested that the second half of a life is spent in living the life that the previous 50 years you’d spent preparing everyone else for. Apparently I am a bit of a slower learner than some as it’s taken me an extra 7 years of so to be ready, but I at least appear to be ready to examine the concept of the purpose of what might be the next 50. For some this is undoubtedly an internal pursuit, but what little self-awareness I have leads me to believe that mine will be a more social, collaborative pursuit.

Should I have gotten here sooner? Is this a call to you if you are younger than I to start now, rather than later? Nah. We get here when we arrive, and not a moment sooner. In all likelihood my purpose will slam me upside the head when I’m looking in another direction. Is that the ultimate in being reactive? Or might the simple fact that I am open to the blow enough to call it a proactive part of the process?

We’ll see, I guess. We’ll figure it out, both you and I. For just this moment though I’m afraid that I have to step away from the keyboard, for out of the corner of my eye I can see the Man Cub headed toward the stairs. Will my dash to snag him before the top step be reactive or proactive?

Sometimes a purposeful life is actually lived in 10,000 3-foot moments.

I’ll see you next week…

–bingo

A pop psychology author, classmate of my parents, once examined life’s stages in a book titled Passages. While I am no fan of her work (somewhat shallow and bereft of any real insight), her choice of a term for major phases of our lives is pretty good. “Passages”. Kind of evokes a journey of sorts. That part of her writing was pretty good.

Our family  will gather this weekend and this has me thinking a bit about those passages. All of our children will spend part of the Holidays with their in-laws; our boys will spend a bit of time with us. Young people truly become a kind of real adult when they take on the responsibility of nurturing a third entity, their marriage. Beth and I used to joke that we would feel like we were “real” adults when we owned our own washer and dryer, but really, we’d gone and grown up as soon as we consciously put our marriage ahead of either of our individual selves. This realization is all we really ask of our young marrieds in these, their middle passages.

This year many of our Christmas tables will have empty seats, or seats that will empty earlier than usual. That final passage demands as much attention as the first one, childhood; it just doesn’t really end as well. Still, it’s also a miracle that we go so very long before that last passage begins, both for us and for those we love. I am struck this week with a single thought: slow down and stay. Stay tiny. Stay young. Stay vibrant. Stay here and now.

Just stay.

In the end all of these passages are a one-way trip. You never back up. You don’t stand still. There’s really no such thing as a Mulligan or a do-over. It’s amazing how much help we need as we start our journey and then again as our journey comes to an end. In the middle, well, we have control. Dwelling in either the past or the future diminishes our present. Doesn’t it make sense to look at each day as its own kind of little miracle? Perhaps aware of what came before (a baby) and conscious of what lies ahead (an empty chair), all the while rejoicing in the miracle of right now.

Safe travels to all on their Holiday Passage.

We are not promised tomorrow.

If tomorrow comes we are not promised a “good” tomorrow. If we lead a virtuous life, whatever that may mean for each of us, we hope that our efforts will translate into a “good” or at least “better” tomorrow. Or not. All we have in hand is today. And every today has something, some thing little or big, that makes it a good day. Each of our privations, every challenge can be borne if we realize that there is some one thing, or if we’re lucky some several things, that are good in each day.

We can hope for tomorrow, and that tomorrow might be as good or better than today. But what we HAVE is today. In the end, that’s all we ever get. There was a time when I awoke each day and checked to make sure that I was still the father of a daughter. That’s all I needed. EVERY day was a good day. Like today.

There’s nothing particularly special about this today, about Tuesday December 20, 2016, except that this is the one you got when you woke up. What’s good for you today? Who’s special to you today? Did you tell them? Do they know? You may not have a tomorrow, but if you are reading Random Thoughts you do have a today, right here and right now. There are only two kinds of “todays”, good ones and great ones.

You got one. Don’t waste it on tomorrow.