Random Thoughts from a Restless Mind

Dr. Darrell White's Personal Blog

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

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

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

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

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

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

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

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

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

Happy Mother’s Day Jim.

The Last Time

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

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

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

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

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

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

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

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

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

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

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

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

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

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

15 Years of Navel-Gazing

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

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

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

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

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

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

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

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

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

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

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

Don’t be a stranger.

Sunday musings…4/7/2024

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

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

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

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

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

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


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

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

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

Images that appear forever in the rearview mirror.

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

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

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

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

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

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

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

And that once they are something really good happens.

I’ll see you next week…

Easter Sunday musings…

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

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

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

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

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

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

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

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

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

And He has been dead for some 2000 years now.

Happy Easter. I’ll see you next week…

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

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

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

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

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

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

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

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

We are, all four of us, happy.

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

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

A Coda For Life Revisited: Sunday musings…3/102024

1 Thirsty. To want something very badly.

“He was thirsty for revenge.”

2 Sweaty. HT Brooks Barnes, Sunday NYT “Shop Talk”.

To be desperate for something. To want something so badly that the wanting becomes anxiety. A term from gaming culture which describes players who compete with a level of intensity that is so beyond the pale that their gaming controllers become covered in sweat. Trying too hard. The opposite of cool.

Not Sprezzatura.

3 Review. While lazing around at home, miserable weather, all chores completed. Beth: “Do you want to watch a movie?” And so we came to watch “Mr. Holmes”, a movie from 2015 now playing on Prime and the topic of this week’s report/review. Sherlock Holmes has retired. His memory is failing him, and he can’t bear to be even a little a lesser version on who he once was. He has retired to his bees in what appears to be a country estate in Dover. Assisted by a housekeeper and her 12ish year old son Roger, he obsesses over a quest to stall the loss of his still considerable. His search has brought him through Royal Jelly to an obscure Japanese plant called Prickly Ash.

Mr. Holmes is tortured by his final case. He cannot remember its final disposition, only that the version of the case written and published by his trusty companion John Watson is inaccurate. Encouraged by Roger who is eagerly reading each installment so painstakingly retrieved from Holmes’ memory, he creeps toward the true story. His final triumph not so much the outcome but the realization that his efforts to find a magic elixir that will restore his memories is but a dream destined to be unfulfilled (more in a moment). Still, we the audience see so much more as we watch his tortured efforts. I’ll not spoil your pleasure by revealing any more, but will only say that “Mr. Holmes” is worthy or your time.

And your tears.

4 Brain Health Part 3. My friend, the person to whom I have been writing this latest series on battling the scourges of aging, lost their mother last week. She succumbed to the most common variety of dementia, Alzheimer’s Disease. Like so many before, her family had long been mourning the loss of their matriarch. Emptied of her essence, her physical being was an increasingly empty vessel that once held within that which made her so special. Despite the months and years of “pre-mourning”, like so many of us my friend was nonetheless knocked off their feet by the loss.

And so I bring to them, and to you, Part 3 of my little series on brain health and the effort to bomb-proof yourself against dementia of all types. I should mention if I haven’t already that genetic tests exist to add a degree of quantification to one’s quest to stave off this terrible loss. For me knowing or not knowing will not really change my approach or my effort; knowing that my risk is X% higher would, for me, simply create a cloud over every hour I lived, putting at risk my ability to find the joy inherent in the fact that I was still alive and still me. You may feel otherwise, and will have to choose accordingly.

Thus far we have covered nutrition and sleep. Next up is exercise. Physical fitness. Conceptually this is actually probably the easiest of the four areas we will eventually cover. Get your buttocks off the bench and get in the game. Like to run? Run. Does lifting heavy stuff off the ground move you? Feel free to grunt all you want and drop your bumper plates with abandon. Pretty much everything in between probably works, too. Seriously, when it comes to brain health the data just doesn’t convince me that any one particular type of exercise is the magic prescription that will inoculate you against dementia. VO2 Max vs. Max Deadlift? Nobody knows if one is better than the other, but you and I both know that in one way or another you will be better off overall if you do some of both.

My CrossFit buddies of yore will argue in favor of CVFMHI, and the editors of Outside Magazine et al will argue for Triathalons and Ultras, with a tiny chorus of folks off to the side sitting on their stones and their loaded barbells and shaking their heads at all of the low BFI folks crowding the room. I think what you do is a distant second to that you do, indeed, do it. Make exercise the third leg of your lifestyle intervention stool. Everything I’ve read and seen and done tells me that exercise is powerful preventative medicine to ward off dementia.

Just as everything I’ve read and see and done confirms for me, as it did for Holmes, that no magic potion or pill exists that will do it for us.

5 Coda. I came across a bit of correspondence between a friend I’ve known for 35 years in which we remembered advice I offered almost all of those years ago. It got me to thinking and reminiscing about the 3 core guiding principles that helped me (and in many ways him) make it through our training and early professional careers. All 3 have stood the test of time, have continued to inform my best decisions both professional and personal, and over the 35 years now since I first said them out loud I’ve only needed to add one additional guideline.

“Knowledge is power.” One is at such a profound disadvantage if there is asymmetry in the amount of information they possess relative to those with whom they interact that at a certain point they cease to be independent entities. Without knowledge, awareness of the ground as Sun Tzu would say, you are at the mercy of another and must depend upon their kindness for, well, almost everything.

“Perception is more important than reality.” The explanation of this, of course, is that perception is the reality of perceiver. While you could say that this is simply an extension of the first guideline–creating the perception is in some way controlling the knowledge–I would simply say that one need only look at the deeply held worldview of some of the U.S. voting public, their perception of what is real and what is important, to illustrate that perception comes from within. Understanding this should inform your approach to any situation whatsoever. What does this individual perceive at this moment? That becomes the reality with which you will deal, your version notwithstanding.

“Evolution is better than revolution.” I first made this statement in a public forum on CrossFit.com, the home of a truly disruptive revolution in fitness. Here is where my conversation with my friend was so helpful, for he was (and still is) a man in a hurry to effect change for the better: evolution involves a conscious attempt to minimize unnecessary collateral damage. Sometimes that damage is directed at oneself, and thinking more along the lines of the “long game” is also sometimes a very reasonable approach to self-preservation. The fire of revolution burns brighter the nearer it gets to the revolutionary. My friend, nearly exactly my age, continues to seeks change in the cool contemplative glow somewhat removed from the fire, conscious always of the need to care for, and be careful for, the growing flock that has surrounded him as he grew older.

These 3 guidelines have served me well, lo these 35 years or so. They may or may not work for you; they may be nothing more than tinder to light the fire of your own guiding principles, or even less, simply the empty musings of an older man much too impressed with his own ideas. I have shared the epiphanies of 9/11 and Heinlein that underly the tactical application of these 3 strategies, and perhaps it is time for me to spend a moment or two reexamining them, as they may or may not apply today. But I believe that there remains plenty to think about in these simple suggestions. “Knowledge is power.” “Perception is more important than reality.” “Evolution is better than revolution.”

They have been a formidable foundation for the coda that guides me, still.

I’ll see you next week…

Sprezzatura: Sunday musings…3/3/2024

This is just perfect. It’s as if the titans of journalism, the wizards behind the curtain at the Wall Street Journal and the New York times, looked into the ether, found the thread that contained my musings, and ordered me up a fully formed essay. Gift wrapped and delivered to my doorstep yesterday and today. My newspapers were even delivered on time, not a particularly frequent event. After reading yesterday’s WSJ Off Duty section on men who became icons of style without any sense that they cared one way or the other about style, my Sunday NYT arrived with a Men’s Fashion of the Times magazine laden with images of men bent double in the effort.

Seriously. Batting practice fastball. They even pre-installed the vocabulary.

The greats, the true icons of yore and near-yore fairly ooze style without seeming to make any effort whatsoever. Italians have a word for that: sprezzatura. It means the art of dressing in a nonchalant, tradition-flouting way (wording from WSJ). I like the use of flout, too. To openly disregard convention. Think James Dean and Steve McQueen. James Baldwin. Younger, more current examples per WSJ might be Brad Pitt or Keanu Reeves. I buy ’em all. Each of these men look like they’ve long ago run out of f^ck$ to give when they go in the closet to pull out the day’s look.

Which of course brings up the obvious question since nonchalant is the sine qua non of sprezzatura: is “chalant” a word and is it the opposite of nonchalant? I’m a words guy as you know and this is just fascinating. It turns out that the answer is no, chalant is not a word. Nonchalant is what is known as an unpaired word, one that sounds as if it should have an opposite, an antonym, but in fact does not (HT Quora). Our English word comes to us via the French “non” (not) “chaloir” (caring). Hence “nonchalant” is “not caring”.

Like I said, one f^ck short…

To be schooled in the polar opposite one could do worse than picking up today’s Men’s Fashion of the Times. Seriously, it is just littered with “too hard”, pretentious nonsense like transparent pants. And I’m not talking just the right wrong light transparent like the debacle that is the new MLB uniforms, I mean like cellophane trousers transparent. Where the sprezzatura stars might embellish their worn-in chinos with a thin chain worn over their tee shirt or a vintage wristwatch (think Paul Newman), the models in the articles and the celebrities in the ads are adorned with enough hardware to make Mr. T. blush. Michael Stipe wearing a bracelet that my Gama, she of the elegant jade bracelets, would find impossibly garish. A model wearing a string of white flowers in place of a tie to accompany a white suit coat and matching shorts.

And the logos. Oh my heavens, the logos! Again, in the WSJ a few folks on the street were interviewed and one of them just nailed the whole logo thing. JF, a 61 year old guy who offered that at his age “big logos just look kind of foolish”. Like me he prefers tiny logos, or even better, no logos at all. When I traveled to Ireland to embarrass myself on the golf course I discovered that I no longer owned any long-sleeve golf shirts. To my delight I was able to find a purveyor of men’s clothes that makes super high quality polos without feeling the need to let everyone know about it. They were perfect, looking like they were made by “somebody”, an implied logo (HT: JF). What a great phrase, “implied logo”.

The chaloir in the NYT? Goodness, they are literally buried in logos. I’m a huge fan of LeBron James. Not just the athlete but the man in full. But really? All those “LV’s” on whatever you call that outfit? If you looked quickly he just blended in with the luggage. Yup, all those logos and you had to look twice to see that they were worn by one of the most famous men in the world.

Now, you could reasonably say that I, a middle-aged White male, have no business looking at a fashion magazine filled with images of naked male models cavorting in nothing but a pea coat, and I would find your position reasonable. You could also say that I am hopelessly out of fashion, or that I have no understanding of modern fashion or the fashion mores of the young or the hip or the wealthy. Again, I would agree that you are on solid ground. I mean, come on, my professional sartorial calling card is a bow tie. Not exactly the strongest foundation from which to lob opinions in the direction of the “chaloir”, I’ll admit.

On the cover of today’s weekly NYT magazine is a picture of a model wearing the denim version of MC Hammer’s parachute pants and a statement that these pants says something about “us”. As you can imagine, this part of “us” won’t be trying that hard. And yet, I find myself somehow validated. Seen, you could even say. I grew up wearing tan pants made by Dickies and thought they were chinos. After an adult lifetime of searching for my next version of the perfect khakis, of wearing logo-free, sun-bleached monochrome polos until they are threadbare to the point of almost qualifying for a pic on a model in the NYT. Of disappearing from my professional self as easily as Harry Potter and his cloak, simply by removing my bow tie. I have found what for me stands for fashion, however aspirational it may be to become nonchalant to the point of truly not caring.

Perhaps, if I can somehow try very hard not to try at all, I, too, might be sprezzatura.

I’ll see you next week…

Bedside Manner: Sunday musings…2/25/2024

1 Flow. Sort of the opposite of “block”. You know, like the writer’s block I thought I had until I sat down and looked over some notes I’d jotted down and the words started to flow so fast I can’t get a handle of which ones go where.

Is this what it’s like to be Steven King sitting at his keyboard?

2 Euderimonia. From Aristotle. A deep sense of well-being in which one feels that a life has meaning and purpose.

Think pre-EMR, pre-Meaningful Use, pre-Affordable Health Care Act private practice physician.

3 Brand. Why do vaccines have brand names? Wasn’t there just, like, one vaccine at a time back when we dinosaurs were the first wave of kids to get MMR, Polio, DPT and the like? Were there brands that were marketed to your friendly neighborhood pediatrician back then?

Sorry. Just seems super weird.

4 Book Report. My daughter in law Tes (TEZ) has this huge book club. Like a couple of hundred women reading books together huge. I should pay closer attention sometimes; she might be the admin member of her group, which would be a pretty big deal (I’ll ask when she arrives tonight to tipple with her hubby and her in-laws). Anyway, I’d started to read rather than have my books fed to me primarily via Netflix et al, and people ask about what I’ve read. So here’s another report: “A Monk Swimming” -Malachi McCourt.

Those of you who know me know that I spend an awful lot of time with “brain candy” like The Grey Man and the Jack Carr “Terminal List” series, alternating with Sci-fi that skews hard toward quantum physics and the multiverse. But every now and again I stumble across a book that latches onto my funny bone and just won’t let go. “A Monk Swimming” is one of those. Invariably I end up with one of these books while on a plane, usually while in the company of Beth, much to her chagrin. I am infamous for snorting when I laugh out loud, and this was one of those books that Beth literally made me put away while we were flying.

Malachi McCourt was the black sheep of the McCourt clan that also included Frank, author of “Angela’s Ashes”. Not a funny book. Malachi, on the other hand, made quite a life for himself by being the funniest guy in a room filled with all manner of people. He quite famously was one of the unnamed crew that aided and abetted the original Rat Pack (Sinatra, Martin, Davis Jr., Lewis, etc.). The guy’s stories are side-splitting funny, whether or not you are on a plane. He turned 91 last year and is probably pouring Manhattans at the retirement home this afternoon.

Do yourself a favor and pick up this gem. Be careful though. You want to drink your coffee or whatever while you are not actually reading. The book starts off hilariously with an explanation of the title (I snarfed on the plane) and just gets funnier from there.

5 Bedside. As in “Bedside Manner”, the antiquated term once used to describe a physician who had an easy way about themself while they communicated with their patients. It’s a term that’s been relegated to the historical junk heap, tarred by incriminations that it was little more than paternalistic and patronizing pulled off with panache. Of course, unlike days of yore during which so much of healing actually took place at the side of a sick bed, there’s not a whole lot of bed going on in modern healthcare.

I digress…

Bedside manner really means nothing more than openly showing that a physician cares about how a patient is feeling. Yes, sure, there was always that little bit of shade attached, an implication that the doc with a great bedside manner was actually hiding the fact that their medical acumen was rather thready, like describing your date as “a really good dancer”, but the reality is more likely that a “good” doctor with a “good bedside manner” was just like anyone else whose job made it necessary for them to be outwardly focused, focused on the patient/customer more than inwardly focused on what would ultimately lead to personal benefit.

In last week’s weekend edition of the WSJ there was a long piece on so-called “supercommunicators.” These individuals did something that I’ve translated as “active listening”: fully concentrating on what another is saying, and then validating that other’s thoughts/position/feeling by repeating the gist of what they said back to them. Even more so, after doing so they intuitively then ask if what they received was at least close to what the other person was sending. The front side of this is really nothing that your grandmother didn’t teach you when your were a kid: listen without interrupting when it’s not your turn to talk. It’s the second part of the equation, paraphrasing and confirmation, that elevate these folks to the “super” category.

Now this article was discussing communication in general, not focusing on the nuances of medical communication. Still, I kinda paid attention to my own habits in the exam room this last week when it was my time to “listen”. There’s a little caveat, of course, because a patient typically tells their story to a nurse or technician first, but paraphrasing the story obtained by another and seeking confirmation that your take is accurate is legit. Being a medical supercommunicator takes a bit more, though. There is an inherent information inequality due simply to the nature of the experience; no matter how much time you’ve spent with Dr. Google or messing around with ChatGPT or other AI’s, it is overwhelmingly more likely that I still know more about why you are in the office than you do.

The crux of having a good Bedside Manner is in how you take the next step in the conversation. How you demonstrate that you care about what your patient has told you. That you heard how much a problem is affecting them, and that you are committed to finding a solution. You, the doctor, may feel this deeply; your Bedside Manner is how you now project this. It is my contention that both House and Marcus Welby cared equally about the patients who presented themselves to be healed. Both were appreciated for their brilliance and the successes it wrought; only one was beloved.

I wish I had a newer, better term to describe a supercommunicator in healthcare. It’s my opinion that “Bedside Manner” has gotten a bad rap, honestly, but I get it. In the rest of the world’s non-medical communications there are some lessons to be learned from those docs who did/do have a “good Bedside Manner” for sure. Be an “active listener”, offering your communication partner the floor when it’s their turn to speak, paraphrasing and seeking confirmation so that they know that they’ve been heard. Like a doctor who sometimes has to prescribe a solution that is not really what a patient wants to hear, confirming that you’ve heard another does not require that you agree with them. Your response, agree or disagree, simply affirms that how they feel has value, too.

In the end we could all use a little bit of Marcus Welby’s manner at any “bedside”.

The One True National Holiday: Sunday musings…2/17/2024

1 Upstander. Better than bystander.

2 Tare. To zero a measuring instrument. I was today year’s old when I learned this.

3 Patrick Adams. While flying home from a meeting I struck up a conversation with my row mate (I routinely talk to strangers), a gentleman named Patrick Adams. Seems Mr. Adams is semi-famous in the general way, but rather genuinely famous among the music cognoscenti of Nashville where he is a songwriter and performer. We shared the last leg of his trip home from performing.

Do yourself a favor, look this guy up on Spotify or wherever you do such things. Listen to his lyrics. Maybe choose, as I did, a playlist of others playing music he wrote. Think of it as talking to strangers by proxy.

4 Book Report. “We get given our faces, but we inherit our lives.” Michael Robotham, “Life or Death”.

Often, when I finish a book, something that happens with some frequency I’m glad to say, I think that perhaps I should have a little space in “Sunday musings…” or “Random Thoughts” that serves as a kind of book report. I dunno, might be a bit presumptuous but when has that ever stopped me, eh? Anyway, a fair portion of what shows up here comes from stuff I’ve read, including the above-mentioned “Life or Death.” It’s a fantastic story, a thriller, and honestly I just couldn’t put it down. A guy has spent 10 years in prison and on the day before he is scheduled to be released at the end of his sentence he escapes from prison.

It’s a story about fortitude. About single-mindedly doing the right thing, no matter how often or how violently you are thwarted. Asked about the wild swings of luck he experiences the hero answers with a bit of southwestern poetry: “I guess I broke a mirror and found a horseshoe on the same day.” While not as filled with the invitation to deepest thinking I enjoyed in “Dark Matter”, it is nonetheless one of the better reads of the 20’s.

5 Holiday. The one, true universal holiday in the United States is Super Bowl Sunday (SBS). Seriously. Is there truly another day in which a super majority of our nation’s citizens unite more completely, with a greater cross-section of the population engaged than the championship game of the National Football League? Seriously. It supersedes Christmas, New Year’s Day and the Fourth of July (which I’ll bet most people do not know is really called Independence Day) for participation. Some 130 million folks tuned in to watch it live, if only to see the commercials (at $7 Million for 30 seconds) they would talk about even more than the game itself.

Some folks tuned in solely for the commercials, using the action in the game as a bathroom break.

“Did you see The Game?” “Where did you watch The Game?” “How about that commercial for XYZ? Wasn’t it awesome/awful?” For days on end both pre- and post-SBS these questions were never more than 30 seconds in to any conversation in my decidedly middle-class world. Man or woman, young or old. Didn’t matter. I’m still processing what it means for such an event to be the singular thing on which a country agrees. It doesn’t matter which team you rooted for, or this year if you were rooting for a team at all.

You know EXACTLY what I’m referring to.

What really struck me, convincing me that SBS is, indeed, that one single universal commonality was reading a couple of newspapers and watching the network morning shows on Monday (I was on vacation, chilling with Beth and Hero as they trained in a more horse friendly clime than Cleveburg in February). The topic at hand was whether the Monday following SBS should be a national holiday. Really. Folks were having serious conversations about whether the nation should cure SBS flu by simply declaring the day a holiday. In a country that can’t somehow find a way to make Election Day a national holiday, shutting down on the Monday after SBS was fodder for serious discussion.

I found myself counting up the national holidays we do have. Days when schools, government offices and the financial markets are closed. Heck, maybe we even celebrate some of them. Christmas and Thanksgiving. New Year’s Day. Independence Day, Memorial Day and Labor Day. Veteran’s Day, President’s Day and MLK Day. Did you know that VE Day (Victory in Europe) and VJ Day (Victory over Japan) were once national holidays? No one remembers VE Day, and Rhode Island is the only VJ holdout remaining. Where once we lived under the umbrella of “Blue Laws” that forbade commerce on Sundays, you can now buy a sofa on Easter.

Do we need another national holiday? Beats me. Looking at our list of holidays we have now they all seem to have, I dunno, maybe a tiny bit of nobility, or something to that tune. Maybe that’s a stretch, the nobility part. I guess I’m thinking that collapsing Washington and Lincolns’ birthday celebrations into a single day while adding MLK Day contains at least a whiff of nobility, no? Anyway, the days we DO have all seem to be backed by long-standing, almost eternal significance (looking at you, New Year’s Day), national impact, or the like.

Like Easter, Super Bowl Sunday does not require that we set aside a day off work for the celebration. Is SBS itself a holiday? Sure. Any day that brings together almost half of the country is some way, shape, or form fits the definition, at least my version of the definition. Indeed, Super Bowl Sunday and all that goes along with it may be the single thing that we can all agree on. That we can all congregate around without major conflict or controversy. Those who celebrate the day pretty much have a live and let live attitude toward those who don’t and vice versa, and really, how many things in our modern America can you say THAT about.

As I talk myself through this I think I’m cool with Super Bowl Sunday as quasi-national holiday. But the Monday after? Nah. Not buying it. In a country that de-holidayed the day commemorating Columbus and the “first” Europeans to set foot in the Western Hemisphere we’re gonna shut down City Hall, local schools and the nation’s banking system so that SBS “celebrants” can suffer their hangovers at home? I’m afraid that I just can’t find the nobility, reverence, historical or civic significance, necessary to make that call.

I’m willing to keep an open mind, though. I mean, if a certain guy had dropped to one knee and you-know-who said “yes”, well, maybe just that once.

I’ll see you next week…

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