Random Thoughts from a Restless Mind

1) Fears. “I’ve started harassing the guards at the borders surrounding my fears.” How one of my patients has described her late-in-life efforts to get outside her comfort zone.

A sound strategy at any phase of life.

2) Volunteerism. Says here it’s a goner. At least for anything and everything that cannot truly be called a charity and can prove it.

Man the sidelines for your kids’ travel soccer team? The one you pay >$1,000/month/kid for? Are you nuts? Hand out water bottles in that adventure race your spouse ponied up $150 for the privilege of suffering? Bollocks. Stand over the fryer and pull out basketful after basketful of fried fish for the PTA? Your property tax is going up regardless.

My epiphany, a reminder of which came via FB this morning, was the ER coverage and associated willingness to provide in-hospital consultations for local hospitals without compensation in the first 25 years of my private practice career. The “D” in MD must have stood for “dupe”. As soon as my younger colleagues pointed out that their peers in outer settings were paid to perform those services the hospitals magically found employed staff to pick up the service.

Unless it’s a real, live, honest to goodness all revenue directed toward the charitable function, it has no right to even ask.

3) Reunion. Man, where did the time go? My 40th medical school reunion is this October. I mean, I know I’m getting older–I’ve been calling myself “advanced middle-age”–but 40? That’s just crazy talk! It just showed up all at once.

My medical school was, if not unique, then certainly not one of the typical model of the times in the 1980’s. These were days when prestige for doctors and the schools that trained them began to shift from the reputations of graduates as practicing physicians to a more research and academic measurement ethos. But not at my Alma Mater the University of Vermont. Nope. UVM was unabashedly committed to training clinicians who spent the majority of their careers in the active care of patients as both primary care docs and specialists. For sure there were exceptions; one of my classmates Steve will receive an award for academic excellence and another was a state medical director.

But from the very outset we were trained as if we would all spend our time in reference, if not reverence, to the “Marcus Welby” ideal of a physician. We even contracted the time given to basic science education in favor of entering the clinics a full half year earlier than almost every other school in the U.S.

There were a couple of other idiosyncrasies as well. To begin with we were tiny. 93 students filled the seats in Hall A, the classroom that formed the center of our first year as med students. If memory serves we had the first med school class with more women (47) than men (46). We were also much older than the typical class with an average age of 29. In a time when most students went straight from college to medical school we had a number of classmates who had a whole career before joining the medical field. Heck, at least 4 of us turned 40 in school, and more people entered school as parents then became a parent over our four years together.

I have no memory of our 5 year reunion but I vividly remember wanting to maximize our attendance for year 10. We had a couple of separate class events, a pattern that has continued over the years. In a completely selfish move I have become what schools call the “Class Agent” even though no such position really exists for UVM’s med school. Well, at least as far as doing anything to help other than send along a class list with only 40 or so active, accurate contacts. Still my desire to touch base with the people who shared such an important stage in my life that I have grabbed hold of this excuse to call, text, and email anyone and everyone!

Why selfish? Well, colleges want to use reunions to drum up donations. I’m ok with that, but that’s not why I spent two weekends doing the above calling, texting, and emailing. Nope. I just want to hear everybody’s stories. I want to hear about their successes. About the dreams that came true and about the one’s missed by THAT much. Every single reunion I’ve gone to has been surprisingly enjoyable in that it was even better than I’d been hoping.

Man, all of a sudden, 40 years.

4) Snap. Or sometimes Slap. Either way, the demise of a rotator cup is the “all at once” conclusion to a process which sometimes has been going on for decades. Oh sure, you can do it all at once and out of the blue; that’s how I trashed my right shoulder in 2008 or 9. T’was the siren “Linda”, one of the CrossFit “Girls” benchmark workouts what did me in then. In the round of 6 I felt a sickening wet “slap” in my right shoulder followed by excruciating pain, simultaneously marking the end of the ascendancy of my physical fitness and my status as a good golfer.

I found enough ways to work around the shoulder that I actually maintained quite a bit of my fitness, at least as we defined it in those halcyon early days of CrossFit, but my golf game was so ugly and unsatisfying that I didn’t pick up a club for almost 14 years.

But slowly, ever so slowly, my right shoulder recovered. In truth, from the start I was not encumbered when doing anything that I really HAD to do. You know, like, work. I could do all of my office related tasks and after a week or so I returned to the operating room and went right back to doing all of the surgeries I’d done for almost 20 years. Same outcomes with no increase in complications. Working out took a bit of time but I found accommodations that allowed me to exercise without pain. Golf, on the other hand, continued to hurt both physically and emotionally.

I didn’t just stink at golf, my version of stinking was really an ugly version of the game.

This, too, changed slowly. Some 3 or so years ago by local friendship crew finally convinced me that the joys of camaraderie on the first tee outweighed the emotional trauma of poorly played golf. I decided to re-learn some version of the game so that I could partake of both the tomfoolery on the first tee and the outlandish lies told about our round while splitting the “G” at the 19th hole. For the first time since freshman* year in college I took lessons. Indeed, over the last 3 years I have taken more lessons and spent more time practicing than I have in the prior 50 years combined.

Did I get any better? Mind you, there was nowhere to go but up. Or so, as it turns out, I thought. From a 24 handicap further marred by pain in right shoulder with every swing I managed to work my way down to a 15 or so hcp with lingering pain in that right shoulder to go along with progressively more annoying pain and decreased range of motion in my LEFT shoulder. Yup, slowly, over the decades following a football injury in my left shoulder, my OTHER rotator cuff has been fraying from the mundane insults of daily life. As funny as it sounds, the rate limiting factor for my return to golf had become my left, or so-called “better” shoulder.

Still, with a little level-setting for expectations, I kinda made my way back to what might be called age-appropriate levels of fitness and activity. Slowly, but still, better. I’d come to a point where I didn’t really think about anything but proper mechanics whether I was in the office, doing chores, or working out. Last weekend Beth and I did some cleaning outside. Not very challenging physically but somewhat atypical movement patterns involved. Cleaning up afterwards whatever remained of my left rotator cuff gave up the ghost.

All at once.

Gotta tell ya, it sure felt like the whole damn thing went all at once. Man, that was really painful. Thankfully, with some unbelievable tender basic care at home from Beth and a couple of ortho buddies rallying and coming to the rescue a couple of days later, I find myself back in familiar territory, albeit 17 or 18 years older: able to do everything I need to do while at least temporarily unable to do a bunch of stuff I want to do. I can work. I can operate. I can type, and hence I can continue to offer my drivel for your reading…ahem…pleasure.

There’s a punchline to this story. This one has a teachable moment. The X-rays of my shoulder showed an amount of arthritis that surprised both my shoulder guy and me. The “slowly’, it seems, was directly responsible for the “all at once”. It makes sense, doesn’t it? Whether on the ascent or the descent, doesn’t it seem as if movement in either direction is so often made up of steps so tiny you barely notice you’ve moved? Working through a gnarly management issue, a complex contract negotiation, or maybe your snatch or pull-up technique. It barely seems as if progress is happening, until you get all the way there all at once.

At least, that’s what I’m telling myself. That left shoulder was slowly failing, moving just under the threshold of awareness. It sure felt like a cataclysmic, all to itself event when that rotator cuff was finished failing, but like so much, both good and bad, the process was actually moving along slowly all this time. Like getting older, eh? You don’t really notice it until that one day you walk by a mirror and your Dad is looking back at you.

The lesson here, however painful it is and however trite the reality of always remembering the lessons that hurt might be, can actually be a positive one. When we are stuck in the middle of a journey we may move so slowly that it appears we are not really moving at all. Until we get there. At least that’s what I’m gonna be telling myself as I slowly build the bridges, physical and otherwise, to wherever it is that’s next.

Hoping that whatever happens all at once is one of the good things.

I’ll see you next week…

This entry was posted on Sunday, August 16th, 2026 at 4:53 pm and is filed under Uncategorized. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.