The Doctor Is In. Sometimes.

I grew up in a small mill village in northwest Georgia. When things did not go right, someone got sick, or we had an accident, or we needed a sports physical, we would head around the circle to the entrance to the mill complex, just across the grassy field from my house, and see Dr. Harry Dawson. Dr. Dawson was that old omnipresent breed of physician who had a small self-contained office, seemed to me to always be there anytime he was needed, and could treat anything. He got kids through the measles, mumps, chickenpox, broken arms, flu, the common cold and of course that time I dropped the hammer on my brother’s head when we were climbing the tree in the back yard. It was an accident, I swear. He’s fine, thanks.

There are a few Dr. Dawsons left nowadays, but not that many. Same goes for psychiatrists. It is getting harder and harder to simply think, I want to go see my psychiatrist, call for an appointment and actually get one in less than a few weeks if not a few months. There are a few good reasons for this. According to a February 25, 2018 Forbes article Psychiatrist Shortage Escalates as US Mental Health Needs Grow, there are twenty-eight thousand psychiatrists practicing in the US, but three out of five of them are age fifty-five or older. (Here’s looking at me, kid.) As we face more and more angst, shootings and the escalation of completed suicides, the number of psychiatrists who actually see patients face to face and deal with crises individually in their practices, modern-day Dr. Dawsons, are very hard to find. My patients tell me all the time that they don’t want to come in to see a counselor, a nurse, a social worker, but that they want to see their doctor. I understand this, but as you shall soon see, what I and many of my colleagues are doing in 2020 is far different than what we trained to do in the seventies and eighties. If you need mental health care nowadays, you may see any one of a dozen people who are part of a treatment team of health care providers. Your doctor may be in, at least physically, but he or she may not be available to see you personally.

My workflow, and that of my colleagues, has changed dramatically over the last thirty years.

While in medical school and residency training, my schedule of activities was pretty much set for me. I had simply to show up at the appointed time and place and work and learn. Training, classes, meetings, patients, all were set by a scheduler or training director. I had very little input. There was little autonomy during training.

Flash forward to early practice in the late nineteen eighties, when I was a junior faculty member of the Department of Psychiatry and Health Behavior at the Medical College of Georgia. I was an attending physician at the state hospital, in charge of residents barely younger than me, attended faculty meetings, and had a practice life that was still fairly regimented. I still spent a lot of my time working directly with people, around people, talking with people. Psychiatry at that stage of my life was still a people profession, driven by conversations, interactions and face to face meetings.

Go forward still to private practice, which I did for about five years. There were personal interactions with my staff and my patients in the office all day long, visits to inpatients in the hospital, and consults sent for patients on the medical and surgery floors. I was still doing most all of my clinical work myself, making my own decisions, and deciding how often to see patients.

Next came work at the mental health center that started as a part time job in 1991 and then became my primary job in 1993. I loved it, and I have never looked back. Oh, I have done work in crisis units and I have now been doing telepsychiatry for ten years, but my primary mental health center duties are still my most loved ones. The funny thing is, with time, my duties to see patients one to one in the clinic have taken a back seat to myriad other duties, especially since I have been serving as medical director of our center. Individual work (“I want to go see my doctor!”) has morphed into leading a team of other mental health professionals, and even more recently serving as a co-provider in these groups, not even officially leading them anymore. Now in 2020, I supervise a medical staff of thirteen other people, the most we have ever had in my time at mental health. Oddly, though in the past we had as many as five or six psychiatrists working at the center, there are only two of us among these fourteen staff now. I have many very talented advanced practice nurses, nurses, administrative staff and part time, locum tenens and other providers who have helped us take care of patients over the last decade or more.

The thing that I noticed when engaged in a conversation with some of our senior staff last week is that now I do not simply see a limited and finite number of patients, as many as today’s schedule will allow. I do much more indirect and direct supervision, answering dozens of emails each day, talking in real time on Skype, and otherwise making decisions for patients who I am not seeing directly, at least most of the time. I am relying on the eyes, ears and assessment skills of the medical staff as they multiply my ability to hear your stories, assess your symptoms and come up with a reasonable treatment plan that will help you recover. This is both sad and exciting for me. I miss the days of seeing one patient after another, my patient coming in to see their doctor, that most pure of doctor-patient relationships. However, this new paradigm of care allows me to have a much broader reach and treat more people than I ever could alone. That is good. When you need to come in for treatment of mental illness, you may not see the doctor initially, but you will be seen by someone on the team that the doctor is intimately connected with.

What does the future hold? Telepsychiatry is making inroads in hospitals, prisons, jails, schools and even patients’ homes. Mobile crisis teams go out into the community and meet patients where they are, giving care at that point, not relying on visits to a clinic. Traveling RVs staffed with teams of providers scour the backroads for people who need help. More and more, care is becoming collaborative, as mental health workers are embedded with law enforcement and medical clinics, and medical providers set up shop in mental health facilities. Psychiatrists are learning that they can teach, supervise and function very well as part of a larger team, reaching far more souls than they could ever do in their simple solo practices.

I think Dr. Dawson would be proud.

A Milieu of Unfriendliness?

As we had our all agency meeting at work the other day, involving mental health employees from all three of our sites and from all types of job descriptions, I was struck by something that come up as we discussed issues of cultural diversity. We had had a good presentation on diversity and how it was germane to the people that we serve everyday. Then, a few folks made observations that made me understand immediately that they felt misunderstood, unappreciated, and unacknowledged in the positive ways that they obviously felt were important.

How could that be, I thought? I started working for the local mental health center in Aiken part time in 1991 and came on full time in 1993 for the specific reasons that I loved the patients, the clinical environment, and most of all the people that I worked with. I have stayed at the center for almost twenty nine years for those same reasons. Now, I know that we are not perfect, but I do get the sense that the folks I see and work with every day are basically good people, caring people and people who care about my wellbeing as well as their own. For the most part, we cooperate, we commiserate, we collaborate and we celebrate, all important parts of being on a team that pulls in the same direction for positive changes and outcomes. I was a bit saddened to hear that some of my coworkers do not seem to feel respected, genuinely valued or appropriately acknowledged.

How did we get from 1991 to 2020 and this angst? I have a few ideas about what might have changed.

We work in a culture of fear-driven productivity at the expense of much else. Being a part of the management team as medical director, I understand this from a purely operational viewpoint, in that we must do a certain amount of business, bill a certain amount, collect a certain amount of money and constantly push for provision of appropriate services to keep our doors open. Otherwise, we would not be much good or be able to provide services to anyone at all. I get that. But it does seem to me that a lot of our staff feel pressured by the numbers, the spreadsheets and the bottom line, regardless of the emotional toll that this pressure takes on them daily. In this twenty first century world, we have perfected the art of cranking out widgets, but we have sometimes lost our drive to connect in meaningful ways with each other in the bargain.

As a corollary to that, the time that we spend with each other, WITH each other, is minimal.  I have noted, as have others, that sometimes we can pass each other in the hallways and not even acknowledge the other with a smile or a kind word of greeting. Now, there are some of us who are excellent at that kind of connection, bright rays of sunshine in an otherwise clinical gray haze, but I’m afraid many of  us, myself included, can easily fall short at times. We need to connect emotionally and model that behavior that we often try to teach our patients about.

I began to think, we have lots of folks working here, lots of people like me and not like me, with different values and priorities and hopes and dreams and ways to act and dress and walk and talk and interact with others. We preach acknowledging these differences, even elevating and celebrating them in our patients, but are we failing to do the same with those who work in the offices next to us? Based on what I heard at our meeting, I’m afraid that might be the case.

Are we fostering a workplace culture of exclusion? A milieu of unfriendliness?

There is enough stress in the world right now to go around, and then some. There are social, cultural, political and class stresses that make us wonder how we will ever get through some days. In spite of those stresses, we do get through each day.

We need to be consciously  aware at home, at work, at play, wherever we are, that there are those who feel marginalized, unappreciated, unloved, unseen and disconnected.

We must start somewhere.

Smile. Acknowledge. Say hello. Check in. Look up. Make eye contact. Tear down the wall that surrounds the milieu of unfriendliness and build your own bridge to a culture of appreciation and hope.

It starts with me, and with you.

 

Loneliness

Loneliness

“One is the loneliest number that you’ll ever do.”

Three Dog Night

Well, dear readers, we have passed another holiday season, one that was magical for many of us, sad for others and downright lonely for a few. I was already thinking about this annual state of affairs the other day when I happened upon an article in the Dec 19/Jan 20 AARP Magazine, of all places, called “Is There a Cure for Loneliness?” It got me thinking more about some observations that apply to many of my patients, and perhaps to all of us to varying degrees. Please allow me to share some of these with you.

One of the last observations in the article, and I think one of the most important, is that loneliness is the difference between what we would like to have in our relationships and what there is in reality. This is a key idea, in that the rest of the article was predicated on the fact that it is very hard to nail down just exactly what loneliness is and how to best measure and study it. According to this article, it is fairly well known that older Americans are at risk for social isolation and that this can sometimes lead to physical illness, depression, even dementia. The piece tried to explore causation for loneliness, wondering whether there exist medical causes for and treatments for loneliness.

Louise Hawkley, a senior research scientist at the University of Chicago, stated that “Loneliness is a universal human experience, and being the social animals that we are, there must be implications when these social connections are not satisfied.” Steve Cole, Professor of medicine, psychiatry and biobehavioral sciences at UCLA School of Medicine, studied biological effects in lonely people. He found that blood cells in such folks “were in a high state of alert, as if responding to an infection”. Ms. Hawkley stated that “we humans have a need to be embedded, connected, integrated in a social network”. Ah, I can hear you right now, as you read this column, saying, “Well, I am embedded in Facebook and Twitter and Snap Chat! Of course I am connected to other people!” Alas, is that a truly fulfilling connection? Is it enough to ward off isolation, illness, mental health problems? See my previous columns and those of others over the last several years. What kind of connections do we desire, need, thrive on? Is it different one person to another? Of course it is. We are all human, but we are profoundly different from each other in many ways, the need for socialization and connection being one of them.

The one thing that does seem to be more and more clear, however, is that if we do not have some sort of meaningful connection to others, that we are adversely affected both physically and mentally. A friend of mine, who is a physician and also an Episcopal priest, was trying this holiday season to reconcile the religious and the secular in his life. He spoke of worship versus parties, as it were. He said that for him, it would be very important to spend worshipful time in quiet reflection about the mysteries of the season, but he also resolved to “accept every invitation to go to every party and gathering I am invited to!” He was always a wise man when he was my surgery attending in medical school, and he is still wise in the ways of social interaction. We do not need false, fake or superficial social networks and connections, but real, substantive connections with other human beings. That is why real time gatherings can be so satisfying and fulfilling. We need deep conversations; letters (not just texts, LOL); groups that support art, therapy, learning, and self-improvement; shared activities; and shared experiences that allow us and others to feel fulfilled and whole.

Is there a financial cost related to loneliness? According to the AARP article, people who live in social isolation add about seven billion dollars to Medicare costs due to longer hospital stays and lack of adequate family and social support at home. Loneliness is a killer. It may worsen heart disease, may make us more vulnerable to cognitive illnesses such as Alzheimer’s Disease, may worsen hypertension and may leave us vulnerable to infections. Loneliness may be more dangerous than obesity and the equivalent to smoking fifteen cigarettes a day. But wait, I hear you saying now, how can an emotion, a very abstract one at that, shorten a life?

Is it the loneliness itself or the social isolation, disconnection in a variety of ways that is fueling this problem? Again, per the AARP article, there are more people living alone these days as shown by census data, the marriage rate has declined, and the number of children has also decreased. Julianne Holt-Lunstad, professor of psychology and neuroscience at BYU, was co-author of a study that looked at three groups: those who were socially isolated from other people, those who described themselves as very lonely, and those who lived alone. The study included pooled data from seventy studies that followed 3.4 million people for seven years. Each group had about the same risk for early death, 29%, 26%, and 32%, respectively. The study data was independent of health status. It is a fact that people who live alone are not necessarily lonely, and it also follows that some who are surrounded by family and friends do indeed feel very lonely. One thing that seems clear, however, is that people who are socially connected live longer.

Can you definitely measure and quantitate something like loneliness? The UCLA Loneliness Scale, according to this AARP article, is the gold standard for research purposes. It is a twenty item questionnaire that asks about the feelings associated with loneliness, without asking about the thing itself.

How to approach loneliness? First, like many illnesses and conditions, this article states that we must recognize that there are likely multiple etiologies for what we see. These can include genetics, social situation and family environment. We must also try to look at this problem from the point of social connection, not loneliness per se. Why? Because like obesity and other conditions, people who are lonely often are subject to stigma and may be looked on as social failures. We can encourage those who are lonely to volunteer, help others, and encourage activities that qualify as life experiences that build connections and memories. Another concept mentioned in this article, that I like to think of as crowd sourcing care, is that we can ask that people who are in the arena (postal workers, healthcare providers, hairdressers and many others who come into contact with many people every day) to watch out for the needs of others and spot those who are struggling. Finally, we can stay abreast of the research that is being done on inflammation, pain and other issues that might be biologically related to loneliness. There are not many hard and fast guideposts for the medical aspects of loneliness yet, and no medical treatments that are panaceas, but more knowledge is sure to come as we learn more about this problem that can affect us all, not just at holiday time.

Happy New Year!

Selling Out?

I do not watch the Golden Globes, or many other awards shows for that matter, but it was almost impossible to escape from some of the recent press about Ricky Gervais and his non-caring (his words, not mine) diatribe towards modern tech giants and other companies and people he had disagreements with. I leave you to peruse YouTube or other sources for more details.

On thing that struck me about all this was that he was jumping all over Tim Cook, stating that if Apple did indeed win any Golden Globes for their new Apple TV+ content (they did not) that they should not use the acceptance speech as a platform for platitudes of any kind. He was intimating, no, coming right  out and saying actually, that because Apple ran “sweatshops” overseas to make its millions of iThings and billions of dollars that they would be hypocrites if they did anything more than simply walking up on stage, saying thank you and exiting stage left.

That got me thinking even more that I usually do about the government, the companies that we usually trust, the businesses that we buy from, and the people that we normally look to as embodiments of at least a modicum of good will and morality.

As a kid, I always looked forward to the fall, when my mother would take my brother and me to the local Sears store to buy school clothes and that wonderful new pair of sneakers. (PF Flyers, if memory serves) . Sears was America packaged in a fairly nice store with friendly people and had the bonus of a cool Christmas Wish Book that we all loved to page through to make our Christmas lists. Who didn’t like Sears, for God’s sake? As I grew up, given that retail background, guess where I always bought tires for my car? New appliances when one wore out? A new and better lawnmower when the time came for that? Sears. I didn’t know a thing at that time, even in my early adult life, about their overseas business practices, their stand on religion, how they felt about gay people, or any of the things that we gnash our teeth about today. They were a decent store that had decent people that treated us well and sold us a good product that gave us something lasting  for our money. Period.

Flash forward to Apple. I ran my first solo practice on an Apple computer. It was much more expensive than I could afford, but I bought it and a companion software program that I knew would work, would serve my needs and help me take care of my patients, and that was that. Ten years or so ago, I bought my first iPhone, and I have had almost every one that Apple has built so far. (I did not buy an 11, as I will wait for this fall’s 5G offerings to see if they are worth the money) I remember being on my white MacBook reading about this newfangled gadget that was going to come out that would be a phone and let you listen to music and send emails and on and on. No way! Way! I knew that I would buy one of those as soon as it came out, no matter how much it cost. Early adopter, I am. Separated easily from my money, I am. At any rate, back then, I also did not know one thing about Apple’s stance on overseas production or tariffs or child labor or outsourcing or gay rights or any of it. I just know they made cool stuff that would help me do what I needed to do, I liked cool tech stuff and I would buy what they were selling.

Are you hungry? Do you like Chick-fil-A? I do. They have good food, excellent food.  I like the superfood salad, the chicken soup, the grilled nuggets. The kids that work there are always nice, respectful, say please and thank you and have smiles on their faces. I have always enjoyed eating at this restaurant. I still do. They have angered a lot of people with their stances on gay rights, religion, other issues I suppose, so some folks have boycotted them. Okay, I get that.

Then there’s Amazon. I spend a lot of money and buy a lot of stuff from Amazon. I would have to say it’s my go-to online place to get stuff. I assume I am not alone in this. A lot of people do not like Amazon, Jeff Bezos, his world view, the way his marriage has gone, the fact that he owns a newspaper, how Amazon is purported to treat its workers, etc., etc. Two hour delivery of some items in urban areas is crazy, I know. What do I really need in two hours? Not much. The convenience, the sheer number of available items, the ease of returns, the ease of ordering, all of it tends to make our lives so much easier than they used to be in a lot of tangible ways. I am not opposed to this. I like it in many ways.

Are Sears in its current iteration (bless them), Apple, Chick-fil-A, Amazon and others perfect companies? No, of course not. Are they paragons of virtue, using best practices while paying their workers top of the line wages and benefits and caring primarily for their welfare? No, I think not. Do they use their retail bully pulpits to foist their opinions about religion, gay rights, marriage, guns, free speech, and other major issues of the day on others, unbidden? Yes, sometimes, yes. Do I always agree with their public stances on these and other issues when I hear about them in the news or on television shows or podcasts? No, of course not.

That being said, am I going to go over every balance sheet and news article about laborers in China and fret over records of gay marriages in all fifty states before I buy grilled nuggets or my next iPhone or order a gift for my granddaughter’s birthday? No, I am not. I absolutely am not.

I may be wrong about this, or I may be too uncaring like Ricky Gervais, or too naïve or whatever, but I’ll be damned if I am going to restrict my purchases of food, phones and happiness at this stage in my life just to do the politically correct thing. I am not going to vet every single day to day decision I make based on the societal correctness of its context, whether or not it offends a particular group, or whether it butts up against the minimum wage in a foreign country.  Don’t get me wrong. There are ways to deal with these real life issues, and they should be dealt with. But I’m sorry, Mr. Gervais, what Tim Cook says or does not say when his television shows win or do not win a Golden Globe is not going to be the deciding factor next fall when I decide to buy an iPhone or its Samsung counterpart.

 

And Speaking of Exercise

Further thoughts after my pain post.

When we are very young children we are flexible, energetic, tough and resilient. We run, jump, pull up, dive under, crawl around, and skip merrily about in that most frantic of ways that is known only to youngsters and those who watch out for them. We have little fear, none that I can remember personally! The exercise, the movement, the physicality of it all is for the sheer joy of the activity itself.

We can move, therefore we do move. We must move.  We enjoy the movement.

Fast forward to those junior high and high school years, when movement and activity and exercise get more regimented by the year. We join sports teams. We learn what it means to be part of a team, a team that wants not only to participate and play, but that wants to win. We train, we strengthen, we drill. Yes, it’s fun, of course, but it’s also regimented and with one goal in mind. Excelling. We train, we practice, we drill, all in the service of victory.

We are told to move. We will move better than anyone else. We will be celebrated for our movement.

A little further. College, graduate school, professional school. For some of us, the rigors of academics and study and preparation started to severely cut into our physical time, our recreation and competitive sports and training and working out. Yes, I still played quite a bit of tennis and ran and competed in races as I have written about already, but it was becoming that thing that I had to find and make time for, not the thing that came first and gave me the most joy. Having fun was becoming more of an obligation, something to be scheduled. The spontaneity was fading.

We wanted to move. We tried to find the time to move. We knew we should move. It still felt good to move.

Adulthood. We’ve made it. School is done. We have a job, a relationship, maybe a marriage, maybe children, a home, a mortgage, bills to pay. We go to church. We join social groups. We go to ballgames. We shuttle the kids around. We do dishes. We clean house. We work in the yard. We clean the pool. We plant a garden. We are tired and stiff and sore some nights, but we fall into bed and sleep and get up and do it all again the next day, because that is the drill.

We must move. Movement is required to keep the schedule going. We resign ourselves to the need for constant movement.

Now. I am sixty two years old. Firmly middle aged, I do not feel old at all. That being said, I do have days when joints hurt, feet hurt, I strain a muscle I never even knew I had, and I have a hard time bending over to tie my shoes. (Now, take this with a grain of salt, because I was diagnosed with Polymyalgia Rheumatica several years back, and although it is not active, I still think it affects me in little ways from time to time) As we age, we find that the little day to day things that we have always taken for granted are sometimes more of a challenge than they should be. Carrying a load in from the car. Reaching for the dryer sheets in that cabinet up above the washer. Going up and down long, steep flights of stairs. Sitting at a desk for long periods. All of these routine daily actions can sometimes take us by surprise and feel uncomfortable or even hurt! Have you ever reached for something or twisted around suddenly and pulled that tiny muscle under your shoulder blade, that then hurts like the devil for about three days before it settles down? Yep, that’s what I’m talking about.

We still need to move. Some movements are now challenging. If we do not move, our quality of life will begin to suffer.

So, what to do as we age?

Continue to move daily.

Get up, stretch, walk, garden, do the laundry, take the stairs and not the elevator, bend down to tie your shoes. Do not sit more than an hour at a time, if that. Get up, walk up and down the hallway, bend over and touch your toes a few times to loosen up. Use a standing desk. Get outside and walk around the block. Hike.

As long as we are moving, we are living.

No Pain, You Must Be Dead

I have always liked to be physically active. Raised in the south, I was no stranger to exercise.

I participated in the usual pee wee football, JV football, basketball, softball thing as I grew up, then settled on tennis as my favorite competitive sport, which kept me occupied all through high school and college and beyond, at least on a fun, non-competitive basis.

Several, I mean several years ago, I blew out a gastrocnemius muscle while stretching for a screaming wide shot off to my left on an asphalt tennis court, and felt like someone had sneaked up behind me and hit me in my left leg with a baseball bat. Think Nancy Kerrigan, although when I turned around there was no Tonya Harding to be seen anywhere. I don’t think I’ve ever had a more painful sports related injury, as I felt a searing white hot heat go up my leg into the depths of my brain and immediately felt like I would never walk again. I did, of course, but to this day I have not stepped back on a tennis court for anything more than a very slow, easy volley.

Have I ever stopped exercising? Of course not. Humans like to move, stretch, and challenge themselves. I am no different from my brethren.

In the distant past, I got into the whole running thing, bought the Jim Fixx books, kept a running journal and spent Saturdays with buddies running up and down hills in Augusta, Georgia preparing for races. We ran 10Ks, ten milers, half marathons, and I even managed to complete one marathon in Augusta back when that was a thing. I have never been so happy to cross a finish line and complete a task in my life. I was happy to be there in the early years of the Peachtree Road Race, back when only ten thousand of your closest running buddies participated. I have fond memories of trudging up the 3/4 mile stretch of road called Cardiac Hill, culminating at the juncture of Peachtree Road and Collier Road, conveniently located just across from Piedmont Hospital, in case you needed to duck in for a quick cath or ablation before you finished this always searingly hot and humid race.

The jewel in the crown of my running days was the completion of the Steve Lynn triathlon on base in Savannah, Georgia. This half Ironman race consisted of a 1.2 mile swim, a 56 mile bike ride and a 13.1 mile half marathon, back to back. I trained for it by running around Augusta, riding my bike up to Clark Hill lake and back on many weekends and swimming laps in a backyard pool. I had a good support team to help me with the logistics of that race, I was in the best shape of my life and I proudly finished it in a respectable time. It was exhilarating and exhausting.

More recently, I have been into hiking. It is as strenuous as you want it to be, as easy and relaxing or as hard and taxing as you choose and gives you the opportunity to get outside, breathe the fresh air, see wildlife and test your skills in nature. I have hiked the Augusta Canal trail at home, the multiple trails at Sesquicentennial Park in Columbia, SC, and the trails at Mistletoe State Park just up the road. I have hiked solo at ten thousand feet in New Mexico on a ridge so high that it felt like I was on top of the world. My wife and I have walked past Mount Rainier in Washington State, enjoyed a walk through Okichisanso Gardens in Kyoto, Japan, and summited a pretty falls in Rocky Mountain National Park. Last January I hiked and up and down Camelback Mountain in Phoenix, Arizona, one of the most difficult hikes I have ever done. My heart rate approached 150 as I made the summit after scrambling up a boulder field. The hike was more a rock climb, and I was glad I brought leather climbing gloves instead of poles for that adventure. I had never been more physically exhausted than at the bottom of that mountain, but it was also one of the most technically challenging and satisfying treks I have ever made.

Last March, as my wife and I descended from the summit of a mountain in Table Rock State Park in Pickens, South Carolina, I had a wake up call. I had hiked this trail several times previously and knew it pretty well. I had not brought poles for this hike, which in retrospect was a huge mistake. Roughly halfway down, following my bride as she lead us back to the car, my hiking boot caught the edge of a rock at the top of a large section of rock steps leading to a lower section of trail, bordered on the right by a ravine. Although the fall is not as terrifying to recall now as it was for weeks following the accident, I can still vividly remember my thought pattern as I went airborn.

“Uh oh.”

“I think this is going to hurt me very badly.”

“I’m afraid this fall might kill me.”

“I don’t want to die like this.”

It was one of those accidents that happens very fast but is strung out in your mind in slow motion. As I tripped, I had the sensation that one always has in that situation, that I could put out my arms, regain my sense of balance, make sure my other foot came down squarely on the next step, speed up a little until my center of gravity was okay again, and proceed on down the trail. Unfortunately, this was a real fall, completely in the air, out of control, immediately disorienting to the point that I did not know up from down, right from left, path from stairs from ditch. I was cognizant of the fact that I was tumbling, that I had not yet hit the ground, and that when I did, it was not going to be good. Something would break. I would hear a snap. I might hit my head. I might be rendered unconscious, with a head injury that would be no joke.

“Uh oh.”

My wife told me that I flew past her (thank God I did not take her down with me, for that would have been truly unbearable) pitching and rolling. I remember her calling out, but not what she said. I had the sensation that I was going to hit a rock step, the ground, or tumble into the ravine sometime very soon. I did not have time to figure out how to brace myself, how to hold my arms to break my fall, how to orient myself for minimum damage when I hit. It was all just too fast. I was at the mercy of gravity and inertia.

“I think this is going to hurt me very badly.”

Seconds that seemed like minutes went by, and I knew this was it. I was going to come to ground soon. I did not know if I was going to be okay. This scared me very badly. What was going to happen to me. How could this happen? This is not supposed to happen to me. It was then that the fleeting thought that scared me most of all came into my spinning head.

“I’m afraid this fall might kill me.”

What would it feel like to die on this trail at this time after this fall? Would it be painful? Quick? Would I know, at the bottom of this tumble, that I was dying? Would I see nothing but black and not wake up again? How would this affect my wife? My God, how would she get me off this mountain? How would she do that?

“I don’t want to die like this.”

I know that I am going to die. I started this blog a while back to deal with my feelings about being sixty two, thinking about my father dying at more or less this same age, and how I was going to move on into the next thirteen years and beyond. I wanted to explore how it was going to feel to become an old man, crotchety and opinionated and feisty and relatively fit (I hoped). I knew all that, but at the moment of this horrendous fall my brain was facing, at what seemed like the speed of light, what it would feel like to experience my own death, an accidental death, a traumatic death for me and for my wife. It was at the same time surreal and vividly real.

I did finally stop tumbling, and came to rest (that is a very soft way to say crashed painfully to earth) on the right side of my head, my right wrist and forearm and right leg. I was stunned and disoriented but I knew I was alive. I tried to pull myself up as my wife scrambled down to assist me. I was off balance, felt nauseated and very sick, and could get no further than on my knees, wobbling, swaying, my brain saying get up, idiot, you’re fine, and my body saying, man, that was really, really, really bad, dude. I was bleeding but I did not know where from. Turns out, a couple of small chunks had been torn from the top of my right ear, and there was stray blood on my hands. My right leg was on fire and numb at the same time. I did not know if anything was broken. In true injured physician fashion, I began to assess myself through my wife’s eyes!

“Is my head bleeding anywhere? Any cuts? Anything else malformed, bleeding? Are my pupils reactive? Are they the same size? Am I making sense? Are my words slurred?”

I can easily say that in all these times that I have played sports, participated in races, hiked, and otherwise done something physically taxing, this spring’s tumble on a mountain trail was the most frightening injury I’ve ever had. I got away with mild abrasions and contusions to my head, ear, hands, and wrist, and had one hellacious deep bruise over most of my upper right leg that took months to heal and that is numb and intermittently  uncomfortable to this day. I did not break any bones. I had no open bleeding wounds. I did not lose consciousness. I did not have a concussion.

My wife swears that two of my guardian angels, always vigilant, swooped down at the first sign of danger and gently laid me to rest (thanks guys) at the bottom of that pile of rocks with only minimal injuries. (Oh, did I tell you that my glasses were still on my face, not a scratch on them, my backpack was still securely in place on my back and I was still wearing my cap when I was finally able to stand?) A fall like this could have easily fractured major bones, lead to compartment syndrome in my leg, caused a head injury, a broken arm, loss of consciousness or death. At minimum, it should have put me in the ER if not in the hospital. At worst, it could have killed me.

Ten months later, I am writing this.

So, no pain, no gain, right? Not exactly. As you get older, if you stay active, you WILL have pain, discomfort, sadness, illness and injury. As a nurse told me one time in the emergency room after I had broken my leg sliding into second base, “Hey, it’s the active people who get out there and do stuff every weekend that get these kinds of injuries!”

As for me, I have plans to fly to Arizona two weeks from today. My wife and I will be hiking on a big ridge just south of Phoenix, as I glare back at that mountain that resembles a camel, and start planning the next adventure.

Let’s face it. If you don’t wake up tomorrow with some pain somewhere, well, you must be dead.

 

Hindsight is Always 20/20

It’s another new year.

January 1, 2020, and I have already been up for a while, read the headlines, had my first coffee of the day, been to the gym and contemplated what to do with the rest of my only day off for the next ten days. Holidays at home are the best. There is work to be done, taking down Christmas lights, organizing thoughts and workflow for the coming year, but there is also the feeling if being at peace, being one with home, one with light and life and relationship and that feeling that this is that one place on earth where I can be myself, for better or worse.

I am munching on pears and cheese lovingly prepared by my wife, who bustles about the kitchen readying the collard greens, black-eyed peas and cornbread for our feast later today, before we watch the Bulldogs play the Bears. The game starts at 8:45 PM which means 9 PM which means way too late for a sixty two year old man who is going to try to sleep at least seven hours per might this year come hell or high water. No, I do not make New Year’s resolutions, but I resolutely recognize that not getting those seven hours of sleep per night is not going to lengthen my life any and therefore doing so is a worthy goal. I will watch the game to the end, unless it is a blowout either way.

The Christmas holiday was a good one, with travel, visiting family and friends and giving and receiving gifts. We got to see the grandkids, growing and learning and getting much too big much too fast. When you are growing older yourself, you do not necessarily feel older until you see your grand children. It is then that you know that your place in the family tree is changing, that you are becoming one of the lower, founding branches and that the little shoots before you are the future. I am becoming not only the older, hopefully wiser present, but I am slipping inexorably into the past. I’m not usually sad about that. It’s just a fact.

The new year for me always means re-evaluation of what works and what does not work. I have a set way of approaching the big things in my life, and for the most part this approach works well for me. Each January, I look at all of it with fresh eyes, and a small dose of skepticism. Did my plans come to fruition last year? if not, why not? Where was the loose connection, the miscommunication, the laxity, the laziness on my part that did not let a thing happen that I wanted to see happen? Where can I fine tune, tweak, let go, add, and change the flow of planning, execution and progression in my personal and professional life that will make 2020 better in some tangible way from 2019?

I spend a fair amount of time thinking about this every year. As  I mentioned in previous posts, I know that time is a finite commodity, and that every year it gets more precious and valuable. Of course, I never know how much if it I actually have left, so it is hard to plan accordingly. I don’t just think about this, truth be told. I obsess about it, as I do about many things. For better or worse, I plan, rejigger, write down,  list, reconfigure, reorder and rethink every part of the plan for life in the coming year. How and when to write? Books by audio or held in hand? Paper or screen reading? More or fewer podcasts? How to make more time for exercise? How to make better and more satisfying connections with spouse, family and friends? Work more, work smarter, or work less overall?

Yes, the new year brings 20/20 hindsight. I know what happened in 2019. I know what worked well and what did not. I revel in my successes and make peace with my failures as best I know how. I vow not to repeat them. I am optimistic about the future. I remember the past, but I do not want to wallow in it or get mired and immobilized.

I do not know the future, but I embrace it proactively as an old friend.

I am older. I am trying to be wiser. I am trying to be kinder, gentler, and more forgiving of others, as well as myself. Will I have succeeded on January 1, 2021?

By then, hindsight will, as always, be 20/20.