It’s a Pandemic Life

I have had more than one patient tell me that although they have no specific plans to kill
themselves, they sometimes just wish that they had never been born. They are so depressed
and hopeless and have so little regard for themselves that they feel that anyone who lives with
them or loves them would be much better off without them. In this time of the coronavirus
pandemic, these feelings have been intensified. Losses mount for some. Loved ones grow ill and
die. Jobs disappear, and with them the ability to pay for food, clothing, rent and even gifts for
the children at Christmas. Think of it. The people who count on you for their very lives and
support are the ones who you think might be better off if you had never existed. Ironically, it is
the strong attachment to those people, especially young children, that often saves us from
ourselves and pulls us back from the brink of an irreversible act of self-destruction.
Have you seen the movie It’s a Wonderful Life? I highly recommend this 1946 film starring
Jimmy Stewart and Donna Reed. George Bailey, played by Stewart, has spent his whole life
giving of himself to the people of his hometown, Bedford Falls. On Christmas Eve, George’s
Uncle Billy loses an $8000 deposit from the Building and Loan that George runs, which is found
by the town’s villain, Mr. Potter. When Potter hides the money, George is in very real danger of
being arrested for bank fraud if an examiner discovers that the money is missing. Thinking that
his wife, his young children and others who love him will be better off without him, he
contemplates suicide. After crashing his car into a tree, he walks to a bridge and is planning to
throw himself off. The prayers of all those people reach heaven and an angel named Clarence is
sent to earth to help George, promised that he will earn his wings if he is successful. Clarence is
able to show George what the world would have been like if he indeed never had existed, and it
opens his eyes. He is able to see all the blessings that are his, the people who care for him and
the fact that love and togetherness and a mutual respect for each other can conquer any
problem.
No doubt, there are many people who are hurting this holiday season. There are those who
cannot take care of their families, who do not have a job, and who feel that life would be better
for those they love if they had never been born. Like George Bailey, they may be thinking of
suicide. But also like George, many of these people may have a Clarence just begging to help
show them that they matter. We sometimes feel that we can do little to change the course of
history or the arc of misery that the world seems to be on. Think about this holiday season and
how you can play the part of Clarence, Angel Second Class, for someone you love. Can you tell a
story and share a memory of a good deed done? Can you offer a smile? Can you send a note
thanking them for the influence they had on your life? Can you drop off a meal or Christmas
cookies or a small bag of toys for the children at the front door? Can you give a card and more
of those cookies to the postman who brings your mail every day?
Especially in this time of pandemic, in this holy season, it is important to count our blessings
and use our time and talents to help those who need it most. Who knows, if you are successful
in making the holidays bright for just one desperate person, you might just earn your wings.

Empathy

I have always tried to understand what my patients are feeling. Why are they depressed? Why are they anxious or afraid? What keeps them from getting out in the world and working or traveling or visiting with families or going to church? It is very hard to put yourself into someone else’s body or mind, or to walk a mile in their shoes, but the practice of mental health treatment almost demands this thing called empathy. Since March of this year, our mental health center has been sorely tested, forced to rearrange schedules, send people home to work, see patients for injections outside under a tent in the open air, and really think outside the box to continue to provide socially distanced, medically safe, efficacious treatment to those who suffer from mental illness in Aiken and Barnwell counties.

So what is empathy? The ability to understand and share the feelings of another. I alluded to the first part of the definition in the first paragraph, but did you catch the second part? To share the feelings of another. Now, I would argue that understanding and sharing the feelings of someone who is hurt, ashamed, fearful, depressed, angry, or suicidal would normally, at least in my field, be a voluntary action. It would be something that I would choose to do, as I care about my patients and what they are feeling and want to figure out how best to help. I would go so far as to set up regular appointments, ask questions, learn about family history and listen to the hopes and dreams of the person, all in the service of understanding and trying to feel just a little of what they feel.

The coronavirus pandemic has forced us all into an involuntary state of misery. The CDC tells us that stress during an infectious disease outbreak can sometimes cause the following:

  • Fear and worry about your own health and the health of your loved ones, your financial situation or job, or loss of support services you rely on.
  • Changes in sleep or eating patterns.
  • Difficulty sleeping or concentrating.
  • Worsening of chronic health problems.
  • Worsening of mental health conditions.
  • Increased use of tobacco, alcohol, or other substances.  

We stay isolated from each other, but we try our best to connect through Zoom, Teams, FaceTime, and Skype. We communicate in real time but we cannot hug or touch or shake hands. We work together as teams, but do so virtually, knowing each other only from the neck up. It is very hard to be empathic if you sit in a locked office, maybe somewhere out of state, talking to a person who is hurting as they walk around their back yard swinging an iPhone that gives you an intermittent view of first their face, then the ground, then the sky.

One would think that this pandemic era would be extremely hard on anyone with preexisting mental health issues, and as plenty of evidence has shown, you would be right. However, I was amazed to learn something new from one of my patients a few weeks ago that made me rethink how empathic I had really been over the last few months. I had asked him how the pandemic had affected his life and if he was more depressed or upset because of it.

“No, Doc, not at all. And you want to know why?”

I did.

“Because now everyone else knows how I feel every single day.”

You see, this man had felt loneliness, social isolation, anxiety about being in close proximity to crowds in stores, fear about getting ill or dying, worry about being able to find and hold a job and pay his bills, lack of transportation, and most of all, the stigma that is associated with an illness that is completely out of his control. He had been living with these very difficult issues for many years. We had just been dealing with them for a few months at most.

“You know, Doc, staying at home, playing with my dog, playing a game on my phone, watching TV, listening to music, it’s not so bad really. It relaxes me.”

Profound words from one of the folks who teach me more than any expensive textbook I ever bought. We have all been forced by the coronavirus to feel what some of our most vulnerable feel and live with every day. We have experienced the social isolation. We are anxious about our health, or jobs, keeping our homes and putting food on our tables. Maybe one positive effect of this pandemic is that we will learn to be just a little more empathic towards our fellows, knowing that only in staying together even as we are apart is the only way we will survive this.

Masks

Masks are the talk of the town lately, are they not? To wear them or not to wear them. Cotton or synthetic. Single layer or multilayer. Inserts or not. Mainstream or rebellious. Republican or Democrat. Individualistic or conformist. Surgical or fashionable. How did a little piece of fabric with ear loops rise to the level of cultural totem for the various groups that see it as medical savior or condemn it as heresy in 2020?

According to Wikipedia, a mask is an object normally worn on the face that may be used for protection, disguise, performance or entertainment. Masks have been used for various purposes since antiquity. The word “mask” appeared in English in the 1530s, from the middle French masque “covering to hide or guard the face”. How have masks been used throughout history? Well, there are funeral masks, life masks, death masks, ceremonial masks, performance masks, ritual masks, religious masks, healing masks, and political masks. Masks may be used in festivals, carnivals, burials, plays, and stories.

Now, all of these are similar, but they differ a bit from the functional masks that have as their purpose the protection of the wearer. We are a bit more familiar with these in the year 2020. There are oxygen masks, surgical masks (including the N95 that has been in the news off and on since March of this year), face shields, and even pocket masks that can be used by a good Samaritan who happens upon someone who needs CPR. Protective masks filter the outside air in some fashion to make it safe for the breather. Other functional masks might include the kind worn by robbers and thieves to keep their identity safe from their victims or security cameras that might capture them as they go about their dastardly deeds. Plague doctors in Europe wore beaked masks that contained herbs in the beak to attempt to ward off the Black Death.

Do you get the point here? Masks have been around for literally thousands of years and have served every purpose from identifying the wearer to hiding his identity to celebrating his life to commemorating his death to punishing him to keeping him healthy. According to Stephen E. Nash writing in Sapiens Anthropology Magazine, the earliest well documented masks came from the arid Judean Desert in the Middle East about 9000 years ago. They may not have been the earliest ones, but they were certainly among the earliest preserved ones. Masks have been important cultural phenomena for thousands of years.

How about the medical aspect of mask wearing, which confronts us now in 2020? A bit of history is informative here as well. A July 27, 2020 piece in The Conversation said that during the 1918 flu pandemic, cities around the world passed mandatory masking orders. In the United States, the American public at that time embraced mask wearing as “an emblem of public spiritedness and discipline”. Mask wearing was widely unpopular in Canada during that time, but was embraced by the public in Japan. To the Japanese, mask wearing symbolized “modernity”. The Japanese continued to wear masks to protect themselves from the flu, and later against SARS and avian influenza. In a country that takes etiquette very seriously, wearing masks has become a form of politeness. Controversies over mask wearing continue in the United States and other countries as well as the coronavirus pandemic rages on. To some, masks represent control, are uncomfortable, unnecessary, and possibly even harmful to their own health. To others, seeing people wearing masks is a tangible reminder that the pandemic is real, and is frightening to them. Some have an “optimism bias” and believe that the coronavirus will not affect them.

The latest advice from the CDC and other groups maintains that the Three W’s (watch your distance, wash your hands and wear a mask when not able to social distance) are still the best way that individuals can protect themselves and others from infection with coronavirus.  Masks have been around for millennia, and they still appear to be one of the easiest and best ways to protect ourselves as we navigate this pandemic. Educate yourself, practice good social hygiene and stay safe out there.

Fake It Until You Make It

I have been talking with friends, family members, and patients over the last several months about our lives in 2020. We continue to try to describe what it feels like for each of us to live in the middle of the biggest pandemic in the last hundred years. We talk about the things that we have all been feeling: the sense of loss, grief over the changes in our normal lives, the lack of social interactions with others, the inability to participate in things that used to give us joy, and the lack of certainty that pervades every aspect of our lives. We talk about how these stressors have changed the way we work, play and interact with others. We talk of the longing for things to get back to the normal, the predictable, and the reassuring. Almost everyone I know feels less confident, less powerful and less able to influence his environment since the start of this pandemic. We have been shrinking into ourselves, staying at home more and shunning the very social interactions that make us fully human.

There is a phrase that I am sure you’ve heard before. Fake it until you make it. This idea probably goes back to at least Alfred Adler in the 1920s. According to Wikipedia, Adler developed a therapeutic technique that he called “acting as if”, which allowed his clients to practice alternative behaviors that would help them to change dysfunctional patterns. You may know this technique by its more modern name still used today, “role play”.  Fake it until you make it leads us to imitate confidence, competence and a positive optimistic mindset until we can actually achieve these things in our real lives.

Wikipedia offers another way to look at this, attributed to William James:

“Action seems to follow feeling, but really action and feeling go together; and by regulating the action, which is under the more direct control of the will, we can indirectly regulate the feeling, which is not.

Thus the sovereign voluntary path to cheerfulness, if our spontaneous cheerfulness be lost, is to sit up cheerfully, to look round cheerfully, and to act and speak as if cheerfulness were already there. If such conduct does not make you soon feel cheerful, nothing else on that occasion can. So to feel brave, act as if we were brave, use all our will to that end, and a courage-fit will very likely replace the fit of fear.”

— William James, “The Gospel of Relaxation”, On Vital Reserves (1922)

Another place that I have recently found reference to this ability to fake it until we make it is in the 2016 TED talk given by Amy Cuddy. In it, she describes how body language visually telegraphs our mood and state of confidence, and how our nonvisuals impact not only those around us, but ourselves as well.

One of her main points in her talk is that we can fake it until we become it, until we can tell ourselves, “I’m really doing this!” Tiny tweaks in our behaviors can lead to big changes in our lives.

We are living in very stressful times. We are dealing on a daily basis with social upheaval, political unrest and the possibility that we might contract a deadly illness. Even without being told, we have felt ourselves shrink from daily encounters with others, decrease our normal social interactions, and forfeit many activities that give us joy. We may not feel overtly afraid, depressed and defeated, but our body language and our actions may telegraph otherwise, both to others and to ourselves.

Can we fake it until we all make it? Yes, I believe we can. Listen to and act on the recommendations by the CDC. Wash your hands. Wear a mask when you leave your home. Observe social distancing recommendations. Be smart about how and when you interact with others both indoors and out. This pandemic is fueled by the spread of a tiny virus that will stop spreading when it is deprived of new hosts. Our behaviors, coupled with the eventual development of viable, effective, safe and reliable vaccines that we all choose to receive, will stop it in its tracks, and this medical nightmare will finally be history. Until then, even if you feel deprived, depressed and distanced from the people and things that make life worth living, fake it until you make it.

Fatigue

Words are interesting, aren’t they? I love to use words to convey meaning, to educate, to enlighten and to try to persuade. We all use words that we are familiar with, that we understand and that are part of our normal vernacular. We get used to these words as ways to express a familiar thought or idea that we hold dear or that comforts us. The interesting thing about the English language is that many of our words have nuanced definitions and can be used to express many similar or related meanings.
Fatigue is one of the words that comes to mind for me lately. When we look to the Merriam Webster Collegiate Dictionary definition of fatigue, we find several aspects of this word that pertain to our current situation as we struggle with pandemic life.
First, a definition that was certainly not top of mind for me. “Manual or menial work, such as the cleaning up of a camp area, performed by military personnel.” There is also a corollary definition that goes with this, being “the uniform or work clothing worn on fatigue and in the field”. Think about many households now as young families struggle with educating their children at home, cooking and eating many more meals at home than usual, and having one or more adults working from home at the same time. This scenario has created home landscapes akin to domestic camp areas, staging areas for vocational, culinary and educational missions that were often outsourced and performed far away from the home just a few months ago. We are constantly “cleaning up the camp area” while wearing the new uniform of 2020, shorts, tees, sweats, and Allbirds, trying our best to be efficient and productive while staying as comfortable and low key as possible. For the most part, I think we are succeeding admirably in spite of all the odds against us.
The second definition is more the traditional one that we think of when we think of fatigue. “Weariness of exhaustion from labor, exertion, or stress.” We have all felt this in one way or another over the last seven months. We are working hard, sometimes in vastly different ways or in different places than we are used to. We are caring for families, our coworkers, and others at the expense of caring for ourselves. Some of us have fallen ill with COVID-19 and that has given an entirely new meaning to fatigue for us. Physical weariness that precludes meaningful activity and productivity wears on one’s body, mind and soul. Even if you want to get up and actively engage the world, sometimes a physical illness like COVID-19 stops you in your tracks and says, “not today”. This fatigue, unlike the camp that can be tidied and cleaned, must be managed until it has passed. It is insidious, long lasting and debilitating.
The third definition that caught my eye was the one describing “a state or attitude of indifference or apathy brought on by overexposure (as to a repeated series of similar events or appeals)”. Now, this definition encompasses several different aspects of our current lives in the time of COVID-19. Not only are we feeling extremely overwhelmed by the pandemic and how it has disrupted our daily lives for months now, but we have been dealing with racial tensions, economic stresses and political dissent and strife as we approach one of the most contentious presidential elections our country has held in our lifetimes. When there were fifteen cases of COVID-19, the threat felt small. When there were one thousand deaths, we felt that this was something terrible. Fifty thousand deaths were almost unfathomable. One hundred thousand deaths were unbelievable. Now, we have had eight million cases of COVID-19 in our country and well over two hundred thousand deaths. We have been seeing and hearing these numbers for so long now, and in such quantities, that we are numb to them. We are fatigued. It is harder and harder to muster compassion, much less hope that things will eventually get better. On top of the ongoing pandemic and its stresses, add the civil unrest, the political intrigues and countless ads on television and in the news, and we are simply bombarded with negativity that further numbs and chastens us.
What to do?
See things as they are. We have already found that one cannot wish away a viral pandemic. It will run its course, relentlessly, until we either achieve immunity overall or we have a workable vaccine. We cannot make the government attend to our financial needs. We have had to be creative to find work and put food on the table. We cannot fix racial unrest and social inequalities overnight. These changes can come, but it will take much time and much work by all.
Limit negative exposure. Keep up with the news, but only in prescribed amounts and at certain times. Constant exposure to negativity and stress will only increase social, emotional and physical fatigue.
Act. Plan. Work. Vote. Talk. Collaborate.

One final definition of fatigue that Webster’s offers us? “The tendency of a material to break under repeated stress.” We do not want to let ourselves get to that point, do we?

COVIDISMS: There’s Got to Be a Morning After

Well, it’s been six months since this hell began for most of us. Life changed about mid-March. The pressures of pandemic life and racial unrest and climate change and monster storms and COVID-19 and political upheaval and all the rest of the plagues that currently beset us are almost too much to bear. Almost. But bear them we do, baring our souls when we need to, our teeth when we must and our hearts, always. As Master Yoda wisely taught us, in times like these, “No! Try not. DO or DO NOT. There is no try.”

Yesterday was the nineteenth anniversary of the brutal terrorist attacks on our country on September 11, 2001. Like many of you, I can remember the exact spot I was sitting in, the exact thing I was doing, the exact sameness of that morning, until someone told us to step into the next room. A group of caregivers, patients, doctors, counselors and family members were glued to the small television on top of the rolling cart, watching in disbelief as a plane hit the World Trade Center. A tragedy. A fluke. An accident. Until it wasn’t. Until another plane took that elegant, sweeping, graceful arc of death into the second tower in a ball of fire and melted glass and metal and a second plane full of people lost their lives in an instant. I listened to some of the phone calls from the planes and the towers last night, against my better judgment, and was absolutely devastated by the sadness, the finality and loss of it all. Lives and families shattered, a city reeling, responders who had been trained to handle anything that could ever happen, except this one thing. No one had ever used planeloads of people as weapons of war. I know that it is not good for me to watch and listen to histories of tragedies such as 9-11 after long weeks of work and stress, especially when I am home alone, but how can I not? How can we not hearken back to that time, that era, that innocence lost for us and for our children? NEVER FORGET.

Today is September 12th, and the thirty sixth birthday of a woman who I admire greatly. (Happy birthday, Greer. I love you!) My oldest daughter, who bears the Scotch feminine form of my first name as her own, has become a force to be reckoned with. (From Houseofnames.com: The old Scottish-Dalriadan name Greer is derived from the given name Gregor. The personal name Gregor, which is the Scottish form of Gregory, is derived from the Latin name “Gregorius” and from the Late Greek name “Gregorios,” which mean alert, watchful, or vigilant.) She is a daughter, a wife, a mother, a friend, a political activist, a party planner extraordinaire, a home schooler, a sister, and aunt and so many other things large and small. As I have written about before, she was performing in a production of Oklahoma! in Augusta, Georgia when 9-11 happened, and was about to celebrate her birthday with friends and family that year. I am quite sure that she has vivid memories of that year as we all do. There was a morning after for Greer, a birthday morning after, and there have been September 12ths every day since that fateful attack. Birthdays must be celebrated, even as losses must be mourned.

My wife has worked for Delta Airlines for forty years. She is very good at her job. She is a people person, remembers details that are lost on most mortals, and can anticipate things that others need before they know they need them. I know, because she does this for me at home all the time. Every time that I see she has left the coffee pot ready to brew the morning coffee for me the day after she leaves for a flight, or manages to fit one more container of that German shower gel I like into her bag on the way home from Frankfurt or fills up the fridge with just the soft drink that I have been craving this week or any number of things, I feel the love that she shows through her actions every day. She has gone back to flying after a voluntary two month furlough. Delta’s business plummeted ninety percent when this pandemic started, and some of her flights have less then three dozen people on them even now. The airline industry will survive, Delta will go on serving the transportation needs of many, but it’s going to be slow going. Some estimates say that the industry as a whole will not be anywhere near back to prepandemic levels of business for four to five years. In this time of COVID-19, political unrest, and commemorations of 9-11, do I worry about her as she flies from Atlanta to Amsterdam to Frankfurt to London to Dublin to Seoul and back again. I would obviously be a liar if I said I didn’t. We don’t dwell on it. It’s her job, it’s been her job for forty years, and she’ll keep doing it for another half dozen or so years and then retire. That is the plan. I believe in the plan. We simply cannot live our lives in fear of terrorists, viruses and world political unrest. We cannot, and we will not.

One cannot be a writer of any kind without reading.

(“Can I be blunt on this subject? If you don’t have time to read, you don’t have the time (or the tools) to write. Simple as that.”
― Stephen King, On Writing: A Memoir of the Craft)

To write, you must get out in the world and experience things that compel you to write and you must read. A lot. Widely. As I age, I find that for some reason my mind takes in the written word better in an audio format than it does by holding physical books or magazines or papers in my hands. Now, I still have stacks of books and reports and papers in every single physical space that I occupy in this life, from the living room to the bedroom to my home office upstairs to my office at the clinic. I pare these down excruciatingly slowly most of the time, and I severely chastise myself regularly for not being more diligent in doing so. Be that as it may, I have loved audiobooks since a physician colleague of mine turned me on to those long cardboard boxes of cassettes that got shipped to me regularly and that I would play in the car on my daily commutes starting back in the eighties. Now, of course, having passed through the cassette and CD phases, the industry is almost purely digital and portable and held conveniently in your phone, computer or tablet. I love this, in that I always have a book or essay or article at hand and there is little excuse for lack of time to read. What do I read? I love political books lately, given our collective angst in that sphere, as well as biographies, novels, and histories. Some of the titles I have enjoyed this year include Me, by Elton John; Leonardo da Vinci, by Walter Isaacson; A Very Stable Genius, by Philip Rucker and Carol Leonnig; You Never Forget Your First: A Biography of George Washington, by Alexis Coe; The Hardest Job in the World, by John Dickerson; Blindness, by Jose Saramago; and Front Row at the Trump Show, by Jonathan Karl. I am currently listening to The Second Mountain, by David Brooks. I also listen to podcasts, mostly on politics, but sometimes on other topics, on a daily basis. The pandemic has caused me to really sit down and evaluate how I use my time, every day, and the results have been eye opening. We waste a lot of time on things that, to use a football metaphor since it is finally fall, do not move the ball down the field. I am trying to rectify that in my own life.

It is Saturday morning as I write this, and football is starting back. I love football, but somehow this year I’m just not feeling it the same way, you know? Life is moving on, and time with it, and traditions and markers too, but things are different. Time will tell if we get back to normal, pre-pandemic normal, ever. One thing I am sure of is that life will go on. We will continue to live and love and work in some fashion, there will be babies born and some of us will die. As my wife and I have been learning by listening to The Great Influenza, by John M. Barry, things are bad now, but they could be orders of magnitude worse. All pandemics end, and the world will continue to turn.

A last thought. There were some good things about the seventies. This song was one of them that pertains to us now, more than ever.

Enjoy your weekend, and thanks as always for reading my Musings.

D Day + 1+ 51

My father died on D Day +1 + 51 years.

It was only fifty three days until he would have celebrated his sixty third birthday.

As many of you know, I have been thinking and writing about his death on and off for years, here and elsewhere. The thought that I might one day outlive my father has never been far from the front of my mind.

Well, tomorrow is the day. Today, September 2nd, is fifty three days from my sixty third birthday.

If I wake up tomorrow, as I certainly plan to do, I will have seen one more sunrise in my life than my father. I will have one more day to live, to love, to work, to play and to think about what is and what might have been, than he had.

What if today had been the last day of my life? I worked at home today seeing patients, as I have been doing for the last half year. I chatted with people by cell phone and on video calls, listening to them and trying to be helpful in the midst of the worst public heath crisis in a hundred years. I electronically prescribed medications that I sincerely hope will help alleviate suffering. I asked after one of my new employees to see how she was doing. At lunchtime I listened to a book about politics, as one does during a presidential election year. After work I took an intense forty five minute bike ride in my neighborhood and along the river with the heat index 106 degrees. I was hot, winded, and soaked at the end of it. It felt good. I felt alive. I missed my wife today, as I always do when she is away on work flights. She sent me a beautiful picture of Germany today, where the temperature and the pandemic are cooler than here in the US. I took delivery of a wonderful set of pastels that she wanted to order for her birthday, which is this Friday. (No, it is not a surprise. One of the pleasures of getting older and having most everything you need is that you can special order your gifts with no shame at all!) I smiled when I saw the box, anticipating the pure joy that these little sticks of color will give her when she holds them in her hand and applies the pigment to the special papers she will use in her art room upstairs.

Did I do enough today? Did I care enough today? Did I get outside my own head, lay aside my own anxieties and worries and needs enough to give of myself to others in a way that would have made my father proud today? Did I learn something new? Did I grow emotionally, spiritually? Did I question my own motives today, vowing to have purer ones if I am given one more tomorrow? Did I care for my physical health? Did I take care of myself in the same way that I am always asking my patients to take care of themselves?  Did I have a good day today, a day that could have been, that could be,  my last?

My wife is convinced and has ordained that I will live until I am  ninety six years old. The odds, not to mention my family genetics, do not support that wish I’m afraid, but I do love to hear her say it. I would love to live ten, twenty, even thirty more years if God grants me that special privilege. There is a lot I want to do. There is a lot I want to experience. There is a lot I want to learn.

Tomorrow, I will have lived one day longer than my father. An accomplishment? No, not at all. A gift. A true gift. A pleasure. A reminder that we are not promised one more day, but that we are allowed over and over again to take possession of that most precious of commodities and choose to use it in any way we wish. We are given the gift of time.

I will wake up tomorrow morning and rejoice in every small muscle twinge, every sleepy yawn, every hunger pang, every emotional surge, every cognitive challenge and every warm sunbeam that graces my aging face. I will rejoice in another day and the simple fact that it has been gifted to me.

Besides, what is my other option? If I die tonight and make it to heaven by morning, I would be greeted by my father, a man who preceded me in death by decades but who would be exactly my age. Somehow, I don’t think even God would find that amusing.

 

Death is nothing at all,
I have only slipped into the next room
I am I and you are you
Whatever we were to each other, that we are still.
Call me by my old familiar name,
Speak to me in the easy way which you always used
Put no difference in your tone,
Wear no forced air of solemnity or sorrow
Laugh as we always laughed at the little jokes we enjoyed together.
Play, smile, think of me, pray for me.
Let my name be ever the household world that it always was,
Let it be spoken without effect, without the trace of shadow on it.
Life means all that it ever meant.
It it the same as it ever was, there is unbroken continuity.
Why should I be out of mind because I am out of sight?
I am waiting for you, for an interval, somewhere very near,
Just around the corner.
All is well. ”

Henry Scott Holland

Things Unseen

You might have heard the stories about how and where Steve Jobs got his design sense and his obsessive attention to detail. Steve’s father Paul Jobs was a good  mechanic with (from his son’s perspective) a decent sense of design. He worked with cars, metal and wood and could build most anything his family needed. Jobs said that his father cared about how things looked, but he cared even more about how the things that were hidden from plain sight looked also. He would never put a flimsy section of plywood on the back of a fine piece of furniture. He would build the back of a fence with the same care that went into the front of that same fence. He cared about the things that were unseen.

Jobs carried that aesthetic into his own work at Apple. He would have rough seams on plastic computer cases sanded and polished. He rejected components that were not precisely made. He wanted employees to sign the inside of some of the computers they made, even though the buyers of those machines would never see the signatures. This was to get them to own and be proud of the quality of the work they were doing.

Today, many of us are working from home. We have set up office space with desks, computers, lights, printers and screens by which we can interview, assess, meet with and deliver services to our patients, customers and coworkers. We spend many hours in front of a glowing screen that is anywhere from five inches to three feet or more across. We are highly visible to the people we work for and with, except for one small detail: the part of us that is unseen.

We are working from the waist, or the mid-chest, up.

I have had several people, when finding out that I do telemedicine from home or office for ninety five per cent of my work nowadays say things like, “Cool! You can go to work in shorts or pajama bottoms or sweatpants! You don’t even have to wear shoes. You can work barefoot!” Yes, that would technically be an option I suppose. Like a television anchorman, you would know what kind of shirt I am partial to (cotton Oxford button down), what kind of ties I wear on the job (NONE!), and possibly a little bit about my taste in jewelry and watches (currently wedding band, Medical College of Georgia senior ring class of 1983, and Apple Watch Series 5 WiFi and cellular capable).

Like Steve Jobs, I believe that the things that are unseen are just as important as those that are. The rest of my working clothes get me into the right frame and state of mind to listen carefully, think clearly and act decisively. You may not see them, but I know I am wearing them everyday, and that makes me feel prepared and ready for whatever the day brings. A nice pair of year round wool slacks, a Hugo Boss or Hanks leather belt, a Bellroy wallet, nice socks from Vermont or (if I’m feeling a little more dressy some mornings) a little mill on the banks of a river in England, and one of my several pairs of Samuel Hubbard shoes. (I am often up and down and on my feet for up to eighteen hours in a day, and I have very unforgiving feet).

So, could I trudge upstairs with a nice fresh Oxford shirt over a pair of khaki shorts and flip flops? Yep, I most certainly could, and no one would ever be the wiser.

Except I don’t. I’m channeling my inner Steve Jobs.

And now, you know.

 

Rhythms

My mother buried her husband this past week, the second man she had to say a tearful goodbye to after her had endured a protracted illness. The first was my father, who passed away suddenly, almost violently, from a brain hemorrhage twenty five years ago. It got me thinking about a lot of things, as these events and times do. I began to think about them in the context of the rhythms that they settle into.

We are born into this world, we hope, the objects of joyful celebration, welcomed to the world with open arms and warm fuzzy blankets and the kootchie-cooing of adoring parents and grandparents. If we are lucky, we are loved. Undeservedly, unequivocally, unabashedly, unconditionally loved. We are cared for and nurtured. We grow and learn and succeed. One day, we head out into the world, adults who know nothing ready to control everything, only to finally realize that our true education has just begun. If we are smart and savvy, we learn even more about how things work, how to live and love in a harsh world that owes us nothing, nothing at all. We create, we procreate, we work, we amass, we collect, we build, we inhabit, we settle in for that delicious part of life which is the “we made it” part. We expect that “we made it” leads to “we earned it” leads to “we deserve it” which gradually morphs into “it will always be this way” and “no one can ever take this away from us”.  The train is heading down the track at a dizzying speed, wheels singing on rails and billows of black smoke trailing behind to darken the other fellow’s sunny skies, not ours. Not ours.

Then, a once in a century, a once in a lifetime event happens for the second, third and fourth time. The hurricane leaves nothing but concrete slab and green slime-infested pool at the edge of a sunny shore that once heard the laughter of children and now hears the wails of retirees who find that their physical address, what is left of it,  has moved over three streets. The lingering siren that warned of the monster heralds a dawn in which the rubble is piled three stories high, the muddied teddy bear and the family album strewn across a neighborhood that no longer has landmarks of any kind after the wrath of the mighty winds visited. A casket is lowered into the ground, a tiny one, and is covered with earth, covering hopes and dreams and sleepovers and play dates and senior proms and trophies that will never be displayed, all because of a stray bullet that was stopped by the innocence of a child.

We are born. We grow. We dream. We work. We love. We die.

The virus creeps in on Sandburg’s little cat feet. Yes, I can’t get that descriptor out of my mind in the past few months because it seems like everything that hits us, hurts us, kills us comes in that way nowadays, gliding on silver airplane wings to knock down buildings, hissed in a a quiet string of expletives designed to hold us down, or breathed quietly towards us, inhaled death. Quiet. Stealthy. Deadly. The rhythm of death.

I’m home. I work every day. I talk to everyone and yet touch no one, shake no hands, pat no one on the back, proffer no gifts except my words. The rhythms of this daily pandemic grind are cold and mocking. Upstairs to work. Listen to music that used to soothe but now just bores. Hear the rumble of the construction workers’ trucks and trailers heading into the area to work. FedEx truck by for the first of one, two or three routes that day, always before ten. UPS truck (What can Brown do for you?) close on his heels before noon. Construction guys to lunch, sans trailers. USPS truck chugging out and back, albeit later than usual these days. Rhythms. The daily grind of good coffee and hard work and tedium and our inexplicable complacency with mediocrity of leadership and one thousand deaths per day.

And yet, we do it.

And we do it again.

And we do it again,

until,

one day,

we understand

why.

The masks come off,

and we smile.