I was talking with my wife the other day about different times in our lives and asked her this question: “What is the period or era in your life that you feel most impacted or influenced you?”

I guess the fact that we have been living through a time of such upheaval in the last year has had me thinking about such things. We have seen the worst medical crisis in one hundred years, political unrest, economic instability for millions and racial tensions that have been escalating and boiling over with the deaths of black men in multiple cities. Now in my early sixties, I am at that point in my life that I know there are fewer years ahead of me than there are behind, and I am trying to make sense of who I really am and why.

I think back to the grammar school years, with the early crushes and football practice and idyllic days of riding bicycles exploring nearby woods on a hot summer day. I remember the many visits to my grandparents. My mother’s parents had a farm in middle Georgia, a wonderful place for a small boy to grow up in the bosom of a loving family. I will never forget finding box turtles in the sandy ditch in front of the farmhouse, swollen with runoff after a monster rain storm. I remember spending hours in the porch swing on the front porch of that same farmhouse, back and forth and back and forth as I traveled in my mind to foreign lands, piloted a plane, captained a ship. Many, many dreams had their origins in that rhythmic motion at the far end of the porch. Butchering hogs, gathering watermelons, fishing at the pond, and taking rides in the back of the old truck to the country store to fetch small paper sacks of candy are indelible memories. Christmases were magic, with the floorboards on Christmas morning so cold that your feet would be numb after jumping out of bed before the gas heaters were lit for the day. Food, so much food, and visits by all the aunts and uncles and cousins, light and laughter and love through the ages.

I have been many places and done many things since that time on the farm as a little boy. I navigated the treacherous waters of the teenage years and high school, went to college, lived overseas with my family in Italy for two years, and then achieved my dream of admission to medical school, with residency to follow. I have had many different groups of friends and associates, professional partners and teachers and mentors. All have shaped me, taught me, buoyed me up and at times torn me down (albeit for my own good, I suppose). I have loved it all. But which time in my life has had the most influence on me, given me the most fuel to move forward, taught me the most about moving through the world and being a productive citizen of the planet?

I think you can see by virtue of the structure of this musing that the time that was most important to me was the early times, the formative times, the times that a young boy learned how to be a teenager then a young man. The time that pulls at the man the most is not the college years, the medical school training time spent in the anatomy lab or the first time I treated a patient on my own as a young doctor. The time that has stuck with me the most is the time that I spent with family before I knew about racism,economics, pandemics or politics.

I have a swing at my house today. It waits at the far end of the front porch, and I sit in it only sporadically. It means a lot to me, not because I spend hours there flying planes or captaining ships and sailing to foreign lands, but because I could do that if I needed to. It is a bookmark in time for me, a stained wood reminder of my past, a clear and present comfort in these uncertain times, a place that I can always retreat to any time I need to feel a connection to those who who have gone before, those who have molded me and shaped me in ways that no other periods in my life could have.

Slow Hand

I did some continuing education this week, the old-fashioned way. I inadvertently signed up for both digital and CD forms of my CME programs from the provider the last time I renewed, and this week’s program arrived as a plastic CD in a paper mailer. Talk about a blast from the past! I have not listened to CDs for this type of education for several years now. I decided that I would use the CD in the car on the way to work, which was just fine.

Now, after one is finished listening to the program, one must complete a post test that is graded for credit. I am also used to doing these online, answering the questions quickly, hitting send and seeing instant feedback of scores and documentation of the completed course. As this particular program was not even showing up on-line yet, I had to (gasp) study the written summary of the material and then (double gasp) take the test on a sheet of paper, filling in those little answer bubbles. Remember those? Then I could either fax the completed form or mail it back the old-fashioned way.(I faxed it)

This whole process, one that I had not used in years, felt awkward, slow and cumbersome. I found myself flashing back to the first time I took my shiny new iPad in the car and FORGOT my beloved iPhone at the house. Both times, I felt like I was cheating on my previous technology.

The positives to this retro CME experience?

It slowed me down. Big time. After listening to the program on the CD, I already had a printed copy of the notes and references for the lectures, whereas before I would have to make the effort to print a copy myself if I did not want to simply read it on my screen. I actually looked some things up, read and re-read them, and could go back and use this printed material to research my answers to the questions.

I was more focused on listening to the program and actually thinking about it somehow.

The testing process felt much more deliberate with the answer sheet and its little bubbles waiting for me to fill them.

Doing this again helped me to think back and remember what learning used to feel like before the age of the internet, podcasts, video lectures, audiobooks and TED talks.

It was not altogether a bad experience.

Which way is better for me personally?

Well, like Marty McFly, I don’t mind going back to a skateboard every once in a while as long as there is a flying DeLorean waiting to take me back home to my waiting Toyota Hilux 4X4 in the garage.

Monkey in the Middle

Keep away.

Monkey in the middle.

Urban Dictionary defines “monkey in the middle” as the person who is in the middle of two fighting sides. This person is friends with both arguing sides and wants to stay neutral but is eventually dragged into the fight, and one of the fighting sides becomes mad at them. 

I will be fifty nine years old next month. I grew up loving to read. I read everything. I was thrilled when the new Scholastic Book Club circular, or anything like it, came home with me, to be lovingly perused and marked up with all the paperback books,  Dell crossword books and dinosaur books that my parents would allow me to order. I was more thrilled when the shipments came in, giving me hours of pleasure like no other activity I enjoyed at the time. I was ecstatic when my parents bought the complete set of the Collier Encyclopedia, complete with annual updates, though I can now come clean and say that I wish they had bought the World Book Encyclopedia instead. Colliers seemed a bit too stodgy to an elementary schooler. 

I simply loved the feel of the page. I loved the color glossy pages. I loved doing crossword puzzle after crossword puzzle. I loved the feel of the spine of a book nestled in my hands, the way new pages stuck together until you riffled them the first time, opening up the whole new world that was hidden in the infinitessimal spaces between the papers. I loved that tipping point that came when you knew by feel, without even looking at the page numbers, that you were just over halfway through a novel, and that it was all down hill from here. A race to the finish, the climax, the denouement, the satisfying completion of a mind journey that could have transported you anywhere in the universe.

I still love to buy books, to keep books, to shelve books that I just know I will read one day (sometimes do, sometimes don’t, let’s be honest). I still like to peruse the colorful pages of magazines, especially when I am tired and just want to kick back and do something familiar, something comfortable, something comforting. 

I am a product of my age, my upbringing, my schooling, the modeling of my parents and mentors and teachers. I am an analog man in an increasingly digital world. 

Now, I love my technology. 

I have bought more iPads that I care to admit to. I have owned every desktop and laptop computer from a Micron to a Dell to an HP to a Radio Shack to Apples. I have lusted after the newest Sony PDA, upgraded to a Treo with a stylus, and was fascinated when I first heard about the marvelous little machine that was to be the first iPhone. “I’ve GOT to have one of those,” I remember saying when seeing the image of the prototype on my laptop screen. I have owned virtually every model of iPhone since 2007. 

I get excited when thinking about moving next month and setting up a new wireless system in the condo. I am already salivating over wireless security systems and what might best serve our needs. I am constantly looking for the next excellent podcast, digital newspaper, newsletter, or blog to read. I love audiobooks. I listen to music on three streaming services, only one of which I actually have to pay for. I watch movies on my iPad, which has more pixels and a much better picture than my widescreen television. 

I am a product of my age. I am a digitally connected man in a world that is watching analog constructs fade slowly into history. 

I am the monkey in the middle. 

I am listening to a fascinating audiobook right now that I would recommend to everyone. The Inevitable, by Kevin Kelly, looks in some detail at where we are headed, and why, in the next three decades. While I do not delude myself into thinking that I will still be around forty or fifty years from now, thirty is definitely doable. I get very excited when I think about the world that my grandchildren will be running, of which I may still be an active, though peripheral, part. The book speaks to the way that society and all its wonderful parts is morphing and continues to change over time, cataloging and saving and curating and dispersing and sharing and annotating knowledge and creativity and thought of every conceivable kind. It also speaks to the generation, MY generation, that finds itself squarely in the middle of two camps, one whose tenets are inscribed on cotton paper, and one whose bits and bytes are blinking and beeping into the future. 

I am friends with both sides. I want to remain neutral. 

It is going to be a fun ride for the next two or three decades, that is certain. I want to keep up, to remain relevant, to learn, to continue to produce and create and to learn to access the new technologies and the new paradigms as they present themselves. I very much want to keep working, to keep helping people through my vocation, to educate myself continually about advances in my field. I want to enjoy music and art and books and the vast amount of information that is the collective knowledge of our increasingly connected world. I do not want to become an old man who is too intimidated to reach out and try something new out of fear or ignorance or apathy. 

I don’t mind being the monkey in the middle, as long as the game of keep away does not turn into a game of dodge ball. 


“How far did you go in school?”

This is a question that I ask every new patient as a matter of course.

Granted, I have gotten some very odd answers, including hearing from a very successful businessman who only finished the seventh grade, or a very psychotic person who has a double master’s degree. Not implausible, but certainly not expected or the mainstream answer from the majority of my patients.

Now, leaving the children aside, most of whom are of course still actively engaged in academic pursuits, what is one of the most common answers to that question that I hear day in and day out?

I’ll give you a minute. Discuss, select a spokesperson for your group, and be prepared to show your work.

The answer is, “I finished.”

Now, if you were me, and you heard that, what would you think?

Depends on your frame of reference, personal experience, your own educational level and your expectations or preconceived notions about the person sitting in front of you. Yes? Do you agree?

The majority of folk who give me that answer, “I finished”, mean that they graduated high school. We could even split that hair further and talk about who got a regular academic diploma, who was on a technical track, or got a certificate of attendance, but that’s not important for this particular post. Fodder for another day.

“I finished.”

Often said with pride, sometimes with hesitation, and sometimes even with a little fear and trepidation.

We often read in our news outlets or see on television, especially in an election year, those who say that the common core is the ticket, others that say we are not setting the bar high enough, and still others who want to abolish the Department of Education all together. I think we all know in our hearts and heads, and can agree, that education, REAL education that can be put to good use in REAL life, is key to longterm success. Many of us know this. We have lived it, studying for years if not decades to learn a trade or skill or profession that will allow us to provide for ourselves, our families, and be active, vibrant members of our communities.

It bothers me, a lot, that many of my patients look towards the age of eighteen and the high school diploma that may come with it as being the pinnacle of their educational experience. Once they are emancipated from their home, and once they walk across that stage and flip their tassel from one side to the other, they really do believe that their education is over. They are not obligated to learn another thing. I believe that they believe that.

How sad to think that before you are even old enough to drink alcohol that you have essentially been taught that you do not have to be taught anymore. That you feel that there is nothing more that really entices you to read, listen, explore, or get your hands dirty in that way that helps you learn something  real that sticks with you far beyond a standardized test.

Life is all about learning. Learning something new every single day that we live. Trying new ideas on for size to see if they fit, and tossing them for others if they don’t. Visiting new places, having new adventures, reading new books, listening to new music, learning a new language, meeting new people who disagree with us, thinking outside the box that we have put the lid on, taped securely shut and put up on the shelf to (not so proudly) display the rest of our lives.

Life is about living, not just existing.

If we convince ourselves otherwise, we are shortchanged and hamstrung, limited and hobbled.

The second you finish learning and experiencing and growing should be the second that you draw your last breath. Who knows, we may even go on learning and experiencing past that point too.

The second you finish learning is the second that you become stagnant.

The second you stop learning, the day you say you have finished, is the day you will die.

There will be time for dying. That time will come for all of us.

For now, living, really living, is the thing that we should strive for.

(Feel free to comment on this post and share your feelings with me and others by visiting me on Facebook (Gregory Smith) or Twitter (@GregSmithMD). I look forward to your thoughts.)

Now I Know My ABCs


So what is the one thing that I see over and over and over again in the management of emergency room psychiatric patients that makes me fear for our survival as a country and even as a species?

Is it the severity of psychotic illness? The rampant drug and alcohol use that starts now when kids are pre-adolescent? Is it the broken families that are producing another generation of children who have one parent or no parents and are raised by distant relatives? Is it financial poverty? Is it reliance on government assistance?

Well, I could write about any of these and make a case for all of them, but that’s not what keeps hitting me right between the eyes most days that I sit in my chair and talk to people via the Polycom screen.

The problem?

Lack of education.

One of my standard questions when taking a medical history is “How far did you go in school?” I ask everyone this question because it is so very important in understanding someone’s frame of reference and their ability to assess a problem and deal with it realistically, be it a kidney stone or an episode of depression. I get answers to this question that are all over the map. I have seen teens who have graduated college already. I see old women who never graduated high school but raised entire families on their own. I see proud aging men who ply their trades, hard workers with calloused hands who had formal schooling up to the third grade and no further. I have seen professionals with decades of formal training and multiple degrees who are as psychotic as they can be, completely out of touch with reality due to drug use or mental illness.

Two things come to mind here of course. One is that mental illness is no respecter of educational level. I have written about this before and I will write more about it I’m sure. The other is that many people do not see the need, or are not given the opportunity, to further their education beyond the very minimal level that gets them by in the world.

This is not a prescription for growing a strong, healthy society.

Often, the answer to my question about education, “How far did you go in school?”, is answered exactly like this:

“All the way.”

That person almost always means that they finished high school.

In many parts of our society, and among many sociocultural levels, finishing high school is the ultimate achievement. The peak. The Holy Grail. You are expected to make that level of education and then to get out, find a job, make your own living and support yourself in the world. Many of the families I see are more than happy to kick their kids out of the front door and onto the street the minute, the second they turn eighteen, never thinking twice about it. The problem is that economic considerations, lack of parenting, lack of role models, early drug and alcohol use, the necessity of working to help support the family and other issues get in the way and take precedence over getting a good education. Kids are passed to get them out of one classroom and into another to avoid further negative behavior. They are still socially promoted, something that might eventually get them a degree but that might be worse than useless to someone who cannot read, problem solve or think critically.

When one thinks nowadays that getting a high school degree is going “all the way”, educationally speaking,  then we have a real problem. There are many other countries (Japan, China, and India immediately leaping to mind) who are producing generations of kids who are hungry to gobble up degrees from our colleges and universities and take high-level and high-paying jobs that Americans are not aspiring to at all any more. It is a sad state of affairs indeed.

It breaks my heart to see a hardworking middle aged man, my own age, in the emergency room, who has a third grade education and is embarrassed to tell me that he cannot read or write.

We have become a nation of people who value smart phones more than we value smart people.

I know that mental illness is a strange beast, hard to ferret out and even harder to diagnose and treat some times. I know that its causes and precipitants are multiple, some genetic, some economic, some cultural. I know all this. I also know, as surely as I know my own name, that if we do not pay attention to the education of our society in America, and our society globally, that we are going to slowly slide down the slippery slope of ignorance, class warfare and division that will be the end of us.

We must turn this around.

We must make it a priority, starting now, to educate our children.  We must teach them to see things as they are, think critically about problems, think creatively about solutions, invent new wonders, and leave the world a better place than they found it.

This is not a luxury for us in the twenty-first century. It is a necessity.