D Day +1 +1

D Day has come and gone once again, and we have remembered. It is a time to look forward as well as backward, as I wrote about this morning on my other blog, Musings.

I have another personal anniversary that I do not celebrate every year, but I do pause to remember and honor. My father died one year and one day after the fiftieth anniversary of D Day. Now, you might think this is an odd way to remember the date of your father’s death, but I love history, and the two just sort of go hand in hand for me.

My dad was sixty two when he died of a sudden cerebral aneurysm. He would have been sixty three on July 30th, had he lived. As I have previously written, I will celebrate my sixty second birthday this October 24th. Lord willing.

This year will prove to be a challenging one for me emotionally. It is hard to explain what it feels like to outlive one’s parent. (Again, I am being very optimistic and taking liberties here, assuming that I will!) I remember vividly seeing my grandmother sitting down at the funeral home at my dad’s service, making the statement that it was very unnatural to outlive one’s own child. There is a natural order to the world and to the greater universe that we all take for granted. You are born, you live, you may be blessed with children and grandchildren, you teach them to care for themselves and the planet, and then one day you make your exit in good time, as it should be. None of us, so far, has escaped that ultimate fate.

I fully expected to see my parents live to ripe old ages, well into their nineties and beyond. My mother is still working on that, thank God. She will be eighty four next month, and she is a young octogenarian at that! My father’s fate was different. He was cut down by a physical abnormality that no one saw coming, at a very early age. He had just retired, was trying to do other things to stay active and busy and was trying to find a “new groove”. It was not fair, of course, but what about life is, really?

I am happy, busy, working, writing, reading, hiking, traveling, driving, visiting with family and friends, planning vacations (Japan in October!) and assuming that life will go on, if not forever, then for a few decades to come. My wife adamantly and confidently predicts, no, commands, that I will live until I am ninety six. She also commands that she will exit this life first, but I think we both know that the odds of that are slim to none. I am reminded of that scene in the John Adams miniseries when President Adams is at his wife’s bedside in her last moments. “I can’t believe I am going first”, she says, resigned to the fact that she will leave her husband, who loved her dearly, behind.

I do not want to merely be somber and sad as I think on these things in this space in the coming year. No, I am realistic as I grow older, but I am also wishing with all my might that I might have the thirty four more years that my dear wife promises me (maybe she has God’s ear or some other inside track not known to me?) so that I can love her, my children and grandchildren and this life that I have been blessed with with all my heart and soul and mind and body.

Yes, that is the goal, my friends.

To live long, if that is possible.

To live and love well, as long as one is given to do so.

Easter Eggs

There are these little pieces of code or images or popup surprises that sometimes lurk in the nether regions of a computer program or DVD or computer game. If you are not aware of them, or do not know to look for them, you may never see them. The programmers that put them there know they are there and they are happy just knowing that, whether you ever find them or not. It’s like an inside joke for geeks. Sometimes the benevolent geeks leave little direct or indirect clues to help you get at these surprises, and what fun that is when you get there! Sometimes you are on your own and may never find them. You still enjoy the game, but not the secret.

These little hidden jewels are called Easter eggs.

Now, you may be celebrating the Easter holiday today or you may not be. That’s your thing, not mine. Easter, the religious holiday, is about atonement, redemption, dying to the old and arising again to start anew. A religious reset button for the game of life, if you will allow me to extend the metaphor.

Children all over have been furiously hunting for Easter eggs, getting baskets full of pink plastic straw and chocolate bunnies wrapped in golden foil and jelly beans galore. It’s a serious religious holiday, more impactful than Christmas if you are a believer, as commercial as Halloween if you are not.

What I want you to think about are those hidden Easter eggs. Not in the grass behind the shed. Not in the computer game that came in the colorful DVD package.

The Easter eggs that are hidden in our daily lives.

I got home about one AM this morning after a long telepsychiatry shift. As I walked into the downstairs bedroom and deposited my stuff and got ready for sleep, I could see that my wife had left a little card on the bed where I usually shed my clothes. It was a little German card, with bunnies wearing golden crowns and Happy Easter Holidays in German on the front. A sweet note graced the inside.

I (and one of the nurses who works with me) got another unexpected card at work the other day from the sister of a long time patient whom we had helped to secure and maintain her United States citizenship. It was sweet, heartfelt and expressed the kind of thanks that does not have to be documented formally but that warms your heart and makes you feel good pretty much forever after you get it. We had done only a little for her, but she was so grateful to us.

I got a phone call the other day, right out of the blue, with good news that was as unexpected as it was wonderful.

Easter eggs.

They are hidden everywhere. No, you don’t have to look for them or even see them at all. Your life can be rich and rewarding without them. You can live your life, be happy and be quite comfortable never having seen one.

But that day that one of those little surprises pops into your life, unexpected, refreshing, wonderful, can be one of the best days you’ve ever had, maybe one of many best days if you become more attuned to the hidden mysteries that surround you.

I hope you enjoy your Easter holiday if you celebrate. Even if you don’t, I hope that as spring settles in and stays with us that you will pay attention, look for the clues that the Programmer puts in your path, and that every once in a while an Easter egg will provide you with that true, unbridled joy that makes this life worth living.

 

Balance

There have been a lot of reasons to think about the past in the last few weeks and months. We have lost music legends, astronauts, family members, friends, and some might argue that we as a nation have just lost our innocence and are in for the ride of our lives beginning in January 2017. At any rate, I think that all of us have had to deal with some kind of loss recently, and that tends to make us look back. Sometimes fondly, sometimes sorrowfully, sometimes with malice in our hearts and venom on our tongues.

But look back we do. We can’t help it. We are drawn to history, the fascination of it, the mystery of it, the supposed good old days that we are always wishing for but can never seem to find.

I love history. I love reading biographies of great men and women and trying to figure out how they did it, how they kept it all together, how they made their marks on this world. I love reading about grand armies and governments and founding fathers and technology breakthroughs and all of it. I love to look back.

Funny thing is, the older I get, the more I see that my looking back is taking away time from my looking forward to what is left to me. Time. Experiences. People. Loves. Challenges.

There has to be a balance. How do we find out just what that balance is? How do we differentiate between studying,  learning from and enjoying the stories of the past from looking to, living for, and planning for the future?

I am starting to build a framework for this level of analysis for myself, and I thought I would share it with you. It’s a work in progress, and it may not fit your own personal framework for looking at the world at all. That’s okay. If it spurs contemplation, then I’ve done my job for this evening and you may take it from there.

I am looking at the progression from birth to death, and the associated looking back versus looking ahead, as a series of dichotomies.

Sadness versus Joy

We have all lost friends and family members, and we have endured changing relationships, shifting alliances, and the loss of stepping-stones, milestones and cultural icons. When these losses occur, we are sad. Why? Because we have lost the familiar, the bedrock of our lives that has always anchored us. We have lost our foundation, and that feeling that we are standing on shifting sand and trying to maintain our balance is not a good one. For me personally, and for many of you I wager, we also start to feel that we are moving ever more rapidly along that continuum of generations, that we are becoming the older generation much faster than we expected to. We get the feeling that, by default, barring miracles, we are next. We have lost our youth, no matter how valiantly we try to hold onto it.

Is there joy in this state? Yes! Knowledge and wisdom (they are not the same) increase as we age. Generativity becomes almost second nature. We begin to realize that the memory of these people, places and experiences will never be taken away from us (notwithstanding the development of dementias and the like), no matter how many losses stack one atop the other over the years. We begin to realize that we are all a very small part of a very large rushing river of time, and how awesome it is to have even existed and been here at all. We begin to develop a sense of unity with something much larger, and much more intricate, than ourselves.

Grief versus Hope

We have all experienced grief. We know what it feels like to lose a pet, a teenaged beau, a friend, a parent, a spouse, a sibling. We begin, as we age, not to just deal with the loss of others, but to deal with the loss of ourselves. Our physical stamina lessens, our sexuality, dexterity, eyesight, hearing, all begin to change and often not for the better. We lose friends, jobs, responsibilities. We are acutely aware that with the passing of each dear friend or loved one, that we could possibly be next. We come to understand in a very real way that we will all die. None of us escapes.

Hope in all this? Of course! Hope that we learn by losing that we need to fully and deeply experience our ongoing relationships, job duties, and activities each day to the maximum degree possible, given time and circumstance and motivation. There is hope in that with each passing there is new life, new birth and a renewal that we may make a part of ourselves. We are making impressions on others all the time, and we have more influence over how the world around us is experienced by others that we often give ourselves credit for. In a very real sense, the way we live on in the future is directly proportional to how much we give in the present, how invested we are in our own lives.

Acceptance versus Anticipation

Do we simply accept that we get slower, more overweight, mentally dulled, boring or incapable of learning just because we are closer to the death part of the graph than the birth part? Of course not. Do we accept that deaths and losses define us, put us in a perpetual state of sadness from which we can never recover? Do we get lulled into thinking that the last half of life is not supposed to be as fun, stimulating or challenging as the first? Do we look back at the past and mutter to ourselves that this is the best it is ever going to be?

If so we can learn to better anticipate what is coming. We can train ourselves to seek out new ways of doing the same old things, to learn new skills and to look for trends that will likely affect us as we age. We cannot predict the future, but we will have a pretty good idea based  on those lessons learned from the past what is likely to trend as time goes on, and rise to meet it instead of having it crash over us like a wave.

Retention versus Sharing

There is a tendency, is there not, to circle the wagons, load the guns and pray when things look bleak around us. When we see that things are getting tight, that there is not enough, then we gather our stuff to ourselves (be it money, time, expertise, ideas, or energy) and retain as much of it as we can for as long as we can. We feel satisfied that if we can just hang on to everything that we will be okay. We look to the past, to the things that we have always had and the way things have always been. We close our eyes tightly and hope that when we open them that nothing will have changed at all. This is folly.

Paradoxically, as we age and mature, we find that this is the wrong approach all together. Gathering everyone and everything we love to ourselves and holding on as tight as we can guarantees control in the short-term, but in the long-term it is suffocating and stifling and leads to an artificial sense of safety. Sharing our time, talents, expertise, money and our own physical presence is so much more satisfying. Giving to others, hearing of the experiences of others away from us is more enlightening and instructive to us than holding onto old patterns and ways.

Control versus Freedom

Control. I often feel that I have it, don’t you? If things make it onto my calendar or my to do list, then they exist, they are real, and I can manipulate them. They will happen as I want them to happen, when I want them to happen. Today, next week, next month, next year. If I choose a path to take or a project to finish, it will be so. I run my life. So it is that I get up every day, or I used to, and tell myself that. It only took one course in college that I almost flunked (after making all A’s my entire life up to that point), one out-of-control clinic day that shot my perfect schedule all to hell and back, one sudden death of someone I thought would always be around, to show me, brutally convince me, that I have very little actual control over my life. I control the store front, the façade, the window dressing. My actual life, the things that happen around me and to me and inside me, are wild and untamable and uncontrollable by me or anyone else.

How wonderful then, how absolutely marvelous, to experience the freedom that comes with letting go the need to control our own lives. I’m talking about the big picture here. I know that I do still have some control over my choice of life partner, what kind of work I will do and when I will do it. But control over life in the grand sense, in the overall scheme of things? None of us have that. We cannot repeat or redo past events, no matter how we’d like to. We cannot fully atone for past mistakes. (Now, before you get started, please understand that these are philosophical ramblings, not religiously based ideas that need fleshing out. That is the job of my friends who are ministers or who are in seminary) We certainly cannot control events that have already happened. If we cannot even control these events from the past that we already know about, how can we delude ourselves into thinking that we have any modicum of control over future happenings that we have no inkling of yet?

I can plan ahead all I want, but I must stay flexible.

I can chart my own course, but I must be willing to change directions.

I can maintain a sense of personal values, religious beliefs, political positions and the like, but I must be willing and able to pivot.

The moment you give up the need and the drive to control and the artificial sense of power and influence that comes with it, that, my friends, is the moment that you are truly free.

Loss versus Accumulation

I think back on my life, and through a certain kind of filter, what do I see? A long, seemingly never-ending string of losses. My own personal trail of tears. Childhood. Innocence. My father. Teachers. Mentors. Bosses. Classmates. Relationships. Loss upon loss, rapidly escalating as I age. Loss portends diminishing returns, decreasing value, shrinking assets, and the very real sense that we are rapidly fading away to a state of irrelevance and obsolescence. The past is slipping away-or is it?

Each loss, though acutely and immensely painful at the time, adds to our overall life experience. The richness of life is increased not just by our acquisitions, not just by our successes, but by our losses and our abject failures. Our reaction to loss, our adaptation to it, the way we decide to go on in spite of it, is what makes us stronger. We accumulate memories, experiences, emotions, and bonds that inform our daily lives, sometimes imperceptibly but always actively. Our present is informed by our past. How could it not be?

We should not carry our past losses and sadness as baggage too heavy to bear, but we should wear our past lessons as a bright garment woven with the golden thread of love and experience. Only then will we be able to feel hope in the face of transition.

Frustration versus Calm

If only I had…

If only she had…

I tried over and over to…

I told you so…

I get so frustrated when…

I should have…

I would have…

I could have…

I wish…

I look back at all those times, and I know, I really know, that I did the best I could with the skills I had, the information I had at the time, the temperament that I possessed, and the logic and reasoning that I could bring to bear on each situation that frustrated me so.

I will not get do overs.

I can’t blame myself.

Today is already here and tomorrow is coming fast.

Hanging on to frustration will not make me any more ready to face tomorrow, my task at hand.

If I remain calm, I have a chance to get it right this time. I truly believe that, and you should too.

Idealization versus Deglamorization

Like many of us, I have a tendency to look back at the past and see it as an idyllic time, a perfect time, a joyous and stress-free time. “The good old days” were not always that, I’m afraid. Life was simpler, yes, we were not so materialistic, we were not plagued by the double-edged burdens of technology, and we always seemed to have enough. I do not remember arguments about gender, who was going to use which bathroom and who could or could not get married or serve in the military. Politics seemed simpler. (I know, I know, they were just as bad then as now…) There were the good people and the bad people, and as long as you stayed away from the latter you were safe. There were wars to be fought, to be sure, but they were against real, flesh and blood enemies with different uniforms and the conflicts were winnable. We expected to win, every time. It was a simple time, right?

No.

Stop.

Not true.

Remembering and learning from the past is fine, but all was far from perfect in those idyllic times of our youth. All it takes is listening to a book like Churchill’s The History of the English-Speaking Peoples to realize that we have always treated each other very badly, we have always killed each other and plundered and raped and stolen and intrigued and schemed. We are human, and we have always been human. I don’t expect that part of the great flowing river of time and history to change that much over the next few thousand years.

Looking at the present for what it is and moving forward with the intention of improving it is admirable. Stripping away the glitz and the glitter of fond memories may not be the most comforting thing to do, but it is the way to lean into tomorrow with an attitude that will get you through the day.

Blaming versus Acceptance

One of the main things that we do in the twenty-first century to justify our anger, frustration, and angst is to blame others for our circumstances. We’re too fat, too thin, too rich, too poor, too black, too white, too liberal, too conservative. You name it, whatever it is, we can find someone to blame for it. Our sense of entitlement is so bloated these says that we think someone else is bound to be responsible for the state we find ourselves in, and we could have no direct responsibility for it ourselves, could we? Furthermore someone else must do the hard work of fixing the problem, whatever it might be. I have to say this, and I hope you know what I mean.

History is an enlightening teacher, but she does not grant absolution.

In order to balance our love for, allegiance to, and fascination with the past with our need to survive and thrive in the present world, we must accept our current state. We must make peace with our history, embrace our present, and faithfully welcome our future.

I really think that is the crux of it.

We must forgive ourselves and others.

We must own our own actions, including our mistakes.

We must take responsibility for our words, our plans and our interactions.

If we can do this in the present, taking cues and learning lessons from the past, only then can we positively and confidently face tomorrow. Getting lost in a dusty past or hiding from an unknown future will not work.

We have life to live.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Old Flame

I listened to a Planet Money podcast, Episode #740, this week. Burnout dealt with the origin and characteristics of burnout, and I would highly recommend it.

You’ve all heard the term and have a vague knowledge of what burnout is, I’m sure. You may have experienced it yourself. It affects call center employees (as in the podcast), all sorts of service workers, doctors and other healthcare providers and countess others.

Looking back on it, I have experienced various degrees of burnout several times in my career in medicine. The symptoms I have fought with, sometimes silently, have included extreme fatigue, emotional withdrawal, disinterest, lack of a sense of purpose, lack of motivation, lack of joy, and decreased participation in enjoyable activities.

I was not depressed. One does not have to be clinically depressed to be burned out. I was simply existing, performing my various tasks and duties day in and day out with little sense of accomplishment or joy. I did not take to my bed for days or weeks at a time, I did not stop eating, and I was not physically ill in the strictest sense of the word.

It was also not directly or solely related to the number of hours I was working at the time. Lord knows there were times during my residency and moonlighting days that it felt like all I did was work, but I was not burned out. Not yet.  It was not related to the difficulty of the work being done. Even now, I average from 60-65 hours of work many weeks, and yet I have never been happier than I am right now.

What are some possible causes of burnout in medicine, or in other areas of endeavor, today?

We are living in an age of marked increases in bureaucracy, regulation, paperwork, and attention to electronic detail like no previous time in the history of work.

We are engaged in mindless busy work, often related to the changes above, that keeps us maddeningly active but leading to much less focus on what is important or even expedient. I have often told my staff that I look for efficiency of process, yes, but that much more important to me is evidence of efficacy in treatment. Both are necessary. I just happen to think that the latter is more important to the wellbeing of the patient.

We are often caught not seeing the forest for the millions of trees before us. In fact, we are now forced to look at so any trees, branches of trees, groves of trees, leaves on those trees, that we have almost completely forgotten what the concept of a forest as a whole is. We have lost sight of what is truly important. We can no longer focus on one paramount outcome or goal, because there are myriad concerns and regulations and rules and reports that must be completed on time, every time, to satisfy someone’s lust for minutiae.

Then there is the firehose phenomenon. No matter how thirsty one is, it is extremely difficult to drink from a fully opened and gushing firehose. We may start out our careers thirsting for knowledge, new skills and professional fulfillment, and even joy in our work, only to be drowned by the sheer volume of information, change, and regulation in our twenty-first century world. This is akin to emotional, intellectual and professional waterboarding, and we now know just how effective that technique really is.

So, all that being said, what works for me when I feel myself sliding towards burnout? I am almost ready to start my seventh decade of life, and there is one thing that has never failed me yet.

Stories.

When I get tired, overwhelmed, bored, or burned out, I have to tell myself, consciously sometimes, to go back to the basics. In medical school, I learned to solicit information by listening to stories. Stories from professors, mentors, and supervisors. Stories from patients, families, spouses, siblings, children and parents. Stories from courts, judges, attorneys and guardians ad litem. Stories from case reports, textbooks, “pot cases” in pathology (ask me about that another day), and grand rounds presentations.

My professional life, indeed most of my life in general, has been built on stories.

When I am sad, tired, fatigued, upset, feeling sorry for myself or feel that I have lost my way, I hit the reset button in my brain. I try to stop over thinking, worrying, obsessing, catastrophizing, planning, scheming, and controlling.

I listen to a good audiobook (or two). Churchill’s The History of the English Speaking Peoples and David McCullough’s The Wright Brothers are my current guiding stars. Oh, and I really listen to them. No multitasking allowed.

I go back to really listening to the stories of my patients. The happy, sad, terrible, frightening, terrifying, disgusting, off-putting, affirming, enlightening, and uplifting ones. All of them. I approach each patient encounter as an opportunity, and in fact a privilege,  to hear a new life story and do something about it. Just today, as I was writing the outline of this post, I resolved that I would start each patient visit this afternoon with the phrase, “Tell me your story.” I did just that. That little change in how I started my interview of my patients today made a world of difference in how I approached my job.

I listen to the stories of my grandchildren. What stories they can tell, long ones and short ones and one sentence ones and multi-paragraph ones about their bedrooms in their new house and their dogs, and their new baby sister, and Power Rangers. On one recent visit, it was so refreshing to accept my almost three-year-old granddaughter’s invitation to go up to her bedroom, lie down on the floor, and have her give me a running commentary on the recent activities of every Disney princess she and her siblings own.

I listen to the stories my love, who is now my wife of thirteen days, brings to our conversations. It doesn’t matter whether they are common stories we share from our teen years in Rome, Georgia, our recent travels to Europe, hiking in the mountains, or some of her trials and tribulations aboard an Airbus at thirty thousand feet over the Atlantic. They are words that connect us, that forge a strengthening bond that is one of the most cherished ones I have at this point in my life.

Life, my life, your life, is a story.

Mine began in Rome, Georgia, on October 24, 1957. I do not know when it will end.

I do know that it will continue to be a rich tapestry of work, play, disappointment, fear, exhilaration, wonder, challenge, and love. If I continue to actively write my own story, every day, being fully present in it, and listen to  the stories of others all around me,  I will continue to live life to the fullest.

Burnout is not the normal, or desirable, state of things.

Fire, as we have recently seen, can destroy and consume.

It can also light our path forward and keep us from falling headlong into the darkness of despair.

 

Things

Things that can happen:

You can choose to be happy for the rest of your life. (Pick this one. Pick this one!)

You can  look for a soul mate, a kindred spirit to share your happy life with. ( I did not say that you were guaranteed to find them, but I can guarantee you won’t if you don’t get out there and look.)

You can share your happiness with others who are less fortunate than you. (Go read about Mother Teresa.)

You can live your life knowing you did the best you could with what you had. (Quit wanting what everybody else has. You don’t need it, and they probably don’t either.) 

You can leave this world a better place than it was when you got here. (That will not be a high bar, given the way the world is headed today…)

You can promise yourself that you will never feel guilty for a decision well-made. (Unless you are a good Catholic. Then, I give you a pass.)

You can make every effort to make good decisions. (You are reading this blog post. Great start!)

All of these you have direct control over. You can make them happen

Things that could happen:
You could fade into obscurity, and no one will even notice that you’re gone. (Are you kidding me? Have you heard of credit bureaus? The IRS?)

You could succumb to loneliness. (Not very likely that loneliness alone would kill you, but folks have tried…)

You could end up isolated like Howard Hughes, your Spruce Goose on the ground and your pee in a bottle. (Who wants that?)

You could become disconnected from every family member and every friend and every acquaintance you’ve ever had in this world and nobody would ever call you, ever. (Don’t you owe anybody money?) 

You could lose your ability to play the piano. (Oh? You never could play the piano? Skip this one, please.)

You could get depressed. Yes, this is a real one, folks. (I’m a shrink, remember?)

You could become completely and permanently disabled. (Do you know how many people come to my office trying to make me think that they are permanently disabled? Do you know how much work it takes to establish that you are truly disabled? See what I did there?)

You could fade into utter irrelevance, loved by few and remembered by none, a mere drop of ink on the rolled parchment of history. (Oh, good grief. Get over yourself, for Pete’s sake!)

Now, all of these you have very little control over, but really, how likely are any of these? If they happen, take action!


Things that will likely happen
You will have some kind of illness sometime in your life. It may be small. It may be metastatic cancer. You will go to the doctor, get that sucker diagnosed and treat the hell out it until you beat it or it beats you. Got it?

You will lose people that you love. We’ve all been there. A spouse. A sibling. A parent. A child. A favorite teacher. A mentor. 

You will be able to do the things at forty or fifty that you did at twenty, just a lot slower. (Thanks Marshall Rice, for that observation.)

You will not be able to do some of the things at seventy or eighty that you did at twenty. (I know, I know, my brain thinks it’s still twenty too, but one day my body will be way, way behind it.)

You will question who you are, why you are here, and if you are doing any good on this earth. (Go back up to the first group, read them again, and read about Mother Teresa like I told you to. You didn’t do it the first time, did you?)

You will have a crisis of faith. (What? You think you’re the only person who has ever had a deep thought, who questioned religion, life’s meaning and purpose and the existence of God? Again, after you read about Mother Teresa, please go get over yourself, then come back and finish this.)

Once again, all of these may not happen to you, but most of them will. No control here, just reaction and pushing ahead

Things that will happen to us all:
We will learn how very lucky we have been to be alive at this particular time, in this particular place, with our particular people. 

We will make our peace with God, as we have come to understand Him.

We will forgive, and we will pursue forgiveness. 

We will pass along the big and small things that we have learned to those that come after us. (They do listen and learn from us, even though sometimes we think they never hear a word we say.)

We will say our goodbyes, given the chance. 

We will be truly thankful.

We will die.

All of us, every one of us, will die. 

Now, I know that the world has been a very stressful place lately. I, like you, grieve for the loss of life, the loss of love and the chaos that is our modern world. I try to deal with it through writing and working and traveling and hiking and loving. 

Some of you deal with it in other ways. That’s okay. 

But I want to ask you just one thing, friends.

Given the things that can happen, could happen, will likely happen, and will happen, where do you suppose you ought to put your time, effort and attention today? 

Think about that, please, and live the best life you can with what you have. 

Peace. 

Same Time Next Year

You may be familiar with the 1978 movie Same Time Next Year, starring Alan Alda and Ellen Burstyn. In 1951, at a small California inn, George (Alan Alda) and Doris (Ellen Burstyn) have an affair. Instead of writing it off as a one-night stand, the pair decide to meet at the inn every year for a romantic retreat, away from their respective spouses and families. In the decades that follow, both George and Doris face their own personal struggles and hardships, and together they develop a level of love and intimacy that exceeds the ones found in their own marriages.

I don’t remember how I was first introduced to this movie, as it’s not the kind I would usually watch. However, watch it I did, and every once in a while I think about it, and even watch it again. It deals with love, loss, change, personality, attraction, conflict, intimacy, trust, and commitment, looking at all of these things in the context of shifting social mores and political upheaval and the effects of aging on relationships. 

There is a subset of patients in my mental health center practice who are stable, have finished with their psychotherapy or groups or other interventions and basically only need to see the doctor and the nurse every so often to make sure that they remain in good health emotionally. This is a medication management program, and it’s mostly a private practice type model. When patients enter this follow up program, they see their nurse once every three months, and the doctor once per year. 

Now, I follow this protocol most of the time, as I should for these patients, but I have always had a little twinge of regret when we transition folks over to that model of treatment. Instead of seeing them once a month or quarterly or even twice a year, I see them today and then roughly the same time next year. I wish them well, hope that they don’t have any major problems in between, and assure them that I am always here if they need me in between those yearly appointments. They rarely do. 

As seen in the movie, a lot can happen in a year. 

People change. 

They wear different clothes or get their hair styled differently, or they lose fifteen pounds or gain thirty pounds. 

They get married or divorced, they have children, they lose children, or they graduate college. 

They beat an alcohol problem, or they find that they have  metastatic lung cancer. 

When my patients and I see each other for those yearly appointments, we assume that all will be well for both of us, and that we will see each other again the same time next year. We assume that things will not change. 

A lot can happen in a year.

Things do change. 

People are murdered in churches.

People are gunned down in dance clubs

We all change. 

We plan for the future, near and far, and we always assume that next year will come, that we will be here to greet it, that the ones we love will be with us, and the world will still make sense. 

Sometimes that happens.

Sometimes it doesn’t. 

We will always remember the Charleston Nine.

We will always remember Orlando. 

You’ll keep doing what you do.

I’ll keep doing what I do.

With any luck at all, we’ll plan to meet right back here, same time next year. 

The Gift That Keeps on Giving

So, Muhammad Ali died at age seventy four yesterday, after a thirty year struggle with Parkinson’s Disease. 

Who can forget “Float like a butterfly, sting like a bee”? 

Who can forget those iconic still photographs of him, poised above a fallen opponent, gloved fist locked in follow through, face set in stone, defiant, confident, supremely confident. 

The Greatest. 

He follows a long list of others into death, figures who peopled my childhood and teenaged world. People I looked up to, tried to emulate, some I never understood, some I knew were crazy, some who we all knew were superstars. 

Robin Williams, Glenn Frey, Prince, Ronald Reagan, David Bowie, on and on. Political figures, business men and women, pop stars, entertainers, scientists, soldiers, presidents. 

Some of us are entering that age where death is the gift that keeps on giving. We are not old ourselves yet, though we are certainly squarely middle-aged no matter how you define that phase of life. We are losing people, daily it seems, though we know that is not quite true. We are losing our icons, our heroes, our role models. 

I was at my allergist’s office this week for a routine follow up appointment for a mild chronic condition that I live with. 

“How’s it going?” he asked. 

“I’m 85-90% better,” I replied, smiling. 

“I want you at 100%,” he said. 

“That’s not possible and you know it. I’m happy with 90%” I said.

He sighed, recorded my responses on his record, then moved on.

“I can give you that TDAP shot today if you want,” he said.

“You don’t think I’ll have some God-awful reaction to it and die, do you?” I asked, only half kidding.

“Of course not. No worries. You can get it while you’re here. Done.” 

“Okay,” I said.

“Oh, have you had the Pneumovax?” he asked.

“No, I’ve been getting the flu shot for several years now, since I’m around patients all the time, but I haven’t had the pneumonia shot yet.”

“Well, you’re going to need that by about sixty, I think. And the shingles shot, definitely that one. Maybe that one can wait until you’re sixty-five, but you’ll want that one. And by seventy, you’ll need…” 

It hit me like a ton of bricks. 

“I don’t want to have this conversation,” I said, smiling wryly. 

He looked up.

“I don’t even feel like I’m fifty-eight almost fifty-nine, much less sixty or sixty five or seventy. I don’t want to think about that yet,” I said, knowing full well that I would have to, needed to if I was going to give myself the best shot I had to live to ninety and beyond.

“I know, I know,” he said, smiling back at me. “The brain never thinks that it’s aging, but the body feels it.” 

“Okay, give me the TDAP today, and the rest we’ll think about when it’s time,” I said. 

“Deal.”

We put off this dance with age as long as we can. Like Ali, we weave and bob and float and dance, thinking that if we never stand still, that if we keep moving that aging and death will never find us. They will always be one step behind us. 

Our brains, being the smartest part of us, the part that thinks and reasons and also tries to keep the worst news from us, because it loves the rest of us, of course, knows the truth. It knows that the little lapses in memory are normal but that they will get worse as we age. It knows that the aches and pains and twinges and stiffness are part of the package too, and that we cannot keep them away forever. It knows that a sixty year old only gets about 20% of the light to his retinas that a twenty year old gets. Our brain knows about cataracts and dry skin and thinning hair and loss of muscle mass and dismissed strength. It knows about loss of balance. It knows about falls. It knows. 

I have been writing and thinking a lot about death lately, and I apologize for that. You, my readers, probably come  here to read something funny, something enlightening, something that challenges you to think. I will write more of that, I promise. My little black Moleskine has pages of unwritten ideas yet to be tapped, so no worries there. 

However, as the icons of our childhood fade and join that long line of ancestors and historical figures who lead backward into history, we know that it is our responsibility to keep living. We have children and grandchildren whose childhoods are NOW. They are living their lives NOW. We are part of that. We are building, in partnership with those we love, memories that THEY will hold onto one day, long after we are gone. 

It is important for us to eat healthy, keep our weight down, keep our blood pressure under control, minimize our stress the best we can, exercise moderately, find hobbies that we really enjoy and DO them, engage in worthwhile work well done, see our doctors for regular checkups to catch treatable conditions early, and when issues or problems are found, address them head on and not be lulled into a false sense of security fueled by denial of reality.

We will all die, one day, somewhere, somehow, of something. That is inescapable. 

In the meantime, we are all here to live.

The lesson that Muhammad Ali brings to us today is not that he died, but that he lived, that he stood up for his ideals and convictions, that he pursued his goals passionately, that he strived to be the best, and that even after he was stricken with a life-long, devastating disease, he kept on being himself, The Greatest. 

We all have greatness in us.

How will others see the greatness in you today?

The Dash

Okay, so news flash.

We will all die.

Some sooner; some later.

This is always brought home to me when someone famous or notorious or personally connected to me or my family passes on.

But wait! This is not a sad post.

What do we do in the meantime? What do we do “with the dash”, the time allotted to us between the birthday and the date of death that will one day be inscribed on a headstone or crypt plaque or other signage for each and every one of us.

  1. Embrace every single day. Get up in the morning ready to live. Physically grab the twenty four hours ahead of you. Look at them as a palette of new paints, a dictionary full of words not yet used, a long list of notes that only need organization to make a symphony.
  2. Do something fun. Life is hard, it’s messy, it’s tricky, but there is a lot of joy out there. So many of us have lost the capacity to go after it, find it, search for it, feel it. Paint a picture. Ride a bike. Eat an ice cream cone.
  3. Simplify. Cut out the unnecessary, the trivial, the time wasters and the attention grabbers. Put the phone down and kiss your sweetheart like you mean it. Talk, Learn. Relate. Experience. Do one thing at a time.
  4. Make a difference in someone else’s life. Give money. Bake a cake. Give your time. Listen. No, you cannot change the whole world, but you can damn sure change the life of the person sitting right there in front of you, begging for your undivided attention.
  5. Stop worrying! Go back to sentence number two of this blog post. Things will happen when they happen. Some of them will be bad. The truth? You can’t make a single thing happen by worrying about it. It’s wasted effort, it’s wasted energy, and it’s just not productive. Clear your heart and your head for Number 1-4 above.

Have a great day!

Time

Several things have prompted the thoughts about this piece and the writing itself on this Mother’s Day 2015.

Seeing the many glorious pictures of mothers, lovingly posted with comments and reminiscences by children, spouses, grandchildren and friends.

Feeling my age, almost fifty-eight now, and that associated middle-aged angst, quite normal I’m afraid, that we all experience at this time of life. If you’ve navigated it and come out on the  other side, bravo. If you’ve not yet arrived at the rocky shoals, don’t worry. Your time will come soon enough. Don’t rush it.

Feeling others’ expectations and reading others’ thoughts about time and what it means to them, how it affects them as they age.

At any rate, all these tiny bright droplets have coalesced in my brain into a trickling, sun-dappled stream and then a rushing, rapid-filled course and finally into a broad, slow-moving, deep-running river of thought and feeling that, while hard to explain and write down, has burst its sluice and will be written, whether I want it to or not.

Ideas, rushing, wet, powerful,  ideas, will crash through the locks and dams we build to hold them back and carve out their own winding ways towards the ocean. They will not be stopped. Nor should they be.

So, my dear readers, time.

Time.

Time may be spent, enjoyed, reveled in, soaked up like sunshine on a spring afternoon, full of promise and tenderness and the expectation of joy that never ends.

Time may be wasted, frittered away on trifling and trivial matters both large and small, things that in the long run mean nothing, but in the short run consume us like fire.

Time may be squandered, absolutely obliterated by the ceaseless worries we give ourselves as gifts, the mental torture that feels like productivity but that disappears like acrid smoke borne off on the chill wind of autumn.

And, yes, friends, time may be used, wisely used, to live life and enjoy all things bright and beautiful and wonderful and good and holy and miraculous. It may bend and slow and wind deliciously through the exquisite waiting for Christmas or the lazy, hazy enjoyment of a summer’s day with catfish dancing on the line and leafy green shade and fluffy cotton candy clouds at end of day, tinged with the pink light of an afternoon well-spent and another grand memory made.

Time is finite for all of us. There’s the rub, isn’t it? This thing called time will end for all of us one day. It is the natural state of things, at least in this physical world that we inhabit now, to be born, to grow, and to die. This stream of consciousness, this awareness, this taking in and processing and living and being, all of it will cease one day. That is the natural course of things, as natural as that slow, relentless roll of river from mouth to ocean.

Yes, time rolls, is fluid, is as slippery and hard to hold onto as that glistening water is if we scoop up a handful of it from Vicksburg or New Orleans or the Gulf of Mexico. It is still the same water, life-giving and nurturing and absolutely necessary for survival, but it has been changed somehow, from north to south, from trickle to rapids to torrent to smooth ocean egress. It has been polished, filtered, imbued with tastes and packed with sediments and particles so small that they cannot be seen by the naked eye. It has been changed with the experience of the ride from birth to death.

Time cannot be controlled, oh no. We fool ourselves daily, dear readers, with our calendars and our schedulers and our theories of time in a box, take it out and wind it up and watch it go. We control time no more than we control our own breathing. We can manage it, yes, I’ll give you that, just as we can make ourselves breathe in and out until the tingling starts around the corners of our mouths and the fingers start to tingle and we know that if we keep doing this that we will soon pass out. We can manage lots of things in this life. We control very few. Time will not be controlled by us, not by anyone. It is fluid, it rolls on, relentless, purposeful and yet with absolutely no certain purpose except to be, to watch, to bear witness to the world that was, the world that is, the world that might be, just around the bend.

Time will end for all of us one day, today or tomorrow or next month or next year or in fifty years. Even so, it will go on, infinitely as far as we will know in our then state of non-being.

We often speak of the past, thinking about it, reliving it, remembering it, dissecting it, wanting somehow to bring back the very best parts of it, the good old days. Some of it we want to change, so desperately. The accident, the diagnosis, the failed love, the loss, the shame, the guilt, the mistakes, oh, the mistakes that if we could just go back and re-do, would change our lives and bring us to that present place called perfect that we all think we need to be.

That’s the fallacy, don’t you see?

There is no past. It does not exist.

There is only the present that was.

We lived it then and it shaped us, just as that rushing river shapes the ground underneath it, carving out a course and direction that even mighty dams cannot alter forever.

We lived our present that was, every one of us. Over and over and over again, we had present moments, opportunities to do the right thing, say something, feel something, reach out, make a difference, change the world. We lived those present moments, as did our great-great-great-great grandparents. We made our choices. We acted, or we did not. Simple as that.

Do not despair that I’ve taken away your memories or your second chances. My words don’t have that power.

Neither do they have the power to give you the hope of a future that will correct your mistakes or bring you happiness.

Because you see, there is also no future for any of us.

There is only the present that will be.

All the worry and the preparation and the mental machinations and the planning and the scheming in the world will not change a thing for me, or for you. I have learned that as I grow older. I have plenty of time, all the time I need, in fact, to get to the present that will be. When I arrive there, I will do my very best to do the right thing, make the right decision, say what needs to be said. But I will not drive myself mad by worrying about how I will get there, whether I will get there.

The only time that exists for me, for you, is this present that we live in today. It is the only thing that is real. It is as real as this hot cup of coffee that sits by my right hand and sends off steam from liquid that will burn my lips just as surely as the sun will rise this morning if I drink it too fast.

The past will not burn me. Neither will the future.

The only time for us, dear readers, is now.

What to do? How to embrace this knowledge that the present that was and the present that will be are things that don’t need our attention? That we don’t need to spend one more second of this river of time rushing past us worrying about how to fix them or change them or anticipate them so that they will be perfect?

1) Embrace the time you are given today. Accept it gratefully and with an open heart and mind. It is the only time you have.

2) Mark it as your own. It does not belong to your memories or your failed expectations or the dreams of others. It is yours.

3) Use it fully. Do not squander a single minute of it. You are not too tired, too busy, too preoccupied, too worried, too important, or too overbooked. You have today. Do something with it.

4) Enjoy it. Immensely. Ridiculously. Over-the-top. Crazily. Like it is the last present day you will ever have. Because it is. Tomorrow it will become the present that was, and it will be out of your reach.

5) When this time is over, relinquish it with the same gratitude that you greeted it with at the start of the day. No anger. No regret. No fear. No sadness. No second guessing. Let it go. It is finished. There will be time enough tomorrow, the present that will be. Enjoy the letting go with as much gusto and gut-wrenching feeling as you enjoyed the gift of time in the first place. It was never yours to keep. Remember that, and you will never again fear letting it go.

My friends, there is only now. Today.

When my time is up, I will be no more. That is as it should be.

My time to make a difference, to live, love, learn, help, to make a real mark on this world, is today.

This post is my gift to you today. Thank you for taking some of your present, your precious time, to read it and to think about it.

Live.

Today.