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.

The Good Old Daze

I was driving to work this morning along the same road that I’ve used for almost thirty years. About halfway between home and clinic, off to the side of the highway, is an old textile finishing plant. It’s long since closed down, and the graffiti-scarred structure is rusting and collapsing. A shiny new pharmacy was built in front of it so one has to know it’s there or be very observant, or it is easily passed by, forlorn and crumbling, hiding in plain sight. 

One of my many jobs growing up was working in the local textile mill that was the mother’s milk of the small Georgia community I grew up in. The plant provided jobs, housing, a post office, a village doctor, decorations at holiday time, and a ready made social fabric in addition to the thousands of yards of cloth it produced. I enjoyed my time at the plant. I learned valuable lessons about people, hard work and the necessity of following rules during my time there. 

The textile mill I worked in, similar to the finishing plant on my route to work, has crumbled, and it has actually been torn down. 

I have good memories of my childhood, my teenage years, and my work experiences. I lived, learned and loved in a Norman Rockwell time and place. Cold, deep swimming pools of water doused the heat of scorching hot summers and the smell of wild onions and grass stains on blue jeans gave way to smoke from chimneys and the smell of turkey and dressing in November. The hill behind the pool became an Olympic sledding venue after the rare snows we had as kids. Life in the mill village was good. Really good. 

The memories of those times are pleasant and often surface when the stress of modern life threatens to overwhelm us. The nostalgia is a balm, a healing salve on the claw marks and scratches  and bites we get from sharp-edged technology, scathing commentary and biting sarcasm. The nostalgia is sweet, but like too much sugar ingested by a diabetic, it can quickly turn to a killing poison. The past is the past, and barring a miracle of time travel or a rip in the space-time continuum, it is never coming back. 

Some of us, including our leaders at the highest levels, revel in the nostalgic vision of that idyllic time and place, with its neatly ordered rows of houses and humming factories and simple social order. They long for a return to a more structured, locally controlled, face-to-face existence. They see a return to that time and place as a return to a strong, powerful, safe, and protected country and lifestyle. They lack insight into how the world is evolving, not at the speed of sound or even light but at the speed of electrons and bits and bytes that travel the circumference of the globe at a mind-boggling pace. They lack the vision of a world that is rapidly morphing into a new era of robotic manufacturing, artificial intelligence, augmented reality and social interactions on a scale we’ve never experienced before. 

This is not only short sighted but dangerous. 

Too much nostalgia, pleasant as the sugar coated predecessor of the poison is, leads to sadness about what we have lost. 

Too much division leads to anger and frustration about what we cannot do. 

We must pivot. 



Each of us. All of us. 

We must anticipate the changes of the future, both short term and long term. Burying our head in the sand about advances in technology, cyber spying, interference in our longstanding institutions and processes will not make these changes go away. 

We must plan for the near future,  paying attention to those things we have a modicum of control over, while allowing ourselves to dream of the distant future, imagining things that are not even concepts or inventions yet. This will keep us strong and productive in the now, but not hamper our ability to create and brainstorm and reorganize our world. 

We must allow ourselves to experience life as it evolves around us, with all its wonders of climate and energy and technology and transportation and entertainment and work. 

We must innovate. 

If we stand still, if we stop dreaming, if we give into the fallacy that the good old days can never be bested and so should be resurrected, then we shall surely watch ourselves drift slowly but inexorably into the sea of irrelevance. 

The future is coming. Of that there is no doubt. 

We must choose to move boldly and be part of it. 


I saw a patient today who looked familiar to me from the moment she left the waiting room and headed down the hall toward my office. 

“Have I seen you before?” I asked, trying to recall.

“No, I don’t think so. No, I’m sure I’ve never seen you before,” she answered, a little befuddled at the circumstance and the question.

I weighed her, showed her to her seat and began the interview with the usual questions, accompanied by the now-commonplace clackity-clack of fingers on keys, second nature to me after a year of learning to “collaboratively document” my interactions with my patients. 

I know her.

She answered the usual demographic questions with little difficulty. Then, on to the reason for her being there, the things that lead up to her referral to us at the mental health center. 

As she told me her story, it became clearer that I had indeed heard it before. I had seen her before.

How did I know this? How did it become clear that she was someone I knew, had listened to before?

Her tone of voice was a giveaway. Somewhere in my brain, that nasal twang and breathy syntax was recorded. 

Her facial expression, or lack thereof, was another clue. She was almost flat affectively, with little movement of her facial muscles, little smiling, no animation.

Her mannerisms, the way she halted between sentences, the way she shifted in her chair, the way she paused. 

Her medical history, of course, as it came back to me when she recited it in detail for me again. 

Even her gait,  a little half-hitch, slightly off balance, shuffle out the door and back down the hall when we were done was another clue that yes, indeed, I had seen this lady before. No doubt in my mind now. 

She did not remember me, but I now remembered her. A quick check of some old records in the EMR confirmed what my brain had already been trying to convince itself of. 

I had seen her ten years before.  

So, isn’t it fascinating that our brains, our minds, can take in, process, catalogue, file away, organize and store memories of friendships past, patients seen, movies watched, music listened to, or sand felt between toes on a faraway beach when we were only six years old. These memories, coded according to certain key elements such as sounds or smells or feelings or emotions, are sometimes retrieved, almost pulled into our conscious minds, at what appears to be the slightest provocation. 

For me, these triggers, the things that bring these memories rushing back, are many. 

A touch, both my touching something or having someone touch me, can evoke tender or emotionally charged memories, almost instantly. 

Smells are a very powerful trigger, as I have written about before. Evergreen and peppermint mean Christmas. Clove and roasting turkey and cornbread dressing and cranberry mean Thanksiving. Incense means holiday time at church. Sweet marsh grass and plough mud mean the Lowcountry. 

Tastes are another. Who among us does not have instant memories,wonderful memories, when homemade strawberry ice cream, creamsicles, boiled peanuts, coffee, fresh milk, or a grilled hamburger cross our taste buds.

Sounds are a big one for me as well. I can listen to a particular piece of classical music and be transported. Rock music, drum and bugle corps, snare drums and pianos all have places in my brain, and my heart. Cicadas at night, croaking frogs by the scores on a warm summer midnight, and the rush of the wind as I drive down the interstate with the music loud and the window open. 

The seasons are triggers for me as well. I have so many memories that are linked to the beginning of summer, the transition to fall, the coming of winter and the holiday season and the rebirth of all things beautiful in the spring time. 

All of these things trigger memories, some wonderful, some painful, some hurtful, but all fresh and new and alive and begging to be front and center again.

What are your triggers?

Happy stickers courtesy of Leonard Porkchop Zimmerman, Augusta, Georgia, USA. 

Smoke on the Water

It is one of those smells that you inhale as a young child and never quite forget as an adult.

I remember it, though I am not really quite sure how old I was at the time. I was at my grandparents’ house in the country, and I woke up on one of those very, very cold holiday mornings, close to Christmas, when stepping on the wooden floor of the farmhouse with bare feet was not only uncomfortable, it was painful. The house got so cold at night that I swear I remember seeing my breath in front of me in the morning. Coming out from under the thick, soft, warm blankets took an act of real courage for a small boy used to the comforts of the city (read, mill village).

But get up I did, as I always did, on that cold morning. Soon someone, whether it was my Grandaddy Jack or my Grandma Ursula or some other responsible adult, would come into the den or the living room (I slept in both over several years of visits to the middle Georgia farm) and do that thing which both terrified and saved at the same time.

They lit the little tan box that was a gas heater.

Now, it was a step up from them having to light the fire, the actual wood fire, that had warmed that front room just a little while before, with its smoke and ash and popping embers. That was another smell for another day, to be sure.

This was a little metal box that had a tiny, single metal grate or guard in the front (little good that did, truth be told), a box that they lit with a long match, a little under a foot long, at arm’s length, and it roared to life with a whoosh and a gush of warmth that was welcome and yet singeing at the same time. I swear I think I still have little white marks on my shins from the times that I sat too close to that heat on those cold mornings, almost wanting to suck it into myself without consuming me, to warm me up from the inside out until it was time for a breakfast of sausage, hard yellow-yolked eggs and biscuits that only my Grandma could make.

It was a whooshy, gassy, warming, burning, wonderful smell/feeling on some of the coldest winter mornings of my idyllic childhood visiting my grandparents’ farm.




I was at work that day, making rounds with the residents and the medical students. I was in a comfortable state of drowsiness, even at that barely-caffeinated time of the morning, as some student or another droned on about some patient or another that had been admitted on some day or another. My pager (yes we did not have smart phones, or even dumb phones back in those dark times) went off.

Odd, I thought, for this time of day. I wondered if my very young daughter was okay…

“You need to come quickly. Your house is on fire.”

My house is on…my HOUSE is on…..MY HOUSE IS ON FIRE!

“I have to go. Now.”

Out the door, into the car, roaring back toward the opposite side of town, turn into the subdivision, down the main street, turn right, a couple of blocks, and on the left, on the left…

Our gray, wooden frame, attached-carport, baby swing hanging from the tree limb in the back yard single family home, which we had recently moved out of and just rented to someone to get us through the next few months until we could get it sold and move on to the next chapter…

…was smoldering.

The firemen had responded quickly (thank the Lord for that) but the fire, I later found out, had started when the renters, moving in that cold day, decided to start a fire in the fireplace while they labored, but did not properly open the vent. The flames roared too high, climbed the inside of the chimney, raced to the attic and then  across it, and soon the whole roof blazed like a giant torch.

The  house was not a total loss (we would later rebuild it completely and sell it), but the smell, that smell that hit me as I got out of the car and saw something that we owned, that we had lived in with a little baby, burning and smoking and dripping now-wet ash, was a smell that I would never quite banish from my nostrils.

Acrid. Hot. Wet. Smokey. Acid.




I walked outside today, leaving the office at a leisurely pace, getting ready to drive home from the South Carolina countryside and the clinic we maintain there. It had been a very light day. Many of my new patients, scheduled to come in right after the holiday for their first appointments with me, had decided that taking down Christmas decorations or cleaning up after the New Year’s Eve party was a tad bit more important than coming in. I was ready to call this one done and go home.

The smell hit me, and a thousand memories rushed into my head, as if poised there and just waiting to be given the signal to come back.

It was that smokey-cold, biting, slightly pungent smell of a wintertime coming later than usual to these parts. A delayed fall, early winter smell that was welcome, since we’ve had unseasonably warm temps and higher than usual creeks and rivers over the last few weeks in both Carolina and Georgia.

It brought back good memories, warm and pleasant thoughts of hayrides and warm, bulky sweaters and hot chocolate and apple cider and knowing that the winter was coming, and feeling sure that meant spring could not be too far behind.

I smiled as I turned Rosie into the bright, low, winter sunshine for the drive home.



Thanks for the Memories




It happened out of the blue, as such experiences often do. 

I had parked my car and was walking a short distance from the public parking deck on a covered concrete sidewalk, past the open expanse of lawn and twinkling Christmas lights in front of the hospital. I was going to visit a friend who had just had surgery, and it had been quite some time since I had been in this hospital for any reason, personal or professional. As I walked, I happened to glance off to my left, and it hit me. 

This is where we used to take my oldest daughter (who is now twenty-nine years old and has kids of her own) to daycare when I was in residency and my wife was working as a pediatric nurse. 

It was a very brief, very concrete thought, attached to nothing, triggered by nothing more than the sight of a brick building. I was struck by how visceral this memory was, how it instantly transported me back to a simpler time when I was in school, had been married but a few years, and had one child. 

I’ve had memories and thoughts like this hit me before, and I’m sure you have too. It seems that at holiday time, these kinds of memories bubble up to the surface more often than at other times of the year. Why, you might ask?

Memories that are associated with our senses are some of the strongest, most tenacious memories we make. Think about how one whiff of Christmas cookies takes you back to your grandmother’s kitchen in a way that feels so vivid you can almost feel the hot stovetop. If you close your eyes, you can taste the icing that you licked off your fingers after they swept the glass bowl once, twice, three times around to catch all the sweetness left there. Think about the perfume your mother wore on Christmas day when you went to church as a family. Anyone can wear that perfume, but only your mother smelled the way she did when she wore it. Smell the evergreen goodness of a freshly-cut and fresh-bought Christmas tree and you are back in your living room, a kid on a mission to shake, rattle and roll every wrapped present until you either knew what was in it or got caught and told to stop. 

Taste cranberries and you remember your aunt’s favorite way to make them. The first bite of turkey this year will remind you of the first Christmas you came home after starting college. How good that bird tasted, because it wasn’t about the turkey. It was about coming home

Touch the tinkling glass ornaments, hear them make that little musical sound, and you instantly remember the story of how they came to hang on your tree. See the lights on the tree and remember the year that all of them were strung before you realized that one string was completely dead and had to be replaced. 

Sensory memories are the absolute best. You can think all you want about the holidays and what they mean to you and your loved ones, but nothing can replace the feeling you get when you hear, see, taste, smell or touch something that instantly brings joy to your heart and a tear to your eye.

Merry Christmas.

And thanks for the memories.