At My Best

I have felt a little ill at ease lately.


A tiny bit anxious.

Have you?


My country, my immediate world and indeed the larger world, are in flux. Change is afoot, change that in many regards I have no direct control over. Change that I am forced to watch and to endure the best way I can.

Personally, I am the happiest I have been in some time. Years, truth be told.

The world, though, seems  a little irritable.

What are we to do?

Well, I can only speak for myself, but when I get these unsettled feelings, for any reason at all, the best thing for me to do is to fall back on my tried and true methods for centering myself. I need to pay attention to what I am doing, what I am feeling, how it affects me and how it affects those around me-spouse, family, friends, patients, and coworkers.

I am at my best when I take good care of myself.

I am at my best when:

  • I am well rested. My propensity is to stay up late and get up early, which I have been able to do for many decades. It started in college in earnest, and medical school and residency only cemented those not- so-good habits. I still like to get up at five, because my quiet morning time gives me space to read, listen to news, have that first cup of coffee, or plan my day. However, in order to get up that early, I now understand that my body expects me to go to bed earlier, like ten PM, eleven at the latest. Just ask my wife (who has my number in more ways than one) how difficult that has been for me to incorporate into my regular daily schedule. She will most likely add five years to my life expectancy because of the way she helps me live healthier. (Thank you, my love.)
  • I exercise regularly. Today was a federal holiday of course. After sleeping until 9:30 AM (hey, my wife is in Amsterdam and I didn’t have to work today! See how that works?) I got up and had a leisurely morning. Then, at about 1:30, I struck out on a wonderful, three and a half hour, eight mile exploration of the beauty of spring in my neighborhood. That plus cold brewed coffee as a mid-walk break. I know that I feel better when I walk, lift weight a couple of times per week, ride a bike, hike a mountain, or otherwise push myself. I even got a standing desk setup this week so that those long telepsych shifts will not entail sitting for hours at a time.
  • I am learning something new or stimulating. Trina and I went to a neighborhood concert of Irish music in a local home this weekend. We heard three wonderful Irish musicians play and sing music that is not what I normally listen to. I sat next to a man from Ireland who had married a Georgia girl and works here now. It’s a very small world, and there are things to be experienced and learned!
  • I am “in the zone”. Whether working or writing or exercising, it is better for my general health and wellbeing if I give my entire attention to the task at hand and “get in the zone”. You’ve felt that way I’m sure. That time when things flow, when  you have to expend very little effort to get stellar results and when you seem to be moving effortlessly through your day.
  • I reveal just a little bit of myself to those around me. As I have been reading in multiple articles this week, physicians and especially psychiatrists are often trained to be stoic, resilient, and in our case, “blank screens” that divulge little of what they feel and less of what stresses them out. I have found over my career that this does not work well any more, especially when I am working with those with major psychotic mental illnesses. They often need to know that I am “real”, that I have a team I pull for in the Super Bowl, that I do have grandchildren, and that I like to hike to relieve my own stress. I was very well-trained in my youth, but the older me now knows that there is something to be said for judiciously and professionally sharing some of oneself with others when it is indicated. and that both parties will leave the relationship or encounter the richer for it. Do I also need to mention that this works well for friends and family and spouses? I am (still) learning that as well.
  • I enjoy the stories that I hear every day. I have already written a recent post about this, but I need to say again that if I do not regard work as a stressful chore, but look at it as a way to learn about others and hear fantastic stories that they trust me to hear, that I can have fun and help others at the same time. We cannot change the way that life throws stress at us sometimes, but we can certainly decide how we are going to respond to it.
  • I let myself be human. Your struggles are my struggles. Mine are yours. I know some things and have some specific expertise. So do you. Contrary to what some have espoused, we cannot do this alone. Life is a team sport, a contact sport. If we let someone have our back and we have theirs, whatever comes can come.
  • I give time  to my family, friends and my spouse. Let’s face it. We are all busy. I work two jobs. My wife travels internationally. My children live in three states and my four grandchildren are an eight-hour round trip from my home. If I want to see people, I sometimes have to make time to travel and see them! My new bride and I love our time together because we already know how precious it really is. Our parents are aging and need our phone calls (Yes, I called my mother this morning to catch up) and our personal visits. We are at our best when we give of ourselves, our time and our attention to those we love and who really love us. That time is never wasted. Never.

So, if you feel a little anxious, a little stressed, a little out of focus in the weeks or months to come, figure out what grounds you, replenishes you, recharges you and feeds you, body and soul.

Make time for those things. Take care of yourself, because you know as well as I do that others are not going to do it for you. It ain’t happening, so get over that right now.

Figure out what makes you the best you can be, and do it.

Have a great week!



First Things First

Our mental health center building was built, oh fifteen years or so I guess. Although the the brick building with steel studs for a skeleton is still quite solid and will stand and serve for years to come, that was not the case for the outside landscaping. The plants around the building were leggy, the grass was pulling away from its borders and turning brown or disappearing and the pine straw or other mulch had long since disintegrated. The trees were still standing, but were also getting unwieldy and misshapen.

As we had some money that needed to be spent by the end of the fiscal year, the decision was made to purchase a large scale landscaping project in toto. There would be a new plan to beautify the building, the old would be ripped out, and the new installed. This would take weeks of time, not to mention tens of thousands of dollars, to accomplish, but of course the desire was to come away with a building that looks as good on the outside as the services provided on the inside. We want both to be excellent. 

Now, on the face of it, one would think that you could just cut down dead trees, pull up scraggly plants, and dig up brown grass, replace them with exactly the same thing, water it a week or so, and call it done, right? (Those of you who have done any degree of yard work or landscaping yourselves can’t answer!) The fact is, if you do this, the same problems will resurface one year, five years, ten years down the road. You will have spent a lot of money, been superficially happy for a decade or so, but then realized the error of your ways. Problems that are addressed superficially, with applications of bandaids or cheap landscaping, are not solved. They are merely hidden, and the goal of fixing them completely is postponed. 

The answer?

A good foundation. 

Like the strong structure itself, our landscaping plan needed a  strong foundation. 

There had been soil erosion problems, water accumulation, poor drainage, and flooded parking lots for years. Changing out a few box woods or throwing down some fresh pine straw was not going to fix it. We were going to have to dig deeper. Literally. 

So what did the landscaping contractor do first? He took weeks to dig out a wide, deep ditch all around the main building. He put a sub layer of gravel in the bottom of that ditch. He installed large drain pipes, sunk several feet into the ground, and then ran other long pieces of pipe from the drain to the parking lot drainage areas. He filled the rest of the deep ditch with another layer of rocks, ornamental and practical, and shored up the whole thing with metal channels to keep it in place. He made sure that the whole filled ditch was wide enough so that at times of heavy rain the water coursing off the metal roof would still fall squarely in the rocky area so that it could be collected and drained away from the foundation of the building quickly and safely. He put flexible drain pipes from the downspouts to the drainage conduits away from the building and its sidewalks. 

This took hours and hours of work, many pieces of big machinery, multiple men, and a lot of raw material. Why did he do this?

Because professionals know that if the underlying foundation of a project, the part that shores up the whole project but is not even seen by those visiting the building, is shoddy, then the pretty part that we will end up seeing later is doomed to crumble in short order. A hastily completed job, with shortcuts and poor workmanship, is a very poor investment of money, time and effort. 

I started thinking about this blog post a month ago, making notes in my ever-present small black Moleskine for later. I thought about it even more when the current presidential contest started to shape up more definitively and then even more when the shooting in Orlando happened yesterday. 


Because we have forgotten how to put first things first. We have lost our way. We have no strong foundation to protect us anymore. Like flora that is dying and soil that is washing away, the values that made out country great are leaching out of the fabric of our democracy.

Do you know what is similar when you form a new country, when you train a new Marine, or when you teach a medical student to be a doctor?

You take them all through a very similar process. You start with raw materials: a group of rebellious colonists, a scrappy eighteen year old who can shoot a rifle, or a nerdy college student who thinks he will be the one who finds the cure for cancer. 

You break them down. You strip away everything that defined them before, and you make them uniform. You take away their previous conceptions of normal, of right, of proper, and of individuality. 

Then you take those empty vessels, those men and women who are ripe for change, and you teach them. You teach them new skills, a new culture, a new set of rules that defines good and bad, right and wrong, tolerable and intolerable, things that are good and proper and pure and things that are flat out evil. You make sure that they know these things backwards and forwards, that they can recite the creeds in their sleep, and that they can demonstrate the skills you taught them under great pressure, with their eyes closed and their minds numb with pain or fear, and that they will never break. 

Next, you take these new warriors, these new recruits, these rebels, and you make them a unit. You rely on esprit de corps and a sense of pride in who they are and what they are and how they are. You make them a team, a group that will do nothing at all if not protect each other and who understand that if one of them is injured, ALL of them are injured. If one of them is hurt, then ALL of them are hurt. If one of them dies, THEY ALL DIE. 

Lastly you challenge them. You stress them. You test them. You drill them. You stress the very fabric of the organism that all of them make up. You make them so aware of their interdependence (not their dependence, mind you) that they know, they KNOW, that if one of them lets down his brothers that all are in great peril for their lives. 

You don’t feed them with fear. 

You nourish them with pride. 

What happens to these people, these rebels, these rabble rousers, these smart asses, and these ridiculously intelligent geniuses who think that individually, they can do anything, solve any problem? 

They become a unit.

A class.

A nation

They emerge fundamentally changed. They are powerful, not in what they can do alone, but in what they can do together

Like a building that looks good on the outside but is slowly being threatened by seepage, rot, and undermining forces of nature, only a wholesale gutting of the bad and replacement with a strong foundation of good will save it from eventually crumbling into a heap of useless brick. 

Tuckman wrote about this same process in the 1960s, when he outlined his theory of “Forming—>Storming—>Norming—>Performing”

Our country is at a crossroads. 

We now consider ourselves too big to fail. One only needs to read about the Roman Empire and other ancient civilizations to know that this is folly. 

We must break ourselves down, down to the bare dirt and the soil that gave rise to this nation. 

We must teach a new new generation, every generation that follows from here on out, what it means to be American. We must go back to the basics, making first things first, and teach them the skills, the culture, the rules, the values and the ideals that made us great in the beginning. 

We must learn to live and love and work as a unit again, not a hodgepodge of squabbling, fighting, backstabbing factions who value their differences more than their similarities. We must repudiate those who would fan the flames of hate and prejudice and death, and find that esprit de corps that once made America a proud, strong, upright nation. 

We must take these challenges that we face and use the stress on our system to come out stronger, prouder and more protective of our neighbor, whoever he or she may be, than ever before.


Because we are Americans. 

We do not give up.

We do not shrink from the battle, whether on the field, in cyberspace, in church, in nightclubs, in schools, or in the streets.

We do not quit.