Future Shock

There is a lot going on in our world right now.

From senate testimony in various hearings to war in foreign lands to giant bombs being dropped (no, not F-bombs, but then again…) to Brexit to special elections to Juneteenth celebrations to the near-explosions of talking heads because of the sheer volume and ambiguity of it all.

We really don’t know from day-to-day what will greet us in the newspapers that we read, podcasts that we listen to, or social media outlets that we frequent. If you’re like me, and many of you must be, or you wouldn’t read this blog, you can’t get enough of the excitement and frenzy of it all, but at the same time it scares the living daylights out of you.

What does the future hold?

No, I mean really. What does the future hold?

How can we know? How can we know, given the impulsivity of our leaders, the shallowness of thought, the depth of misery around us and the unpredictability of the world around us today?

The short, slightly comforting answer is that we can’t know.

How then can we focus on, contemplate in a serious manner, think about intentionally, plan for, reasonably anticipate, embrace, and not fear the future?

I’m trying to take this bull by the horns in a few ways.

One is to break down my response to that lump in my throat that rises periodically, fueled by uncertainly and fear, into three easily considered and actionable steps that I can take every day.

  1. I intentionally contemplate three things that I’m looking forward to tomorrow.
  2. I think about three things that I plan to do in the next year.
  3. I think about three really important things that I want to do before I die.

This may not work for you, but along with other intentional reviews of my activities, my short, intermediate and long-term goals and my actionable plans, it works for me. It keeps me grounded, helps me make achievable plans and keeps me looking at the future as a time that will be healthy, happy and exciting for me and my family.

I also conceptualize the way that I look at the future in this way, utilizing a series of feedback loops:

One of my goals is to decrease fear.

One of the ways that I know really helps me to tame my fear is to learn more about the thing that is making me afraid.

Once I learn more and thus decrease my fear, I am more likely to take action.

When I take action, I experience growth.

Growth further decreases my fear, which helps me to take more action, and so forth.

Growth also leads to happiness, and with continued, ongoing happiness, contentment.


Does the future make you feel afraid?

Try the simple contemplation exercises I listed above.

When you are afraid of something, learn more about it, take action based on what you learn, experience the growth that comes with actionable knowledge, and from that growth begin to experience happiness on the way to true contentment.

We can’t fully predict the future, but we can productively shape our responses to it.

Have a great Thursday.




Do What You Gotta Do

This has been one of those weeks when I need to step back, look at things critically, evaluate my performance, and make adjustments to my approach to the workload and obligations currently on my plate.

Ever had one of those weeks?

First things first.


What are the current assignments, burdens, schedules, relationships and tasks that I need to attend to?

I work, and I work hard. I currently have a full time job as medical director of a busy, three-site mental health center. I also work seventy-five hours a month doing telepsychiatry on some evenings and weekend days depending on how the scheduling falls. Mental health is a rewarding business to be in, but it is very stressful for psychiatrists and others who choose it as a career. Burnout is a very real possibility.

I have relationships that I cherish. These are with family, online friends, IRL friends, coworkers, confidants, and others who I want to spend time with, talk to, share a meal with, or just feel safe with. These relationships don’t happen in a vacuum, and they don’t flourish without some effort on my part. (Some of my closest and dearest friends have gently reminded me of that when I fall down on the job) Being with others is healthy. Isolation for long periods of time is not.

I have a need to create and spend time in my own head. Now, psychiatrists spend a lot of time trying to figure out what other people are thinking and feeling and why, but they need time to attend to their own thoughts as well. I am no exception. For me, writing things down and thinking things through is as important as breathing. If I go too long without doing it, I get a physical air hunger for the words, the sentences, the paragraphs and the physical look and feel of my words on the page.

My body needs my attention. I will be fifty-seven years old in October. Do I feel fifty-seven? No. Do I realize that my physical body is no longer nineteen years old? Yes. Using the old excuses (I’m too busy, I don’t have time, it hurts, it’s not fun, I’m older and I don’t need to exercise) doesn’t cut it. Attention to physical needs such as exercise, sleep and nutrition is as important as working hard to pay the bills. Probably more so. If I don’t pay attention to the former, I won’t be able to keep doing the latter.

Second stage?


Given that I really believe that the things I just told you about are really important, how do I plan to make sure they get the time and effort they deserve as I go about my daily life?

Schedule. I make time for the work, the people, and the personal activities that are most important to me. I keep my calendar sacred. If it gets on my calendar for a certain time on a certain day, it must be done at that time on that day. No exceptions. That makes it absolutely imperative that my calendar is pruned ruthlessly and only things that need to be there are there.

I keep a constantly changing and dynamic to do list. Unlike the calendar, this list is always churning, moving, and morphing from one look to another. It is a living thing. It is meant to be a playground for ideas, projects, writing topics, shopping lists, vacation planning, and things to do. I work in it and on it many, many times every day.

Third stage?


The most beautiful calendar and the most organized list in the world will not help you if you don’t get up, get out, and execute.

I have to show up at the places on my calendar. I must attend the meetings and participate fully. I must go to the gym. I must message someone on Facebook or call a friend or remember to schedule a dinner to catch up. I must share something of myself, open myself up to others, in order to get them to do the same. Those of you who know me well know that this does not come naturally to me. I work at it every day. I love it when it clicks, when it feels right, when I feel that special connection with a good friend or a confidant who knows exactly how I feel and sticks with me anyway!

I have to pay attention to cooking, eating right, exercising, and feeding my mind as well as my body. These things don’t happen by themselves. It takes effort. The effort is worth it.

When I am tempted to just go home and call it a day, sometimes I need to reach out to a friend. When I think I can get just one more task done at ten o’clock at night, I am learning to tell myself that it is time to go to bed, because the extra two hours of sleep I get will lead to much higher productivity the next morning.

The business of the week is behind me.

Today I will get my car serviced, buy a nice bottle of wine, spend two hours at the gym, cook a couple of nice meals, talk to someone special, sit in the sunshine, take a nap, watch a movie, and get to bed by ten.

I have assessed.

I have planned.

Now, it’s time to execute.

Have a good weekend, all.

Disorderly Conduct

My friend Jordan Grumet wrote yesterday about a house call, a visit on someone else’s turf, as he put it. Read this short but poignant post, The Home Visit, here. 

This post stirred something in me, as Jordan’s posts often do, especially in light of my own recent thinking about the new year and what it means to me and how my life is run. As I have recently written, at this time of the year I think about putting things in boxes, into their proper places, just as his cancer patient had her home arranged just so, everything in its place. I pride myself on keeping a tightly orchestrated to do or reminder list, following it, organizing it by date or priority, and not letting things fall between the cracks. Everything in its place. Everything with its appointed timeframe and due date and project goals mapped out for me. This usually works pretty well. I feel comfortable with my work load, how it flows, and my ability to get things done. 

However, I practice medicine, and a type of medicine that can be very unpredictable just by its very nature and the type of illnesses I see and deal with every day. Just when I think that I have my schedule mapped out for the day, a code blue is called as a teen is having a seizure out front on the bench in the freezing cold. I excuse my self hastily from the present appointment and patient in my office, walk briskly towards the front of the building, and deal with whatever I find when I get there. When the paramedics and ambulance arrive and the child is safely loaded up for transport to the local hospital emergency room, I go back to my appointment, shifting gears quickly as my pulse comes back down to normal range. 

I carefully orchestrate my schedule for the first month of the year, coordinating two jobs that usually mesh together tolerably well, filling up each patient slot for the next six to eight weeks ahead. There is little room for error, few slots for extra duties, and very little wiggle room in general. Funny thing, that, because my third grandchild is due in the next forty eight hours, and I don’t think he or she will care much about what my schedule looks like on Tuesday or Wednesday or whenever the delivery date turns out to be. I will juggle and reschedule and make time for the trip to be with my family because that is most important to me. I will make it all work somehow. 

I will do my best this year to advise my patients on the best treatments available for their presenting complaints, utilizing the available evidence base and my own experience and crafting the best treatment plan I can for each patient who asks for my help. The problem with this is that mental illness is insidious, chronic, and debilitating. It affects mood, judgment and impulse control. No matter how diligent I am, no matter how good the plan is, sometimes it will fail. Like Jordan’s patient with cancer who decided not to have surgery or chemo or other “disorderly” treatments, my patients will decide to stop their oral medications, not come in regularly for their injections, forget to get blood drawn for lab work, and decide not to attend AA meetings after all. 

Medicine, again by its very nature, has a certain amount of built-in entropy. We schedule and plan and scheme against it, but to no avail. Sometimes things just don’t go our way. We doctors are trained to diagnose and fix things, to problem solve and make decisions and move logically from one problem to the next to the next. When this happens, we feel smart and happy and powerful and in control. When it doesn’t, we get irritable and angry and depressed and then we are not at the top of our game. 

Like Jordan, even if things don’t go exactly my way, I would still rather they are clean, crisp and orderly. The patient with schizophrenia may not live as long a life as I wish he would live, since he does not take care of his diabetes, he drinks too much and he goes off his medications every few months. The patient with bipolar disorder will get manic at intervals and spend too much money, end up in jail, or take a cross-country trip that has family and friends worried sick about her. These things will happen. 

I will still see them when they come back, get them back on track with a reasonable treatment plan, write the prescriptions for medications that should help them, and schedule them to come back to see me the next time, wanting to believe that this orderly way of doing things will keep the disorderly conduct of illness and infirmity at bay for just a little longer. 

In this new year, I hope that Dr. Grumet and I, and all of our colleagues, are successful at doing just that.