So Much Is In The Doing

My wife and I both work in service industries. We both do a lot of listening. She is a flight attendant who travels all over the world, walking up and down the aisles of Boeing and Airbus airplanes at forty thousand feet, listening to stories and responding to requests. I am a psychiatrist who is usually found sitting behind a desk, tapping away on a laptop, listening to stories and responding to requests. We have have many conversations about how people interact with each other, how they talk, how they ask questions, how they respond to demands and rules, and especially how they function under stress. I know you have seen the various YouTube videos of enraged, unruly passengers who have attacked cabin crew members over issues of mask wearing or alcohol consumption or some such. My wife has never been on the receiving end of one of those attacks, thank goodness, but she is aware of the possibilities every time she signs in for a flight. I have been hit twice and lunged at several other times but never seriously injured while doing my job. We do realize, as I am sure you do, that the last eighteen months has brought out the best and the worst in all of us, and part of that is the lack of attention to the social graces and the simple interactions and courtesies that we once paid each other as a matter of course.

In her recent 8-14-21 article “COVID Anxiety and Fear of the Base”, Wall Street Journal columnist Peggy Noonan addressed some of this. Now, my own column is not political, so some of her writings in the beginning of her piece are beyond the scope of what I want to discuss with you. However, she does start out by stating that people now have mask fatigue and other associated side effects of living through the first serious global pandemic in a century, and that issues such as mask wearing are pushing people to pick a side. Moderation, which in my book went hand in hand with politeness and social grace and simple courtesy, has now become only “for the gutless and insincere”. My wife and I have both noticed, in our very different but very similar worlds, that moderation, patience, respect, and tact have all become signs of weakness. As Noonan put it in her piece, “nothing has been so damaged by the pandemic as what had remained of American tact”. We pick sides of an issue or an action, then demonize and vilify those with different opinions. Noonan suggests that we “make a decision, then encourage, persuade and and exemplify helpful behavior” to win over our fellows who may have opposing views. We all tend to talk and rage against one another, but she says that instead of emphasizing the verbosity, “so much is in the doing, especially in a crisis”. Why are we this way? We are tired. Very tired. We are irritable, and we are much less confident than we were even a year ago because we simply do not know what is coming at us next. We cannot predict the future of this pandemic, and that now makes us gun shy about predicting anything that has meaning in our lives.

Now all politics and divisions aside, the part of her column that I liked the most was the part where she asked, “What rules of the road might help us…….what general attributes?”

First, she challenged us to “regain a sense of give”. We should stop pushing each other around. We should strive to have a generous and sympathetic sense of who our fellow Americans are. Those people that you so vehemently disagree with? Have you ever thought, asks Noonan, that they might be thinking about things that had not even occurred to you? We should be patient. I am always looking for signposts in my own life and work. Two recent events assured me that patience was a virtue that I sorely needed to pay attention to. First when my seven year old granddaughter stayed with us for five days, we learned that operating on her schedule and living life with her level of energetic intensity requires planning, stamina, and yes, patience! The other was when a patient told me the story of living with an incurable and potentially fatal disease, while caring for an elderly relative with their own serious health issues, and how this had lead to a major upheaval in schedules, vigor, and enjoyment of life that was not as it used to be, but as it now was.

Second, Noonan challenges us to stop picking on each other. Does it help to ostracize others? To demean or fight or assault? No. Once again she asks us to empathize, teach, educate, and lead by example. Third, we should admit that there most likely reasons that people do not trust the experts. (This could hold for virologists, and psychiatrists and flight attendants too, I suppose!) If you are ever in a position where you are the designated expert, and believe me, almost anyone who reads my column is more than likely in that camp at some point, play it straight, says Noonan. If you don’t know, say you don’t know. (It took me years after I finished medical school to get comfortable with this very simple but extremely difficult act) Do you like your fellow Americans? Are they “other”, “imbeciles”, or dare I stray into the political quicksand and use the term “deplorables” to you? Or are we all Americans, with different ideas and beliefs and values, and through our differences, embody e pluribus unum? Noonan tells us that if we do not like and respect each other, no matter how hard we try to hide it, “nothing is more obvious than a lack of affection”.

Lastly, she says we must “adjust our sense of proportion”. Put quite succinctly, “COVID now is part of life; it’s not life.” There are so many pressing issues in the world right now, war and famine, and climate change and heart disease and cancer and poverty and mental illness and we focus just on this pandemic and lose sight of all the others at our own peril. We will be dealing with emotional stress of these times for the foreseeable future. Life is hard. Illness is hard. But as the WSJ column concluded, “Life has to be lived.”


“Woah, ah, mercy, mercy me

Ah, things ain’t what they used to be.” Marvin Gaye

I have another podcast that I want you to know about in this week’s column, but first I have a few questions to ask you. Better yet, I want you to ask them of yourself as you read this and think about it today. We have been talking a lot, a lot, about the COVID-19 pandemic and how it has affected us physically and now mentally as we struggle to find the finish line of this biological disaster. Many of my family, friends, colleagues and patients have been dealing with issues of isolation, depression, anxiety and stress for well over a year, and the dilemmas that have come up have not been easy to resolve.The questions I have for you?

Has the pandemic made you reevaluate your associations and friendships with others?

Do you find that you have been carrying grudges based on old wounds that now feel just a bit trivial in the shadow of six hundred thousand deaths?

Do you struggle, amid the pandemic, with wanting to unburden yourself of hurt and anger but somehow find it easier just to keep carrying them after all these years?

The podcast suggestion I have for you this week is Hidden Brain, hosted by Shankar Vedantam. This is a wonderfully rich podcast that takes deep dives into emotions, motivation, relationships, stress, coping and everything in between. On a recent episode, Shankar welcomed Charlotte Witvliet, a psychologist at Hope College in Michigan. They had an in-depth discussion about grudges, holding them, dealing with them, letting them go, and the emotional stress and strain involved in all of that.

Dr. W, if I may be so bold, started out by telling us that we often go about our lives with a detailed ledger of all the wrongs that have ever been done to us, all the betrayals and hurts that we keep meticulous records of. Our anger over these can fester and grow stronger with time, not fade as we might think. It can feel both good and bad to hold a grudge. It is sometimes easier to keep it and nurture it than it is to let it go once and for all. Grudges, she says, may take the edge off of our profound sadness, and help us feel that we have a tiny bit more control over our emotions and lives.

We may always be on the lookout for clues that justify why we feel the way we do, clues that feed our anger. We sometimes dismiss things that might get us out of our destructive loop and actually make our lives better. Sound familiar as we navigate the treacherous waters of this pandemic? As we get more inflexible in our responses to a pandemic or an old grudge, we tend to get stuck in a do loop of bad behavior and anger that brings us further down. This rumination on negative emotions can actually affect us physically, according to Dr. W, in that our blood pressure rises, our heart rate increases, and our beat to beat variability ( a measure of healthy heart function) may be off as well.

Have you noticed that your response to that old friend or even a new acquaintance may sometimes be out of proportion to the thing that they said or did that set you off in the first place? Dr. Witvliet says that focusing on the humanity of the person, the fact that they are a person just like you, with a story, stress of their own, and their own baggage, may help you deal with them in a more positive way. The interesting thing about this to me was that even if you cannot completely give up the thoughts and hurts that might haunt you, if you truly try to understand the person that offended you and truly try to forgive and show mercy, your actual physical response will be very real, in a very positive way. She goes one step further (and you may or may not agree with her here) and says, “Forgiveness is a moral response to a relational breech.”

Now, you might tell me that in your case, you can just distract yourself with other thoughts, other activities, other pressing issues and that the grudge is dealt with in that way. You might be right to some superficial degree, but real forgiveness trumps distraction every time, says Dr. W. The real physical effects that I mentioned above, such as lowering your blood pressure, tend to be much more long lasting if the forgiveness, the grace, and the mercy are sincere and real.

Forgiveness is a process, says Dr. Witvliet, a journey. It unfolds over time. It’s like grief in that way, in that it is not a linear, A to Z process, but more a series of rolling waves. We have all had deep hurts from losses. All of us. That’s being human. Where we fool ourselves sometimes is that we tend toward decisional forgiveness, which is based mostly on our cognition, instead of the truer emotional forgiveness which involves a change of heart. The psychologist says that the two are not equal.

The trick to dealing with these relationships that you are struggling with now that things are opening back up? The way to deal with the hurt, the anger and the wounds that have been allowed to fester for over sixteen months now? Generate positive, empathetic responses to other people, says Dr. Witvliet. Empathy is key. Think about the gift of grace, forgiveness and mercy that you can give that person, and then think how wonderful it would feel to receive that kind of gift. Commit to giving the positive, not committing the negative again.

The hardest relationship, hurt, offense or slight to deal with? One that is truly targeted, evil, or destructive. These kinds of hurts are not just subjective or a matter of having our feelings hurt, muses Dr. W. They are objectively terrible wrongs that are terribly hard to forgive. One example that hits close to home for us in South Carolina? The shooting of nine innocent churchgoers at Mother Emmanuel AME Church in Charleston, South Carolina. The tragedy that occurred there that day was unspeakable, but the responses from the families of the victims, a commingling of grief, sadness, anger and profound love and forgiveness towards the shooter, was almost unimaginable. But, as many of you might know more than I, it was about as real as it gets.

So, back to my questions. In this time of reentry into the almost normal of a post pandemic life, are you struggling with relationships, grudges, long ago hurts and injuries, or the inability to let destructive issues in your own life go? Were these magnified or made center stage by the isolation and stress of lockdown, working at home, more time with your family or wearing multiple hats between work and home and schooling your kids? Do you harbor and carry those heavy grudges towards someone and wish you could unburden yourself? As the psychologist in this podcast episode about the power of mercy instructed us, thinking about the humanity of the transgressor, truly forgiving them, and approaching the coming days with positivity and creativity will surely help you to experience less anger, stress and physical ills than you ever did before. Find this episode, listen to it, and ponder. You will be glad that you did.

Janus Moments

Janus, according to ancient Roman mythology and religion, was a god with two faces. Purportedly, he could look toward the future as well as back to the past. When we think of him, we might think of someone who is “two-faced”, one who talks out of both sides of his mouth, one who cannot be trusted. We have many examples of people who behave in this way today. Just pick up a newspaper, sign on to your favorite news outlet, or turn on the television. Say one thing, act in the opposite way. Promise one thing, deliver another (or nothing at all). Smile at someone while stabbing them in the back. “Make something great again” by tearing it down. (that works well in medical school and boot camp, but other than that I’m not sure it’s a good way to run a railroad, if you get my drift)

Janus was a two faced god, for sure, but he was more than that. He was considered the god of beginnings, gates, transitions, time, duality, doorways, passages and endings. I am so sick of seeing and hearing and experiencing modern people and circumstances that do little more than belittle, tear down, marginalize and destroy government, institutions, morals and other people. Could we not look at Janus as a chance for looking back at history, learning from it, and then facing the future with a bright optimism that fuels positive change and enlightenment and respect for others? How many Janus moments could we find, if we could but look for them actively?

  1. New relationships. We meet people all the time, in the stores we frequent, at our places of worship, at work, at school, at play. New relationships are just that-new. They are opportunities to show compassion and friendship to others, while receiving the same from them and learning new things from them as well. While we have many fine older relationships that span years and even decades, new ones offer us the opportunity to  expand our worldview, our reach and our circle of influence for the better.
  2. Online encounters. We sign onto Facebook, Instagram, Twitter, Snapchat, WeChat, and dozens of other on-line clearing houses for ideas, self-expression and commentary. We pick and choose who to associate with there just as we do IRL (in real life). We look, listen and learn. We comment about the things that we feel most strongly about. It is a slippery slope, social media. Why? Anonymity is one big reason. You can say anything to anybody with impunity, to a point. You can cut someone down, cut them off, and cut them out of the herd. You can spew racist commentary, spout your political views and wish someone a happy fifth birthday, all on the same medium. Is this not the perfect place to model behavior, good behavior for others? Yet, we look backwards to arguments and wars and disagreements from the past, fanning the flames of hate and unrest that we thought had long since died down to a heap of cold ashes. We spew vitriol. We curse others. We demean others for their customs, their dress, their sexual orientation, their religious beliefs. It seems that social media is rarely the bringer of good tidings and happiness, as least on the whole. Where better to turn things around and use this Janus moment to look forward, literally turning our backs on hate and racism and homophobia and discrimination and fear?
  3. Death and loss. I was reading several articles this past week about D Day and its aftermath. On June 6, 1944, more than 160,000 allied troops made a spectacular beach assault on the German defenses on the coast of France. The attack involved incredible planning, unbelievable numbers of planes, trucks, amphibious assault vehicles, and of course the soldiers themselves. Nine thousand allied soldiers were killed or wounded that bloody day, but their sacrifices allowed one hundred thousand more troops to begin the march inland that eventually lead to Hitler’s downfall and the salvation of Europe and democracy in the free world. We mourned their sacrifices and their loss this past week, as we do and as we should every year, but is this also a Janus moment? I believe what I am thinking about this was best said by General George S. Patton. “It is foolish and wrong to mourn the men who died. Rather we should thank God that such men lived.”
  4. Aging: In another blog, I am writing out my feelings and coming to terms with Growing Older. Aging is that perfect mix of looking back and looking forward, never in equal parts. When we get up in the morning and have our increasing aches and pains and feel stiff and sore and tired, we look back at how young and spry we once were, and we grieve just a little. We have inevitably lost our physical youth. Ah, but what have we gained? As our physical bodies age and change, as they must, our minds are filled with memories and thoughts and ideas processed and lessons learned.  We have lived. No matter if our life spans ten years, fifty years or a hundred years, we have lived. That counts.
  5. Transitions. We all go through those times in life when things change. We graduate kindergarten and move to the first grade-real school! We finish high school and decide to go to college-or not. We get our first job and begin to pay our own way in the world. We pick a life partner. We have children. We lose a parent, We move to a new city. Transitions are those perfect Janus moments that let us say goodbye while looking ahead. We mourn the loss of certainty, yet we eagerly anticipate the joy of discovery. We are in one of those global times of transition in our country right now, on many levels. We are deciding who should be insured and have healthcare. We are deciding if women control their own bodies. We are deciding who can love who can marry. We are deciding how we fit into the world economy and the culture of man.

Like Janus, we look forward to these transitions as we walk through the gate of history. We anticipate the future. We want it to be bright for everyone.

Also like the god of doorways, passages and time, we look back at the past with some nostalgia, sense of sadness and loss. This is normal and should be embraced.

However, we turn our back on and ignore the lessons of the past, the signposts left by those who have gone before, at our peril.



Three Little Words

As Chris Brogan and others have made customary in the blogging world, I offer up my three little words for 2015.

1) Books

I have thought about how I spent my time in 2014 and the recent years before. I found that a lot of my “ear time” was taken up by listening to music, but sometimes even more time was taken up by listening to podcasts. Tech podcasts. Mac podcasts. News podcasts. Productivity podcasts. A lot of time. Like hours and hours. Some of these podcasts are one and a half hours long or longer. Geez.

The fact is that the ear candy that is podcasting is a pleasant diversion akin to mental masturbation. Like the real thing, it feels very good but it’s not nearly as satisfying as a real relationship.

Enter books.

Remember those? Real ones with covers or audio ones on or your collector and distributor of choice. I have always loved books and I used to be an avid reader. Somewhere along the busy byways of life I lost that ability to really get into a good book, to focus and concentrate and enjoy the character development and the plot and the suspense of disbelief. I lost the pleasure I got from reading biographies of great men and women in history. I lost my passion for the many big, colorful, detailed Civil War books that used to litter my desk.

I want that back.

In 2015, I will read. Real books. Audio books. Books.

2) Breaks

Give me a break!

I’ve got news for you, kiddies. Nobody, I mean nobody, is going to give you a break. Not a leg up. Not a moment in time. Not a promotion that you don’t earn by busting your butt.

Now, in 2015, the word break is going to mean two things for me.

One is that I am going to make my own breaks, things that help me get along, move on up, get ‘er done, and make my mark. I’m going to “carp the diem” (Yes, Rob, of course that is for you-Happy New Year!)

The other side of the breaks coin will be the actual breaks that I take to recharge and rejuvenate this coming year. I’ve already had a good running start at this year-long goal in 2014 with my three week, seven thousand mile cross country trip and the several little mini-vacations I took to the coast to relax, Christmas shop and have coffee by the river, just because I needed to and I could.

This year, I intend to travel, see some new places, eat some different food, and enjoy the company of friends new and old alike. Break time is necessary to stay sharp, stay focused and stay happy.

3) Brinks

Now, what is this brinks thing, you’re asking?

One can be on the brink of a new discovery, at the brink as in getting ready to fall off a cliff, or on the brink of a major life-changing event.

I will be at the brink in the coming year, and I know it. Work, career path, relationships, all may see me walking right up to the edge and deciding whether it is a good idea (or not) to step back and think a while longer, to put one toe in and test the waters, or to simply decide that it is time to jump off and see if I can fly.

The rush of adrenaline that comes from pushing yourself to the brink, and then deciding how to negotiate that predicament and come out feeling happier, stronger and more alive, can be powerful indeed.

So, there you have it. My three words for 2015.




Three little words that over the next 365 days will guide me, remind me, and help me to be the best I can be in the new year.

What are yours?


High in the mountains above Golden, Colorado, October 2014. Photo by Chelsea Smith.

New Years Restitution

Well, we have a couple of days left in this year 2014, then it’s on to the next one.

Someone once told me that they did not get this whole celebration of the New Year thing. One day turned into another day, the old calendar was dumped in the trash and the new calendar was hung up on the refrigerator and it was a new year. Big deal. Who cares?

I disagreed then, and I disagree now.

I think that the marker and the milepost that is New Year’s Eve and the resultant blank slate of a fresh new temporal canvas are both very important to us. We can let go of the bad, the mistakes, the regrets, and the clouds of the past year. Then, we can say hello, wave, and acknowledge the entrance of a bright, shiny new 365-day stretch of possibilities and opportunities.

At 12:01 AM on 1-1-15, your canvas will be blank. You may paint on it anything you wish. You may choose bright colors and bold lines and a year of dazzling discovery, or you may choose broad brushstrokes of gray and brown and black, each bleeding into the other to cover the medium from top to bottom with mundane, uniform, depressing muck.

It’s your choice.

One thing I do not like and do not participate in is the public declaration of New Year’s resolutions. I think they are artificial, short-lived, feel-good bandaids for full-thickness burns. We make them, we don’t keep them, and we think we have done our duty to the New Year to do so.


What I will do this year, and I invite you to do too, is to engage in a very pleasant gift-giving to myself, the act of New Years restitution.

What is that, you might ask?

Restitution is 1) the restoration of something lost to its rightful owner, or 2) the restoration of something to its original state.

I have a very good life, I think, but there are many things that I have let slip, consciously or not. I need to make a very active effort this year to restore those things, to give back to myself those things that I need to be active, productive and happy to the best of my ability.

After all, I know (and you do too) that nobody else is going to do that for me. I make the effort, I set the priorities, I do the work, or it just ain’t happening. Simple as that.

Things that I will pay myself back or restore this coming year:

Sleep. We need seven to nine hours of sleep per night. That’s just about a given, no matter where you look it up or how you slice it. I have always deluded myself into thinking that because I went to medical school and work hard and am always on the go, that I do not not need that like all other humans. I have always gotten by on four and a half to six hours sleep and why should that change now? Because it’s not healthy, that’s why. Lack of adequate sleep negatively affects alertness, cognition, eating patterns and weight gain, energy, hormonal balance, stamina, sex drive and mood. Bottom line? Sleep more, live longer, feel better, enjoy your life. My target for average sleep per night this year? Seven hours. Why not nine? I’m a realist. I’ll start with seven.

Quiet time. My job involves talking to people. Lots of people. All day, and sometimes half the night. Up to sixteen hours per day of talking and listening to others talk to me. Then what do I do on top of that? Listen to music, podcasts, watch movies, watch the TV out the corner of my eye at the gym. My days and nights are filled with sounds and voices and stories and noises of all kinds. Now, this is not a bad thing, in my opinion. However, when there is no time left for quiet, no time left to reflect, no time to process and plan and dream and think, havoc will ensue. A rumbling sense of dread and then panic starts, fueled by the inability to get off the merry-go-round and have any down time at all. Like lack of sleep, this is not healthy. I will pay myself back for all the hours and hours of time I spend engaged each day with a few minutes of quiet meditation, reflection and soul searching each day. Every day. I had the time to do that once. I can find it again.

Forgiveness.I have gone through some pretty heavy changes in my life over the last two years. I have made some life-changing decisions, ones that affected not only me but those I love and care about very much. I have said some things that I probably should not have said. I have done (or not done) some things that I probably would do differently if I had it to do over again. I cannot go back and change the past. I cannot undo things. I cannot unsay things I’ve said. I cannot second guess major decisions that were made the best way I knew how to make them at the time with the information, resources, and energy I had. I can, however, forgive myself. I must start there. If I can’t forgive myself, how can I possibly hope to forgive others? I will treat myself better as 2015 starts by letting myself experience forgiveness.

Creativity. I enjoy writing. I enjoy putting thoughts on the page. Always have and probably always will. I have been writing stories and essays and other short works since I was in grade school. I have been blogging since 2007. I will, in 2015, let myself enjoy creativity in any way it presents itself to me. I will try very hard not to be stilted in the way I see the world or the way I convey thoughts, feelings and ideas to others. I will take that next step in the creative process when it presents itself to me.

Relationship. I have let some of my most positive relationships go in the last two years. Whether this is from guilt or fear or shame or for some other reason, I don’t entirely know. It doesn’t matter. What does matter is being in relationship. I have come to see and feel, once again, that this means being in relationship with God, with my family and friends, and with special people who give my life profound meaning and purpose. I have already started to re-gift myself with the wonderful sense of connection and relationship this year, and I want very much to continue that and expand on it in wonderful ways in 2015. As one of my friends told me this past year, we were not made to be alone. We are happiest when we are in communion with others. I am starting to understand that again, and it feels nice indeed.

Spirituality. As I have stated here before, this is not meant to be a religious blog. I do not want to force my views on anyone, and I do not want to proselytize. However, one of the things that I need to restore in my life is my faith. I have thought long and hard about how my grandmothers, my father and mother and others who helped form me into the person I am today leaned on their faith very heavily as they weathered life’s storms during their lifetimes. It is hard to convince myself that it is reasonable to pick and choose which parts of their examples I will follow, divorced from the whole. Spirituality is a gift, no doubt, and it is something that as I get older I see is more necessary to my happiness and stability than I ever thought it was in my youth.

Gratitude. How can we go through life not being thankful? How can we start each day without being thankful for breath, for sight, for the abilities we have? It is easy to think that we are self sufficient and that we have it all figured out. That we need nothing and no one to make it in this world. I will concentrate on restoring active gratitude to my daily life this coming year.

Generosity. This follows naturally after gratitude, don’t you think? When one is thankful for life and all that it gives, it is almost impossible not to share some of that joy with others. That is why I love the Christmas season so much. I love giving gifts and thinking about what would make someone else happy. I have an abundance of riches and really don’t need anything of import, materially, and so it is a lot of fun to share! I will look for ways to be more generous to others this coming year, with my time, my resources and my attention.

Play. I’m already doing a pretty good job with this one, but I could improve, as I guess we all could. Watching my grandchildren is the best prescription in the world for me personally in this area. Little children know how to play! They know how to take whatever is at hand and use their imagination to make it magical. The know how to dream. They know how to throw themselves about with abandon. They know that if they want to be a princess or a super hero that they can do it! All of us adults could certainly use a refresher in how to play.

Exploration. It is easy for us to fall into our own easy, or at least tolerable ruts on a day-to-day basis. We get into a routine, a prescribed schedule and we get stuck there. Again, that’s not all bad, especially if we enjoy very much what we do and how we spend our time. However, I discovered when I was on my seven thousand mile driving trip around the United States that the ability to literally get off the beaten path and explore was the most invigorating thing in the world. To see things one has never seen, to learn new things, to meet new people, all are exciting and life-renewing. In 2015, I intend to continue exploring, visiting, traveling and getting outside my comfort zone. I am going to give myself the gift of peregrination, and restore the sense of wonder that comes with it.

So, there you have a long list of things that I want to restore in my life, or at least fine-tune and experience in deeper ways in 2015.

What do you want to give back to yourself, to restore in your life in the coming year? It will take a conscious effort, it will take work, and it will require a promise to yourself that you will see it through.

I challenge you to make your own list.

Happy New Year to all of you, dear readers. I hope that this one is the best yet for you and yours.


Faith, Hope and Love

I don’t usually crowd source my blog posts. As a matter of fact, I never do. First time for everything, right?

I published this status update in Facebook yesterday as I was having a late pre-fishing trip breakfast, and over sixty people have already liked it. There have been many good comments and personal takes on the situation that prompted the post. I would like to expand on my feelings in this blog post, and I would like to share some of what you said to me that made me think even more about the topic at hand (thank you for that!). Here is the post from yesterday:

Just saw a very sweet elderly couple quietly enjoy a large breakfast, smile at each other, and talk very respectfully with their nice waitress.
Then, he got up, unfolded her walker with the dayglo yellow tennis balls on the back legs, gently helped her up, steadied her, and slowly walked with her to the door and into the parking lot.
Love, real love, is patient and kind.
Respect only grows stronger with time. It does not see class, color or infirmity.
Devotion is dogged. When challenged, it only becomes more tenacious.
Well done, sir. Well done

First off, some of you might remember that I talked about another couple I saw in another setting, two people who looked tired and sad and said not a word to each other as they ate their meal. Watching them, I felt sad, defeated, worn down. The futility I felt while watching them felt very real to me.

This elderly couple was different. They had to be in their eighties, both a little feeble, he a little kyphotic but still tall and relatively strong for his advancing age. She, obviously post-stroke or some other event that necessitated the walker, but with a sweet face and a look in her eyes when she made eye contact with him that spoke love in a way that was unmistakeable. They enjoyed a hearty breakfast, eating more than I did! They didn’t say much to each other, but in this case I don’t believe they had to.

His attention to her was slow, measured, careful, loving and supportive. He never pushed her, never scowled at her, never hurried her at all. She made an obviously difficult effort to rise, balance herself and walk. He never wavered, supporting her arm at the elbow, guiding and letting her shift her weight onto him as she needed to.

I had no doubt that he was always that way with her, that he loved and cherished her, and that he would do anything to make her life easier. No words were needed. He didn’t need to explain himself. It was all so clear, so very clear in his actions.

One of you told me that what mattered was that this was their reality and their life. Sometimes, we don’t get to choose what happens to us. We do, however, choose who to spend our lives with, who to love and cherish and who to support. We also choose who to show our vulnerabilities to. This loving companionship, this caring and sharing and supporting, work both ways in a good relationship. A relationship cannot last, not in any meaningful way, when these bonds are not real, not strong.

Another reader told me that she had spent a lot of time “unfolding the walker” for her dear husband. She said more in that one little comment than I could ever write in a thousand words.

One reader asked if I thought this was the exception. I certainly hope not, though I think the world likes to hear more about the sensational, the negative, and the outlandish much more than it does about the quiet humbleness of a man acting out his humility and servitude in the context of love and devotion.

One of my friends commented that love and resilience are two qualities that must be present in a successful marriage, and she is so right.

Another friend reminded me that love and respect go hand in hand. The former is not real without the latter.

I was very humbled by the likes and responses and opinions shared on Facebook about this tiny little status update as I sat there drinking coffee and eating eggs. There is so much sensationalism in social media these days that sometimes we forget to sit quietly, observe our world, and allow ourselves to think, observe and learn.

For those of you who have this kind of relationship with someone, cherish it, please. Work on it. Nurture it. Feed it. Let it grow and grow as the years go by, so that when the inevitable storms come and the stresses mount up and you feel lost and unable to cope, you can look across the table at the love of your life and know that everything will be okay.

For those of you who have never had this, I hope you find it. At twenty or forty or sixty or eighty. I hope you find it and it knocks your socks off.

For those of you who have had it, or even a part of, and lost it, take heart. Never give up. Miracles, true miracles, happen. Love blossoms and grows in the most unlikely places. Old loves come back. New loves spring up.

Never stop looking.

“For there are these three things that endure: Faith, Hope and Love, but the greatest of these is Love.”

Aramaic Bible in Plain English

Aging Gracefully


Many of my notes begin something like this:

Forty-five year old white female, who looks older than her stated age, presents with symptoms of depression, hopelessness, and suicidal ideation.

I was discussing with a fellow worker in the mental  health field yesterday the fact that we are all well-trained in observation. We must be, to do our jobs properly. I have written posts in the past, and have even taught medical students, about how to do a fairly complete or at least serviceable mental status examination on a patient who never says a single word to you. It is not optimal, but it can be done. 

We notice what our patients look like the moment they walk in the door. How is their hair done? Are they wearing makeup? Is it tasteful? What kind of clothing are they wearing? Is it appropriate for the season? Do they have jewelry on? As they walk down the hall toward the office, we can see if there is any disturbance of gait or balance. When they sit down, body language, abnormal movements, and eye contact are all readily available markers of what might be going on that brings them to see us. All this before we have said much more than good afternoon to each other. 

What we forget to remember sometimes (for we knew it all along; we just don’t want to acknowledge that it is true) is that our patients also notice us. They notice how tired we look one day, or the bags under our eyes if we have not been sleeping enough. They notice if we wear new clothes or have new glasses or a new wristwatch. They may have a mental illness, but that does not mean that they are not concerned about the welfare of the person who is treating them. 

Most of the time this is harmless, but sometimes it can be telling in a very important way that impacts good patient care. Like the time that I hired a temporary doctor to help with coverage in a rural clinic. Shortly after she had met some of my longtime patients at the office, I received a message that one of them wanted me to call him about something important. Now, this patient never called me and left a message like that unless it was truly important to call him back. I did so, promptly. (As background, please know that I had already heard grumblings from the staff at the main mental health center office where this doctor was also spending some time.)

“Dr. Smith?” my patient began on the other end of the line, his southern drawl so thick it took him days to tell a story.

“Yes, Bill?” I answered, wondering now what was up. He sounded good, calm, together. 

“You know that lady doctor you sent down heah to see us until you can git sumbody else hired to help you out?”

“Yes, I do. What about her, Bill?”

“Well,” he hesitated.

“It’s okay. You can tell me whatever you need to tell me. It’s all right.”

“Well,” he began again, “Dr. Smith, you’ve known me a long time. I may have a bad mental illness, but Dr. Smith, that lady is one of the craziest doctors I think I’ve evah met.”

He went on to tell me details of some inappropriate behaviors that impacted care in the center, consistent with the feedback I had already been getting from others. 

I fired the doctor the next day.

I saw a young patient in clinic recently. He had not been in to see me in well over a year, maybe two. He greeted me this way:

“Well, I guess we both got older, Doc. A little gray there since I last saw you.”

Just a few years ago, this might have bothered me. No more.

I’ve come to like my rapidly whitening goatee, the touch of gray-white at my temples. Badges of experience. Signs of (hopefully) wisdom gained in the struggle? I’m not as skinny as I was in the ninth grade in high school. My hairline has receded a bit, but at least I still have hair! Some days, I’m sure my patients notice me sitting down with an audible groan or struggling for a half-second to get up when my polymyalgia has flared. I’m sure they notice that I forget things, parts of their history that I know and have known for years, but that get swept away downstream in a modern-day torrent of electronic medical records, red tape and sheer volume of information coming at me from a dozen different pipelines. 

I think my patients give me the benefit of the doubt, because they know I care. 

We grow old together, my patients and I.

I am treating the fourth generation in some families now, seeing first hand the living textbook of mental health genetics that is a family plagued with substance abuse, depression, or schizophrenia. I have always said that I am privileged beyond words to be let into a patient’s life and circumstances on such an intimate level as this. I mean it. It is an honor. 

Aging gracefully is a skill. An art.

In this age when we value beauty and youth, we sometimes forget how important it is to revere and respect our elders. They hold priceless memories. They have seen things we have not had to see. They have picked us up when we have fallen and protected us from untimely hurt. They have known that they could not forestall the inevitable painful education that life bestows on us all, long before the first gray whisker or arthritic joint visit us and take up permanent residence. 

Yes, my patient pointed out the gray. He reminded me that, like my patients, I grow older with each passing year. Not a bad thing, given the alternative. 

I work.

I play.

I love.

I lose.

I learn.

I share.

I live.