Blackbeard

He came to see me for his annual visit. He had been stable for many years, taking his medication and not having any of the psychotic symptoms that had gotten him to me in the first place two decades ago. This visit was pretty much like all the rest-at first.

Check on his symptoms. Check on his medication, the dose, any side effects, the last time he had routine lab work drawn to check liver functions, blood glucose, lipid levels. All routine.

He was, as usual, quiet, subdued, soft-spoken, looking mostly at his shoes and not making any direct eye contact. No hallucinations, no delusions. No suicidal ideation. Mood good. Sleep and appetite good.

Then, quite abruptly, he looked up, straight at me.

“How long you been seeing me?” he asked.

“Probably twenty years or more, I think,” I said.

“That long? How long you been working here?” he was curious.

“Twenty six years,” I answered. “I started with the mental health center in 1991.”

“That long? ”

“That long.” I said.

“Oh, yeah!” he suddenly sat up straighter, looking right at me, like he was seeing me for the first time in two decades. “I remember you. That, that there (and he pointed in the general direction of my beard) used to be black, dark, black, didn’t it? And that up there (he made general hair mussing gestures over his own short-cropped hair) was dark too. Now, it’s all white. It’s white, ain’t it?”

I smiled. What else could I do?

“Yes, it is a little whiter than it used to be,” I answered.

He looked dead at me again.

“You old.”

There it was. Simple.To the point. True. Sort of.

I smiled bravely again.

“Yes, I guess we’re both getting older, aren’t we?”

 

Time goes by much faster than we realize.

We form relationships, big and small, acquaintances and deep friendships, professional and casual, lasting and fleeting.

Patients age. Customers age. Teachers and mentors age. We age.

We don’t really want to. Not consciously. Not really. But we do, all the same.

We have developed institutional memories of our most cherished places, we have gained expertise, and we have developed confidence.

We think that it will last forever, but deep inside, in those places that we hear late at night as we drift off to sleep or first thing in the morning as we rub the sleep from our eyes at first light, we know that it can’t. It won’t. It shouldn’t.

Eventually, we will find ourselves being cleaned from the grimy window of time so that the generation following us may see clearly into the future. As it should be.

Now, those of you who know me know that I don’t consider myself remotely close to being old yet. I have a whitening goatee and my hair is now visibly salt and pepper when I look at my recent wedding pictures, but I pay that little mind.

I will continue to work because I find it a challenge, travel because it broadens me, and love because it gives me a reason to live another day for someone other than myself.

My work life?

It will end, if all things go according to plan, on April 2, 2032. I will be seventy-four years old. I have made an appointment with myself for that day to start the rest of my life. I have a lovely lady I would like to spend more time with one day, and an insatiable urge to see more of the world.

I’m quite sure that before I do anything else that week  I will be right here, where I am tonight, sitting at my dining room table,  writing something for you to read.

I have no doubt that I will have something to say.

 

 

You

I have been enjoying an hour of reading each morning before work, and Thomas Friedman’s Thank You for Being Late is my latest fare. It is a fascinating book that addresses the many different types of accelerations that we are experiencing in the world right now, and how we had best conceptualize and cope with them in order to survive and thrive.

One thing that Friedman makes very clear, and that other writers are echoing, is that our assumptions, the things that we have always taken for granted and have counted on to be eternal, have started to erode. We have always assumed that if we played our cards right, kept our noses clean, and played by the rules, that life would turn out pretty well for us. We were always told that if we worked hard, went to school, got an advanced degree and met the right people, we would land that nice job with benefits in a company that was too big to fail and that would see our careers through until we could take a retirement package that would let us ride softly and gently into the sunset of old age.

The world is changing. Rapidly. Fundamentally.

Previous assumptions do not hold true any longer. Previous plans, tried and true, that everybody followed, do not work. Traditional training, preparation and thinking that used to get us firmly attached in industry and the world of work now provide little except for artificial trappings that say what we should know and what we should be able to do.

Tradition, once the bedrock of our predictable lives, is changing faster than most of us can keep up.

This is the age of You 2.0, or maybe even 3.0.

You are now the startup. You are the company of one that is making the pitch out in the world. You are the one trying to convince someone important that you have the knowledge, skills, training and flexibility to perform, to produce.

There is now the need not only for a specific amount of schooling and training, but for continuous learning throughout your working lifetime. Finite training and degrees, static and sterile, are entering a phase of obsolescence. Continuous self assessment, pivoting to meet the current needs, retraining and skill acquisition are the watchwords of You 2.0.

You must not only be prepared and properly trained, but you must have fully developed emotional intelligence, the skills necessary to handle groups of people, exemplary communication skills, and flexibility. You must be willing and able to turn on a dime, to meet new challenges and take on new projects that in years past you would have thought were out of your league. Continuous self assessment will be your watchword, and adaptation and skills acquisition will be your goals.

As Friedman said in a previous book, the world is flat. It is also fast and furious, changing at the speed of Moore’s Law and then some.

Those of us who are overwhelmed by this rapid change will fade away, some fast, some slowly.

Those who embrace change, who thirst for knowledge and who adapt to different landscapes and environments will be successful and drive the next wave and the next and the next.

You 2.0 will look nothing like the prototype.

Then again, did we really expect it to?

 

Casual Friday

A disclaimer before I even get started on this post.

Some of you who know me or work with me will think that by writing this post I am talking about you or even attacking you. I am not. If you’re especially sensitive, don’t read any further.

I am simply writing something that has been kicking around in my head for a long time. Feelings that I have about a concept.

A concept called Casual Friday.

It is fairly common nowadays in companies and facilities and services of all sizes and types to allow employees to wear more casual clothing to work on Fridays. The thinking is, of course, that it’s close to the weekend, things are winding down, people are starting to  loosen up a bit, and that consumers and customers and patients won’t really care one way or the other.

I disagree.

Why?

There are several reasons.

One is that one of my major male role models in life growing up, my father, was a manager for a large textile company for most of his working life. I remember Dad wearing pressed, short-sleeved white shirts, a tie, dress slacks, and business-dressy belt, socks and shoes every time he would go to work. Including Fridays. Sometimes on Saturdays. Maybe Sundays after church if something needed checking on. My memory may have dimmed through the years (Mom, maybe if you read this you can provide a reality check for me on this point), but I never remember him going to the plant in a polo shirt or jeans or anything less than his professional “uniform”.

My Dad impressed me, and impressed his work ethic upon me, because he always cared very much about how he presented himself, how he interacted with his people on the floors of the plant, and how he was a role model for the kind of dedication and hard work he expected from all his subordinate employees.

As I grew and went to school and eventually found myself in a medical school environment, it was impressed upon my very early on that one should present oneself as a doctor at all times, not just when on duty, but at the grocery store, in church, and at the football game on Friday night. Part of this was, of course, how one dressed. Somehow, and I’ve written about this before, people can tell that you’re a doctor without your saying a word. I’m still not sure exactly how that happens, but I know that clothing, in certain situations, quietly proclaims professionalism-or not. It’s part of the package, the persona, the training, the projection of who the professional is. It’s the way doctors of my generation were trained.

Also, we were trained very explicitly to observe every little thing about the patient we were bringing back to our consulting room, including their hygiene, gait, clothing, makeup, hairstyle, arm swing, and level of alertness. Would it not be very naive indeed to think that patients would not be checking us out as well? First impressions are huge, especially when you are entering in to a relationship with someone who is going to be asked to tell you about everything from their drinking to their sexual abuse history to their suicide attempts.

Now, fast forward to the present. I see patients every day of the week, including Fridays in the clinics and now via telepsychiatry on some Saturdays and Sundays. Again, it may just be the way I was brought up, but I feel that every patient, no matter which day they are scheduled or how late in the day or the week it is, deserves the same attention to detail, professionalism and interaction that every other patient gets. I had fourteen patients scheduled in the clinic today, a Friday. Are they any less important to me just because I see them just before I am getting off for a weekend out of town? Of course not. Do they deserve the same presentation and professionalism from me that the Monday, Tuesday and Wednesday patients get? In my opinion, yes.

That being said, I do not feel comfortable wearing jeans or polo shirts or flannel to see these folks just because it’s Friday. Sure, I would be more relaxed and probably be more easy going, but is that the way I’m supposed to be on Friday visits with a suicidal sixteen year old or a defiant five year old and his distraught parent?

i have noticed over these last few years that when I dress professionally for the day, just as when I now wear a close-cropped beard that is more white than it used to be, that I get a lot more “yes, sirs” and “no, sirs” than I used to. A function of age and seniority? Sure. Clothing? Probably? Demeanor and confidence? Absolutely. It’s a package deal, remember?

When one does a telepsychiatry consult, all the folks on the other end of the camera see is you from the waist up, or more if you pull the camera angle back some. You could certainly were jeans or even shorts and flip flops for all that matters. Do I do that? No. Why?

Because the other part of all this for me is that when I am dressed for work, I am thinking work-related thoughts. When I am dressed in casual clothing, I’m ready to head for the beach or the football game or dinner with my relatives. It just goes together for me. Again, I think this is due to upbringing, role models, intensive training, and personal choice as my career has evolved. I have a standard uniform now, I’m comfortable in it, and when I have it on I know it’s time to see patients or run meetings or do supervision or write prescriptions or type progress notes. Anything less and I just don’t feel like the doctor is in.

So, Casual Friday will most likely still be around for some time in some fashion in many of the places that we frequent.

Just don’t expect that if you come see me on Friday that I will look much different than I would look if you came to see me on Tuesday.

If Not Us, Who? If Not Now, When?

Okay.

This is going to be a hard post to write. Even after thinking about it last night and sleeping on it (the time when many of my posts write themselves, ready to pop out at 5:30 in the morning with little help from me), there is a jumble of thoughts in my mind that need to come out in some logical order. That may not be the case this morning, but I beg your indulgence as I try to make some sense of them. I want to make you think about some important things today, as well as sort out some of my own thoughts. 

I got home yesterday evening and sat down for supper. I reached for my iPhone and fired up the NPR app, ready to  listen to some of the stories of the day. One hit me especially hard. I am a middle-aged white man living in the southern United States, and I grew up in the sixties and seventies. I know about racial tension and inequality and the struggles that have gone hand-in-hand with them for the decades since Reconstruction in my home state of Georgia and my now adopted home state of South Carolina. To hear this story about racial tensions as pertaining to the extension of bids for sorority pledges at the University of Alabama, for some reason, just made me want to scream. I don’t really know, yet, why it affected me so much last night. It just did. I got really angry. I think I scared one of my Facebook friends. (I’m sorry about that.) 

From NPR:

“The campus newspaper, The Crimson White, reported allegations this month that two prospective black members were passed over by all-white sororities because of pressure from alumnae, and in one case, an adviser. The coverage caused a wide-ranging debate, even prompting Alabama Gov. Robert Bentley, an alumnus, to say that fraternal organizations should choose members based on their qualifications, not their race.

The debate came at an embarrassing time for Bonner’s university, which is marking the 50th anniversary of its racial integration. Alabama admitted its first black students in 1963 after then-Gov. George C. Wallace infamously stood in a schoolhouse door to protest their enrollment. Wallace relented under pressure from President John F. Kennedy’s administration.” 

I immediately flashed to that iconic image of Governor George Wallace standing in the doorway denying black students admission to his state’s school, defiant until President John F. Kennedy’s administration finally made him see his way clear to step aside and allow events to unfold as they finally did, and for the better. I thought about the judge talking to us prospective jurors in the courthouse in my hometown two years ago, two years ago, about the colored only and white only signs on water fountains and bathroom doors that were still there, even though not enforced, after all those years. 

I thought about the injustice of these things. It bothered me. A lot.

Later in the evening, a Twitter friend who reads this blog commented on my not-so-subtle hint that I would soon be returning to a combination clinical and administrative mental health job in the public sector in South Carolina. Her responses to me, in her usual straightforward, no-nonsense way?

“Glad to read that you’re getting back into the fray. You should be out there fighting for the things you’ve been writing about.”

These two things, separate but related, got me thinking a lot last night about our individual and collective responsibility to make the world a better place. To right wrongs. To push for changes that need to be made because they are right. To stand up for those who cannot fend for themselves. To get out of our comfort zones and stick our necks out and push for social and institutional and political change when it is called for. To not be complacent as we go forward in life. To not succumb to the feeling that this is the best it’s ever going to be. 

When I gave up my medical director job four years ago, I was tired. I realized how burned out I was. I was tired of dealing with issues that were out of my control. I was tired of trying to motivate people who just wanted to whine and complain. I as tired of trying to mold systems into positive forces for good, when the architects of the systems and the people who held the purse strings that funded them just wanted to keep things quietly the same, knowing how poorly the target populations were being served. I just wanted to fill my days with clinical work, seeing my patients and making a difference in the world one visit at a time, helping those that I could and hoping that by the grace of God that all the others would find their peace and redemption some other way, through some other channel. Their salvation would not be my direct responsibility. I could not take on the weight of the world. I was no Mother Teresa. 

I have quietly worked in this mode for almost four years now, seeing patient after patient, hearing story after story, writing prescriptions and admonishing and advising and reassuring and listening. It has all been good. One thing has really hit me in the last few months though.

Just because I sit in my office and see patients and pretend that the big picture problems, the systems issues and the moral dilemmas are no longer real does not make it so

I will be fifty-six years old next month. I am highly skilled, highly educated and in the prime of my career. I am not alone. There are many of us. There are big problems in this country and in this world today. They need to be addressed. 

If not us, then who? If not now, then when?

Some twenty-something kid just out of training who is idealistic as hell but has not a clue how the world works? Some seventy-five year old who has all the wisdom and experience in the world but little energy left to be a player on the field?

No.

The people just like me who are old enough to have experience but still young enough to be energetic and resourceful and willing to shake things up must, I mean MUST, get out of their chairs and start the process of change for the better. This is imperative. 

If we don’t tell the world, again and again and again, that it is wrong to discriminate based on the color of one’s skin, Martin Luther King, Jr., will have died in vain.

If we don’t tell the world, again and again and again,  that it is wrong to marginalize someone just because they have mental illness, then more Navy Yard shootings will occur. 

If we don’t tell colleges and universities, again and again and again, that it is wrong to look the other way for decades while children are being abused, then more Penn State coverups will happen.

Count on it.

What is wrong with us?

Why can’t we see that we must be stand up and be responsible for the world around us and do something to make it better for those who will come after us? Why can’t we see that there can be, and should be, more than just one Greatest Generation? 

If not us, who?

If not now, when?