Saturday, September 3, 2016


If you walk north from my front door a half block, the sidewalk dead ends into a path juxtapositioned between the golf course and Leahy Park.  Continue a few hundred feet and turn east on Lincoln Avenue, and eventually cross Sheridan.  Go past the water reclamation building and around the athletic center, and you will come to my favorite place.

Wend your way through the ambling students and the outdoor athletic field, and eventually you will reach Lake Michigan.  Almost as if by surprise, the incomprehensible body of water jets into view framed by green grass over landfill, a winding path along the waterfront, and an odd assortment of grafitti'd concrete haphazardly placed as an embankment.

This is my Evanston

This is particularly odd for a guy who has never owned a beach pass, hates sand, and rarely swims in anything but pools.

Certainly my youth was much more colored by the shops lining Central Street on the northwest side.  Primordial memories of riding in the back seat of my mother's Buick station wagon while we dropped off laundry at the drive through dry cleaners.  Or stealing my first candy at Deacon's Dime Store and then feeling remorse shortly thereafter.  There were trips through the alley that started adjacent to the old house on Lawndale and ended at the White Hen Pantry.

The pantry eventually turned into a 7-11.  Then it closed.  The Deacon's is now a real estate office.  Strangely, the dry cleaner still stands.  The path leads from Central Street, through a tunnel where laundry is dropped off at a window, and then dead ends into the same alley that I use to traverse to get to White Hen.

Did I mention the Baskin Robbins?

Adulthood has changed my paths, although I still awake occasionally from childhood dreams with the taste of the Lawndale house on my lips.  I drive past occasionally but the facade has changed.

It's not the same.

My kids and I now walk Sherman or Orrington to get downtown.  We pass by the 201 bus stop I used to take home after going to my after-school tutor when I was diagnosed with a learning disability.  The Betty's Of Winnetka has long been replaced by some store or another.

We cut through fountain square (much the same as my childhood) and end at the renovated Chandlers Building and eat at Edzo's or Potbellys.

And we always walk home along the lake.  Down the same path but from the opposite direction.  Passing the rumbling machinery as Northwestern builds new constructs of glass and steel facing the lake.  The strange beauty of technological colossus adjacent to greenery and natural waterway.

Katie, the kids, and I.

I have changed since childhood.  I walk different paths.

Yet my city still lives. Like me, filled with contradictions.  The ugly concrete slabs slathered with multicolored paint somehow not detracting from the picturesque lakefront.

Familiar yet mysterious.  Uncertain.  My DNA entwined in a small imprint of soil.  On a street full of houses.  In a world full of cities.

The place I was born.  Where I spent the only eight years with my father.  Where I brought my children home from the hospital.


Monday, April 25, 2016


Sometimes before I go on a run, I take the laces of my jogging shoes and tie them together in a knot.  I wear the pair around my neck with each shoe falling to opposite sides.  The heels clunk against my chest as I make my last minute rounds.  It's as if running is my job and the shoes are the instrument I use to perform that job.  Eventually I slip them off my neck, and onto my soul.  It's time to go running.

Today started in much the usual fashion.  The first few blocks were rocky, but eventually I established a pace.  A mile in, I turned the corner, and I was on my beloved lakeside path.  I could still feel the thumping on my chest.  At first, I couldn't help but smile.  I was on the right path, the right journey.  I passed fellow runners, and we shared a knowing glance.  We were brothers and sisters, comrades in a common goal.

As the miles continued, my joy began to fade.  My feet burned and my knees started to buckle.  The sun battered my brow occasionally providing warmth, but often scalding.  I passed my normal turning point, but kept going.  The pain faded and was replaced by a certain fatigue, a weariness. I was still uncomfortable, but I no longer cared.

Suddenly, I tripped on the shoelaces as if they were still tied together, and collapsed onto the pavement.  For a moment a dagger lanced through my hands and wrists before abating.  The blood now dripped from my extremities.

But I was miles from the beginning, I couldn't just stop.

My pace home was slow and methodical.  The miles clicked by as my head hung down, no longer entranced by the joy of the lakeside path.  I hid my eyes from my fellow joggers as they whisked by.  I was embarrassed by my all to visible scars.  My all to apparent pain.  

I returned to the entrance of my house haggard and beat down.  I no longer remembered neither the joy nor the pain of the journey I had just taken.  Instead, I was empty.

Had I taken the wrong path?

I climbed up the steps and pushed the key into the lock.  I sat on the bench in the mud room and took off the blood spattered shoes.  For a moment I went to tie the laces in a knot again, and throw them around my neck.

Muscle memory.

Instead I chucked the miserable pair unattached into the hallway closet.

Maybe it is time to stop running.

Saturday, March 26, 2016

Arms Wide Open

We are born with arms wide open, and we die in much the same way.  It is that which we carry, in the time between, that defines us.

The new born, caught in the primordial stew of beginnings, is unable to recognize the difference between self and other.  She grasps and roots at inanimate objects with the same voracity she reaches for her mother.  It is a time of differentiation, a time of definitions

The toddler understands more of his surroundings  His eyes survey the landscape and fall lovingly on one gleaming object or another.  The word mine dribbles from his mouth as he learns the pleasure of lust.  The pleasure of ownership.  He lugs his baubles with him and looks longingly when his line of vision is distorted, object permanence has long been mastered.

The school age child shoulders a mountain of books.  A transition has occurred from ownership of inanimate objects to attainment of knowledge.  She transports with her a means to an end.  She holds in her precious hands the tools that will lead to an as yet ill defined version of success.

The young adult has completed the transition from objects, to knowledge, to affection.  He grasps tightly to his beloved, no longer satisfied with the baubles of the toddler or the knowledge of the school child.  He has traded in such worldly artifacts for something deeper, more complicated.

The new parent once more finds her arms encumbered.  Whether a crying baby, a car seat, or a dirty diaper, there is not much advantage in deeper contemplation.  Like the new born, she often finds herself grasping in all directions.  The lines of differentiation are again blurred.

Middle age can be a time of great consternation.  One's arms are often empty.  His children have grown and can carry some of their own load.  Instead he struggles with a metaphorical burden.  Will his children be successful?  Will his parents age well?  Will he make a difference in his profession, in the world?

The aged, once again, finds her hands full.  Whether it be a walker or cane.  She struggles with physical frailty and laments that others have to do the heavy lifting for her.  The time of building has long gone.

If we are lucky, by the time we die, we have used or let go of most our material possessions,  We have passed on knowledge to our loved ones.  And we leave this world empty, just as we entered it.

We are born with our arms wide open, and we die in much the same way.

Thursday, March 10, 2016

Letting Go

Vacation was perfect.  We went to one of those all inclusive places.  They slip a bracelet around you wrist and a world opens up.  The pool.  The beach.  Bars and restaurants.  I lounged by the pool and walked in the sand.  I ate far too much and actually slept late into the morning.  The staff was as kind and courteous as could be.  The kids were almost all smiles


But as everything in life, even perfection has to end.  We packed up our bags, loaded onto the plane, and taxied back home.  That evening sitting in bed, I contemplated the little string bracelet that had been my passport  to such thrilling adventures.  My vacation was over but for some reason I couldn't bare to cut the cord.  I couldn't remove the bracelet.

Now the edges had become frayed and the color had worn from the string.  My skin didn't take too kindly to the material, and a small itchy rash had started to form.  My mind new that this bracelet was no longer my vacation.  It was no longer my happiness.  It was a small vestige of that which had once been.  A physical, tangible reminder of the ephemeral.

As the days grew long, and I threw myself head first into reintegrating into my busy life, I pined for the simplicity and satisfaction that that little piece of jewelry signified.  It was no longer the thing of my desire but a wisp, a memory.  It was my vacation on life support; gasping and sputtering and just barley alive.

And I clung to it during sleepless nights and overbearing days.  My wrist became fiery red and itchiness turned to pain.  Whenever things were going badly, I looked down hopefully at my wrist wishing to recreate a moment, a small taste of what was gone.

Eventually the pain got bad enough and I propped my arm belly up on the counter.  I grabbed a knife and  pressed the dull side to my wrist resting just below the band.  Then I pushed up quickly.

The string exhaled, splayed, and fell lifelessly onto the counter.  In an instant my vacation, a living/breathing thing, transitioned from a palpable finite object to a memory.

The rash cleared over the next few weeks, but I often caught myself looking down at my wrist.  Always half expecting to see the band still there.  For just a little longer.

Afraid of what it would mean to hold on.

Afraid of what it would mean to let go.

Tuesday, February 16, 2016

How Good Medicine Has Become The Exception

Joe had one of the best geriatricians in the city.  So when he got a call from the pharmacist saying his new prescription was ready, he assumed that it had to do with his recent annual visit and blood draw. His suspicions were confirmed, a few minutes later, when he got through to the nurse at the office.

Joe was politely informed that he had high cholesterol and was being put on a statin. Although he hung up the phone satisfied and raced out to the pharmacy to pick up his new pills, a casual observer might find a few things concerning.

Neither the doctor nor the nurse actually talked to Joe about the significance of high cholesterol. No one bothered to discuss with him the risks and benefits of statin medications.  There was no mention of side effects or complications.  No joint decision making.  And certainly no consideration of a trial of diet and exercise.

A few weeks later, Joe received his results in the mail.  He marveled at the total cholesterol reading of 227.  But no one explained that a large part of his total cholesterol was made up of HDL or good cholesterol.  Joe's HDL of 75 was actually protective when it comes to cardiac disease.  His bad, or LDL cholesterol, was 148.  Not perfect, but not horrible either.

Now, did I happen to mention that Joe is 85 years old and is only on one other medication?  He takes a piddling dose of Lisinopril for high blood pressure.  Joe has never had a heart attack.  Never had a stroke.  He doesn't smoke or have diabetes. He exercises daily and has a normal BMI and waist circumference.

Joe has an exceedingly low risk of having a cardiac event, and in his case, a statin has a much greater likelihood of causing harm than good.    

Yet now he takes Simvastatin, and avoids eating his favorite desserts.

This is not just a fictional story, it happened.

You would think that by now we would be better than this.

But a large number of physicians are still practicing medicine without using even a modicum of evidence or common sense.

And actively engaging patients in shared decision making is still the exception and not the rule.

Monday, January 25, 2016

Alarm Fatigue

I felt like the stack of charts rose past my head and all the way to the ceiling.  I pulled out my pen, opened the first, and started charting.  I took a moment before each note to collect my thoughts.  The patients were complex, the problems sometimes insurmountable.  The nursing station at the facility was buzzing with activity around me.  Phones were ringing, alarms were crying for attention.

On the desk beside me was a case filled with a dozen pagers.  Every thirty seconds, one of the pagers would sound off and vibrate.  The motion would send the case rattling against the desk and not only obliterate my concentration but also fray what was left of my poor fragile nerves.  Every thirty seconds a chorus: rattling, chirping, beeping, or chimes.

Every now and then a staff member would distractedly reach out, press a button on a particular pager, and then go back to whatever they were doing.  Hell, I even silenced the racket from time to time when the noise became unbearable.

I endured this dance for an hour as I finished writing my notes.  By the time I was done, my eyes were red and my hair was disheveled from running my hands through it.  As far as I could tell, the only function of this barrage was to drive the poor doctors, who often had no other choice but to use the desk for charting, crazy.  I had not seen one definitive action taken in response to the buzzing pagers, besides turning them off.

I passed the secretary on the way out of the nursing station and couldn't help but inquire.

Me: Hey, you know those pagers on the desk.  They are always going off.  What a racket!  What are they used for.

Secretary:  Those pagers?  They are connected to the patient's call lights.  Every time a person hits the button at the side of the bed for help, one of those goes off.

Me: Really?

Secretary: You know, like if a patient needs to get out of bed, or is hungry, or has to go to the bathroom.

Me: Or if they have chest pain, shortness of breath, or fell and broke a hip?

Secretary: Yah, I guess that stuff too.

Tuesday, January 5, 2016

Doctors, He Felt, Were No Longer Helping People

It was never his intention that the name would stick.  A decade ago, when he first began working in the restaurant, some of his fellow employees knew that he was formerly a practicing physician and started to call him "Doc".  Although many of his coworkers had since moved on, taking the knowledge of his previous profession with them, his moniker persisted.

Doc liked the simplicity and tedium of his bartending job.  He spent the majority of his nights doing what he liked most, interacting with fellow human beings.  He remembered a time when medicine offered such enticing rewards.  When he could sit across from a patient with a paper and pen and record only the most salient information.  He could look into their eyes, wax philosophical in the exam room, and still have enough time to comfort a grieving family member.

The practice of medicine was once both amazingly complex and laughably simple.  The convoluted path of the ailing body was matched by the enduringly straightforward need to be loved and cared for.  And Doc loved his patients.  He loved them so much, in fact, that the wave of computerization, legislation, and compliance almost got the best of him.

He no longer enjoyed his day to day activities.  His warm greetings and kind words were overtaken by a nagging electronic medical record system and voluminous rounds of paperwork.  Doc was deeply depressed and on the verge of suicide when he made the life altering decision.

He had no children, no wife, and no debt.  He would leave the job he once loved in order to save his own life.

And save his life, it did.

As the months past, Doc felt the stress wash over his body and fall like a puddle to the ground.  He started to laugh again.  He smiled at strangers as they shimmied up to the bar.  He became a spectacle on his own.  A group of regulars appeared at all times of the night to chat as he worked.

It took a full year before the phantom sensation of a pager buzzing on his belt loop finally disappeared.  Double that to get used to sleeping the whole night without being interrupted by a phone call.  Doc was happy, but couldn't forget quite everything about being a doctor.

Although his mind was elsewhere, his keen eye kept lurking back to his training.  He might notice a Bell's Palsy or the shuffling gate of Parkinson's in some unlucky patron making his way to a seat in the restaurant.  Occasionally he gave advice for minor ailments.  Originally his customer's eyes would raise in disbelief, but eventually they learned to trust his instincts.

Once a young man started to choke on a piece of steak.  When Doc heard what was going on, he leaped over the bar and ran to the table.  He performed the Heimlich, and cleared the man's airway.  It appeared as if his actions were too late.  But Doc expertly delivered a few breaths and started CPR.  The man recovered by the time the ambulance arrived.

It was times like these that Doc wondered if he made the right decision.  He still loved medicine deeply.  But he also knew that what doctors were practicing today was no longer medicine.  It was a bastardized version overtaken by technology, administrators, and rules that made little sense.

Doctors, he felt, were no longer helping people.