Saturday, November 12, 2016

Weight Loss and Change

I lost quite a bit of weight in the last year.  It was on purpose. I started by tracking my intake and monitoring food choices.  Before I knew it, the pounds melted away.  I dropped two pant sizes and had to completely flip my wardrobe. My body was transformed.

Strangely, it didn't always feel that way.

After losing twenty five pounds, I looked in the mirror one morning after getting out of the shower.  I couldn't discern a bit of difference.  I could see the same layers of skin and love handles as before. Although my outsides had changed drastically, my brain was stuck in its former state.  My internal version of myself was so deeply ingrained that I couldn't recognize that which was so obvious to my family and friends.

Sometimes I think I resist external change not only out of fear, but also because I am a creature of habit.  My brain often deceives me.

I now know cataclysmic change is upon us.

Unfortunately, it is exceedingly tempting to look into the mirror, as I have done many times, and convince myself that reality is as it was before.

I think this is dangerous.  I also think it is dangerous to consider the fact that we elected a buffoon as president the main problem.

The problem is that half the electorate felt so disenfranchised and desperate that they would knowingly elect a buffoon because they thought they had no other tenable option.

And yet, as I look back at the last eight years, I am filled with such optimism and hope.  I am so proud.

Or is that my brain again, tricking me into seeing a reality that no longer exists?

Maybe a reality, that for some, never existed.

Thursday, October 27, 2016

Glue

Glue

As Leila giggles blissfully at something Katie said, I realize that I lost a moment.  Maybe I was on the phone, maybe caught up in my own head about some patient conundrum or another.

Cameron is tugging at his mother's sleeve.  He tries to wile her attention from dinner and across the table to his iPhone where he discovered a new glitch.

It's pasta a la vodka night and we are all ravenous.  A natural chef, Katie one day glanced over a recipe and created a masterpiece.  We long ago lost the actual vodka and other ingredient modifications have taken place.  It's now one of our favorites.

I tuck my shirt in carefully, and try to avoid splatter as I shovel pasta into my mouth.  A busy day at work, I haven't yet had a chance to change.  I received many compliments on the shirt throughout the day, and I don't want to ruin it.  Katie bought it for my birthday.  I can't quite remember when I stopped picking out my own clothes, but it was probably shortly after we met.  Thankfully, I now look reasonably well put together and current.

After dinner the kids have violin group practice.  Katie thought it would be a good idea to get them started on instruments early.  That was years ago, and now the screeches have turned into intricate melodies.

Looking across the table at my family, I can't help but feel a certain pride and cohesion.  We all have our place.  I, the workaholic spacey dad.  Cameron, the techy, sensitive son.  Leila, tough and smart.


Saturday, September 3, 2016

Evanston

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.

Evanston

Monday, April 25, 2016

Sometimes...

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

Perfect

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.