Day 1 Drive
Today I noticed that the spin machines are much simpler than the more sophisticated stationary bicycles located in the main Gym room. It was my first spin class. I pulled myself out of bed at 5:45AM to make the 6AM class. I was the only student, which was a relief. Who needs the embarrassment of being out-cycled by a sixty year old in amazing shape. The teacher’s disproportioned body, beer belly, and thick neck were not very inspiring. He set up my cycle and instructed me to remember the numbers. I thought that the seat was not high enough because my knees were still bent when my legs were outstretched, but he insisted that it was the right position. An older woman joined the class a few minutes later and sat on a cycle behind me. Spin class was exciting first, of course, because I had no idea that I would be doing the same two things for forty five minutes straight. Stand up, sit down, turn the knob quarter or half, to the right or the left, while listening to irritating night club music, also called Gym music. The more advanced cousin of the spin, the stationary bicycle in the main Gym room, is more entertaining. I stay seated and focus internally as I listen to Mahavishnu orchestra, Pink Floyd, or sometimes the Beatles. When my legs get sore, I push myself just a little more, then stretch them, and on to the weight machines for some upper body workout. Spin class needs focus, a lot of focus, to hear what the teacher is saying, his words muffled by the loud beats of the ambient music. Two more songs, one more set, thirty more seconds, it never seemed to end. I was trying very hard to dry my face. I had a white Gym towel on the handlebar and used it frequently, almost every time I sat down, to carefully wipe my face off, up to the hairline and the ears and the neck. No matter how well I tried, a few drops of sweat managed to escape the grip of my warm skin, and landed on the bar connecting the seat to the handlebar. With my heart pounding against my sternum, I stared at the drop of sweat, as it crawled slowly to the side of the bar. It stared back at me with contempt. You sweat too much. You are out of shape. I knew that.
Day 2 Routines
Today I noticed that most, if not all, people tend to get into daily routines, whether they like it or not. I see this every day, in myself and in others. We all do it and we have a hard time deviating from it. The rigidity with which we approach our daily activities may vary depending on our individual need for consistency, however, the nature of the daily activity itself is in no way a free choice. It is predetermined by circumstances, imposed on us by our parents, partners, children, job and so on. I started a new habit of listening to audiobooks in the car. My daily commute is not that long, but on days when I have to drop off my son at his school before going to work, it may take me over an hour. On those days, my son and I listen to a children’s book on the way to the school, then I switch to a novel on the way from school to work. It is a new activity that I have taken on. I thought it had dual benefit. Listening to a story in the car may help my son, who sometimes has some attention problems at school, be more focused. It is certainly much better than playing video-games in the car. The second benefit is for me. I have very little time to read fiction and this would allow me to “read” more books, which is essential for anyone trying to write. The first book I chose to listen to is a novel by William Kent Krueger called Ordinary Grace. I am overall enjoying it. It is very well written and is well read by Rich Orlow. One scene in the novel struck me as very significant when it comes to our daily routines. A couple walked into their minister’s office in the evening with a request for counseling regarding their intimacy. The wife complained that her husband comes from work every day, sits on the couch, drinks a beer and falls asleep, and is never interested in being intimate with her. The husband, on the other hand, complained about his fatigue throughout the day at his labor-intensive job and the fact that the thought of that cold beer in the evening keeps him going and gives him purpose to finish his job and get home. This type of daily routine gives us comfort. We all like to do what we are good at. We tend to do the same things every day because we like predictability and fear change. The danger lies in routines that may be harmful, whether on a personal level, physical and psychological, or an interpersonal and social level.
Day 3 The Meeting
Today I noticed that climbing the ranks of the corporate ladder entails attending more meetings and listening to people with oversized egos boast about themselves and their achievements, and spue lavish compliments about other members of the same board, praise, of course, expecting them to reciprocate. My first patient of the day comes from far away and arrived nearly half an hour late. Against office policies, I agreed to see them. After all, in a subtle way, it feels like lavish praise when a parent travels such a far distance, passing many, many other neurologists, to see you. By the time I was done with them, it was already 11:00AM. The next patient had been waiting in the exam room for about half an hour. I was late, half an hour late, for the meeting. It was not really a meeting, it was the inauguration of the new emergency room. As the newly elected chief of the medical staff, I had to attend, at least show my face. I had forgotten to account for the meeting in my patient schedule, so I thought I would just squeeze it in between patients. Which I did, despite running behind. I walked very fast to the front parking lot where the president of the board of trustees was giving his speech, followed by this and that speech, a hypnotic effect. It was already 11:30. I emailed the office staff from my phone and asked them to apologize to the patient stating that I had to run to the Emergency Room. Now, this was not entirely a lie. I was actually right in front of the new emergency room. It was an implied lie, which taps into the very essence of the fundamental changes affecting healthcare. The transformation of healthcare from a primarily small business model with focus on service, i.e. the patient-doctor relationship, to a corporate model, focused on reducing cost, saving money, and, of course, shifting profit from the people who actually do the work to the those self-proclaimed, ego-centric, mutually praising, executives, with a strong sense of entitlement, who believe, truly believe, that their time is valuable and expensive, as they bestow their wisdom into another useless meeting.
Day 4 Intention
Today I noticed that, contrary to popular belief and cliche statements, execution actually matters more than intentions. I am in no way trying to minimize the importance of intentions, however, a poor execution, whether due to inattention to details or incompletion, may be caused by a lack of motivation, which in certain cases, could reflect a whole set of different and deeply seated intentions.
Day 5 Focus
Today I noticed that my flexibility, strength and balance have declined since my previous Yoga class. The instructor kept emphasizing that each should move at their own pace and frequently offered the option of resting in Child’s pose. I am not sure if she was talking to me specifically, trying to be polite. The problem is that we live in a competitive world and it is hard to change our mindset suddenly, for Yoga class. Competition is not only with the other students, although it might very well be, the girls in their mid twenties with amazing flexibility, or the older men with great balance, but it is also a competitiveness within, the desire to achieve and reach goals. My form was probably bad as I was trying to sustain inhumane and non-human poses, probably inspired by observation of other animal species that would not necessarily experience nearly as much back pain and muscle aches. This reminded me of an interview with Bill Evans, a famous Jazz musician, that I recently watched in black and white on YouTube. The interviewee was Bill’s brother, a less accomplished musician, who asked about advice to younger musicians. Bill walked to the Grand Piano, set down, and played a progression with improvisation that was impecable, sweet honey to the ear, then told the interviewer that it is very important to know what you are doing and play precisely. He said that some people try to impress by playing fast, but they are confused and imprecise. The interviewer asked about what should musicians who do not have as much time to spend practicing do. His answer was simple. The should play simple but precise. He then played an example of slower and simpler improvisation, that sounded equally good, then an example of a fast but less precise tune, which sounded confused. The idea was that you should always try to play in a precise manner, regardless of your skill level, then you have a strong foundation to build on. If you play confused and imprecise, then you are unable to build up, you will just remain confused. It was such as timeless and universal advise, which I should very well apply to my poor Yoga skills. My flexibility, strength and balance have definitely declined since my previous class, which was several months ago. My bad balance bothered me the most, a sign of the years perhaps, which could have been better, I am certain, if I could only have better focus.
Day 6 Coffee
Today I noticed that the first sip of coffee tastes different than the rest of the cup. This is true for every cup of coffee of the day, but especially noticeable with the fist cup. In fact, the first sip of the first morning cup tastes different than any other sip throughout the day, even the other first sips. That slightly creamy sweet warm flavor touching my dry tongue reveals the beginning of the day, as if the day can not start without it. It has an exceptionally delicious taste that lasts an entire morning. I usually fill my second cup once I finish making rounds at the hospital, typically by late morning. I used to have a second early morning cup in my travel mug, however, once that large, shaped-like-a-bowl-of-soup, mug from Costa Rica became my preferred mug, the amount of coffee of the first cup fills my stomach with no appetite for a second one that early. I usually stop by the doctor’s lounge on my way to the car and use the fancy coffee machine. My only option is espresso, or my preferred, double-espresso. Someone told me once that if I learned to drink black coffee, I would never be miserable. Well, never is a bit of a stretch, but that advice served me well when I found out, after years of confusing symptoms, that I was lactose-intolerant. I only add lactose-free milk to my first cup. The rest of the day, I settle for black coffee. I do not even add sugar, it ruins the taste of coffee. For some reason, sugar gives flavor to milk, but takes away flavor from coffee. I usually grab a small chocolate or blueberry muffin or a small plain bagel for the road. I almost never wait to get to the car to start eating. Coffee on the other hand, waits. It is usually hot and needs to settle down and wait for me to settle down, before the first sip. Something is exceptionally sensuous about espresso. The scent penetrates deep in my lungs and overshadows the actual taste. I make my third cup once I am finished with my last patient at the office. Sometimes I get annoyed if the Keurig machine in the office kitchen is off and I have to a wait a few long minutes before I can brew a mediocre tasting coffee, which I also drink black. I use my special work mug, which was a gift by a patient. It has a very cute drawing of a doctor in color with my name underneath it printed in black handwriting font. I drink my coffee while typing up my notes at my desk. The last sip of that cup tastes so good. The bitterness of black coffee builds up gradually, sip after sip, and trains the taste buds to appreciate its flavor. By the last sip, every corner of my mouth experiences this amazing flavor, that somehow carries along closure and concludes the day on a good note. Each cup of coffee occupies a place and has a role in the evolution of the day, as if my whole day is scaffolded around these flimsy cups with a robust taste.
Day 7 Anger over anger
Today I noticed that sometimes I get angry at people for the sole reason that they are angry at something that, in my opinion, does not deserve to be angry at. I do not do it too often, or with anyone, just with people that I really care about and love, like my wife and kids. I truly get angry at them for being angry. I feel this rage that is hard to control. I have a hard time understanding why they are so upset, which makes me mad because I want them to be happy and feel that they are wasting their energy, and feeding negative emotions over something that is not worth it. What a fool! My own reaction mirrors their behavior. Somebody else’s anger at a matter that I find trivial or not serious enough is not worth getting angry over. Exactly. In fact, my reaction usually backfires, making them angrier, and me, of course, even angrier. On the other hand, when I try to reason with them and explain logically why they should not be angry, it does not work either. This is because the relationship between reason and emotion is different for everybody. Trying to understand would be the right approach, but understanding requires a whole set of skills, that I have certainly not mastered yet.
Day 8 The flow
Today I noticed that most people that I talk to during any given day, are unhappy. I am not sure whether people just pretend to be unhappy, for the cool factor, or if they truly are. The typical conversation in the hospital elevator goes like this. “How are you?”, “OK, another day.”, or “well, I am here”, usually with that facial expression, a combination of disgust and disappointment. This is usually followed by a grin with a one sided eyebrow lift, and “at least I have a job”. The state of our daily lives has been reduced to this. We have a means to make ends meet, without begging. We are not happy, in fact, we may be miserable, but we should not really complain. As a science enthusiast, and a staunch believer in evolutionary biology, I like to go back to the basics. People survived and evolved around their basic needs, food and reproduction. The concept of work or job stemmed from that need to provide food, which started out as hunting or farming. The path that our civilization has taken us through, drove us in a direction that increased tremendously our wants and made us confused between “wants” and “needs”. A chimp spends its days hanging out in a tree. Food is plentiful and shelter is conveniently located right next to the food source. Work started out as a means to fulfill a need, but evolved into an end by itself, from a way to ensure survival, into its own animal. We work to work. All we think about is work. We wake up too early instead of letting for our bodies dictate when they had enough sleep. We intoxicate our bodies with stimulants. We worry about our performance and other people’s impression of our skills. When we have a minute to sit down, we rely on others to entertain us, without realizing that the entertainers go through the same miserable daily process to provide us with entertainment. Life lost its basic simplicity and purpose. The life of any individual has become too complicated, intertwined with the lives of hundreds, thousands, of other people. Happy moments are scarce. We do not spend enough time building pleasant memories. The end of every day is the couch, sometimes a restaurant, where the chef and staff successfully put up a happy facade to hide their stressful lives. The end of the year is a week or two of vacation. I usually spend the first few days of vacation decompressing leaving me with a few days of relaxation, which again, completely depend on other people’s stressful lives. These few hours or days of non-work are the only time when we feel free, and intentionally choose to ignore the fact that our freedom relies on other people’s misery. It seems to me that a fundamental shift in the way we conduct our daily lives is necessary. I feel that I am always going somewhere, working toward a goal that will only open up the road for another goal. The elevator conversation with an Indian doctor made me think. He said that he moved to the US in 95 and visits India for at least 2 weeks every year. His friends and family in India have one tenth of what he has, but are ten times happier. Maybe it is this goal-oriented, highly driven culture. Maybe it is time to park my kayak against a flat rock and take a break in the shade of peach tree and watch the river flow.
Day 9 The Value of life
Today I noticed that I am a bad doctor. I frequently decide, as I am listening to patients’ complaints, whether their complaints are valid or not, irrespective of how they feel about their symptoms. This becomes especially problematic when there is a clear discrepancy between the importance I assign to a complaint and the concern of the patient. I find this to be especially true when I treat elderly patients who present with soft symptoms like dizziness or trouble with balance. I often catch myself thinking that these symptoms are almost normal in somebody of that age, as if the years of wear and tear are allowed to take a toll on the body, and these symptoms are almost expected to happen. While this may be true, the patient does not necessarily know that, or accept it as fact. In reality, elderly people probably have a stronger hold on life than younger people, and worry about every little symptom they experience, as if it is drawing them closer to the end. The sensation of not feeling well is probably experienced similarly regardless of age. The value we accord to our lives determines, in a way, the level of concern that we experience when our bodies feel different today than yesterday. I frequently fall into that dangerous trap of assigning a different value to the lives of patients based on their age and overall state of health. This is hypocritical in a way since I personally do not feel that my life has less value than a 20 year old stranger. In my mind, I get annoyed and want to tell elderly patients that their bodies will continue to degenerate and crumble and their feeling of well being will dwindle down over time, and they should just accept it. The years will continue to eat away at their bodies like a small mouse chomping away slowly at a piece of cheese. That sensation of waking up in the morning feeling well, with energy and oomph to beat the day into darkness, will cease to exist. This is such a cruel way of thinking about disease, because disease does more than that. It invades the body like an entitled tyrant and forces it to move at a rate faster than that dictated by the years alone. Sudden and unexpected, the change takes us by surprise, before we are ready for it.
When I finished examining Mr. B in his chair which was next to his hospital bed, I asked if he would be able to walk. Mr. B was in his late eighties, still sharp as a wip. The recent bout of dizziness worsened his balance and he had not been comfortable walking for the past three days. I insisted that he tried. He got up by pushing both arms against the chair handles ignoring my hand which was fully outstretched next to his. He stood up independently, made the first step cautiously, then a second. I thought his gait was slightly unsteady, but he seemed comfortable walking without my assistance. With every step, his confidence increased, and so did his speed. After a few step, I could see a grin on his face which he was clearly trying to hide, as if he felt a secret triumph, the restoration of a crucial skill that he thought he had lost, the invasion of the tile. He mumbled softly a few words that I could hardly hear, but I am confident that he said: “I can walk “, with a surprised and thrilled tone. We left the room and walked down the hall to the window, which overlooked the parking lot of the hospital. It was a sunny day and the rays of sun reflected on the new black pavement and freshly painted white lines. This is when I realized that I was a bad doctor. I completely failed to remember that the changes that our bodies undergo as a result of age are slow, years and decades slow. In reality, we never feel exactly the same today as we felt yesterday, or last month or last year, but we adapt to slow change and only abrupt and distant leaps are noticed. People are realistic, at least most are, they do not expect to feel the same as they did five years ago, or twenty years ago for that matter, they just want to feel almost as good as they did yesterday, and this is a very reasonable expectation, irrelevant of age.
Day 10 Nanny
Today I noticed that the candidate interviewing for the nanny position had a few unusual features. She was slightly taller than me and skinny. A model body with a pretty face and long black hair. She was dressed in jeans, a tight shirt that showed off her large breasts and flip-flops that exposed her well done toenails. She was 25 years old and is only in her second year at community college, studying to be a special education teacher. She said that she took a year off between her first and second year, and plan on transferring to a 4-year college next year. She was nice and pleasant, with a smiley face. She had no objection to our schedule, picking up my youngest from his private school, which was about 30 to 45 minutes away depending on traffic. She was also fine with driving him to Karate class if we ever sign him up. She was willing to help him with homework, make him practice piano, and do various activities with him, like taking him for a walk, or to the playground. She understood that we prefer to limit screen time, including TV and video-games. She was also willing to supervise my older son, who has major attention problems. He typically has tutoring after school. We were planning on instructing the tutors to work with him on his homework, but the hour of tutoring would not be enough to finish, so he would have to finish his homework on his own. This boy could sit at his desk and stare at the wall for two hours, especially if he encounters a difficult problem. She seemed to get it. He may need a nudge. He also needs to practice his piano and drums if possible and limit screen time.
She asked about food allergies and stated that she had no problem driving the kids. She prefers using her car, which is a mid-sized sedan. In her previous job, she was offered to use the family Minivan, but thought that it was too big. We talked about our cars, the Rav4 and Honda Pilot, which she would be comfortable driving if needed, since both her parents had large SUVs and she was used to driving them. Another unusual aspect was her car. It was a white Mercedes. She said that her first car was an old Mercedes given to her by her father, which was exchanged last year for this one. Her hourly rate was somewhat higher than we were used to paying, twenty dollars an hour. She said that she usually charges that much for two kids. She had previously stated that our two kids would be easy for her because of their ages. She had cared in the past for younger children, who required much more attention. We thought that the rate was acceptable given that she would be working only 3 to 4 hours a day.
Our experience with nannies had been less than satisfactory, to put it nicely. We started hiring nannies about two years ago, when Cheryl went back to school. We were hoping for someone with an almost parental approach to our kids. We expected them to come home around noon, tidy up the house, prepare food, do the laundry, then sometimes pick up the younger one from his far away school and take care of the kids at home. Our high expectations were consistently met with disappointment. We went through a few different nannies. Usually the first few weeks go well, then the work quality deteriorates. Suddenly, laundry takes hours to finish. The kids are playing video-games or watching TV all afternoon. Lunch boxes are not unpacked. Homework is not completed. The piano and drums sit lonely, collecting dust. Afterall, nails had to be done, Spanish TV had to be watched and friends needed to be texted. Of course, not to forget that folding laundry can take up to several hours. With every nanny, there was a breaking point. Our expectations dwindled down with every consecutive bad experience, but the low point kept getting lower, or maybe our tolerance ran out. This was usually followed by a period of struggle. Managing the afternoons was not easy without help, but it seemed the better option in view of the alternative.
This time, we came to the conclusion that a nanny should be just a nanny. No more coming early to clean the house, no need to make food or do the laundry. Just focus on the kids please. This is all we need. I feel that our previous expectations may have been unrealistic. No stranger will act as a caring parent. When we heard stories from other parents who adored their nannies, we felt jealous, almost deprived. We had nanny-envy. Now I wonder if it had to do with their expectations or maybe ours. During the interview, there was no mention of any household work. We only discussed the after school schedules. We did not offer the option of coming in early and she did not ask. She was fine with the hours since she had class every morning. In fact, we specifically looked for applicants who were students for that particular reason. We felt that people attending school may be more ambitious in general and may take more pride in the quality of their work. She did fit our criteria, but her age was a question mark. It was not clear what she had been doing for the past six years since she graduated high school, and she seemed a little cryptic about it, muddling the answer.
Perhaps the most unusual aspect of the candidate was the google search results of her full name. The first hit, the one on the very top of the page, was not an Ad, it was a blog from a police department in an obscure town, reporting that a person with her name, the town she is from and her exact age was arrested last year swerving her car into the wrong side of the road, nearly causing several accident, and seeming under the influence. A DWI. Great, the person who is going to drive our precious little treasure back from school. I think we will pass this one. Cheryl went further and found some recent pictures posted on a social network picture-sharing website, that suggest, let’s say without being too explicit, that she might be still acting a few years younger than her age, taking serious pride in her model figure.