Blessed are the Cheesemakers

"Blessed are the meek. Oh that's nice, I'm glad they're getting something, they have a helluva time."-The Life of Brian


I keep trying to wrap my brain around gravitational waves. Take a minute and watch this video: (which I like to call) a brief history of physics for idiots like me.
The only thing I must disagree with in the video is the assertion that Earth, Wind and Fire (and Air) are "hooey".



There is a weird thing that happens with age, or at least it is this way for me. I am both less able to believe in anything and more open to the fact that anything could happen at any time. I can give concrete examples:
When I was 14 I believed the only thing I needed to beat Suzy Favor in a cross country race was guts. Turns out this was false. I mean, she could outrun a guy with a chain saw. I do not know what I was thinking.



Today, some number of years later, I woke up not believing I could run even a step, and that the only reasonable thing to do on my last day of vacation was to stay in bed. Yet, I ran. 12 miles, which is something like 14000 steps. Anything can happen, at any time.

Back to gravitational waves. One interesting thing to me is how they were heard as a sort of rising chirp. This could've rose to any one single tone. But it did not land on a sexy note, nor a particularly unusual note. It landed on middle C.




For those that escaped piano lessons (it is never too late, by the way!), this is the note your piano teacher will have likely introduced first, and one that you will always come back to like a well-worn teddy bear or a favorite novel.

I am not saying middle C is any better or any worse than any other note. But what does it mean to be the theme song for a ripple in the space-time continuum? I just don't know.

In the meantime, there was another shooting spree today, this time in Kalamazoo, MI, where I spent many a summer holiday visiting cousins, aunts, uncles, and the matriarchal Oma of our clan. Kalamazoo for me is the ice cream truck (creepy, but delicious), Aunt Teddy's cooking, and sleeping in my sleeping bag next to the grandfather clock which comfortingly chimed the hours. How can the very same species that allows scientists to study something as outrageous as the theory of relativity with laser interferometers (which, let's face it, not too many of us, even those of us that believe education is important, have a clue what that means) also believe that freely carrying guns meant to kill other human beings is acceptable?

Maybe it gets to that thing about youth versus experience with life: you can believe many things despite the evidence as a youth, and yet doubt the subtle brilliance of scientific breakthroughs or that finding love again is even possible. With a tad of experience/age, you actually start to disbelieve that which has been proven wrong again and again and again (guns make us safer). But you can hope for a better world, as you suspect there are some smart cookies out there with compassion and, in the case of this whole gravitational wave thing, pretty decent grades in physics class.

Statistically speaking, the use of statistics never convinced anyone of anything, unless they had an open mind in the first place and also had a healthy dose of nerd in the fabric of their being.

I used to believe people were born to be good. Be a peacemaker, and your children will figure that is a good idea too. Have a sense of care for your community and it will care for you right on back, and you won't have to go to church or the grocery store or elementary school or restaurant or ride Uber with fear in your heart. I have been accused of naiveté more than once and I suppose I will be again. And therein lies the subtlety, the openness to the potential of compassion and forgiveness. Go ahead and laugh, I am used to this, being a bald, eyelash-less mother of 3 teenagers who has an autoimmune skin disorder and a very goofy sense of humor and an olympic-level standard poodle (in the burping competition) and the audacity to suppose I actually belonged in Osler's days of medicine rather than the present, with its "meaningful use" and dysfunctional EMRs and complete denial of death as a part of life. Also, I once ran neck in neck for almost a mile with Suzy Favor. You shoulda seen the look on her face!

The think about gravitational waves, automatic weapons, long distance running, education, Dr Osler and the vocal range of Philip Bailey (see above, Earth Wind and Fire video, yeah let's hear you try that), is none of it matters unless we show compassion to each other. I don't mean to get preachy here, but I am, after all, a Pastor's Kid. Also the niece of 6 pastors, and the granddaughter of yet another one. Plus some cousins. My father made Bernie Sanders look slightly conservative. He preached compassion and peace and was willing to keep his head held high, even when people threatened him for his views. Once I received a phone call from a man threatening to come and shoot my Daddy dead, in regards to something to do with homosexuals (though I am sure he did not use that nice of a term). I was maybe 8. I was already unimpressed by the grammar, but also remember this moment as the first time it dawned on me that there were some real whack jobs out there, and they had guns.

So how does one move forward? One step at a time. And make sure you are wearing your fitbit, Garmin, Apple Watch or have one of those apps on your phone recording it so you get credit for every single step.

Also, laugh. And don't pick your nose.

God Bless the Child

"God bless the child that's got his own."-Billie Holiday

I am thinking of writing a book on parenting, as I am an expert. Or as much as an expert as any other fool out there who thinks they can tell everyone how to properly raise children. I have three children. One biological, 2 adopted. Adopted from abroad, adopted from here in the USA.

Adopting children requires a long process of meetings with social workers, writing essays about parenting techniques, having background checks, getting physical exams by one's physician, and sometimes travel. If you are lucky, you get to communicate with the biological parents.

Birthing a child requires sex, a uterus, some luck (or lack thereof, depending on your perspective I guess), a high pain tolerance, and lifelong access to hemorrhoidal relief.

Raising a child requires showing up.

There! My book is written. I'm gonna sit back and wait for the royalties now.

What, I wonder, defines success in parenting? In the ancient times, or even the first half of the last century, this would be defined by your kid living to see 18. Now we would probably (at least here in the US) see this as the bare minimum. If you go by what they say in the doctor's lounge, success is:
1) your child winning the state science fair, and pretty much being a shoe-in for the next Nobel prize
2) your child attending an Ivy League college and having a dazzling smile and being the state champion in their chosen (or forced upon them) sport
3) your child being a doctor when they grow up, but a richer and more successful doctor than you

Surely I jest. Because as anyone who knows me knows, no one could be richer or more successful than I.*

I take care of elders, as a doctor. And what strikes me is that even the oldest of old continue to think and worry about their children. Parenting is a lifetime gig. Sometimes, the roles reverse, as frailty and dementia can turn the relationship all cattywampus. And this must be hard for the children, as they want their parents to be in charge. They want this, except for that time between age 12 and 20. Because, as we all know, parents are idiots during those particular years.

I will not divulge the secrets of my children here. I love them dearly and wish for them the best. The very best.

Billie Holiday was, I believe, tongue in cheek with her God Bless the Child song. I think it meant to say that
1) the bible talks about love and justice for all, but no one seems to want to actually follow that part of the bible
and
2) "my Mom really pissed me off"  (maybe this is apocryphal, but the story suggests she argued with her Mom about money, and this song came out of that)

So what is the very best, in terms of hopes for children? And what the heck does this have to do with redwoods and running? Well, to answer the second question, I am a better Mom when I run regularly, and I raised my children among the mighty redwoods. I strongly believe that they will always find themselves rooted in the strength of those trees.  To answer the first, this is my hope for my children:

1) Leave the world a better place than you found it.
2) Don't do drugs. Not even pot.
3) Do not smoke cigarettes, as they will surely make you miserable in the long term.
4) Read a lot of books. They make you better able to understand everything, and they make good company when you are bored or lonely.
5) Follow your passion.
6) Please do not put me in a nursing home.
7) Eat vegetables and fruit as often as humanly possible.
8) Travel as much as you can!
9) Call or write or text. I like to hear from you.
10) Exercise daily

#10 may be the most important of all.

My parenting advice?
Don't take yourself too seriously, and always make sure your kids get enough sleep.

There, that's the sequel to my bestselling parenting book. Now I can retire and follow #5 of my 10 hopes as noted above.

My passion? Running, piano, love. Well, to be honest I kinda like the whole doctoring gig too.

Take it, Ms Holiday:
*I am neither overly successful nor particularly rich, but I do like rich food and I twice broke 3:30 in the marathon.

Speed

"You cannot play it fast until you can play it slow" said every piano teacher ever. I tell my medical students and other healthcare students the very same thing. Because it is true. Do not rush through the physical exam when you are still learning. Take your time, starting at the head and noticing every little thing, normal and abnormal from head to neck to chest to thigh to knees to toes.

You notice things when you run slowly. Your weaknesses. Your breath. The color of the dirt under your shoes. The little flower abloom in February in the crack in the sidewalk, which still freaks you out, as you are from Wisconsin, and blooming flowers in February is miracle material.

When you run slowly, you can run forever, or so it seems.

When you run slowly, you lose races.

A doctor in practice, a musician on the stage and a runner in races must go at the appropriate speed. We call it the tempo. Which is the relative speed, derived from Italian for "time" and Latin "tempus". Like tempus fugit (time flies). The temporal lobe of the brain is involved in memory, speech, perception and language. Tempo runs, per Hal Higdon, are the "thinking runner's workout." Run fast, building up to like a 10K pace, and feel some pain. That is my personal definition of a tempo run:"Feel some pain."

How much pain is involved in developing speed in any particular endeavor that is important to you? Well, I suppose that depends on your :
1) talent
2) guts
3) tolerance
4) perception

Which is to say, the temporal lobe, genes, stupidity, and physiology has a lot to do with your tolerance for a good, hard tempo run. And a good, hard race.

When you run fast, you notice what hinders your speed. Today, it was some large rocks that threatened my recently sprained ankle with another nasty turn. Also, a deep lake-like puddle with a squishy mud path along the edge. There was traffic and curbs and hills and potholes and self doubt. Speed is complicated, because we do not want to fall, physically or mentally. We do no want to fail. We do not want to have our Strava feed look pathetic. We have secret goals and when we declare them publicly, people might laugh or scoff. Scoffing might be the worst human attribute ever. Along with taking Donald Trump seriously and lack of compassion toward others. Which, come to think of it, may be one and the same.

I have this patient with Parkinson Disease, who has adapted to the spastic and frankly frightening movements the treatment for their disease has caused. Imagine having your limbs flail everywhere at once while you are just trying to sit still or take a few steps here or there. Imagine the outrage of fellow humans watching you flail. They wonder if you are OK. Are you insane? Are you about to fall down? Should I assist you?

Speed of movement is the saving grace of this patient, even if it scares the rest of us half to death. Speed is a bad drug, v=d/t per Galileo, this and success, in the old terminology of Godspeed.

Once, years ago, I was riding bikes with my eldest child. She is a Zen Master, if ever there was one. She was pedaling along, and I finally lost my patience with the slowness of her progress. As I sped by her, she called to me "Mommy! Just remember, slow and steady wins the race!"

It does, it does not. We are creatures of swiftness, and we are not.

The best runners have the slowest resting heart rates. The fastest way to a demise is to go to quickly on a path you do not understand or revere. Speed with reverence. Speed with respect. Speed with understanding. The only way to success. When you realize nothing is lacking, the whole world belongs to you. Or something along those lines per Lao Tzu.

Steve Prefontaine died at age 24. He is reported to have said : "The only good  pace is suicide pace, and today looks like a good day to die." Is this suicidal ideation or striking fear in the heart of competitors?

For a 46 year old doctor, mother of 3, working full time, overweight, with an autoimmune disease and utter lack of confidence, what does speed mean? You would think being bald and almost hairless would offer some kind of advantage, speed-wise. You would think the discipline gained in practicing piano 8 hours per day and being on call for 48 hours at a time would offer some kind of advantage, strength-wise. You would think that being surrounded by what my daughter has describes as a "book moat" and being the chair of an ethics committee would offer some kind of advantage, wisdom-wise.

All I can say is I keep trying to show up. I find inspiration in the feats of others-local, regional, nationwide and internationally. I would like to find some kind of inspiration from outer space, but my telescopic lens is limited. My imagination is endless though. It sees beyond my physical and mental and emotional and age-bound limitations. I would really like to run a sub 3 hour marathon before I die. Go ahead and laugh at me, because it is a truly ridiculous goal.

And why do I care? "No trophy, no flowers, no flashbulb, no wine". Just going the distance, and going for speed.

Death

I want to discuss death.

I have not died, so I am not an expert. I have seen quite a few people die, though, and each time is both the same and entirely different. The same: breath and heart beat stops, person dies. Different: they may be related to me, they may not, they may be serene, they may not, they may have someone they love at their side, they may not, they may be old, they may not, they may be ready, they may not, they may be human, they may not, and the list goes on.

When my mother died, I was 26 and a new Mom myself, with a 3 month old. I was a new Mom, with a 3 month old, and I was a medical student. Mom was not really "old enough" to die, whatever that means. It took sooooooooo long for her final breath, and that has helped me when I sit with families or friends of people who are dying. I know to tell them it can take awhile, and prepare yourself for that. Sometimes people need you to leave the room when they die. My Mom did. We finally left the room entirely, after holding vigil for days and days, and 15 minutes later when we returned, she was gone.

A lesson I learned too is even when you hold vigil, which is to say you KNOW they are going to die, when the damn thing actually happens it is like you are blindsided. It is just so final, that last time you get to touch your loved one, to smell and kiss them, while they are warm and real.

Though a few months after Mom died, I opened the plastic sealed container that held the last outfit before a hospital gown she wore. Her smell pounced on me when I pealed away the lid and I lost my breath with the impact. They say our memory for smells is profound. I still have that container of clothes, but the smell is gone.

When my father died, I was 29, and almost done with medical school. Two children now, and being the "medical expert" in the family, I got the call from the doctor about the end being near and the recommendation to focus on comfort. Dad died at home. It was also a longer process than expected. He too was "too young." When they came to take his body, I sat on the basement steps of the home in which I grew up, and held my hands over my ears against the zip of that bag. We get put in a bag when we die. Arguably, we are not we, so who really cares. But that was my Pops. Zipped in a bag.

When my dog died, I slept on the floor with him. But then I had to go to work, and the hospice veterinarian came over and ushered him into the hereafter while I tended to the here and now. When I came home for work, I sat on the place where he died and wept. My son held me. It wasn't just the dog I wept for.

And the patients I have seen draw their last breath? Those stories I must hold close to my heart, because they do not belong to me.

Death is not bad, in itself. If every human being stayed alive forever, we would have quite an issue with real estate. It is poetic that we return to the earth, matter not destroyed but repurposed, and that we live on in memory and mail. I am here to tell you I still get mail addressed to my parents, now gone about two decades. Mostly political. Also retail-related. It was a long while before Columbia House gave up on my Mom. Bless their capitalist hearts.

This week held the death of two artists. Well, probably a lot more than two, but two very well known artists that made our world a little bit better than it was before they were born. Incidentally this was one of the last things my Dad said to me: "Make the world better than it was". Also "It is over." *fart* "It is not over (chuckle)". Damn, I loved that guy.

Alan Rickman and David Bowie were both 69. Arguably "too young to die". I wonder how they died, and how their doctors treated them, and how their loved ones are coping. I know for me it is a loss. The morning I heard of Bowie's death, my gut twisted and tears threatened when the cafe I was in played "Changes" over the speakers. I saw Bowie play once, and I know he is/was mortal, but somehow you just don't picture these types of people dying. Alan Rickman was more than Professor Snape, of course.  He was an accomplished actor in the theater, on film, and a good man too, by all reports.

I am well versed in palliative care. I have cared for patients in hospice. I have seen many people die. I have sat at the bedside of some of the people I have loved and known best in the world and watched them die. Still, it never gets easier.

Atul Gawande brought this discussion into the mainstream. Well, at least into the New York Times bestseller list, which may not be mainstream, but still, a feat to be appreciated. We are mortal. HOLY SHIT!

So, I continue to show up each day and I love my family and friends. I run, because it is a blast and perhaps will let me usher in old age with some grace. I respect my elders, and I miss my parents. I feel sad about those who have gone and I never lose sight of the gift of each healthy day offered.

We might be like Lazarus. We might not. Either way, freedom lies in making peace with our mortality. And who knows, maybe what comes next will rock our world.

Snow Day

I remember my clock radio as a kid, which I used as an alarm in the morning, and to go to sleep with, on timer with about an hour of music from WIZM 93.3 FM. In the snowy mornings, I would turn it on and listen to the school closing reports. They would list off which schools were closed, and if yours was on the list…yes! The day could then be spent sledding, cross country skiing, sipping cocoa and generally annoying your parents.

Now that I live in California, snow days are nonexistent. Though there is snow to be found, in the hills. Up there, we go to sled and ski and generally frolic. And with our smug California attitudes, we note that on the same day we could surf and ski. We could run in our shirt sleeves and later bundle up for winter sports. We are obnoxious in our weather choices. We have it all.

Just the other day, I ran in snow. This was in Portland, while there to drop my kiddo back at college. The snow, unexpected. Because this was Portland, Oregon, not Portland, Maine. We ran with our good friend and enjoyed the muffled quiet of our foot steps. Daughter stated she prefers snow to heat. I am happy at 72 and sunny. But even I will admit our Portland snow run was magical.

What strikes me most about the snow run is the joy. How often do we encounter joy in life?

Life is hard. Our president is trying to talk some sense into our nation about gun violence. If airline or food safety or "terrorism" statistics were like this, there would be mass rebellion, demanding our safety.
Life is hard. I witnessed two care crashes today, one where the person was out cold, then aroused and as I tried to get them to sit still while awaiting the ambulance, they tried restarting their demolished car, with the air bag in their bloody face and smoke coming out of the crumpled hood. It might have been head injury befuddlement, or it might have been the drug paraphernalia strewn in their lap and the front seat. It took 5 cops to subdue them. I hope they are OK. The idiot. The next car crash was an hour later, when I was driving to the hospital and someone ran a red light and plowed into the car in front of me. Not a great day to be on the road. Life is hard. my team and I show up every day to try to lend a healing presence to the people we care for. Yet we meet so many barriers, as the system and the societal expectations are somewhat askew. I am somewhat mollified by Dumbledore, whom quoted at me while I was driving and listening to a Harry Potter book for the millionth time. Not the part where he marveled at finding the room with all the chamber pots when his bladder was very full, though how cool is that? But rather where he notes that looking for universal popularity is folly, and he himself receives at least 2 owls a week telling him what he could be doing better or demanding he resign immediately.



Joy comes as we invite it in. The double rainbow today greeted us in the morning and again in the afternoon. It arced its way over the very spot the likely methamphetamine-induced car crash appeared. Joy comes as we invite it in. Like the person I cared for today who refuses to be categorized as a patient, and delights in every little nice moment, no exaggeration. Joy comes in as we invite it, in the marvels of a well done 3 pointer, or in the case of SOME people, hundreds of well done 3 pointers.



We can close the door on joy, but that seems rather stupid to me.

Life is hard. Joy is abundant. It is like a Shakespeare tragicomedy. Life's a stage or something to that affect.

Joy comes as we invite it in. Little chocolate donuts, for instance.




And, snow days.

Wellness and Wabi-Sabi

"well, Ness…"

I am expert in disease. This word hails from the French for "trouble, discomfort, inconvenience, lack of ease". That's a hell of a thing to be well schooled in, and even though I am well-schooled (to the tune of 1/4 million bucks in student loans which I will possibly pay off before trouble and discomfort claim me), I still struggle with just how well a living being is supposed to be.

Should we never have pain? Should we always be at our athletic peak, able to leap down stairs without a thought and climb hills without gasping? What does it mean if you are born with disease? Why is good health "normal", when in my experience, every day threatens us with trouble and inconvenience? Some people, whom the modern slang might describe as "haters", even consider disease and trouble as a sign that God is angry with a person, or more often a group of people who do not share the hater's views. Most of us, when we get sick, can find some blame somewhere, and I suppose most often in ourselves. Because we are supposed to be healthy.

I have a kid who likes to get 100% on tests and assignments. And though we are not biologically related, I can tell you that apple did not drop far from the adoptive tree. I find myself telling her to let there be imperfection, to rest more, to cut herself some slack. Deja vu and bullshit, because I have heard those words myself and do I listen? Yes, I do! And I meditate five times a day! And I lived happily ever after.

Being bald, with an autoimmune system that eats my skin alive and stroke-worthy hypertension is the trifecta of beauty and perfection. Just the other day, Sports Illustrated called up to see if I would be the centerfold for the next swim suit edition. I, of course, had to tell them no because I am too busy doing my  MKSAP 17. Also, napping and taking warm baths. "My doctor made me take some time off, and posing for your magazine is way too strenuous for my delicate self. Good luck finding someone as cute as I am!"


I am not so delicate as to stop running though. Yes, I recently found myself on a casino floor and yes, I sprained an ankle on my Thanksgiving day run. But me and Klay? Nothing can keep us down. Not even hypertensive encephalopathy, the Milwaukee Bucks and other such inconveniences.

Why should people be unwell? And if being unwell is part of being human, why do we fight it so very hard? Many of my colleagues bristle at the battle analogy for dealing with disease. I tend to see more grey area here, because I understand, as an athlete, how approaching something hard as a challenge that you must face is valuable. We find out who we are and tap into our own strength when we compete. The thing is, disease is not a foe with any scruples. As a matter of fact, disease is a concept that we have created to describe the physical and mental imperfections of being human. Therefore, fighting disease is a little like fighting ISIS. It hurts, it stinks and it makes no sense. Finding the perfect battle plan is folly.

Which is not to say we should give up on being well. Here are ten pointers on how to guarantee wellness in the New Year:

1) Psych! Never believe this shit!

Seriously though, I do have a few thoughts on wellness.

1) Listen to your doctor/NP/PA. No, I am not saying this to promote my already inflated sense of ego, but rather to say, these folks care about you. I actually listened to my doctor and I am starting to feel better already. It was not easy, because it is widely known that doctors are second only in being the worst patients to nurses. Nurses: love ya!

2) Exercise.

3) Beethoven. Or whatever music floats your boat.

4) Allow yourself to grieve. For whatever life throws at you that gives you grief.

5) Hugs.

6) It is normal to have some disease. Don't ignore it. Seek help. And don't judge others OR YOURSELF for their/your suffering or infirmity. That's just mean.

7-10) For me, personally, I have to run. Even when I've been benched from the rest of life for impending cerebrovascular disaster.

Lucky for me, I get to run here (watch this video). And while watching this, remember, even the young and fit have imperfections. They just hide it better. Imperfection is beautiful. Reduce dis-ease by accepting the transient nature of suffering. Go full on wabi-sabi!

It Was a Dark and Stormy Night

I was lying on the floor of my hotel's casino after my recent half marathon, wondering what the point of   anything was and whether anyone would ever notice that I was there. Perhaps it is a frequent occurrence, the person laying flat on their back on the (rather digusting) carpet while the lights continue to flash and the booze continues to flow. Thankfully, a friend texted:
where r u?
To which I answered:
on the floor of the casino

She heroically came down to fetch me, and the hotel pseudo-medics did their best to talk me into an ER visit. No offense to my friends in the ER business, but no thanks. So instead I got a first class limousine wheelchair ride to the 22nd floor of Mandalay Bay, baby, with a gallant assist-transfer into the fetal position in bed.

The end.

All of this is to say, if you are going to run a half marathon, consider adequately training first. Then consider that 40-50 mph gusts of cold wind with sand flying into your eyeballs while rain is falling in the dark on the strip of Las Vegas at night may not actually be ideal running conditions.

Still, I am glad I did it. No really, I am. Mainly for the time with the good people that I spent time with in Sin City. Also, because it reminded me that even when running reminds me of some kind of Dante circle of hell I still like it and the medals in Vegas had these slot machine things on them that were pretty snazzy. Also, I met Meb at the expo. He is very kind.

Big race expos are bizarre. Or maybe like a bazaar. How much running related merchandise can one fit into a convention center? Is that much spandex in an enclosed building hazardous to your health? And how much stranger can the Gu energy gel flavors be? These are the questions I have.

Today I was walking down the street, basically minding my own business, when a bird nailed me. That is to say, it shat upon me, on the front of my pants. I was 15 minutes away from my next house call and this was one impressive stain. The last time I was targeted by a bird was in 6th grade, on one of my first dates with my boyfriend Fritz. That time we were holding hands under a tree when a bird nailed me on the shoulder. He laughed at me. That relationship was short-lived.

Last night, I was awakened by a windy, rainy storm. I groggily raised my head, and my trusty dog was sitting up on his haunches, staring intently at the skylight. I finally coaxed him back to a restful position, but he was disturbed.

Storms, bird assaults, casino floors. What is the meaning of all of this?

As Snoopy noted, it was a dark and stormy night. And this, though terrible writing, is an accurate depiction of so much of life. Why do people hurt each other? Why do children die? Why must people respond to fear with hateful actions and thoughts?

A wise person I know mentioned that the woods at night represents the dark parts of our being. However running in the woods is like the light that diminishes what is scary and dark. And having someone with you running in the woods at night is even better.

Running the Las Vegas strip at night? Perhaps not so profound. Still, as I ran toward the finish line at The Mirage in Las Vegas (the irony here was not lost on me), I could see the light. Mainly from the fake volcano and the neon signs. Still, light is nice, especially on a dark and stormy night.

My dog peering at the fathomless night sky may not know the mystery but he knows that what matters is we are safe. Or maybe we are not. If you cannot be safe, be near those you love. Thus he snuggled next to me, spine to spine. And the wind howled on.