Sleeping In My Driveway

If I were a car, I would probably be a minivan. Sensibly designed with just enough flash to make me interesting. Ferrari’s are exciting, but if you need to get the job done you hop into a reliable and roomy Honda Odyssey.

Are you a person who likes to fly by the seat of your pants? I don’t fit into that category, I’m a planner and a tester.

A few months back my friend Tom and I installed a mains power port on the side of my campervan, and in the weeks afterward I created a simple power distribution system for the vehicle. However, I never operated it.

Dear readers, a Midwest October is upon me; perfect to do a little van exploration. With nighttime temperatures in the high 20s (-2C) it was time to test several different camper systems.

Early yesterday I pulled out the 30 Amp extension cord from the camper’s storage bin and attempted to connect it to the van’s receptacle. Crap! It wouldn’t go in. The pins on this type of plug are circular, and with some study, I was able to determine that they were slightly out of alignment. A little bending with my multi-tool and the plug slid in and mounted.

I went back into my van’s storage and located the $16 Walmart electric heater that I had purchased a few weeks earlier. I plugged it in, turned it on and… it worked! I was then off to the basement to find my 25-year-old sleeping bag. It is old and flattened, but it is also extra-long and thereby perfect for my 6’3” frame.

With heater and bag in place, I was ready to do a test run. The wilds of a National Park, you may ask?  No, my driveway, of course! When I told Julie about my plans to sleep in the driveway, she nodded in acknowledgment. After 25 years of marriage, she didn’t feel it necessary to comment on the absurdity of my vision. My more adventurous friend Tom thought that I should try to sleep in the cold with the heater turned off. Likely, as some sort of manly exercise. It should be noted that Tom possesses an ultra high quality and very warm REI sleeping bag, as opposed to my 25-year-old “pancake.”

As bedtime approached, I gathered my camping essentials:  water bottle, laptop, and iPhone. I traversed the 30 feet from my front door to the camper and entered with anticipation. It was cold! On went the electric heater powered by my garage’s outlet. I reached down and powered up the van’s 12V power system, and then flipped on its interior lights.

The heater seemed anemic, and I thought I would be spending the night freezing. But, in short order the van warmed up. I settled in my sleeping bag, fully dressed including a stocking cap. Like any other wilderness he-man, I opened up my laptop and checked Facebook, braving a weaker wifi signal from my house.

I worried that I wouldn’t fall asleep, as I fell asleep. Comfortable, warm, sleeping in a van parked in my driveway Silly for Dr. Mike, a 65-year-old physician, exciting for the 9-year-old Michael inside of me.

The outside temperature dropped to 29 degrees, but my little heater plugged on. In fact, I had to turn it to low in the middle of the night because I was getting too hot.

I write this the next morning after following my tradition of walking to Starbucks. Here I sit at my usual table, typing and sipping coffee. Mission accomplished.

My adventure may seem childish to you, or it may not. However, it was fun and informative for me. I tested out several of my camper’s systems and felt the security of reassurance. I had a “backyard” camping adventure. I had a good time.

Dear reader, so often we get locked into doing only “appropriate” behaviors. We don’t allow ourselves simple pleasures because we have deemed them childish. We criticize our children, “You are too old to do that.”

I am here to tell you that it is OK to explore the child in you because that is the part of you that still possesses wonderment. I challenge you to rediscover that aspect of you. I believe that you will grow just a little bit more in the process.

My $16 Walmart heater, and 25-year-old sleeping bag.
View of my front door from my sleeping quarters.
Plugged into the house’s AC power.

September Song

Oh, it’s a long, long while
From May to December
But the days grow short,
When you reach September.
When the autumn weather
Turn leaves to flame
One hasn’t got time
For the waiting game.
September Song
M. Anderson-1938

———

We sit around the kitchen table. Julie, my wife. William, my 17-year-old son. Diana, my 3-year-old granddaughter. Sebastion, my 9-year-old grandson. Me.

In front of Sebie is a large stack of conversational cards. He pulls one and reads it. “If you could always live in your favorite season, would you?” We go around the table, and all participants answer, “No.” We agree that each season possesses its own magic. As we tire of one season, we are given the gift of a new one.

——–

I pick up my sister Carol from her apartment and drive to Arrowhead Country Club to celebrate her 80th birthday with a Saturday lunch. We talk, nibble, sip, and talk some more. “I have never been happier. This is the best time of my life,” Carol says in earnest.

——–

I walk to Starbucks in the pre-dawn. I pass by a tree, its leaves turning a golden orange.

——–

The fall of my life is upon me, the days are growing shorter. Time is accelerating.

Would I want to go back to any other time in my life? Childhood? Early adulthood? Middle age? I don’t think so. Each phase of my life had its advantages and its disadvantages. Each stage of my life added to my wisdom and to my appreciation of the gift of life. I don’t want to give up the present to live in the past.

There are disadvantages to being 65. I have more wrinkles on my face than hairs on my head. My stamina is a percentage of what it was when I was 30. My short-term memory is less acute than in the past. I am more inclined to take naps.

There are advantages to being 65. I care less what others think of me. I am less concerned with what I don’t have and more satisfied with what I do have. I realize that most happiness lies in small things: dinner with my family, coffee with a friend, learning new things, giving back.

In January I left my private practice of 30 years and gained perpetual 4 day weekends. As a person who likes to move forward, I had developed a productivity plan in anticipation of this change. That initial plan has been only partially realized. Frankly, I’m OK with my partial compliance.

I am writing, taking pictures, and converting a van into a camper for future adventures. I have made a weak effort to organize a basement storage room. I’m not practicing the guitar, and I have not started the process of learning a foreign language. I think that this latter objective may be on a permanent hold.

I am spending a lot more time socializing with people who I care about. I am stretching my introverted boundaries. I am learning about construction and power tools. I know that this last fact may seem odd for an old retired doctor, but I assure you that it is not. I come from a blue-collar background, but I was never mentored in the art of the Sawzall. One of the reasons that I gravitated to science was that it was an entirely novel discipline in my family, and somehow that fact made it OK for me to teach the subject to myself.

There is a joy in learning those things that I was so curious about as a child. I see the similarities between medicine and construction. Each discipline requires training and practice. Each discipline follows a specific methodology and is protocol driven. However, with building the fruit of your efforts is immediate and tangible.

I have spent much of my life goal-directed; focused on practical knowledge. However, I appreciate learning something that serves no personal purpose in my life. Learning for the sake of learning is my cocaine.

At 65 my world isn’t shrinking, it is expanding. I wake at 4 AM anticipating what that day will bring. What will I see on my walk? What will I write? What new thing will I learn? What projects will I tackle? What adventures will I have with those people that I care about?

The days may grow short in the September my life, but they are still days to be celebrated. Today I know more than I knew yesterday. I have connected with others more. I have done more. Each day is a gift, never to repeat.

Dear reader, celebrate today!

Change Your Life With A Gratitude List

Why is it that I can focus on a single negative in my life while ignoring so many positives? How can I change this waste of energy?

I think my thinking pattern is similar to many others. I can let a single worry dominate me. Typically, I find that this stance is a waste of my time and energy. Yet, I continue to do it.

I have made attempts to change my behavior, and some of my efforts have been more successful than others.

I have gotten better at letting go of trivial slights. The driver that cuts me off no longer spoils the rest of my morning.

I also employ cognitive techniques to correct my perceptual distortions. When I get upset about something, I will pull back and logically explore the problem and reframe the information at hand in a more realistic way and less catastrophic way.

Also, I work hard to let go of situations that I have no control over. I’ll, “Let go and let God.”

The above techniques all fall into what I would call a pathology model. In other words, they focus on lessening my current worries. The problem already exists, and so I actively treat it.

Good doctors not only treat problems they also practice preventive medicine. I would like to think of myself as a good doctor and what I advise my patients can also apply to me. So how do I prevent worry? There are many ways, but the one that I would like to share with you today is called a gratitude list. This technique is simple, but it does require some practice and thought.

The positives in my life far exceed the negatives. However, I can take my blessings as expectations and thereby ignore their significance. A gratitude list is one way to acknowledge these good things, and when I do this, I automatically have a more positive outlook of my life.

Here are the steps I use.

-Once a day I think of 3-5 things that I’m grateful for. They can be significant things or minor things. For instance, I might be thankful for my health (major thing), and I also may be grateful for having coffee with a friend (minor thing).
-I make an effort to vary the things that I’m grateful for. In other words, I don’t repeat the same list every day.
-Sometimes I’ll write down my gratitude list, sometimes I’ll only make a mental note.
-I don’t just write down a list, I also think about each example on that list. I may recall that I’m no longer on any medication and that I’m able to walk long distances once again. I might think about a walk that I took and how much I enjoyed it. For my second example, I may be grateful for having people in my life who want to spend time with me. I might remember the conversation that I had during my coffee klatsch, or how much I enjoyed the taste of the coffee.
-If possible, I recall my gratitude list during the day, repeating the above technique.

When I first started this daily exercise I had trouble coming up with unique things to be grateful for. However, over time, it became easy. The trick is to limit your list to a manageable number. I find that 5 examples works for me. I want to have time to think about my list, I don’t want to write down a lot of meaningless examples.

By doing this exercise regularly, it has become evident that I have much to be grateful for. When I think about my life in positives terms I feel more positive about myself, I attract more positive people, and many of my problems feel more trivial. All of these benefits for the cost of a little time!

I would encourage you to make a gratitude list every day for the next 30 days. Let me know if it makes a positive difference in your life. If the answer is yes, it is easy to incorporate a gratitude list into your daily routine.

Dr. Mike

The American Dream: Have You Been Lied To?

Are you feeling overworked, and undervalued? Here are a couple of facts.

Fact #1: We have more leisure time than ever before. Life is good!
Fact #2: Fact #1 is a lie.

Mid-century prognosticators predicted that good times would lie ahead for the people of the 21st century. They believed that automation would make work more meaningful and efficient. It was predicted that work weeks would shrink to 15 hours, and leisure time would expand to fill the void. The United States, with all of its industrial might, would be at the forefront of this change, and its educated and skilled workers would benefit the most.

Data suggest that overall leisure time has increased in the US, and we are working less than we did a few decades ago. So, life is good, right?

Dear reader, do you have a job? Is your life easier in 2018 than it was in 1998, or is it harder? Do you feel that you have more free time, or less free time? Are you enjoying life more, or enjoying it less? I hope that your answers indicate a continued movement towards a positive and meaningful life. A life where you have time to do those things that you find personally satisfying and rewarding. However, for many of you, I doubt that this is the case.

Random statistics are like other generalities, they make great bullet points, but they only tell part of the story. Data suggest that our lives are better now than 50 years ago. We have less pollution, we live longer, our houses are bigger, we have more stuff. In addition, our lives have become more automated. We can order a new shirt with a click of a mouse. We can summon Alexis, Siri, or Google to start our favorite music playlist. We can cook a meal in minutes with the touch of a microwave button.

We have been told that to have a good life we need to become skilled and educated. We have been told that using our brains instead of our backs will give us lives full of meaning, and an abundance of leisure time.

So why are many of us stressed? Why do we feel that we have no time for ourselves; that we are on a hamster wheel frantically running but never moving forward?

Erik Hurst, University of Chicago economist, looked at leisure time and found that there are individuals in our society that have an abundance of leisure time and that this abundance makes them happy. However, they are not highly trained or educated. In fact, they are at the opposite end of the spectrum. A 2015 study found that twenty-two percent of undereducated males between the ages of 21-30 had not worked in the previous 12 months. These folks were typically living in a relative’s home (think parent’s basement), and they often filled their free time with cheap entertainment, usually video games.

On the opposite end of the spectrum were men who he referred to as “elite.” They were skilled and educated. Elite men had less free time than their fathers did. They often defined who they were by their work life, rather than other interest. They worked long hours and produced more than similarly skilled men in other developed countries. They did not rate as high on the happy scale.

I believe it would be reasonable to claim a similar outcome for elite women. More work, an extended workday, less free time, less happy. Many Fortune 500 companies expect their workers to work longer and to be more productive than previous generations. We can never escape work, as we are always accessible via our smartphones and laptop computers. A long commute used to be a time to listen to music or catch up on the latest sports news. Thanks to mobile devices our cars have now become our second office. Vacations served as escapes; now wifi and laptops help us to catch up on work emails when we should be catching rays.

We are stressed and tired, so we use services to supplement our energy gaps. We pay someone to watch our children, cut our grass, and clean our house. We go out to dinner or buy premade meals. We use our credit cards to procure an expensive vacation or buy an unnecessary item with the false belief that these things will make us happy. All of these behaviors cost us money, which means we need to work even harder.

Social media makes us feel that we don’t have enough. We see pictures of Jerry’s new car, Mary’s exciting trip, Bob’s bigger house. The visual images make us feel dissatisfied and want more. Our new purchases make us feel better, but only for a short amount of time. We live a bipolar life of working hard and playing hard. There is no middle ground. There is no balance.

Stressed, our normal life jobs become burdens. Routine tasks like helping our kids with their homework turn into annoyances. We ease our frustration by distracting ourselves with texting our friends or playing games on our phones when we should be focused on the task at hand. This multi-tasking disconnects us and we become less present, which makes us feel alone and lonely. Affairs, addiction, increased debt, compulsive eating, compulsive sleeping, compulsive buying, and other fixes serve as temporary ego patches that often result in long-term negative consequences.

Despite the evidence to the contrary, we continue this cycle with the magical thought: “If I only could make a little more money I would be happy” However, this is often not the case. Money is like heroin, whatever you make, you want a little more, and like heroin, cash promises much but delivers little.

So what is the answer, dear reader? Should we quit our jobs and move into our parent’s basements? For most, that is not the solution.

What do you really want out of life? Ask yourself, “Do I want”…

More time with my family? A safe living environment? Good health? A sense of real purpose? or Fill in the blank?

Are your actions consistent with your wants? Don’t make the mistake of thinking that making more money will automatically solve your problems.

Things that you may want to consider:

-Try to find a balance between work life and personal life. I have known some people who took lesser jobs or gave up careers, with a resulting increase in happiness and wellbeing.
-Realize that more stuff will not make you happy
-Practice being in the present.
-Designate times to silence your phone.
-Spend time with people who you love and cherish, and who love and cherish you.
-Avoid people whose connection with you is based only on what you can provide them.
-Develop a spiritual life.
-Connect with others in a meaningful and giving way. Consider helping someone for the pleasure of helping, without any expectation of a return for you.
-Realize that most of the things that we do are work, but the type of work can make a big difference not only in how we feel but also how others feel about us. I have heard many an adult talk glowingly about their parents. Beautiful memories of doing a project with dad, or baking cookies with mom (Feel free to reverse gender roles, if so desired). I have never heard an adult lovingly talk about an absent parent who bought them a new car on their 16th birthday. Further, I have never heard someone say, “My parents were awesome, they each worked 100 hours a week!”
-Write down a list of things that you are grateful for, and read it twice a day.
-Be thankful for what you have, instead of always thinking about what you want.
-Stop watching shopping networks; stop reading ad papers.
-Limit your time on social media.
-Leisure time is that time that we can devote solely to personal interests. It doesn’t have to be expansive when our lives are filled with other meaningful activities. Yes, those unemployed 21-30-year-olds may find happiness playing video games for 10 hours a day, but for most of us, a life of leisure would be unfulfilling. Consider leisure time like a desert. A bowl of ice cream can complete a meal. However, a diet of only ice cream would make most of us sick.

Life is short. Decide how you want to live it.

Dr. Mike

Rat race traffic.

An Odd Morning

I find fascination with simple lessons.

I alerted my Google Assistant that I was up, and she wished me a good morning.  She informed me that it was cooler and that there was rain in the forecast. I figured that the rain prediction was for later in the day.

I put on my running shoes, donned a jacket, and stepped out onto my front porch.  It was raining! Back in the house for waterproof duck shoes, a raincoat, and an umbrella.  Off I went.

Cold, and raining, I expected to have the streets to myself, but this was not the case.  Animals were darting here and there in the pre-dawn, including a skunk with a tail raised just for me.  I crossed the street and counted my observational blessings.

As I approached downtown I walked past our public library.  A lone car sat in the empty parking lot, its hatchback up, and the radio blaring out a political radio station.  Odd.

I continued my walk and saw two middle-aged ladies sitting on a wet park bench having a loud and animated conversation. It was 5:30 AM.  Odd.

I moved on to the next block, and it sounded like someone was calling to me.  I turned my head to discover a mom talking to her baby, who was in a stroller. She was walking her baby at 5:35 AM! Odd.

I started to cross the street, but  I had to jump back as an elderly man wearing full high vis rain gear barrelled past me on his bicycle. He seemed oblivious to my presence. Odd.

I arrived at my Starbucks and was greeted by a barista, who looked up, smiled,  and poured my coffee without ever asking for my order.  Finally something familiar.

As humans, we try to predict the future.  What team will win?  What will the stock market do? What will that lab test show?

This morning I predicted that I would have a very quiet walk, but that was not the case.  In fact, it was not only much busier but the type of “traffic” was completely different from what I normally observe at this very early hour.

Many logical prognostications turn out to be erroneous guesses. I am great at projecting in the future, and sometimes that leads to unnecessary worry.  Dear reader, I assume that you have done the same.

It is good to plan for problems, but that planning should be a sidebar, not the primary focus in our lives.  When we live in the worry zone we waste valuable energy that often serves no purpose.

How should we face potential problems?  That rule has been long established.

  • Accept the things you cannot change.
  • Change the things you can.
  • Pray to know the difference.

Have a good day, dear reader.

Mike

A colder and damp morning in Naperville.

A Coffee Date With Nancy

The date was set, we would meet at Starbucks at 7 PM. Not the Starbucks that I usually go to, but one on the far side of town. We had talked about this for months, and now we were finally doing it. At the very least it would be a fun adventure; I had nothing to lose.

I arrived at 6:59 and found a quiet table. I went up to the counter and ordered a Tall Pike’s, decaf. Moments later my phone rang, it was Nancy. She was outside the store trying to park her car, but the available spots were all blocked by a police prowler. The officer was apparently thinking that his convenience was more important than preserving three open slots for other customers.

Soon Nancy was sitting across from me, and we started to talk. First small talk, then more about what was going on in our lives. However, this chit-chat wasn’t the reason that we were meeting, our conversation was just a common preamble.

We reminisced and evoked memories from past years. Nancy, 7 years my senior, my friend, my older sister. We had decided to meet to explore our creativity. Like me, Nancy is a writer. Like me, she is trying to find her voice. Unlike me, she has studied her writing motivations though workshops and creativity groups.

Nancy tried to focus me. “What do you want to write? Fiction or nonfiction? What is your passion? Who is your audience? What is their age range? What topics have gotten you the most hits?” Questions that I never thought about.

So, dear reader, what is the purpose of this blog?

Drmikekuna.com was created as a writing exercise to see how far I could push myself in a public forum. As an introvert, I’m naturally reserved and private. However, to write effectively, I need to break through these limitations without fear of judgment from others. I also created this blog as a record of who I am. Eventually, I’ll download its contents onto a memory card and place it with other momentoes of me. Cards and letters that were written by patients when I left my private practice, notes from loved ones who wrote memories of me to commemorate my 65th birthday, and other things. I want my children and grandchildren to have a broader understanding of me. I want to be more to them than a few scattered recollections.

Like most things in life, my blog has evolved. It continues as a writing experiment, but there has been a shift. I now let my flow of consciousness take over as I write. It seems that my posts eventually evolve into some sort of life lesson. I find this new process interesting, but I have no idea if anyone else does.

I am trying to find myself, and redefine my purpose. My professional life has been a life or providing service to others, and I feel fortunate that I have had the opportunity to do so. However, I am entering a new season of my life, and my energy has shifted. I still want to contribute to the world, but I want to do so by engaging other talents. Specifically, writing and photography.

I need to determine what my goals are. Am I writing for an audience of one? Has my blog become a journaling exercise that would be better accomplished if it was done privately and within the confines of a spiral notebook? Should I abandon the blog and start the daunting task of developing a book? If so, what would my topic be? It is clear that my writing would reach a broader audience if I focused it on popular issues and selected demographics. Do I want to do that? Do I want to become more commercial in my writing? Would such a change remove the pleasure that I derive from my current spontaneous musing?

It is clear that I have just started this journey. I will meet again with Nancy next week as we continue to examine how we can support and help each other in our pursuits.

Dear reader, as I move into retirement, I am aware that I not only need to be flexible but also realistic. Grandiose ideas and plans can fuel the genesis of any new project. However, work, reassessment, and realignment are the real building blocks of growth.

Do you have goals and dreams? How are you approaching them? How are you redefining them? Let’s grow together!

How Doctors Should Talk To Patients About Obesity, An Open Letter To Doctors

Last week I had surgery, a long surgery that required over an hour of operating room time, but the operation was not my greatest fear as I approached this process.

What concerned me the most? I feared having to get a pre-op clearance from my internist; a simple visit that would require less than 10 minutes of contact time. You may be thinking that my primary care physician is mean, rude, and evil. Of course, this is not the case. He appears to be a nice man and a good doctor. If I felt otherwise, I would not work with him.

So Dr. Mike, what is the problem? First a little more background information.

As a person who has battled obesity all of my life, I have become acutely aware of the stigma that comes with weighing excess pounds. Few human attributes can be ridiculed and condemned in the millennial “microaggression” culture of 2018. Imagine criticizing or mocking someone because of their race, sex, religion, sexual preference, gender identity, physical stature, or a multitude of other differentiating human characteristics.

Making fun of “fat people,” is an acceptable national sport, even though the CDC reports that over 70% of adults in the US are now overweight. Of course, as the overweight population explosion redefines the concept of what is normal weight, there will always be those outliers who exist beyond a standard deviation from that norm. There will always be a group to abuse with fat jokes, both overt and covert criticism, and outright disdain. If you are obese, it appears that it is OK for others to assume that you are lazy, dirty, and stupid.

We would never make such assumptions for other medical epidemics. Imagine someone undervaluing you because of your high blood pressure, or your fasting blood sugar? Just like obesity, these illness are caused by multiple factors: genetic, environmental, and lifestyle. Unlike obesity, there are good medical treatments for these ailments, making them easier to treat. The majority of folks with high blood pressure can significantly reduce health risks with medication management alone. However, the majority of obese people will continue to be fat despite diet plans, medications, exercise, and shaming television shows.

I lost over 100 pounds about 3 years ago. I did this after failing many traditional techniques of weight loss. I feel that my weight loss was indeed a miracle that was fueled by common sense, rather than modern medicine.

We are humans, not machines. We are motivated and influenced by a multitude of factors. This variability can be considered a weakness, but it should also be acknowledged as one of our greatest strengths. We are complicated, and as such simple blanket solutions have marginal utility.

Over the three years since I lost weight, I have regained a small percentage of my weight. Most people have told me that I look better with a few extra pounds. They say I look less gaunt, and more vital with this increase. Additionally, I have long shifted from judging myself based on a number on a scale. My lifestyle changes have been just that, they are not strategies to lose weight and thereby achieve some sort of false utopia. “My life will be good if I am not fat.”

Three years into this process:

I still can wear my same wardrobe.
I still exercise every day, walking from 3.5 to 8 miles.
I still avoid all forms of concentrated sugar.
I still practice healthy eating.
I still make an effort to eat more natural foods.
I still assess and correct hidden forms of weight gain, like emotional eating.

When I determine my current status I would say that my efforts continue to be successful, but what about the matter of my small weight gain, does this one objective parameter signify failure? I would say, “No.”

************

I sit in a chair opposite from my primary care doctor who is staring at a computer screen.

“You have gained weight.” My doctor says. My initial impulse is to apologize for my failing. I resist. My second impulse is to defend my position. I resist and remain silent. “Are you exercising?” I reply that I am and had already walked four miles before our appointment. “But what about cardiovascular exercise?” He retorts. And so it went. Three minutes of questioning that felt like three hours of interrogation. Pain always feels worse when inflicted on an open wound.

***********

Dear readers, I’m am a resilient person. Besides, I am good at using the counterbalance of logic when dealing with my emotional exaggerations. However, there is more to this story than just a detailed account of me stepping on the scale and my emotional response to that event.

Being a physician, I understand the power that doctors have over their patients. Patients come to us in an extremely vulnerable state looking for help. Studies have shown that a statement like, “You need to quit smoking,” will convert some active smokers into former smokers. Unfortunately, in medicine one size does not fit all. It is easy for physicians to generalize the above truth and think that simple pronouncements can be used to motivate all lifestyle change. However, a doctor’s command is a partial solution at best, and should only be used when wielded within a broader understanding of what causes people to change.

Many of the illnesses that physicians treat on a daily basis have a strong lifestyle component. My weight loss eliminated my need for blood pressure tablets, high cholesterol medication, and a CPAP machine. So why is it that physicals don’t learn and employ simple motivational techniques so they can move their patients towards health? I don’t ascribe to know all of the answers to this questions. However, I do know some of them.

Physicians in the US work in a production model. We get paid by the volume of the work that we do. See fewer patients, make less money. As medical practices get bought up by business investors the push for physicians to do more continues to increase. A good business model consists of finding ways to spend less and make more. This fact is contrasted by a simple truth; we are caregivers, and most of us want to provide care.

Our contact with patients is reduced by the use of physician extenders. Someone else takes our patient’s blood pressure and obtains their chief complaint. We employ electronic medical records (EMRs), which provide a clear notation of our treatment plan, but does so at the cost of patient interaction. Patients now have the “privilege” of answering our questions as our eyes are focused on a computer screen instead of them. Patients want care from us, and we want to meet their needs. There is a pill for everything, and today’s EMR makes prescribing absurdly easy. Is writing prescriptions the same as providing care? I believe that it is only a part of our job, and it should not define us in total.

When I retired from private practice, I was fortunate to have patients write goodbye letters to me. Almost universally they said that they valued their time with me because I listened to them, didn’t judge them, and guided rather than controlled them. To do these things I needed to spend time with them. I would have made more money if I saw 6 people in an hour, rather than the two that I scheduled. However, I would not have known my patients as well, and more importantly, they would not have known me as well. Trust is a function of integrity multiplied by time. Trust by itself offers a positive corollary to patient satisfaction and well-being. Besides, a career that includes connecting with others is eminently more satisfying to we providers than one that does not. A win/win.

One factor needed to motivate change is time. Unfortunately, extending the length of appointments may not be possible in today’s corporate medicine climate. There are indeed a variety of stop-gap strategies that doctors can do to build a connection, such as deliberately spending a few minutes directly with the patient before turning to a computer screen. Such simple changes can make a patient feel more connected, but they still don’t address the elephant in the room.

How should doctors interact with patients to create change? Fat people know that they are overweight, and should lose weight. Alcoholics know that they drink too much, and should stop. Diabetics realize the importance of blood sugar control, and that they shouldn’t eat that extra donut. We live in a culture that shames, and it is likely that some will avoid being humiliated by their physician by avoiding seeking necessary medical care. I admit that I have been an avoider in the past.

Big problems become smaller when shared with someone. I am willing to tackle projects that I would not usually attempt when I have someone at my side. This phenomenon is even more evident if that “someone” has expertise that I lack. If you have been reading my prior post, you know that I have been converting a cargo van into a camper. I dare to significantly modify my van because I am doing the project with a friend who has expertise far beyond mine in such manners. We, physicians, have expertise far beyond our patients in such manners as health. Most reasonable patients accept this, despite the advent of the Internet. A colleague of mine has a cup in his office that reads, “Please don’t confuse my medical degree with your Google search.” However, most patient’s intrinsically understand our expertise, which is why they are seeing us.

Doctors need to connect with their patients as human being to human being, and they need to do this on a level that patients can relate to. We need to become trusted knowledgeable friends rather than overbearing, critical parents.

We need to understand where our patients are coming from, and how willing they are to make change. We need to problem solve with them. Imagine if my doctor asked me, “Are there any barriers that prevent you from seeking medical attention?” Or, “Are there any ways that I can help you with your lifestyle change?” Those simple questions would instantly change my relationship with my care provider. I would want to meet with him, and I would look at setbacks as problems to be solved, rather than justifications for criticism.

Once a patient’s cards are on the table, all things are possible. Is the doctor’s goal the same as the patient’s? What are the barriers to achieving the desired goal? What steps should be tried? How will progress be measured? How is a reversal of progress addressed? Empathy joins, criticism divides.

A meaningful connection with a patient doesn’t happen all at once. Relationships develop over time. However, imagine helping your patients make a significant and real change. Imagine the satisfaction of having a substantial connection with them. What would it be like to work with real people instead of being a reviewer of lab data? What would it be like to end your workday with the knowledge that you truly connected with someone in a meaningful and significant way that changed their life? What would it be like to move from treating diseases to treating people?

We blame our patients for their failings, while we steadfastly hold on to methods and techniques that simply do not work. Imagine if our relationships with our patients were more as a knowledgeable and caring peer rather than a stern and critical parent? Imagine yourself as the patient. You are aware that you have a problem and you need help. Who are you going to ask? Someone who tells you what you already know, makes you feel bad, and offers no real help? Probably not.

Patient Mike

Perseverance, Guilt, Childhood, And My Campervan.

Ninety-degree temperatures, 100% humidity, unforgiving sun; I baked. I had spent the morning with a friend under similar conditions as we destroyed the interior of my campervan with the hope of transforming her into something better.

Before the installing of the campervan insert, I had carefully run wires between post and pillar so there would be two electrical circuits available. One to power the yet to be installed exhaust fan, and another to electrify the proposed LED ceiling lights. These wires now covered by the plastic ceiling panels installed in Colorado just weeks before. It was now time to reveal them from their hiding place, and so the panels came down.

A 14 inch by 14-inch hole was cut out of her roof, an exhaust fan screwed into that gap. Huge solar panels were carefully bolted on. Another hole drilled into her roof’s center to carry the cables from those panels into her cabin. Yet another hole, almost 3 inches, was gutted out of her side to provide a place for an AC power connector. Interior side panels were removed to allow wiring access. Her beautiful kitchen was unbolted and temporarily abandoned in my friend’s garage.

Steps that should have been straightforward were difficult. My friend has all of the right skills, all of the right tools, and enough motivation to get the job done. To the best of my ability, I also did my job. Researching and buying products, watching YouTube videos, pre-testing, and pre-planning whenever I could. Yet, every step was hard.

As you know dear readers, it is difficult for me to ask for help. Asking for help in this situation was even more difficult, as such a request placed me in an especially vulnerable position. I do not have the skills, tools, or understanding to complete the project on my own, and once it was started it had to go to completion, there was no half-way. If my friend decided to walk away at any moment, I would be helpless. I do not like being helpless.

Naturally, I knew my friend would not walk away, but I had not placed myself in such a vulnerable place since childhood, and if you have read my previous post you know why.

The work continued with 10 individual LED lights bolted into the ceiling. To attach them properly each screw had to be individually cut with a grinder. I had previously tested all of the lights, but when I re-tested them in situ, they refused to illuminate. The screws that were so carefully cut were shorting out the LED’s circuits and had to be insulated. And so it went.

Despite my best efforts, I found myself transformed to a past time and prior role. I was no longer Mike, the doctor, I was was Michael the 9 year old. Old unwanted roles, high temperatures, lack of skills, and real problems conspired against me. I took my usual stance and soldiered on. This is a strategy that I have long practiced in challenging situations. I don’t give up. I don’t give in. I command my intellect to overpower my emotion, and I move forward.

The ceiling panels were re-bolted to the roof of the van, but even this task was difficult as some of the screws spun aimlessly, refusing to tighten. Why did everything have to be so difficult when I just wanted to get the project completed and to move on?

Add to this the guilt that I was feeling for imposing so considerably on my friend. He did not complain, but I had already consumed days of his personal time, and the end was not in sight. I thought I would let him know how appreciative I was by publicly announcing my gratitude on Facebook. But in honest retrospect, I think my actions were done in part to relieve my guilty feelings. I find it strange that I can willingly and joyfully help others, yet I cannot ascribe these attributes to those who offer a hand of help to me.

Now alone, I re-enter my van. Once beautiful, presently a mess of disarray. With me is my tester device. Made from a battery pack and fuse box, it stands at the ready. In my pocket is a multimeter.

I connect the wires that should power the LED lights and turn on the power. Only two out of the 10 lights illuminate. I connect the exhaust fan’s power supply and click on the remote control. It sits silent. I pull out my multimeter and set its controls to 50 volts DC. If all goes well, I should get between 10 volts to 20 volts registered on it when I touch the solar panel’s input cables. I press the sharp probe tips into the wires, and the meter records 1 volt.

A wave of desperation covers me. How is this possible? I have experimented with electricity since childhood. I have an advanced class amateur radio license. These circuits are simple, my planning was good, my friend’s work was flawless. Suddenly I’m enveloped by guilt. A pang of guilt from the distant past. A pang of guilt that tells me that all of these problems have to be my fault. That I am to blame. It was now time to approach my friend and admit this to him and accept my consequences. He, of course, tells me that my guilty assumptions are ridiculous.

I am persistent, and I don’t allow illogical thinking to rule me. Despite my guilt, I press forward, and we approached each issue methodically. The LED malfunction is traced to a faulty connector. I remove it, manually spliced the wires together, and 10 lights shine brightly. We test the fan’s electrical supply circuit, and despite being new, it is shorted. I piggyback the power wires from the fan onto the LED feed line, and the fan jumps to life. Each of the solar panel’s MC4 connectors are explored, and it is discovered that the final one in the chain is defective. Being a planner, I have a backup connector at the ready. It is replaced and the multimeter reads a stable 18 volts. From desperation to success, all due to perseverance. All due to not allowing my old and inaccurate emotions consume me.

Dear reader, most of my posts have a theme which is that we are continuously given life lessons, but most of us choose to ignore them. These lessons come in the form of projects, problems, our experiences, and our connections with others.

It would be great to say that the above experience transformed me. It did not. I will need to ask for this type of help many more times before I feel comfortable with that action, and I will likely succumb many more times to falling back into my childhood persona when I do take that risk. However, I now know that I can ask, I can receive, and I can survive. That is important knowledge.

The process also opened up new issues that I need to face, but isn’t that what life is all about? As they say, life is a journey, not a destination. I will never reach perfection, but hopefully, I will improve each time I challenge my false beliefs and inaccurate perceptions. Walk with me, please.

A Weird And Odd Monday

Today is Labor Day. Or is it Memorial Day? I wished my Facebook friends a Happy Memorial Day this morning and then had to edit the post to reflect today’s true identity. Luckily it was at 4:30 AM, so it is doubtful that anyone viewed my ignorance

In the US many holidays have been realigned to fall on Mondays, as is the case of Labor Day. I would look forward to such holidays as in the past I would work from 8 AM to 10 PM on Mondays. Having a Monday off felt like I was actually getting two days off! Now that I’m semi-retired I’m always off on Monday, and the Labor Day holiday is less of a gift.

After my usually wake-up routine, I shot a good morning text to my friend, Tom. However, I didn’t expect a reply from him. He will use the holiday as an excuse to sleep in. Tom often shows up at this Starbucks, and we will catch up on our lives. Naturally, that also won’t happen this morning.

There is a significant event happening in my town called, “The Last Fling.” It is smack dab in downtown Naperville, and right in my walking path. The event consists of a carnival, food vendors, and multiple music stages that host both local artists and formerly famous headliners. This year’s FF offering is “Cheap Trick.” Blocked streets, sleeping amusement rides, and the smell of stale beer all announce to me that this Monday is different from other Mondays.

Another change is that today we have our town’s Labor Day parade. It is well attended, which means that patrons need to secure a spot on the verge to view the spectacle. The spots fill up quickly and are typically saved with strategically placed lawn chairs. The parade starts at 11, but many chairs filled the parkway at 5 AM as I walked down Jefferson Street.

This morning I saw a large group of people milling on the sidewalk a block ahead, and directly in my path. My “growing up in Chicago” instinct kicked in, and I crossed to the other side of the street. As I approached, I saw that the crowd was actually a large group of women. On the road next to them was an extended passenger van pulling a cargo trailer emblazoned with the logo, “Wisconsin Women.” I walked another block, and I was met by another group of women, all dressed in black, silently riding past me on bicycles. Apparently some sort of bike event, and additional spice adding flavor to today’s oddness.

I entered my Starbucks. At 5:30 AM it is usually populated by a few guys who sit around and talk. I wasn’t surprised to see that they were absent on this holiday morning. What was surprising was that the place was pretty packed. This time it was another group of women, younger ones from North Central College. They were all engaged in friendly conversation. I parked my coat and briefcase on a table and took a side trip to the bathroom. I returned moments later to find the place completely empty as if the 20 women present moments earlier simply vanished. Odd.

Dear reader, I am a creature of habit and prefer the predictability of routine to the excitement of the unknown. I am capable of handling a Labor Day Monday, but I am looking forward to a back to the usual Tuesday.

After I type this post, I’ll walk back home among silent Tilt-A-Whirl and shuttered Funnel Cake stand. This Labor Day is a different day for me for other reasons too, as typically I would watch the parade with my kids. Perhaps we would go to the carnival, we might have a cookout, and we would definitely celebrate the day together. That won’t be happening this year. Anne is with her family, Kathryn and Grace are at university, Will will be working.

I’m unsure of Julie’s plans, and so I have committed myself to some of my least favorite tasks, paying the bills and paperwork. As the day progresses, I may go on another walk, or perhaps a bike ride. Hardly, the excitement of years past.

Despite being a seeker of routine, I need to understand that life will throw me a curve ball every now and then. Today’s curveball is relatively trivial, others will be less so. Like Labor Day, most disruption will be temporary, and my life will quickly return to its status quo. However, it is not unreasonable to expect changes that could my alter my life. Since I have no control over these, I am forced to accept them. Wanting things to be “the way they were,” is useless and energy wasting. It is more important to think about the issue at hand. Can I change it? If so, I will. Do I have to accept it? Then I will do that, but I’ll also ponder how I can make the best of this new situation.

Dear reader, I plan on making the most of every day. Join me in this quest. Stop living in a world of regrets, and what could have been. Take hold of your life, and move forward. We can do it together!

One foot in front of the other…

My Crazy Solo 2000 Mile Car Trip

How is it possible to be semi-retired and not have enough time? When I was working 60-70 hours a week, I found time for extra tasks. Apparently, that ability has magically evaporated.

As you recall from my other posts, I recently bought a Ram Promaster cargo van with the idea of transforming it into a simple campervan. I studied many conversion options, and I finally decided to go with a kit that could be installed in my Promaster in a couple of hours. The only problem was that the shop that installs these kits was in Colorado Springs, over 1000 miles away.

My busy retired schedule was already filled with chores, events, and tasks, but I still needed to find a block of time to make the long trip. Ideally, the drive could be a fun adventure if I had enough time to drive/sightsee and if I could travel with someone. Julie initially said she would be my companion, but she changed her mind because she felt that she couldn’t be away from home. My friend Tom has family and work responsibilities, and my kids work summer jobs. That summed up all of the people in my life who would want to spend days of their time sitting 3 feet away from me in a cargo van. Based on these realities I bit the bullet and decided to limit my total time away to less than 4 days and to travel solo.

Saturday arrived, and I drove over to Tom’s house at 5 AM to do our usual “solving the problems of the world.” I then came home to say my goodbyes, and to load my bare cargo van. Into its cavity went a gym bag of clothing, an air mattress, a sleeping bag, a throw pillow, a 5-gallon carboy of water, and a large duffel bag filled with food, cooking gear and a butane stove. With Google Maps as my companion, I was off on my adventure.

Mile after mile, hour after hour. I spent much of the first day of driving in silent thought. Tom had visited the Iowa Capitol building earlier with his son, Charlie, and highly recommended the free tour. I took his advice and had a two-hour layover in Des Moines. The capitol building is magnificent, and the tour guide was excellent. He also suggested a $10/night county campground on the western edge of Iowa which is where I spent my first night. For a sawbuck, I got to camp on a grassy site that was right on a river. I didn’t mind sleeping in my bare van, it felt like an adventure ala the boxcar kids.

Unfortunately, I had about 13 hours of driving the next day, which was both windy and raining. My Promaster acted like a sail in the strong wind forcing me to grip the steering wheel for the next 600 miles tightly. Needless to say, I was pretty exhausted by the time I reached Colorado Springs on Sunday night. I had booked a room at the Hyatt, as I wanted to make sure that I would be up and alert for Monday’s big installation. I was so spent that I didn’t want to leave the room and so I heated up a can of Annie’s Quinoa, Kale and Red Lentil soup for dinner. After a hot and soapy shower, I crashed into bed.

The next morning I ate my complimentary hotel breakfast and headed off to Wayfarer Vans. There I met Ian, the company’s owner. He kindly lent me his personal car during the install, which allowed me to go to the Garden of the Gods state park. I hiked there among the wildflowers and red rock formations. By 1:30 PM the job was completed and I hopped into the driver’s seat for the very long drive home. I felt more lonely on the return trip, so I gratefully talked on the phone and listened to podcasts on Spotify.

Into the night I drove, thinking that every hour on the road would be one less hour the next day. I stopped only for gas and necessities while dining on gas station hot dogs and diet Mountain Dew.

At around 11:30 PM I pulled into a Nebraska rest stop. I spied the sign that limited stays to 10 hours or less. “Perfect,” I thought. I would be long gone before that. Instead of having an air mattress on a metal floor I now had a real mattress on a platform bed. I crawled into my sleeping bag wondering if I would fall asleep. Within moments my eyes closed and I drifted off to the diesel drone of the nearby tractor trailers.

The next morning I cooked up oatmeal and coffee in my new campervan, pulled myself into the driver’s seat, and continued my trip. Many hours later I arrived home. Once again exhausted, but very happy as I had reached my goal.

The trip served many purposes beyond my intended one. I tested my ability to drive for hours by myself. I put to use my camp cooking skills by preparing meals in the van. I explored my ability to entertain myself for days on end. I stretched my introverted self by talking to strangers. Overall, it was a successful trip, and one more step in my quest to go on the road to write and to take photographs.

Dear reader, I have a dream, and I am doing my best to achieve that dream. The overall results may be successful, they may be unsuccessful, or they may lie somewhere in the middle. I am OK with failing at my goal. However, I am not OK with never trying to achieve it.

In this world, we have external limits and obligations that prevent us from doing those things that we desire. However, it is the individual who often crushes their own dreams. Sometimes this is because of fear. At other times it is due to lack of ambition. Still other times it is due to being comfortable with the status quo. In this latter example, the person’s life is good enough, and they are willing to settle. I have never wanted to settle. Why should you? Ever forward, one step at a time.

Do you have goals and dreams? What are you doing to achieve them?

Random thoughts and my philosophy of life.