Category Archives: psychology

How Corporate and Governmental Greed Used The Distance Rule To Control You and Your Beliefs.

The following is my personal opinion.

Over the years, I have observed a phenomenon in various situations: I have dubbed it the Distance Rule. The rule is simple: the greater you can separate yourself from a person or group, the easier it is to justify or ignore harmful actions against that person or group. 

The converse rule, which I call the Closeness Rule, also applies.  The more one can relate to a person or group, the more difficult it is to justify harmful actions against that person or group.  

There is a qualifier.  These rules apply to individuals who have a moral center.  Those with sociopathic tendencies will do whatever is in their best interest, as their ability to empathize with another person is absent.  

Lastly, there is the phenomenon that I call Convenient Sociopathy, where it is so advantageous for an individual or organization to dehumanize an individual or group that they find a rationale to do so, often using the Distance Rule. Think of the corporation Enron, which regularly turned off electric power to parts of California, which caused harm to the most vulnerable while increasing the wealth of Enron’s shareholders. 

Entire nations can use these rules, often employing propaganda to reach a goal. This tactic is always seen in war situations.  During WWII, American propaganda portrayed both the Japanese and German citizens as bloodthirsty monsters, making it easier for US soldiers and the homefront to unite against them.  Naturally, similar campaigns were launched against Americans in those countries.  

Additionally, a systematic propaganda campaign was developed against non-Arians in Germany in the 1930s, and specific efforts by Germany, Italy, and Spain were developed to eliminate a particular minority population, the Jews.

Other groups were also targeted, from Eastern Europeans, to Romani, to gays, to those with physical, mental, and psychological issues. Creating an emotional distance between these groups and the general population allowed ordinary citizens to do the most horrific things to human beings.

It is easy to devise a method to separate one group from another. However, this process is more effective if the aggressor uses an easy-to-identify characteristic such as race, religion, economic status, education level, sexual orientation, or nationality. The aggressor’s goal is to gain power and control. That power can be expressed in privilege, wealth, or other forms of domination. 

A common characteristic of serial killers is that they dehumanize their victims, using the Distance Rule to turn them into objects for gratification. This can be seen in predators who kill for sexual thrills, such as John Wayne Gacy and the BTK killer Dennis Rader.  

The ability to distance from others to justify a behavior can be seen in less global ways. As a psychotherapist, I would see patients use the Distance Rule to create an emotional separation from a spouse when they enter into an affair relationship.  At the same time, I would witness them using the Closeness Rule to idealize the affair partner as further justification for their actions. I have never heard a person active in an affair say something like, “My spouse is great, but I decided to cheat on them anyway.”  Typically, an excuse is made focusing on their spouse’s flaws, lack of sexual response, inattentiveness, or whatever.  Likewise, the AP is usually characterized in an ideal way as the one “who understands me,” the one “I can talk to,” or the one “who appreciates my sexual prowess.” 

This Distance Rule is commonly seen in the corporate world and was promulgated by Jack Welch, the former CEO of General Electric. Before Mr. Welch, most large corporations’ strategies were for long-term, steady growth. Giving a workforce a sense of stability and rewarding them for their loyalty was part of that growth equation. Jack’s focus was very different. He saw a corporation as a profit-generating machine for stockholders and felt that the role of a corporation was to benefit those individuals. So be it if a job could be done less expensively in another country. A division that was not as profitable as another one should be closed and damn to the factory workers and communities that they lived in. Using that method, Jack made a lot of money for GE’s shareholders and himself.

GE survived as a corporation. However, this Distancing Rule sometimes destroys not only lives but also corporations. One example of that phenomenon is former Sunbeam CEO Albert Dunlap, known as Chainsaw Al for his business practices.  

Sunbeam Corporation was a 100-year-old company that made small appliances under the Sunbeam and Oster brands. These were well-regarded US-made appliances. My mother used a Sunbeam Mixer daily from the 1950s until the 1970s, when she was gifted a Kitchenade Mixer. That original Sunbeam Mixmaster was a quality product.  However, due to mismanagement, Sunbeam was less profitable than possible, so they brought in Chainsaw Al to improve the bottom line. Al fired around 50% of Sunbeam employees, closed down most of Sunbeam’s factories, and reduced their product line, destroying the lives of many.  Robert Reich, then secretary of labor, noted, “There is no excuse for treating employees as if they are disposable pieces of equipment,” Chainsaw Al promoted stock options, which meant that any profit for Sunbeam shareholders would also benefit him.  He was incentivized to do whatever it took to inflate Sunbeam’s stock, and that is precisely what he did, using fraudulent and illegal tactics that resulted in Sunbeam filing bankruptcy in 2001. Al left the corporate world with millions in his pockets despite paying off federal fines and penalties for his illegal practices. His fines were a small price to pay. Sunbeam was sold several times to larger entities, and Newell Brands now owns it. You can still find Sunbeam-branded products, including a crap version of the Mixmaster, which is now manufactured in China. No one aspires to have a new Mixmaster as the once legendary product has fallen far from grace.

The top 1% of income earners are those so isolated from the general population that the populace can become an object to achieve further gain rather than human beings with lives, families, and aspirations. 

I know of a university student who was given an internship at Amazon.  She was treated well in that temporary position, but she was appalled that workers were treated like machines.  For instance, lower-level workers were written up if they ever sat down.  Can you imagine?

Educated professionals can also be treated like commodities. For decades, we have been told that the secret to success was to become educated. Universities grew and prospered as US tuition reached stratospheric proportions.  Students studied complex STEM disciplines like engineering and computer science with the promise of a secure and financially stable life. Currently, many of these individuals can’t find jobs or have been laid off as they try to cope with massive student debt, excessive mortgages, and rising inflation.  

A particularly heinous practice in the US has been incentivizing shareholder profits in health care.  Let me first say this clearly: there is no justification to murder another person. However, I can understand the anger and rage placed on corporations that enrich themselves by acting as the unnecessary middleman in an industry that is supposed to help people and not cause harm.

We have been sold a bill of goods that says our health system is the best in the world; it is not.  Did you know that citizens in 48 other countries, including Costa Rica and Albania, have greater longevity than in the US?  Did you know that many citizens in countries with universal health care are happy with it and can’t imagine the healthcare shenanigans that happen in the US?  Did you know that medical debt is the number one reason for bankruptcy in the US?  Did you know all developed countries except the US have healthcare for all? It is accepted as a benefit of an enlightened society, just like free education, fire departments, and public libraries. No one says, “I don’t want my kids to learn how to read and write because it will turn our country into a socialist state!”

Many attempts have been made to establish universal health care in the US starting in the 1800s, including efforts from Presidents Theodore Roosevelt, Franklin Delano Roosevelt, and Harry Truman.  Are you aware that beyond profit interests, one reason for this not happening was racism?  Efforts for universal healthcare in the US started after the Civil War, but they were shot down by politicians, mainly from the South, as universal healthcare would have to include blacks.  White legislators noted, “Free assistance of any kind would breed dependence, and when that came to black infirmity (Ed note: sickness), hard labor is a better salve than white medicine.”  This should not be shocking as blacks have been excluded from many social reforms.  Large numbers of blacks were excluded from the 1935 Social Security Act, and structural discrimination limited black’s access to the GI Bill.

Private health insurance became a popular perk used by companies to entice workers during WWII when wages were frozen. This perk became a factor in amplifying the health insurance industry. 

Somehow, PR has made us believe that healthcare isn’t a right but a privilege.  To that end, 27 million US citizens are uninsured despite programs like Medicaid and the Affordable Health Care Act. This impacts all of us and our economy and is often the case due to governmental barriers at the state level.

Traditional Medicare is a government-run healthcare program that its users generally like.  Its administrative costs are 10 times less than private health insurance programs like Medicare Advantage. Traditional Medicare has a near-zero denial rate for accepted procedures. Lastly, its network of hospitals and doctors is vastly more expansive than any Medicare Advantage program.  Medicare Advantage subscribers often give up traditional Medicare and sign up with a private insurance company because they are promised trivial perks. Getting free stuff sounds terrific until you have a significant and expensive need and your Advantage program denies or delays approval.  

Regular private health insurance also practices these tactics.  A loved one of mine had a spinal fusion, and we were told that she would be in the hospital for 4-5 days due to the complexity of the procedure. After 24 hours, the insurance company was pushing for discharge, and despite my efforts, my loved one was discharged at 36 hours. My loved one wasn’t making sense, could barely stand, and was in terrific pain. We had to provide complete nursing care at home for many days.  Thankfully, I’m retired and have the knowledge and family support to take on that role.  How many others don’t have those resources?

Medicare Advantage programs are under government investigation for fraudulent billing practices and denial of claims. It has been proven that Medicare Advantage offers a lower quality of care while costing the government more than traditional Medicare.  So why are seniors always being pushed to go with an Advantage program?  Well, there is a reason that insurance companies spent over $117,000,00.00 in campaign contributions and lobbying efforts in 2024. We already have government health insurance in conventional Medicare, and it works quite well, but it doesn’t make a profit for shareholders and CEOs.

By using the Distance Rule, insurance clients become objects to be manipulated to increase profits for shareholders and employees of the company.  The recent tragedy of the murder of the CEO of United Health Care brought to the forefront the level of corruption in the industry.  Yes, that CEO was being investigated for insider trading.  Yes, he made 10 million dollars in his last year’s salary.  Yes, he illegally sold 15 million dollars of UHC stocks when he knew the stock was about to tank due to an FTC investigation.  That is horrible, but nothing compared to a 32% denial of claims by UHC.  That means almost one-third of requests from mammograms to life-saving surgeries were denied. Those denials were made by a computer program, not a medical expert, and that software is reported to be wrong 90% of the time! Consider the consequences and damage to our society by turning human beings into objects that can be manipulated to gain corporate profit. 

You may think insurance company denials are based on preventing evil doctors from performing unnecessary procedures, but that is not true. Some of the most significant legal investigations involving health care are due to insurance companies’ fraudulent billing of Medicare/Medicaid. Additionally, many doctors have stories of insurance companies denying payment even after getting pre-approved for a procedure. When insurance companies do pay, they can delay payment for months, causing hardship for practices with large overheads . Many rural and less endowed hospitals have been forced to close because of these and other practices, leaving entire communities without health care.

Insurance companies know that only about 0.2% of denials are ever appealed.  Clients may not know that they have that right to appeal or may not have the psychological energy to launch such a process during their health crisis.  Recently, our family had to face an insurance denial.  A loved one was diagnosed with a rare and life-threatening condition that was so complicated that it required traveling to a university hospital. A very long, complex, and potentially dangerous operation needed to be performed, and the university hospital got pre-approval for the procedure from the insurance company.  The operation took over 7.5 hours and involved a team of the hospital’s top doctors, including department chairs. Yet, 6 months after the operation, we received a bill for thousands of dollars as the insurance company denied a PART of the operation. I’m a physician; how do you deny PART of a pre-approved operation for a life-threatening condition?  That makes little sense. I did appeal the decision and was rejected twice by the insurance company.  I eventually filed a complaint with my state’s insurance commission before the charges were reversed. If only 0.2% appeal an insurance denial, how many of those 0.2% also know you can file a complaint to a regulatory commission?  Likely, not many.  Bonus for the insurance company. 

In our modern society, individuals are becoming more isolated from each other. People work from home, friends connect via text messages, and groups isolate themselves due to their ever-widening economic status. All of this makes it easier to apply the Distance Rule.

I live in an affluent community. I see entire families dining at expensive restaurants on weekdays. It is a place where people walk down pristine walking paths sporting designer clothes.  A place where many belong to a gym because they rarely do productive physical exercise.  It is a wonderful place to live, and I’m very grateful that I am fortunate to have called my town my home.  However, a short drive in almost any direction can take me to a different place.  A place where poverty is evident.  Where grocery stores don’t exist. Where schools are places of violence.  A place where poverty drives crime, addiction, and fear.  I generally avoid those places, as most of my neighbors do.  We don’t have to think about the plight of those human beings; they are far away, making it easy to objectify them.  Objects that we can blame and then ignore. “That’s not my problem.  Look at how successful I am,” we say—ignoring the opportunities that we have had. That is how things work in our society.  If it doesn’t directly impact the individual, it is ignored.  However, as we continue to distance ourselves from others on all levels, the result is that we will also eventually suffer. 

I was raised in a working-class neighborhood but managed to attend one of the country’s best medical schools.  Everyone who works hard enough can do the same, right?  Wrong.  I had many advantages in my favor.  I lived in a stable home and never worried that we would be evicted.  There was always food on the table.  Both sides of my family are academically oriented.  My parents strongly emphasized the importance of education.  I didn’t have the advantages of some, but I had many more benefits than many.  This enabled me to use my only gift, my ability to think, to my advantage.  Would that be the case if I was always hungry or afraid to go to school because I could be shot?  I don’t think so.  

Yet, it is still easy for me to objectify others using the Distance Rule.  I have to actively put myself in the shoes of others. I have conservative friends and family, and I make an effort to understand their positions.  I have working-class friends whose reality differs from mine, and I try to put myself in their shoes. When I drive through a poor neighborhood, I try to comprehend those people’s obstacles.  When dealing with a persecuted minority, I imagine what their life must be like on a day-to-day basis.

Recently, I have had someone I know come out as trans.  She possesses the courage and resolve that few, including myself, have.  However, as a minority, she will suffer from the Distance Rule. In my professional life, I have worked with trans people.  They represent an extremely tiny percentage of the population.  Their wish is simple; they want to have freedom to live their life and to be left alone.  There is NO evidence that they want to convert others to their position or that they get off from entering a bathroom. They just don’t want to be persecuted.  Yet, look at how easy it has been to use the Distance Rule to objectify them and make them into an object of hate. Why do this? If you want to control a group, find another vulnerable group they can fear and hate and then promise to protect the majority group from that imaginary threat. A method as old as time.

We live in a society where the distance between different groups grows daily.  That distance may be measured in terms of physical distance, monetary distance, educational distance, belief distance, racial distance, sexual orientation distance, liberal vs conservative distance, and just about any other separation you can think of. Consider this quote from our Pledge of Allegiance, “One nation, indivisible, with liberty and justice for all.”  Think of the power and wisdom of that statement.  When we apply the Distance Rule, we negate this promise.  In the short term, it makes our lives easier.  In the short term, it allows others to manipulate us and makes some richer.  But what about the long term?  What about our country and its promise to treat all fairly? In a country that should be the greatest on earth, such separations make the rich richer and the poor poorer. This can only lead to eventual collapse and disaster. That is common sense. Did you know that the three wealthiest individuals in the US have more money than the lowest 50 percent of the population? Three individuals have more wealth than the combined worth of 167 million humans. Their distance from that population is unfathomable. 

Government and industry leaders have employed the Distance Rule to split populations so they could manipulate them and extract power and wealth from them.  Why do we buy such a ridiculous concept that hurts everyone except for a few at the top? 

If you accept even ten percent of the premise of this post, it is incumbent on you to move from passive acceptance of the status quo to active pursuit of a better way.  You need to reject the Distance Rule and embrace the Closeness Rule. You need to look at how we are all more similar than different. At the same time, it is imperative to accept those slight differences that we do have and not buy into the manipulation of others who use minor differences as weapons to separate us.  

Find common similarities between you and someone different from you.  Listen to their dreams and their life struggles. You don’t have to adopt their ideas; they don’t have to convert to yours.  It is OK to be different. At the same time, open your mind, as you may find that some of your beliefs may change as you understand who they are as human beings. In turn, they may do likewise. Focus on the humanity of others. Immanuel Kant developed the Categorical Imperative in the late 1700s. The Golden Rule is as old as time. We know what we need to do, but we are manipulated to do otherwise.

A talking point from this last election was, “Are you better off than you were 4 years ago?”  It was a powerful point and likely won the presidency.  However, it was a manipulation because the statement should have been, “Are you better off than you were 40 years ago.”  For most, the answer would have been “No.”  But that reason is not because of the immigrants, or blacks, or trans people, or whatever.  It is because wealth has steadily moved from the poor to the rich.  That is the reality that the 1% doesn’t want you to know. They effectively used the Distance Rule to deflect blame onto vulnerable groups that can’t defend themselves. Remember, we are always stronger when we work together.  We are weaker when we allow others to separate us into groups, as that weakness can be exploited to all our detriment. 

Peace,

Mike

How I Became A Psychiatrist

When I told my father my plans he was clearly displeased.  It was a spring day, and I was talking to him in his south suburban backyard. “Dad, I’m going to specialize in psychiatry.”  His response was quick and sharp, “Why would you want to do that?  You should become a real doctor.  Psychiatrists aren’t doctors.”  

By that point in my life, I had long charted my own course.  I listened respectfully, but internally, I ignored his commands.  I no longer needed his approval, and my conversation was more perfunctory rather than advice-seeking. He had his agenda, and I had mine.  Since my decision would directly impact me, it was my decision to make.  I subtly changed the topic to something that I knew would interest him. It was a deliberate manipulation on my part to a neutral subject, and the conversation moved forward.

His question was valid for other reasons. Why had I decided on this career path? My answer was both surprising yet understandable.

There are certain key events in my life that I write about repeatedly. They serve as markers that indicate significant changes in my knowledge of myself and the world around me.  They are the road signs to my life.  Many other factors are equally important, but these events note a change in understanding or direction.  A fork in the road that led to a different journey.   

I often talk about my dyslexia, a diagnosis that is only partially accurate.  I use the term because it is relatable.  In reality, I have a variety of processing differences that can make simple tasks difficult for me.  For instance, I can visualize abstract concepts but can’t assemble a simple children’s jigsaw puzzle. This processing disparity was evident when I was in second grade and couldn’t read. In the early 1960s, the concept of learning disabilities was utterly foreign at the Catholic grade school that I attended.  My teacher, a nun, recognized that I was smart and erroneously concluded that my inability was caused by a vision problem, which prompted my parents to get me a pair of glasses.  This was a significant expense, and my father was not pleased, but he complied. 

I was hoping for a miracle and was crushed to discover that they did little to translate the incomprehensible set of symbols that moved around the page with a mind of their own.  I was at a phase in my life when I thought that any imperfection in me reflected poorly on my family and parents, and I was terrified of gaining even more displeasure from my father.

Yet, I had a certain confidence in myself, likely boosted by my teachers, who would comment on how smart I was.  I had to devise a solution, and I felt confident I could. But what resources did I have?  How could I take something I already had and use it as a tool?  The answer came to me via the Sunday comics. There was a strip called “Nancy” that was very simple in both its storyline and vocabulary. I could piece together the words by tying them to the pictures.  The traditional way I was being taught to read would never work for me because I could not see the separation between words and lines of text.  However, if I viewed a word as a shape instead of a series of letters, I could decipher its meaning.  My brain could do that, and print started to make sense.  I did many other things to teach my brain how to read. Soon, an entire world of information was revealed to me. By the time I took my 4th-grade achievement tests, I was testing at the 11th-grade level. 

I was a big kid, so I can’t say that I was the object of a lot of bullying.  I was part of the mass group of kids; neither a member of the popular crowd nor the reject group.  I had friends, and I did things.  Yet, I felt like an imposter.  Subjects that interested my friends didn’t particularly interest me, and things that I was interested in held no interest with them.  I learned that to be accepted, I would have to show interest in what interested them while hiding those things that I was interested in. 

My salvation was science, and my teachers were the pseudo-scientists of the B science fiction movies that I would watch on late-night TV. My ultimate hero and male role model was Don Herbert, AKA “Mr. Wizard” of TV fame.  Mr. Wizard seemed to have the answer to how everything and anything worked. He showed me that there was a method to understanding, a way to prove ideas, and a methodology to learning.  What he demonstrated formally was consistent with what I had been doing organically.  Mr. Wizard didn’t know me, but he understood me.  He had to, as what he was explaining on TV was exactly how I was already solving problems.  Mr. Wizard allowed me to feel “normal.”  I no longer believed I had to fake who I was; at least one person understood me. 

My success in learning how to read taught me that authorities didn’t always know what was best and that there were solutions to seemingly impossible problems if I allowed myself to think outside the box.  Mr. Wizard gave me a formal set of rules to test ideas. Science and math provided the tools to implement those solutions.  I was suddenly empowered. 

It was only natural that I would pursue science, and as I have said in a previous post, the most logical course of action would have been to obtain a Ph.D. and pursue a university career. I’m a rational person who examines potential outcomes, plots a course to achieve a particular goal, and then pursues that goal with force and dedication.  It works… well, sort of… well, sometimes…well, hmmm..ummm…keep reading.

I have already told you how I successfully reached my goal of graduate school and even had the school pay for my education. A perfect plan?  Then, despite all logic to the contrary, I had an irresistible urge to abandon my plan and apply to medical school, which was an insane idea that was bound to fail.  I knew that I would never be accepted into medical school.  All of my logic, all of my “scientific method,” and all of my dreams were tossed aside for a whim. Yet, that was precisely what I did; I allowed a force outside of myself to control my actions.  I was as shocked as anyone when multiple medical schools accepted me. Many of them referred to how meaningful my personal statement was to them. Here was a kid who couldn’t read in second grade who was now moving doctors with his writing.  Life is strange, isn’t it?

I have always had an immense interest in the interface between chemistry and biology.  My graduate work centered on changes to proteins as they are extruded through a bacteria’s cell membrane.  During my application to med school year, I left grad school and got a research job at the University of Chicago using tissue culture models to study Multiple Sclerosis.  We were using a cutting-edge technology (this was in the 1970s) called monoclonal antibodies to create specific markers.  Even then, I could see how such a targeted method could be utilized clinically, from cancer treatment to fighting infections.  However, those advancements would be decades in the future.

Logic would dictate that I pursue an area of medicine that incorporated my scientific knowledge with clinical practice.  The options were plenty: internal medicine sub-specialties like infectious diseases and endocrinology to specialties like Neurology.  I knew that one of those areas would be a perfect fit.  However, they weren’t.  

I was so excited to do my internal medicine rotations, but they disappointed me. I spent 90% of my time running down labs, examining scans, and writing notes.  The time that I spent with patients was minimal.  It felt like I was back in the lab, but my subjects were humans this time. As a family practice doctor, I may have been happy as that medicine was more integrative.  However, family practice options were discouraged at Northwestern.  When I asked the medical school dean why, he responded, “Our mission is to produce specialists.”  Despite this, my problem-solving and goal-direction abilities pointed me toward an internal medicine subspecialty. It was where my background and interests led me. 

Psychiatry was never a consideration.  I had some fears about the profession.  My mother was frequently hospitalized for ketoacidosis, a condition caused by her out-of-control diabetes.  Once, she was in a medical unit that shared a floor with Christ Hospital’s psych unit.  That unit had an imposing locked metal door with a thin slit window made more solid with embedded mesh wire.  It was scary looking, but young me was curious.  I crept up to the door and, with all the courage I could muster, looked into the window, not knowing what to expect. From out of nowhere, a face appeared directly opposite me.  A deranged and disheveled-looking man started to shout at me and threaten me. His face was one inch from mine, only separated by a thin piece of glass.

Along with his verbal threats, he started to beat on the door, and I could feel the vibrations inside my chest. I wanted to escape but felt frozen.  My heart was racing, and I was overcome by fear. Eventually, I broke away and ran down the hall.  In the background, I could hear laughing.  At the time, it sounded like an insane laugh reminiscent of those heard in horror movies. In retrospect, I believe it was the laugh of someone who felt he had just played the greatest joke on an unsuspecting, nosey kid.  However, it took me quite some time before I deciphered that realization.  I was freaked out for years, and at one point, I even had a fear that I could accidentally be locked up in a psych unit, never to escape.  

Our family has an intuitive psychological understanding, which stems from my mom. However, I never thought of pursuing psychology in any form. I was a science guy and never took a psychology course as an undergrad.  

Medical students rotate through all of the specialties as part of their training, and at Northwestern, all M3s are required to do a 6-week general psych rotation. This rotation was a low priority for me, and my main concern was completing it as simply as possible. I wanted a site close to Northwestern’s downtown campus for convenience and picked the least desirable one because it was only a block away.  I knew I would get it because no one else would want it.  It was a drop-in center for the sickest psych patients, the most chronically ill.  There, they could socially mingle, play a game, attend a group, get medically seen, and renew their prescriptions. Fellow students told horror stories about bizarre behavior and poor hygiene.  No one wanted that rotation, so I picked it.  I could survive anything for six weeks, and I wouldn’t have to travel to a distant site to complete my obligation.

My first day was as expected: bizarre, often disheveled individuals milling about, talking, and sometimes shouting to themselves. Mismatched clothes, sometimes garish makeup. “It is only six weeks out of my life,” I told myself. “I’ll do this one day at a time.” I had many obligations at that place, from doing initial psychiatric evaluations, to being a group therapy leader, to helping manage meds, to injecting patients with long-acting antipsychotics.  However, I also had more free time than was typical for a clinical rotation.  I started to hang around the day room.  Sometimes, I would sit in the day room and read; at other times, I would play a game with a client. Eventually, something strange happened.  Patients would come up to me and start a conversation. Those conversations were not about meds or the latest therapy; they were about their lives, hopes, and dreams.  They would ask me about me, not in an intrusive way but in an interested way. I was becoming part of their group.  They seemed to look forward to seeing me.

One day, a client could be rational, on the following day, completely psychotic. As they gained trust in me, they let me into their life, and I developed an admiration for them.  Despite having constant hallucinations and delusions, many could still navigate the world, form relationships, and problem-solve.  I would lack these abilities under such circumstances. Many lived a life of scorn and rejection, yet many of their desires were no different from mine.  They wanted to connect with others, have value, and have those basic needs that we all require. In this crazy setting, I was doing what I wanted: helping someone improve their life, even if it was just a tiny bit. Knowing the biochemistry of psych meds helped, but just relating to them as human beings was just as important. I looked forward to showing up, playing a game of checkers, or talking to them about their past and present lives.  I always felt different growing up, but kind individuals seemed to find me and convinced me that being different was OK. 

Here, I was dealing with people who had problems very different from mine, people who were very different from me, yet all I could see was how similar we were underneath.  These were human beings, not trash.  They deserved to have the best life that they could. I felt called to spend time with them.

Once again, my logic, planning, and goal-setting were about to be tested.  I had so much training in hard science, but much of Psychiatry was soft science. However, my course of action was right before me and couldn’t be ignored.  Hard science told me that I could use powerful drugs to block dopamine receptors and reduce psychotic symptoms.  However, soft science showed me that listening and relating to another human could be even more powerful.  My beliefs were being challenged, but I was willing to listen. But was this experience a fluke? The only way to find out was to test the hypothesis, and I did that by picking psych electives that were completely different from my drop-in center experience.  I did, and my mind did not change.

And so it started: residency, becoming chief resident, jobs, co-founding a clinic, working with the underserved, then… then…then.

Do you ever think there is some guiding force beyond yourself that directs you if you allow that direction?  A guardian angle? God’s direct interest in you? Some other force. Despite all of my planning, logic, and science, my best decisions in life seem to come from outside of me.  Interesting, no?

I spent many years sitting at this desk in my co-founded clinic.

On Dyslexia And Backpacking

Freddie Nietzsche has referenced the impact of life’s difficulties in a much more eloquent way than I ever could, but with that said I do have the ability to turn something negative into something positive. 

 

I have mentioned my dyslexia in the past, but I think it deserves re-referencing here. As some of you know, I was unable to read in second grade. My teacher told my parents that she thought I was very bright and attributed this inability to poor vision. My parents took me to an optometrist who prescribed a very weak eyeglass prescription. I guess optometrists have to make a living.  

 

My 7-year-old expectations were dashed when I put on the specs only to discover that I was as illiterate as before. The fear that my parents would be angry at me pushed me towards a solution; I created my own method to make sense out of the jumble of random symbols that my mind was seeing. I feel that my alternative way of reading has given me an advantage. I may read slower than many, but I have superior comprehension. Beyond comprehension, I appear to have an excellent ability to understand the subtext and sub-connections in a written piece. My reading difficulty turned into a reading advantage for me.

 

I apply this concept to other aspects of my life; most recently to the subject of backpacking.In a past post, I wrote about my trip to Glacier National Park, and how it had a life-altering impact on me. A subplot in this post centered around backpacking. 

 

I enjoy day hiking, but I declined an offer from my friend, Tom to backpack with him. Tom is an inexperienced backpacker who challenged himself to hike in the backcountry armed only with knowledge from YouTube videos, and a healthy cash donation to REI.  

 

His 4 day/3 night trip turned into a 6 day/5 night experience due to dehydration, electrolyte imbalance, and physical exhaustion. Despite these barriers, Tom succeeded in his quest and enjoyed the experience. Further, he feels that he bonded even closer to his son, as they had to work together to accomplish their goal.

 

I am happy for Tom’s accomplishment, but I am also grateful that he brought me a wealth of information on this topic. I had thought a lot about backpacking and read extensively on it, but third-hand data can only yield so much real-world details. Through Tom’s narrative, I was able to get an up-close understanding of the experience. What were the primitive campsites like? How did he go to the bathroom? What would he change in future hikes? What were the positive things about the experience? What gear did he wish he brought? What equipment that he brought was unnecessary? It is one thing to watch a YouTube video from an athletic 25-year-old backpacker, it is another thing to listen to a 52-year-old guy’s first time out. Tom’s story gave real context that allowed me to visualize myself in his situations.  

 

My personality is such that I get enjoyment from learning information and skills. As a new area of interest, the topic backpacking offers both opportunities. Additionally, my solo day hiking trips revealed something about myself that surprised me. Despite being a loner, I very much wanted to share my experiences with someone else, and I wanted to do that sharing in the first person.

 

I already had a sleeping bag, and I decided to buy an inexpensive lighter weight tent. Other small purchases followed: a blowup pillow, Smartwool socks, a better headlamp. 

 

My next phase was to try out new behaviors in a controlled environment. I set up my little tent in the living room, unrolled my sleeping bag, and climbed in for a nap. Success!

Setting up my backpacking tent in my living room. Making sure my sleeping bag fits (and taking a little nap).

When Tom came off the trail he gifted me all of his Mountain House freeze-dried food with the statement, “I’ll never eat that stuff again!” I have eaten MH on occasion and found it reasonably palatable. However, Tom ate Mountain House for all of his meals, and quickly became sick of his soft and lukewarm diet. I would likely have a similar reaction, and so I have been exploring other simple backpacking meals. In fact, I have created a few homemade “freezer bag” meals that my official tester (my daughter, Gracie) said tastes better than the commercial stuff. 

Trying to rehydrate pasta and my own dehydrated veggies. Rehydrating commercial freeze dried veggies. Making my own freezer bag meals that will be compared with a MH meal.Thanksgiving dinner in a freezer bag. Just add hot water and wait 10 minutes! My meal rehydrated.

 

The next phase of my experiment will be to attempt a backyard sleepout. I’m curious if I’ll be able to stand up straight after sleeping on the hard ground all night. Pending the weather forecast, I will likely do this in the next few days.

 

So, will I backpack? Unfortunately, I have run into some pitfalls in advancing this process. My goal was to do a three-night hike with Tom next summer when he travels to Yellowstone National Park. When I mentioned this to him, he was receptive but informed me that he was thinking about a 5-6 night adventure rather than a 3-night trip. This long trip would not be wise for me based on several factors. Tom is younger than me but in similar physical shape. Despite drinking a lot of water, he became dehydrated, and due to the sequelae of electrolyte loss simple movement became difficult for him. It is also clear that he became physically depleted after day three of his hike; this was his energy limit based on his level of physical conditioning. Any additional days became ordeals for him to conquer rather than enjoy. I would likely have a similar experience. Lastly, the way that he coped with this exhaustion was to lengthen his trip, advancing his adventure from 4 days to 6 days. This expansion would be multiplied with a more extended trip. For instance, a 6-day trip could turn into 9 or 10 days. Based on all of this, it would be foolish for me to consider such a long hike. I did suggest to him that we go on a few short local overnighters, which would allow me to check out my ability in situ, but as of this moment, he isn’t too interested.

 

What about other options? It would be great to hike with my son, Will, but he has no interest. Julie has never expressed a desire to go backpacking. My other kids are busy with their lives, friends, and activities. 

 

I am starting to explore the option of an organized club or Meet Up group, but I wonder if the cohorts would be too advanced for me. I have even pondered finding someone on Craigslist, or some other public forum. What would I say in an ad? “Wanted a middle-aged or older guy who has never backpacked who would like to go backpacking with someone equally inept.” For some reason, I don’t think I would get a lot of takers.

 

At this point, I am enjoying learning about a new topic and testing out new skills. If this hobby advances further, all the better. With that said, I believe that learning new things is always useful, even when the knowledge doesn’t have an immediate practical purpose. Seemingly specific information can often be generalized. For instance, my ability to develop decent freezer bag meals is directly related to the many years of hotel room cooking that I did when I worked 2 days a week in Rockford.

 

My goal is to enjoy the journey and not negate the process by only focusing on the end game.

 

Today I told you about my backpacking transformation, but the same techniques can be used when dealing with much more difficult problems. In fact, these rules also apply to other issues, even trauma. There are several factors necessary to turn an unwanted experience (a negative) into one that is desired (a positive).

 

1. Understand the process. 

2. Explore the pitfalls. 

3. Practice the behaviors. 

4. Evaluate if the overall outlay of time and energy are justified.

 

This methodology works, and so I thought I would pass the tips on to you. 

 

Peace

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.

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

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

Kathy’s Story: Life As A Caregiver

Life doesn’t always turn out the way that you expect it to. This is the story of Kathy.

Kathy sits across from me sipping a herbal tea, at 71 she is active and tells me that she is going dancing after our interview. Kathy has been a widow for 4 years, and she is trying to adjust to her new life.

She met her husband at a dance when she was 19. He was the older brother of one of her friends, and after the dance, he got her phone number from his sister.

Dave asked Kathy out on their first date by posing her a question. “If you can tell me the color of a red pencil, then you can go out with me.” She liked her husband Dave because he was smart, funny, and a little sarcastic. “I got tired of the sarcastic part pretty early on, and I let him know that.” Dave had a significant limp from a bout of childhood Polio. He was born before the advent of the Polio vaccine and contracted the disease as a baby. Growing up he worked hard to compensate for his handicap by regularly working out in his homemade basement gym.

On the surface, Kathy felt that they were dating casually. However, six months into the relationship she ended a connection with another man. Clearly, there was a part of her that knew that there was something special about her future husband.

She was still in school, and Dave returned to college studying at Lewis University. Kathy recalls a letter that he sent her around their 3 month anniversary. In the letter, he thanked her for the brownies that she made him and told her that he would also like some cookies. Although humorous, that simple comment foretold of things to come.

They had little money, and it took them 6 years to save enough to get married. Dave eventually became a special education teacher, and Kathy taught elementary education, both for the Chicago public schools.

They saved and bought a home on a large lot in the country. They traveled a bit. They raised a family. This was the American dream of the 1980s. Dave loved to eat. In fact, Kathy says that he was obsessed with eating. Dave started to gain weight and went from thin to morbidly obese. Along with his obesity came diabetes. Along with diabetes came diabetic neuropathy. Along with diabetic neuropathy came immobility. He was already limited by the aftermath of his polio, but his neuropathy made him disabled. It became difficult for him to walk or maintain his balance. This made it hard for him to contribute in a meaningful way at home.

Slowly, but progressively, more and more of the home tasks fell on her. This is how she describes a typical morning in those days:

“I would get up at 4 AM and walk the dog. Then I would throw clothes in the clothes washer, and empty the dishwasher. In those days I made a lot of oven breakfasts, and so that would be cooking. After breakfast, I would get my kids ready and drive them to school or the sitters. Then I would go to my full-time teaching job.”

Kathy was feeling tired and stressed. Despite this, she put one foot in front of the other and pushed forward. “I didn’t think about it, I just did it.”

Dave’s condition continued to worsen and his doctors came up with a new diagnosis, Post Polio Syndrome. Post Polio Syndrome is a syndrome that occurs many years after a person has contracted Polio and it is characterized by muscle weakness, fatigue, and pain. Dave went from using crutches to being a wheelchair user in 1996. It was becoming increasingly difficult for him to get out of the house, and once out he could only go to handicap accessible locations. This was not only difficult for him but his entire family.

Kathy continued to push forward, but her life was becoming further limited, and she was avoiding social gatherings because of the enormous difficulty in transporting Dave. Her world was closing in.

In 2009 she started to notice another change in Dave, he was beginning to stutter. Dave was a bright and inquisitive individual, but now his logic seemed way off. Simple things, like learning how to use an electric wheelchair, were beyond him. He was complaining of vision problems, although his eyes tested OK. He had trouble writing. In 2011 an ophthalmologist examined him and thought that he may have Parkinson’s Disease which can be confused with another illness called PSP. Dave was seen by a Neurologist who did an MRI of his brain. That test showed an unusual hummingbird pattern which is the classic sign of PSP or Progressive Supranuclear Palsy, a disease that destroys part of the brain. This explained the stuttering, lack of coordination, problems with logic, and the fact that Dave had gone from being a nice person to a nasty one. Dave started to show a lack of empathy, and at the same time, he was becoming progressively needier. If Kathy was out of his sight for a moment, he would bang on the walls or call her cell phone to get her attention.

She now had caregivers coming in, but they were only present 3 hours a day. “Sometimes that was the only time I could sleep as Dave would often be up at night.” Another symptom of PSP is dementia. Kathy’s situation was similar to someone who had a spouse with Alzheimer’s disease. It was a tough time. She had discovered a Facebook group for PSP caregivers, and that served as a lifeline for her. “Connecting with other caregivers, I started to understand that Dave’s behaviors were due to his disease.”

The course of PSP runs from 6-15 years, and on August 17, 2014, Dave passed away at home.

Kathy spent much of her marriage taking care of Dave, and through the process became ever more isolated from the outside world. A part of her wanted to live, to experience, to explore. In many ways, she was like a person who had been released from prison after spending 20 years in confinement. She had a desire to move forward, but her life had been so structured that she didn’t know how. “My friends in the PSP group talk about this. That first year is go, go,go. It is like you are trying to make up for all of the years that you couldn’t do anything. You move forward, and you make mistakes. I joined a dating site, but I didn’t understand that there are predators that lurk on these sites. Let’s just say that I got hurt.”

Kathy continues to move forward, but at times it is difficult to know what forward is. She is starting to do things for herself. She travels more, she has joined a gym, she is taking dancing lessons, she casually dates, she learned how to swim, she learned how to ride a horse, she is a regular at a senior MeetUp group. Despite this she is lonely. She has gone from being a caregiver to being free. However, being a caregiver was her identity. She has lost her identity.

“I decided that it was time to talk to someone who could help me figure out where I go from here. I need to accept that fact that I may never have another partner. I need to be happy with myself.”

Kathy says that she is still a work in progress. She continues to expand her experiences, but at a less frantic pace. She is enjoying her friends, family, and grandkids. She continues to learn and grow.

We never know where life will take us. Every day is a gift. Good days have bad in them. Bad days have good in them. It is our task to extract what good that we can from every day, as we will never be given that day again.

Kathy is a heroic person who is trying to live by that philosophy. I wish her well.

If you have a story that you would like to tell me please click here for more information.  It is free and it is a way to preserve your legacy. 

To read more stories click here.  

Kathy

Shari’s Story: Living With Autoimmune Disease

It is 7 PM on a Thursday, and I am seated across Shari, a 46 years old woman with shockingly red curly hair. This is her story.

Shari grew up in the middle-class Chicago suburb of Downers Grove. She showed exceptional creative talents at an early age and would entertain her parents with her complex stories about bunnies. There was something different about Shari, an old soul with an inquisitive mind.

Early intelligence testing gave a partial answer. Shari was a genius. Coming from a family of achievers, she was right at home. Shari was in the top two percent of her high school class, a fact even more amazing as she was involved in over 20 clubs/activities while she worked a part-time job. Despite her accomplishments, Shari always found the most peace in simple things. She deliberately choose the smallest bedroom at her parent’s home and shunned excessive possessions.

College was expected, and she applied and was accepted to the University of Illinois, a premier university. Always a storyteller, she decided on a rhetoric major. As a concession to her father’s fears of unemployability she also took courses in accounting. As in high school, Shari excelled at the U of I. She overloaded herself with classes, worked different jobs, and even became a resident advisor for her dorm. “I took six years of classes in 4 years,” she told me. Her academic achievements at the U of I were significant enough for her to be named a Bronze Scholar, one of the university’s highest undergraduate honors.

Despite her success, something was not quite right. Late in her college career, she became ill to the point of requiring hospitalization. Despite her academic success she felt stressed, instead of accomplished. “I raced to the top of the mountain, and there was nothing there.”

More studies followed at the University College of Cork in Ireland where she obtained a certificate in Irish Studies. Then it was time to get a real job.

What jobs are available for rhetoric majors? Not many, and so she accepted a two-day temporary position at Ace Hardware corporate doing routine data entry. When you are smart, you can generalize what you know and see the bigger picture. In Shari’s case, she was able to use her accounting knowledge to see errors in the data that she was inputting into the computer. She told her supervisor what she observed and went from a two-day temp worker to a full-time position on her first day. Shari was entering the corporate world.

One task led to another, and soon she was designing complex databases and doing statistical analyses for Ace. At the same time, a romance was forming in her life. She met her first husband when she lived in Ireland. He traveled to the US so they could check out the viability of their connection. When his visa ran out, she quickly decided to marry him.

Unfortunately, the relationship was doomed. Her husband couldn’t hold down a job, and would impulsively spend money. She would react by working harder to pay down their debt. Shari learned more programming languages, and soon was working on mainframe computers. A lucrative but time demanding job in pre Y2K.

Wanting to do the right thing it wasn’t uncommon for her to work late in the night and then bring home additional work. The stress of unnecessary debt, extraordinarily long working hours and a difference in values eventually took its toll, and her marriage ended. Raised in a strict Roman Catholic household, the divorce was devastating to her.

More jobs, more responsibility, more challenges. Shari was being pulled by two forces that were equal, but opposite in direction. A desire to have a simple life, and a wish to do an outstanding job in the corporate world.

Along the way, she met her second husband. He was resentful that Shari had a circle of friends and convinced her to move so they could start anew and be on an equal playing field. Where did they move? They moved from Chicago to Australia. In Australia Shari did what she does best, learn. She finished a Master’s degree in creative writing at the prestigious University of Sydney and then went to work at the university. Shari told me that she loved living in Australia, as everything she needed was within an easy walk. A simple life was what made her happy.

She traveled to India on holiday and became ill. She returned to Australia sick and very weak. She found herself working from home, as she did not have the energy to get dressed and travel to work. This went on for many weeks. Slowly, and with the help of medical professionals, she recovered. However, something had changed, something was wrong. Also, her second marriage was now failing, and another divorce was on the horizon. The prospect of a second divorce was sobering.

Shari continued to work at the University of Sidney, and her brilliance promoted her. She was given important projects and a team to work under her. One of her hires was a man named Jason. A person who barely said two words to her while they worked together. But more on Jason later.

With a broken second marriage, she decided to leave her life in Australia and return to the United States. She left behind true friends and the basic life that she loved.

Now back in the US she once again got jobs in business and IT. Learning new systems quickly, always seeing the bigger picture, always overworking. After 18 months she returned to Australia to visit friends and co-workers. Her former employee Jason was at one of her welcoming dinners. “He seemed different, more talkative and engaged.” By the end of the evening, they were holding hands. Four years later they married.

Finally, it seemed like things were going her way. She was married to the love of her life, she had a small and manageable home in Downers Grove, and she had a good job.

Stress was working overtime in the background as she continued to overwork. In the first year of her marriage, she was hospitalized with a bout of Ulcerative Colitis. She developed chronic anemia. In 2012 she was hit by a severe, unknown malady that left her twitching, and uncoordinated. She couldn’t think straight and had no short-term memory. She was in constant pain, and she was continually sleeping. She went from being able to see the bigger picture to not knowing if she let her dog out. It was a horrible time for Shari.

She sought medical attention and diagnoses were made. Autoimmune thyroid disease, autoimmune neuropathy. She started to do her own research and determined that one of her problems was Hashimoto’s Encephalopathy (HE), a diagnosis later confirmed by her physicians. HE is an autoimmune disorder that causes an inflammation of the brain and produces neurological symptoms because of that inflammation. Other related problems emerged, Lyme Disease, Possibly PANDAS (another autoimmune disease caused by a Streptococcus infection). The combination of stress and infectious agents were creating a one, two punch that was making her life unmanageable. Her body was literally destroying itself.

Shari fought back. Using her own research, novel treatments, and an expert medical team, a multi-modal treatment emerged. Thyroid replacement hormone, steroids, neuro-cognitive training. These have all helped improve Shari’s functioning. However, her health is still fragile. She takes one step forward, only to slide backward with the slightest stress.

Shari is a giving person, but she can become over-involved helping others. She willingly helps friends and family, but her actions can result in an exacerbation of her autoimmune illnesses making her non-functional for days. She would like to be a financial contributor in her marriage, but even part-time work can be too stressful. She struggles with her current lack of functioning, her poor memory, her fatigue.

She says that many doctors missed her diagnoses; they only reviewed simple lab panels and didn’t delve further. She wants to advocate for others who are dealing with undiagnosed maladies. At this time she is a health coach for a young woman who suffers from another chronic disease, but Shari wonders what her next step should be. She knows that it can’t be fueled by the obsessive drive that gave her success but contributed to her sickness. Her illness has forced her to re-explore what has consistently made her happy in the past, a simple, basic life.

Despite her illness, she is grateful. Grateful for the beauty and majesty of nature, grateful for her caring friends, grateful for her loving family, and most of all grateful for her soulmate, Jason.

Life is what you make of it. Sometimes it is more important to celebrate what you have than to constantly grieve over what you have lost. Rejoice in today as will never be repeated.

Do you have a story that you would like me to tell?  If so, click here for more information on this project.

 

Shari

What A House Fire Taught Me

Many people see events as separate dots on a timeline. This is not the way that I view things.  To me, everything connects to everything else. I believe that the world is continually teaching us life lessons, but most people ignore them. This leads me to the story of Mike and the builder.

My father was reasonably handy, but only repaired things under duress. Our house was in shambles.  Although we had a basement workshop, he didn’t teach me the arts of construction and repair. Mostly, he would just tell me to fix things. The results would often be poor, and I would hear about it.

I assumed that by some magic I should know how to do things without any teaching or experience.  This made me a self-starter. It also made me hesitant to tackle significant repair jobs.

I never lost interest in fix-it-up projects, and they still fascinate me today. Accomplishing a small repair can give me a sense of pride and joy.

If you have read some of my other posts, you are probably familiar with my friend Tom.  He is a general contractor, and we are the best of friends. We complement each other in our skills.  There are things that I know how to do that are helpful to Tom. There are things that Tom knows how to do that are helpful to me.  The fascinating thing is that many of the ways that we help each other are not by providing direct services to each other. Instead, we complement each other by our association.

Tom is acting as the general contractor on a home rebuild project.  A fire started in the garage of the home, and in 20 minutes it caused an immense amount of damage.  In 20 minutes the homeowner’s lives were changed forever. Their family was safe, but almost all of the contents of the home were destroyed.  Part of the house will need to be rebuilt entirely. All of the interior walls, floors, doors, and fixtures will need to be replaced. The roof, siding, and driveway will have to be reconstructed.

I have been documenting the progress of the repair with photographs.  This project has been done in short segments. However, recently Tom invited me to spend the whole day with him as he was having his carpentry crew do some significant deconstruction and construction of the house.

He picked me up in his dually from Starbucks, and we headed off to the Naperville site. The house was boarded up, and about one-half of the siding had already been removed. I pulled out my Canon 5D Mark III from my Manfrotto backpack, and I started to shoot.  Soon his crew arrived. A caravan of trucks and vans lined the street. Their contents contained carpenters ready to do battle with a house. This job was too big for one person alone.

Tom’s carpenters are experienced, and they scattered over the house without so much as a word from him.  Soon they were ripping down the remaining siding and pulling off the charred wood. The house started to disappear as pile after pile of burnt wood, siding, and other materials filled the driveway.  As the walls came down in the garage, I could see the destruction that the fire caused. It was sobering.

Tom was now coordinating their activities.  Soon we started a shuttle process. To the recycling center with the siding.  To the lumberyard for lumber. To the garbage dump to offload garbage. To the hardware store to get hardware.  To the grocery store to get water. And so it went.

Piece by piece the garage came down, one slice at a time.  Piece by piece a new structure started to emerge, one board at a time.  The new construction wasn’t rising from the ashes; the ashes had been swept away.  The new garage was rising with careful and methodical planning. The new space modified to improve on the old, but still on its familiar footprint.  A structure connected to the remaining beams that were healthy and strong.

There will be a bigger loft above the garage, better lighting on the adjacent porch, a concrete driveway to replace the melted asphalt one.  The new space will look similar to the old, but it will be better.

The effort will be immense, the cost high. In the end, the owners will have their familiar house back, but it will be improved.  Something good will arise from something terrible.

You may think that I’m am using this construction project as a metaphor. However, I would like to challenge that belief.  A metaphor is typically a word or phrase used to describe something which is not literally applicable. What if these life lessons were utterly relevant?  What if there was a cohesiveness that binds us to our planet and all of its occupants? Like laws of physics, these laws were also constant. If one understood these “laws of the world” he or she could apply them globally to improve other aspects of their existence. I believe that we can enhance who we are, what we do, how we feel. The world around us can be our teacher; we need to stop, look, and listen.

Here are just a few of the things that this house taught me:

-Bad things can happen for no reason.

-It is important to accept things that you have no control over.

-It is essential to take responsibility for those things you do have control over.

-Most events or situations are neither good nor bad. We assign these values artificially.

-We can take good things and make them bad.  However, we can also take bad things and make them good.

-When faced with a difficult task, things go better with friends to help you.

-The homeowners will have a better house once the construction is completed.  They will need to pay for this metamorphosis with discomfort, time and effort.  They will have to accept a certain amount of uncertainty. This is no different than making a change in a person’s life. Changing from an unhealthy place to a healthy one will require discomfort, time, effort, and uncertainty.

-At the recycler, we saw mountains of worn metal that will be melted and repurposed.  At the garbage dump, we saw broken cardboard boxes being prepared to be processed for future use. We also saw garbage that had to be discarded, as it was dangerous and toxic.

We may have parts of us that we think are bad, but with effort, we can make those parts good. Other parts have to be discarded, as they are so broken that they pose a danger to us.

-The fire destroyed some of the homeowner’s garden. For new growth to thrive, the dead plants need to be removed.  

Just like the dead plants we need to rid ourselves of bad habits, behaviors and relationships to make space for good, healthy ones.

These are just a few of the lessons that I learned from a burnt house and a general contractor.  Dear reader, look around you, life lessons are everywhere. Perhaps your clothes dryer is trying to tell you something.  Think I’m being ridiculous? Think again.

After the fire

Removing the bad to make room for the good

Rebuilding

Old metal will be melted and become anew

Some things are so toxic that they have to be completely discarded