Friday, November 25, 2016

Seasonal Changes and Mind Games

Does anyone else think that the change from summer to autumn is the most drastic of the seasonal changes we experience?

I was driving late yesterday afternoon and I could not help but be struck at the "all of a sudden" differences I saw and felt as I made my way home. A sea of red tail lights from the traffic slowly moving with me, stood out in contrast to the wave of white headlights approaching from the opposite was barely 4 pm. Surrounding us all, dusk, with its rich hues of purple created by the sun setting through both thick and thin cloud layers, rapidly disappeared as night fell.

The busy surface streets, lined with shopping centers, brilliantly lit with a variety of colored lights displaying restaurant names, gas stations, grocery stores and pharmacies, became brighter as the darkness increased. Residential neighborhoods, illuminated by streetlights, were also starting to glow as residents turned on lights both inside and outside their homes.

Here and there people dressed in light coats and hats -- resilent North-westerners armed with an umbrella, a flashlight or a dog, walked along the sidewalks not bothered by the occasional drizzle. Some, the more athletically determined I suppose, dressed in running shorts and shirts, passed and out distanced the walkers with their rhythmic and almost effortless strides. Still the darkness silently enveloped us.

This growing lack of light did not stop many people from continuing their work-related activities either, be that yard clean up, garage cleaning, or in many instances, putting up Christmas decorations. Yes, Christmas decorations. As November moves out and December moves in, we enter the Holiday Trifecta: Thanksgiving, Christmas and New Year's celebrations.

What happened to those long, lazy days of spring and summer? The hours of daylight beginning around 5 am and lingering until 9 pm or later? Not that I utilized the gift, mind you, but that flexibility to be able to be outside to enjoy a sunrise or a sunset was sort of always there should I make use of the opportunity. The busyness of the days, it seemed, could begin or settle like waves gently lapping on the shore.

The shortened days of autumn and winter -- especially as the year closes -- bring an almost frantic state of mind as the holiday activities loom ever-closer on the daily horizon. Morning light delays its arrival which means I am less inclined to move from the warmth and reverie of bed. Once up and moving, the race to complete daily tasks before early sunsets is much more like trying to get to  safety as waves crash the shore ahead of a coastal storm. The added holiday activities, simple ones, really, like decorating our home, the office, just seem to add to the frenzy.

So for what it is worth, isn't it an interesting contrast that we talk about the "lazy" days of spring and summer, in spite of the fact that the days appear longer; while the shortened days of autumn and early winter are crammed with activity that puts an ant farm to shame? It is the same 24 hours. Nothing more. Nothing less. The challenge is making the most of the daily gift we are freely given, which for me means getting out of the mind-game of light and darkness and just doing what needs to be done.

Thursday, November 17, 2016

In the Clinic Building Relationships

Remember the scene in You've Got Mail when Joe Fox (Tom Hanks), having put Kathleen Kelly (Meg Ryan) out of business, visits her after learning that she is sick, and the conversation turns to relationships? The conversation went like this:

Joe Fox:  It wasn't...personal.
Kathleen Kelly: What is that supposed to mean? I am so sick of that. All that means is that it wasn't personal to you. But is was personal to me. It's "personal" to a lot of people. And what's so wrong with being personal, anyway?
Joe Fox: Uh, nothing.
Kathleen Kelly: Whatever else anything is, it ought to begin by being personal.

This is at the heart of all things....being personal. In the clinic we see this every day. Going to the doctor is of all things personal, right? Patients new to the practices may, in a matter of a half hour's acquaintance, be asked to get undressed or otherwise expose parts of their body to near strangers....zooming from, "Nice to meet you," to "Let's take a look at that sore on your___________. Would you please take off your shirt and pants?" Pretty darn personal.

In today's healthcare culture, the trend seems to be heavily focused on the "science" of medicine. We are blessed to be living in an age where technology advances enable practitioners to identify with greater clarity not only a patient's medical problem or condition, but also hone in on the severity of the condition. A cough can be a cough, or it can be the symptom of something more serious, which might be identified by imaging studies. The ability to use this technology gives medical doctors information that helps them better treat their patients' medical problems. It seems that the advances in both technology and drug therapy should improve the quality of medicine. Or not.

Certainly the ability to diagnose and treat conditions has improved and lives are saved, for which we should be grateful. The price paid for these advances can have an unseen but perhaps a negative effect. We see this every day in the clinic: Imaging reports from X-rays, CT, MRI tests, lab results and consult reports flood the office fax machine, mail, and email. Our providers spend much time each day reviewing data and planning the next steps in treating the patients who come through our doors. Ours is a small office; I can only imagine what the larger clinics must see, and wonder how the providers deal with the tsunami of paperwork in a practice panel of 2000 or more patients. Time consuming tasks that either bring the provider into the office hours ahead of clinic time to complete, or keep them hours beyond the time the clinic closes can negatively impact both quality and work satisfaction.

All the paperwork and reports needing to be completed for specialist referrals, insurance companies and the government pull doctors, therapists, counselors away from the "art" of medicine; the intangible something that should really be at the heart of working in a medical setting. Asking a physician or nurse why they chose the profession, the most common answer is not because they enjoy reading medical test results, completing forms to justify medical treatment for a patient, or even the money. The most common reason, almost to a person, is that they want to serve others by using their knowledge and skill to improve their patients' health and wellbeing, to treat them when they are not feeling well and to be there ready to help when needed.

So for what it is worth, patients don't know or remember that our doctors spend a great deal of time behind the scenes shuffling papers and jumping through hoops to get services or prescriptions needed in patient treatment. This is science and now bureauracy of medicine. Patients do know and remember, though, how they felt after seeing the doctor; the time spent in conversation with them; the caring touch received on physical examination or even in a handshake or hug; the tone of their voice; a smile. This is the art of medicine. It is building the relationship and feeling valued. It begins, grows and thrives by first being personal.

Sunday, October 30, 2016

The Unintended Realities of Getting a Song Stuck in Your Head

It is probably a safe bet that most of us, at one time or another, have heard a song only to have the melody stick in our heads for hours (or maybe days) on end. It is the sort of thing that can drive you nuts.

This very thing happened to me the other day. Paper Moon found its way into my brain after seeing a clip from A Streetcar Named tormented me for three days. It was while driving home from work with the melody playing over and over in my mind, I began singing along to the tune running through my head.

Then I started to think about the lyrics I was singing, trying to figure out what (if anything) this song meant.

For those who do not know the lyrics or have even heard the song, Paper Moon was written by the song team Harold Arlen (music) and E. Y. Harburg (lyrics), with Billy Rose in 1933. The song has been recorded many times in a variety of arrangements by such notable singers as Nat King Cole, Ella Fitzgerald and Frank Sinatra. The verses are as follows:

It's only a paper moon
Floating over a cardboard sea
But it wouldn't be make believe
If you believed in me

It's only a canvas sky
Hanging over a muslin tree
But it wouldn't be make believe
If you believed in me

It's a Barnum and Bailey world
Just a phony as it can be
But it wouldn't be make believe
If you believed in me.

Many people have looked into the meaning of the song, and there are a few theories out there. For a broader discussion on this  click here

For me, though, my perspective is quite different. As most speculate that the lyrics are driven to explain the relationships we experience on a human level, be that between a man and a woman, or, in the case of the feature movie Paper Moon with Ryan and Tatum O'Neal, parent and child, or in A Streetcar Named Desire, looking back on our life and getting back to those places and things that gave us happiness, I look at it in that most important relationship between us and God. What if we look at this as if our Creator speaking to us through these verses?

Could God be telling us that everything we see and do in this life is nothing without Him? Is there an emptiness, a shallowness, a facade in our existence without knowing and loving God and His loving us in return? How many of us are truly ever happy and content believing that what we have is the result solely on what we do and create?

Our modern world is filled with the "famous and beautiful people," who spend time and money in the attempt to stay "famous and beautiful." Can they truly be happy? Is their life one of simplicity and reality, or do they live in a world of make believe?

The world is also filled with those who have amassed fortunes and then spend their time and effort trying to keep it. Can they truly be content? Is their life one of fulfillment, or do they live in a world of make believe?

Or, those people whose primary focus is on gaining more and more power, then having to spend yet greater energy staying there. Can they be truly happy and content? Is their life one of continuous inner peace, or is their life like a Barnum and Bailey circus?

The refrain breaks the verses, so instead of God speaking to us about the triviality of life without Him, from our perspective, in the refrain we acknowledge the idea that living without the mantle of God's love and guidance, we are destined to spend our lives in in a world of shadows and illusions:

Without your love
It's a honey-tonk parade
Without your love
It's a melody played in a penny arcade

So for what is worth, that irritating event when a tune plays over and over in my mind may not be so bad after all. I can't say for certain if the writers had any other intention than to amuse the masses with a cute little tune and clever lyrics. Isn't it funny, though, how the audience reacts to the piece and takes away something that touches their own life? The unintended reality of this common human experience for me has been the realization that my life would really be less full, less meaningful and less real without the Greater Good. If you are interested in hearing a version of the song -- performed by the fantastic Ella Fitzgerald, you can find it here.

Thursday, October 13, 2016

In the Clinic with Exercise

One thing about it, you have to love the habits of health and the ripple effect they have on those around you.

In the office we try as often as possible to model those activities that support good health and overall wellbeing. This "do-as-I-do" attitude lends credibility to the things our providers tell their patients when discussing medical problems related to lifestyle choices, such as diabetes, metabolic syndrome, high blood pressure and the like, but is often easier said than done.

To facilitate this healthy focus, I purchased a Nike FuelBand several years ago and was immediately depressed by the paltry number of steps I achieved in the course of a day. I found that by 5 pm (when the clinic closed), I failed to come close to my goal of 10,000 steps a day, which meant that I had to find time to add those 6000-7000 more steps I needed to track before midnight.

In our small office it is difficult to hide much of anything and my comments about the lack of progress I was making soon became a topic of general conversation. Our ever-energetic and enthusiastic medical assistant Andrew caught quite an interest in my healthy endeavor and also decided to jump on the 10,000 step per day bandwagon.

Armed with his own Fuelband, he started tracking his steps and we enjoyed comparing notes throughout the day as to our step-status. Eventually this led to a friendly competition to see who could clock the most steps before quitting time. As late afternoon approached, we would call out to each other as we passed through the clinic our current count, and there were times when we were quite literally within dozens of steps of each other. All of this produced a frantic push on the one of us behind at that point to be as active as possible, and I have to admit that I found myself stepping in place while I waited for a fax to come through or some such other menial task.

Not to be outdone, Andrew decided that he would build himself a workstation where he could stand to do his work, and keep in "perpetual motion" as he answered phones, completed forms or did computer work. Mary soon joined in the fray, creating her own workstation where she had the flexibility to either sit or stand. She soon upped the ante, and with her FitBit firmly planted on her wrist, twice a day both she and Andrew took time to complete the "7 Minute Workout" from an app Mary had downloaded on her phone. Attempts, by the way, to get Jeannine involved in this, were hit and miss -- but this is the topic for another story.

Since I still have too much pride to lend myself to doing crunches on the floor in front of a few onlookers, I had to figure out something else to improve my FuelBand numbers. It was at this point that I made the decision to haul myself out of the comfortable reverie of slumber and begin my quest for 10,000 steps at 5:30 in the morning.

Puffed up like the Stay-Puft Marshmallow Man, I began greeting Andrew as he entered the office each morning at 8:15 with my 3000+ steps already showing on my FuelBand. My good-natured friend would with humor acknowledge his deficit and the day would move forward.

All of this effort on healthy movement lasted for about two months. Not sure how or why it happened, but we all sort of lost our competitive spirit. We still get plenty of movement in during the course of the day, but the teasing and tormenting has fallen by the wayside.

So for what it is worth, most of us in the clinic still embrace the habit of healthy movement. Andrew has replaced his office chair with a huge blue ball -- core training at its best during office hours. For me, I can still find time to run in place as I wait for a fax or am taking a lengthy phone call, but I now find that the best movement I get seems to be when I have waited too long to use the restroom and, at the point of almost no return, am forced to dance around waiting for the room to be less occupied.

Wednesday, September 21, 2016

Best Party Ever

By far, the best party ever was "The Run for the Roses" party we hosted in May, and it is one that I would do again or attend in a heartbeat.

Normally, we host events for our church group, and there is no particular theme: we just want to bring together our faith community of friends for informal fun and fellowship. Our April trip through Kentucky, though, with a stop at Churchill Downs, inspired us to plan a party with a Kentucky Derby theme.

It may have been learning that there was really something to "the most exciting two minutes in sports," or it may have been a greater understanding of the history and tradition of the Derby -- I don't know -- we just came back home and the idea just grew.

The Kentucky Derby is always on the first Saturday in May, so with literally less than an month to pull this off, we went to work. Online invitations made it easy to create a theme-appropriate evite. Less easy was organizing how and what we would do once the party gathered. Wanting to have our guests get into the fun of the party, our first idea was to encourage anyone interested in placing a "bet" to download our version of the "racing form," complete it, and send it back before the actual race. There would be prizes for anyone whose horse won -- or who actually scored the trifecta: all three horses in winning order.

As fashion is as big a deal at the Derby as the race itself, guests were invited to dress Derby-style in any way shape or form they chose. A simple (or not so simple hat), elaborate dresses and suits, ties and the like were encouraged, and the guests did not disappoint. I am sorry to say that we did not take photos of our company as they arrived, because it was delightful to see how our group of about a dozen embraced the challenge. My favorite, if I had one, was our friend Dennis who came decked out in a white suit, black string tie and a hat -- clearly the image of Col. Sanders!

For the bill of fare, our potluck assortment included many bourbon-inspired dishes: fruit salad with a bourbon dressing, BBQ ribs, a spicy sausage casserole, Benedictine spread and, of course, Derby Pie.

No Derby event would be complete without the famous Mint Julep, and we did not overlook this important detail. As we are not cocktail drinkers, we had all the ingredients necessary for the potent potable, along with the recipe. Our guests were encouraged to build their own, or just use the pre-mixed Mint Julep we found at the local liquor store.

Completing our party activities were two multiple choice trivia contests: one on the Derby itself and the other on Kentucky history (who would have thought that Johnny Depp was born in Kentucky??). Prizes for winners of these contests, as well as for the race itself included a Southern Living magazine, a bag of glazed pecans, and a bottle of Kentucky bourbon.

The highlight, though, was our Kentucky Bourbon tasting. Anyone who was of a mind could bring a bottle of their favorite Kentucky bourbon for a little competition, and our party closed with our spirited (literally) group enjoying conversation on family, work, life and the Derby.

So for what it is worth, our spur-of-the-moment, themed party was a great success. Bringing together our friends is always fun, and while we do not need a reason to host such gatherings, this one will be remembered for a long, long time. Next year? Well perhaps we will all be inspired to put together a Triple Crown event!

Tuesday, September 13, 2016

Perfect View (Writing Challenge 6)

The view from my office window does not afford me much in the way of a tremendous scene in as much as it is obscured by a very large leafy tree. From the second story window, though, I am the proud observer of the many weather changes that come and go throughout a workday in Portland and am surprised by the connection I feel to the natural world on the other side of window.

Today the view is green. The tree, with its many long branches rife with leaves of both green and yellow, is dancing as a brisk wind moves through, pushing the branches back and forth. Looking through the sheltered branches closest to my window, I see the wind roughly playing with the branches on the wide open other side.

Occasionally the wind calms to a gentle breeze and the branches slow to imperceptible movement, but the leaves continue fluttering on their limbs. Beyond the tree and across the parking below, three tall fir trees stately stand, guarded, as it were, by several Aspen trees. These trees perform their dance, entertaining the majestic conifers while the wind swirls around them. When the wind picks up, these trees join in the dance, their movements slower, clunkier than their smaller attendants.

On sunny days like today the morning sunlight brightens a flawless blue sky that provides a nice backdrop to the scene. As the day moves, and the sunlight along with it, the blue will deepen its hue, forcing the trees to pop in contrast. At this point in the day I am able to shut off the small desk lamp, as the sun offers ample illumination to my tasks.

I like this view. It matches my moods through the day. The shade afforded in the early morning facilitates the quiet, steady desk and computer work I do. As the light creeps around the building, the perception changes as the light forces its attentions on the tree outside my window, and in sync, my mood shifts to more active tasks -- so much so that by the time I am once again settled at my desk, I feel the sun in its late afternoon westward travel. The wind may have calmed or even died, and the trees, no longer happily dancing, shut down for the evening -- just like me.

Monday, September 12, 2016

Before and After with My Water Container (Writing Challenge Day 5)

Given the fact that the human body is roughly 60% water, you would think that we would naturally gravitate to any and all ways to replenish this vital fluid. Yet many of us don't get close to the amount of water we need on a daily basis. Until a little more than two years ago, I could have been considered among those who avoided water (almost) at all costs.

I really convinced myself that unless there was some fizz to it, I couldn't drink water. Coffee? Sure. Tea - iced or otherwise? You bet! Soda? Ah, soda...there you had me. There was nothing like popping the tab on a can of cold pop to hear the escaping pressure of carbonation, or seeing the bubbles rising to the top as I twisted the cap on a bottle of Diet Coke. And I didn't wait for a reasonable hour of the day to indulge in this, either. While so many others grasped that cup filled with the black gold of coffee as soon as they arose, I was completely happy grabbing  a can of pop.

Of course it did not help that I never really felt thirsty as the day progressed. I would have to say that for the most part, hydrating through the day, be it iced tea, coffee or soda generally was attached to eating something, or, even in an effort to avoid eating something.

A little more than two years ago, I engaged the help of an optimal living coach, with the goal in mind of keeping my (good) health ahead of the aging curve so that I could continue to be Jeannine's primary life manager and ease the burden of my other children who I knew would step up if needed should I crump. It was not an easy decision,  and it was not pretty when, as we progressed through my health assessment, I had the humiliating confirmation that I had no consistent habits of health.

The first thing we tackled was this very issue of hydration. My coach told me that I needed to deep six the pop and replace it with water - half my body weight in ounces each day. Thankfully we put some strategies in place that would facilitate me drinking this much, which is the standard habit of water health. This is when my water container became my favorite thing.

My container is nothing really out of the ordinary: these 24 oz plastic glasses can be found in high-end department stores, coffee bars and dollar stores. Mine has a permanent straw and a screw-on lid. Armed with this, I began this change to healthy hydration -- drinking at least 85 ounces each day.

Ironically, I found that it was really quite easy to dump the soda. As long as I had my container filled with ice water, I was fine. After about a week, I was routinely consuming not only 85 ounces, but 90 ounces or more! There was the slight drawback during that first week of bathroom running, but it was not very long before my body adjusted to the new and improved hydration system, and my "visits to the necessary" decreased.

I also found that my skin looks better. I have had many comments about how I look younger and I even seem to have more energy. I feel better focused on everyday tasks. By taking the container of ice water to bed each night, I can sip on it if I happen to wake up, and seeing it sitting on my nightstand when I get up encourages me to start my hydration routine for the day. The biggest plus, though, is that by making this change to water, I have lost weight and am better able to maintain the loss.

There really has been no downside to having this water container. As a matter of fact, if I happen to forget it, I feel lost without it!