Random Thoughts from a Restless Mind

It was a Tuesday. For sure. Tuesday is an OR day for me, and I was with my work people on what looked to be a pretty vanilla Tuesday morning. That’s how you like it in the OR: vanilla. A good day is no memory of the operations whatsoever. A great day is one where you remember some interaction with your teammates, something good or funny or nice.

9/11 was definitely a Tuesday. What I remember is being with one group of my people.

Everything about the day was going just like every other Tuesday. Fast cases with great results. Stories flying back and forth between doc, nurses and patients. Just a joy to be doing my job. Until, that is, one of the nurses came into my room and said a plane had hit a tower. To a person our collective response was something like “huh…that’s weird. How tragic,” and then back to work. Back to normal until that very same nurse came back and said a second plane had hit the second tower. We all stopped after that case and headed to the family lounge, a TV and CNN.

I remember being in a similar place when the Challenger blew up, surrounded by colleagues, patients and families. That’s where I was when the first tower collapsed. After that nothing was normal about the day at all. There is literally nothin in my memory banks about the rest of the morning. I know we finished the cases, but then everything came to a full and complete stop. Clinic hours were cancelled, schools let out, and the wheels of American life ground to a halt. The rest of the day was spent in tracking down my brother (traveling now by car from Chicago to Connecticut), and best friend (stranded in Brazil). The skies were empty for days.

Our new normal had just kicked in.

My parents worried about an attack on our soil from Germany to the east (U-Boats off the coast of New England) or Japan from the west (a friend posted the story of a Japanese pilot who actually fire-bomb Oregon!). As a child our politics and our lives were spent worrying about the specter of a communist attack. As an adult, a father and a grandfather, it is now the fear of Jihad unleashed. The post-Reagan/post-Berlin Wall years of relative peace and security seem so very long ago now, don’t they?

The reality, of course, is that we are far safer than we think we are. Yet our own personal realities are driven by the same psychology that led our parents to fear a coastal invasion, for us to fear Russian bombers. We march on each day, as we must. We march on so that each day’s completion becomes one more tiny victory in yet another long war fought for us mostly between the ears, so much like the Cold War before it. We seek victory once again in the daily act of living our normal lives.

We remember, though. Like I remember that it was a Tuesday. We never forget, nor should we try to forget. It is in the remembering and carrying on despite the remembering that we do our tiny part to honor those who were lost. Today is a day to take a moment away from normal to remember.

I remember.

“Billy Ray (not his real name, of course) turned off his implantable defibrillator (ICD) yesterday. Billy Ray is 44.

In my day job I was asked to evaluate him for a problem in my specialty. I was told he was about to enter hospice care and assumed that he was much, much older and simply out of options. I admit that I was somewhat put out by the request, it being Saturday and the problem already well-controlled. Frankly, I thought it was a waste of my time, Billy Ray’s time, and whoever might read my report’s time, not to mention the unnecessary costs. I had a very pleasant visit with Billy Ray, reassured him that the problem for which I was called was resolving nicely, and left the room to write my report.

44 years old though. What was his fatal illness? What was sending him off to Hospice care? I bumped into his medical doc and couldn’t resist asking. Turns out that Billy Ray has a diseased heart that is on the brink of failing; without the ICD his heart will eventually beat without a rhythm and he will die. A classic indication for a heart transplant–why was Billy Ray not on a transplant list? Why, for Heaven’s sake, did he turn off his ICD?

There is a difference between being alive and having a life. It’s not the same to say that one is alive and that one is living. It turns out that Billy Ray suffered an injury at age 20 and has lived 24 years in unremitting, untreatable pain. Cut off before he even began he never married, has no children. Each day was so filled with the primal effort to stop the pain he had little left over for friendship.

Alive without a life. Alive without living. Billy Ray cried “Uncle”.

I have been haunted by this since I walked out of the hospital. How do you make this decision? Where do you turn? Billy Ray has made clear he has no one. Does a person in this situation become MORE religious or LESS? Rage against an unjust G0d or find comfort in the hope of an afterlife? Charles DeGaulle had a child with Down’s Syndrome. On her death at age 20 he said “now she is just like everyone else.” Is this what Billy Ray is thinking? That in death he will finally be the same as everyone else?

And what does this say about each of us in our lives? What does it say about the problems that we face, the things that might make us rage against some personal injustice? How might we see our various infirmities when cast in the shadow of a man who has lived more than half his life in constant pain, a man alone? The answer, of course, is obvious, eh?

The more subtle message is about people, having people. Having family, friends, people for whom one might choose to live. It’s very easy to understand the heroic efforts others make to survive in spite of the odds, despite the pain. Somewhere deep inside the will to live exists in the drive to live for others. The sadness I felt leaving the hospital and what haunts me is not so much Billy Ray’s decision but my complete and utter understanding of his decision.

Billy Ray gave lie to the heretofore truism that “no man is an island”.

Go out and build your bridges. Build the connections to others that will build your will to live. Live so that you will be alive for your others. Be alive so that your life will be more than something which hinges on nothing more than the switch that can be turned off. Live with and for others so that you, too, can understand not only Billy Ray but also those unnamed people who fight for every minute of a life.

Be more than alive. Live.”

What is the meaning of a marriage? More so, what does it mean to enjoy a long, happy marriage? Today is the 40th Anniversary of the happiest day of my life, the day I married the love of my life, Beth. 40 years! Big number, that. We’ve been together for 43 years in all. I’ve written and talked about our marriage and our decades-long love affair many times before. Today is a day to visit once again how wonderful it’s all been.

Much ink and many electrons have been spilled lately on the topic of marriage. The demographics of marriage are said to have shifted. Young people have been putting off marriage until they have reached certain very specific milestones in their lives. Education, job, savings, a self-defined state of security, and only then, marriage. This pattern has been dubbed the “capstone” marriage: once the structure of a life is built the celebratory “edifice” is added. As an aside since this leads to first marriages that occur after age 30, this pattern has been blamed, at least in part, for the decline in the national birth rate in the U.S., especially among the college educated.

For the most part our generation seemed to look at marriage more like our parents and grandparents had. Beth and I met at ages 21 and 22, dated, lived together for a bit, and then married at 24 and 25. In our extended circles of friends and acquaintances we were kind of in the middle of the Bell Curve age-wise. Judging by the number of weddings we attended together, admittedly a very suspect data source, it sure seems in retrospect that a majority of the weddings in an around our groups and our families took place around 24 or 25, give or take a couple of years. Likewise, when it came to starting our families, it sure seems like we all got to it within a year or two after getting married.

Pundits of today describe marriages like ours as “cornerstone” marriages. It’s not just that they are similar to patterns described in prior generations when it comes to things like age at marriage and first offspring, it’s that they are the primary building block of our lives as we became adults. Marriage and all that comes with it was, and is, both the foundation of adulthood and the gravitational center around which we lived our lives. For Beth and for me, and for our siblings and so many of our friends, this is pretty much nail on the head.

Our marriage began as our cornerstone, and for 40 years has been the touchstone of our life.

So what’s the secret? How do you stay happy, stay excited, stay married for so long? We both get asked this all the time. Have been asked since very early in our marriage, actually. When asked we both start with the leg up that we had from having parents and grandparents who had very long one-marriage lives. Having role models, especially ones you loved and looked up to was a huge head start.

From the gift of a good start what came next was the commitment to build around our marriage by putting it first whenever we had decisions to make. Beth likes to say that the adage that everything has to be 50/50 in a marriage is wrong by 50%; putting your marriage first means that you both need to be 100% committed to both the marriage and to each other. It’s 100/100! 50/50 might be a very workable strategy when you are divvying up the household chores, but it’s only a halfway commitment.

As much influence as our parents, grandparents, and their married friends had on our outlook on marriage we were also very aware of the classic life stressors that seemed to lead to divorce, especially in medical families. So many marriages that seemed so successful during the child-raising years seemed to fall apart just after the nest emptied. In my mind’s eye I imagined an empty-nester couple sitting at the kitchen table, drinking coffee. They turn down a corner of their newspaper and realize that they don’t really know the person sitting across from them as anyone other than their parenting partner. Without conscious effort it seems all too easy to expend most or all of your time and energy supporting and raising a family, with little left over to support the marriage.

How can a couple avoid having to start all over again? The cornerstone only supports the house you’ve built if you continue to revisit it, touch it, and remember what it means. For us we declared that our courtship had never ended and so we never stopped dating.

Those dates were comical in the earliest days of our lives as parents. In those days of no time and less than no money a date might mean playing board games, holding hands while we watched “Hill Street Blues” or laughing together at silly stuff like “Alf”. We declared that Wednesdays would be “date night”. Out together as boyfriend and girlfriend, perhaps with another couple of two, never with a child in tow. Our first dates were pretty spartan affairs. With enough money for either a babysitter or an activity we opted to spring for the sitter and get out of the house. I remember holding hands at Burger King while we shared a cup of coffee. A “fancy” date might be sharing a cappuccino and reading magazines at Barnes and Noble.

Date night took wing when we moved into our first real house in Ohio and a neighbor gave us the phone number for the sisters who would be our babysitters for more than 10 years. Kerry and Chrissy became big sisters to our kids and little sisters to us, so much a part of the family that our kids were invited to both of their weddings. Beth and I signed up for ballroom dancing lessons. The perfect date night activity: hug your soulmate for 90 minutes every Wednesday so that you can practice dancing in your furniture-free living room every night after the kids go to bed!

And we still go out on dates every single week.

Was it easy getting here to year 40? Meh, nothing in life is easy, right? It never felt hard, though, and looking back it sure seemed like almost all of it was fun. I mean, every week I went out on a date with my girlfriend! No matter what was going on at home or at work we went left Mom and Dad at home and went out as Mr. and Mrs. And now here we are, married for 40 years, 43 years together. Put marriage first, 100% commitment, and never stop dating. As I drink my morning coffees and I turn down the corner of my newspapers I look at the woman who gave me the first happiest day of my life on Saturday, September 7, 1985.

And every day since.

Happy Anniversary, Dollie. I love you to the moon and back.

I’ll see you, 7 more happiest days of my life later, next week…

My darling wife Beth spent many of her formative years living in what was once a one-room schoolhouse and went on the be the family home to 4 generations of the Hurst Family. It’s been 8 or 9 years since we lost both of her parents, and with them many of the memories they carried from their younger lives. Beth visited some of those memories as she cleared out all of the closets of one family’s history. Here, then, is “The Curator”.

An attic is in many ways similar to the vast storage facilities that lie hidden beneath and above every museum you’ve ever visited. The exhibits you walk through are like the life you see being lived right in front of you. If you are an experienced museum goer the existence of that treasure trove of unseen artwork is something you know is there somewhere. For the archivist, all of that art is there for the asking.

A life remembered lives in the attic or the basement or the back of a closet in the remotest room in the house. Beth spent 3 long days and nights pulling together the totems of her parents lives from the nooks, crannies and crevasses of what is literally the Hurst family ancestral home. No fewer than 4 generations lived significant parts of their lives in what was once a tiny one-room schoolhouse surrounded by Amish and Mennonite farms. What an incredibly daunting task, that.

Hearing her tell of her task (we were “together” on speakerphone) was what it must have been like if you could have been an open ear at the excavation of St. Paul’s Cathedral in Rome. The attic had an attic; each closet had a closet. Every step further into each space unearthed another layer of the family’s history. Here a deed to the original schoolhouse, there the wedding certificate for her great great grandparents. Was her Dad a good student? Well, he had a pretty solid 3rd grade judging by his report card.

And the pictures! Oh my, yes, there were pictures. Beth and her sisters Lisa and Amy fell straight down the Schaeffer family tree. Who knew how much they looked like their Mom when they were all younger women? I got to see pictures of the stunning beauty I fell in love with some 35 years ago, a literal restoration of the portrait in my mind’s eye of our days of courtship. Treasures unearthed in the attic.

Stories, journals, histories, legends…they all came out of the attic’s attic and emerged from the closet’s closets. Beth’s “legs” fairly buckled under the responsibility of curation. What to keep? What should go? They are the last of their line, these Hurst sisters. Whatever was consigned to go would be forever gone. There are no more attics; there will be nothing to curate. She felt the presence of not only her parents but of their parents, and theirs, and theirs as well.

Is this nothing more than a melancholy musing on memory and loss? Maybe. There was a lesson in there, though, one that Mrs. bingo and I stumbled upon as we “walked” through those archives together. It didn’t have to happen like that. As it turns out each attic corner, each tiny closet contained notes and stories that lead, like so many tiny treasure maps, to the next discovery. Why had my in-laws not taken us all in hand and walked us together along those pathways? For sure there were stories that should have been buried elsewhere, art not meant to be seen by generations hence (note to self: remember this lesson when it is time), but still, we thought of the joy we could have shared had we just known these treasures were there to share. That’s the lesson my friends, one that Beth would agree afterward was worth the lonely emotional lifting she did as she curated a life remembered, archived like so many art treasures in the attics and closets filled over generations and hidden from view.

Someone may be alive today who’s been filling those attics. Find them. There is joy in the attic. Like so much that is joyful, to share your discoveries with those who created them is just too wonderful to let it pass now that you know that you don’t have to.

1) New love. “My parents have been married for 40 years, and they don’t really talk to each other like newly in love people do.” Meaghan Brown in Outside Magazine, Spring 2025.

Beth and I will celebrate our 40th wedding anniversary next weekend. I typically wake up first (still working, and all), and I honestly can’t wait for her to get up so that I can tell her how much I love her.

2) Audience. “Know your audience but don’t underestimate them.” Sydney Sweeney, actress/producer. WSJ Magazine Fall 2025.

I like this. The better I know my audience the better I tend to connect with them. The better I tend to provide some sort of value to those listening to me. What I think I will take from Ms. Sweeney’s quote is a little strategic tweak: Having done my homework studying my audience I will assume that they are up to the task of keeping up with whatever I am transmitting. If it becomes clear that I have overestimated them, either through faulty research or some other miscalculation, I will pivot in a way that better aligns my transmission to their reception “bandwidth”.

One thing worse than underestimating your audience is to speak “over” them, especially if you’ve recognized that you are flying at a different altitude. Demonstrating your respect for the audience is as important as any other part of the transmission.

3) Odds. “Don’t look at the odds. If you look at the odds, you won’t try anything.” Hoda Kotb in the WSJ Magazine Fall 2025.

This is good. Kinda lines up well with another quote I like: “If you’re not living on the edge you’re taking up too much space.” The new stuff, the true change-agent stuff isn’t typically found in the middle where you and your ideas are odds-on favorites to be right. Just like everyone else. Sometimes you just have to have faith that what you know about yourself and your footing out there on the edge is all you need to know. Look within for the courage to not just buck the odds, but ignore that there are odds there in the first place. Winston Churchill’s classic quote clinches this: “Success is never final. Failure is seldom fatal. It’s courage that counts.”

It takes courage to ignore the very existence of the odds.

4) Value. Friendship has a cost. There’s a price for each friendship, a certain trading level if you will. Think about your friendships, where you are financially with regard to your friends, how you talk about money together, deal with money when you are together.

People are weird about money. I was reminded about a couple of stories from my younger years that illustrate this. I grew up with two small groups of friends, one older and one my age. We were all sorta middle of middle-class economically, and our folks made all of us work for our spending money. I don’t ever remember “owing” any of these guys any money, and I don’t ever remember any of them owing me. We kinda fell into this “it’ll all work out” kinda thing; whoever had money bought the beer and/or the pizza. Our young family once dropped in on one of these guys en masse a few years ago and nothing had changed. We stayed for a week. Our wives had never met one another. I don’t remember, but I’m sure we bought some food or some wine or something; I’m equally sure that Tom doesn’t remember, either. Tom and I just knew it was gonna work out.

All of the “investments” we made all of those years ago paid out in spades.

When I was a young physician in training, missing both nickels to rub, Beth and I chose to live near some college mates, all of whom were doing very well, thank you. We received many very nice invitations to spend time with them at some very lovely places in and around NYC, Dutch treat, all of which would have required both nickels and then some. We couldn’t go, of course, and our invitations for them to join us in our very modest apartment for burgers and dogs always found them busy.

Only one friend understood, the one who had less when I had more when we were youngsters. In New York his family accepted all of our invitations, and his invitations were either to his home or on his dime, making it clear that it was HE who was getting the better of the deal because we were together. He remains my closest friend on earth.

I’ve been fortunate as an adult in that I’m relatively free of needs, and there have been times when I could cover the wants of my friends, or cover my wanting to cover them even if my friends were able. What’s interesting is how difficult it can be to have it be comfortable when someone is “treating”, especially with friendships that were formed after your trajectory has sent you well beyond school and first jobs, etc. It can be a little trickier to pull off the same “it’ll all work out and be even” thing, even with your closest friends. Think about it a minute: do you feel owed when you treat or that you owe when you are treated? To be fair this is almost universally the default mode, at least the “owing” someone for a generosity extended to you.

Beth and I are best friends with a couple we met in grad school in the ’80’s. It took 10 years AT LEAST for my buddy to stop keeping score when I was the one more able, to understand that I was actually the one getting more out of the deal because he and I were doing stuff together. Over our 40+ years of friendship we have moved in and out of periods where one or the other of us has been at least one nickel short. And yet, once we managed to stop looking at the tab, we have been free to do whatever it has taken for the two couples to be together. Bill and Nancy did all of the legwork on our recent early anniversary trip to Italy.

I never gave the nickels a single thought.

Last weekend I enjoyed a wonderful example of friends doing whatever it takes to be with each other. There are 8 of us who were originally brought together by our wives and the local pre-school PTA back when our kids were too young for even kindergarten. It’s been 30 years since we met for couples nights out as our wives’ plus-ones. Interestingly, the girls don’t really hang out very much any more. We’ve been playing golf and going out to breakfast together for decades, most recently for five days of golf in central Ohio. Everyone did whatever it is that they do best in this group. For some that meant choosing a menu, shopping, and making a meal for 8, remembering that two of the guys have a special dietary thing to consider. Others, like yours truly, simply show up with wine.

What we didn’t do is keep score on the tab. With the exception of the one big ticket item, lodging, we honestly all pretty much assumed that the numbers were going to work out.

There’s a cost to every friendship, a trading range if you will, and the greater the range between those involved the more difficult it can be if you look at it this way. For me, with those friendships like my close friends from high school, college, and my life as a young father that have passed the test of time, the money involved is nothing more than a measure of how much that friendship is worth.

The more we ignore the cost, the more valuable we find the friendship.

I’ll see you next week…

How much information is too much? Is there an element of timing in that question? For instance, is the amount of information that is ultimately enough (and not too much) subject to a schedule? I’m prompted to think about this by a couple of very current events, or types of events: two instances of death resulting from police/citizen interactions and more than several instances of government officials enmeshed in scandal, or the appearance of scandal. You’ll not find commentary here about the particulars of any of these current events; I have no standing. My thesis, though, is that the twin virtues of transparency and disclosure have been tarnished by the evil twins impatience and entitlement.

Think about it for a moment. Events that are large and important fairly cry out for patience and a deeper, more thoughtful discussion. One that begins after facts have been extricated from the web of innuendo born in the bosom of opinion. The stampede of analysis now comes even as a story unfolds, before it even ends. It matters not whether we are observers of an event that touches on a certifiable “big theme” (e.g. racism), or one that is tiny, local, or personal (e.g. infidelity). The commonality rests not with the protagonists but rather within the observers, especially those who comment: it’s all about them.

Are you old enough to remember when it was considered unseemly to be a self-promoter? Even if you are, it’s tough to recall those days before the ever-connected world when blatant “look at me” or “listen to me” behavior was met with the collective cluck of a society bred for humility. This “cult of self-promotion” not only imposes itself on big events and grand issues (comments that begin with “I think…”), it also means that no one is to be allowed a privacy if the entitled self-promoters decide that they simply must know, well, whatever. “A universal, wrathful demand of the public for complete disclosure” about everything and anything. (Gideon Lewis-Kraus)

The need to know trumps all; one who asks the question in some way is granted all manner of primacy over one who might have the answer. It’s uncomfortable to watch at times.

The phenomena is not without irony. Witness articles critical of self-promotion that tell the story of someone who is almost famous for talking about not promoting him/herself. Nice, huh? It’s like a hall of mirrors, a kind of “Inception”. Trust that it doesn’t escape my attention that there are more than several folks out there who consider my “musings” a form of self-promotion. An irony within a discussion of irony.

There’s a certain power in thoughtfulness, a seriousness that induces thoughtfulness, in turn, in the listener. If we always know what you think or what you did precisely when you thought or acted, how are we to ascertain what, if anything, is important? If one demands full and immediate disclosure of any and all information, regardless of how significant or trivial it might be, or how public or private the consequences, how are we to order anything at all along the great/small continuum? At some point the primacy of the inquisitor must find its limit, if only for a moment.

A moment of peace for the rest of us, should we care to think about something deeper than the event in question. A moment of peace for an individual who might harken back to an earlier day, one when it was possible to graciously decline to offer anything at all, lest it encourage someone to be interested.

The White Family is moving. Beth has declared that the “Netty Empsters” shall live in a one-level abode. Furthermore, she has decreed that said abode shall occupy ~50% of the land and air now taken up by the dwelling “Casa Blanco” in which I’ve lived for 21 years. Let the purge begin!

The challenge is in part rather prosaic: what do I/we/you need? There’s really no doubt that there is plenty of extra around here. Plenty of stuff and clutter. Where, though, does one draw the line between necessary, desirable, and…I dunno…neither? Once the line is drawn where does one dispose of “neither”?

I’ve got two very real problems with this process, one understandable and one irrational and silly. The silly one: what if I pitch something, only to discover later that I wanted it? Or worse, NEEDED it? That really is just silly; anything I truly need will be obtainable in a pinch, and anything I think I want will likely be forgotten by my next meal. Yet however silly and however irrational, I still worry over that as I sift through stuff.

The understandable one is a little more poetic and has to do with the totems of my past, those little knickknacks that tease out an equally little smile each time I stumble across them. Even if “stumbling across them” only occurs during a purge. Pictures, yearbooks, trivial little souvenirs of trips and places mostly forgotten.

Only, not really.

It’s that tiny connection to an event or a place or a person, or all three, that I most fear losing. Is this irrational, too? Or worse, is this also silly? I don’t dwell in the past, mine or anyone’s really. I don’t really spend very much time there at all. Yet each of us has a little collection of memories–some real and some (like last week’s musings) just little lies that we choose to believe–that are bathed in a soft sunlight of something that could be called “happy”.

Perhaps it’s generational. Will my kids (and both of you other kids out there their age reading this) ever experience what my darling Beth and I did in our garage yesterday as time stood still, frozen again and again by a picture, a seashell, some trinket? I sure don’t know, but that doesn’t really help me as I sift through the delights and the detritus of a house filled with 21 years of our family and the stored 32 years of memories that came before. The memories and their “triggers” rest in my hands at this moment, not among the electrons dancing across the internet to someday rest in a place that may never need purging.

The rational, actionable answer probably lies there: utilize the tech of the present to preserve the memories of the past. It’s different, though. It really is. Much like the difference between turning the pages of a real newspaper, one made of real paper, and swiping through the same sentences on the device of the moment. The words are the same and the information is transferred equally effectively, only not.

Physically clipping an article or a picture and then carefully husbanding that memory over time, physically, is both qualitatively and quantitatively different from clicking “save” to either Instapaper or Evernote. It takes so little effort to do that latter that there’s no commitment to the memory! I look at a photo on FB, often one of 100+ in an album, and it’s…different.

I think that’s it, really. Commitment. Each time I sift through “stuff”, be it photos or books or trinkets, I make a tiny little on-going commitment to a particular memory when that little trigger goes back in the box, and the box goes back in my house. I make a tiny little commitment to the people who were a part of that memory (usually without ever telling them), a commitment that I will continue to remember them, to remember when being with them made me happy.

Will it be the same for our SM-centric, cloud-connected younger generations? Will it be the same for me and for Mrs. bingo as we go forward, hopefully not done creating tiny memories that will one day elicit those same tiny smiles? Will something be there to prompt them or us to open those virtual boxes that store the trinkets, that store the memories?

I only know that today I am visited by memories, by the people who populate my past, as they compete for a place in my present, the survivors of this latest purge. The ones that still make me smile.

8/11/2013

“In talking about the past we lie with every breath we draw.” William Maxwell.

If I know who William Maxwell is I can’t remember at the moment. That’s kinda the point anyway, isn’t it? There’s a certain amount of self-delusion in any historical account, whether it be small and personal or global, encompassing all of humanity. You know, history belongs to the victor and all. It’s possible to uncover the unvarnished truth; inexorable technological advancement makes even the best of lies fall open eventually. Tabitha King says that when you lie “all you do is postpone the day at which you’re revealed to be a liar.”

Memory is a funny thing; that’s kinda what Maxwell is saying. How we remember things oft times involves more than a little lying, to ourselves and others. Each of us remembers the part that was good for us, then or now. There might not have been any part that was good and in those cases we remember the part that hurt the least. We can bury the pain if we fail or refuse to remember it.

The inability to truly remember challenges our very sense of self, a challenge that is unacceptable to the subconscious. We seek to defeat that challenge to our essence through confabulation, the wholesale creation of memories from the scrap yard of our mind. One who cannot remember lies out loud in the hope that he, and we, will believe what we hear. Being unable to remember is kinda like having a damaged hard drive. We might be able to muster the technology to repair the hard drive, exhume the memory, expose the lie.

But must we?

The truth is powerful. Like a powerful storm it washes away the veneer that the victor places on history. Like the sun that never sets the truth eventually bakes through the permafrost of the lies we tell ourselves. The truth, like the storm and the sun, is the proverbial double-edged sword that both cleaves the fat and cuts the flesh. One man’s truth unhinges another man’s lies. The sun shower might pre-sage a tsunami, as it were.

Where’s this all going? Talk of lies and history? I’ve been on a little quest, a walkabout of the mind if you will, examining the little lies of omission and commission that sit at the foundation of the house of cards that is my own little self. Seeking a more accurate truth by trying to wash away some of the veneer that covers my history so that I might own up to whatever part I might have played in creating hard stuff in my life, or the lives of those who travel alongside me. I find myself saying stuff like “boy, I really coulda done a better job of that”, usually followed by some version of “I’m sorry.” Find myself saying that quite a bit, actually.

At a certain point I will have to stop doing this, at least out loud, for at some point the exposure of my own little lies will produce a kind of destruction elsewhere. If you think about it, what appears to you as a little drizzle might be a raging downpour to someone else. All of those trite little sayings like “the truth will set you free” are balanced by “the truth hurts.” My poor Dad has no memory whatsoever of the horrific pain he suffered 6 months ago, and yet by now he has no memory of today’s breakfast. He’ll have no memory of the lies he will tell to manufacture a memory.

For the rest of us, memory intact, the lesson is probably as simple as “tell the truth” starting now. At least “tell the truth” with kindness and compassion extended both to others and yourself. Some lies, some memories should remain right where they are, in the past. For some, maybe most, we might be able to invoke the great philosopher Rafiki: “it doesn’t matter, it’s in the past.” Every little truth told now, though, is a lie that need not be given breath, past or present.

Every little truth told now is the cornerstone for a house to provide shelter from storms yet to come.

In an airport, once again, traveling between friends and family, family and friends. Sadly, I’m on my own for these couple of legs. This “sandwich generation” stuff is getting harder by the day. MCO to BOS this morning as I travel from the funeral of my best friend’s Dad to what looks like an abridged version of the annual White Family Cape Cod adventure. We are down one parent, too, and the next generation is in the early stages of careers and families of their own which makes it difficult to get away for a week on the beach. My journey is solo as Mrs. bingo awaits the arrival of the Man Cub’s little sister who begins her own journey any day now.

In the middle of the sandwich, where we welcome babies into the family as we say goodbye to parents who leave, we hopefully share this stage with at least one good friend, and hopefully for our longevity three or more (turns out that’s a magic number). In addition to a brother with whom I cannot be closer and my darling bride with whom I could not be more in love, my journey has been blessed with a best friend who has ridden shotgun or been my driver for 40 years now. We have taken turns carrying each other whenever one of us needed the lift. Mostly we’ve just walked side by side, as friends do..

Friendship is on my mind quite often. I ponder it as I think about friends old and new. My 35th college reunion was a month or so ago, and I am pleasantly surprised at the number of old friends and friendly acquaintances who are emerging from the mists of my past. Misplaced, lost, or cast aside, the skeletons of friendships past walk with me, still.

We are blessed, fortunate beyond measure, if we can count among the masses a single friend. One to whom we can always turn, from whom we withhold nothing, who will give to us everything. To have more than one friend such as this is to have a kind of wealth that beggars description. My parents gave one in 1961; Rob, the friend who just lost his Dad, showed up in 1978, and Bill came along in 1982.

If we are lucky enough to have such friends they are joined in the garden of our lives by that next best thing, friendly acquaintances, and these in turn are surrounded by acquaintances. The entire garden is encircled by farmland that lies, for the moment at least, unexplored. The enterprising gardener is always on alert for new seedlings out there to plant in that garden of friendship.

The garden analogy is an apt one for friendship. A garden requires tending and so, too, does a friendship. Left untended, left to chance, it is certainly possible for a garden to flourish. All too often both gardens and friendships ignored too long have a beauty that is but a cherished memory, seen only with the mind’s eye.

Friendship, like a garden, grows best when exposed to both sun AND rain, albeit for different reasons. A friendship that has known only sunny days may weather that first storm; a friendship that has known both sun and rain is steeled against any and all weather, especially if we gardeners were active in the tending despite the elements. So it has been for my friends and me.

Who is your friend? Who is there for you in both sunshine and rain? From whom do you wish only friendship, and who asks only the same from you? Have you done your part? Have you tended your garden in both sunshine AND rain?

I am in an airport, leaving my friend and headed toward my brother. It’s raining; we are all missing our Dad. But we have tended these gardens for decades. The sun will come out soon enough.

A couple of weeks ago Beth and I were invited to spend a little time with the VP of Development for the health sciences departments at the university where Beth got a BsRN and I got my MD. “Development” is a coy term that non-profits of all types use to describe asking people to donate money to whatever the cause may be. Mark, the VP who invited us out, is a delightful guy only slightly younger than we are. We danced around his core purpose for “discovering” that the unofficial class agent for the Class of ’86 lived 40 minutes from where he and his partner were visiting friends, and enjoyed a very nice couple of hours sitting at the bar of one of our favorite restaurants.

After a short time exchanging standard issue “elevator” origin stories Mark asked if I’d been the student speaker at my graduation ceremony. Mind you, my graduation from med school was 40 years ago, but I’m pretty sure that no one from my class spoke, and that we weren’t addressed by anyone other than a dean or two at graduation. No invited speaker, no University or department luminary, and certainly neither I nor any of my classmates were handed a microphone and a spot on stage. At some time over the years graduation has come to include not only speakers at the university-wide ceremony, but also at the smaller ceremonies for specialty programs such as medicine. Those invited typically have a connection to the school, and are often alums.

I am in love with the sound of my own voice, and so I immediately told Mark that I would jump at the chance to give the graduation speech at the University of Vermont Lerner College of Medicine.

To be sure, this is an entirely fanciful proposition. Not that I don’t have anything worth saying, or worth hearing by any college or grad school graduating class, it’s just that in the big old world in which we all live I am honestly and truly exactly who and how I have long described myself, a C-list celebrity with B-list aspirations. There are literally thousands of “known” entities higher on every university’s list of potential speakers, hundreds and hundreds on whatever list UVM might have, of folks with even the most tenuous thread of a connection than yours truly. I’m kinda like the guy in “Spill the Wine” by War singing about his unlikely casting in a movie, overfed long-haired leaping gnome, now skinny-fat and earthbound. Calling this a long-shot is exaggerating the possibility.

And yet, I really have something to say to a class of graduating doctors, or for that matter a class of graduating college seniors. I am, after all, a doctor; we are in many ways little more than paid observers (HT: WJP). I have willed myself to be a writer, an interpreter of what it is that I have observed. Now and again it all spontaneously distills itself into a package that occupies a little corner of the “restless mind” and like the rest of my random thoughts, seeks a way out into the world.

Herewith, then, is my graduation speech, this version tailored to my med school alma mater, that I will likely never give there, or anywhere else:

Dean Page, esteemed faculty, friends and family members, and my newest colleagues and fellow alums of the Lerner College of Medicine, thank you for this wonderful invitation. It’s been 40 years since I last graced this stage. A short walk that begin a long and wonderful journey. You know, I honestly don’t remember any speakers at our graduation ceremony in 1986. Certainly none from our class. What a cool thing, to be elected to speak to your classmates, the 140 or so folks who’ve walked the same walk and talked the same talk as you have. Maybe Dean Luginbuhl spoke. Honestly, I can’t really remember. The highlight was seeing my classmate Mike Philips receive his diploma from his Mom, the chairperson of pediatrics, while his Dad sat on stage with the rest of the faculty.

That was cool.

So what have I done to merit this invitation? What’s so interesting, unique, or special about my career or my life that makes me someone who would show up on a list of characters who get invited to address a graduating class of doctors? Honestly? Nothing, really. I grew up, went to school and made my childhood dream of becoming a doctor a reality. Like the majority of my classmates I have been a clinician in the community, in my case as an ophthalmologist in private practice just outside a mid-sized city in middle America. Back in the day UVM was known as a school that created the doctors who left school and training and headed off to a lifetime of taking care of patients. Again, nothing unique or special.

If anything has brought me here today it’s probably the stuff that doesn’t necessarily have anything to do with medicine, but rather what I’ve learned from the other thing that I’ve become over my lifetime, a writer. I have willed myself to become a writer, albeit one with only the tiniest of followings, none of which are likely represented here today. My classmate and close friend Bill Petraiuolo describes doctors as paid observers. Writers take this one step further and seek to find the larger themes that tie together those things we have observed. Sometimes, if we’re lucky, those observations and the interpretations we make crystalize into little nuggets of useful, actionable advice. One could think of them as wisdom I suppose.

Could be that I’m just getting old though!

Ah well; old or wise, in the end I’ve come up with three nuggets. The first: Talk to strangers. I know, your Mom always told you never to talk to strangers, and that’s really good advice when you’re a kid and just starting out. But as you grow up, go to school and start a career in pretty much anything, NOT talking to strangers handicaps in ways you might not realize. I mean, unless you’re a pathologist or radiologist, every day at work means talking to strangers, right? Patients and their families mostly. You can’t escape them. With all that practice at the office or in the hospital, why not take advantage of this necessary skill and bring it out into the “civilian” world?

Contrary to what your Mom was trying to protect you from, the overwhelming majority of our fellow travelers are really quite friendly and nice. Most are interesting, and many have stories they are happy to share. If I never talked to strangers I never would have met that really smart business consultant who designed partnerships for small, boutique service companies like specialty law and accounting firms. There was the marketing consultant I stood in line with at a Chipotle who described how the culture behind the counter was what really set the brand apart. Or the genius engineer I sat next to on a flight who described micro-marketing targeted to an individual identified by armchair-mounted screens with iris scanning to ID a patient so that you could show them educational information about the very reason they had come to the office.

All of those chats occurred in the early 2000’s; parts of all three became part of the DNA of my practice, SkyVision. I would have missed all of it if I didn’t go out of my way to talk to strangers.

Always ask for the job. Wayne Gretzky once said something to the effect that you never score on the shots you didn’t take. One of my sons, all full of himself after making Dean’s list first semester in law school, marched into the business school’s office at the university where he was studying law and declared something to the effect that they should accept him into their next class. Tickled and intrigued that he simply asked for the gig the dean told him to take the GMATs, that she would see if he was serious when she saw his results. The kid’s a pretty good test taker; she gave him the job. My other son traveled the world after asking for an internship in what was then known as CrossFit Kids. At age 18 he was teaching full-grown adults how to safely and effectively teach fitness to kids. My daughter, a behavioral therapist, built and ran two ABA clinics from scratch. When she learned that her company needed someone to do it, she asked for the jog.

Last, but definitely not least, don’t forget to sing when you win. Friendly strangers and the perfect next job both out there for the asking notwithstanding, this can be a hard world. Victories are there to be had but they don’t come easily. You can go a very long time between even the tiniest wins, so you need to rejoice each time you get one. You are all doctors, and I’m sorry to say that the hardest days of your medical career lie in front of you, not behind in the classroom or the lab or the clinics through which you rotated.

And so I ask you to be sure to celebrate every win. This might be the most important of my three little nuggets. Big or small, sing your victory song. You get that kid off the ward in time to graduate from kindergarten? Don’t forget to sing. That guy who showed up asystolic in the ER who you stayed with all night in the CICU? Yah, he just walked his daughter down the aisle. Don’t forget to sing. You went into psych and a desperate and depressed high school student came to your clinic, battered and beaten by what our modern world can do to us. Ready to be done with all of it, forever, but you saw them every day for a month. Gave them your phone number. A last desperate call before giving up and you took them to the ER. Now married, almost finished their Ph.D. You won! Don’t forget to sing.

Me? Well, talking to strangers helped me to create a culture-driven practice that rests upon a foundation that places caring for each other in the office and the OR first. We give better care for those who come to us because we care about each other. I am here today mostly because I asked Mark for the job! The last thing he heard from me as my wife Beth and I were turning to leave was to remember me for the gig. What a win! I’ll be singing as soon as I step off the stage.

And you? You’re about to be handed a fancy bit of paper that says you are officially a doctor!

Don’t forget to sing!

I’m back from the graduation I will never attend and the speech I will never give, and I’ll see the rest of you next week…