I thought I would write a third act, maybe a year or so later, to show how the surgery experience changed me.  To explore what remained as real changes in my character, what passed into nostalgic memory, how my body and mind was changed by the experience. There were a number of false starts because each time it seemed that everything was different.  The world has rapidly overrun my bourgeois self-centered musing. Shortly after I felt basically well, one of my college roommates who had been sick for a long time, started a steep decline. I spoke to him weekly and then his passing and funeral loomed much larger than my own intellectual fascinations. 

Ok, maybe I could write about that. Maybe I could write about the experience of trying to be there for him, on the phone, occasionally in person. Maybe I could write about his funeral and seeing his kids, his ex-wife — I officiated at their wedding! — maybe I could write something about that.  I started to think about writing a eulogy, something that respected who he was but was also true and about him as a real person. And then the pandemic swept over us with a sudden change in everything about day-to-day life; most negative, but some suspiciously positive.  What is the death of my one friend in the face of the millions of COVID dead?

Maybe I could write about that too, but only maybe, because everybody is writing about it.  But I have some thoughts, some feelings, some experiences and maybe I could write about it, and then, boom. Racism, Black Lives Matter, suddenly my discussion of diversity in the previous essays seems so small in light of the wave passing over the country.

And in my own family: My mother was diagnosed with Alzheimer’s and we needed to prepare for a harder future. My daughter in California evacuated during the pandemic because of smoke from wildfires and the risk of them coming closer.

And throughout, the drum beat of Trump destroying the country.

The small, the introspective, the detailed view is overrun with exaggerated, garish, over loud events. We are living in a time where the news of the day is bigger than our personal thoughts. Seemingly this whole structure of essays I started is worthless in light of current events. What needs writing are revolutionary manifestos, bold policy proposals, political diatribes. The tenor of the times is screaming. Should I scream this third act? Is there any worth in writing about thoughts? Or is the only writing worth reading the kind of writing that will cause the reader to do something: To get off their couch and take action.

Fucking vote. The very existence of a world suitable for human life depends on it. Vote out Trump and all the weak, hypocritical, corrupt assholes that have enabled him.  You can see I have made many attempts at writing this introduction and happily Trump is out, but now we have a war in Ukraine and it looks like a fascist is coming to power in Italy.

Instead of waiting for the world to pause while I finish and distribute these words, I’ve decided to wrap them up and maybe reading them will be a welcome change of pace and focus.

The End of Surgery

It is more than three years after my surgery and I’m happy to say I don’t think about it anymore; almost never.  I don’t feel the dent in my skull behind my ear.  I don’t focus on the tinnitus. If I have trouble swallowing something, I just drink some water and swallow harder and don’t give it a second thought.  I’ve already had three MRIs confirming the surgery’s success and the absences of any tumor regrowth.

Is my balance worse? Perhaps a little, but I’m 62 now and it might not be worse than it would’ve been. That is the same comment I can make about any symptom I can name. With swallowing, maybe I have a weaker swallow reflex? Or maybe I’m just used to being a slower eater. Perhaps I’m more forgetful? Or maybe I’m more aware and that awareness allows me to notice when I’ve forgotten something.

Sometimes I wonder if having had brain surgery raises my chances for other problems in the future, but even if it does, I’m sure the preventative advice would be the same as it is for staying healthy in general.

I hardly ever think of the surgery in my daily life, and I don’t talk about it either. It’s just something dramatic in my past.  Something big I went through which is surprising both to me and to whoever I mention it to if the subject comes up.

For anybody reading these essays with a medical motivation, the message is clear.  It’s not pleasant, but the surgical miracle can be real. I’m fine, you or your loved one can be too.

Has the experience changed me?

Two Definite Changes

I am more relaxed when facing unpleasant medical procedures.  Getting an IV, a tooth drilled, a vaccine shot, donating blood and even getting my ear trimmed a little as an anti-cancer preventative measure are procedures I’ve had post-surgery.  It’s not that I like them and not like I’m immune to pain, but I have a certain detachment before and during which makes it easier. I feel certain I won’t like it, but also that it won’t last long and that I will survive and be fine afterwards.  They are just unpleasantness to be endured.

It's an unexpected example of “what doesn’t kill you makes you stronger” because in this case, being stronger is all about learning to relax, submit and endure. I am sure this is a product of living through the surgery experience.

The second change is my increased patience with people has remained. The understanding that sometimes, eventually really, the physical body fails, and people cannot be who they once were or who they want to be. It’s not necessarily their fault and regardless, it would be presumptuous to assume their behavior had anything to do with me directly.  Sometimes people need to be slow. This increased empathy was unfortunately put to the test.

Death of a Friend

I met Cary my freshman year of college.  We were friendly, but not quite friends.  We grew into real friends by sophomore year and junior year decided to room together. We had a lot of fun that year. I didn’t see as much of him senior year, but the summer after graduation we went on a bike trip together in Europe.

Cary was an unusual person; brilliant, creative and sometimes painfully frustrating. We had a lot of fun together and seemed to understand each other effortlessly.  There were a group of friends in college, some of us closer than others, certainly all of us with other friends outside of that group, but finally, in our senior year, we realized all of us had at least one parent in the business of psychotherapy. We are a strange tribe and subconsciously (of course) had managed to find each other. Once I realized that, I noted that my best friend from high school had the same pedigree.

Cary, like myself, was a full-fledged member of this group with both parents in the business.

When talking about Cary, it is hard not to focus on his unusual exploits – like filling his dorm room with six inches of water and stocking it with fish for his roommate’s birthday. Thankfully, I was not that roommate (the room truly stank after that prank – he hadn’t planned how to get the water out). People that knew him in college might also comment on his unbelievably bad diet.  Donuts, pasta from a can, pizza, some chocolate when needed – though as I was his roommate, I can attest that he did eat real food on occasion; Chinese food or out for pancakes and eggs at 4am. In college, he slept in a sleeping bag on top of a mattress with no sheets.  I don’t know if he ever cleaned that sleeping bag.

But he did shower, and he was funny and personable.

Cary was my roommate during junior year of college when I had to choose a major. He suggested computer science. He argued it would be easy to find a job and it wasn’t necessary to go to lectures.  Given my state of mind at the time, the lack of classes might have been the stronger argument. I could debate whether this was or wasn’t a good decision, but I can’t deny it paved the path I have followed.

We moved to different cities after college. Then he moved to California and stayed there.  When he married Nadine, they asked if I would officiate at their wedding. How could I say no?  I signed up as a minster of the Universal Life Church – “We believe what we believe, and we believe what we believe is right.” – and performed the ceremony at a private wildlife preserve for endangered animals. It was a memorable experience; me realizing that I had to respond seriously to the question “so, do you have a church back in Boston?” and Larisa playing the role of the minister’s wife after two years in the USA.

We moved to California for a couple of years, but our lives were too different to be close in a practical way.  I still felt very much that he was my friend, but we both had small children and were raising them differently.  We kept our kids on a strict sleep schedule; their kids slept when they dropped and woke when they felt like it. He had his own business and never traveled for work.  I worked at a big company and often found myself traveling to the east coast or Japan.  They lived in San Francisco: We lived in Palo Alto; not that far apart but in two years we only got together four or five times.

I saw him more after we moved back east.  Whenever I traveled to the Bay area I would try and stop by for dinner.  We would chat for a bit and then I would head home.  He was having a progressively harder time.  He was sickly. His marriage broke up, and he shut down his business.  As you might imagine, both were hard. The end of his business was hard in a way that might not be apparent.  His dream had always been to have a video game company – and he did – and discovered he didn’t like it.  He was lost after that.

And then I stopped traveling for work and stopped seeing him. Time passed. He got sicker.

Cary died after a a long and protracted decline.  He didn’t have ALS, but something similar where gradually his nerves stopped working.  Bit by bit he became paralyzed and then over the space of a year he found it harder and harder to eat and talk. A year and a half before he died, he got in touch with me and asked if I would visit because he thought he was losing the ability to talk.  I found a way to visit him in San Francisco and was shocked by what I saw.  He was bedridden and paralyzed. He was hard to understand, and he was worried about declining further and how fast that might happen.

His mind was focused and sharp and he was able to describe memories of things we had done together which had been buried deep in my mind.  Those recollections brought forward feelings of friendship and closeness from our shared past and amplified the sadness and desperation of his situation.  When I left his house and was walking to my car, a loud “FUCK” came out of my mouth.

When I got home, I decided I needed to find a way to stay in touch with him and so we set up a weekly call.  Every Wednesday at 5PM Eastern I would call him.  Sometimes I would be late and sometimes we would have to reschedule, but we talked pretty much every week. Because the call was at 5PM, I would take it from my office. I tried once or twice to speak to him from home, but it didn’t work as well. For one thing, the audio at the office was best – high quality call center headphones. But the bigger factor was the lack of visual distraction in my work office.  I would sit at my desk, often staring at a white wall, sometimes looking at the ground with my head in my hands and I would focus solely on the words he was trying to say.  What words might he want to say in that sentence? Could I guess?

I found the mental exercise of imagining myself sitting next to his hospital bed in the middle of his living room made it easier for me to understand him.  Why would that be? Is it establishing a mystical connection? Is it just a way to tune my communications for the person and place I was imagining? How much do we tune ourselves to people? Or did it help to turn on all the Cary related brain cells and quiet the rest?

We talked about the most serious of topics. How he didn’t want to live anymore but couldn’t make the decision to end his own life and how if you take a cheeseburger with ketchup, pickles and bun and blend it into a mush, you can still taste the different ingredients.

We had a conversation where, with few words, we thanked each other for our friendship and being in each other’s lives. In that conversation, I was speaking from my most authentic self in a way that was connected both to the joy of being alive and reality of being mortal. We said goodbye to each other when he was still somewhat intelligible.

As time passed, he continued to lose the ability to speak. Often, I didn’t understand and would ask him to spell the word and sometimes that didn’t work either and I would guess at the first letter, which might be enough for me to guess the words, but sometimes not. During my last conversations with him, I might understand twenty words in the space of an hour. Towards the very end, I would just talk to him and near the very end, I would talk to him, over the phone, and not hear him at all.  I would only hear a person who was with him who said that yes, he was listening and wanted me to continue.

I’d like to believe I would have gone through this experience in just the same way if I hadn’t had brain surgery, but repeatedly I felt myself finding extra levels of empathy.  The fear of what is going to happen.  The loss of control of one’s body. I had briefly been in contact with those feelings. Sometimes we compared experiences, but most of the time, my brain escapade was something underneath providing more patience and understanding. In the scheme of things, my problem had been minor. The doctors knew what needed to be done and did it, successfully.  In Cary’s case, there was no hope.

His ex-wife and two sons were at the funeral. His younger son was the same age as Cary was when we first met and looks a lot like him. There is nothing positive in Cary’s passing, but I’m happy some of his essence remains in the world.

Meaning Part 1

I have read that patients who find meaning in their troubles are more likely to have a better outcome.  This worried me because I couldn’t find any useful meaning to having a tumor that needed to be removed.

Post-surgery, the question was less urgent, but it still gnawed at me.  It was such a big experience, what did it mean? Did it have any significance? What was the lesson and what could I learn from it?

During the pandemic the meaning has become clear to me. The surgery is a signpost, a marker, the point of transition.  There is before the surgery and after. The transition had started earlier, but I wasn’t taking it seriously. There were steps along the way that I could have taken more seriously but didn’t.  I was still sleep walking.

First, we became empty nesters, but unlike my departure to college, thankfully, we retained a strong connection with our children.

Then we moved houses from the town where we raised our kids to a house in the trees with no sounds but nature outside.  It was a big change, but a very comfortable one.

Then I had my left hip replaced. That was big, but wow, it went so smoothly that it didn’t cause much reflection.  I still was not getting the message.

But then, finally perhaps, there was the bright light and big pause of the brain surgery experience. Shortly after we paid the last college tuition bill, my mother was diagnosed with Alzheimer’s and the pandemic started. Then I turned 60.  It was the first birthday that has given me any pause.  The first time that I felt like my life was slipping by and my time was getting limited. 

The meaning or perhaps better, the value of the surgery is as a bright line separating life phases.  Before, I was primarily a father working to support my family and doing my best to be there for my wife and children. I’m still a father and still married, but this is a new phase. The question of how I want to live and what I want to do now has an urgency to it.  I have both less responsibility (more freedom to choose) and less time.

When I think of the surgery now, I think of the last few days of my recovery when I was mostly better, but still had no obligations.  The question of what to do with myself was difficult and would have caused more anxiety, but I knew I would soon be back at work.

I did get back to work and certainly that fills my time, but the question of the meaning of my surgery was percolating and perhaps it has saved me a decade of working blindly, because it has caused me to think hard about this new phase. I could not ignore the experience.  Could not give up on finishing this last set of essays.

Which brings me right back to the eternal, but now more urgent question of how I want to live the rest of my life.

Learning from my former self

Jimmy Kimmel (a late-night TV host) has a segment where they go out on Hollywood boulevard and ask people questions.  The usual humor is the discovery that people are clueless.  I don’t know how much they put their fingers on the scale.  How many people that get everything right in the first guess do they simply not show?  But it doesn’t matter, it is amazing how ignorant some people are – or is that just a way of making us feel better about ourselves?  How much are we being manipulated? But this is not my reason to bring this up. 

One segment had the host on the street questioning a young man / boy.  How old was he?  I’m not sure, he could have been anywhere from 14 to 25, but what was most obvious was that he was stoned, high, baked, wacked, pick your slang. My next thought was wow, he looks like I looked (roughly) when I was 16 and sometimes, I walked around NYC stoned, high, baked, pick your slang. My 60-year-old current-self had a sudden feeling of empathy for that poor lost 16-year-old, stoned, on Jimmy Kimmel displaying excessive ignorance.  Poor kid, doesn’t anybody care about him?  What is he doing out on the street stoned by himself? And by extension, I looked back at myself in 1976, what was I doing?

After a week of mild shock at this revelation of the sad picture of my teenage self, poor stoned lost waif, I started to hear a voice from deep inside. It was my 16-year-old-self answering. He said,

“First of all, no problem answering questions while stoned.  It’s like getting stoned at lunch before chemistry. You remember? In chemistry we would raise our hand to answer one question only to discover the question had changed before being called. “What? What was the question?” And then we’d answer the new question on the spot. It was an extra challenge that spiced up the class. That year, junior year in high school, that was peak coolness. You haven’t beat it yet. Friends, excellent grades, the run of New York, and parents that don’t pay attention to where I am or what I’m doing.

“Poor? Lost? I always seem to have a dollar or two in my pocket.  A slice of pizza is always an option. I have a subway pass that gives me free transportation wherever I want to go. I have a coat that is warm enough for the weather and pockets big enough for whatever I need.”

My sixteen-year-old self says, “What’s wrong with you? Why are you so uptight? Where is your swagger? Why are you working so hard? For what?”

Indeed, my 16-year-old self has a point.

But I respond, “You’re just a kid, you don’t know about responsibility.  In fact, if you would have been just slightly more responsible, we would be in much better shape right now.  Just a little bit more homework completed in college would have set us up – “

He interrupts, “College, I’m 16, that’s on you.  And no, more homework?  Don’t you remember?  Don’t you remember deciding, we thought about it, that it was more important to spend time on the phone with friends building relationships than spending more time on homework?  We thought that through, and I was right. What do you do now? Math? No, you manage people. Don’t you even know yourself?”

I, the 60-year-old, answer “Ok, it’s true, talking to people is my profession, but don’t you think it is a bit sad how we were so lost in high school? No purpose? No direction?”

“Again, wrong. Unbelievable, is that what I’m going to turn into? Purpose? Direction? I know what I want to do every hour of the day and I do as much of it as I can. That’s my purpose. Dig down, remember me, the person you were.  High school is fine.”

My High School Manifesto

My 16-year-old-self is right about that. Not always, but often, I was happy in high school, and I had little doubt or hesitation about what I wanted to do at any particular moment. Here’s an attempt to write the lifestyle manifesto that I should have written then.

A good life is centered around quality experiences that increase your connection to the world around you and which brings personal growth and joy.

An important concern is making sure the world around you is one you want to be connected to. The most important attribute of your world is people – friends and partner-in-love. [I was pretty good with friends in high school, but it took me a long time to figure out how to find and keep lasting love.]

There should be all sorts of arts in your life. I was spoiled in this regard.  I didn’t have to work hard to have exposure to art, it was part of my world, museums, galleries, artist parents of friends and maybe most influential, public art. I was outside a lot. We had a nice neighborhood library and tons of bookstores and people selling books in the street. I took pleasure in reading, and I always had music playing. In those years, in NYC, you didn’t need to be a certain age to get into a place where music was being performed.  I don’t know if that’s because there weren’t rules or because nobody was checking.

Living creatively is important. Inventing ways to have fun. Being artsy without being an artist; I made my own pot pipes and won a Halloween costume contest. Learning was important too.  I liked to learn things, but never had a future goal related to learning. On the street I bought a biology textbook and read it. Similar for physics.  I was curious. They were interesting. I did not follow up either with further reading, I was on to the next thing.  E.g., reading all of Kurt Vonnegut and whatever they suggested at the Science Fiction bookstore – yes, we had a bookstore filled solely with sci-fi.

There were two hidden features of those years which were foundations of my happiness that I sadly didn’t understand. The first is that I didn’t let my obligatory activities (school) take too much of my time. I figured out that if I wanted truly exemplary grades I would have to work hard, but if I wanted just excellent grades, that was easy.  My 60-year-old-self bemoans the fact that I didn’t learn how to work hard towards a goal and how the lack of challenge didn’t force me to figure out what I cared enough about to work hard for. But my 16-year-old-self would surely point out the days exploring New York City, evenings reading, listening to music and talking to friends; that time made me who I am.  At college, I learned the Mark Twain phrase (thanks Mike) ‘Don’t let schooling get in the way of your education.’ In high school, I was living that advice. (Apparently Mark Twain might not have literally said that, but I’m sure if we asked him, he would agree he wished he had.)

Sensuality

Much of this fell apart when I got to college, but some of it continued. While academics were a mess, I continued to live as a sensual person.  Here I mean sensual in the full definition of the word.  A college manifesto, if I had written one, would probably focus on sensuality.  I didn’t go to classes, so I had plenty of time to live at my own pace. Sometimes I lived at night, awake for only an hour or two of daylight, and enjoyed the way the world is when everybody is sleeping. It was a different perspective.

If the weather was nice, I had to be outside and would think carefully about which place was right, just outside on the college green? A city park? A drive to a beach? A picnic on the grounds of the Rhode Island Capital building (at midnight) for fun? The roof of some building on campus? Maybe walk around the east side taking in, appreciating and adjusting to New England architecture?

Extra money was often spent on restaurants, exploring both high and low cuisine. And there was always music, recorded and live. And yes, of course sex was a priority, but I’ll go elsewhere for a description of my sensual college life. It is evening, 1981, Providence, a hot summer night. I drove to a laundromat and did my laundry. That’s the short version of the memory.

The longer version:

It was a warm summer night, not quite hot, humid, just humid enough to be comfortable if you stayed relaxed, but too much if you did any work or exertion.  Humid just enough so that you could feel the air.  Feel yourself moving through it, feel that you were in something, not just standing on the earth, but in the atmosphere.  The warmth meant that moving quickly in the car, with the top down, yes, a convertible, moving in the car quickly was a sensuous passage through the air.

The top down, the exhaust ringing out in a steady burbling rumble, smooth, working fine, and working fine in a car that didn’t always run fine, so when it did, it was special, a comforting noise and the top down and the wooden steering wheel and the snug seats holding me comfortably moving me through the air and feeling the air blow over me, cool when moving, warm at a stop light and some music playing. Not streamed music, not music chosen by an algorithm in a computer in a datacenter a thousand miles away, but music on a cassette which I had recorded after spending time thinking about what songs to have next, which would be best for the car, which songs, in which order and to make the tape I had spent an afternoon playing each song on vinyl, because that’s where they were and pushing the record button on the tape deck for each song, pushing stop at the end and all in real time, no speeding up the process and while the song was being played and recorded maybe I looked at the lyrics, maybe I looked out the window or sorted through the albums, records, 13 inches square, to pick the next song, but during that time I did not check my phone for email or facebook or Instagram or anything else because there were no such phones, it was 1981. 

So in the car, this music, where I had read the album cover of every song, the lyrics, the picture on the album and remembered the day when I was in the record store and decided to spend my week’s extra money on that particular album after looking through the bin – yes, this was a physical process, you physically went to the record store and physically flipped through the records and picked one – imagine how much I knew the songs and the order on this tape – and like food that you cook yourself, this made the music all that much better.  They were my favorite songs for that period of time.

The light turns green, and I pop the clutch for a little chirp from the wheels and accelerate away – yes, a clutch, controlled by my foot and each gear selected by my right hand, some people still do this, but it is almost gone.  Even I finally gave up my last manual transmission car to move to electric, but that night, each gear shift a question of how fast to accelerate, how smooth to move through the gears, which gear to choose, how high to rev the engine and with the top down, hearing the motor and the tires against the pavement and the air on and around me flowing faster and then slow and finally stopping by the laundromat.

The door of the place is open, and the bright fluorescent lights are lighting the sidewalk sharply in front of the big plate glass windows. The light is so sharp that small bumps in the sidewalk create sharp shadows; like a moonscape which looks cold in the hot night.  The laundromat is almost empty, but with the door open you can hear some of the machines running with that steady hum and some water sounds, calming, mesmerizing, primal, clothes in mechanical wombs getting clean. I take my laundry in and pick some washers.

In spite of the loud background noise from the washers and dryers, the sound of coins dropping is sharp and distinct and nicely signals the start of my laundry.

I look at the people in the laundromat, but don’t talk to them. We are doing laundry on a summer evening and there is something very intimate about it. Talking would be too much. With clothes in the washer, there is literally nothing to do.

No wonder I remember this night. No wonder the memory comes back to me often. What a different sense of time there was. What deep relaxation in the simple chore. What privacy in the moment. Compared to now, what absolute freedom. No cellphone, no email, no connection, no need or ability to do anything but the laundry.

To sit in the seat of a car and just listen to music for half an hour while watching the world go by, in my life today that is close to a determined effort to meditate or the kind of thing that would only happen during a carefully arranged off the grid vacation.

The clothes come out of the dryer hot, and the night is still warm and I start to sweat. I’m not great at folding but I get them back into the bag somehow. Driving home is even nicer as I need the breeze to get the heat off of me.

Living in the world as a physical being. Head turned off, skin, ears, all senses turned on.  There was a lot of Zen in my life in those years, but I didn’t have a label for it.

Surgery and Sensuality

The surgery and especially the six weeks of recovery are now clouded with a healthy haze of nostalgia.  When I think back on that time, it is mostly positive memories that come back to me. I had absolute ‘freedom in the small.’  It started when I woke up, with no alarm clock, whenever I was awake and wanted to stay awake, that was my time to wake up.  I would have breakfast in bed and read the newspaper – or whatever I wanted to read – with no obligation or rush to do anything else.  What amazing luxury.

The weather was nice and often I would read on a lounge chair on the deck. Frequently I would lay in the sun with my shirt off and make vitamin D.  It felt therapeutic; ten to fifteen minutes per side. It also felt good.

It was during my recovery that I discovered minimalist shoes and had time to take slow walks where I could adjust to no heel and no padding – and one of the points of minimalist shoes is your feet can sense the texture of the ground underneath.  It’s not quite barefoot, but with socks off your feet are woken from their sensual slumber; pavement feels different than grass than gravel, than walking on pine needles or bricks.

Living in our house in the trees with a real need to take it easy and move slowly; filtering out the hard parts, there was beauty in the experience. Peace and freedom and the love and care of my family. This is the part of the experience that I want to remember.

Meaning Part 2

Purveyors of advice suggest doing something meaningful.  The books are filled with stories of people quitting Wall Street and becoming teachers or volunteering for the homeless or similar.  Meaning is simplified into doing something hands on for others.  This answer has never felt satisfying for me.

In those stories, most of the activities pursued by the protagonists are helping other people.  I don’t have a problem with that notion in general, but there is something about the specifics which is confusing.  The stories assume the person is being selfless in some way; that they have found a calling which is both good and good for them.  I can’t help but separate the good and the ‘good for them’ parts of the story.

Compare two activities which I might pursue; one, serving food at a homeless shelter and the second, going to work and doing my current job.  Experts say that serving food might provide a lot of positive emotional reward.  Feeding people in need is a primal activity. It might be good for me. And I would be helping – especially if I also donated food or money to help the operation.

Now consider my current job.  We make software that helps companies design things. Nine years ago, I started a program to make it easier for startup companies to adopt our software.  This raises their chance of success. Over 5,000 startups have taken advantage of this.  As an example, and more directly related to this topic, over 400 of those startups are designing medical devices (most of the rest of the startups are doing interesting and good things, but to keep the example clear, let’s stick with medical devices). Almost all of these devices are novel and inspiring; robotic eye surgery, better control of radiation in cancer treatment, exoskeletons to allow paralyzed people to walk again – these are real examples.  Even if access to our software only creates a small advantage – even if only one percent of those startups succeed because of our help – that is four companies whose devices have the potential to help thousands of people in need.

If I want to spend an extra few hours doing good, why wouldn’t it be an evening doing extra work on the startup program?

In that case, I am just an influence in a chain of people, so it doesn’t provide that ‘good for me’ emotional boost of ladling out some soup, but in terms of doing good, it’s really hard for me to see the leverage in serving dinner to a few people.  But maybe I need to do some good directly for my own mental health?

What is meaningful anyway?  This has been difficult because I have always wondered about meaningful in an absolute sense.  But I don’t believe in God and humanity won’t survive forever, so what can be forever meaningful?  It was only this year that I had a breakthrough on this topic.  I realized that meaning could be meaningful for me and me alone.  It doesn’t have to connect to some absolute set of values and doesn’t have to stand a test of time longer than my own experience.  It’s a simple change, but rephrasing from “What is meaningful?” to “What is meaningful for me now?” makes it more conceivable that I might find an answer. What raises that feeling for me?  What do I feel to be meaningful?

When I passed around the first set of essays to friends and family, some people were moved to contact me with a response.  I felt like I had communicated, and it felt meaningful. That is the strongest motivation for me writing this third set of material. An urge to communicate and connect.

What is meaningful for me?

My America

It has taken the Trump disaster to make me realize that I have always had two visions of America.  One I was comfortable talking about while a second was often hidden from my own consciousness and certainly one I never acknowledged.  Let me start with the one that is easier to talk about.

For most of my life, I have been on the side of the opposition.  I grew up in the 60’s and 70’s in a neighborhood that was pro civil rights, pro gay rights, against the war, against Nixon and incredulous that the rest of the country wasn’t with us. I remember talk of New York City seceding from New York State and, for that matter, leaving the United States completely. At the time we assumed everybody in the government was corrupt, on the take, out for themselves: I grew up fully believing, a belief as strong and as sacrosanct as a born-again’s faith in Jesus, that the government was filled with self-serving, egotistical, blow-hards.  My first self-directed experience of political events was watching the Watergate hearings after school. 

And it wasn’t just corruption, the government was horribly incompetent. Whether it was the stupidity of the Vietnam War, New York City approaching bankruptcy, the physical condition of the streets, subways and parks or the decline in quality of the schools — everything seemed to be getting worse. How could this be?

I was not consistently politically active, but I remember demonstrating at 8 years old (anti-war), at 10 years old (anti-war), at 14 (legalize marijuana), at 15 (against teacher lay-offs). These were large demonstrations, and their size enforced my cynicism.  Clearly the rest of America was not with us, or worse, maybe it was, but democracy was a sham. How could it be that 8th avenue was full of people all on the same side and nothing was changing?

In that first phase, I did not consciously reflect on the positives.  The Senators doing the questioning at the Watergate hearings.  I knew I was on their side, but it didn’t sink in that they were government too.

At the same time, there was something else going on. Without realizing it, unconsciously, I was absorbing the dream of America. The country that welcomed my grandparents and while those grandparents stopped school between 4th and 8th grades, their children, my parents earned PhDs and a different life. We learned about the beginning of the unions and worker protections. The building where the Triangle Shirtwaist fire (1911 a famous disaster where a sweatshop burned and 146 people died. It accelerated the move for worker’s rights and the growth of unions.) happened was in my neighborhood and that added reality to school lessons. Civil rights was happening. Still needed, but happening, and there were signs of progress. Gay rights and women’s rights were expanding. And maybe one reason for the Vietnam war being so painful was how it tarnished the remarkably positive stories of the main conflicts we learned about: revolutionary war, civil war, WW1 and WW2. There’s fault one can find in the execution of those wars, but at least the basic premises were something one can support. (independence, end slavery and keep the union together, save Europe and save Europe and the rest of the world again).

Unconsciously, I was a complete believer in the dream of America. The founding documents and principles. The idea that I was a patriot would have struck me as ridiculous, but at the same time, in all my international travels, I never came close to wanting to emigrate. Consciously, I was with the opposition, but unconsciously I was (am) a patriot.

I’ll focus on George Bush for a moment.  He doesn’t seem so bad now that we have Trump in the White House, but he was terrible in so many ways.  The turning point for me was his stance after 9/11.  He chose the simplistic, bring the bastards to justice, get revenge stance which set the country on a path to war and more war improving nothing.  Especially at that moment, with the whole world sympathetic to the United States, how might things have been different if he instead treated the individuals as criminals and used the crisis as a way to open dialog.  Maybe absolutely nothing would have changed with respect to curing root causes, but we wouldn’t have been responsible for the deaths of hundreds of thousands of civilians, and setting in motion the regional crisis which helped create the Syrian civil war.  I won’t dwell on this because it is presumptuous to think that any path would have made things appreciably better, but at the very least, rhetoric that positioned the US as a mature leader as opposed to a wronged middle schooler could have helped.

I’m sad for our soldiers and military; especially because they all volunteered. For reasons practical or patriotic, they chose to enlist in the military and put themselves, their lives, at the disposal of the politicians. How will they feel about the wars we’ve been fighting? How did adults feel in the 1960’s when soldiers went off to war? No doubt most of them were filled with patriotic enthusiasm for the mission and pride at our military marching off to prevent the spread of communism (or whatever it was that proud people thought then).  But adults in my childhood neighborhood, viewed the draftees as victims.

I remember being in camp during the summer of 1968. There was one night, a summer night in a simple wooden bunk house with screens and crickets outside and the smell of unfinished wood; our two counselors were huddled around a small AM radio.  The younger of the two was very fit. He did 100 pushups every morning.  He had a sort of bowl haircut. I remember them both as being reasonably nice guys, if not all that attentive. They were huddled around the radio because the draft numbers were going to be called.  It was the younger one’s year.  I had no idea of the details of how this worked – and still don’t – but I knew that he was packed and if his number came up he was going to get in his car and drive to Canada. We were in upstate New York.  Canada wasn’t far.  I don’t think he had a plan.  He had a car and some money.  Remember, it was 1968, no cellphones, no GPS, no ATM machines for cash. If he went it would be with a map, the cash in his pocket and not much else.

It was late, at least for eight-year-old me. I had trouble staying awake and I don’t remember being able to make out the words on the radio, but I do remember the relief in the two of them as they shut it off and that counselor was there the next morning to do his hundred pushups.  There had not even been a question.  He was ready to flee. The war was something to be avoided.

I don’t want a draft, but I do wonder what the country would feel about the Afghanistan and Iraq wars if every 18-year-old male had a chance of being called to war.

Much smaller morally, but equally disappointing for me, was Bush’s tax rebate.  To stimulate the economy there was a decision to give people money.  I remember getting a check for something like $250. This struck me as a completely pointless waste of resources.  Some people might desperately need that $250, but if they did, it wasn’t going to help them for very long. Some people might save it, but most probably spent it on some random impulsive purchase.  And random impulsive purchases are often cheap consumer goods which are manufactured overseas.  The US Government was taking a loan to give to its citizens so they could squander it on junk which would likely be purchased from China and similar.  That is not investing. Pick your cause; almost anything would have been better; infrastructure, education, research.

George Bush did change me fundamentally.  Since the moment I had considered the question “do you believe in God?” I had been agnostic.  I knew I didn’t believe in an old man with a white beard high above the earth or Santa Claus, or Zeus, but as a scientifically oriented youth, I didn’t feel like I could prove that there wasn’t some kind of spirit or force that was bigger than humanity.  There could be something, how would I know?  In fact, I’ve always been sure that we don’t really know what’s going on.  We don’t yet understand how things really work.  We might think we do; civilization always thinks it does, but science keeps advancing and almost always, we find we had some core assumptions incorrect.

I was agnostic and then along came George Bush and the evangelicals.  It pissed me off the way they acted as if the United States of America was a Christian Nation.  All my reading said that most of the founders were distinctly not Christians in the George Bush sense of the word.  Many of them were Deists. The Deists thought there was “a creator,” but this creator had no involvement with humans.  A clockmaker that built our universe and was now eating popcorn and watching creation or maybe off creating another universe with better weather.

Suddenly being agnostic seemed insufficient.  People asking, “do you believe in god?” were not asking an intellectual question about first causes or mysterious forces.  In the United States they are asking about old or new testament God – or perhaps about the god of Islam. From that perspective, I realized that I was as atheist as anybody and started saying so. I am a non-believer. At first, I found it difficult to tell people I was an atheist.  I thought people might be offended, but interestingly, they didn’t seem to take it that way.

Why did I think that people might be offended?  It’s the flip side of a Christian thinking that a sinner is damned.  I say I’m an atheist and they have pity on my soul.  People don’t seem to think through what an atheist might think of a religious person – because they are too stoned on the opium of the masses.

I remember talking to one religious friend about George Bush.  About how he supposedly heard God talking to him.  I pointed out that most European leaders would take that as a sign of psychosis, not virtue. Perhaps because we were not talking about each other’s views, I said it a bit too bluntly.  I think that friend sometimes hears from God (whatever that means) and so I was subtly calling him delusional.

Over time, saying “I’m an atheist” has gotten easier.  I just say it as a matter of fact and it might be my imagination, but I think people have respected me more for it. Perhaps because they secretly are too.  Maybe they feel vaguely guilty for not following the rules of their birth faith. Or feel as if others will criticize them for their lack of faith.  And then here I am, a seemingly reasonable, caring and moral person and I’m saying I’m an atheist with the same lack of gravitas as pointing out that I wear glasses and that is like absolution for how they truly feel about the world.

Are you an atheist? Don’t literally believe in a land of milk and honey and pearly gates and all the rest? Don’t be shy, just say “I’m an atheist” and see how people react.  That is thanks to George Bush.

I won’t write about the republicans blocking Obama and I won’t write about Trump. I will say that the last four years seem to confirm my worst prejudices. That Trump is who he is, while disgusting, is not particularly surprising.  That he got elected in 2016 is surprising, but explainable.  What is shocking is that after four years of him being as bad as I expected, 70 million people voted for him. I won’t write about that either; it’s ground that has been tread over time and again.

Rather than stew in that negativity, how about we get our mojo back. Here’s my view of America, and I’m including myself in it.  On a typical day, if we can, we’ll cut school and go to the beach.  We’ll laze on the couch with the biggest pizza we can find playing video games. We’ll surf the Internet shopping for garbage until we find the right garbage and then we’ll buy it on credit and throw it out a month after we get it.  For this America, progress is the number of states legalizing marijuana.

Sure, there is a percentage of Americans who don’t do this, who are fit and disciplined because they know they should be, but those people are not what makes America special. The special thing about America is what happens to the masses when we get motivated. When there’s a reason to get off the couch and make something happen. Not because it’s good for us individually, not because somebody is telling us we have to, but because it is the right thing to do. A cause, something bigger than ourselves, a challenge. Individuals, of their own free will, deciding to commit themselves to a higher purpose. We know how to self-organize.  How to lead when we need to and how to follow the neighbor who seems to have it figured out. We don’t need to wait for the government to tell us how, we just need a purpose, a direction. We can figure the rest out on our own.

Here are three examples of Americans being great.  As is often the case when you learn something about yourself, the first insight comes from a foreigner.

1.      I used to go to Japan on business often. One time a customer (Japanese) told me about how Americans were great at self-organization. I didn’t know what he meant, so he proceeded to tell me that after the Kobe earthquake, (also known as the Great Hanshin earthquake, 1995, over 6,000 people died), after that quake, some people in the government noticed something deficient in their response. They thought Americans were better and made a fact-finding trip to study how Americans deal with disasters.

The difference was that in Japan, in the immediate period after the disaster, people didn’t know what to do and so they didn’t do much. In contrast when they observed Americans, they saw groups of people spontaneously jumping into action. He talked about a flood; I don’t remember which one. You can see it. Somebody with a boat finds another person, they find a rope and other random useful stuff and start searching the neighborhood for people that need help. Other people gather together and set up a field kitchen. Some people lead and some people follow. Sure, eventually the helicopters need to arrive to pull people off roofs and we’ve had some amazing government fuck-ups, but the point is that people are willing to take initiative as individuals.

2.      One winter there was a huge ice storm and we lost power.  A constant fire in the woodstove kept the house somewhat livable, but we don’t have water without electricity.  Short power outages are no big deal but by day four we gave in and booked a night in a local hotel; the Westin on 128.  We checked in and walked to the elevator to go to our room.  There were tons of workmen in the hotel, obvious because of their hardhats. And there was a small crowd of them waiting for the elevator.

I got into a short conversation with one of them while waiting.  Half the hotel was contracted by the local power utility and was filled with out-of-town crews.  The reason for the rush at the elevator was that dinner was being served and they were all going to a basement ballroom to be fed.  He went on to tell me that he had retired the year before but had made way more money in the past year than he ever had.  This is because he went to Puerto Rico to work on their grid after Hurricane Maria and had worked 12 hours a day 7 days a week for months.  Free room and board, overtime, bonuses to stay on; it all added up. He said the hardest thing in Puerto Rico was the lack of accurate records. Finding the equipment was often the biggest repair challenge. The elevator doors opened, and he left.

We dropped our bags in our room, took quick hot showers, what luxury, and went down to the restaurant for dinner.  After ordering, while sipping cocktails, I noticed four workmen talking to a waitress as they made their way to a table.  She was explaining that the free dinner was served in the basement ballroom, but was over, so they would have to pay for their food.  They looked disappointed but didn’t argue.

When the waitress next came to our table, I did something for the first (and so far only) time in my life.  I said I’d like to buy a round of drinks for their table.  A little while later, one of them came over and we chatted for a couple of minutes.  He said they couldn’t drink because they were on the job, but he thanked us for the gesture.  I don’t remember, we might have bought them a round of soup. But then I got their story and that’s the point of this vignette:

The four of them lived spread across Louisiana, Arkansas and Tennessee – I think there were two in Arkansas. They were all retired, but still licensed assessors. (I think they were called assessors).  Their job is to go a place where the power is out and figure out what is wrong so the right kind of crew, with the right parts, can be summoned to do the repair.  When they heard about the size of the ice storm in the northeast, they decided they would come help.

I want to emphasize that while this could have been automated on the internet with them applying and registering in advance, etc., that’s not the way it was.  It was them calling each other and deciding on who would pick up who, gathering their gear and from Tennessee driving nonstop, rotating between the four of them until they arrived in the Boston area, found the gathering point, registered, and got to work. They were late for dinner because they hadn’t finished as much as they could do in a day.  We told them we were in the hotel because our power was out and were as appreciative and thankful as we could be.

Not to overly dwell on these four heroes, but a quality documentary that follows disaster recovery workers could be good therapy for America. Imagine the scene. An older, slightly pudgy male is watching TV in a small house in Arkansas.  The phone rings.

“Hey, what you doin’?” 

“Just watchin’ <I have no idea what they watch>”

“Well look, I was talkin to Jimmy and we’re thinking of going up to Boston, you heard about the ice storm?”

“Yea, that’s a big one.”

“So you in?”

“OK, sure, I’m not doing much anyway.”

“You gotta’ leave real soon though – we’re meeting 10AM at the Walmart near Jimmy’s”

“Here to Nashville, drive all night –I’m not taking the first shift tomorrow.”

“Sure, Jimmy will start, we’ll take his Suburban.”

In less than two hours our hero has downed some coffee and is on the road with his gear.  I’m writing these words just after hurricane Ian turned off the lights for 2M people.  How many electrical workers are, right now, driving south on 95 with their gear bags and license paperwork?

Is this uniquely American? Would four retired Spanish lineman pack their bags and head up to Hamburg, Germany in response to news of an ice storm?  If they did, would the Germans let them touch their wires?

Our power was on the next day.

Before continuing to the next point, I need to spend yet more time with our linemen.  For reasons that have more to do with tradition than reason, these gentlemen would be viewed as “blue collar” or perhaps “skilled workers” with all the implied prejudices about educational level, political party and intelligence. I think it is time for many of us to drop our elitism.

One of the supposed sources of the rise of the uneducated republican is the way the democratic party became associated with identity politics, “east coast liberal elites” and urban white-collar workers – less emphasis on Unions, the Trades and the working poor.

To my fellow college educated knowledge workers:  Many of us like to think of ourselves as being highly skilled in careers which are more valuable than others.  And because these careers are more valuable – pay more in the market – than others, we sometimes start to think we are better than those in the less valued careers. We think we’re smarter or better adapted. We think our future prospects are better or at least our path is different from blue collar workers.

Since our path is different, our politics start to diverge. For example, I think that healthcare should be a right and everybody should have it, but everybody I know does have it. We either get it through our employers or have enough money to buy private insurance.  That’s my cohort. I think its distressing when people lose their jobs because they can be done cheaper elsewhere, but for the most part, this has not affected my cohort either – or at least the ones affected have been able to switch to other jobs without too much disruption.  But note, the fact we can do our jobs during the pandemic (virtually) means they can be done elsewhere for less.

I’d like to break down some of these attitudes.  With some perspective, it is quite clear to me that many jobs which originally looked like they could only be done by geniuses are no more complicated than all sorts of jobs which are often associated with people that didn’t do well in school.

Take software. When people talk about writing software, there is a huge range of possible activities.  Some of them indeed are best done by geniuses, but many of them are no more complicated than almost any job done in the trades. The difference is that it is something of a new career, a new skillset. Until recently, you weren’t likely to learn about it from your parents or your relatives. Until recently it wouldn’t have been taught until high school. There was a time when connecting to a network was a high-tech specialty. Now “what’s the WiFi password?” is a question everyone can ask.

Some of this is due to the processes getting simplified, but a good portion is due to familiarity. It’s hard doing something for the first time which you’ve never seen done.  Even having the confidence that you can do it at all can be a hurdle. But once you know that anybody can do it, trying is not so scary. Once you’ve seen the benefit of doing something, you have more motivation.  When you have five friends or colleagues who can point the way the first time, the hurdle is lower.  And then you realize there’s nothing to it and off you go.

I write this in an attempt to create a little more mutual respect between blue and white collars. Or at least respect from white to blue collars.  It’s clear to me that many “high tech” jobs require no more brilliance or education (learning about the job) than advanced manufacturing, plumbing or electricians.

Our political concerns should be much closer than they are.  A very large portion of software jobs could move to India, Eastern Europe or Latin America. Equally likely, a large number of them could become obsolete; replaced by packaged applications and automation. Same for financial services jobs and a good number of other high paying careers.  How does that make you feel? What do you want to happen in the country based on that feeling?

There used to be a big computer industry in Massachusetts. It’s basically gone. First it moved to the west coast, then the manufacturing portion moved to Asia. Unless you own the company you work for, you are a worker and are just as disposable as textile workers in the south or auto workers in Michigan.

I’m not advocating for any particular policies, just for more empathy.

3.      In approximately 1994, I was traveling on business in Italy and had a good conversation with a local.  He was commenting on how Americans were too ready to abandon traditions.  He thought we were taking frightful risks with our society.  The issue that was bugging him was women going to work.  I find this ironic, because I think Europe has done a better job of supporting women at work, but I don’t know when that happened, and I don’t know any meaningful statistics tracking the number of women in management or other measures comparing the US to Europe.  He viewed the change in family responsibilities as a big risk. What would happen to society if women didn’t stay home and take care of the kids?

I saw the point he was making, but for me, it just didn’t matter.  Women want real careers, they are capable and if that’s what they want to do, why would anybody have the right to stop them?  Sure, there might be difficulties, but there are always difficulties with change and we’d figure out how to adjust – or maybe some would choose to have one parent stay home and not work. At a deeper level, he was assuming that things should mostly stay the same and staying the same was both possible and positive.  My baseline assumption is that nothing can stay the same. Everything is always changing, and the goal is to make the changes positive instead of negative. Nothing stays the same.

When I worked at AMD, I had people in my group in Texas.  I managed Texans, how unlikely is that? During this period there was a spike in gasoline prices. The spouse of somebody in my group had a nice truck and a long commute.  One day she did the math and figured she could trade in her truck for a new Honda and completely cover the car payment with her savings on gas.  In a week she had a new car.  I contend that true Americans are highly pragmatic and not afraid of change.  We’ve been selected for that trait.  Most of us are less than a few generations from immigrants who decided to roll the dice on a new country.

4.      In approximately 2006 I had a conversation with a guy from the Department of Energy (can’t remember his name, but I do remember his face). He had a vision for fixing America which was simple and built on classic American traits; pragmatism, DIY and willingness to change – and the ability to fit items up to 4’ by 8’ in the back of their vehicles. His vision was based on just a few technical advances, most of which are now almost here.

a.      Electric cars with big batteries (here and more on the way – CA and NY have already announced no new gas cars after 2035)

b.      Ability for households to sell power back to the grid – already here in some states.

c.       Ability for the batteries in the cars to be used as part of the house power supply –  just starting to be possible.

d.      Ability for these power transactions to be done over the Internet – I contend that everybody with an electric car has Internet and Wi-Fi.

e.      Crucially, for it to be easy and obviously a good deal for a homeowner to self-install solar panels. Throw those panels in the back of the pick-up, put a roof on your patio and connect it to your house battery. The technology is here. Any minute now Home Depot or similar will wake up, put the package together, and a bank, maybe with government backing, will make credit available. What farmer wouldn’t do this? Why drive into town for gas when you can charge your Ford Lightning pickup with your own electrons?

This time, for this round of great awakening, we don’t have to kill anybody. We only have to save the planet. The country has it all, we have deserts with unlimited sun, onshore and offshore wind, geothermal, tidal power and a good bunch of fusion startups.  We can do this.

We need to rebuild our infrastructure to be more efficient and less carbon intensive than every other country on the planet, and in so doing, we can again become the leader that we all want to be.  Free, equitable, fun, the place the whole world wishes it could move to. 

And when we have cheap clean energy and fusion powered reactors pulling carbon out of the atmosphere; when we’re using smart agriculture to produce yet more food with less water in a way that builds the soil instead of destroying the rivers; when the wealth created from these activities is properly funding healthcare and education; then we can spend a decade or two on the couch, eating pizza, playing video games, getting buzzed and relaxing until the next global crisis.

We can do this.

In Contrast, Skip the Second Planet for Now

I have recently read some very intelligent people coming out in favor of us working to move to space.  There are different versions of this proposition.  A base on the Moon, settle Mars, work towards interplanetary travel, they have different reasoning, some of it well argued, some inspiring, but recently, I’ve found I fundamentally distrust the motives behind these urgings.

Consider the history of our species. Amazingly, we colonized all continents except Antarctica well before the invention of GPS or travel insurance.  In fact, before the invention of writing. Sure, some of that migration might have been at a rate of a few kilometers per generation, but some hardy souls got into boats and wound up on Hawaii (for example). Likely plenty of people died trying, but we’re descendants of the survivors.

For most of our existence, it has been a reasonable strategy to pick up roots and leave town in search of something better.   That urge even has a cliché which describes it; “the grass is always greener…” And that cliché reflects the problem I have with the go-to-space crowd. In that cliché there is an assumption that there is grass on the other side – which implies water, breathable atmosphere, and a reasonable chance there are edible plants and animals.

The problem now is one of investment, aka gambling, is it better to spend a trillion building a base on Mars or on figuring out how to control the climate on earth? It’s a question of odds, expense and timing.

My opinion: let’s secure our home base before searching for the next thing – control the climate, unlimited clean energy, stable population size, global peace – if we can’t do that for ourselves, what right do we have to pollute the rest of the universe with our barbaric species?

Three Pandemic Observations

1.     My Career Rises in Value

The early days of the pandemic made me feel better about my career. I’ve spent my adult life working on different aspects of computing technology – networks, computers, software tools for engineers and scientists. It has always been an unproven leap of faith to believe that the people using technology for good were doing more good than the people using it for evil.  It’s the problem of building tools for others.  You never know exactly how they will be used.

During the early days my work was confined primarily to the people using computing for science and civilian purposes and those using it to build weapons. But as time went on and the general public became users – Internet, smart phones, social media, games – there was a new question of whether humanity’s day to day life was truly benefiting or if we are all just addicted to our devices for the profit of commercial interests. Faster cheaper computers for what? So we can stare at our phones instead of visiting friends?

But then the pandemic happened, and lock downs started – and it worked! In the space of a week a huge percentage of the population was doing business from home on video calls.  So much had to work to make that possible, fast networks, powerful computers cheap enough for most people to have them, vast server farms orchestrating our connectivity – I’ve spent time on all those topics. And then there was the cure; vaccines, ventilators and all the rest of the medical devices to help people survive.  Most of those companies use software from my current employer. My involvement is small and only supporting, but it helps validate my original leap of faith.

And once humanity’s focus moves from pandemic to climate crisis, information technology is likely to play a significant role in finding and building solutions. I feel good about this.

2.     Sharing Something with Some of You

I don’t know what percentage of people will relate to this, but I know I’m not the only one.  Many of us are spending a lot of time on video calls now. Some of us have taken the trouble to organize our offices properly with webcams on top of large monitors and some of us haven’t.  Some people use software to blur their backgrounds. Some people have nice bookcases behind them and some haven’t bothered to move their dirty clothes off the floor because they are out of range of the camera (like me).

I was on a video call with a woman who was clearly just using her laptop.  Her face was in focus and the background was the blurred off white of the ceiling.  Her laptop was sitting on her desk about two feet in front of her and the camera was a foot or so lower than her face. I was looking up at her from close range. The angle was unusual but also somehow familiar.

You got it? Enjoy the rest of your intimate work video calls.

3.     Anxiety Comparison: Brain Surgery vs. Pandemic

There’s plenty of anxiety going around, but pandemic anxiety feels different from brain surgery anxiety and for the most part, pandemic anxiety is worse.  With brain surgery, there were a finite number of things to worry about and very well-defined time frames to worry about them. For example, once my surgery date was set, there was no problem with us leaving for a vacation in Quebec City where we had quite a nice time including visiting the Ice Hotel and going dog sledding. For the most part, I didn’t worry about the upcoming surgery.

The worries were specific and the list of actions I could take to prepare was short; there wasn’t much else to be done.  For the most part, the bad outcomes would be primarily on me. In short, for brain surgery, there is some fear and some worry, but it is possible to go through all the scenarios until it is boring and then put them aside. Sure, they will pop up from time to time, but it isn’t interesting to think “what if I lose control of the left side of my face?” over and over, because the answer is always a simple “that would suck, but it isn’t very likely and it would suck worse to eventually lose control over much more if I don’t get this tumor out.”

The pandemic is quite different. The timeframe where new and different problems can arise is unknown.  It’s December, 2020 as I write this and we don’t know when we will get vaccinated, whether the vaccines will be effective and that leaves off the gazillions of other kinds of problems this pandemic can cause.  Most importantly, it’s not just me. Family, friends, co-workers, all of humanity is suffering at least a little and some have been stricken; either by the virus directly (sickness or death) or by problems caused by the virus; loss of work and everything bad that can flow from that.

It’s not possible to ask three simple questions, have three simple answers and move on when thinking about the pandemic.  Literally anybody I know and care about could catch the virus and wind up in a bad state. Any of them could lose their jobs or have their lives disrupted in countless other ways. Spend 10 minutes thinking of bad possibilities and you’ll never get to the end of them. It’s the same with timing.  The schedule for the pandemic is not known. Brain surgery was May 18th and an expectation of 6 weeks initial recovery. For the pandemic, who knows?

The solution to the pandemic is troubling in another way.  With my surgery, I was impressed with my team (my surgeon, Massachusetts General Hospital and my family that would care for me during recovery).  All of them were eminently qualified to do what would need to be done.  Contrast that with the pandemic – a global problem needing coordinated and quality responses across a vast number of people including our government agencies. 

Unlike my pre-surgery essays, where I planned to trust that even the mechanic who was responsible for making sure the back-up generators were ready, here during the pandemic, we can see vividly how unprepared, it might be more accurate to say how anti-prepared the federal apparatus has become.  Imagine the poor government workers at the CDC.  The very same workers that made Ebola a non-event in the US. The very same people that debated and hassled amongst themselves over every word in the pandemic playbook – the playbook that many other countries followed, but which their own country ignored. I pity those people.

Maybe I’ll meet one someday (once we get back to meeting people.)  What incredible anger they must have.  To be so skilled and so prepared, so ready to lead the country and the world with well-considered best practices and pre-positioned supplies and then, to have it all descend into stupidity and chaos and instead to see their colleagues, family and friends suffer and their whole country be such a disaster on the world stage. I hope some of them go into politics. Like veterans returning from war, perhaps some of the first responders, medical people – essential workers even – perhaps some of them will be motivated to run for office and get the idiots out of power.

No End to the Story

The advice from my younger selves feels useful.  To rekindle the ability to put all obligations aside and deeply experience and enjoy the current moment, to be present in the moment.  It is almost cliché. But there are so many reasons why it feels important. Some that are obvious, but one that is deeper.

The obvious: Current life is endlessly diverting. Smartphones make you change your focus before you even realize that you were focusing in the first place; a text from somebody close, a reminder for a task you need to complete, and then once you’re looking at the phone, the risk of being taken further afield with social media, news or many other distractions. Also obvious: I’m not a kid. I have responsibilities and often, they take almost all of my time. Work, chores, feeding myself, making sure I get some physical movement.  Frequently life is like a time jigsaw puzzle and a free moment becomes an opportunity to check off a task which has a chance of fitting that slot.

Less obvious is a bit of reality that I have started to consider.  Out for one evening walk, it occurred to me that I was unlikely to live long enough to know if humanity would rise to the challenge of climate change.  I might have a good idea of the end of the story if I live a long life, but I’m unlikely to know the full story.  That started a whole series of similar realizations.

Will the US and China find a way to lead the world to a better place or will we fall back into typical human competition and eventually warfare?

Will the bike trail from Boston to Northampton be completed?

Will fusion power become viable, and will it be needed by the time it is ready? (or will solar and wind continue to improve to the point that fusion is redundant)?

How much Spanish will I learn? Will I ever get back to trying to learn Russian?

When will Cape Cod be inundated by rising seas? And what about the three eastern cities where I’ve lived most of my life; New York, Providence, Boston – what will they do when the seas rise?

How long will the dollar be the world’s reserve currency and what comes after?

How many species will go extinct before we fix the world – assuming we do fix the world?

And then, more personally, my daughters, how will their lives go? Where will they live? Will they marry? What kind of work will they do? Will they have kids and if they do, what about the kids? How will their lives go?

The point is, I’m not going to know the answer to most of these questions.  More generally, the older I get, the fewer active questions are going to fit into my remaining lifespan.

What does this mean? If you knew you were going to have to leave a movie in the middle, would you still go? Would you start reading a book if you knew somebody would take it from you before you were done?

And if you went to that movie or started that book, how does knowing you won’t get to the end change the experience?

I see three answers to this question.  The first is probably the worst. The answer could be to narrow my focus, withdraw from the world, not commit to anything new or long term.  This often happens to people when they become seriously ill and contemplate death.  Fewer friends, no new activities, don’t go far from home. This is not a happy state of affairs.  It has been shown that when people recover from a serious illness, they open up again.  But I’m not talking about illness here.  I’m fine.  It’s just that I’m 62 and even if I assume I’m going to live to 105 (a very generous assumption), that time is finite.  I’m not going to suddenly recover from my mortality.

The second answer is how I lived before that evening walk.  It is the answer that suffices for childhood and for the unaware. I could just forget it.  Act as if I’m going to live forever and deny the reality of my mortality. Stay busy.  Follow topics of interest with no thought of any impending end. This is not terrible.  Ignorance is bliss.  In fact, after surgery and realizing I was going to recover, I did broaden my horizons.  That’s when I started learning Spanish, got back to reading books, got back to work and started learning about any number of new topics.  But I don’t think this is the best answer.

There is value in watching the movie fully aware there is no guarantee of getting to the end. It’s easier to describe what I mean using a book example.  Imagine you’re reading a mystery.  The usual point of a mystery is tracking the clues and thinking about who did it.  Waiting for that big reveal at the end.  Reading that sort of book, I would tend to read quickly, searching for clues, pushing as fast as possible, a page turner, how is it going to turn out? 

But if I’m not going to get to the end, either I will quickly decide I’m not going to put up with low quality writing or, hopefully, and here is the key, I’m going to linger deeply on every phrase.  The description of the type of hat the detective is wearing and the way he jams pens into his back pocket to the point of punching holes in his pants. I’m going to wonder if the ink leaks or whether he pokes his butt when he sits on those pens. I’ll remember a time I put a pen in my shirt pocket and it leaked and I had to go into a meeting sporting a big blue ink stain.

Every paragraph of life becomes the whole story.  There is such infinite depth in every moment when you allow yourself to dive into it. The question is not how my kid’s lives will look in thirty years, sure I’m curious about that, but how much more important and rewarding it is to focus on being as present as possible with them in moments when we are together.

For now this my answer to how to spend the rest of my life: living it much the way I do every day, but from moment to moment, every moment, seeking the deeper wonder in present existence.

© Copyright 2024 David Rich All Rights Reserved

I wrote a short set of essays before surgery.  My motivation was to focus my mind and say anything I felt I needed to say before the big day.  I didn’t think about whether I would write an “after,” but now that it is after and I can still think and type, it feels like there are a few things to be said, but the motivation and situation are different.

For the “before” there was a definite deadline and the time to start writing was up to me. The motivation was almost entirely selfish; I wanted to say what I wanted to say. Now in the after, there isn’t a definite deadline.  The first deadline I considered was before I went back to work.  But that was during recovery and I only had just enough energy and presence of mind to take notes. 

Time is passing, as I write this, I’ve been back to work for three months.  There hasn’t been a deadline and waiting until the one-year follow-up MRI is too long.  And for motivation, there is still some of me wanting to say just exactly whatever I feel like writing, but I feel less permission to do so.  The surgery went well (basically, I’m fine), so why exactly should I write these thoughts for sharing?

There is something else different in these “after essays.”  I’d like to give an account of the experience for others facing brain surgery and that is challenging because as I explained in the before essays, brain surgeries differ strongly from each other.

There are two sections to match these motivations: The first talks about surgery and recovery.  The second is a small set of essays on topics which are related, inspired or stirred up by my experience. Stirred up is not quite right.  It is more that the experience has provided an occasion to share.

But First; Thank You

Thank you to the doctors, nurses, and everyone living and no longer alive that made it possible for a blob of cells to be removed from my brain in a way that allows me to continue my life. Thank you to family, friends and coworkers for your support before, during and after the surgery. A strong sense of appreciation and gratitude is a big part of this experience. 

Brain Surgery: The Experience

Day Before

I went to the hospital to have blood work done and to meet with the surgeon. The blood work was unremarkable.  The meeting with the surgeon was short, but interesting.  I learned they had reviewed the second set of images of my tumor and determined it was much rarer than previously thought.  The first diagnosis was an “epidermoid cyst” which is composed of skin cells (in the wrong place). This is rare, but common enough that you can find a support group on the Internet. But after looking closer they believed it was a “neurenteric cyst.”  Similar idea, some cells that incorrectly differentiated while I was in utero, but instead of being skin cells, they were gut cells.  These are truly rare. No change to treatment or prognosis, but a better conversation piece - with doctors anyway.

Sitting on the examination table, because that’s where patients sit, and with Larisa sitting nearby on a guest chair, the surgeon asked me if I was ready.  I said, “Yes I’m ready, but I don’t have to do anything but show up. Are you ready?”  His reply, “I’ve spent the last 30 years getting ready.”

“So, you know how to do this?”

“It’s not like I’m going to be up late studying.”

Day of: Before the Surgery

The day started early.  I was due to check in at 6AM in Boston.  This meant leaving home at 5AM to be sure and so we woke up around 4:30AM.  No drinking or eating allowed, but I did take a shower; my last for almost a week.

There was no traffic, and we arrived at surgery admitting on time.  The Massachusetts General Hospital – known also as Mass General or from now on, as MGH – is huge.  I think the room we made our way to was for a specific class of surgeries.  Even a casual glance around the room made it clear that many people were in worse shape than I was, and because I was also there for surgery, I felt more sympathy for them, as if we were in the same class at school, but they were struggling.  It brought back a memory from long ago.

One of our daughters had to have surgery at 5 months.  It was obviously stressful, we were worried stiff, and it filled every waking moment of our thoughts and actions.  That said, the doctors were not concerned.  They knew exactly what it was and were confident they knew how to fix it – a regular procedure. At the time, I was working, and Larisa was not.  It was tiring, but we had no trouble finding a way to be with her at all times. You can easily imagine the mental state we were in with our infant daughter in Children’s Hospital.  In that mental state, I was waiting for the elevator and overheard a bit of conversation between a mother and I believe her mother.  The situation was their child had bone cancer and while the mother had taken some time off from work, she needed to go back.  They needed both incomes. The question was how much time the grandmother could spend in the hospital.

It broke through my thoughts; they didn’t know if their child would survive, didn’t know how long they would be in the hospital, but had to somehow manage.  Later we encountered young children that were left alone in the hospital. People just didn’t have a choice. Seeing what other people were dealing with brought a wave of compassion and gave me strength. Surely, we would endure.

That set of memories and the situation in the surgery admitting waiting room was perhaps the first inkling of the thankfulness that I’ve been feeling.  After all, I walked into the hospital on my own to have a surgery that was well understood.  Yes, they were going to dig around my cranial nerves, but that’s what they do.  Things could be much worse.

We were given a buzzer – like the kind you get when waiting for a table at a large restaurant – and when it went off we met a nurse who checked through the paperwork, asked a few questions and then introduced us to an orderly who would take us to pre-op to get ready before going into the operating room.  He was friendly and outgoing and kept up a steady stream of conversation. When I was fourteen I volunteered in a hospital and briefly had exactly his job, but I always had less serious assignments.  For example, I’d take a patient from their room to radiology. I never took anybody to surgery. I never said anything; I was shy in those years.

He chatted with us and when we got to the elevators, I could tell he was trying to find an excuse to not have us join another patient in the same elevator.  That patient was prone on a bed, already with IV and did not look happy at all. I could be reading more into it than was there, but I think he wanted us in our own elevator, so we could continue with the chit chat and the light mood as long as possible.

It wasn’t a big deal, we went up a few floors, left the elevator, down a hall, through a wide doorway into the surgical pre-op area and were deposited in a room where I would wait and be prepared. There was a friendly nurse waiting for us there.  This preparation area was as big and looked much like an emergency room facility looks in a smaller hospital, except it was cleaner and emptier. Shiny clean. There were at least eight rooms, but I didn’t take a tour. I changed into hospital garb, gave Larisa my glasses and then took off my wedding ring.  The nurse gave us a urine cup, the kind with a screw plastic top.  She said it made rings easier to keep track of, so the ring went into the cup and the cup into Larisa’s handbag. She then took my vitals and went through all the usual questions.

If you’ve never had surgery, be ready to answer the same exact questions many times before you get to the operating room.  Your name, date of birth, what surgery are you going to have today? Which side? Do not be annoyed. Every time they ask, say to yourself, “they don’t want to fuck up and I don’t want them to fuck up either.”

With that I climbed onto the bed and was offered warm blankets.  It’s a nice touch. Soon after, the resident anesthesiologist came in to chat.  From my perspective, he looked young and probably was young.  But he seemed competent. Later I met the main anesthesiologist and was relieved to know that it wasn’t just going to be the kid on his own.  The kid put two IVs into me.  My left arm got the regular IV (into a vein).  My right arm (and later also my left foot) had arterial catheters inserted; “a-lines”.  Apparently, the a-lines are better for monitoring blood pressure in real time and can be used to help get meds into the blood stream ASAP if needed.

Then the neuro-surgery resident came in.  It was such a relief to meet him.  I could see the focus and intelligence in his eyes. He was on his way to becoming a fully qualified neuro-surgeon and was working with a top neuro-surgeon at a world-class hospital. We talked briefly about what they were going to do, but I didn’t really have any questions.

Next a woman came in who introduced herself as “I’m your advocate.” I believe she was a nurse perhaps or I’m not exactly sure what, but wow she was a force of nature. She said she was going to watch over me through the surgery.  That made me happy. She ran everybody through the checklist, what they were going to do, how they were going to do it – often with the phrase “Dr. Barker prefers...” as part of the sentence. I was glad to be awake to be part of this.  They talked to each other clearly and with focus.  They were communicating.  They all seemed excellent individually, and I felt comfortable they would work well as a team.

They gave me a first dose of something to ease me into things. Exactly on time, ready to be wheeled into the OR at 7:45 to be ready for an 8AM start.

Here I need to pause for a slight diversion.  In my before essays I spoke about diversity at work, so let me describe this team from that perspective.  Dr. Barker, the surgeon, is a white guy, late 50’s, Harvard undergrad and med school.  The young anesthesiologist resident is Asian racially (I’d guess Chinese, but wouldn’t bet my house on it), but most likely born and definitely raised in southern California (he said so in a voice that matched).  The main anesthesiologist, probably in his 40’s, is from India (apologies if I have that wrong and it is someplace nearby) and I would guess he is an immigrant but has been here a long time. The neurosurgery resident is hard to peg, my guess is that he is an American citizen, born here of mixed race parents. The “I’m your advocate” woman is black, and an immigrant, but I can’t be sure of her accent.  It wasn’t that thick and anyway, she was all efficiency and business with short clear sentences which tend to hide accent. And to fill out the list; the pre-op nurse was a white woman, mid 30’s, no memorable accent, could be from anywhere in the US.  The woman that greeted us at surgery pre-op, white woman in her 40’s definitely a Boston native. And lastly, the cheerful and friendly orderly that wheeled us from admitting to the pre-op room; a Moroccan immigrant, perhaps in his 40’s, with an excellent mustache.

In short, a diverse team. Do I think MGH woke up and said, we think surgical teams might work better if we had a more diverse set of individuals in the room?  I suspect not. Based on the quality of these people, I think instead they look for the best people they can find and perhaps have practices and programs that make sure they do not let race or gender influence their selection process.  I’m currently a big fan of MGH, so – have you seen “Men in Black”? – remember the “best of the best” scene? Like that. These people would move the table. (Here’s the scene, watch until the end.)

At 7:45AM I say goodbye to Larisa and am wheeled into the operating room.  I have perhaps one minute to look around, maybe less.  The room has a distinct blue tinge to the lighting.  It is a big room, perhaps thirty feet square.  The walls and ceiling are white.  The ceiling tiles are perforated, and I wonder if that is part of the ventilation. It is not warm. The lights over the operating table look super modern and high tech.  I’m surprised at first to see there is at least one remote monitoring station. By this I mean there is a table perhaps ten feet to the left of the operating table with double monitors.  I knew they were going to monitor some of my nerve function during the operation, but it didn’t occur to me that this could be done from a distance, but of course it can and why would you want those people crowding the surgeons?  I wanted to look around more, but that’s not what I was there for.

The anesthesiologist put an oxygen mask on my face, which I found to be more flexible and pliable than I expected. I was told to take a couple of deep breaths, which I did.  Or at least I took one, because while I was taking that breath he said, “and now we’re giving you something stronger” and that’s the last thing I remember until waking up in my room in the neuro-ICU (intensive care unit).

The Surgery Itself

That’s the odd thing.  This is all about my brain surgery, but that is the time I was least present. What do I know? They inserted a breathing tube. They screwed my head into a contraption to hold it steady – tight enough so that I was left with at least four small holes that scabbed over around my head.  Larisa also expects they must’ve pined my left ear forward because it was bent a bit for a day or two after surgery.

They shaved one side of my head and made an incision, perhaps five inches, behind my left ear, starting on the neck and extending upwards.  Presumably then they peeled the skin back, pulled the neck muscles apart to get access (cutting them where needed), took out a piece of my skull (drills? saws?), made an incision on the three layers of membrane which surround the brain and then fished around – very carefully, staring through a microscope – removing the cyst.  And when they were done, they had to sew the membranes together, so they are “water tight” as leaking of cerebral fluid is bad, fill the hole in the skull with titanium mesh and stitch the neck muscles and scalp back together.

One thing we are marveling at is how well the incision on the scalp is healing.  The scar might be close to invisible by the time it heals. But then, if these guys are good enough to sew a water tight seal in thin brain membranes, it’s not much of a surprise they would do a quality job with regular skin.

Waking Up

When I say waking up, I mean the beginning of the process of becoming aware.  They told me in advance that it would take a day or two for the anesthesia to be fully out of my system: My early memories are fuzzy.

The first thing I remember is opening my eyes while sitting up on a hospital bed.  In front of me I saw my wife and daughters sitting next to the bed looking at me. They were a bit pale and looked concerned and not yet relieved.  Maybe a little horrified? I didn’t yet realize it, but I know from later that I was well connected to medical devices; an IV in my left arm; the a-line in my right arm; EKG leads attached to multiple places; an oxygen monitor on my left hand; a blood pressure cuff; devices on my calves which I would describe as special socks – they are inflated and deflated to massage the calves in a way that helps prevent blood clots; and not to forget, a catheter which I didn’t even realize was there until the next morning.

And, if they looked, they would have seen the dressing over my incision.  The dressing was likely bloody and was literally stapled to my head. I did not know this at the time.  I didn’t know about the staples until they removed the dressing before I left the hospital.

The surgery started at 8AM and took six and half hours, add an hour or so for getting hooked up in the ICU and waking up, maybe it was 3:30 or 4?

I think I might have talked, but I don’t know what I said or what they said.  It was nice they were there. I remember being concerned that it must be boring for them to sit and look at me doing nothing.  I found out the next day that behind my bed was a wall of windows looking out over Boston.  Perhaps that helped.  I didn’t have any sense of time and I don’t know how long they stayed there.  I’m sure they were there at least half an hour, but they could have been there for hours. I don’t know. Of course, I could ask them. This applies to much of the narrative. I could interview people to see what was really going on during my fuzzy periods, but I’ve decided not to.  As such, these are my, very imperfect, recollections.

My first bit of thinking was to realize that while my body was warm, my head was cold and that was making me uncomfortable – I have very little hair on my head, and while I didn’t realize it at the time, the left side of my head was also shaved. I managed to express this and asked for a hat or something.  Larisa suggested a towel and the nurse came and wrapped one over my head.  Problem solved, my head warmed up, I relaxed and then fell asleep.

Either after that or before, I’m not sure, I took my first swallow.  Before the surgery we had heard about “swallowing nurses.”  We understood this to mean that there was a special nurse who knew the procedure to use when a patient takes their first swallow after a long period of intubation (having a breathing tube down their throat).  This is because there is a risk that the swallow goes wrong.  I imagined some nurse traveling around the hospital, ready to help at a moment’s notice as patients took their first sips.  We had that wrong. All the neuro-ICU nurses are trained in the first swallow protocol.  I was kind of disappointed.

I had read of instant tracheotomies when it was discovered that brain surgery patients were not able to control their swallow reflex, so I was nervous when I took my first swallow. It was difficult, but worked, so the only part of the protocol I saw was the nurse right by my side, paying careful attention, but not making a big deal of it.

Some food came.  I scratched at it but had no appetite – in spite not having eaten since the day before.

Dr. Barker visited in the evening.  My family had already left and nobody else was there.  It was still light out, but the sun must’ve been setting as the room was dimmer. We chatted briefly. He told me they either got all of it or if some was left it was absolutely tiny, but they judged it wasn’t worth the risk to keep digging (my words, not his).  He said he was going to a conference over the weekend, but that the residents would take good care of me.  I was still blurry, he might have said more, I don’t know what I said, but I hope I said thank you.  It’s odd, at that point, I had seen him only three times; the first visit, maybe half an hour, the pre-op visit, likely thirty minutes or less, and perhaps five minutes at this post-surgery chat.  But he’s seen me, or at least part of me, for an additional six and a half hours during surgery.

That night was exactly the sort of night you imagine in a hospital.  Every couple of hours somebody, usually a nurse, would do a test to make sure my brain was working.  Smile, raise both hands “as if holding a pizza box” and close your eyes, watch my finger (and they would move it left and right), touch my finger then touch your nose, push your toes down, pull them up. Meds at least every four hours, some pills, some IV. I came to understand that if I bent my left arm that it would set off an IV alarm. Later, with the nurse, we determined that when I moved my right hand it was setting off the a-line alarm.  She wrapped an extra layer of tape around the board protecting the a-line, which kind of worked. And in between that, I caught bits of sleep while sitting up. (45 degrees for a couple of days, elevated while at home for a couple of weeks.)

Later I asked if it was possible to sleep more on one side.  The answer was yes, I could be turned about thirty degrees.  The protocol involves the nurse and an aide.  First, they put the head of the bed down somewhat.  Then they grab the pad which sits under your butt, the nurse on one side of the bed and the aide on the other, and slide you back up the bed – you tend to slide down over time – after which they roll you a bit and stuff pillows under that side.  Then the head of the bed comes up and you’re in a new position.  I was moved in this way at least three times during my stay and was thankful each time.

The Next Day

I woke early and felt very alert.  I had a thought, “What am I going to do with myself? And how am I going to spend the next six weeks just sitting around?” About ten minutes later I was sleeping. The next time I woke, more aware of how unaware I really was, but still I had to do something besides sit there. I turned on the TV and discovered this was the day of the Royal Wedding of Prince Harry and Meghan Markle.  It was the perfect thing for me to watch.  Lots of color, everybody happy and it was easy to follow.  And how funny it was telling my wife and daughters about it when they visited.  Who would guess that I would be the one to know about boat neck dresses?

Somebody from physical therapy arrived and I succeeded in walking around the floor.  That’s all I had to do to be cleared to go home from their perspective.  The plan was for me to move from the ICU to a regular floor, but there were no beds available, so I spent another night in the ICU.  I was still out of it, from the anesthesia, the pain killers they were giving me – regular oxycodone and valium every four hours – or perhaps from having had surgery in the first place. Time went quickly.

Leaving the Hospital

The doctors checked me out early in the morning and must’ve concluded that I was ready to go home, though they didn’t tell me at that time or maybe they did.  Then another doctor, I suspect an intern, came to remove the dressing over my incision.  That’s when I learned that it was stapled to my head. “I’m going to remove the staples…” Doesn’t sound good, but it didn’t hurt. Or maybe it hurt, but I didn’t feel it.  She looked at my incision and said it looked good.  They fuss over the incision for two reasons (my guess);

1.      The incision is over the area where they sewed that “water tight seal” of the brain membranes.  If it leaks, that’s a big deal and it does leak in a small percentage of patients.  Worst case, they have to open things up again and redo it.

2.      They worry about infection.  Of course, infection is never good, but in an area where the infection can spread into the brain, it is particularly serious. (Which is why you’re not allowed to have a haircut right after the surgery – don’t want you to get poked by any dirty scissors.)

Then a new nurse came in, told me I was going home and was immediately in rush, rush mode.  They took the catheter out.  (It wasn’t that bad, but I’d be happy if I never experienced it again.) This nurse was different, unlike the other nurses, she did not seem kindly and caring.  Maybe her specialty is kicking people out.  She didn’t do anything wrong but was all about me leaving. “Are your people on the way? How far away are they?”  “Would you like to try sitting in the chair?”  I said, yes and moved to a comfy chair, my first time sitting in a chair after surgery, at which point she immediately began clearing the bed to get it ready for the next person.  In other words, I was committed to trying the chair until I left.

The rest of the departure is exactly how you might imagine.  The big disconnect; IV out, a-line out, EKG pads off, oxygen sensor off. Then a print out of thirty odd pages of instructions related to meds and what I could and could not do and until when.  Phone numbers to call if there was an emergency, that sort of thing. I don’t remember the details of how we got to the car, but I do remember all the green as we arrived in Sudbury.

Recovery

The plan was for six weeks of recovery.

Week One; The Blur

The first week was a blur and I don’t remember much from it.  I had meds to take four times a day.  I wouldn’t have kept up with them without the help of my daughter who made a schedule and then often checked to see if I was up to date.

I was up and walking around, sometimes, but often times, even if I wasn’t sleeping, I felt a need to be in bed.

In spite of the blur, or perhaps because of it, I didn’t feel that bad.  My incision and the row of stiches and my half-shaved head were all invisible to me.  They were behind my ear. I was a bit wobbly, but not in an unpleasant way and I was careful. I expected to be wobbly. Before doing something, I would pause and imagine how bad a fall would be; going down the stairs, going to the bathroom at night and being sure I did not want that to happen. I would hold the banister or put my hand on the wall or just make sure in some way that I was stable. I did not fall once during recovery (yes, after writing that, I did knock on wood).

I did not have horrible headaches.  Sometimes I would feel a headache coming on and that was usually an indication that I was late taking a Tylenol.  At least by the point that I can remember, I did not use the prescription meds for pain. I had Oxycodone and Valium.  For a few weeks I used these to get and stay asleep.  But even there, I cut the pills in half and used them sparingly.  I think the makers of Oxycodone (famously, a gateway drug for Heroin), have designed the pills to encourage addiction.  Unlike the Valium pills which are easy to split in half by hand, the Oxycodone pills are small and the scoring in the center doesn’t really work.  You need a sharp knife and a table to take half a pill.

With respect to the head aching I did have, there were three types.  First, they stretch the neck muscles considerably to get to the skull and had cut some as well, so they hurt in a way that muscles do.  Second, sometimes, after trying to concentrate or solve some problem (and I’m not talking about calculus, simple problems like what order we might do a set of activities), it would feel like my head was just tired out and it would be painful to continue thinking and I would have to stop. And third, occasionally a headache would begin to appear over the top of my head on both sides, that’s the one that would send me to my med schedule to see if it was time for a Tylenol (which I could take every six hours).  All of these symptoms reduced steadily over three or four weeks.

About the med schedule, I wound up using a double accounting method.  There was a schedule of what meds I had to take which my daughter drew up and which also listed what meds I could take and how often.  When I took a pill, I would check it off on that list.  But I also kept a second running list of what I took and when on a separate pad of paper.  This was useful, especially for the optional pills as it answered the question of, when did I take the last Tylenol? And was separate confirmation in case I forgot to mark one of the lists.

I had a lot of acupuncture.  I don’t know how much, not every day, but multiple times a week. Acupuncture helps specifically and generally.  By specifically, I mean that it cuts down on pain, helps with upset stomach and helped clear my sore throat.  But the general effect is equally important.  After acupuncture, you just feel better; more relaxed, more optimistic, balanced. Thank you Larisa.

One thing I do remember from the first week was how incredibly thirsty I was.  Surprisingly so – after all, I wasn’t sweating, I was hardly moving much at all. But fluids are good, so I just kept drinking.

Week Two; Steroids Rule

The main drug that I had to take was Decadron which is a steroid. Because I was taking Decadron, which causes an acidic stomach and possibly acid reflux, I was also taking Pepcid.  Starting in week two, my lack of wellbeing was all about the side effects from steroids. As I realized this, I became curious about how quickly the steroids would get out of my system.  Based on the half-life, I graphed the total dosage in my body.  You can see from the graph that the peak comes in the second week.

As I approached the peak, I noticed that I wasn’t sleeping much and felt buzzy, as if I had too much coffee.

When I say not sleeping much, I mean four or five hours a night, often with no nap during the day.  One night I slept less than three hours.  True, I wasn’t doing much during the day and felt exhausted much of the time, but I was literally not sleeping. Part of this was from the Decadron-fueled burst of energy, but a good part of it was because of what was going on in my stomach.

My stomach, especially at night, was filled with what felt like a painful, caustic, acidic, dangerous liquid which sloshed around as I moved.  I tried various things to improve the situation.  I don’t think any of them worked.  I would go on “walks” doing laps around the house.  Sometimes I would eat. Sometimes I would make sure that I hadn’t eaten. Sometimes I would take additional anti-acids, sometimes not.  It didn’t matter.  What eventually worked was time and the reduction of Decadron in my system.

The problem with sleeping was primarily due to a need to cough.  I was coughing frequently enough that the muscles in my chest hurt.  The cough would wake me up when I was falling asleep. It was not enjoyable.  There was one time when I was trying to nap, I was tired and wanted to sleep, but I kept coughing.  Suddenly I got frustrated and got up and decided to exercise.  I put on loud music and started to move. It felt good to move and that woke me up, but it didn’t fix anything, and I was still tired through and through.

One week after getting home, I went on my first outing.  Isabelle drove me to the library. Until that point I hadn’t been more than 20 feet away from our house. The library is at most two miles away.  There are no stop lights between here and there.  It was mid-day on Saturday, sunny and warm. For me, the drive down the hill was like a roller coaster.  The sensation of movement was magnified. I don’t know how much this had to do with the surgery or the fact that for a week I hadn’t moved faster than a slow walk.

When we arrived, I walked slowly through the parking lot, unsure what speed was right.  It wasn’t difficult, but I wanted to make sure I walked slow enough so that I wouldn’t have problems. What problems? I wasn’t sure, lose my balance, get tired? It was fine, but I moved slowly and somewhat stiffly.  Inside the library, we quickly found the book of fiction I was looking for on the first floor. – “The 100-Year-Old Man Who Climbed Out the Window and Disappeared,” Jonas Jonasson – suggested by my friend Phil when I said I was looking for something, light, humorous and easy to read. The beginning was good, but I got a little bored with the rest (but did finish).  – It’s the first book that I read and listened to at the same time (alternating, not literally at the same time).  Worked well actually. I decided to take the elevator to the second floor.  There I took out a bunch of large art and photography books.  Books filled with pictures that I could page through idly.  One of them was huge and heavy and over my 10lb limit.  Isabelle carried the books for me.

I’m mentioning all of this because it was an experience that fit, almost exactly, what I meant by “Deeper” in the first set of essays.  Everything was vibrant.  The excitement and rush of movement in the car.  The greens of the trees along the road.  The warmth of the air in the parking lot contrasted by the cool air inside the library.  How much I appreciated my daughter taking me and how she was attentive to how I was doing. The library itself, all the books and the fact that we could take out any of them. I love libraries. Everything exaggerated by my slow speed and the inherent question in each new action.  Would I get car sick? How far could I walk before having trouble? How tiring would it be to look through the shelves of books?  Everything went fine and that was a relief; my first outing was ok.

Other early experiences had similar elements.  We went to the garden store.  The one near our house is old, started in 1876, and the interior is a hodgepodge of old and eccentric constructions.  One section connects to the next with a steep ramp down. Would that be hard? I slowed down and walked it consciously.  I was ok!

We had friends over for dinner. I showered and for the first time put on real clothes; long pants and a shirt. What a pleasure to engage in conversation. They were sweet and brought the dinner to us. It was at this dinner when I became sure I was having problems swallowing. More on that later.

A trip to the supermarket was entirely more exciting than usual. In the parking lot I had my physical frame of reference obliterated.  I was in the passenger’s seat looking at my daughter to my left as we backed into a parking space. Past her, through the driver’s window I saw the car parked in the space next to us.  What happened was, just as she slowed to a stop, the car next to us started to pull out.  How I experienced it was that she hadn’t stopped and was going to go through the back of the parking spot to hit the car behind us. I said “stop, STOP.” But we were already stopped.  It took me an extra moment to understand what had happened and to calm down.

Inside the supermarket, I used the cart to make sure I kept my balance and walked a little faster.  A modern supermarket is no less than a miraculous wonder.  My first time back, I felt this acutely.  Foods from all over the world and not just from far away, but fresh food from far away.  And then prepared foods too, ready to eat. The amazing thing is there are four different full-size supermarkets in less than ten minutes from our house. 

Week Three; No Coffee, Throat Problems

I developed a practice of eating breakfast in bed.  I woke early, an hour or two before Larisa, cooked my oatmeal and returned to bed.  Took my meds, ate and read the newspapers on a tablet; New York Times and Boston Globe.  I should mention that Larisa moved into one of the kid’s bedrooms when I came home from the hospital.  This was good for both of us.  I could cough when I felt like it and not worry about waking her.  She could keep her usual schedule without worrying about interrupting naps or waking me when she went to bed.

This was the first time in a long time when I consistently spent a good hour in the morning reading the news. On the positive side, it is a lower stress way to get the news than TV or radio.  It is also more time efficient.  Cable news stretches everything out and you can’t choose which stories to hear fully and which to skim. But then I started to notice how bad the news was.  All of it, really terrible.  Worse, there was bad news all over.  National Geographic filled with extinction and environmental degradation.  New York magazine with long form writing delving into details of some disgusting piece of scandal.

Quitting coffee was a good idea. I’m not saying I’m never going to have caffeine again.  I’m not opposed to caffeine, but it was a good idea to quit before surgery.  If you’re the sort of person that gets a headache if you miss your coffee, then I recommend quitting before a big surgery that will rob you of your normal routine.  Sometimes I woke up at 5AM. Sometimes I woke up at 7. Sometimes I needed a nap (at any time), but I didn’t have to wonder if I needed the nap because I missed my coffee.  And I didn’t have to make coffee first thing in the morning, when first thing in the morning might be too early.  On a couple of occasions, I woke up, had some breakfast and an hour later was napping.  I needed those naps.

Plenty of times I felt a headache coming on (happily not a serious one) and instead of being confused about coffee, I went directly to my meds list and almost always discovered that I had pushed the time between Tylenols.  It’s just simpler.  If you’re the type of person who is affected by caffeine, quit it before surgery.

This is the week my stiches were removed and during that visit I was cleared to drive again.  The worry about driving after this surgery is because some people’s neck muscles are sufficiently sore and stiff such that consciously or not they just don’t move their head enough to check for traffic.  My neck was reasonably ok and besides, Sudbury is not a difficult place to drive.

It was also the week when we concluded the throat problems I was having were serious enough to warrant investigation.  During surgery a breathing tube is inserted down your throat.  It is normal and expected to have a sore throat for a week or so after.  But now in week three, with my throat seemingly getting worse and having trouble swallowing besides and then I started to lose my voice, it was time to get checked. 

The check is done by an “ENT” – an ear, nose and throat doctor.  It’s going to sound weird, and it doesn’t feel good, but is tolerable.  If you must have it done, don’t stress.  The way they do it is to first spray a numbing mist up your nose.  Then a flexible tube goes up your nose and around and down to look at the throat.  There’s a camera connected to it.  Larisa watched the screen and said she could see my vocal cords clearly. It was probably less than a minute total.  He had me make some sounds and then pulled out the tube.

The good news was that both sides of the vocal cords were moving. The bad news was there was plenty of irritation, an unexplained large amount of fluid and the cords weren’t quite coming together.  The preliminary indication was that the left side was not working quite right. He said it was hard to say exactly why I was having trouble swallowing.  The only way to be sure was to have a “modified barium swallow” test.  He also recommended physical therapy.

Week Four; Brain re Calibration, Walking, Eating

Physical therapy is a term I usually associate with activities which feel like a work out – lunges, leg lifts, stretches, that sort of thing.  Physical therapy for the throat is also exercises, but they are different than what you would see at a gym.  Over the course of the next few months, I had two physical therapists because the first one went out on maternity leave. Both of them were friendly, chatty and thoroughly knowledgeable about throat issues.

The first visit happened before the barium test.  We decided to focus on swallowing.  She had me eat some applesauce and drink some water and then prescribed a set of exercises. Things like pushing the tip of the tongue to the roof of the mouth and swallowing while sticking your tongue out (it’s tricky).

I was often in a bit of a fog, but there were also plenty of hours that felt almost completely normal.  I started walking around the neighborhood – initially with somebody walking me and later by myself – and felt mostly fine, just a bit tired.

I found a clue to understand my mental exhaustion.  In the before essays I described how my audio processing was jolted such that I was no longer correctly calibrated as to where sounds were coming from.  I described how our purring cat to my left was incorrectly located on my right by my faulty auditory processing.  In other words, I was misaligned by about 30 degrees to the right.  I think this started to correct itself before surgery.  It’s a good thing the brain retains the ability to recalibrate and to learn.

But then after surgery, I started to notice that when I boiled water in an electric kettle that the boiling sound seemed to be coming from a few feet to the left of the kettle.  For a few days I assumed that this was caused by the way the sound bounced off the window behind the kettle, but then it all became clear when I played music on a single portable speaker.  The music was magically coming from the corner of the table; the corner to the left of the speaker. Time for more brain recalibration.

At least in computers, training neural networks takes much more energy than using them.  I’m sure this is part of the cause of the exhaustion.  This is even more likely because the removal of the tumor effected the nerves and even after the removal there was post-operative swelling in that area that was forecast to diminish over the course of six months or so.  This means my brain was in a state of constant recalibration of balance and hearing processing.

One way the surgeon had described people’s lack of energy during recovery was to say, “People say they plan to clean out their closets, but mostly they don’t.”  I took this as something of a challenge.  I decided I would definitely clean my office during recovery.  My office is also my dressing room.  And I did clean it.  I went through file cabinets, threw out plenty of old papers, found a big trash bag’s worth of clothes to donate, and moved a few boxes to storage.  The problem was, I finished it too quickly.  Even by the end of the fourth week, my office was rapidly settling back to its normal level of clutter.

Week Five; No Meds At All

I usually do the New York Times Mini Crossword puzzle.  There’s one a day.  Maybe I would someday enjoy doing the full crossword puzzles, but they are harder and take more time.  The challenge of the mini puzzles is to complete them as quickly as possible.  Before surgery, I rarely completed any in under a minute.  Then a few weeks after surgery I found myself beating a minute fairly often.  Of course, it could have been a patch of easy puzzles, but this gave me hope that my brain had not been harmed.

This was the week of my “modified barium swallow” test.  If you have one of these, don’t worry about it at all.  It’s an almost funny experience.  In my case it was extra funny because there was an extra tech in the room.  One of techs was going on leave, so there was a new woman who was going to fill in.  She was experienced, had been working for years in this exact job, but in different hospitals.  Every hospital does it slightly differently so there was an experienced, local tech in the room with her.  Initially it was confusing because the local tech was younger than the new one.  In addition to the two of them, there was a radiologist and a supervising MD.  Four people to watch me do the test (all women).

When I find myself as the only male in some experience, it makes me think and have respect for the women that I work with now and especially the women that I worked with years ago.  There have been relatively few women in those organizations. They spent days in meetings with only men. I’m not talking here about the potential for discrimination by men or inappropriate behavior, though that was obviously possible.  Even leaving that aside, working in an environment which is overwhelmingly not your gender means learning a whole new group dynamic.

The test has you eat a series of foods while getting lit up by the x-ray machine.  They film you swallowing.  Sometimes from the front, sometimes from the side.  The test includes a number of elements, but it is also adapted on the fly based on what they are seeing.  The first step is to drink a liquid which looks like milk and is about the same consistency, but its whiteness is from the barium.  Barium is opaque to x-rays so they can watch the fluid as you swallow it.

After fluid you progress to pudding.  It’s approximately the consistency, maybe a little bit thicker, than chocolate pudding but is white and tastes like barium with artificial sweetener and a touch of vanilla; not great, but tolerable.   Then they make a small sandwich with graham crackers and barium pudding in between.  In this case you have to chew it up first to make a mush of the pudding and barium and then swallow.  Finally, they give you a barium pill to swallow to see how that goes.

While I was doing this there was conversation and pointing at the screen and then some with me sitting and some with me standing, sideways and forward, pudding and crackers.  Finally, they concluded and instructed me to try swallowing after first turning my chin to the left and then look down pushing my chin towards my left shoulder.  They looked at the screen and were done. 

Their conclusion was that my swallow reflex was weak on the left side.  By looking to the left and down, I had closed the left side of my esophagus and forced my right side to do all the work – which created a successful full swallow.  After the test we sat in an unused radiology room and she advised that I should try to stick to moist foods, have fluids at the ready when eating and to always remember that I could look to the left and down while eating if I was having difficulties.

The best news that she and the physical therapists were most happy about was that I was not aspirating any food (food was not getting into my airways).  That is dangerous.  The next best news that I learned upon my next trip to the physical therapist was that usually, if things were working at all, then there was a good chance of full recovery. 

Looking to the left and down is not that big a deal, but I found that it was not acceptable in social company.  I think there are strong norms about what acceptable behavior is at the table.  Looking to the left and down is weird.  Worse was the occasional need to cough up a bunch of food that hadn’t gone down in the first swallow.  I got good at doing it discretely, at least I thought I did, but still felt like I was doing something unacceptable.  The experience gave me more compassion for people who can’t, for whatever reason, follow the niceties of our social norms. The saddest part is how they must be able to see how each new person reacts to their behavior.

The best I could do was to tell people, after a coughing fit, that I wasn’t contagious. On one occasion, after I had gone back to work, I was coughing excessively and had to pull out the big guns – “it’s a side effect of the brain surgery.”

I had physical therapy for a couple of months and everything got better gradually.  At this point, months later, I’m almost completely over it.  I’m now the slowest eater in most groups, but there’s nothing wrong with that.  I’m a little more conscious of the act of eating and that’s probably good.  The only difficult situations are dealing with a plate of good food if I’m truly hungry and sometimes, managing to participate in a lively conversation during a meal can be tricky.  It’s hard to catch just the right moment to jump in to the conversation while managing to chew thoroughly and swallow mindfully.

By the end of week five, I was off all meds. Not even any Tylenol.

Week Six; Ready to Work?

I had my post-surgery check up with the surgeon and given the ok to go back to work – or go back to whatever I felt like doing. “Skydive if you want.”  I also had the happy news that I should be able to ride a bike no problem.  They also said that the weird numb area on the side of my head would eventually get back to feeling normal.  It might take six months or longer. 

This last week was a window into why retirement could be difficult.  The time moved quickly but I had this annoying feeling of not getting anything done.  True, if I was really retired, I could have projects and routines which didn’t make sense to start that last week, but still, I can now viscerally see how the transition could be difficult.

On the other hand, the weather was nice, and I spent a good amount of time reading on the deck under a sun umbrella. That was enjoyable.  I made it through Steven Pinker’s “Enlightenment Now.”  One of the most optimistic books I’ve read in a long time.

Back to Work

I went back to work on the week of July 4^th which was a great way to start.  The 4^th was on Wednesday so besides a break in the middle of the week, many people were on vacation, so everything was slower than usual. On the one hand, I was tired and there was a lot of context to reload, but on the other, people were positively surprised when they saw me. Why? Because while out I lost 10 pounds, got some tan, and was rested.

In the months since, I still wonder if I’m more tired than I would have been pre-surgery.  On the other hand, I haven’t restarted drinking coffee, so I can’t be that bad if I’m getting through the day ok.  Sometimes I have trouble remembering things, but again, is that more than in the past?  If you spend on average seven out of nine hours in meetings, how much should you expect to remember anyway?

Recent Thoughts

Gratitude and Appreciation

The first thing to say is a big thank you to everybody that took care of me.  The doctors, nurses, aides, administrative people, even the guy delivering my food in the hospital (which I hardly ate).  The people in the operating room I thank because they succeeded in doing exactly what they said they were going to do. I only know this by the results. On the other hand, I was awake when I experienced the care of the nurses in the ICU; Cheryl and Kaitlin in particular, they were great. Thanks to all of you.

Thanks also to my wife and daughters for being there when I woke up and for everything before and after. 

Thanks to Larisa for all of the acupuncture; what a luxury, if you can find a way, skip the meds and get acupuncture a few times a week after surgery. 

Those feelings of gratitude and thanks came quickly and were obvious, easy to understand and expected. What I didn’t expect were the feelings which started on the way home from the hospital and which have only grown as time wears on. The first solid wave happened while driving on route 20 at the boundary of Wayland and Sudbury.  There’s a small bridge over the Sudbury river and to the right a view into a large wetland which is part of a National Wildlife Refuge. It was so green and lush and alive; I stared wide eyed absorbing the view. There was something comforting about it.

Over the next few days I continued to see things with fresh eyes and marvel at how wonderful everything seemed.  Trees swaying in the breeze. My first shower. I find myself much more appreciative of everything; simple existence.

In my before essays, I wrote about wanting to go deeper into experience.  The amazing thing is that, so far, the experience of brain surgery has done exactly that. For the experiences I choose to have, I’m feeling them more. Appreciating them more. Or in some cases rejecting them. It’s as if the surgery peeled an insulating layer off me and I find myself more exposed and connected with the world around me.

This closer connection to reality and to people is fueling an engine of gratitude and appreciation.

Nurses

The nurses need special mention.  Especially Cheryl and Kaitlin – apologies to others that might have cared for me, but I remember Cheryl and Kaitlin. The medical team performed a space aged miracle in the operating room, but I was not conscious while they were doing their magic.  On the other hand, the nurses are there for you in a way which is more personal.  The surgeon operated on me, while the nurses cared for me. This on top of both of them having long commutes and 12-hour shifts. 

Cheryl works three, 12-hour, weekend night shifts, every week.  They no longer allow this, but as she started that way, she’s kept the schedule. She wanted it originally because her husband could watch their kids, but it’s hard for me to imagine why she still wants it – no weekend nights free.  Cheryl took great care of me.  There was only one time where she took perhaps an extra ten minutes to show up when I called (note: the desk knew it was not for a medical emergency – I wanted to be turned).  She apologized when she came into the room and told me her other patient was “on prevention” (might have been another word).  Prevention meaning at high risk of infection.  Every time she went into his room, she had to suit up as if she was going into surgery.  She had gone back and forth between our rooms I don’t know how many times.  He probably had meds too.  Every four hours? More? But every time she arrived in my room she was calm and friendly and thinking about how to make my life easier.

Kaitlin lives up on the north shore somewhere. She is younger and still has kids at home.  I asked her, “Did you ever consider getting a job closer to home?” She said, “Oh, no, this is where I want to work.”  The minute she said this, I realized I had asked a stupid question.  She is a nurse at the MGH neuro-ICU and I had asked her if she had considered cutting her commute by working in some community hospital. Duh, it would be like asking a major league baseball player if they had considered switching to a minor-league team that was closer to home.

I want to do something for them, but I don’t know what. Sending chocolates or flowers seem trivial.  I was thinking of making them medals or trophies.  Research is needed.

Something about people with Boston Accents

Both Cheryl and Kaitlin have Boston accents.  Not thick accents, but you could tell they are from around here.  Last year we went to see the Tall Ships sail into Boston Harbor.  Security was tight; there were police everywhere.  As we walked by yet another group of police talking to each other, my younger daughter asked, “Do you think they are required to have strong Boston accents?”  She was had a point.  Every cop we heard that day was certifiably from Boston.

There is something comforting about meeting somebody with a local accent; nostalgic even. In an era where everybody sees the same stores in malls all across the country – actually we’re leaving that era to – in an era where we all shop from Amazon, listen to NPR (or Fox News) and when so many people move from place to place, it is wonderful to hear somebody who is truly local.  You quickly imagine they have lots of family and old friends close by.  Maybe there are many people in the country who are like this, they live and work where their parents and grandparents did, but this does not describe my circle of friends and co-workers.

For example, if I do a quick look at the group of people we know who we might have over for dinner or visit with, the total comes to 22 (including my wife and I).  Of those, 5 are from the Boston area (all from the near suburbs, none literally from Boston), 1 from elsewhere in Massachusetts, 7 are immigrants from other countries (6 different countries represented) and 9 are from other US states. Of the 6 from Massachusetts, only one went to college here.

Years ago, I visited CERN in Switzerland.  It’s an amazing place.  Brilliant physicists from all over the world are gathered to investigate the structure of the universe we live in.  I met a number of people and luckily for me, the language of the institute was English, sort of.  I say sort of because it was not the full language.  People spoke to each other in a reduced version of English; a little bit slow, few idioms, a reduced set of adjectives and little or no use of references to shared experiences.  It was tiring in an odd way, as if I was partially gagged, and I was relieved later when I had time to chat with somebody I know there who is from the US Northeast.

I mention the CERN language situation because perhaps it is just a more extreme case of how I speak to my current circle of friends vs. how Boston natives (or any natives who have stayed in their home culture) speak to each other.  If I had stayed in Manhattan, gone to college there, worked there and if my high school friends had stayed there (some of them are there, but none of us went to college there), would we speak to each other more fluently?

Perhaps cops should have to pass a Boston accent test.  If you have the accent, it means you are from here, went to school here and never left.  You have lots of friends and family close by. You identify yourself as from Boston. You intend to stay, and you hope and assume your children will too. Whether you say it out loud or even to yourself, you love this place. Not the worst person to add to the police force.

But in practice I disagree with this line of thinking. This path tends to ignorance, tribalism, and discrimination.  In practice, I left my home town, which I loved, to go to college and that changed me.  I learned that different places have different pros and cons.  Different things that make them special and the trick is to figure out what you like about a place, not to fret about what you’re missing from your previous life.  People in different places have different values, different assumptions about how to live, and different practices adapted to their environment.

My family used to play a game where they would say something ludicrous and see if they could get you to believe it. “Can you imagine, they are now selling live chickens at the supermarket?”  The right answer to that would be, “bullshit.”  I never had a problem with this game before college, but after, it was suddenly difficult.  Could they be selling live chickens? Would that be for people to keep as pets? For eggs? Some people keep pigs as pets. Or maybe people are going natural and want to kill them themselves? Doesn’t seem likely, but? Fundamentally, I stopped assuming that my assumptions were valid.

As an aside – I marvel at the small differences between places that are not that far apart. For example, between Providence and Boston.  In many ways, I prefer (preferred, I haven’t lived there since 1982) Rhode Island.  Consider; Massachusetts got its European start when puritans arrived.  As a group, they are obviously puritanical.  It’s what they are about.  That’s what kids learn about here. On the other hand, Rhode Island was founded by Roger Williams – from Wikipedia; “He was a staunch advocate for religious freedom, separation of church and state, and fair dealings with American Indians, and he was one of the first abolitionists.” Every kid in Rhode Island learns their creation story and that’s what they hear. When I moved to Boston in 1982, it was palpably more uptight than Providence. Is that the long arm of history? Happily, 36 years later, I think Boston has managed to loosen up a bit.  Or maybe I’m just used to it?

Note: The reason why I spelled puritan with lower case ‘p’ can be deduced from PILGRIM AND PURITAN: A DELICATE DISTINCTION, by Richard Howland Maxwell

In summary, I want my cake and I want to eat it too.  I want people with highly evolved local identities.  I want people from Maine to sound like they are from Maine and people from Boston to sound different from people in New York.  I want to take a trip somewhere and find something wonderful and different that I haven’t experienced before. But at the same time, I want people to be open to others, willing to learn and relate to different ways of living and it is a core value of mine that knowing about different cultures is a positive quality.

I want those thick accented Boston cops to be welcoming to all sorts of others. Of course, that tolerance opens the door to the end of those accents.

Has a fire reignited?

During week three of recovery I had a surge of energy and ambition; to do something. I began to feel that I would be ok.  That I would survive. While I still was not feeling good, the stress of the previous six months or so was lifting.  They say that when people feel they are nearing death they tend to narrow; focus on old friends, family and familiar activities. But if they recover, they tend to open up again – new friends and experiences are once again welcome.

That’s me.

I don’t know what it’s going to be, but I have that feeling.

What is it about Brain Surgery? (in the past tense)

I’ve found that telling people you had brain surgery gets entirely different reactions than when you tell people that you are going to have brain surgery. To review, if you tell somebody that you are going to have brain surgery, it’s as if a huge black cloud has instantly formed.  It takes people down.  In many circumstances, it also distances the person as they are not sure how to react.

But when you tell somebody that you just had brain surgery, there are two kinds of reactions, both of which are positive.  The first kind of reaction is where the admission of the surgery instantly brings people closer.  They open up about a relative who recently went through some difficult surgery or even perhaps died, which sounds like a downer, but the conversations I’ve had in this category were not so much of a downer as of an immediate increase in intimacy.

For example, in my first conversation with a chimney sweep, due to an initial confusion – in email I said I was available any time because I was home on “leave.” He is ex-Navy and assumed I was in the service. – I said no I was home on medical leave. That led to me admitting it was brain surgery, but not cancer. To which he told me about his father who he had just lost to cancer. It wasn’t a long conversation, but we were talking directly to each other as human beings in a way that I wouldn’t normally expect at that point.

The second kind of reaction is fun, and usually happens in person.  This is because even after only a couple of weeks out of surgery, if I was awake, and my voice was working, I appeared perfectly normal.  So, if you’re talking to somebody, and they see that you’re just fine as far as they can tell, and then you have occasion to tell them that just a few weeks ago you had brain surgery, you get this reaction which is the opposite of the dark cloud.  As if I was saying, “Yes, there was a monster under the bed, no big deal, I reached down, pulled him out, and we played cards.” As if I was saying, “Brain surgery, no big deal.”

This is the reaction I got from the solar salesman – we’re planning to get panels installed.  We had been talking with him for a while.  Had already walked around the property.  I don’t think I showed any signs of being sick or in recovery.  He didn’t know that my beard was way overgrown – I’m sure plenty of solar customers have overgrown beards.  But his presentation was somehow not coming to an end. At some point I said, “How much longer to this process?” He thought I meant the process of getting solar installed, so then I said “No, I mean this, this meeting – you know I’m recovering from surgery, I only have so much energy for this sort of thing.” Which led to him asking and me replying “Brain surgery.”  His eyes went  wide “You’re kidding.” “Not kidding, brain surgery, three weeks ago.”  His reaction was all a happy, and I have to say, supportive “wow, you’re doing amazing.”

The idea was that since I was going to be home for six weeks, this was a perfect opportunity to get a bunch of projects done on the house – because I could almost always say, “I’m available anytime.” For the most part it was a brilliant idea, but occasionally it was a bit much.  E.g. one day the chimneys were being swept, the painters were stopping by, and the solar guy was expected right after.

I had the combination of both kinds of reactions when I went for my first haircut after surgery.  I went to a fancier barber shop than usual because of the mess that was my hair and beard and because I needed a place that would cut my hair without using buzzers. When I sat down, I had to point out the healing incision, now less of an incision than just a scar and explain that he couldn’t use buzzers over that.  Then I also felt obliged to point out that I don’t usually keep my beard in such a mess, it was just that I hadn’t been able to trim it for a month.  His first reaction was more of the fun one, brain surgery? Wow. Then he went on to talk about his family and told me quite a bit more than I suspect he tells most people, though people often tell me more than they tell most people.

Another example of a fun response came in email from my Kung Fu instructor.  I stopped Kung Fu quite a while ago when I first had vertigo symptoms but well before I knew I was going to have surgery.  This week I sent him an email explaining what had happened, that I was recovering well and would likely be back in the fall – a bigger break than I expected when I last contacted him. His response (in part); “So do you think brain surgery is an excuse not to do kung-fu? Recover faster! Lets do this :)” I am certain the tone and content would have been very different if I had said “I’m going to have brain surgery next week.”

This pattern likely applies to any form of bad or difficult passage.  If you meet somebody who says they are going to declare personal bankruptcy, that’s a downer. But if you meet somebody who is obviously doing ok and they say that last year they had to declare personal bankruptcy, then you can have a conversation about how they got through it. Similar, if somebody says they are flunking their courses and have to drop out of college, that’s sad.  But if you meet somebody who is doing well or just graduated and they tell you that two years ago they messed up and had to drop out for a year, then that is a positive story of resilience.

I’m hoping my experience becomes a story of resilience; something that didn’t kill me but made me stronger or at least a little bit wiser. It will take years to know the answer to that question.

Email Withdrawal

I have two main email accounts, like many people, one for work and one for home.  Sometimes I mix home email with work email and now I’m sure I need to stop that; not so that I don’t answer the occasional home email at work, but instead to make it easier to completely ignore the work email account when I’m not working.

I get tons of email at work, between 100 and 200 per day. Many of them have an assumption of fast response.  Because of this, I check email frequently during the work week.  I don’t get nearly that kind of traffic on my personal email account, but because of the volume at work, I often fall behind on personal emails and tend to catch up in the evenings or on the weekends, which has the effect of getting me in front of the screen and so I tend to check work email as well during off hours and sometimes respond depending on the topic and who is involved.

What this means is that before surgery, I was in the habit of checking email at least hourly, almost always.

During my medical leave, I set people’s expectation that I would not check work email at all.  For the first week or two, it was easy to keep that promise to myself because I was out of it, and happily, that helped me sever my connection to my work email account.  I haven’t been checking.  I’m not at work.  Time is flying, I’m writing this after four out of the expected six weeks of leave has already past.

Not checking work email has allowed me to catch up and clean up my personal email account. I don’t think I owe anybody a response and there are no unread emails. The last few days it has become obvious that I don’t need to check email as often as I do. It could become a once a day activity, like opening the physical mail. This possibility is fascinating to me. What an amazing increase in focus and relaxation.

At the same time, I’m going through something like withdrawal.  It was a strong habit and obligation and my internal timer keeps bugging me; check your email. This is in week four, but I can say, writing from the perspective of the beginning of week six, that I only had a few days where I began to understand what a life without constant email was like before I started to prepare to re-engage with my electronic work life.

Now, weeks after going back to work, I’m fully back to old habits.  There is always email to read and respond to. I am never caught up. This is a modern disease.

When you Don’t Have Confidence in your Body

For the most part, everything is just fine.  I’m mostly recovered from the surgery and pursue my life with few, if any, issues.  But that “if any” is caused by the nagging doubt that everything might not be ok.  Because of the surgery, I do a double take with every unpleasant sensation.

For example, I feel wobbly sometimes; a little off balance. Occasionally it causes me to have to do something to deal with it.  For example, yesterday I started up the stairs, but on the first step, somehow, I was off balance, so I stepped back and started over.  What about that? Is that a sign that I’m losing vestibular function or was it just one misstep easily dealt with?

If I don’t understand something, or don’t remember what I had for lunch is that a sign of degradation or just noticing how things have been for years? I wasn’t remembering things well before the surgery either and at that point I attributed it to lack of sleep and stress.  Why isn’t that the likely cause now?  But I have to wonder.

An unusual example happened while I was listening to music through a web browser (Pandora).  The music started playing too fast and sounded odd.  It wasn’t too different than some of the strange audio effects I’ve experienced so I didn’t know if it was the computer or my brain that was malfunctioning.  Happily, a restart (of the computer, not my brain) and the music sounded fine.

I think this sense of not trusting my body will last for a long time. 

The Good in the Bad

I have been thinking about this off and on for a long time.  When I was 22 I moved into a house with two other guys.  There was no Internet in 1982 and the way I found them was by going to a storefront which contained listings of people looking for roommates; a piece of history, a physical set of Craig’s List pages.  One of the guys became a friend of mine (though I haven’t seen him now in many years), the other not.

The house had a dishwasher.  That doesn’t sound unusual, but I didn’t grow up with dishwashers.  We didn’t have one at home until I was almost out of the house – or maybe not until I was in college.  Rented apartments weren’t set up with dishwashers and the building managers worried about what they would do to the pipes.

Both of these guys grew up in suburban houses in New Jersey, where I suspect there was a well evolved culture of how to use a dishwasher.  From them I learned that I was loading sharp knives into the dishwasher incorrectly. 

“Put the sharp end down so you don’t risk cutting yourself when taking them out.”

My first reaction was that this was an unmanly way to load the dishwasher, wimpy, wussy, doing something unnatural because of worry about poking yourself.  After all, from the knife’s perspective, it would obviously rather be resting on its handle.  I didn’t vocalize this reaction, because my second reaction was that it made obvious sense and there was no reason to do it any other way.  Pointy knives go in point down and then can be easily removed by grabbing their handles.

Six years ago, I started to work in my current company as a manager and noticed that everyone is trying to do a good job. That doesn’t mean everyone is succeeding, but they are trying. Where are the people with bad attitudes? The answer is we don’t hire them and/or don’t keep them, but the more confusing question is, are we worse off for not having a few people with bad attitudes? People who would be more likely to say, “I don’t want to do that, it’s stupid and a waste of time.”

Recently I explained to somebody, who was truly surprised, that in the 1970’s Times Square was filled with triple X porn movie theaters.  I’m still surprised when we go there, and I see that it isn’t.  New York was dangerous when I was a kid. There was a regular tinge of fear. A constant awareness and suspicion. Today people worry about gentrification, but at that time it was urban decay.  The presumption was that everything would steadily get worse and hard to say when it would stop. The Bronx was burning. Crime was high. Stores closing. The parks off limits at night. Graffiti on everything and mostly not the artistic kind. Trash everywhere. Gritty New York.

I remember coming home late one night when I was in high school; likely one or two in the morning, maybe later.  The building I lived in had a simple lobby on the first floor.  No doorman, but a locked door and then entry to a room, the hallway beyond and an elevator.  This night the outside door was propped open and there was a policeman who looked me over as I came in.  He didn’t say anything to me, as he was focused on the street. In the lobby room there was a fellow building tenant, an older man, who had been beat up.  His head was bloody, and he looked unsteady.  I understood from the chatter that he had been jumped just after unlocking the lobby door, pushed inside, beat up and robbed.

There was some confusion as to whether the assailant was still in the building.  One terrifying aspect was the police that were there.  They were different from the usual cops.  A different type of human; huge, in shape and absolutely ready to beat the shit out of somebody. I was OKed to go up to our apartment, but the lesson of the evening was not lost on me. No relaxing until the bolt was locked on our door.  It was a wake up. Not a happy one, but effective.

But now things have changed. It’s great and wonderful that New York, and everywhere in most of the US is so much safer than it was. Nobody who can think clearly would want to go back to those bad days, but have we lost something?

In the past year I’ve been fascinated by two “movements” which are similar in their core.  Wim Hof is a Dutchman who advocates getting cold – that’s the easiest way to put it.  He believes, and seems to have proven by demonstration, that humans are designed to be comfortable in much colder temperatures than we allow ourselves to experience.  There’s training that needs to go into it because there are muscles in the blood vessels that we don’t use (because we don’t let ourselves get cold) and they need to strengthen after atrophying for a lifetime.

I was not motivated or disciplined enough to follow his full prescription, but during the course of last winter, I would occasionally stand outside for a few minutes in shorts (or naked at night) and when driving to work, I would sit in the car with the heat off for the first ten minutes, allowing myself to feel really cold before turning it on. This did not change my life radically however, I noticed I had an easier time walking between buildings at work with no winter coat (we have a four-building campus where 100 or 200 yards separate the buildings).  I think the training helped and I can imagine more training would help more.

The second movement promotes giving our bodies a ‘movement diet’ that is closer to what we were originally designed for.  Katy Bowman’s book “Move Your DNA” is a good example of this.  If you’ve heard of “Sitting is the New Smoking,” that is part of these ideas.  For example, we all use many labor-saving devices that we don’t even think of as labor-saving devices.  A good example is a kitchen counter.  She points out that without kitchen counters, we would be squatting and doing those tasks on the ground.  In fact, we would all spend a great deal more time squatting. It’s easier not to squat – but squats certainly stretch many muscles and joints.

I’ve been using a sit/stand desk at work and at home for many years and spend about half my time at desks standing.  It feels good. At the very least, it makes museums easier (lots of time standing). Based on Katy Bowman’s book, I’m now experimenting with “minimalist shoes.” So far so good.  Minimalist shoes have three main characteristics; 1) they are flat, no drop from heel to toe, 2) they allow you to feel the ground (minimal padding), if you step on a stick you can feel it and 3) they have plenty of room for your toes.  It’s only been a few weeks, but I think the little toe on my left foot is starting to straighten out.  Maybe the right one will too.

A little more detail on the notion behind these shoes because it is such a great analogy.  Bowman says that the invention of sneakers (and other shoes) with substantial padding and shock absorption in the heel encourages a fundamental change in a person’s gait.  The sneaker wearing gait is one where you strike the ground first with the heel and roll forward to the toe.  It encourages longer strides as well.  With minimalist shoes there is no padded heel and people tend to strike the ground with the full foot or on the ball of the foot and absorb the shock through the foot, ankle and calf – and people take shorter strides. Regardless of which might win a race or feel better, we are designed for no shoe locomotion and the gait that works best in that condition.

In the case of Wim Hof, he links his practices to a reduction in a number of diseases.  In the case of Katy Bowman, she talks about reductions in joint problems and aches and pains.  Both of them claim practices which use our bodies in ways which they are designed to be used are good for us.  This makes intuitive sense.

How do these physical examples relate to our emotional development?  Do we need to cut ourselves on a tip of a knife to become aware of our surroundings?  Do we need to be scared from time to time? Do we need to have a risk of not having enough food, shelter, or clothing and experience getting through those challenges? Do we need to encounter ‘bad’ people (or be a little bad) to more fully develop our theories-of-mind? (If you’re not familiar with the term – here’s what Wikipedia has to say.)

Unfortunately, I come to the conclusion that full mental and emotional comfort is likely as unhealthy as complete physical comfort combined with inactivity.

Brain surgery is a wake up too, but I don’t suggest that either if you don’t need it.

Upon more reflection, not all examples of this point I’m trying to make encourage difficulty.  Have you ever noticed that sometimes when smoke or water with waves are displayed on television that the compression algorithm can’t keep up?  If you look closely sometimes you can see little squares instead of the detail of the waves and spray or the random curlicues of smoke and flame.  This is because the compression algorithms depend on seeing regularity, dicing it up and predicting where it will move.  Think of a person moving in front of a wall.  The person has a lot of detail and is moving, but the whole wall remains constant.  Even the person, for example the side of their face, doesn’t change it just moves across the frame.

But real nature has all sorts of changing variety.  Sitting on our patio on a breezy day I find it immensely relaxing to stare up at the trees and watch the way the leaves move.  Staring at waves crashing on a beach is mesmerizing as is sitting around a fire.  Why?  One simple answer could be that it is because that’s what we’re designed to do, but what does that mean?  Could it mean that a significant portion of our visual cortex is designed to process these kinds of images? Could that mean that sitting in a room with four walls, with no moving images and little detail is depriving a kind of stimulation we need for healthy living or even that it causes some part of us to atrophy? Somebody rev-up the fMRI.

fMRI is functional magnetic resonance imaging.  This technique makes it possible to measure changes in blood flow in the brain.  It shows what parts of the brain are involved (and how involved) in different activities.  I wonder if watching a constantly changing dynamic pattern, like a fire, occupies a large portion of the visual cortex.  Going further, perhaps it occupies enough of the brain such that it quiets other functions; causing relaxation.

“Rev up” is a reference to accelerating an internal combustion engine.  I wonder how much longer that reference will work, though I suppose “crank up the fMRI” might still work too and that is much older.  We don’t start our cars with cranks anymore. For that matter, you could still probably use “build up a head of steam” in polite company and most would get your drift.  Still, this idea of building up potential energy in preparation to do something is likely to fade.  So long as we’re connected to the grid, all the power we need is right by the plug. Pity, “turn on the fMRI” doesn’t have the same ring.

It’s been proven that people are more creative after walking in the woods.  That people recover faster when they can see trees and plants.

I spent my recovery looking at trees and that was good.  It is important to remember that the software which is our twenty-first century minds exist in wetware which was designed a very long time ago.

Evolutionary Reason for Belief in God

I have a theory, but I have no basis for it other than it sounds right to me.  I’m not exactly sure how one might go about testing the theory; this is not science.

To clarify my topic, I’m not talking about the phenomenon of organized religion, which strikes me as much more complicated. I’m focused on belief in God.  And when I say God, I mean what some call “a personal God.”  I’m not talking about being generically spiritual or believing there might be forces we don’t understand.  I’m talking about belief in a God that pays attention to us, that listens to our prayers and that might intervene on our behalf.

I suspect humans are genetically predisposed to believe in God (or Gods) because it has survival benefit. Further, I think it is a development somewhat required by our curiosity, intelligence, and ability to have reasoning effect our motivation.

Let’s start with a single celled amoeba.  It senses food and it moves in that direction.  It doesn’t move quickly or slowly, it moves at the speed that it moves. It doesn’t move differently based on how easy it thinks it will be to find its next meal (it doesn’t think).  I am not an expert in the biology of amoebas, (is that the plural?)  but I’m fairly confident they don’t have thoughts and emotions as we define them.

Or ants.  They are more complex, sensing many more inputs and making decisions – or rather – reacting based on more complex instincts.  Which way does an ant go if there is a rotting plum to the left and an Oreo to the right?  Let’s say it goes to the Oreo, we’d guess the Oreo has more sugar or there is some other elemental characteristic which causes the ant to make that choice.  It isn’t because it remembers eating Oreos when it was young, hasn’t had one in years and thinks now would be a good time to see if they are as yummy as the ant remembers.

Skipping right through the rest of the animal kingdom to ourselves, the situation is more complicated.  We are highly effected by our emotional state. We are constantly thinking, planning, and calculating what is best for us as well as what disasters might lurk around the corner.  The problem is that we are often wrong about what we think.  Further, from our gene’s perspective, we should try as hard as possible even if there is no cause for hope, because we might survive.

Consider this with respect to anxiety and motivation.  Imagine the situation; there’s a lion circling the camp.  Somebody has to kill it or chase it away.  Maybe a few somebodies together.  It is terrifying but must be done. Imagine that in previous cases somebody always gets injured.  It is justifiably terrifying. Praying to a higher power, getting strength from an amulet, believing that your good deed might give you credit towards an afterlife, all of these might help you gather yourself to meet the challenge.

Or more simply, imagine an early human walking in the desert, gradually running out of water.  The expected water hole was dry and now our human is walking in an unfamiliar area and has no confidence that water will be around the corner.  Hours are passing, our poor ancestor is getting tired and has lost hope. In fact, losing hope is quite logical and the odds are stacked against success, but belief in a spirit might be worth an extra hour or two of exploration before giving up in a hopeless heap. But maybe in that extra hour or two they would have found water.  This belief in the spirit preserves the ability to make the best possible judgement of chances, but still have a reason to persevere when rationally, the situation is hopeless.

And that’s not the only benefit.  How often have you solved a problem by talking it out with somebody?  Not that your companion provided the answer, but that you figured it out in the course of laying out what you know and have thought about the problem.  Imagine our ancestor walking in a strange land, desperately looking for water and then a conversation with a spirit begins.  Perhaps the water god?

“Oh water god where are you? I’m so thirsty?”

“Why don’t you come to me?”

“But I want to, you weren’t in the usual place. Where are you?”

“Where would I be? You have found me before.”

“Right, I have, now where was that? Hmmm, usually near clumps of trees and bushes.”

Or something like that. What I’m saying is that belief in a spirit can help motivation, can help when somebody is alone facing a problem and that creates a survival benefit.  This gets magnified when groups of people are synchronized in their beliefs. Sticking with water as an example problem to be solved; Native American rain ceremonies went on 24x7 until it rained.  It was a group activity.  I’m not saying this increased the chances of rain, but it must have drastically reduced the possibility of internal strife before the rain and greatly increased community cohesion once it did rain.

Given the huge role “in-group” vs. “outsider” plays in our psyche; the role of god(s) in community cohesion likely also offers survival benefit.

The spirits do not have to be real to extract these benefits. In some sense, this is the problem.  I believe it is more correct to be an atheist – that is my belief – but I can’t deny that it makes it harder for me to be sure I’m on the right path.

I once worked in a startup which was majority owned by Samsung, a Korean company.  Half the staff were from Korea.  There is a portion of Koreans, perhaps a larger portion when considering Koreans that have moved to the US, who are devout Christians.  Really devout. I don’t know the details of what they believe (or how they express it), but from the outside, they seem to be right up there with fundamentalists and evangelicals.

One of the guys, an MIT graduate, told me that I should believe in god.  I said that I didn’t believe. He said he understood but asserted that if I did believe in god that my life would be easier, and things would go better.  I said that I agreed with him to some extent and could see how that could be true. He said, “So believe, and then if things go better, you can see how believing is the right path. That’s what I did. That’s how I came to believe, because at first I didn’t.”

This was a mind-bending notion for me.  First, I didn’t see how I could believe, but at the same time not believe.  He was asking me to lie to myself and then be gullible enough to believe my own lie. I pointed out the reason I thought believing might make things better had nothing to do with the existence of a deity and was surprised when he didn’t disagree with me.

Ultimately, he was taking a completely utilitarian approach to belief.  His actions were saying ‘I know religion is the opium of the masses, but I like life better when I’m high.’

This is the big challenge for us non-believers.  Instead of focusing on how unlikely the existence of god is, we need to elaborate how an individual’s life can be improved by giving up belief.  That’s not easy and might not even be true.  Subject for a future essay.

People can be Great, but lots of People Together is Problematic

Pretty much every individual I encountered through this experience was wonderful; supportive, helpful, compassionate.   And thanks to all of you.

The question is whether it will ever be possible to get humans to agree enough to make progress on the big problems.  Take climate change: In my opinion, most of what we would need to do as a species to combat climate change would feel good.  It would cost some money and likely many habits would need to change, but they would not be painful.  I would love it if there were high speed trains.  Closing coal plants would make the air cleaner.  Massive re-forestation doesn’t feel bad. Electrifying the infrastructure to take advantage of renewables would eventually be cheaper than what we do now. For that matter, shifting towards a culture that buys fewer, but higher quality and more durable products also sounds good. From the perspective of human and planetary health, moving to more plant-based foods is also good. 

Each one of those actions implies compromise by a sub-group.  The price of the investment will have to be borne by people that can afford it.  In other words, the cost will be levied progressively.  Perhaps a consumption tax.  The big money people won’t like that.  Some environmentalists won’t like wind turbines on the horizon.  Some rural people won’t like something about the way large tracts of land will be allocated for re-forestation or conservation. Suburban people may object to the switch to trains. Plenty of people will object to the rise in price for meat vs. plants based perhaps on sustainable water pricing. And of course, the coal miners will have to find something else to do. Wouldn’t they rather plant trees anyway?

But this is literally “save the planet” (for us humans). It’s insane that we can’t make progress on this.  It’s all a matter of political will, not resources or technology.

Palpable Mortality

Last comment on the brain surgery experience; it’s already fading, but for a time it made my own mortality real and present.  We all know we’re going to go sometime, but mostly the thought is thrust to the background, because it is hard to contemplate.  The silver lining of being forced to consider the end is a strong appreciation of being alive and a desire to live the most authentic life possible.

© Copyright 2024 David Rich All Rights Reserved

I am having brain surgery on May 18^th.  I’ve had operations before, been in a serious car accident, talked in front of thousands of people and done any number of other things which made me anxious, nervous or scared, but this one is big and it’s not taking me by surprise.  I have time to think about it and time to think about how thinking about it is affecting my thinking.

One of the best ways of understanding what I’m thinking is to try and write it down.

One of the best ways of working through thoughts and feelings is to share them with people.

That is the preamble to these essays.

One other thing.  I’m giving myself extra license in this writing.  I often edit based on the potential to cause problems with others.  I won’t mention something which might not look right to a co-worker or a friend.  I carefully consider multiple audiences as I speak or write.  Management is my profession, and these are good qualities for managing.  But on May 18^th I’m having brain surgery and I don’t want to worry about others as I write.  Instead, when I have a thought like “I don’t know if I should share this” I will add an * and write on.

Focus

I have a white board in my home office.  On one side I use magnets to put up various papers related to the future; tickets to shows, doctors’ appointments, real estate tax bills, anti-Trump stickers.  The right two thirds have three groups of text lists.  One in brown are house projects; fix the roof, things like that.  On the right side of the board in green is a list of potential projects or hobbies which I might like to take up; learn Spanish, learn to draw, (re)learn Math and more. 

In the center of the board is a small list in black.  It is titled “Goals” and has four lines.  The first line has fun crossed out and replaced by enjoyment.  Like this; “Fun Enjoyment”  I made the change because fun, while fun, seemed like too fleeting of a word.  Enjoyment is a longer lasting more durable experience and that’s what I want.  The next line is “Health” followed below by “Fulfillment” (but with no extra words to define what I mean) and the last line is “$’s when older” (remember to save for retirement).  It’s a fairly generic list.

I wrote those on the board a while ago and hadn’t changed them since.  I’m not sure about lists.  Sometimes the last things I’ll ever get to are the ones I’ve bothered to write on lists.

Then, in the light of needing brain surgery, I took a look at this list and made a change.  I took the red marker and made an arrow from “Goals” and pointed it directly at a new word, in caps, “SURVIVE”.

What is it about Brain Surgery?

When you say you are going to have brain surgery, even to yourself, you get a big reaction.  A mix of horror, anxiety, and fascination.  The idea of opening the temple which is the skull and exposing the organ to the world provokes – so far in everybody I’ve met – an undeniably heavy reaction.  And you get this reaction before sharing any details; just the fact of brain surgery is enough to provoke it.

It’s not that the surgery is necessarily bigger than others.  I had a hip replaced.  Think about it, to replace a hip, they had to open up my leg enough to get a buzz saw in there to cut the top off of a big bone and to ream out the socket.  One part of the artificial hip is slammed into place with a three-pound hammer.  A set of muscles are stretched so far that it takes months to build strength back in them, and you have to work it with regular and determined exercise.  That was a serious surgery, but I didn’t get nearly the reactions I’m getting now.

At a recent party, I was talking to somebody who is also going to have surgery soon* and the risks of her surgery sound really scary. She is having disks removed from her neck.  Those disks surround her spinal cord and I think they are going to replace them with something artificial.  Maybe that operation is well known and low risk?  But in the meantime, her neck is somewhat unstable and the wrong accident could have horrible consequences.  Really horrible.  But somehow, my surgery was worse. Brain surgery.

I think there is an assumption or feeling that the brain is a single thing and that operating on it means you’re having an operation on all of it.  And all of it is a lot.  We know the brain is the organ that connects our mind to the physical world.  Cut the optical nerve and you can’t see.  Sever parts of the spinal cord and lose control of your muscles, lose feeling or worse.  And even if the connections aren’t damaged, we all know on some level that if something in the brain is messed up that has to do with these functions, then it amounts to the same thing; an inability to process signals from your eyes makes you blind, to generate the control signals to your legs; or breath.

One could argue these physical connections are not too different from other surgeries.  If my hip operation had gone horribly wrong, then I would have perhaps lost the useful operation of that leg. But of course, with the brain, there is more.  We all believe that our deepest sense of ourselves, our thoughts and feelings, our memories and desires are stored in and executed by; given reality by our brains.  In that sense, brain surgery means somebody poking a sharp object into my memories; first kisses, child births,  the first time I realized I loved my wife.  When they pull out that cyst, what else comes with it?  The way I laugh? My ability to enjoy music? From this perspective brain surgery is operating on the total self.  You can lose a hand, an eye, a leg, those would all be downers for sure, but it would still be you afterwards and if you’re strong and determined and have people that love you, you know you will pull through.  But not if you lose your brain.

If that wasn’t enough, it goes further.  I’m an atheist, but lets imagine I wasn’t. If I was to guess, religious people do not believe your soul is in your right foot, or your hand or legs or arms.  I doubt there is a priest or rabbi that would say that a quad-amputee has lost their soul.  People now live with electric pumps instead of hearts (yes, truly, I met an engineer that uses our software to design them* -- no heartbeat!), but again, I’m sure the pope would agree with the notion that those people still have their souls.  You see where this is going. If there’s a soul, it must be in our heads and continuing the thought experiment, surely it must be in some part of the brain (people with metal plates instead of skulls must pass the ‘still has a soul’ test).  From this perspective, when they open up my skull they will expose my soul to the outside world.  No wonder people make that serious face when I say I’m having brain surgery.

From this perspective, I hope there’s good music playing in the operating room.  Larisa will put up with a lot, but I’m not sure what she’d do if the surgery turns me into a country music fan.

Plot Disturbances

People are said to understand the world through stories.  We especially like stories about people and I learned recently this is part of our evolutionary destiny as the ability to discern the intentions of other humans is critical to success in our social society. We make up, tell and listen to stories about people endlessly.

We sort people instinctively as within or without groups we belong to; whether that be work, race, religion or book club.

Naturally, we play the leading role in the stories of our lives and, at least in the story of my life, there are a limited number of people who have significant parts.  When I see or talk to these people, I feel certain I will see them again.  Saying goodbye has little confusion. There are also countless people who are extras.  They show up briefly, performing blandly or remarkably and then disappear.  I don’t expect to see them again.

Within the last couple of years, I have sometimes confused myself through kindness. Most often, this happens with somebody in a store.  I go in to buy something, find it and am in the process of paying. If the moment is right, I feel open and pay real attention to the person behind the counter.  I look them in the eye with a friendly glance and say something off script, something that is a real snippet of conversation and sometimes, they respond. A short conversation ensues, usually very short and not very significant.  Something like this,

Me, “Did you lose power during the storm?”

“Yes, we were out for three hours.”

“Did you close? Did you go home? That must be hard.”

“Actually, I couldn’t get home, because I didn’t have a ride until the end of my shift.”

“So you just stayed in the store in the dark?”

“Yea started to get cold too.”

‘Well, at least you were getting paid for it.”

Sometimes the conversation goes longer, and I leave the store a little confused.  Is this character going to be written into my life story? How big a part will they play? What is my involvement with that person?

A similar thing happens at work.  I work at a big company and don’t nearly know everybody.  There is a sequence to initiating a conversation with somebody you don’t know but see regularly in the halls.  At first, you walk by people with no recognition.  The next step is a kind of blank glance as you pass.  It’s a glance that indicates that you recognize their face.  After that goes on a bit, you can graduate to indicating recognition.  Sometimes with a raise of the eyebrows or a kind of half smile made by pushing up the lower lip a bit.  If this becomes mutual, you will eventually graduate to a smile and maybe say hi in passing, after this point, if you encounter the person somewhere where you are both stationary it is likely that one of you will engage in some meaningless piece of conversation, which, over time might evolve into actual communication.

That is the normal sequence.  One time I confused somebody with somebody else and jumped from blank stare directly to smiling and saying hi.  It messed up the plot completely. 

These are small plot twists in the natural flow of the story of my life where I am the main character, but they at least prepared me to consider a bigger plot twist.

I was lunching with somebody that works for me. It’s fair to say that I have been pivotal in accelerating her career*, partly through coaching, but mostly by giving her the chance to do something bigger.   It was shortly after learning that I would need surgery. Suddenly I had the thought that maybe I wasn’t the main character after all.  Maybe she was the main character and I was just color for her story; one of her influences that would help “the audience” see how she developed into what she would become.

The thought was powerful, because I realized that eventually this would have to be true.  It is what mortality is about.  Eventually each and every one of us is gone and our story is only continued to the extent we have been part of the lives of the people that survive us. This idea percolated for a couple of days as I tried to make my peace with it.

Finally, something changed in me and I decided I didn’t want to accept this plot line just yet.  I had the feeling that I’m not done.  There is more to my story. That is when I wrote SURVIVE on my whiteboard.

Thank you for Insurance

I have insurance.  A good amount of it and I’m thankful for this.  There are at least three levels of thanks.  The first level, the one I want to be true and want to be thankful for is the way that I hope and intend for this experience to play out.  I’m going to be out of work for a little over six weeks.  During that time, short term disability insurance will pay my full salary.  Even if it takes me a bit longer to be ready for real work, short term disability extends to twelve weeks.  I could, theoretically, leave work mid-May as planned, be out on disability and then take a couple of weeks’ vacation time, not return until September and would not lose out financially.  It’s not insurance exactly, but I’m also thankful that I trust that my employer wants me back.

Further, and this applies to all three levels; my medical insurance is quite good.  I expect I will hardly pay anything for this experience and that is a miracle.  I don’t know what the cost is going to be, but I expect it will be north of $100,000.  After all, the cost for my hip replacement was something like $45,000 and I only paid $250 for that experience.  This will cost more, though maybe I’ll be surprised in the other direction.  There’s no replacement brain to pay for.  There’s no physical therapy.  But there is a night in the ICU, 4 nights total instead of 2 in the hospital, and the surgery itself is at least three times longer.  And, also, it is brain surgery.

The second level comes into play if the surgery doesn’t go so well; what if I can’t work after surgery?  This could be due to relatively minor to major causes. I could lose substantial control over the left side of my face.  If that happened, I don’t think I could be effective in a job that involves influencing people. Or I could find that for whatever reason, I’m only good for three or four hours a day of work before experiencing exhaustion or headaches or who knows what.  Or maybe it is worse and I lose, through whatever mishap, some significant percentage of my cognitive abilities.  Whatever the reason, if I can’t work, more insurance comes into play. In particular, long term disability which covers me until I’m 65.  It would be a big step down in income, but as we’re almost done paying for kid’s education (1 more year), and have plenty of equity in our house, the obvious choice would be some real downsizing and then live within our means.  We would not be ruined.

The third level is the topic which must not be named; the “… or death” part of the consent for treatment.  If I’m gone, then there’s life insurance for Larisa and the kids and they will be just fine (after a suitable period of grieving of course!)

At this moment, just a couple of weeks before surgery, the main point of the thank you is I don’t have to worry about this.  What a nightmare it would be if I had to simultaneously worry about surgery and a potential disaster of not being able to pay rent/mortgage/food bill/school costs.

This thank you obviously must end politically.  Every other developed country has found a way to provide health insurance for their residents.  What’s wrong with the USA?  At least Massachusetts requires health insurance and over 97% of people have it. 

I Quit Coffee

Why? Because it was pretty much the only thing I could do to get ready for surgery.  If I miss coffee, I tend to get headaches.  Headaches are the most common problem after brain surgery.  I didn’t want to be concerned with needing to time my coffee doses.  So I quit.

Climate Change, Root for Humans

We who care about the environment have taken the wrong approach to describing our concerns to motivate people who don’t seem to understand or care.  Pictures of starving polar bears and melting glaciers get me down, but they aren’t working.  Messages about protecting species from extinction and preserving wilderness areas aren’t working either.  “Protect the earth” as a rallying cry isn’t working.

And why should it?  The earth will be fine.  If the earth had a perspective, these changes are trivial, meaningless, and infinitesimally short.  Oceans rise and fall.  The composition of the atmosphere changes, species come, and species go, what does the mass of the earth care about that?  What is this craziness that earth cares about anything at all?

Mother earth is a terrible moniker in so many ways.  Yes, we came from the earth, so in that sense, the earth did give birth to us, but more in the way we give birth to pimples than the way human mothers give birth to babies.  We are not baby earths.  And while, to date, the earth houses and produces materials which sustain us, it hasn’t been doing so for us.  Our relationship is more like shoplifters in a shopping mall.  On top of which, what mother feeds their adult children?  We should be an adult species by now and should be on our own.

The earth is no mother, it is a planet.  We’ve got to stop anthropomorphizing everything.  I was talking to a landscaper working on a neighbor’s place.  We were commiserating about the unusual weather going around and the troubling sea rise coming in the not too distant future.  About hurricanes he said something like “Hurricanes are earth’s way of dealing with the warmer ocean.”  I didn’t have time to disabuse him of this.  Earth isn’t dealing with anything.  Earth doesn’t care.  Warmer oceans are not something that need to be dealt with from the earth’s perspective.  Earth doesn’t care and doesn’t care if the gulf stream stops flowing (making lobsters and cod extinct, freezing Europe, melting Greenland and putting a good bit of the east coast under water).  And even if it did, hurricanes don’t deal with that anyway.

Which brings me to the point. We, us, humans, we care. Climate change is about us.  For once, we need to recognize and embrace our usual self-centeredness.  The earth doesn’t care what percentage of the land is usable for farming the few plants we prefer to eat, but we do.  If we want the planet we call home to continue to support us, we have to prevent it from turning into a planet suitable for different species.

The crisis of climate change is a crisis for humans and that’s the message we need to get across.

On the other hand;

Some years ago, I was guilty of anthropomorphizing myself.  I couldn’t help it.  We lived in California for two years and it seemed to me the land had a different personality.  In New England, you get something horrible almost every year, but not too horrible; hurricanes and Nor’easters are terrible, but you can see them coming days in advance.  Cold snaps and snow storms are sometimes pretty and sometimes a drag, but mostly are not dangerous if you behave appropriately.  From this perspective, nature on the east coast is predictable and somewhat comforting. It knows how to vent its grievances before they become problematic.

The west coast is different.  It is absolutely gorgeous most of the time.  Sunny when it is supposed to be.  Not too cold, not too hot. Some rain in the winter, just enough (hopefully) to fill the reservoirs.  But then, without warning, there are these disasters; mud slides, fires, earthquakes.  If only west-coast nature could learn to share its feelings better, maybe it wouldn’t lose it so badly.

From this perspective, mother earth is really going to squish us if we don’t start behaving right.

Not quite, except for one thing

One day about a year ago I had the thought that if I was to write an autobiography, this would be the title; “Not Quite, Except for One Thing.”  That’s the way I summarize my performance to date in the trial of life.  In most aspects, I’ve done ok, but not quite great.  Academically, I was adrift starting in 9^th grade, with fits and starts of doing well enough to get me into and through a fancy college.  My career is ok, but not what it could have been considering the advantages I’ve had and the mistakes I’ve made along the way.

I read a lot, but kind of randomly, so I don’t know a lot about any particular thing.  Same with hobbies, I’ve tried all sorts of things (and enjoyed them), but haven’t stuck with any.  I’ve started writing novels, but haven’t finished any. I did a bunch of martial arts, but stopped when it really got serious.  I’m a dabbler, not quite committed.

But there is one thing, and I worked for it. I was committed to the idea that it was possible: I am in love with my wife and happily married and I love, enjoy and am proud of our children.  These are not simple-minded statements made lightly.  None of us is perfect and we are living real lives where there are struggles from time to time, but in terms of our relationships, it seems to be working.

My parents are divorced and didn’t have an easy relationship when they were together.  The neighborhood I grew up in had few intact families.  In my middle school friend group, my parents were the only ones that were together and in retrospect, they shouldn’t have been.  Starting in high school, I went through a series of fairly serious, relationships.  In my 20’s I went as far as moving in with two different girlfriends, but in time I understood that something was off – whether with them, with me or with the combination doesn’t really matter. Some thought I had a problem with commitment, and I wondered about that myself, but from this perspective, I had my parents to thank:  I did not want to marry somebody, have kids and then have that crumble into an emotional mess and broken family. It had to be sure.

This connects to some of the “not quite’s” – it was my choice.  Instead of obsessing about starting a company or climbing a ladder or traveling the world or saving money or playing music or writing or doing art or anything else that I could have obsessed about, I was obsessing about finding “the one” and learning the hard way about how to be in relationships, how to communicate, what really worked for me and what didn’t.

But then, when I met Larisa in the most unlikely way, I was ready to leap, and she was ready too. And it has worked.  We just had our 26^th anniversary.

This has extra meaning on the eve of brain surgery. If I was going to pick a “one thing” to have at this moment, a loving family is really the best.

Two Work Related Topics*

I hesitate to write these two. They are hardly related to brain surgery.  But they are things that have been in the back of my mind to say and there has never been the right time or way to say it.  They are not that important, and I doubt I have anything unique or terribly insightful to add to these conversations. In that sense, these are both here to clear my mind.

1.     Diversity at Work (thoughts on)

By diversity, people mean having a mix of gender and races in the workplace.  Sometimes they also mean sexual orientations and age groups, but this is less common.  Most of us on the liberal side are in favor of diversity (as am I), but I think there has been some unnecessary baggage added to diversity as a goal, which I find counterproductive.

There are two arguments I hear in favor of diversity;

1.      To provide equal opportunity

2.      To build more effective teams

The first one is a matter of human rights and I agree with it whole heartedly.  If I am interviewing somebody different than myself (or a minority as compared to the people in my group or company), I make an extra effort to listen and provide space for the person to make their case. If they don’t have all the qualifications we are looking for, I try to consider whether they have any extra capabilities which might offset the missing skills.

The irony here is the clearest example of me putting aside my prejudices and making an extra effort to listen (which resulted in the person ultimately getting hired), was in the case of a slow talking, white, southern, evangelical.  In all other cases that I can think of, when I had the opportunity to interview somebody from an underrepresented group, either they were obviously qualified (and hired) or the conscious extra effort did not change my opinion. 

I admit I haven’t done all I could have done to create opportunity for underrepresented populations. E.g. I have not pushed for recruiting at all-women’s colleges, historically black colleges or other similar actions.  On the other hand, based on the groups I manage, I am rarely, if ever, hiring new graduates.

That’s all about the first argument ‘to provide equal opportunity,’ but what about the second? As soon as people talk about diversity at work, they almost always quickly say that diverse teams perform better. It is here that I am unconvinced of its truth or at least, I think it might focus people on the wrong goals and ultimately blind them to what they need to do to create a highly functioning team.

I don’t have time now to evaluate the literature on why people come to the “better performing” conclusion, but I’m suspect;

• Are they confusing correlation with causation?  Could success, requiring rapid team growth be the reason for diversity?

• Is the reason really about the culture and residents of certain regions (San Francisco, Silicon Valley) which causes success? E.g. the geographies have a diverse population but the reason for success is the superiority of local venture capital.

In contrast, there are obvious advantages to lack of diversity; clear and concise communication; shared values and goals; similar work styles.  The oft-cited pitfall of a uniform team is their lack of ability to understand customers or to see a problem from different perspectives, but these pitfalls have some ugly assumptions under them;

• They are saying that ways of thinking are tied to race, gender, religion and similar and seem to indicate that it would be hard to have a spread of different types of thinking without having different colors, sexes, or other categories of people.

• Further, they are implying that you need to have a person of category x in the company to understand a customer of the same category.

I worked in a Japanese company for a time. The Japanese have been highly successful selling products in the USA, while also being a perfect example of a non-diverse workforce. What I found in that company was that everybody deeply understood that they did not intrinsically understand their customers.  They worked hard to study, experiment, and debate customer preferences based on their observations and results – not based on their “innate” understanding of a typical American.  This attitude to understanding the world outside your company feels like a stronger predictor of success than the diversity of your team.

I do agree that diversity can help with this attitude in the sense that if you have a highly functioning, and diverse, team, that implies the people in the team have the emotional skills to communicate with people different than themselves and that is a precursor to working with a diverse customer base.  It is also a precursor to building a larger company as there is no practical way to hire enough quality people from one group once you get big.

The point I’m trying to make here is that I believe it is better to focus on diversity from the perspective of finding as many quality people as possible, to ensure that these diverse communities within the company work well together and, more broadly, to foster a welcoming and diverse society.  But I’m not convinced that it makes sense to focus on diversity as a way to build a better performing company: work instead on customer understanding and resisting groupthink.

2.     A Male Problem

I suspect it is impossible to write this entry in a way that won’t either be misunderstood or actively disliked. There’s so much wrapped up in the topic that it is fraught with argument and there is perhaps little point in me bringing it up.

I’ll start here.  One time I forgot to zip my fly before going to work.  It was probably 11AM before I realized this. I was wearing khaki pants that day and as luck would have it, on that day I was also wearing bright red underwear. Before my realization, I was walking in a busy hallway and saw a female co-worker who looked and me and then seemed slightly distracted, perhaps she even looked at my crotch?  What was that expression on her face? Later, when I sat down and noticed a bright red patch of color in my lap, I concluded that she probably did.

Many years ago, I interviewed a young man for a job.  At least that day, he was perfect looking and the recruiter (female) made numerous comments to the effect.  She even urged a couple of other women in the office to walk by and take a look at him.  They were all in agreement and there was considerable chatter that day and for a few days afterwards about the benefits of hiring him.  We didn’t hire him, I don’t remember why not, but I did run into him a couple of years later.  At that second meeting, he was dressed less perfectly, had different glasses – also less perfect – and his hair was unattractively sloppy.  He was an entirely different person.  My first reaction was that perhaps his new job had worn him out a little, but later I wondered if he had changed his persona to stop the hassle of unwanted female attention.

With that preamble, my question is, what are guys in office jobs supposed to do when a woman comes in showing cleavage? We are strongly programmed to want to look, but at the same time, at least in the Boston area, we know we’re not supposed to.  I label this a male problem because the reverse situations I described above seem to be both rare and not societally problematic.

My solution, which seems to work well enough, is to do my absolute best to never comment on how anybody looks and never to look below the neck when talking with women at work.  This relates to my previous entry about diversity.  People come with different assumptions about acceptable dress and acceptable looking – so far, the only solution is to stay safe on both ends; don’t comment on the clothes and don’t look.  Thank goodness I’m happily married and don’t have to figure out these signals anymore.

Trust

For the most part, I am a trusting person, and this helps in preparation for surgery.  Part of the reason I’m trusting is because it is unavoidable.  There are countless occasions where you are implicitly trusting that others will behave rationally and with skill.  We don’t think of many of them because they are common, but they are rampant and we really do have to trust.  If you get your car’s brakes fixed and leave the shop and head out onto a highway, you’re trusting with your life that the brakes are going to work.  Plane travel involves trust of pilots and air traffic controllers, but also thousands of engineers and manufacturing technicians.

I grew up in New York City and regularly visited friends in tall buildings. I remember a party my senior year in an apartment that might have been on the 50^th floor.  Another time, I remember a very pleasant afternoon sitting on a friend’s terrace on the twenty something floor overlooking a wetlands in the Bronx (co-op city). In those days, I never had any doubt that we were completely safe in those structures. Now it gives me pause.  Especially with some of the most beautiful apartment buildings, like the pre-war apartment buildings on the upper west side. Who designed those? Why is there any reason to believe they would be structurally sound one hundred years later? But ultimately, you have to trust that somebody, somehow is making sure things are ok.  If not, it wouldn’t be possible to visit NYC.

Consider my upcoming surgery.  There’s the surgeon of course and the anesthesiologist, likely some assistants and I don’t know how many nurses and techs.  I’m trusting them, all of them, to be focused and do excellent work for six hours straight.   But given my background, I can’t help but think of all the machines in the room; monitors, pumps and tools.  All of those have to work perfectly too.  And there needs to be electricity.  I’m trusting a whole institution to be excellent, from the neuro surgeon to the guy that makes sure there is diesel in the backup generators.

There are plenty of stories of malfeasance and incompetence in the world, but for this occasion, there is no choice but to trust and to hope, as it is with the people I manage, that the more I trust, the more they will rise to the occasion.

What is it about Brain Surgery? – Part 2

With most medical procedures, at least from my limited experience, it is reasonable to talk to people who have had the same procedures and use their stories as a way to learn about what you are in for. A few conversations about wisdom teeth will cover the likely range between easy, but still unpleasant extractions through to the more difficult oral surgery required to remove an impacted tooth.

For hip surgery you will hear about the choice between anterior and posterior approach and once you’ve chosen, you can find people who had the same surgery and their experiences will be roughly the same as yours.  I had “anterior” and had a slightly better than average experience in most respects, but an especially better experience with respect to pain because of close to daily acupuncture.

[From my wife, who is the best acupuncturist in the Boston area.  She thinks that’s too boastful of a statement, and I’ve only tried four other acupuncturists, but two of those are supposed to be special.  E.g. one is the acupuncturist for some of the Boston sports teams* and another was her teacher* who she still looks up to, but neither of those is close to as good as she is. They might know more specific techniques, but from the perspective of having a treatment and feeling better, she’s the best. Perhaps I’m biased, but that’s how I see it.]

But it turns out that “brain surgery” is not nearly a specific enough term to allow any comparisons.  It’s like two people who have each broken bones trying to share experiences without being allowed to say which bone they broke.  One person might talk about a horrible experience of needing surgery to install metal plates, while the other’s bone might have healed with no extra support. Amazing, how could this be?  An obvious answer could be that the first person had a clean break of their femur, while the second fractured a bone in their little toe.

I was reading some stories of people’s recoveries from brain surgery on a site devoted to the same kind of cyst as the one I have.  I would get half way through a story with a horrible sinking feeling “down to one seizure a day” but then read the person had just had a kiwi sized tumor removed, in part because they had been having seizures.  There are plenty of horrible possible post-surgery complications – e.g. an eye that no longer points in the right direction, but again, these people had tumors in different places than I do.  And there are people that relate serious headaches and pain in their scalps and skulls, but there are many different ways to get through and mend the skull and of course, I don’t know what exact method they had and how the size of the opening compares to what I will wind up with.

I also hear positive stories about people who had the progression the way I want it.  Surgery, recovery, back to life and I notice myself assuming that these are the people that my condition is like, but actually, I don’t know that either.

The point is, most of the surgeries I can name; joint replacements, bypass operations, prostate, breast cancer, appendectomies are fairly specific about what they are.  Brain surgery to remove a benign tumor is no more specific than saying, “surgery to remove a benign tumor which is inside my torso.” And the mystery is magnified by the relative lack of understanding of the functions and interdependencies of the parts of the brain. 

With all of this uncertainty, I find myself more open to positive thoughts and prayers.  Some cousins on my mother’s side are reciting specific Jewish prayers for me in the mornings.  We have Catholic friends who have prayed for me.  Southern Evangelical Christian prayers have been made on my behalf. Islam too. To get more bases covered, I might be able to have some authentic Hindu prayers added.  A more scientific friend of mine told of the evidence that people sending positive thoughts has been shown to improve outcomes; according to him, best on the day of the surgery.  I might recruit more of those. I wasn’t thinking this way for hip surgery. Maybe it’s true; ‘there are no atheists in foxholes.’

Deeper

I have done some traveling; more than many, less than some (roughly 4 million air miles).  Most of it was business travel, so it is not nearly as fun or enjoyable than what you might otherwise imagine. On the other hand, I do spend lots of time with locals when traveling on business.

There are other places I might like to go and more generally, there are plenty of other experiences that I might like to have.  Hobbies to try, people I haven’t met, music I haven’t heard, art I haven’t seen, movies, flowers, animals, books not read.  But the point is that when I think of what I wish I had more of, what I crave, what I would seek if I had time to just do what I want, it isn’t a question of more.  It’s a matter of deeper.

There are moments I look back on when something was perfect.  When the world, the situation I was in, was art and I was part of it.  Sometimes this was due to extraordinary circumstances; a stream flowing over large flat rocks framed by tall pines in Banff, Alberta; the Forbidden city; lunch in a café on the cliff at Santorini in Greece, Impressionist paintings in Musee L’Orangerie in Paris – these memories are special and I wouldn’t mind more of those experiences of course, but to write about something everybody knows is special, beautiful, unique would at best serve as a poor substitute of the image you may already have in your mind or from one you could get quickly with an Internet search.

By deeper, I mean a moment which is so full that you want time to stop so you can spend as much time as needed to fully explore and experience every aspect.  On that family trip to France, yes, I did feel like I came face to face with part of my cultural foundation while looking at the originals of paintings which I had seen in books since childhood – an almost religious experience, but that’s not the moment I would choose from that trip.  Instead I would choose a moment right before dinner in Aix En Provence.  Let me see if I can do this moment justice.

We had spent the day sightseeing, touring small villages around Aix En Provence; churches, art and views of farm valleys and ancient towns.  It was a beautiful day with the right balance of walking, seeing and relaxing.  At some Roman ruins I thought, yes, this is a great place to live and I can see why people have inhabited the region for so long.

Our apartment was on the second floor of a small building.  It had a nice terrace overlooking a narrow street.  On the way to the apartment we stopped for supplies; bread from the bakery, cheese from the cheese shop (an aged goat cheese), lettuce, perfect tomatoes and of course, some wine.

We set the salad on the table with a nice sprinkling of balsamic vinegar.  The sky was a deep blue as the sun was low in the sky, but not yet setting.  The buildings across the street were painted a cross between orange, tan and pink and seemed to glow in the lowering light.  The table was old wood slats, a nice contrast to the plates and the rich colors of the tomatoes and green salad.

The colors of everything were deep and alive.  We were relaxed, hungry and ready to eat this simple meal. The family was all in a good mood.  It is sometimes hard with a family, everybody needs to be happy for a really good time and this evening we were all on the same page.  As a parent, it is wonderful and special when your kids are brimming with happiness.

The food was as tasty as anticipated, the crust of the bread with a nice crunch and a soft fresh center.  The cheese tangy and soft inside.  The tomatoes fresh and sweet.  The wine, cold and crisp.

As the sun gradually set, the colors continued to change, getting deeper and softer as the blue left the sky. Cezanne lived on that block and I can see how he was captured by the light.  Physically, I was relaxed and comfortable.  The world was wonderful, within and without.

The yearning is to retain all the wonder of that moment.  But maybe that is too simple of a moment.  Another example;

I met my wife in Riga, Latvia two months before the collapse of the Soviet Union.  It was June and we were working together but had precious little time alone. One of our two dates was to go for a walk in the Zoo. I believe it was a Friday afternoon.  The zoo was empty.  The afternoon was warm for Riga and all the animals were sleeping.  Perhaps they were starving. I can imagine the dramas that must have gone on in those days where zookeepers were likely not paid enough to properly feed their families and at the same time must have been scrambling to get the food needed for the animals.

We walked slowly through the park, getting to know each other, looking at the animals.  I noticed immediately that the cages were from a previous era, with not enough room for the animals and as there was no liability in the USSR, there were few “don’t do” signs or extra fences to prevent stupidity.  In the Soviet Union, your personal safety was your personal responsibility.

Then we came upon the tigers.  There were two tigers, each in their own cage.  The cages were like small gazebos, maybe only ten or twelve feet in diameter.  Two cages sat about thirty feet apart from each other, each made of metal, but not very thick metal.  These were not steel bars, more like a mesh of two-inch squares made of thick wire and some of it was rusty.

More amazing, from a USA perspective, it was only a single layer of that mesh and there was no other barrier. You could walk right up to it and lean on the mesh if you wanted to.  Could easily put your fingers through.

Like the rest of the animals, both tigers were stretched out, seemingly asleep.  I did not touch the cage, but still this was much closer to a tiger than I had ever been and wow they were big.  We looked at them for a few moments, but they paid no attention to us.  We were the only people there.  Just Larisa and I and these tigers.  Probably because of that privacy, I said, “I just started to learn ‘tiger form,’ I wonder if they would take any notice?” (I used to study martial arts)

Larisa encouraged me to try it.  I knew very little of tiger form.  The first part is to get your hands firmly into a claw shape and to put as much power as possible into the fingers and palms.  The form starts with an imitation of a tiger sighting prey and then advancing.  This is followed by swiping motions with the hands in the tight claw shape.

I positioned myself in front of the cage and started moving. At first nothing happened, the tiger hadn’t been paying us any attention.  Then the tiger seemed to catch me moving out of the corner of its eye and raised its head.  I kept moving.  Not knowing much of the form, I started over.  The tiger fully woke up, stood up and started pacing.  It was watching me and pacing.  I started over again.  Then, what was likely at least a 400 pound tiger started purring.  It was definitely purring and not growling. Very deep, very low, rumbling from deep inside, it was purring.  And then it started rubbing its cheeks on the cage.

I started to feel nervous, but Larisa urged me to keep moving.  I started again.  The second tiger in the other cage now noticed what was going on, stood up, began to watch, and then started pacing.  It was clear I was communicating with these tigers, but I had no idea what I was saying or what they were trying to say in return.  Then, suddenly, the tiger in front of me raised up on it’s back legs putting its front paws on the cage.  It was enormous. In that position its head was likely 7 feet off the ground.

I was feeling shaky. Scared, energized, awed, I’m not sure, all three.  I stopped moving.  Larisa thought I should keep going, but I couldn’t or rather, wouldn’t.  The second tiger was now completely awake and moving quickly.  I felt it could be dangerous.  She felt certain they were happy, but even that could be dangerous from my perspective.

The experience was certainly less then ten minutes, maybe less than five.  It was an amazing moment, something I would love to watch in slow motion from multiple perspectives.  I would love to go deeper into that moment. More, I would like to have the ability to experience these moments as deeply as possible. 

But the problem with both these examples, France and the tigers is they are obviously special moments.  When I’m talking about deeper, that applies, potentially, to almost any moment.  Existence is amazing.

Right now, I am sitting in my office at home.  It is raining and there is a nice pitter pat of rain on our roof (we have no attic, so the rain is quite audible inside), I have crackers and hummus with jalapeno peppers which tastes great. I had an active day gathering fallen branches around the yard and a nice walk before dinner, so I’m physically tired and a bit relaxed in a way that makes water taste good.

I’m listening to music too and this is now extra special; when I first lost some hearing in my left ear from the cyst, music sounded broken and I didn’t want to listen to it.  The idea that I might lose the enjoyment of music was hard to consider, so I went into denial. Luckily, in a week or two things improved.  So now, when the music is good, I appreciate it more than ever.

In a few minutes, I’ll get ready for bed and we’ll sleep under the rain, in a comfortable bed, with warm blankets. In its own way, this moment is just as special and wonderful as any other.

Uncertainty and Humility

One evening, I was suddenly dizzy.  I stood up and realized I was truly dizzy and while it wasn’t painful, and it wasn’t enough to make me fall, I did become nauseous and the thought quickly grew in my mind that this was not right.  Something was going on, and not long after, Larisa took me to the hospital.  The strange thing is this first bout of vertigo was likely not connected with my brain tumor. Instead it is called BPPV and has a simple fix – though you have to find people that know how to do it.  BPPV is caused by crystals getting loose in the ear canal.  The fix is to rotate your head through a series of movements that allow the crystals to fall back to where they should be.

If this should happen to you, look for vestibular physical therapy.  If you’re in Boston, go directly to the Mass Eye and Ear emergency room.  They know what they are doing.  In fact, after this experience, I concluded that if you have a problem with a body part, and there is a hospital named after that body part within driving distance, then you should save time and go directly there.

Things got mostly better, but not completely.  My current theory is I was slowly becoming impaired on my left side, but was effectively compensating with my right, but when the crystals got loose on the right side, the lack of input from the left became more noticeable. Regardless, it was still not “all better” well after the time the Internet told me it was supposed be.  I scheduled a follow up appointment with an ENT. 

Then, before that appointment, I woke one Sunday morning with considerable tinnitus in my left ear.  Worse, when I put on headphones to listen to music, it felt as if I had lost most of my hearing in that ear.  So much so that I thought the headphones were broken and swapped left and right on my head to check.  But it was my ear.  That’s the event that started the chain of diagnostic procedures which led to an MRI and the discovery of my tumor. 

[To prevent confusion, it is a brain tumor, but not cancer.  It is a cyst formed by a few cells which, three to five weeks after I was conceived, didn’t get with the program and stayed skin instead of turning into brain.  They grow slowly and eventually become noticeable by pushing on something.  While not a rush emergency case, they will keep growing and pushing and need to be removed before they become dangerous.]

The sudden hearing loss created one of the strongest illusions I have ever experienced.  It’s a simple scene.  I’m in bed sitting up and reading before going to sleep.  Our cat, Robert, is on the bed between Larisa and I about at the level of my knee.  The center of the bed is to my left.  I see Robert there, but I distinctly and clearly hear a cat purring to the right of my right knee.  My visual and aural senses do not agree.  With my eyes open, the eyes win and I’m sure Robert is to my left, though I hear the purring to my right. With my eyes closed I can reach my hand exactly to where I am sure there is a cat purring, but of course, he’s not there, its my ears that aren’t working right.

I had this sort of experience once before when my hip went bad.  The pain showed up in my knee first.  I was sure there was something wrong with my knee, but it was “referred pain” from the hip.  It is disturbing when you can’t even trust your perceptions of yourself.

My hearing symptoms have since improved.  I have regained some of the hearing in my left ear.  My balance is not as bad as it was.  This is contrary to the expectations that were set, and I’m happy about it, but I have a high-pitched tone (about 8khz) in my left ear almost all the time and I’m much less stable than I used to be.  Others haven’t noticed, but I’m not sure I’ll ever ride a (two wheeled) bicycle again and that makes me sad.

On top of that, the main risk of the surgery is that exactly these symptoms will get worse.  The process of removing the cyst from around these nerves might damage them.  I say nerves because the cyst is pushing on two sets of cranial nerves.  I’ve felt effects on my auditory nerve (which includes balance) but it is also pushing on the bundle of nerves which controls the left side of my face.  I haven’t noticed facial symptoms but the possibility of significant facial impairment is worrying.

There are two sets of feelings which I’d like to comment on.  First, as happened when I had my hip replaced, I have much more empathy for people now.  When parts of you stop working, it is easier to relate to others working through their own ailments. I have patience now for many behaviors that used to annoy me; most of them having to do with speed; people walking too slowly, taking too much time at a register, driving slowly, that sort of thing.  From a distance, you really don’t know what somebody is going through.

The other feeling is related to an essential question about what effect this tumor has had on me over the years.  In ninth grade when I was suddenly uninterested in academics and learning, was any of that related to the tumor?  The confusion of my college years? I know that by the time I was in college that my right eye was noticeably (if you looked for it) more open than my left eye, was that related? What role did it have in any of the negative experiences in my life? For that matter, could it have had a positive effect of any kind?  These questions are more than just curiosities as I do wonder if and how I will be different post-surgery – not just from the perspectives of gross symptoms (hearing loss, that sort of thing), but on a deeper level related to thinking, memory and personality.

I will have to watch carefully to see if there are differences between who I am now and who I will be after.

Writing on the Eve

My friend Mike has given me some excellent writing advice today. There’s less than a week to go before surgery and he says to write down anything that comes to mind; anything even potentially interesting.  Capture everything in half written scraps on whatever media comes to hand. Later, sort through it and expand on ideas that resonate.

But there is a different consideration given the circumstances; the small chance that there won’t be an after.  Or that the after will be different in some way that makes it hard to remember or empathize with the way I’m feeling now.  From that perspective, I’m going to try to follow his advice, but still will try to spend time to write just a little bit more than a brief note.

A Cold Proves I am Ready

I came down with a cold on Friday.  It started a few days before, but I wasn’t sure that’s what it was. By the weekend it was a definite cold; sore throat, clogged nose, low energy.  The extra stress is whether I would be well enough by Thursday to pass the “ready for surgery” test.  I’m writing this on Monday and I’m feeling somewhat better already.  I think I’m going to make it. 

This possibility of not being ready has clarified some things. If I wasn’t ready, then all the preparations would be messed up.  I’d have to go to work for days, maybe weeks or months, again in the position of worry and expectation. The truth is I have been gradually preparing myself mentally. Focusing more and more on the surgery.  When I say focusing on the surgery, I don’t exactly mean thinking more about the experience itself because there isn’t all that much to think about. I’ve said already that there really aren’t many materials available that are predictive of what each individual might go through. 

 I take that back.  There are some expectations which are set by the materials provided by the hospital:

• Four days after surgery I can take a shower and bend down to tie my shoes.

• Two weeks after surgery I can do some light walking or stretching – and likely stop taking anti-seizure meds.

• Six weeks after surgery I can get a haircut, exercise (starting gradually), drive and have a drink.

• Eight weeks after I can submerge my head underwater – and color my hair.

When I say focusing on the surgery, what I mostly mean is not focusing on other things.  Not worrying or even thinking about work.  Not considering future plans; of all sorts – I’m not trying to evaluate or decide about anything that happens after the surgery.  As the surgery is only 4 days away, that means I’m not really thinking about much.

This is a notion that comes up often at work.  When trying to focus, there is usually no difficulty in defining what you want to focus on.  The hard part is having the discipline to not get distracted by other goals or activities.  Focusing is a process of eliminating, not adding.

That includes these essays.  I’m going to complete a draft by tomorrow, Wednesday. If there are things to mention Thursday and Friday I will take notes as Mike advised, but not write them until after (hopefully).

By Thursday, spending time with the family and the surgery will be the only things on my mind.   I will be truly focused.

People Can Be Wonderful

So many people have been so perfectly caring and understanding, offering to help, wishing me well, earnestly concerned for my wellbeing. Thanks to all of you.

© Copyright 2024 David Rich All Rights Reserved

After the surgery, and after a reasonable amount of recovery, it felt natural to write about what happened.  This was harder to write because there was no urgency of a specific date, and I was confused about what to write.  I wanted to record a description of the experience, but I had other thoughts which were less directly related. What to do? I included both. I called that set “Brain Surgery, Results and Reflections.”

Still, I wasn’t done. It felt like I needed to wait longer to see how I was affected by the experience.  I wanted to write about changes that endured the test of time. But how much time? This last set was the hardest.  Again, no deadline, but more importantly, the last few years have been quite tumultuous, and I was continually distracted by external events. Need I say more than “2020”?  Eventually, on October 5^th of 2022, I decided I was done. This set I titled “What Brain Surgery?”

In summary, for context, the first set were written in a small number of weeks, the second in a few months, while the third set was written in a stop/start fashion over a couple of years.

Essays On the Eve of Brain Surgery

Brain Surgery, Results and Reflections

What Brain Surgery?

© Copyright 2024 David Rich All Rights Reserved