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Being human Reflections on Life, Being Human, and Medicine Updates on my health

Life Lessons from an Old Diesel Engine (or How to Live a Wise and Sustainable Life)

Our sailboat has a 3-cylinder Universal M25 diesel engine. The engine is the same engine that is used in Kubota tractors. It is rugged and reliable. It is designed to run for hours and hours and just work. It is what you would expect from a farm tractor. It is like a mule or a work horse. It is not intended to be a racehorse. 

We use the engine to get in and out of the marina. We commonly will motor our way around Lake Macatawa and down the channel to Lake Michigan before we raise the sails and turn the engine off. Other times if the wind is too weak or in an unfavorable direction we will opt to just motor, or do a combination (motor/sail) to get where we want to go.

If I push the throttle all the way to its stop, I can get the boat to do about 7.3 miles per hour (about 6.3 knots). If your goal is to get somewhere quickly, a sailboat is not generally your best way to do so. That is not really the point when you go sailing. You go for the experience more than the destination. It is the joy of being there (on the water with the wind, the waves, and the quiet) and the people that you are with, more than where you end up. 

Sailors sometimes talk about how hard you should push the engine when you are motoring. Some have noticed that the difference between full throttle (at 2400 rpms) is not that much greater than partial throttle (at 2000 or 2200 rpms). You end up going about ½ to 1 mile per hour slower. The engine runs cooler. You burn a lot less fuel. 

I have taken to doing this on our boat. I pull the throttle back a little bit. The engine runs a little bit quieter. It is easier for people to talk. We go a little bit slower. It is not really very much of a difference. We may get to the end of the channel 2-3 minutes later than we would have otherwise. That really doesn’t matter so much.

The idea is that maybe you shouldn’t just peg the throttle the entire time. Instead perhaps you should count on the trip taking a bit longer and settling in with some margin on what your engine (and boat) are capable of.

That concept might make sense in the context of motoring on a sailboat. When it comes to our own lives, however, it seems we have a lot harder time doing this. 

I have had times in my life when I was just crazy busy. I deprived myself of sleep and heaped stress upon stress on top of myself. I can remember feeling overwhelmed at times. I would get up in the early morning feeling the weight of the things undone and the coming day. I would step into the shower and try to have the hot water wash away the fatigue. As I did so I would wonder if I was approaching my breaking point. I thought that if I did, then I would be forced to stop and rest, and back off in the intensity in my life.

Everyone has a limit. That is obvious. You are human. There is only so much you can achieve. 

So let’s just say that you could quantify your breaking point. Let’s say that your breaking point is at a level 100. You can operate at a level 99 but feel very stressed and be dangerously close to your breaking point and personal tragedy. Someone else might have a breaking point of level 80. Perhaps they too are getting pressured (either internally or externally) to deliver their most. So they push themselves to a level 78 or 79 all the time. The funny thing is that no one really knows what everyone else’s breaking point is. To be honest, most of us don’t really know what our own breaking point is. But the important thing is that we accept the level 78 or 79 from the second person as giving their all. But what would life be like if you (a person with a breaking point around level 100) lived your life with limits set at 78? I suspect you would be happier. It clearly would be safer. Your life would be much more sustainable. Some research data suggests you might actually achieve more by being less stressed and more focused. You would also have reserve. When a real crisis hits, you will have a reserve that you can draw upon to counter the crisis.

A wise sailor doesn’t feel the need to push the throttle to the max. He knows it is okay to set the engine at a nice sustainable level and leave a little bit of margin left. He can use the extra throttle if or when there truly is a crisis. The majority of the time crisis mode is not needed. The engine is happy doing what it was designed to do. The sailor is happy living with reasonable expectations for the journey.

A wise person sets limits in their life that allow for margin. While everyone around them might push them or insist that they give their all, they choose to instead set their limits wisely. While their internal drive may tell them to say “yes”, “yes” and “yes” they know that they do ultimately have a limit to what they can do. They choose to define that limit carefully. They look to having a sustainable life.  

It doesn’t mean that they are lazy or neglect what is important. It does mean that they seek to avoid overcommitting and burning their reserve. They resist the urge to try to overdeliver.

There is always a limit. Everyone has a limit. That is not a question. The question is where the limit is set. Is your limit set wisely? Or do you live your life forever in crisis mode?

This is for me easier said than done. 

I have been an optimist. Whenever I would see something to do, I would really want to do it. But at times I really pushed my limits. On top of being a husband and father, a cardiologist, and building and growing a transplant program I would commit to research, writing textbook chapters, speaking events, and a host of other things. I wanted to do them all. In the end I mostly pulled them all off. But I am not sure that I should have.

Now my world has changed. Cancer, surgery, radiation, mitotane and recovery were definite limits. Persistent adrenal insufficiency was not a limit I counted on but one which has become a reality for me. A level 100 person has become a level 50 person. 

What do I give up? How do I set limits? I routinely hit the limit now. Navigating this has been a much bigger challenge for me than it was to just work really hard and really long hours. I am not good at setting priorities. I don’t know how to set limits on myself. I am struggling to learn. It feels like it would be easier to just run away from everything than to figure out how to prioritize and set more reasonable limits.

We pull out of the marina with the engine running at a slow speed. I push the throttle all the way to its stop. The engine pulls hard and the boat picks up speed. I intentionally pull back on the throttle a little bit. The engine quiets down. We make a reasonable speed. All is good.

Can we be wise? If you have pushed the throttle to the max, can you pull it back a little bit? Can you let your engine settle in at a reasonable and sustainable level? Your boat may not move as quickly. You will have to change your expectations. But maybe that is okay. If people ask, “Is this as fast as we can go to get there?” You can answer, “This is the exactly the speed that we should go to get there. It’s all good. I am doing my best.”

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Being human Reflections on Life, Being Human, and Medicine Reflections on the Christian Life Updates on my health

What Do You Do When You Cannot See See Out of the Windshield?

I had my repeat CT scans this week. I tried to remain calm. I went to work after my scans were done and tried to act normal. I felt better doing things. Busy was good. 

I got the results early the next morning. 

Better.

The lymph nodes that were there before measured a bit smaller. The conclusion: “No contrast-enhanced CT evidence of locoregional or distant metastatic disease. A prominent subcarinal lymph node and right hilar lymph nodes are largely stable in comparison to 5/14/2020.”

To put it plainly: Still not sure why these lymph nodes are enlarged. Maybe I had a bronchitis or allergies or something? They are not behaving like spread of my cancer. 

That puts me back where I was before: The cancer could be completely gone. Or maybe not. I will continue with CT scans every 3 months and we will see.

Below is a blog that I wrote the week before I got my repeat CT scans. As usual, I wrote this as an honest expression of thought. I share it in the hope that others might identify and somehow it might be helpful. 


The Dream

I couldn’t see.

I had that dream again last night.

It is a dream I have had many times in the past.  

I am driving down the road and then suddenly I cannot see the road or anything in front of me. The dream I remember the most is driving at night in the rain. Suddenly everything is dark, and I cannot see the road. Last night the dream was driving in a snowstorm. I was following another car. I could see the car’s taillights. Suddenly the car slowed down. I assumed they were frustrated with me following them and wanted me to pass them. When I passed them however I was suddenly in a blinding snowstorm. I couldn’t see anything at all. I had just accelerated to pass them and was going at full speed and I couldn’t see.

It feels like I have closed my eyes. No matter how hard I try I can’t force my eyes open, or get them to clear enough so that I can see again. I know it is really bad. I am rushing down the road and I cannot see.

What do you do when you can’t see the road in front of you?

In the dream world, the answers may be a bit strange. I worried about slowing down too quickly because I had just passed the other car. I didn’t want to have him hit me. I felt like I had to keep driving. But yet, I couldn’t see anything. Certainly, I couldn’t continue to just drive forward without being able to see anything. I had to slow down. I had to do something. 

I kept driving straight. I figured this was my best hope. Just keep going in the direction that I had been going in before I was no longer able to see. I hoped that I could somehow keep the car going straight down the road. I hoped the road would continue to be straight in front of me.

Slow down. I know it was foolish to keep moving. I needed to slow down in a controlled manner. If I was going to be running into disaster maybe it would be better if I wasn’t barreling toward it out of control. 

Try to stop? This was what I thought I needed to do. Unless I were to regain some sight soon I should try to stop. This also seemed risky, however. I knew the other car was behind me and also likely to not be able to see me. It didn’t seem like it was an option. I had to just keep moving along.

Eventually in my dream, I came to a town. As I entered the town, things started to become visible. I saw houses and trees and then I could see the road again. I saw enough that I was able to pull over to the curb and stop and rest.  When I did so, I began to think about all of the horrible things that could have happened to me in the storm. But they didn’t.

It is morning now. I am sitting alone in our sunroom and looking out the window. I can see. The early morning sun is soothing. The trees look beautiful. I breathed in deeply trying to take in the calm before I get ready for work. In that moment the dream came rushing back to me. I remember it suddenly in great detail.

Why do I have that dream?

Is it that I am currently driving forward and not sure where the road is going to go in front of me? Does it feel like my eyes are forced closed or frustratingly blinded? 

I don’t feel stressed. I am not obsessing with worry. From a psychological standpoint I think I am fine. This dream comes as an unwanted intrusion on my understanding of myself.

But there is my upcoming CT scan to reassess some enlarged lymph nodes in my chest. I also have an ongoing issue with fatigue and lack of stamina. Where am I going? What is the future? I keep trying to see the road ahead. I blink and try clear my eyes and strain to see. No matter what I do, my vision is obscured. 

That is not good. I am rushing down the road and I cannot see.

What do you do when you can’t see the road in front of you?

I keep driving straight. That seems the most logical thing to do. I will take whatever direction I was going in before the snow blocked my vision. I will just keep trying to point in that direction. I will just keep going on the same path. That is not a great answer, but it is the best that I have. 

I think I should try to slow down. It doesn’t seem wise to be barreling ahead at full speed. The road might just suddenly turn in front of me. 

But how do I slow down? What does that practically mean in how I live my life? 

In my dream I cannot compel myself to push on the gas when I have lost my ability to see. So also, in my life I feel a loss of drive. I now see it is the exact same sensation. I cannot compel myself to push forward when I have lost my ability to see. I find myself pulling my foot off of the accelerator. It is not that I am stopping. But I just can’t make myself keep powering forward with the same intensity.

Earlier this week I was clearly getting frustrated with myself. In the past I have been driven by my calling and passion. I could push and push and push. But now, where is my drive? Where is my passion? Where is my energy? I find my foot is unable to push on the accelerator. My brain will not let me do it.

Can I stop? But just like in the dream, I don’t know where or how to safely stop. As odd as it is in the dream, I feel safer coasting along then I would if I slammed on the brakes.

In my dream the road didn’t turn. I miraculously didn’t drive off of the edge of a cliff or into a tree. Once I was able to see and then stop, I sighed a deep breath of relief. In that moment, I thanked God for guiding my car when I had no idea where the road was.

So also, now, in this moment I do the same thing. It is a helpless dependency. It is like driving at full speed and suddenly being unable to see. Maybe that is ok. Maybe that is what I am supposed to have in this moment. “Dear Lord, I cannot see. Please help me to not drive over the edge of a cliff.”

In my dream the town was a nice town. It wasn’t anything dramatic. But it was wonderful and soothing to have a place with people, and safety and the ability to pull over and stop and think. It was nice to be able to see again.

What is next? I wonder what the next town I am coming to is going to look like? I hope it is charming. I hope it has a curb with plenty of easy parking where I can stop for just a few minutes. I hope it has a lot of little shops and a real main street. Maybe we can get out and walk around and take a break for a little while. Then I will feel ready to climb back in the car and step on the accelerator again.


But for now, I drive on and try my best to control my car, even though I cannot see anything.


My CT scan showed no evident spread of my cancer.  I am on summer vacation now. 

For a moment my vision has cleared. I can see out of the windshield.

There is a nice little town. It has a parking space for us to stop. We are going to get out of the car and walk the street and look at the little shops. A little while later we will get back in our car and we will start driving again.