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

Magic Moments: Learning to choose to live these moments.

We call it the “magic moment.”

We use our diesel engine to get from the marina, down the channel and onto Lake Michigan. In the open water I hoist the sails. When the boat starts to be powered by the wind, the time comes.  We reach down and pull the T-handle that controls the fuel to the engine. Pulling it out shuts down the engine.

What comes next is wonderful:  Silence.

In that moment I can feel myself relax. I didn’t realize that I was tense. The noise of the engine didn’t seem to be much of a bother but the quiet that comes after turning off the engine is a special feeling. 

Take a minute. Force yourself to set aside any worries, things to do, or things that are pulling at your mind. Take a deep breath and then slowly let it out.  That moment – that feeling – is what I am talking about. 

This is something that I am working on. Let me explain.

First, a quick update on my health journey:

  • I am coming up on 4 years since my diagnosis with adrenocortical carcinoma and the subsequent surgery, radiation, and chemotherapy.
  • I am getting CT scans every 6 months now. My last scans in May 2022 showed no evidence of recurrence.
  • I have been left with adrenal insufficiency. 
    • The adrenal glands produce various hormones but most importantly cortisol. Normally the adrenal gland cycles up and down the amount of cortisol that it produces to match the demands (or anticipated demands) on the body. In the non-stressed state, cortisol levels are the low. When the body faces stress, cortisol levels go up. 
    • In persons with normal adrenal glands, the cortisol levels are lowest in the evening as they go to sleep. Starting in the very early morning (around 3 am) the adrenal glands start to produce ever increasing levels of cortisol, with the levels peaking around 7 am. This is part of a normal pattern of rest and then preparing the body to wake up and be functional. Have you ever noticed that chilled and achy feeling that you have if you wake up in the very early morning? That is because your cortisol levels haven’t risen enough yet.
    • If you are exposed to stress the adrenal glands will surge and produce extra cortisol to respond to the stress.
    • After the removal of my left adrenal gland and then a period of taking mitotane to suppress my other adrenal gland, I don’t make enough cortisol to keep up with what my body needs.
  • I take replacement cortisol, but there is no easy way to match the sophisticated up and down patterns of normal adrenal glands.  For me this creates a variety of symptoms that I have been learning to live and cope with.

I am continuing to learn.

If I am under stress my symptoms of adrenal insufficiency get worse.

Not all kinds of stress make me worse. I seem to do okay with some physical stress (exertion). I am surprised that I can do well with stressful medical situations at work (patients in cardiac arrest, ECMO cannulation, intense goals of care discussions, etc…) Some emotionally stressful situations I do fine with. Others can destroy me. I will suddenly feel weak, lightheaded, with my muscles aching and a sense of heavy fatigue.  It is like a car that sometimes runs fine and then other times, without warning, starts bogging down and loses power.

I have been trying to learn and understand the patterns to figure out how to cope with it all. 

Some tasks or situations are well suited to my personality. Other situations go against the grain of who I am. In those situations, I am supposed to step up and be the person that I need to be rather than the person that I am.[1] I have learned that those situations are the ones that can be more likely to drain me and make me feel the low cortisol symptoms.[2] I can’t avoid, and I may not want to avoid, all of those sorts of situations, but I can strive to be in places that fit me and my strengths most of the time.

I have also been working to learn more about how to deal with stress in my life in general.


There was a time when I would feed off stress. When we are young, we often pursue whatever is exciting. I can think of lots of examples: roller coasters, adventure movies, exciting stories, etc. I can remember the heart pounding thrill of each call for the ambulance. I would act casual (no big deal) about it. I was professional and calm. But each time, driving down the road with the lights and siren, I would feel a surge of adrenaline. It was addicting. 

It reminds me of Dr. Gerald Abrams. He was one of the pathology professors at the U of M medical school. He was famous for telling us that we all crave to learn pathology (what is wrong.) People say they like what is normal but they really don’t. They are drawn to the excitement of the abnormal. He would tell us that all of us were secretly longing to see and learn what goes wrong with the body (the pathology). He would then go on with his lecture and show us gory slides of all sorts of maladies. As young medical students we would eagerly take it all in.

We say that we want calm and peace. We spend most of our lives looking for adventure and trouble.  That is fine. Life is an adventure, and we should live it in all of its glory.

But we need moments away from the stress of the world. I am learning that I need these brief breaks. I am also learning that I am not very good at taking them.

One of the nurses I worked with told my wife that I was like a little duck. I would be floating on the surface of the water looking completely calm. But underneath, my little feet would be paddling away with full force. I pretend to be a sailboat, peaceful and calm. The truth of the matter is I tend to push the throttle forward, with my engine clanging away and then wonder why I am running out of fuel.  I am learning that I must make myself reach for the T-handle and cut off the fuel to the engine. I need these quiet “magic moments” and when they come, I need to experience them and enjoy them.

When I have a moment of quiet, my habit is to immediately fill it. I instinctively reach for my phone. I open up Facebook, LinkedIn, Twitter, Instagram, the news, Worldle, etc. I should be savoring the moment of peace and calm.  Instead, I keep running in my mind seeking out the next thrill. 

  • Sitting in a moment of quiet, my mind races ahead to things that I need to do or the worries of my life or the world.
    • It is okay to admit that I can’t and don’t need to solve all the problems around me (“all the problems of the world”) in that moment. It is good for just a little while to let go of all the worries and stress.
  • Driving in the car I flip through the satellite radio stations and if there is nothing I like, I click on a podcast. 
    • Sometimes I should just take a deep breath, push out the worries of the world, and in silence enjoy just rolling down the road. 
  • Sailing on the boat, I get up and fuss and tweak this or that sail.
    • Sometimes I should just be still and experience the moment.  I am learning to take a deep breath and let myself be still. 
  • In a conversation with someone, I let my mind race ahead to my next comment or to the next topic.
    • I am learning to instead just listen and experience being with them. Life will go on if there is a gap in the conversation. It is not a performance. The moment is about being with them. 

Pull the T-handle back and let the engine shut down for a little while. Let the wind push you forward in wonderful silence. We don’t have to always fix, do, or perform. There will be time to do that later. 

I also don’t have to stay in those moments. Life is full of adventures and stress. That is just the way things are and normally we can rise up and meet the challenges that are presented to us. I do enjoy a thrilling show on satellite radio or when I have the energy to take on a new project.

But we also need these “magic moments.”

It is good for me to look down the road, or at the scene on the lake, or at the face of my dinner companion, and give up trying to achieve something. I take a deep breath and for a moment, let myself just be.

[1] https://manmedicineandmike.com/can-you-be-the-person-that-the-uniform-demands/

[2] https://manmedicineandmike.com/the-deeper-lessons-from-twelve-oclock-high/

Categories
Being human Reflections on Life, Being Human, and Medicine

The Storm: An amazing story from my grandfather. Learning to live through and face the storms in life.

Sarah and I were driving back to Virginia from a visit home to Michigan when we stopped to see my grandparents. We sat at their dining room table as we talked. As we did so they started talking about what things were like when they were a young couple.  

That was when we heard about the storm.

My grandfather was a fisherman in the UP (Upper Peninsula of Michigan). The day of the storm he was alone out on Lake Michigan working his fishing nets. Without warning dark clouds came in quickly and enveloped him. Waves of rain came dumping down in sheets. He quickly finished what he was doing with his nets, started his boat, put it into gear and headed for shore.  The waves grew bigger and bigger as the rain poured down on him. His boat started to fill with water. He pushed the throttle all the way forward, hoping to get home as quickly as possible. This was a simple fishing boat, however, and it was not powered or designed to move fast. Things got worse. The rain was falling in sheets that poured down into his boat. Waves broke over the stern filling the boat with water. 

“I looked around and I didn’t even have a bucket or anything to bail water with. All I had was my hands,”  he said.

I found myself subconsciously cupping my hands as though to help throw water from his boat. 

He kept motoring to home as fast as the boat would go but it seemed like he was fighting a losing battle. The waves were breaking over the sides of the boat, and it started sinking lower and lower into the water. The water was getting so deep in the boat that the gunwales (upper sides of the boat) grew close to the water line. Once they reached the water line there would be nothing keeping the boat afloat. He eventually decided that his situation was hopeless. He was too far from shore. His boat was going to sink. 

What was he to do? One thing was clear: What he was currently doing wasn’t helping.  He pulled the throttle back to idle as he thought about his options. “I started looking for anything on the boat that would float,” he continued.

I had not heard this story before. I was riveted. I sat up in my chair as I listened and once again, I found myself wanting to cup my hands and throw water from the boat hoping to rescue my grandfather. I imagined myself on the boat, looking around to see if there was anything to grab that would float. What would I have done? He had a young wife and children at home. Where they ever going to see him again? He was in a desperate situation. 

He continued with his story.

Once he pulled the throttle back to idle, a surprising thing happened. The bow of the boat dropped down and the stern settled higher in the water. The gunwales rose just a little bit higher above the water line. The stern of his boat was floating better, and the waves were lifting and passing around and under the stern rather than dumping into and filling the boat. The storm he was trying to outrun, started to pass over him and move ahead of him.

By “giving up” and doing the opposite of what seemed logical he had saved himself. The storm passed, and he was able to motor slowly back to his dock. He was shaken and wet but otherwise perfectly fine.

He had been doing what any of us would do when the storm came: He was trying to flee and get to safety. By doing that however, ironically, he was putting himself and his boat into peril. It was only after he accepted his fate (the need to go through the storm regardless of the consequences) that he and his boat were saved. 

It makes me think. Do I run away from the storms of life, or do I stay and deal with them? Do I flee, doing whatever I can to avoid conflict, or do I stay and face it?  

I hate conflict. I enjoy peace. I have learned that I am much more likely to try to calm things down in a tense situation then live or work through them.  When conflict comes up, I routinely push the throttle all the way forward hoping to get away from conflict as quickly as I can rather than turning to face the storm.

What is the correct answer? There is no hard and fast rule here of course.  If you are out on the big lake and a storm comes in, the best answer generally is to start your motor and get to a safe harbor as quickly as you can. 

But not always.

Wisdom means that we need to know that there are times to steer clear of conflict and there are times to embrace it. Sometimes we need to go through the storm to get to the other side. That is a hard lesson for a “conflict avoider” like me. I have had to learn to recognize this tendency (at times a true deficiency) in myself and learn that it may be important for me to push myself to do what is best in each situation. 

Let me share an example:  I am sitting in a meeting when a clear conflict arises. Things are getting tense. People are shifting in their chairs. My natural tendency is to rush in as a mediator, trying to smooth things over and calm them down, and hopefully cover over the conflict. But conflict is sometimes the only way to get to a solution.  There are times when we need to live through it. In these times the answer might be as simple as closing my mouth, sitting on my hands, and letting everything develop. 

In other words, instead of trying to flee the storm, I need to pull the throttle back to idle. I must make the conscious choice to live through the storm rather than avoid it. The situation can become tense and uncomfortable. The dark clouds, the thunder and the waves can be frightening. But it is only by going through the storm that we get safely to the other side. 

It might seem possible to run away from problems but the relief may be only temporary. The problem hasn’t been solved and can keep coming back. In that situation, running away doesn’t help. It only delays the solution. The best thing is to go ahead and deal with it. Instead of running, hiding, or ignoring the problem, it might be better to pull the throttle to idle and focus on what needs to be done. Make the phone call. Have the conversation. Or let the situation develop around you so that you can then deal with it or live through it, rather than having it just chase you.

Sarah has taught me the, “Can we talk?” technique. She says that she will throw that phrase out and then she is committed. It is her way of pulling the throttle back to idle and turning around to face the storm. She says that there are times when you need to walk through the chaos so that you can get to what is good on the other side.

It was great that day that my grandparents shared the story of the storm (and a few other storms) with us. It was amazing sitting with them in their kitchen having them reminisce on what life was like when they were young (like we were as we listened to their stories). I loved it. It was so valuable to us to learn more about them and their lives. It helped me see them differently. There was so much depth and so many experiences that made up who they were. They had been through many storms and events in their life. They lived through the storms. They came out on the other side.  

In life, storms will come, and storms will go. Often it is perfectly fine to run for shelter. Sometimes that is not the answer. Sometimes you need to turn and face the storm. By the grace of God, you can live through the storm. My grandparents did. Most of us have lived through many storms. 

You can live through the storm, face it and come out okay on the other side. You might even be better because of it. 

And you may have a wonder of a story to tell your children and grandchildren after you do.