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Being human Reflections on Life, Being Human, and Medicine

The Old Heavy Flannel Shirt

I was on the elevator running between meetings. I do not recall what it was or where I was going at the time. Whatever was “so important” suddenly was out-shadowed by an old heavy flannel shirt. That I can remember in detail.

As I stood on the elevator there was a woman coming from visiting a family member in the heart center. She had on multiple layers of clothing. The outermost one was an old heavy insulated flannel shirt. It was worn and faded and looked a bit thin in areas. She was “squishy”. She was older, somewhat weathered, and did not have on any makeup. She was not dirty. She was clean. Her hair was not fancy but not unkempt either. She was just herself.

I wore a business suit and dress shoes. My hospital ID badge was prominently displayed on my chest. My dress shirt was crisp. We stood in contrast of each other.

In an instant I envied her. 

My mind was suddenly pulled to imagining her life. I was back on the farm. I was in my grandparent’s house. There was clutter on the kitchen counter. Not unkempt but just the things of life. There was a cast iron frying pan on the stove with fried potatoes in it. There was a jar of Folger’s instant coffee on the dining room table. There was a stack of newspapers in the living room. Covers protected the sofas. A small television was on the one wall. It would get two or maybe three channels. My mind filled with the images and smells and sounds of the place. I longed to be back there.

It was winter. There was some work to do but it was not high pressure. After coffee and breakfast, they would be out in the garage grading apples. Their dog would come with them. Depending on the day they might take a mid-morning coffee break. They would certainly break and come inside for lunch. When the day ended so did the work. They would be in the house and would have dinner and watch Jeopardy and read the newspaper. They might have worries about the farm. But there also would be seasons when there was not as much to think or worry about. There would be times when life would be simpler.

They would be together in the warm house in the evening. They did not have to be dressed up. They could just be.

I remembered the hours working on the farm. My mind would drift off in a thousand directions as I worked. I would have adventures in my mind or solve great things in my mind as I worked. There was plenty of time to think as I went about my work. I can remember the times working on the tractor and getting into a groove. Sometimes I would just be. Other times I would think through stories or daydreams as I drove along in a repetitive pattern in the field.

The elevator doors opened, and the woman in the flannel shirt got off the elevator. I wanted to speak to her, but I had no idea what I would say. I wanted to tell her to celebrate the wonder of her life. I wanted to tell her that I envied her. I wanted to tell her of the wisdom of her manner of life. I somehow wanted to escape. That perhaps I could put on such a flannel shirt. That I could recapture the wisdom of simple things. That I could escape the complexities of a sophisticated life. That I could just be at home with my family, in a warm house, with nothing to do but watch what was on the 2 or 3 channels of television that would be available and accept that that would be enough.

When my grandfather died my family found several unworn dress shirts in his bedroom, many still in the boxes. It seems that each year when a birthday or Christmas would come around the family members would give him a new shirt. He would be appreciative of the gifts. But he had shirts that still had a lot of wear left in them. He didn’t need new shirts yet. He would wear them when they were needed. He didn’t need to wear a new shirt to be happy. 

Should we flee to the farm? For some that may be the answer. Escape to a place that is simpler. Wear old and worn but clean clothes. Eat breakfast in your own dining room every day. Go about your work with your dog by your side. Work with your hands. Let your mind have time to dream and be free. Be in your house for lunch and supper. Have a little too much clutter around. Have furniture that is not perfect but comfortable. Settle in for the evening at the end of the day.

Do we all need to flee to the farm? Is it just the farm that we seek? Is the farm really nirvana? Certainly, it carries with it its own worries and concerns.  Then what are we seeking? 

Perspective. Simplification. Margin. Family. Contentment.

It is not just one thing. It is more like a picture. You look at it and you like it. But trying to describe the feeling or the appeal in words can’t quite capture it. Perhaps you shouldn’t try to put it into words. I don’t know that I can get quite enough words to repaint the image or feeling that is in my mind.

There is a painting in the hospital by Mathias Alten called “Man with Wheelbarrow.” It is by one of the elevators. I really like it. I stand and look at it as I am forced to pause to wait for the elevator. It captures my mind and takes me to a place that I like to go.  In it is an older man with a wheelbarrow walking alone through a field. It captures what I am talking about. Nature. Quiet. Physical work. Not hurried. Doing the work of the moment. His mind is clear to think but not pressured.

I went into my next meeting. My mind followed the woman from the elevator. I actively participated in the meeting, but somehow, little things didn’t seem quite so important. Perspective. Simplify. Margin. Family. Contentment. 

The woman wore a heavy flannel shirt. It was old and worn but clean. It was still a perfectly good shirt. She was on her way home. I could smell and feel and imagine the home that she was returning to. It was not fancy. It likely had a bit too much clutter. The sofa and chairs had softened and were a bit broken down with age. But it was her home and her life. And it could be a happy place. In my mind I wished her well.

Your home, your family, your life, your world are all great gifts. Enjoy! 

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

Wisely Managing Life’s Problems or How to Drive an Old Truck Down the Road


I learned to drive on the farm. First on tractors. Most of them were quite a bit older than me. One forklift was a tractor configured with a seat facing backwards. That way the forklift portion would be on what was the back of the tractor to better bear the weight. But in order to drive it at speed, it wouldn’t handle well unless you drove it backwards (what would normally be forwards). It surprised me how you could get pretty used to that, however.

The trucks and the tractors seemed to wander a bit as you went down the road. Perhaps it was some looseness in steering linkage? But for whatever reason the steering was never “tight”. That also took some time learn. The key was to look further down the road and avoid trying to overcorrect. If you stared at the road in front of you, you would get into a pattern of turning the wheel too far. You would then have to correct by turning the wheel the other way and you would turn it too far the other way. You would then have to correct that, and the cycle would continue. Left on this cycle you would run off of the road. Or at least panic and have to slow down and stop.

The key was to look far down the road and pick where you were planning to drive.

By focusing farther down the road, you could see that the minor wandering of the tractor or truck was indeed minor in the grand scheme of things. You would then be less prone to overcorrect. Your wild side to side steering would turn into calm and controlled driving to your goal. With experience there was no problem driving the old tractors and big trucks.

I discovered that there is a term for this during my flight training in the Navy. It is called, “pilot induced oscillation.” It is based on the understanding that human beings have a tendency to overcorrect. In aviation they would tell you to take how much correction you thought you should put in and then only do about 1/3 of it. As I went through my career as a flight surgeon, I had the privilege of flying some really nice helicopters. The HH60H Sea Hawk was amazing. It, like most of the larger helicopters, had an automatic flight control system (AFCS). One of the big functions of the AFCS was to dampen out the normal human tendency to overcorrect. I was surprised how easy and how fun it was to fly the helicopter with all of these “gadgets” turned on.

To be honest, when I tried practicing hovering in “the box” I needed some help. The idea was to hover over a large square and then in a controlled manner to move the helicopter horizontally to each corner of the box. With this there were a couple of times when I would fall back into “pilot induced oscillation.” The experienced pilot I was flying with would skillfully take the controls and correct the chaos that I was causing. With practice I got better. The pilot then turned off the AFCS and it got harder. A lot harder.

We all tend to overcorrect.

When we do, we create real problems for ourselves. We go from one problem to a bigger problem to an even bigger problem. Left uninterrupted we end up crashing.

I was treating a patient for hypertension. I was eager to get his blood pressure into control. I started an ACE-inhibitor. He called me a week later with his blood pressures and they were still elevated. I increased the dose. I kept doing this every week pushing to get his blood pressure into control. He ended up 6 weeks later with dizziness and with a dangerously low blood pressure. I learned an important lesson. I should have been a lot more patient. The peak effect of an ACE-inhibitor, in my experience, seems to come on a few weeks later. I needed to calm down and slow my control inputs. I needed an AFCS to override my tendency to overcorrect. Or in the absence of that I needed the maturity to be patient and make intentional changes looking at the long term. I needed to look far down the road and not just at the ground in front of me.

I work in a large health system. It can be frustrating how slowly things change. We can have the world’s greatest idea, but it seems like nothing is happening. It can take months to implement a change. “Patience, young grasshopper.” The change comes but you must wait for it. You must look farther down the road. You must not whip back and forth from one solution to the next.

I suspect by now you are already starting to see the life lesson.

You must not look at the ground or just the immediate problems that are in front of you. You must look farther down the road. You must be calm and wise. If you fail to do so you will flail back and forth. You will look foolish. You might even harm yourself.

Here is some more from Kung Fu:

Master Po: Close your eyes. What do you hear?
Young Caine: I hear the water, I hear the birds.
Po: Do you hear your own heartbeat?
Caine: No.
Po: Do you hear the grasshopper which is at your feet?
Caine: Old man, how is it that you hear these things?
Po: Young man, how is it that you do not?

This quote may seem a bit off from what I have said so far, but it is not. In youth we lack the ability to calm ourselves and truly hear and see our universe. We see and hear only the obvious. We look and react only to the problem that is immediately in front of us. In so doing we miss so much of what is truly important.

Today may bring many worries and issues to your life. Some you will need to address immediately. But do not be pulled into a caffeine crazed manic effort to fix all of them. Be calm. Be mature. Reflect. Listen. Look farther down the road. What is the big picture? Where are you going? Only then can you make the intentional clear actions that you should.

Patience, young grasshopper.

Can you test it now?

What is there that worries you today? Can you stop and sit and close your eyes? Listen to your world. Refocus. Look far down the road. If the worry is personal this may be an issue of faith. You may need to look very far down the road. If the worry is about work, you may need to refocus on what the long terms goals really are. Only until you have your eyes fixed far down the road should you then go back to the problem. Is it truly a crisis? Or is it a minor wandering on a long road to your goals? Once you have done these steps, only then can you act wisely.

I am perhaps a little bit proud that I still remember how to drive an old truck down the road and not lose control.

I just wish that I was always wise enough to apply the same wisdom to my life.