Monthly Archives: July 2013

Concise Communication

We just received an 11-word letter from son #3, who is away at a 12-day fine arts summer camp, playing bass in the jazz performance program.

You know how some people can go on and on and not really say much?  (Risky thing for a writer/speaker/blogger to point out, I know – something about stone-throwing and glass houses, or pots and kettles.  But I digress.)  My youngest son doesn’t have this problem.

Some narratives stretch on a little (or a lot) longer than they should.  Sometimes it’s because a person may be, like Dickens, effectively paid by the word.  In many circumstances, a person hasn’t yet learned what information to leave out for a particular audience.

You should watch the face of a general surgeon receiving a third year medical student’s verbal presentation of a patient.  That student has been taught to document every detail about a patient’s current medical situation, past medical history, family history, social history, positive and negative answers to a barrage of questions about symptoms across all body systems and state of mind, and every finding, including everything that is “normal,” on the physical exam.

What the surgeon wants to hear is: “14-year-old male with no significant past medical history presented to us with right lower abdominal pain and fever, has tenderness and guarding in this region, physical exam otherwise within normal limits, and ultrasound shows evidence of acute appendicitis.  There’s no personal or family history of reactions to anesthesia or of any bleeding or clotting problems.  He hasn’t had anything to eat or drink for over 12 hours.”  The surgeon may fire off a couple of questions on the phone, and she’ll ask anything else she needs to know when she goes to see the patient.  So when the medical student regales her with information about the patient’s mild acne, stage of puberty, visual acuity, dietary habits, or school activities, the surgeon’s eyes will glass over and may roll back far enough in her head that she can see her own brain.  This is why the emergency room residents don’t let medical students call the surgeon.

The surgeon in this example is being called to respond to a surgical emergency.  In this situation, the relevant information needs to be communicated in a clear, concise, and quick manner.  It needs to be complete as well, but complete within the realm of relevance.   The kid’s appendix could burst while the student is reporting on the child’s use of seat belts and bicycle helmets.  However, the above clinical description of the patient’s appendicitis presentation would be a woefully incomplete picture of that person during a well-child visit at a new pediatrician’s office six months later.

To communicate well, you need to tailor your communication to both audience and situation.  This is quite important within the field of medicine.  An internist generally needs a much broader and different knowledge of a patient than an orthopedist needs.  Both doctors and patients need to know what information to relay, the right way to phrase things, and the right questions to ask.  And that communication makes all the difference in the world.

So here is my child’s letter from camp, in its entirety:

“Dear People,

Birdland Combo.

Cabin’s awesome.

Kids cool.

Best counselor ever.”

He used fewer than a dozen words to convey: 1 – that he’s alive, 2 – which ensemble he’s in, which tells us how his audition went and enables us to look at the schedule to see what time his concert will be on pick-up day so we know when to show up at camp, 3 – that he’s happy.  Would I have liked maybe a little more detail?  Of course.  But he communicated what was important for us to know now.

Maybe my son thinks I’m a surgeon.  I think next year I’ll offer to pay him by the word for his camp letters.

Brief Update on the War with the Weeds

So for anyone who’s keeping score: the weeds are winning.  It’s not even a close contest.  Landslide victory.  But that undesired greenery is a veritable font of reminders of health (and other) advice:

– When you’re squatting for a long time as you pull up a bunch of short weeds, remember to stand up slowly.  Or better yet, don’t squat for a long time.

– Fasten your glasses with Croakies or some such, since when you are leaning forward and yanking out plants and your hands are full of vines and burrs and your glasses slide off your sweaty nose and you can’t catch them in time because your hands are full of aforementioned stuff and the glasses fall into the jungle that is your yard, it is difficult to find them (especially because you can’t see because your lenses are not in the appropriate location to counteract your myopia and astigmatism).

– Wear thick, protective, leather gloves rather than the thin fabric ones that the spiky stuff pokes right through.

– Beware of mosquitos.

– Huge spiders may appear out of nowhere, so don’t panic if your spouse screams unexpectedly – one of you needs to remain calm enough to handle the situation.

– Shower immediately after yard work to minimize the time potentially irritating plant oils are on your skin so you don’t get little itchy red dots all over your arms.

– Long sleeves and pants are a good idea.  White pants are not.

– When you’re filling a yard waste bag, it’s kinda dumb to lift your foot up and jam it into the top of a bag full of previously mentioned spiky stuff and sharp sticks to try to make more room.  Just start another bag.

– Buy a fingernail brush.  I don’t know how dirt gets through even the thick, protective leather gloves, but it does.

– If you have a big picture window and you’re weeding the area with thick groundcover in front of that window, it would not be too far a stretch of the imagination to predict that one might occasionally find a dead bird that had flown into said window (“so THAT’S what that thunk was last week!”), so again, try not to have a heart attack when the person tending that area lets out a shriek.  The household member with the most strength of character should simply use an elaborate mechanism of multiple-plastic-bag-covered-shovels to dispose of said bird so that you don’t have to come anywhere near touching it (or anything it’s touched) and it ends up at least quintuple-bagged.

– Those yard waste bags can get awfully heavy awfully quickly.  Check liftability frequently so you don’t end up with a 200 pound paper bag of weeds as permanent garden art.

I hope your Saturday afternoon was as much fun as mine was!

The Paths We Follow

We all have paths that we blaze and that we follow.  Educational paths, career paths, health paths, spiritual paths, life paths.  You may set off down one, or expect to be on one in particular, but find yourself on a different road entirely.  You may reach your various destinations quickly and easily or circuitously and with difficulty.  Or you may end up at a completely different place than you had planned, as you reconsider your original destination along the way.  You may choose a direction deliberately or by default.  You may lead or follow others.  You may set off on your own.

As I hike through life, I realize that like snowflakes, no two paths are the same.  Even when you hike the same path you’ve hiked countless times before, although the trip may be similar, it is never identical to one prior.

Walking along a path through the woods, you step on different patterns of rocks along the way. New leaves fall with each breeze that blows.  The wind changes direction.  New plants grow.  Newly fallen trees block the way.  The chipmunks have scurried to a different spot.  Your shoelaces are looser.  Or tighter.

When someone is walking right next to you, he views the scene from an ever-so-slightly different angle. And he has his own expectations and past experiences which affect his view.  While you hike with your son, he experiences hiking with his parent.

New passages emerge along the way, sometimes seemingly hindrances at first.  A fallen tree in front of you can provide a bridge to a new point.

There are so many ways to deal with an obstacle in the path.  Go over it.  Go under it. Go around it.  Go through it.  Turn around and head back.  Or forge an entirely new trail.

You may choose to follow a well-worn path, but your steps still fall uniquely along the way.  You may be lucky enough to have someone next to you or a step or two ahead of you who will reach for your hand to help you up or down a difficult step.  But you are the one taking that step.

And that step, like the ones that preceded it and the ones that will follow, is singularly yours, whether you are walking alongside a river in a quiet section of the woods or along the sidewalk in Times Square.

I love hiking.

The Immense Power of a Touch of Extra Help

Two summers ago, my family discovered trekking poles. We were out west, hiking in the grandeur of our national parks, and noticed early on in our travels that a lot of folks were using what looked like ski poles. We asked the pole wielders about them, and they all answered that they were extraordinarily helpful.  So when we stopped in at a Wal Mart for supplies and noticed that they carried these items, we purchased a pair for each of us. We never realized that we had been missing them until we had them. Aside from the National Park pass itself, the poles were probably the best $100 we spent on that trip.

I’ll show you why.  Try this:

Stand in your kitchen with the counter about six inches to the side of you.  Lift one foot slightly off the ground, and try to balance on the other.  If this is difficult for you, put one finger on the counter as you try to balance.  If the one foot balance is easy for you, hold your hand up over the counter, and then try the one foot balance with your eyes closed (and catch yourself by grabbing the counter and opening your eyes when you start to fall).  Now try the eyes-closed balance with one finger touching the counter.

It’s pretty amazing how that one finger, that tiny bit of sensory input, helps, is it not?

When you are hiking, you need to look ahead (to the future) and down (to the present).  When you walk with the poles, you swing each one alternately out ahead, and gently hold on as you take a step to catch up with the pole, which ends its cycle at your side before you swing it out ahead again. Each pole touches the future and transmits information back to you so that your steps are adjusted accordingly.  Even if you’ve never had any difficulty with balance, it’s fantastic how much more in-balance the poles allow you to be.

Most of the time, you swing your poles lightly, and hold them very lightly, as you move easily ahead.  At times you need to hold them a bit more tightly and to put a bit of weight on them.  Generally, you place your poles ahead of you by a step.  But sometimes, like when you are stepping over a log, it’s more helpful to have one pole stay back and take a little of your weight as you lift your leading foot and pole over the log.  Then you transfer your weight forward from your trailing pole and foot to the lead pole and foot after you’ve cleared the obstacle.

Although your poles help you, you always direct them.  It wouldn’t work if someone else directed them.  You point them in the direction you want to go, and they help check the stability of the ground ahead, the change in grade, the hardness of the ground.  Your trekking poles can act as brakes when you feel you are losing control or gaining too much speed down a hill.  They can help you catch yourself and stop a fall.  They can help you pull yourself up a hill.  But you are in control, you guide yourself, you plan your steps, and you carry yourself.

There are some times when the poles get in the way.  When they do, when you want to stop and take pictures, when you are at a place where you need to hold onto railings with both hands, or when you just don’t want to walk with them, you can collapse your poles and stick them in your backpack.  And you can pull them out when you need them again.

I cannot help but liken a hike to a medical journey, and a pair of trekking poles to your doctors, your personal medical advocate, and the rest of your healthcare team, when that team is working as it should be.  Try reading this piece again with this analogy in mind, and please let me know what you think.



In celebration of our recent 20th wedding anniversary, my husband and I spent a romantic (read: “without kids”) three days in the beautiful mountains of western Pennsylvania.  We hiked, kayaked, hiked, and hiked some more.  It was warm and fairly muggy, but breezy enough to make it pleasant.  The smell of the pines, the sounds of the forest and river and their creatures, the pleasant cooling raindrops on our skin (just enough to soothe, but not enough to drench), the beauty of the colors surrounding us, and the just-tired-enough-ness of our muscles, combined with nightly soaks in our room’s fireside Jacuzzi to allow stress to slip away quite nicely.  And my husband knows me well enough at this point that the fact that I had brought along Lysol wipes to use on said Jacuzzi tub prior to our first night’s soak evoked in him only a slightly bemused smile.

Cell coverage in the area was very limited, so we were not bombarded with constant texts, e-mail notices, or Facebook updates.  There was no TV in our room, so we sat out on the balcony at night (second story – high enough we didn’t have to worry about hungry, wandering bears) and smelled the faint wafts of smoke from a nearby fireplace.

And there was no clock in our room, nor was there any clock in any of the public areas of the rustic, log-constructed lodge.

Was this lack of official timekeeping devices a throwback to earlier, simpler times, or a nod to the fact that we were in the woods and close to nature?  I don’t think so – that wouldn’t be consistent with in-room Jacuzzis and gas fireplaces.  I think the clock-less-ness of the place was a symbol of both luxury and freedom.

In my own life, I frequently do not have the luxury of time nor freedom from schedules.  With my client and meeting schedules, my husband’s work schedule, the kids’ school, sports, and music lesson schedules, deadlines, committee meetings, community events, social engagements, kids’ rehearsals and concerts – our family calendar looks like a Jackson Pollock painting.

So the lack of a clock makes a powerful philosophical statement: you are on vacation and are here to relax.  You do not have a schedule.  Go to bed when you’re tired.  Eat when you’re hungry.  Of course this is not consistent with the lodge’s policy of having you sign up for a specific time slot for breakfast each morning, but to paraphrase Emerson, to demand consistency is to lack imagination.  Our creative response to this discrepancy was to ignore the rule and show up whenever we wanted to.

Of course our cellphones have clocks and alarms on them, and these work even when there is no cell signal and the phones are on “airplane mode” to conserve battery.  But you have to purposefully look down at your phone and turn on the display to see the time, and you must purposefully set any needed alarms.  We chose not to set any alarms.  We went to bed when it was dark and we were tired.  We got up when we felt rested, which turned out to be about 8 hours after going to sleep.

Certain health conditions can tie you to a clock a little more – someone with esophageal reflux needs to time their eating so that it’s not too close to when they lie down.  Someone who uses insulin needs to time their injections and meals precisely.  Anyone on medications needs to time them consistently and evenly.  But aside from clock-dependent requirements such as these, it does a body good to lose the watch for a bit and listen to your own internal clocks.

I wonder how long it would take to find your own time groove.  I wonder if a loss of clocks would decrease overeating – there certainly wouldn’t be any “it’s lunch time, so I’d better eat a lot now, since dinner isn’t for several hours.”  I wonder if we’d get the ideal amount of sleep, with our own internal signals and a little input from the sun.

If anyone knows of a study like that going on, please let me know – I’ll volunteer!