Author Archives: Abi Schildcrout

A Year. A Lifetime. A Moment. A World.

How does one measure time? By the moment? By the hour? By the day? By the thought?

How do we mark that passage? Do we note the sun? The moon? The stars? The leaves? The rain? The snow? The pain? The joy?

Do we count the moments? The moments missed? The steps? The breaths?

We humans have a very long history of marking time. We know this because we’ve taken note of how long we’ve been marking time.

We notice patterns. We notice seasons. 

We make associations. We’re certainly not the only creatures that make associations, but we are, as far as I know, the only ones that make calendars.

We mark time with holidays and anniversaries – symbolic reminders of the cycles of time and of life, of profound change, and of profound persistence. We note what carries through. We note what’s missing. What feels different? What feels the same?

It is coming up on a year since my friend lost his son. In Judaism, on the Hebrew calendar, the anniversary of someone’s death is called a yahrzeit – translating from the Yiddish for year (“yar”) and time (“tzeit”). The Hebrew calendar is a lunar one, but it has extra months added in cycles so that it stays in sync with the seasons and in rough sync with the Gregorian calendar. So the lunar years and the solar years, the school years, the seasons, the Jewish, Christian, and secular holidays, maintain their temporal proximity. But not exactly.

The young man died four days before the evening of the first day of Rosh Hashanah last year, on the 25th of the Hebrew month Elul, on the 21st of September. So his yahrzeit is by definition on that same Hebrew date, the 25th of Elul, four days before the first evening of Rosh Hashanah (the Jewish New Year), but this year that Hebrew date corresponds to the 11th of September. Today.

But perhaps not exactly. Because days in the Jewish calendar begin at sundown. I don’t know if he died before or after sundown. If after sundown, the Hebrew date would be the 26th of Elul, which would correspond to the evening of September 11th and the day, until sunset, of September 12th. If it happened before sundown, the 25th of Elul begins at sunset on September 10th, and goes until sunset on the 11th. 

How do we measure time? From sunsets? From midnights? From a phone call or a knock on a door?

The befores. The afters.

How do we measure time? In weeks? In heartbeats? In tides? In generations? In fishing trips?

Because there is no one way to measure time, because our measurements overlap and ebb and flow, because some cycles are regular and some wildly irregular, the consistency of both the regularity and the irregularity drives us to continual, expected, and unpredicted reminders. We make associations. Only some of those associations are on our calendars.

This year, my friend’s family will have received a yahrzeit reminder for today – a day that falls, at least partially, on September 11. A day when we mark the twenty-second anniversary of the shattering terrorist attacks, this family also marks the first anniversary of their own world’s shattering. And then they will have their second Rosh Hashanah without their son and brother. And then it will be September 21, a year in our currently accepted international calendar.

Rosh Hashanah is the Jewish new year. But there are four Jewish new years, signifying different things. Rosh Hashanah is the “new year” that commemorates the creation of the world. 

There were no calendars at the time of the big bang, but there is value in reminding ourselves periodically that there was a time before the universe existed. Just as we celebrate a birthday as a marker of an individual’s coming into existence, it’s nice to celebrate the existence of existence.

How do we measure time? In how old we feel? In tears? In laughs?

In Judaism, one of the most, if not the most, important tenets is that of the importance of a human life. The talmud (the text of rabinic Judaism and the basis of Jewish law) teaches that one who saves a life is considered to have saved the world. I find this thought particularly beautiful – that a human life represents a world. And the thought that I extrapolate from there, that every action of one’s existence, every moment of one’s existence, changes every connecting human, every connected world, and the “world” as a whole.

My friend has been posting on Facebook on the 21st of each month, marking the time. Naming the time. Reminding the world. Defining the before and the after of his lost world and of the time that was and is.

So many worlds. So many moments in those worlds, each affecting other worlds. How many do we save? How many do we enhance? How many do we enable to save others?

We know the most dramatic and obvious saves – the stopping of a hemorrhage, the opening of an acutely blocked coronary artery. How many do we not recognize? Being present in a time of need? Making someone laugh?

How do we measure time? In its finiteness? In its eternity? In the power of a profound or a seemingly inconsequential moment? Maybe simply sitting with someone – on a porch, by their bed, on a boat – gives them the strength to hang onto life for just a tiny bit longer, with that tiny bit longer of time enabling the growth and temporal elongation of countless other worlds.

We mark time. Birthdays, yahrzeits, seasons, memories, associations – the cyclical reminders of people’s coming into existence, the cyclical reminders of people’s exiting physical existence, both the cyclical and the seemingly random reminders of the times in between. The entire worlds of overlapping calendars, of dates that mean the world to some and nothing significant to others. The worlds of unmarked time march through as well, with their own ebbs and flows, with joy, with anguish, with fear, with hope.

I wish strength for people through the official markings of times of loss today and every day, and through the unofficial markers. Every moment of the lives and worlds that have gone by mattered and matters. 

I wish everyone a New Year with sweetness, with love, with peace, with connection, with memories of the good stuff, and with curiosity and hope for the beauty of the infinite, interconnected, unique worlds that we will help unfold in the year to come. May we all appreciate the beauty, the importance, and the potential of our time together in this universal world of humanity. Shana Tova – to a good year.

Clinical Detachment and a Bridge in Brooklyn

Another day, another mass shooting in America. And last night’s is close to home.

At 8:30 p.m., our house phone rings. Must be one of our parents or spam (they’re the only ones who call our house line). I look at the caller ID – it says “Michigan State.” Because I’m faculty for MSU’s med school, I’m on the list for their emergency system’s warning calls. I answer, and the computerized voice begins: “There are reports of shots fired on Michigan State’s East Lansing campus…”

I tell Doug. He pulls up the police scanner app on his phone, puts it on speaker, and we listen. It’s real.

Multiple casualties. They’re requesting all available emergency medical support.

We have three children. A subset of their friends are our children. We have friends. A subset of their children are our children. We have friends whose children are friends with our children. Those children are our children. Our sons are in their 20s and we live in the metropolitan Detroit area. You can do the math – this is close to home.

I call the kid down the street, a junior at MSU. He doesn’t answer. Of course not. Kids don’t talk on the phone. I text him: “There’s a shooting on your campus. Are you ok? Call your parents to let them know you’re ok, and then text me back.” Two minutes later I text him what we’ve heard on the scanner about the location of the shooting. And I implore the kid to call his folks and me. Three minutes later I’ve somewhat lost it and text him something to the effect of “Jesus Fucking Christ, call me.” That does the trick. He responds. We talk. He’s safe.

At this point, I’m in my clinical detachment state. Doctors have to have this psychological skill or we wouldn’t be able to do our jobs. Everyone, medical or not, employs this defense mechanism at times.

Youngest son and girlfriend are home with us, middle son in Ann Arbor, eldest in D.C.

Family group chat is going. We try to figure out whose kids, whose siblings, which friends, are in East Lansing. I’m no longer trying to message known East Lansing kids first to have them contact their parents – I’m reaching out to parents directly, even though I know what it will do to them if they hear from me before they hear from their children, because I would want to know if my child were there. Some parents have heard. Some haven’t. At some point, it’s late enough that they all know. Our/our kids’ most direct connections are safe.

Clinically detached.

Listening to the scanner.

Texting in family group chat. Detached, but listening for tone, observing, watching for evidence of any danger sign in psychological state of offspring. Watching, listening to offspring/significant other in my house, observing body language and facial expressions, listening to tones of voice. Watching and listening to my husband, who hasn’t stopped listening to every word on the scanner.

Talking to other parents. Clinically observing tones of voice. Figuring out who needs to hear what words as they process the situation of texting with their children who are locked and barricaded in buildings on campus.

Watching news briefs. Detached.

Listening to the scanner. Clinical.

That scanner, though.

Detached. Clinical. Listening to the radio conversations between dispatch and the rescue response teams. Listening. Observing. Drawing parallels, as I am wont to do, to medicine.

It’s all about communication. It’s all about objective information. It’s all about being methodical. And yet the communication is fragmented – so many moving parts, reports from all over the place. The theoretically objective information is overwhelmed by the subjective tainting of terrified humans. The method takes time, it is not instantaneous.

I am detached, clinical. Observing, considering, interpreting, and synthesizing information, trying to make sense of it.

Sons are scouring internet. Mostly Twitter. Texting in our group chat. D.C. son, who lives in a sea of helicopters, is incensed that the shooter is still at large and that there isn’t chopper support. Engineer son is incensed that all campus security cameras haven’t been used to triangulate and locate the shooter.

But there is helicopter support. It’s not on the scanner channel available to us (much of police communication occurs on encrypted channels inaccessible to the public). There is analysis being done on what has been captured on the cameras.

The scanner channel we’ve got access to covers communication between a central dispatch and rescue response teams. But at this point, there are hundreds of police officers from campus police, city police, state police, police from not only the local county but other surrounding counties as well, the FBI, all on campus, all coordinating to ensure students’ safety, to secure buildings, to question witnesses, and to find the shooter. We are hearing one part of that.

The rescue teams are checking out all of the areas of reported shooting. And Doug is keeping track of all of the reported locations – at least ten buildings on campus if not more. But most of the reports of shooting turn out not to be actual shooting. The dispatcher will report that people heard gunshots at building X, and there will be a response from a team at that building saying they’re there, and nothing is going on, that all is quiet.

But there are 50,000 scared students. A door slamming can sound like a gunshot. If you hear something, you report it. We hear the dispatcher relay a report that someone saw someone throw something into a trash can. An explosive device? A gun? A sandwich wrapper?

There are multiple reports of people with guns. Of course there are. It’s dark. People are looking out of windows. There are tactical units of law enforcement everywhere, carrying guns. Is one of the sightings the shooter?

It’s like practicing medicine.

As a doctor, I have a person in front of me. One whole person. With a lot of parts, a lot of systems. And a family. And friends. And perhaps an imperfect memory of his symptoms. Or an interpretation or a descriptive term that differs from a specific medical term.

Get five people reporting “dizziness” and get five different phenomena being reported. Feeling of room spinning? Feeling that you are spinning? Feeling lightheaded as if you are about to faint? Feeling “off balance”? Feeling a little “fuzzy”? What was tossed into that trash can above?

Did the dizziness start last week? The patient in front of me is adamant that it did. His wife is certain it’s been going on for a month. His daughter never heard him complain about dizziness, but right now she feels like she is going to pass out. Is something serious going on with her right in front of me?

Figuring out what’s going on. Clinical. Observing. Detached enough to stay objective, to see what’s in front of me and find the answers and find the problems, and at the same time looking and listening closely so I can connect and communicate and help.

Diagnosing and assessing and planning. History, family history, social factors, lifestyle, physical exam, laboratory testing, imaging studies. All take time. If a family member only focuses on one, it looks like we’re not doing anything and why is it taking so fucking long to figure out what’s happening? And no one is talking to anyone else! No one knows what’s going on!

But we are talking to one another. It takes time. We’re all caring for multiple people and multiple families and coordinating with multiple departments. Information comes at different times, and one piece may come for one person while we’re looking at a different piece for another person.

The coordination and communication logistics are mind-boggling.

Detached. Clinical. Seeing how the moving parts in East Lansing are analogous to the moving parts in my own profession. Seeing the reactions of those outside of the active team, those who have no control over the situation and who feel that lack of control to their core. Their fear. Their anger.

We hear on the scanner that the shooter has shot himself as officers approached him. We hear that officers are doing CPR on the suspect. A short time later, there is another briefing – confirms that the shooter is dead. And three of the people he shot are dead. And five are in critical condition. There will be more details later. The investigation is ongoing. There is no further physical threat.

It’s one a.m. and I’m exhausted. I’m clinically detached. I hold Doug as I try to fall asleep. You know that little jerk awake that sometimes happens as you’re falling asleep? That happens. But the jerk involves a scream. I’ve never done that before. It wakes Doug up. I apologize.

I have no idea what actually happens with my sleep last night. My exhaustion this morning is overpowering. And whatever tossing and turning I did has pulled a muscle in my neck.

There is more information today. All of the dead and critically injured are students. Two names of the victims have been released. The shooter has been identified – a 43-year-old man with no (as yet known) affiliation with the university.

I’m clinically detached.

Our neighbor kid gets back home this morning. I see his car, knock on his door, and hug him. He knows one of the deceased people.

I’m clinically detached.

A 43-year-old man has killed three people’s children and critically injured five other people’s children.

I’m clinically detached.

Putting ice on my neck makes it worse.

I’m clinically detached.

Another day in America, another mass shooting.

I’m clinically detached.

And if you believe that, I have a bridge to sell you.

To Play or Not To Play

In last night’s Monday Night Football game, Damar Hamlin, a 24-year-old player on the Buffalo Bills, made a tackle, stood up, and collapsed on the field in cardiac arrest. CPR was administered, a defibrillator restored his heartbeat, and he was taken, still unconscious, to the University of Cincinnati Medical Center, a level one trauma center. As of this writing, he remains in critical condition and there has been no information released as to the cause of his cardiac arrest.

The lack of an official diagnosis, however, does not stop speculation, including my own.

There are a number of possibilities high on the differential (the list of potential causes). Vascular injury (injury to a blood vessel – for example a severed artery, or a ruptured aneurysm) can occur spontaneously or after a forceful blow. A spinal cord injury can occur with a forceful collision, and a severe, high (neck-level) injury can lead to cardiac arrest. An issue within the heart itself can lead to cardiac arrest – a heart attack (blockage of an artery that provides blood to the heart muscle) or a problem with the electrical conduction system of the heart can cause the heart to stop.

Mr. Hamlin was running fast to tackle the ball-carrier. The ball-carrier was running fast as well, and his shoulder hit Mr. Hamlin’s chest as they ran full-force into each other, and you can see effects of the rapid deceleration forces on their bodies as you watch video of the collision. Mr. Hamlin stood up and quickly collapsed.

Because of the timing of his collapse in relation to the collision, and because emergency medical personnel were able to get his heart to resume beating, I think there’s a significant possibility that his cardiac arrest was caused by “commotio cordis,” a phenomenon where a blow to the chest occurs at exactly the wrong time in the heart beat electrical cycle and can lead to ventricular fibrillation (fibrillation is a disorganized electrical firing of the cardiac electrical system which stops the normal, coordinated electrical pattern, and instead of an organized, coordinated, functional heartbeat, you end up with ineffectual random, uncoordinated contractions of cells that do not create a functional heartbeat – were you to touch a heart in ventricular fibrillation, it would feel reminiscent of a bag of worms). A physical blow actually creates an electrical impulse, and this impulse can affect the heart’s electrical cycle just as an electric shock from a damaged electrical cord or downed power line or a lightning bolt can. It can be caused by a baseball or soccer ball to the chest (the sport it occurs in most frequently in the U.S. is baseball), a punch or kick to the chest, a fall onto the chest, etc. at a very specific time when the heart’s electrical system is resetting itself for the next beat. It is rare, because of the specificity of the timing in a tiny window.

If commotio cordis is the cause, the fact that he had immediate CPR and defibrillation gives him the best chance of a positive outcome, and I very much hope that this kid is ok (and yes, he’s a man, but he’s the same age as our middle son, so to me he’s a kid).

In medicine, we are always weighing risks and benefits. Risks of differing treatments. Risks of not treating something. And we all do this in life in general. We assess which potential risks are worth which potential benefits and we live our lives accordingly.

Which brings me to the topic of playing football in general.

I love watching football. The beauty of the strategy, the athleticism and skill of the players, the teamwork, the meticulous planning and also the changing of plans in response to unexpected situations, the constant action – when you know what’s going on, it’s a remarkably fun sport to watch.

I hate watching football. I hate seeing players’ heads jerk sharply when they collide with another player or hit the ground.

I won’t watch professional boxing. I appreciate the skill needed to be a professional fighter. I appreciate the work that needs to be put in, the fitness level, the practice. I cannot ignore that the goal is to knock your opponent out. The objective is to cause a degree of head injury that renders your opponent unable to stand for a full ten seconds. The intent is to harm. I cannot, will not, condone this as a sport.

But in football, the goal is to move a ball across a goal line (or through goal posts). The intent is not to harm. The intent is to move a ball. The intent is not to render your opponent unconscious. But the effect, even if not the intent, can indeed be harm.

I hate CTE (Chronic Traumatic Encephalopathy) – the condition that comes from repetitive sub-concussion-level head hits (or even non-head hits – when you slam into a tackle dummy bag and your body stops, your brain continues to move and hits the inside of your skull, and if forceful enough can then snap back and hit the other side as well) and/or repeated concussions. It’s a progressive brain disorder which can eventually lead to dementia. It occurs mainly in people who participate/participated in sports with repetitive collisions (e.g. boxing, football). It occurs with hockey and soccer as well.

Concussions suck. Spinal cord injuries suck. Knee injuries certainly aren’t desired.

All three of our sons are athletic. All three of them wanted to play football in middle and high school. I told all three of them “no.”

Our sons are athletic. Our sons are not big. Basic physics – when a small guy and a big guy run into each other, the small guy is going to take a lot more force in the hit.

Would they have had fun playing? Yup. Would they have learned things they wouldn’t have learned elsewhere? Yup. Would there have been other potential advantages? Also yup. Were these benefits to my kids worth the repetitive collisions? In my calculations at the time, nope. And if I were to have it to do over, my answer would remain “no.”

But every time I watch the Michigan Wolverines play, I’m watching other people’s children take those risks, and I really enjoy watching. I kinda suck as a human, if you think about that.

But here’s the thing: We allowed our kids to do plenty of things that involved not-insignificant risk. They all ski. They all did track and cross country through high school (dehydration and physical exhaustion are not benign, and runners certainly frequently experience injuries). They all did martial arts (in a dojo where you worked with “partners” rather than “opponents,” and where respect and safety were emphasized, but I’m not an idiot – I am well-aware it was not a risk-free activity). There are plenty of folks who would not allow their kids to take on the physical risks of skiing or of martial arts, but they enjoy watching the competitions in the Olympic games – I don’t think these people are unethical for accepting a risk for others they don’t accept for themselves. We all have our level of risk tolerance, and for so many things, even if the risk isn’t worth it for us, we can appreciate those things (think air shows, or gymnastics, or car racing).

So when one of my friends asked me if I think Damar Hamlin should retire from the NFL after this, assuming he recovers fully, and if the cause of his cardiac arrest was a piss-poor-luck timing of impact and not an underlying cardiac condition, I honestly cannot answer. His risk of continuing to play would be the same risk of brain injury that all players assume, and that I would not want my children to assume.

And the cause of his collapse may be something else. We don’t know yet.

I would like to see football evolve so that there is less collision. One may ridicule me here, but two of our boys played flag football, and it’s a great game. We have technology that we could adapt with sensors on uniforms to make football more of a two-hand-touch type of game. It would be different. But a new football could evolve that would keep much of the strategy, athleticism, and esthetics of the game and mitigate some of the more catastrophic risks.

Note that I said “mitigate” and not “eliminate” risk. To live is to be at risk. But risk mitigation allows us opportunity to do more. A freak accident can happen anywhere, with any sport, and in life in general, but we can set things up so that there are fewer accidents expected.

Risks. Benefits. Intent. Mitigation. It’s a lot to think about.

Again, I hope this kid is ok. And I hope all the players get the professional emotional support they need.

The Imperative of Hope

Many friendships are contextual, deriving from circumstance and position or profession. Some professional relationships stay strictly so, while others morph into varying degrees of friendship. Depending on the person and their openness to brushing aside a professional veneer, social media has the ability to give us glimpses into others’ lives and make us feel closer to them – through pictures, stories, and brief exchanges, and can carry connections over longer times and farther distances, even when the initial connecting impetus is long in the past.

The man who was principal at our sons’ high school is such a friend. For the consecutive eight years our boys were there, he was the face of the school. As reasonably involved parents with kids active in sports and music, we had plenty of interactions through the years. We had his cell phone number. Lest you be impressed with what one might assume is a sign of a special closeness, I need to tell you that he put this number on a big slide during back-to-school-parents’-night (or whatever they called it – curriculum night, maybe?) every fall, kept it up for a good several minutes while he gave his spiel, and simply requested that folks refrain from using it in the middle of the night except for a true emergency. He openly friends parents and students on Facebook, and shares pictures and stories and intense glimpses of his family and his life in general. He also sees those pictures and stories and glimpses of others, and that of course contributes to how well he knows his students and their families.

Halfway into our family’s tenure at the high school, after our eldest had graduated and as our youngest was starting, I made an appointment to speak with him. I could count the number of times I had an actual complaint about something in our school system on one hand, even if I were missing a couple fingers, and this was one of them. It was something quite trivial in the grand scheme of things, I assure you. As I walked into his office, I prefaced my explanation of my concern with something to the effect of “I’m not necessarily completely rational at the moment and I’m overreacting to things because I’m really missing Zac” (although our children took flight from the nest with ease, it was not so easy from my side). I started to launch into my reason for being there, and he said “Stop. Wait a minute.” And he hugged me. Not a perfunctory social hug, but a real, honest-to-goodness hug you give someone when you really mean it. And he’s a really big guy, so it made an impression.

Fast forward eight years from that hug. He’s moved to another state. All of our boys have graduated from college. We’ve kept up with him through Facebook and comments and messages – he is a friend. It’s not an even friendship – by nature of the circumstances and positions of our connection, he is much more of a friend than I am from a give-and-take perspective – but I still see it as a friendship.

But this isn’t about friendship.

Two weeks ago, I was on the phone with a friend who’s recently moved overseas when Zac called me. I texted him to let him know I was on the phone with her and that I’d call him back later. I saw a notification that he’d texted back, which I assumed was the normal expected “ok, talk to you later” response. But ten or fifteen minutes later, I realized something about the text fragment at the top of my phone wasn’t hitting me right, and I clicked to read it: “Can you call her back? I saw something very sad on FB that you should know about now.”

Fuuuuuck. My stomach sank, I told my friend what Zac had texted and she said, “Go. Call him. Call me back.”

I called him, my heart already racing. Sad shit happens all the time. Generally, one of us will put it in our family group chat. If this required a phone call, this wasn’t going to be easy to hear.

Our high school principal, that man who leads communities from within, who shares his family with all of us, who listens and hears and sympathizes and empathizes and shares the sublime and the ridiculous, had just lost his 21-year-old son.

Fuck. Just fuck.

I called Doug and told him. Then Ryan and Andrew. Was not able to keep my voice from breaking during any of those calls.

Our family was hit with a ton of bricks. As were thousands of other families who are in the communities in which our principal and his family have been such larger-than-life, yet down-to-earth and humble, parts.

The next part of this story is somewhat surreal. At a time of utter devastation for this family, when the world should carry them, they continued to carry others.

The family held a celebration of life ceremony the morning after announcing their child’s death. It was outside, on the shore of a beautiful pond on the grounds of the university where he had just begun his senior year. His mom spoke, then his older sister, and then his dad.

His name was Sam. And it was suicide.

I say this out loud, because Sam’s mom was adamant that we do – without shame, without stigma. She spoke of her son and his strengths and his silliness and his empathy, and with an unwavering assertion that her son was wrong, that there is always hope, and that suicide cannot be an option. Sam’s mom knew her son and her audience – there were hundreds of people both at the pond and tuned into the video from afar, many of whom were Sam’s friends, who had turned to him for support. Her message was one of a person making damn sure that people who looked to Sam as a leader did not, ever, look to his final act as one to follow.

Sam’s sister spoke of her brother’s goodness and kindness, his ease of making friends, his never hesitating, even for the smallest fraction of a second, to help someone, and how we could all learn from that.

My friend, Sam’s father, spoke of the light of fireflies in a field and of the stars in the sky and of a perfect evening fishing trip just taken with his son, whose invitation he had almost turned down, and the importance of maximizing the time, the moments, with those you love.

Sam’s aunts made Facebook posts in tribute to their nephew, speaking clearly about suicide.

But this is not about suicide.

Sam died in the week before Rosh Hashana, the Jewish New Year. Rosh Hashana is a time of celebration, of eating apples dipped in honey to symbolize wishes for a sweet new year ahead. I could not stop thinking about how, as I and my family were entering a new twelve moon cycle much like any other, with our family whole, my friend and his family, who also are Jewish, were now embarking on a devastating and new rest-of-their-lives.

Rosh Hashana marks the beginning of the Days of Awe, a period of ten days of self-reflection, of focusing on how we might have hurt others, and how we can make amends. The Days of Awe culminate with Yom Kippur (the “Day of Atonement”), a day of fasting – of “afflicting our souls” – and prayer. During the ten days, God is making judgments and decisions as to who will live and who will die, who will suffer and who will experience good things. Although we all “sin,” and sins are confessed communally, repentance and prayer can lessen the severity of judgement. At the end of Yom Kippur, so the liturgy goes, the gates of judgment are closed.

I have always hated Yom Kippur, Judaism’s holiest day. It scared me as a young child, as I had a very concrete take on it. I was convinced that my little brother, a toddler at the time, was going to die because he had a temper tantrum and fought with my parents on Yom Kippur. That leaves a bad taste in one’s mouth.

As I got older, I moved to a much more symbolic understanding of religion and learned to appreciate what I see as the good parts of it – tradition, community, ethics, helping others, providing structure for people who need it, providing solace for those who are suffering. I pick and choose the traditions I follow. I have my own interpretations of the words I sing and actions I do – very big on the symbolism aspect of “God” and “prayer” and “soul” and such, with much poetic license taken.

I don’t believe in closing gates or predestination. I believe that “life,” which Judaism (and most other religions as well) holds as sacrosanct, includes more than a clinical definition.

The body, the mind, the soul, are intertwined, inseparable. And that soul, that nebulous concept, to me is the unique, permanent, indescribable (though I’ll try), indefinable, undeniable, combination of a person’s thoughts, words, emotions, and actions and their interlacing impact with people and with the world. My understanding and view as a doctor is that Sam’s body is no longer alive, but his impact on the world lives – people are different because they knew him. The impact of his soul continues, and will ultimately affect people who haven’t even been born yet. Similar to the light of the stars my friend spoke of, which show us light from billions of years ago yet help us navigate today.

And may Sam’s family, his beautiful, devastated family, whose souls have been so deeply wounded, have an interpretation of Yom Kippur that does not tell them to “afflict their souls” and “fast” and “refrain from pleasure,” but allows them, if they should experience a joyful memory, to revel in it, and to have the hope and sweetness of apples and honey or a taste of one of Sam’s favorite foods. May the concept of holding life above all include healing souls over “rules” of a day.

The gates are not closed. There is hope. There is always hope.

Wishing all of you sweetness.

A Birthday and Anger and Resolve

Today I turn 53 years old. I do not want to celebrate. I will politely thank the people who post their kind wishes on my Facebook wall, but I will not have a “great day.”

This birthday, I and my siblings and my friends and my children and their partners/future partners and potential future grandchildren face fewer rights and more danger than what has been the case in this country for the past 50 years.

My head is still swimming. I alternate between rage and more rage. There is so much harm from medical misinformation regarding “abortion.” It is difficult to know where to start. But I will start.

In many states, women have completely lost their rights to privacy and bodily autonomy.

Women will die.

Doctors’ jobs of saving the lives of their patients have been criminalized. Women are already being denied appropriate, life-saving medical care. Sepsis kills. A miscarriage in process but not completed is a set-up for life-threatening infection. Doctors now have to wait and watch until fetal cardiac activity ceases or the mother has already gone into shock (and has a far smaller chance of survival) to do what needs to be done.

Women will be forced to bring to term, deliver, and watch the prolonged suffocation deaths of their children with horrible chromosomal and other congenital defects – they will be forced to allow the brain of the fetus to develop maximally so that it will have the greatest ability to suffer as it is born and dies over hours or days or weeks due to lethally underformed lungs.

Couples will be denied fertility treatment. In vitro fertilization (IVF) will no longer be an option.

Women who are pregnant when they are diagnosed with hormone-sensitive cancers will be forced to allow those cancers to grow and take hold and spread.

Couples who are carriers of lethal genetic diseases will not have the choice to do IVF and implant embryos without the lethal diseases. They will have the choice only of not having children or of risking the intolerable.

Those impregnated with twins who develop twin-twin transfusions will be unable to choose to save one. They will both be condemned to death.

Women who have miscarriages have already been investigated and charged. There will be more of this.

The religious zealotry of the few is being imposed on those who do not share in that empowered minority’s beliefs. Politicians who have no idea what they’re talking about are forcing their medically ignorant, religiously-based lay-opinions on others.

That the intrusion into privacy, that intrusion into a doctor’s office, that intrusion into the health and well-being of others trying to make the best decisions possible for themselves and their families in unthinkable situations, is infuriating and unconscionable.

And even if the act is illegal, as my eldest has pointed out, rape is now, in effect, in several states, a legitimate means to reproduction.

Yes, there are states that protect against this. But many are working their hardest to make their states as intrusive and controlling and harmful to women as possible. And there are folks openly working to make this hateful, harmful, intrusive, controlling repression national policy.

It is not a “happy birthday.”

My college roommate knew not to wish me a “wonderful day.” Instead, she hoped that I would be surrounded by people I love and that I could enjoy the beautiful weather. I am indeed surrounded by people I love, and I appreciate the blue sky, cooler temperature, and gentle breeze.

I will absorb the energy of that love, of that sunshine, and of that wind, and I will let it fuel me as I fight alongside the vast sea of others for my own basic rights and the basic rights of the people in every state in our great nation.

Today I do not want to celebrate, but I will use the symbolism of today to vow to make my presence on this planet a presence that makes this world a better place.

An Early Snow in a Long Year


Snow falling and swirling and sticking and coating the ground, the trees, the leaves.

Yes, the leaves.

The leaves are still here. It’s not their time to go yet.

They’re beautiful, these leaves. A perfect rainbow of greens, yellows, reds, and browns, varying from tree to tree and even branch to branch. Lush verdant deciduous holdouts along with evergreens, punctuating pumpkin orange, gilded flax, opulent burgundy, burnt sienna, and toasty brown canvases, with a smattering of gray, newly baring branches thrown in.

The depth of the hues, the strength of the crunch underfoot, the bright smell of the pine needles, all speak to the coziness and comfort of autumn.

And right now it’s all coated in snow. Bright white, fluffy, cold snow. A blanket of winter, foreshadowing what will soon be here to stay for a while.

But it’s not time yet.

The colors peek through.

I stop repeatedly to take pictures with my phone, trying to capture the sounds, the cold, the smell of wood burning, but there aren’t enough pixels to conjure on the screen what is aroused in my senses.

The excitement and rapid heart rate as we trudge down the path along the river, slipping and catching ourselves on the little hills, the brief stab of nervousness as a branch cracks somewhere overhead and my husband and I speed up our steps – this also doesn’t come through in the digital images.

Not even the colors come through.

The brightness. The persistence. The depth. The tone.

What shows on the thumbnail looks black and white. The camera won’t extract the complete information. The snow is dominant, unrelenting within the portrait.

I try different angles, different positions, different directions, different locations, managing to get a few shots where a hint of the pigments show through, though never coming anywhere close to what I see outside of the viewfinder.

And I think about the snow.

And the word snow.

When we “snow” someone, we’re duping them, fooling them, even betraying them.

I think of the snowflakes themselves, their intricacies, their points, their spikes.

And I think of the spikes on a virus.

And I think of a coronavirus, falling everywhere, blanketing the earth, hiding the colors, hiding the brightness.

I think of how it’s duping us, fooling us, betraying us, causing us to turn on one another, hiding our humanity from one another, leading us to think in black and white, us and them.

I’m a child of the northeast. I know snow.

And I love snow.

To love snow, you have to know it well. You have to know that its freshly fallen beauty belies its frigidity. You have to know how to dress to protect yourself from frostbite and hypothermia. You have to know when you’re going to need to shovel, and when it’s going to melt. You have to know when it’s the right consistency to make a snowball or a snowman, a snow angel or a snow fort. You have to know how to slide down it on a sled or on skis or how to walk on top of it in snowshoes. You have to know when it needs to be raked off the edges of your roof so that your roof doesn’t collapse and so you don’t get ice dams. You have to know when it’s too deep to be safe to walk through and when it’s falling too hard to drive. You have to have shelter. And you have to have good boots.

You have to know, no matter how deep it piles up, or how dirty is gets along the road, that it will, without fail, give way to spring, to new leaves, to new life.

Snow is a disguise. A cloak.

A mask.

It covers the dirt. At first glance, it’s just pretty. The first coating obscures its power, its destructive potential.

It covers the still living leaves, making the branches hang heavy, threatening to break them all and managing to break some.

It weighs the leaves down, concealing the depth and intensity of their hues, knocking some of them to the ground weeks before they would have drifted down of their own accord.

But even though the pictures refuse to show it, we can see the colors as we walk through the woods. When we’re there, when we’re in it, we can see what’s there.

We have to stop and look. We have to place ourselves there. If we are not physically there, we have to extrapolate from the photos taken by others. The cameras cannot manifest the sounds, the smells, the tastes, the temperature, the emotions, or even the true colors, so we need to go further – allowing ourselves to enter the photographs with our souls, breathing the cold, crisp air in our minds.

We are still here. We are still beautiful. The youthful greens, the peaking yellows, oranges, and reds, the aging siennas and browns. The firs and the maples, the spruce and the oaks, the pines and the beeches and the ashes and the elms and the birches. The leaves and the colors and the depths and the branches of humanity.

With apologies for the triteness of my analogy, for now facemasks are our boots, physical distancing our shelter, and vaccines will be our jackets. They are how we will manage.

Our housemates, Zoom, Facebook, telephones, and neighbors and friends outside on the lawn are our skis and our sleds. They are how we will thrive.

More snow is coming. Know the snow. Know what’s under it – what’s hidden, what looks dead, is dormant, resting, waiting. Know how to manage the snow and how, as best as possible, to protect against its damage. Know how to thrive in it.

Grieve what the snow breaks that is not reparable.

And know, always, that the snow will melt, and that we will emerge in all our colorful splendor.

Live DocThoughts 3/24/20

Due to technical difficulties, I did last night’s live talk on Facebook on my personal page. I will do another tonight (8:30 P.M. Eastern time), also from my personal page – while on Facebook, search for “Abi Schildcrout”. You can choose to “follow” me if you want my public posts to show in your feed. I do not accept friend requests from people I don’t know.

Last night’s talk dealt mainly with public health and societal issues related to COVID 19. Tonight’s talk will deal more with personal/individual issues related to this outbreak. From my Facebook description for this evening: “Body, mind, “soul.” Will touch on Advil/NSAIDs, ACE-inhibitors, steroids, asthma, high blood pressure, and other chronic conditions and how they play into this, disinfection/self protection, differentiating health/medical bullshit from non-bullshit, “self care” – staying at optimal health and staying sane during this time, and elevating our selves and others so that this crisis brings out our best. If this gets to be too much for one session, I’ll continue these subjects tomorrow. I plan to do this nightly as long as people are interested and as long as I’m helping.”

You will be able to view the videos after the live talks are over, but they won’t be interactive for Q&A as they are in real time.

Please let me know if there is anything in particular you’d like me to touch on during these talks.

Stay healthy. Stay home. Stay away from others.

Thoughts on COVID 19

People are either calling me in a panic or rolling their eyes at what they believe to be massive overreaction.

Big actions are being taken. Ones most of us haven’t seen before.

Universities are moving to “remote learning” for the rest of the academic year. The NBA has suspended its season. St. Patrick’s Day parades have been cancelled. There is temporary restriction on people entering the U.S. People are being told to change their behaviors – to stand a few feet away from others when out in public, to avoid crowds, to cancel large gatherings.

It seems terrifying.

But the above is not cause for panic nor for eye-rolling – it is prudent, it is sensible, and it is cause to be reassured that the public and private sectors are working together to slow the spread of a highly contagious disease before it has a chance to overwhelm our medical infrastructure.

The disease itself is concerning. COVID-19 (this particular circulating corona virus, which is related to previous viral outbreaks such as SARS and MERS from past years) has a reasonably high mortality (death) rate in lab-confirmed cases. This overestimates the actual mortality rate, since many people will have only mild symptoms and not seek medical care and no one knows they have the virus because they aren’t that sick and so they aren’t counted in the denominator of people with the disease. This virus is really bad for older individuals, those with weakened immune systems, and those with underlying heart or lung issues. Everyone should be diligent with general hygiene and infection-control practices to reduce spread (frequent hand-washing, not touching your face/mouth/nose/eyes, not sharing drinks/silverware/etc., covering coughs/sneezes, frequently disinfecting high-touch surfaces (door knobs, tabletops, etc.), keeping a few feet away from people when out in public, and staying home and away from others when you feel sick). All of the aforementioned, I might add, is what we should do in general, but we tend to get sloppy about it when there aren’t publicized or imminent infectious threats.

People with underlying heart or lung issues, older individuals, people with compromised immunity, and others at higher risk (or who spend time with those who are at higher risk) will want to be more aggressive about avoiding public or crowded places. Follow WHO and CDC recommendations and the recommendations of your local health department. From current data in Korea (where they have done extensive testing for the virus), it appears that the overall mortality rate is around 0.6% (although current worldwide case mortality is looking like 2-3.5%, and we won’t know more exactly for some time), which is higher than that of influenza (which is generally about 0.1% or so in the U.S.). And even though most young, healthy people who are exposed to and contract this virus will be fine, some will die. The number of cases is likely to increase substantially – the reason for avoiding crowd exposure and cancelling conventions and big events/gatherings is so that we can avoid too many people getting the virus at once, causing us to run out of ICU beds and/or ventilators if the spread isn’t contained/slowed down (which is why we should listen to WHO and CDC recommendations, as well as the recommendations of our local health departments).

Here’s some of what we know so far about the clinical aspects of COVID 19: Virus symptoms start with achiness, feeling run-down, cough, low fevers, then development of difficulty breathing about 8 days in, and lung inflammation about 9 days in. (This is in contrast to influenza, which hits you like a Mack truck). Fever is usually, but not always, present. The most common lab finding is a low lymphocyte count (a specific type of white blood cell), but overall white blood cell count can be elevated or low. The CT scan findings show patchy inflammatory changes in the lungs. No other symptom/lab/radiologic findings are consistently found. Looking at a large group of patients in China, it appears that onset of symptoms from time of exposure is between two to nine days, with a median of 5 days, but there are reports of incubation periods up to two weeks, so quarantines are officially two weeks for those who have been exposed. The virus seems to be most contagious when a person has symptoms. A person can “shed” viral RNA for several weeks after they’re better, but it is not yet known whether those post-illness viral RNA particles are actually infectious. So for now, patients are kept isolated until there are two consecutive negative tests (i.e. no viral RNA detected) at least 24 hours apart.

Most people in the U.S. who have severe disease have been receiving Remdesivir (an anti-viral medication) from the company Gilead on a compassionate use basis, but soon patients receiving it will need to be in an official randomized controlled trial. There are other medication recommendations coming out of China and Korea that are indicating that there has been success decreasing the mortality rates (death rates) with other anti-viral medications, with chloroquine (an anti-malarial med), and also with some other types of drugs which target the immune system response, since some of the severity of illness and death is due to the immune system’s reaction to the virus.

There are some very smart brains in multiple countries working on medication and vaccine development to combat COVID 19, but it will take some time to figure out and, once figured out, to ramp up production, so slowing the spread of this virus is our best defense at this time.

Our best chance to slow the spread of COVID 19 is for all of us to work together. Wash your hands. Keep your hands away from your face. If official large gatherings have been cancelled, don’t make your own unofficial large gatherings instead. Avoid movie theaters for a few weeks and watch T.V. with a couple of friends instead. Don’t share drinks/plates/eating utensils. Keep at least 3 feet between you and other people, 6 feet if possible. Wash your hands. Keep your hands away from your face. Avoid unnecessary travel in busses/planes/trains/subways. Wash your hands. Keep your hands away from your face. Work from home if you can. Stay away from others if you feel sick. Disinfect high-touch surfaces regularly. Wash your hands. Keep your hands away from your face.

There will be inconvenience. There will be economic consequences. But hopefully there will be lives saved and grief averted if we all do our part and work together.

Oh, and wash your hands and keep them away from your face.

M-ing My Own B – Or Not

Sometimes I suck at minding my own business. Usually I’m pretty good at it, but it’s harder for me when I really care about someone. And unfortunately (or fortunately, which is how I generally look at it), I really care about a lot of people.

So sometimes I open my big mouth.

When I do it in a way that I know risks crossing a line, it’s because 1- I know what I’m talking about, 2- I genuinely believe that disseminating the information has the potential to make an impact on someone’s life/health, and 3- I care about the person enough that the risk of pissing them off is outweighed by the potential that the information/suggestion will do good in that person’s life.

And it’s hard to take the doctor out of a doctor. When a patient is sitting in front of me in an exam room, or when a medical advocacy client is talking to me about a health/medical/weight-loss issue, I have carte blanche to give my opinion. I mean, that’s why the patient is there, and that’s why my clients pay me. They asked for my opinion.

But sometimes, when something is revealed in a personal, not professional interaction, and my opinion wasn’t asked for, the doctor in me comes out anyway.

It actually comes out all the time – like most docs, I’m always analyzing, synthesizing information, asking ridiculous numbers of questions, and trying to find answers. That questioning is probably inborn and leads a lot of people to become physicians, and through the process of becoming a doctor it is honed into a sharp weapon of third-degree-interrogation.

And then information comes out that puts me in a spot of feeling compelled to offer unsolicited advice. So of course it’s my own fault.

Anyway, I was with a (relatively new) friend today, and what started out as normal small talk conversation about candy bars and fast food got Abi-ified into a little more questioning and resultant disclosure that this friend and his wife “really aren’t doctor people,” and therefore he had no idea about his blood pressure because he hadn’t seen a doctor in almost 40 years.

Which of course then shot my blood pressure up about 20 points as I swallowed and thought about 1- how doctors in general have done a horrific PR job and how a doc with a less-than-ideal bedside manner can turn people off from all doctors and how the corporatization of medicine is making that even worse and driving wedges into whatever tenuous doctor-patient relationship had been there in the past, and 2- what, as an internist, are my biggest worries when a middle-aged patient walks into my exam room who hasn’t seen a doctor in decades and what are the things most likely to kill him if we don’t check now and what is a person who’s not-a-doctor-person possibly going to listen to and would have the biggest potential impact of overall health, function, and longevity and if I say something to this person in front of me who’s not my patient or client am I going to annoy him or piss him or his family off and cause problems or if I say something could I maybe get him to consider getting just a few basic things checked and save himself and his family potential heartache or if I don’t say something will something awful happen that I could have prevented by not being chicken-shit and just saying something.

Yes, I always have that many thoughts at once. I should really learn to meditate.

But yeah, I said something.

In the few-second brain arc between his disclosure and my opening my mouth, I figured the things with the biggest bang for the buck would be checking blood pressure, screening for diabetes, and colon cancer screening. There’s more, but if I had to pick three, those would be the big primary-care-doc-office-visit items I’d hit first (at least without knowing any other specific medical history, and even with my incessant questions I do have an understanding of basic boundaries and don’t do complete medical interviews with my social contacts), so I suggested he consider seeing a doc to discuss these things and explained (minimally) why they were so important. If he were a woman, I’d have thrown in suggesting a PAP smear and a mammogram. And if I had thought fast enough, I’d have also recommended a flu shot and a tetanus booster and a few other immunizations (which, if he actually goes to a doctor’s office, the doc will suggest).

I assume he won’t listen to me. But maybe he will. I’ll zip him the name and office number of a doctor I know and trust who works near where this friend lives.

If someone with professional knowledge of building structures were in my house and noticed a crack indicating a loss of structural integrity, I’d want him/her to tell me so I could do what was needed to prevent my house from collapsing. If someone with a knowledge of cars heard that I changed the oil in my car myself so never took it in to the mechanic but I’d never checked any fluid levels or spark plugs or tire treads or break wear, I’d want them to share their expertise and tell me what I didn’t know so that I didn’t end up broken down on the side of the road in the middle of nowhere or in an accident because of something that could have been prevented or caught early and fixed.

I really don’t want to be a pain in the ass. But I do show my colors pretty openly, so if someone chooses to spend time with me then they are well aware of my pain-in-the-assness.  

Somewhat recently, I didn’t like the description of a complaint by another friend of mine when we were exercising. I pushed her to see her doctor immediately. I was a pain in the ass. And it turned out she needed cardiac bypass surgery.

So yeah, I’ll keep on being me – a pain in the posterior who asks a lot of questions. At least you know that if you’re getting unsolicited advice from me, I’ve spent some brainwaves agonizing over whether I should have said anything.