Memory is a funny thing.

This morning, Doug and I were walking past a playground where our kids used to play. The memories spilled over me like a giant wave. I swear I could reach out and squeeze those babies from 15, 20, 25 years ago. Their faces. Their smiles. Their voices. The way they ran, jumped, laughed, played. It was so. Damn. Real. And so close. I could smell them. I could feel their arms hugging me. I could see them jumping and swinging and could feel their joy as they climbed and the wetness of their tears when they fell. A combination of so many memories, spanning years, compressed into one beautiful, powerful flashback.

Time is a funny thing.

It stretches and shrinks, with long days and short years, or short days and long years, or other combinations of fleeting and eternal seconds, minutes, hours, days, weeks, months, years, decades.

When doctors evaluate patients, we always check to see if they’re “oriented to person, place, and time.” Do they know who their family member is who’s standing next to them, do they know they’re in a hospital or a doctor’s office, do they know today’s date? 

It’s an important part of patient assessment, time. The number of heartbeats and breaths in a minute, the pattern/regularity of those heartbeats and breaths. The knowledge of the date. The duration of current symptoms or of a longtime condition. 

Orientation to person, place, and time.

I was walking with my husband today, March 29th, 2024. And in the space of ten footsteps, I passed through 1999 to 2009. I was standing in a playground 50 feet from where I actually was, with children who are men hundreds of miles away.

The number of breaths in a minute. I think I held my breath through those ten steps. Or a little longer.

Sometimes I’ll walk into the basement to get something, forget what I went there to get, and have to walk back upstairs to remember what it was so I can go back down to get it. That’s not beautiful – it’s actually a pain in the ass.

Both of the above scenarios rely on triggers. Something sets off a recollection – it can be random and involuntary, like passing the playground, or we can purposely use the phenomenon as a tool, like walking out of the basement into the kitchen where something in that setting will remind us of what we had been thinking that had prompted us to descend the first time.

The mind is a funny thing.

Sometimes we can control it. Sometimes our mind has a mind of its own. Which is weird, because it’s our own mind.

Today I’m going to enjoy my mind’s mind of its own. Its orientation to time. To place. To people. To what was and what is. It can go where it wishes.

Unless I need something from the basement.

My friend Joan died this morning.

She was 86.

Eighty-six. That’s seven dozen plus two. Which is roughly the size of the batches of cookies she’d bake.

If you knew Joan, you knew her cookies. Not one type in particular, but that array of sweets for every, any, and no occasion that was uniquely, immediately recognizable as a plate from Joan.

Joan created sweetness, and she shared it freely. 

For a woman who loved chocolate, she was surprisingly facile with walnut, almond, apricot, lemon, vanilla, and butterscotch. For Joan, there was no one way to be a perfect cookie – she appreciated each confection for its own innate delightfulness.

Which is how she approached people, as well.

There was no one way to be a perfect person for Joan. She appreciated each individual lucky enough to be in her sphere for their own innate self. 

There’s an old joke – when two Jews are having a conversation, one of them is talking and the other one is waiting. Joan never waited when she talked to you. She was not formulating in her head what she was going to say while she waited for her turn to speak. She listened. Fully. And then she responded. Her attention was on you. She was fully present – listening, hearing, and remembering what you said. 

We became friends twenty years ago, when my sons were seven, six, and three. The math is easy – they are now twenty-seven, twenty-six, and twenty-three. She watched up-close as they went from boys to men. And I had the good fortune to watch so many of her interactions with them along the way. And those interactions stayed fundamentally the same – a simple, respectful, thoughtful curiosity and appreciation for the children, then the teenagers, then the men in front of her. She showed them, even as little, loud, somewhat messy people, the same regard for their person-ness that she showed me and my husband and the other grown-ups in her life. 

Joan understood that we’re all a little messy. That we all adjust our flavorings or chocolate chip content from time to time. That we all do better when we know we’re valued for who we are. 

Did I mention that she used to be a kindergarten teacher? I can’t imagine anyone more suited to launch a roomful of five-year-olds into the world.

Joan didn’t use cookie cutters. Her confections were dropped, rolled, broken into brittle. They were never shoved into a mold or forced into a rigid shape. They were not even, uniform morsels, but were relatively free-form in their shapes and sizes, and fillings would frequently overflow.

Before our lives intertwined, she and her husband had raised their own two men. If you know them, you know that it looks like Joan used two different recipes, but you can tell that she used the same technique, the same baking sheets, the same respect for their individual essences. Her eyes lit up every single time she spoke of them. And that same radiation of joy emanated from those eyes every time you asked about her brilliant grandchildren. 

Joan did not skimp on sugar or butter. She wanted the full richness of life. She was devastated by the loss of her husband a decade ago, but she didn’t allow that to stop a different sweetness from developing when she found a companion some time later. A different cookie. A different texture. But Joan knew quality ingredients when she saw them.

For years and years, I would get an annual birthday delivery from my dear friend – a heaping plate of apricot-filled nuggets of deliciousness. I do not know what was in them. I can’t even really describe them – I just know that they were rich and sweet and they made me smile and my smile made Joan smile. Part of me wants to ask her sons for permission to search her recipes so I can try to recreate this nectar of the gods. And most of me knows that I would never be able to recreate it. I know I would look at the recipe and decide that it’d be fine with half as much sugar, with a third less butter, with low-fat cream cheese. I would be too careful with how much apricot preserve I added to each one – I wouldn’t want to overdo it. 

But maybe I will ask to raid her recipes anyway. I know a few guys in their 20s who know their way around a kitchen and spent enough time in Joan’s kitchen to do her recipes justice.

Joan brought sweetness and richness to all of us. She brought her presence fully to every interaction. She loved. She was loved. She made the world a better place. Her memory is indeed a blessing.

A picture. A thousand words.

The viewer’s interpretation. The artist’s intent. The evocation. The inspiration.

The emotions. The feelings. The thoughts.

The gestalt. The detail. The distance. The closeness.

My friend is an artist who creates glass tile mosaics. Her pieces are stunning. They have depth. They have soul. They have light. They speak.

My friend is stunning. She has depth. She has soul. She has light. She speaks.

She and her husband have three adult sons, the eldest of whom lives with his wife in Israel. They are very much in harm’s way.

Since the October 7 atrocities, the stress in my friend’s life has been unbearable. Yet she’s bearing it. Because what choice is there other than to do so?

She has “sketched” out her next piece as a painting. The painting is beautiful. And haunting. This is what my artistically untrained eyes see:

A dark, stormy sky over a churning ocean. A thin tightrope stretches across the painting. There is a dark, shadowy silhouette of a person on the tightrope, left knee bent, left foot and right hand on the rope, right leg hanging down, left arm up at the level of the figure’s head. I can hear the wind and the surf in the picture. Although there is no lightning depicted, I can hear a low, rumbling thunder.

I look at the figure on the rope. Are they falling? Are they tired? Have they just lost their footing and caught themselves? Are they in the process of pulling themselves back up? Are they edging the entire way along with their hand on the rope for balance? What is on the side they are coming from? What awaits at their destination? Is their left arm up for balance? Or is it shielding their head from something?

Is what lies beneath actually an ocean? Or is it a view of the world from so high up that clouds obscure land and coastline and inlets?

The painting is dark. It’s frightening. It’s turbulent. And yet it is inspiring in its determination, courage, and grit.

There is tumult and darkness all around. There is a fine line of support through the violence above and below. But the support of that fine line is strong. There are anchors where the line originates and where it ends that I can’t see, but that the figure on the rope knows or trusts are there. Is there someone calling to that figure?

Part of the cloud cover towards the top is white. Is the sun attempting to peek through? The sky is darkest at the horizon – is the sun setting behind us? Or is it rising?

The rope walker is tired. But still going.

They are alone in the painting. But I see them. I feel them. And others do, too.

Who is the figure? Is it my friend? Is it her son? Someone else? 

What will the final mosaic piece show in its texture and reflections? 

May all of us have strong anchors on our own tightropes. May we reach our hands out to others on theirs. May others reach their hands out to us. May we be lifelines. May we have lifelines. May those lines be plentiful and interweave among us to form the strongest, most beautiful fabric.

May we persevere and find our balance and find our strength and know that we are seen, even when we think we’re the only ones in the picture.

Here’s a little background on why many of your Jewish friends are not ok right now.

At this point, I think most people in the U.S. have heard about the monstrous, gruesome, horrific terrorist attacks in Israel that began the morning of October 7. Words cannot describe. And I know a lot of words.

I am not ok right now.

Not one of my non-Jewish friends reached out to me on Saturday. Or Sunday morning. Or Sunday afternoon. By Sunday night, after one of my sons posted something much more eloquent to the same effect, I posted the equivalent of “Why the fuck is no one reaching out or saying anything?!?” That got some response. As I’m writing this on Monday afternoon, 60-some people have put emoji reactions on my post, and 16 people have commented (12 of whom are not Jewish). 

One of the comments took me aback. It was sweet and supportive and simple and kind, but it hit me so strangely: “I’m so sorry, Abi. My heart breaks for you, your family and your country.”

My gut reaction was “WTF? I’m an American, not an Israeli!”

And then I thought for a few minutes, and I realized that the complexity of being an American Jew isn’t something that others just know, and how Israel might figure into that identity is most definitely something most non-Jews wouldn’t intrinsically understand, since it is so different and varying among Jews ourselves. And maybe this is why so many Jews have felt slapped in the face by the silence of their friends – maybe most people don’t get it and don’t want to say the “wrong thing.” The person who made the above comment out of kindness made a linguistic error that perhaps some people were afraid of making, equating being Jewish with being an Israeli. 

So here are some basics:

Jews are a religious group. Jews are an ethnicity. Jews are a people. Jews are diverse in thought, practice, religiosity, geographic roots, race, and other areas.

We are a religious group, but many of us are not at all religious. Doesn’t matter whether you observe anything religiously – if you’re born into Judaism, you’re Jewish. Once Jewish, forever Jewish, even if you converted to Judaism. 

Jews are big into symbolism. Our sabbath, our festivals, our holidays all have symbolism woven throughout. Wine, candles, spices, rams’ horns, menorahs, salt water, flat bread, braided bread, round bread, eggs, so many other foods, rituals, prayers, choreography of prayers, so much more – it’s all about the symbolism. 

The central text of Biblical Judaism is the Torah – the five books of Moses, along with the books of Prophets and Writings (taken together to be “The Old Testament” by those who include “The New Testament” in the “Bible”). There are religious folks who see the words in the Torah as the word of God, some who see it as the word of God as interpreted by men – “divinely inspired.” I see the words in these books as stories written long ago to transmit what was previously oral history, to serve as allegory, and to convey frameworks for what was seen at that time to be a just society.

“Israel” is the Jewish biblical homeland. It is spoken of throughout the Torah. It is a central part of Jewish liturgy (prayers) – the ancestral homeland, and Jews are “the people of Israel.” The biblical character of Abraham (the “father” of Judaism) had a son, Isaac, who had two sons: Jacob and Esau. Jacob later became known as Israel, and Jews (who descended from him) became known as the “children of Israel.” 

Israel is also a current country that received its official status as an independent country in 1948. It is the world’s only Jewish country, and contains between a third and a half of the world’s Jewish population. Israel is about the geographic size of New Jersey and has a population of about nine million people, seven million of whom are Jewish. Any Jew in the world has a right to move to and become a citizen of Israel, but non-Israeli Jews are not citizens of Israel unless they move there and apply for citizenship. 

There are very few Jews in the world, relatively speaking – like 16 million or so. For perspective, there are about 2.3 billion Christians, 1.9 billion Muslims, 1.1 billion Hindus. About half of the world’s Jews live in the United States. 

Jews have been lethally persecuted throughout history. Most adults in the U.S. know about the Holocaust, but there’s also a long history of oppression and of pogroms targeting Jews throughout eastern Europe and the Middle East. Antisemitism runs deep and it runs strong. It may wear a swastika, but it frequently doesn’t.

There is intense antisemitism in the Middle East. It is not hidden. Hamas’ charter spells out very clearly its hatred of Jews and its goal to annihilate us. Saturday’s barbaric attacks make clear that their charter is not rhetoric. 

Hamas has the backing and support of Iran. Iran also has its proxies in Lebanon (Hezbollah) with an arsenal of 130,000 rockets, dozens or more of which are precision guided.

Please look again at the population numbers above. And pull up Google maps and scroll over to the Middle East. Then look at the descriptions of what the Hamas terrorists did and proudly documented in photos and videos. Mass executions. Torture. Rape. Think about the viciousness and violence and targeting of Jews, the parading of Jews’ dead, naked bodies in the streets, surrounded by celebration. Think about the pictures posted by the murderers on social media of the bodies of their victims for their victims’ parents and families to see. 

That is hatred. That is barbarism. That is monstrosity. That is “antisemitism” taken to its conclusion.

Take a look at the celebratory rallies going on now.

Think about the population numbers.

There are only 16 million of us in the world. Seven million of us are in Israel, in a New Jersey-sized strip of land.

Think about Hamas’ proudly displayed photos and videos again. Think again about the people gleefully celebrating.

Think about who was targeted. Think about how they were targeted. Think about how their corpses were treated and displayed.

Look again at the celebrations.

Now think about that line I threw out earlier: Antisemitism runs deep and it runs strong. Well, it also runs wide.

And now look very closely at where there are celebrations and who is celebrating.

Jews know that the uptick in violence against Jews in their own countries will begin again. It always does.

So. Jews and Israel.

It’s not “my country.” But it’s my people. It’s my family. It’s me. 

I am not ok. We are not ok. Please say something.

I’m sitting down to write this less than an hour-and-a-half before a funeral begins. The man being honored, remembered, mourned, is a dear friend of my husband’s family, one of those friends that’s like family. He was an English professor at the university where my father-in-law taught chemistry. He wrote plays. He created puzzles and games.

So many games! They were published in Games magazine, but what I loved was when we’d stop by and he’d excitedly run out of the room and run back in and hand us copies of his latest creations for us to try. 

The games and puzzles were fun, but what took them to another level was the enthusiasm with which he shared them. He loved seeing the “Aha moments” when we got the wordplay or the twist. It was that intellectual connection, that meeting-of-the-minds in an unexpected, unconventional way. He remembered the unusual, the quirky – he would always bring up a line my eldest child had uttered as a very young child, seemingly randomly, about a certain professional sports team not being his favorite. I’ve forgotten the specific line, but this man remembered it verbatim, decades later, because of his fascination with words and with thought processes, and he related to people through those patterns and networks and logic.

Which is why Parkinson’s, and specifically his manifestation of progression of the disease, was so particularly cruel.

As the disease degraded his neural connections, it progressively severed his specific way of connecting with the world. 

His wife is someone who projects strength and models dealing with things as they are. She doesn’t sugar-coat, and she optimizes what she can. When he was no longer able to cover his end of conversations, she was still covering hers. He was never alone.

The fucked-uppedness of neurodegenerative disease juxtaposed with the magnificence of the good side of humanity. Such a twist. Such a puzzle.

Life is certainly not fair. Which is what my family-friend-in-law saw and appreciated so clearly. What you would think should happen, what you would think should follow, frequently doesn’t. There are bends and convolutions in the arc of existence that can leave you confused, begging for an answer. He appreciated the struggle of the search. His wife and family continue the game, even if not knowing the whys, figuring out the hows. 

Sending all who knew this man of so many words a wordless hug. May his memory ever be a source of laughter and connection.

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.

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.

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.