This week, 30 years ago, I graduated from medical school. My mother, my aunt, and my nanny attended the ceremony; all are gone. You probably know that medical school merely provides the infrastructure and the lexicon of the profession and that the most important learning comes from direct patient care. Only a few weeks after my graduation, I started a four-year stint at Maimonides Medical Center, as extern, intern, and resident in internal medicine.
If asked why I became a physician, my answer has always been the same: to be a healer, to help my community, and to lessen people's suffering. And I'm lucky to have chosen my calling at age 9, thus narrowing my professional aspirations considerably. My idealistic side never evaporated, having been formed and solidified in the late 1960's. And it's a source of happiness and contentment that I've saved thousands of lives by heroic intervention, uplifting motivation, and maybe a book or two.
But the life of a physician is a difficult one, filled with unpleasant tasks, conversations, and decisions. We expect physicians to be humanitarians, not simply scientists, and that is quite a weighty responsibility. Everyone probably has a story of the aid and comfort given to him or her by a doctor, perhaps even an anonymous emergency room physician. The words might stick in our minds forever. I have somewhat more down-to-earth epigrams carved into my memory, such as this one from my internist Benjamin Rosenberg during my teenage years, when I asked him if he liked all his patients: "Stu, I have put my finger into the rectum of people I wouldn't shake hands with."
Perhaps Dr, Rosenberg was being flowery, as we Brooklynites have been known to be. Interestingly, I found out what he meant, metaphorically speaking of course, when I worked as an attending physician at Cabrini Medical Center's emergency room: many of the patients were criminals, Runyoneque-types, or worse, yet my duty was to diagnose broken bones, suture lacerations, and restore vital signs--this was not the location for social change, personal opinions, or dramatic confrontations. I was simply their physician at that moment in time.
My great-uncle Abe Fischer, the only other doctor in my family, had dazzlingly colorful stories that would make me even more excited to be going into his exalted profession. As a general practitioner in 1920's to 1930's Brooklyn, he had suffered through an ordeal in his Maimonides training (being on-call every night for three years), accepted a chicken as payment for a house call during the Great Depression, and treated the high (young Maria Callas) and the mighty (Al Capone and Dutch Schultz). Being a physician, he always sat at the head of the table wherever he went and was the sole speaker, with beautiful silvery hair, orotund tones, and a Freudian beard. He had gravitas, authority, and a wealth of experience, the sort that can only come after witnessing the ravages of disease and the pain of earthly sorrow.
In reflecting on my journey through the medical profession, I recently recalled another early influence, this time a fictional character: Doctor Astroff in Uncle Vanya. I had seen a stellar Mike Nichols production of the classic Russian play on Broadway, with George C. Scott as Astroff and Julie Christie as the woman he loved and lost. The more I watched Astroff's world-weariness, combined with his refusal to stop being a caretaker and healer, the more I knew I was on the right path, challenging though it might be.
Dr. Astroff might be a fictional character, but all students of theater know that he's a stand-in for the playwright himself, Anton Chekhov, also a physician. How much of Astroff is Chekhov? And how much of Chekhov is Sonya, the melancholy and lonely woman who experiences life as a vale of tears and longs for peace in the grave? How could someone have written her final speech without experiencing at least some of the emotions? I'm as ebullient and fun-loving as anyone else yet over the course of 30 years, I've seen, by my own estimate, 3000 people die in front of me.
These conflicting, seemingly irreconcilable aspects of a life in medicine haunted me when I began to record excerpts from Uncle Vanya for my project "The Art of Medicine." A house call by Doctor Astroff proved very dramatic, stirring up memories and feelings that are as much a part of my medical education as pathology and anatomy. How do we become who we are? Sometimes the insights come not from science and textbooks--but from art and life.
Monday, May 25, 2009
Friday, April 10, 2009
The Art of Medicine
Who said "Ars longa, vita brevis" [Life is short but art is long] ? It was a Greek physician, namely Hippocrates, and although he was referring to the "art" of practicing medicine, we generally use this famous phrase as an appreciation of the durability and complexity of self-expression through drama, painting, movies, and music.
The Roman philosopher Seneca translated this famous statement into Latin, and its common usage is also a truism: our earthly activities have a finite duration but creative work can transcend the boundaries of time, geography, and ethnicity. An easy example: theater pieces dating back 2000 years often surprise modern audiences with their topicality and psychological insights (for example Lysistrata, The Trojan Women, and The Bacchae).
As a physician since 1980, I have always had special interest in artistic works that address medical and health topics. Often the author/composer/poet discusses the topic directly--a favorite might be the role of Dr. Astrov in Uncle Vanya, a stand-in of sorts for playwright Anton Chekov (himself a general practitioner). Other times the focus might be on illness as a metaphor for the tragic arc of a pitiable character; successful performances of Puccini's La Bohème should have the audience in tears when Mimi succumbs to tuberculosis.
I will be sharing some of my lifelong favorites with you on my website--and in upcoming personal appearances--and I'm thrilled to have accumulated a wealth of entertaining, insightful, and quite contrasting selections drawn from diverse sources. The title for this performance anthology seemed to suggest itself: The Art of Medicine.
Up first: ten contrasting literary works that address the topic of health in completely different ways. I’ll leave it up to you to discover how, letting the authors speak for themselves. The settings are quite different (a Civil War hospital, bucolic Tennessee, cholera-infested Venice) and so are the characters (drunken medical students, Medieval true believers on pilgrimage, an artist doomed by tertiary syphilis). To come: two songs from 1929 about health issues, one naughty, one frightening. But the focus is similar: our fragile bodies, the human spirit, and the gift of life.
The Art of Medicine: where science ends--and poetry begins.
Enjoy!
The Roman philosopher Seneca translated this famous statement into Latin, and its common usage is also a truism: our earthly activities have a finite duration but creative work can transcend the boundaries of time, geography, and ethnicity. An easy example: theater pieces dating back 2000 years often surprise modern audiences with their topicality and psychological insights (for example Lysistrata, The Trojan Women, and The Bacchae).
As a physician since 1980, I have always had special interest in artistic works that address medical and health topics. Often the author/composer/poet discusses the topic directly--a favorite might be the role of Dr. Astrov in Uncle Vanya, a stand-in of sorts for playwright Anton Chekov (himself a general practitioner). Other times the focus might be on illness as a metaphor for the tragic arc of a pitiable character; successful performances of Puccini's La Bohème should have the audience in tears when Mimi succumbs to tuberculosis.
I will be sharing some of my lifelong favorites with you on my website--and in upcoming personal appearances--and I'm thrilled to have accumulated a wealth of entertaining, insightful, and quite contrasting selections drawn from diverse sources. The title for this performance anthology seemed to suggest itself: The Art of Medicine.
Up first: ten contrasting literary works that address the topic of health in completely different ways. I’ll leave it up to you to discover how, letting the authors speak for themselves. The settings are quite different (a Civil War hospital, bucolic Tennessee, cholera-infested Venice) and so are the characters (drunken medical students, Medieval true believers on pilgrimage, an artist doomed by tertiary syphilis). To come: two songs from 1929 about health issues, one naughty, one frightening. But the focus is similar: our fragile bodies, the human spirit, and the gift of life.
The Art of Medicine: where science ends--and poetry begins.
Enjoy!
Friday, April 3, 2009
Resilience
What is resilience? Faced with a serious crisis, some people have the ability to cope with stress in a positive and productive manner rather than crumbling under pressure and falling to pieces. Other people don't, and their world can be shattered as lifelong plans unravel and health deteriorates.
And who has this most evanescent of traits? Where does it come from, innate survival powers or learned behavior?
These questions had always puzzled me before reading a brilliant book by the esteemed psychiatrist Dr. Frederic Flach, Resilience, that focuses on this very lofty and necessary behavioral skill. Yet true to the complexity of life, resilience is also a phenomenon in ecology (whereby an ecosystem tolerates natural disturbances and thereafter returns to a stable state) and physics (the ability of a substance to absorb energy when deformed and then elastically restore itself--something cartilage does as a "shock absorber" in our hips and knees).
I have witnessed careers ruined due to relatively minor personal problems, individuals turned into recluses when intimate relationships ended, psyches scarred by failure preventing further attempts at success. Various philosophers have had their say, as in this passage from Twilight of the Idols by Friedrich Nietzsche:
or in this memorable truism from the Broadway musical Gypsy, via lyricist Stephen Sondheim:
Your ability to be resilient is directly linked to your self-concept (the sum total of all your ideas about yourself) and therefore your image (the projection of your self-concept into the social world, a visible representation of your belief systems). The stronger your self-confidence and the stronger and more realistic your bonds to the outside world, the more impervious you will be to negative thinking, feelings of hopelessness, and abandonment of plans. Resilience isn't courage, egocentricism, or focus, although these may be some of its components--nor is it a conscious effort to ignore pain, loss, or potential tragedy.
Resilience, on the other hand, implies a practical approach to problem solving, one where sadness and despair are redirected into new goals, new situations, and a new set of rules. I have often thought of life as a narrative that Charles Dickens might have written, full of twists and turns of the plot. His most memorable characters, Oliver Twist, Nicholas Nickelby, and David Copperfield, for example, endure poverty, loneliness, and estrangement, only to find themselves unlikely heroes by the end of their ordeals. The outcome of the story could never have been predicted at the onset.
It is this view of life, as a rather prolonged roller-coaster ride, that makes resilience an easier process to accept, a survival technique that must be learned by transcending life's challenges. Various social institutions have proved helpful for many troubled people seeking a pathway back to a happier life: religion, artistic self-expression, therapy. All are potentially helpful, yet the outcome must still be the same: moving on to a new chapter of one's life, turning the page as it were in one's own non-fictional narrative. Like self-confidence, resilience is a learned skill; hopefully, as we mature, it will help to keep us steadfast and comforted.
Resilience, like physical strength, requires effort, repetitive steps, and balance. Practical tips and remarkable insights are provided in Dr. Flach's masterful book, one that belongs in your library. Simply put, whether discussing resilience or Resilience, you can't live without it.
And who has this most evanescent of traits? Where does it come from, innate survival powers or learned behavior?
These questions had always puzzled me before reading a brilliant book by the esteemed psychiatrist Dr. Frederic Flach, Resilience, that focuses on this very lofty and necessary behavioral skill. Yet true to the complexity of life, resilience is also a phenomenon in ecology (whereby an ecosystem tolerates natural disturbances and thereafter returns to a stable state) and physics (the ability of a substance to absorb energy when deformed and then elastically restore itself--something cartilage does as a "shock absorber" in our hips and knees).
I have witnessed careers ruined due to relatively minor personal problems, individuals turned into recluses when intimate relationships ended, psyches scarred by failure preventing further attempts at success. Various philosophers have had their say, as in this passage from Twilight of the Idols by Friedrich Nietzsche:
Was mich nicht umbringt, macht mich stärker.
(What does not destroy me, makes me stronger.)
(What does not destroy me, makes me stronger.)
or in this memorable truism from the Broadway musical Gypsy, via lyricist Stephen Sondheim:
"Some people have it and make it pay. Some people can't even give it away!"
Your ability to be resilient is directly linked to your self-concept (the sum total of all your ideas about yourself) and therefore your image (the projection of your self-concept into the social world, a visible representation of your belief systems). The stronger your self-confidence and the stronger and more realistic your bonds to the outside world, the more impervious you will be to negative thinking, feelings of hopelessness, and abandonment of plans. Resilience isn't courage, egocentricism, or focus, although these may be some of its components--nor is it a conscious effort to ignore pain, loss, or potential tragedy.
Resilience, on the other hand, implies a practical approach to problem solving, one where sadness and despair are redirected into new goals, new situations, and a new set of rules. I have often thought of life as a narrative that Charles Dickens might have written, full of twists and turns of the plot. His most memorable characters, Oliver Twist, Nicholas Nickelby, and David Copperfield, for example, endure poverty, loneliness, and estrangement, only to find themselves unlikely heroes by the end of their ordeals. The outcome of the story could never have been predicted at the onset.
It is this view of life, as a rather prolonged roller-coaster ride, that makes resilience an easier process to accept, a survival technique that must be learned by transcending life's challenges. Various social institutions have proved helpful for many troubled people seeking a pathway back to a happier life: religion, artistic self-expression, therapy. All are potentially helpful, yet the outcome must still be the same: moving on to a new chapter of one's life, turning the page as it were in one's own non-fictional narrative. Like self-confidence, resilience is a learned skill; hopefully, as we mature, it will help to keep us steadfast and comforted.
Resilience, like physical strength, requires effort, repetitive steps, and balance. Practical tips and remarkable insights are provided in Dr. Flach's masterful book, one that belongs in your library. Simply put, whether discussing resilience or Resilience, you can't live without it.
Saturday, January 31, 2009
The Other Side of the River
An inevitable part of life is transition, whether from one height to another, as we grow, from one location to another, as we relocate, or from one image to another, as we change. And may I remind you that "the only thing constant is change" ?
Part of this change--specifically learning how to change--serves as a protective mechanism. This is not unlike an evolutionary modification described by Charles Darwin, when he studied how physical changes in a species (such as larger wingspan or the ability to camouflage) reset the species' genetic makeup and help insure survival.
Humans don't adapt by changing body parts. This takes millennia, not a few decades. Instead, we change by adapting our image to the surrounding world in a way that maximizes our comfort, safety, and success--maybe by developing better interpersonal skills, so we can make new friends in a new setting (a new job, a new school, a new city) or perhaps by changing our "look" (dressing differently when we move to a new area of town, for example from swank Sutton Place to the cooler-than-cool West Village in New York City).
Is transition an enjoyable and painless process? Not really, because truth be told, emotional and social inertia is somewhat reassuring. All of us can get used to unpleasantness, stagnancy, or "a routine" and we may not want to summon up the energy, self-awareness, and courage to change. How many times have you been in a situation that was quite negative but you didn't want to look for an alternative (job, friend, home) because you'd "gotten used to" a modicum of unhappiness and dissatisfaction--or loneliness? Did you convince yourself that being unfulfilled was easier than trying for something better? Such is the "personal myth" of people trapped in go-nowhere jobs, dead-end relationships, social isolation, or, as far as this diet-doctor is concerned, obesity.
People who have forged a successful path though life avoiding its many physical, psychological, and social obstacles have made the ability to change, to transition, a useful and oft-called-upon skill. They upgrade their appearance frequently, watching the latest fashions and choosing the best, most au courant look. Their hairstyle reflects the latest trends; their conversations include the most interesting current subjects; they make new friends gracefully, slowly, and sincerely.
No one is incapable of making such a transition. Conversely put, we all must learn this essential skill and learn not to fear change. Beyond your current surroundings, whether geographical or emotional, are new opportunities for personal enhancement, upward mobility, and fun. By working on improving your weak points (whether in appearance or behavior--or just weight) a better version of you will emerge, one which will be more capable of success and more attractive to the outside world. Surely you don't think you're a "finished product." On the other hand, it's best to believe that you are "a work in progress" and strive daily to add embellishments of every type.
And when the time of transition comes, and you might not recognize it, the hallmark will not be something you see but something that the outside world sees in you: a new friendship might suddenly blossom, for example, someone very special that might have forever remained a stranger or a missed opportunity for intimacy. But once that transition occurs and your life becomes happier and the sun shines brighter, you will never want to reverse the process, go back into your shell, and return to a life of comfortable stagnancy.
I've likened such a transition to crossing a river on a raft. Once you've summoned up the courage to make that journey and made the necessary changes in appearance and behavior to become a better version of yourself, you will arrive on the other side of the river and step into a new world. You might be tempted to look back and see where you came from, but if all the right variables align, you will never want to go back again. Now on the other side of the river, you can take your first steps inland and explore the new territory. Of course you will be a little afraid. All people take their first steps cautiously when their physical or emotional landscape is new.
Learning how to make transitions, how to cross the river, gets easier with each new challenge. Some day it might be much less problematic, but as you learn to improve your life--and you may have to, whether you want to or not--the process will become more comfortable. Get off the raft, put your feet on the dry land of a new chapter of your life, stand tall, walk forward, and never look back.
Part of this change--specifically learning how to change--serves as a protective mechanism. This is not unlike an evolutionary modification described by Charles Darwin, when he studied how physical changes in a species (such as larger wingspan or the ability to camouflage) reset the species' genetic makeup and help insure survival.
Humans don't adapt by changing body parts. This takes millennia, not a few decades. Instead, we change by adapting our image to the surrounding world in a way that maximizes our comfort, safety, and success--maybe by developing better interpersonal skills, so we can make new friends in a new setting (a new job, a new school, a new city) or perhaps by changing our "look" (dressing differently when we move to a new area of town, for example from swank Sutton Place to the cooler-than-cool West Village in New York City).
Is transition an enjoyable and painless process? Not really, because truth be told, emotional and social inertia is somewhat reassuring. All of us can get used to unpleasantness, stagnancy, or "a routine" and we may not want to summon up the energy, self-awareness, and courage to change. How many times have you been in a situation that was quite negative but you didn't want to look for an alternative (job, friend, home) because you'd "gotten used to" a modicum of unhappiness and dissatisfaction--or loneliness? Did you convince yourself that being unfulfilled was easier than trying for something better? Such is the "personal myth" of people trapped in go-nowhere jobs, dead-end relationships, social isolation, or, as far as this diet-doctor is concerned, obesity.
People who have forged a successful path though life avoiding its many physical, psychological, and social obstacles have made the ability to change, to transition, a useful and oft-called-upon skill. They upgrade their appearance frequently, watching the latest fashions and choosing the best, most au courant look. Their hairstyle reflects the latest trends; their conversations include the most interesting current subjects; they make new friends gracefully, slowly, and sincerely.
No one is incapable of making such a transition. Conversely put, we all must learn this essential skill and learn not to fear change. Beyond your current surroundings, whether geographical or emotional, are new opportunities for personal enhancement, upward mobility, and fun. By working on improving your weak points (whether in appearance or behavior--or just weight) a better version of you will emerge, one which will be more capable of success and more attractive to the outside world. Surely you don't think you're a "finished product." On the other hand, it's best to believe that you are "a work in progress" and strive daily to add embellishments of every type.
And when the time of transition comes, and you might not recognize it, the hallmark will not be something you see but something that the outside world sees in you: a new friendship might suddenly blossom, for example, someone very special that might have forever remained a stranger or a missed opportunity for intimacy. But once that transition occurs and your life becomes happier and the sun shines brighter, you will never want to reverse the process, go back into your shell, and return to a life of comfortable stagnancy.
I've likened such a transition to crossing a river on a raft. Once you've summoned up the courage to make that journey and made the necessary changes in appearance and behavior to become a better version of yourself, you will arrive on the other side of the river and step into a new world. You might be tempted to look back and see where you came from, but if all the right variables align, you will never want to go back again. Now on the other side of the river, you can take your first steps inland and explore the new territory. Of course you will be a little afraid. All people take their first steps cautiously when their physical or emotional landscape is new.
Learning how to make transitions, how to cross the river, gets easier with each new challenge. Some day it might be much less problematic, but as you learn to improve your life--and you may have to, whether you want to or not--the process will become more comfortable. Get off the raft, put your feet on the dry land of a new chapter of your life, stand tall, walk forward, and never look back.
Friday, August 22, 2008
The Gravitational Pull of the Future
Great military strategists have told us that the outcome of a battle is determined before a single shot is fired. This is not clairvoyance but an astute insight into ways in which the future is inextricably tied to the present.
Might I extrapolate even further from this idea? We know that heavenly bodies like the sun and the moon exert a gravitational force on all surrounding planets, asteroids, and comets, based in part on their length, width, and depth, the famed three dimensions. Yet what about the fourth dimension, time? Could there be forces at work that draw us inexorably closer to our personal, professional, and pathological fate? Is there, in other words, a gravitational pull of the future?
For most academic physicians, this concept isn’t really too far-fetched. Take, for example, chronic illnesses such as diabetes, high blood pressure, or circulatory problems. Once these have taken root within a given individual’s body, a new course is chartered, as if a ship’s captain has rerouted his craft according to a different set of nautical maps. “Without firing a single shot,” so to speak, an ailment like diabetes recharts the destiny of the person’s heart, arteries, brain, and kidneys. Unfortunately, diabetes is known to cause microvascular changes 5 to 10 years before blood sugar begins to rise—the seeds of future, possibly fatal health crises begin to work their mischief long before the person or the physician have a clue that something is wrong.
To this we can add many other factors, particularly those associated with DNA, the unique “hard drive” that is embedded in every single living human cell—yours is yours alone, unshared with anyone else in human history. Let’s not worry about the specifics of genotype, phenotype, karyotype, histocompatability antigens, and the like; you can read about these in Star Magazine at your leisure. Simply put, you may have an increased risk of cancer, ulcerative colitis, high cholesterol or even acne (from an inability to fight skin bacteria, in case you’re wondering) based on your genetic makeup—your future may be partially predetermined by these mysterious and highly complex molecules.
Of course, your daily routine of selfcare is neither mysterious nor complex. Do you exercise effectively, if at all? Do you eat with isocaloric balance in mind--namely, keeping your weight healthy and stable? Are you developing rewarding and profitable relationships that may flower eventually into financial stability and personal happiness? Are you continuously learning newer skills that enhance and solidify your self-confidence? Is improvement in itself on your “to-do” list?
Or have you convinced yourself by means of delusional personal mythology and/or self-validating beliefs that it makes no difference how much you weigh, what your blood tests represent, or how high your blood pressure is? You might feel that your appearance is adequate, even if your clothing choices and posture telegraph a negative message to the outside world. How much are you in touch with what others see and think, as well as the “first impression” you make at school, work, or a social event?
These insights will also partially determine your future, and, conversely, given your present lifestyle choices in appearance and behavior, your future may evolve as a consequence of how you are acting right now. The “gravitational force” of disease, disability, antisocial behavior,and other negative entities might be pulling you inexorably towards a scenario of incapacitation, frustrated dreams, and unhappiness.
However, unlike unchangeable genetic codes, your lifestyle choices are exquisitely sensitive to change—better skincare, hairstyles, outfits, nutrition, and physique are helpful to anyone at any time, even by glamorous celebrities who continually reevaluate and recreate their image.
Whether “the future” is interpreted as next month, next year, or decades from now, there is always something you can do to make it better. Look in the mirror at your own three dimensions—length, width, and depth (or calculate your Body Mass Index, essentially the same thing). Then consider the fourth dimension, time, and its role in the outcome of your life. Fortune tellers might look at your palm, tea leaves, or a crystal ball in order to divine your fate. But using your own honest powers of self-observation, you can do this in a more predictable and cost-effective way—and, through the enjoyable process of self-reinvention, pave the pathway for yourself to a happier and healthier tomorrow.
Might I extrapolate even further from this idea? We know that heavenly bodies like the sun and the moon exert a gravitational force on all surrounding planets, asteroids, and comets, based in part on their length, width, and depth, the famed three dimensions. Yet what about the fourth dimension, time? Could there be forces at work that draw us inexorably closer to our personal, professional, and pathological fate? Is there, in other words, a gravitational pull of the future?
For most academic physicians, this concept isn’t really too far-fetched. Take, for example, chronic illnesses such as diabetes, high blood pressure, or circulatory problems. Once these have taken root within a given individual’s body, a new course is chartered, as if a ship’s captain has rerouted his craft according to a different set of nautical maps. “Without firing a single shot,” so to speak, an ailment like diabetes recharts the destiny of the person’s heart, arteries, brain, and kidneys. Unfortunately, diabetes is known to cause microvascular changes 5 to 10 years before blood sugar begins to rise—the seeds of future, possibly fatal health crises begin to work their mischief long before the person or the physician have a clue that something is wrong.
To this we can add many other factors, particularly those associated with DNA, the unique “hard drive” that is embedded in every single living human cell—yours is yours alone, unshared with anyone else in human history. Let’s not worry about the specifics of genotype, phenotype, karyotype, histocompatability antigens, and the like; you can read about these in Star Magazine at your leisure. Simply put, you may have an increased risk of cancer, ulcerative colitis, high cholesterol or even acne (from an inability to fight skin bacteria, in case you’re wondering) based on your genetic makeup—your future may be partially predetermined by these mysterious and highly complex molecules.
Of course, your daily routine of selfcare is neither mysterious nor complex. Do you exercise effectively, if at all? Do you eat with isocaloric balance in mind--namely, keeping your weight healthy and stable? Are you developing rewarding and profitable relationships that may flower eventually into financial stability and personal happiness? Are you continuously learning newer skills that enhance and solidify your self-confidence? Is improvement in itself on your “to-do” list?
Or have you convinced yourself by means of delusional personal mythology and/or self-validating beliefs that it makes no difference how much you weigh, what your blood tests represent, or how high your blood pressure is? You might feel that your appearance is adequate, even if your clothing choices and posture telegraph a negative message to the outside world. How much are you in touch with what others see and think, as well as the “first impression” you make at school, work, or a social event?
These insights will also partially determine your future, and, conversely, given your present lifestyle choices in appearance and behavior, your future may evolve as a consequence of how you are acting right now. The “gravitational force” of disease, disability, antisocial behavior,and other negative entities might be pulling you inexorably towards a scenario of incapacitation, frustrated dreams, and unhappiness.
However, unlike unchangeable genetic codes, your lifestyle choices are exquisitely sensitive to change—better skincare, hairstyles, outfits, nutrition, and physique are helpful to anyone at any time, even by glamorous celebrities who continually reevaluate and recreate their image.
Whether “the future” is interpreted as next month, next year, or decades from now, there is always something you can do to make it better. Look in the mirror at your own three dimensions—length, width, and depth (or calculate your Body Mass Index, essentially the same thing). Then consider the fourth dimension, time, and its role in the outcome of your life. Fortune tellers might look at your palm, tea leaves, or a crystal ball in order to divine your fate. But using your own honest powers of self-observation, you can do this in a more predictable and cost-effective way—and, through the enjoyable process of self-reinvention, pave the pathway for yourself to a happier and healthier tomorrow.
Saturday, August 2, 2008
A Lifetime of Transitions
Summer is usually not a time for philosophical reflection, but 2008 is different for me. As I prepare for a series of publicity-related events to promote The Park Avenue Diet, my thoughts have taken me backwards and forwards in time—reflecting on the past and anticipating the future. “This is a transitional time for you,” my friend and mentor Dr. Stanley Krippner noted a few months ago. Agreed, but as I pondered his overview, I began to think of the entire arc of life, in itself, somewhat inflexibly, a series of stages not unlike a grand railway journey with multiple stops.
No matter who you are, where you live, or what surrounds you, you too will experience a social, academic, and professional environment that is continually being reshaped and redefined. How will you be able to manage these multiple transitions seamlessly and painlessly? The answer will depend to a large extent on your ability to redefine your image, an amalgam of visible behavioral and physical characteristics that reflect your philosophical beliefs.
Are you the same person you were a few years ago? Probably not, although you might wish to believe that your current relationships, appearance, and health are permanent—at least the positive aspects. But physicists teach us that “the only thing constant is change.” So prepare yourself for a roller-coaster ride that might last 80 years by learning to adapt, to upgrade your image, and to develop an evanescent trait called “inner strength.” Otherwise, your roller-coaster ride may be a bumpy one.
I have had many life-defining experiences over the past few years, moments of unbelievable happiness and moments of painful heartache, and so have you. But in looking back even further, I’ve been blessed with a most circuitous and surprising pathway that has brought me to this point—and into your life. I’ve been a shy high-school student, an idealistic Yalie, a frazzled medical student, an overworked intern, a colorful emergency room physician, an associate of a famous diet-doctor, and now an author and media personality—all of these without knowing the next chapter of the story.
At each point of transition, my image changed, but not in some vague spiritual way. Building upon one knowledge base after another, I improved my weight, bodily physique, skin, apparel, hairstyle, interpersonal skills, and self-confidence to match my new responsibilities and hopefully impress my new colleagues. However you look today, good, bad, or indifferent, it’s not a permanent state of affairs. Your ability to reevaluate yourself periodically—and honestly—is not a superficial onceover. It is a survival technique that you will need to call upon repeatedly if you want to develop the resilience necessary to endure, thrive, and excel.
Let’s take as an example your weight. It may seem adequate or at least tolerable to you (66% of American adults are either overweight or obese according to recent CDC statistics) but what will someone else think?--someone such as a college admissions interviewer, a potential employer, a new friend. Their first impression of you, a phenomenon that my fashion expert colleague Helene Hellsten estimates as taking three seconds to formulate, may negate your chances of academic advancement, job placement, or romance. Weaknesses in interpersonal skills may mean nothing to you, but they might convince the gatekeepers of your future that you “haven’t got it all together.”
On the other hand, mastering the various components of appearance and behavior—and upgrading them periodically to present yourself as continuously fresh and interesting—allows you to move from one stage of life to another as seamlessly as possible. People who ignore this learning technique are often described as being “in a rut” or stagnant. You may need to transition from school to an office environment, from living with your parents to coping with your own apartment, from solitude to an intimate relationship. Transitions are as complex and multifaceted as the people that they affect, so don’t try to predict the future—instead, prepare yourself for a series of reinventions, opportunities for creativity, redesign, and productive introspection.
Whether you know it or not, this is a transitional time for you too, just as it is for me. You may not know when the next chapter of your life will begin or who will be the principal characters—but change is inevitable, like the change of seasons we experience every year. Nature makes it happen to trees, insects, and weather patterns, and people make it happen with kaleidoscopic social dynamics and relationships. Your armament against these powerful forces is not merely self-knowledge but the ability to reinvent yourself, after careful reappraisal and inventory of your appearance and behavior. It’s an important and necessary skill, and you can have fun doing this with the proper input from experts such as the team assembled for The Park Avenue Diet.
This is not just a transitional time for me…or you. We all lead a lifetime of transitions.
No matter who you are, where you live, or what surrounds you, you too will experience a social, academic, and professional environment that is continually being reshaped and redefined. How will you be able to manage these multiple transitions seamlessly and painlessly? The answer will depend to a large extent on your ability to redefine your image, an amalgam of visible behavioral and physical characteristics that reflect your philosophical beliefs.
Are you the same person you were a few years ago? Probably not, although you might wish to believe that your current relationships, appearance, and health are permanent—at least the positive aspects. But physicists teach us that “the only thing constant is change.” So prepare yourself for a roller-coaster ride that might last 80 years by learning to adapt, to upgrade your image, and to develop an evanescent trait called “inner strength.” Otherwise, your roller-coaster ride may be a bumpy one.
I have had many life-defining experiences over the past few years, moments of unbelievable happiness and moments of painful heartache, and so have you. But in looking back even further, I’ve been blessed with a most circuitous and surprising pathway that has brought me to this point—and into your life. I’ve been a shy high-school student, an idealistic Yalie, a frazzled medical student, an overworked intern, a colorful emergency room physician, an associate of a famous diet-doctor, and now an author and media personality—all of these without knowing the next chapter of the story.
At each point of transition, my image changed, but not in some vague spiritual way. Building upon one knowledge base after another, I improved my weight, bodily physique, skin, apparel, hairstyle, interpersonal skills, and self-confidence to match my new responsibilities and hopefully impress my new colleagues. However you look today, good, bad, or indifferent, it’s not a permanent state of affairs. Your ability to reevaluate yourself periodically—and honestly—is not a superficial onceover. It is a survival technique that you will need to call upon repeatedly if you want to develop the resilience necessary to endure, thrive, and excel.
Let’s take as an example your weight. It may seem adequate or at least tolerable to you (66% of American adults are either overweight or obese according to recent CDC statistics) but what will someone else think?--someone such as a college admissions interviewer, a potential employer, a new friend. Their first impression of you, a phenomenon that my fashion expert colleague Helene Hellsten estimates as taking three seconds to formulate, may negate your chances of academic advancement, job placement, or romance. Weaknesses in interpersonal skills may mean nothing to you, but they might convince the gatekeepers of your future that you “haven’t got it all together.”
On the other hand, mastering the various components of appearance and behavior—and upgrading them periodically to present yourself as continuously fresh and interesting—allows you to move from one stage of life to another as seamlessly as possible. People who ignore this learning technique are often described as being “in a rut” or stagnant. You may need to transition from school to an office environment, from living with your parents to coping with your own apartment, from solitude to an intimate relationship. Transitions are as complex and multifaceted as the people that they affect, so don’t try to predict the future—instead, prepare yourself for a series of reinventions, opportunities for creativity, redesign, and productive introspection.
Whether you know it or not, this is a transitional time for you too, just as it is for me. You may not know when the next chapter of your life will begin or who will be the principal characters—but change is inevitable, like the change of seasons we experience every year. Nature makes it happen to trees, insects, and weather patterns, and people make it happen with kaleidoscopic social dynamics and relationships. Your armament against these powerful forces is not merely self-knowledge but the ability to reinvent yourself, after careful reappraisal and inventory of your appearance and behavior. It’s an important and necessary skill, and you can have fun doing this with the proper input from experts such as the team assembled for The Park Avenue Diet.
This is not just a transitional time for me…or you. We all lead a lifetime of transitions.
Friday, August 1, 2008
A Modest Weight-Loss Proposal
As a practicing physician it never ceases to amaze me when an overweight patient doesn’t follow my advice. After a Yale University liberal-arts education, a degree in psychology, four years of medical school, an Internal Medicine residency, four years of emergency room work and more...where did I go wrong?
Usually people respond positively to my gravitas and depth of knowledge. The recommendations I give can make an enormous difference...after all, we are talking about life-shortening, debilitating chronic illnesses, the ones precipitated and worsened by overweight.
Why don’t most overweight or obese Americans slavishly follow the warnings of the medical community? It’s certainly not from lack of publicity: every newspaper and television show seems to have an article or segment devoted to health issues. Yet only 5-10% of dieters keep the pounds off permanently and never revert to their former bad habits. What’s wrong with the other 90%? Aren’t they afraid of death?
Somewhat sheepishly I have often posed to colleagues the hypothesis that there is only one diet that would really work wonders. I call it The April 15th Diet. Don’t bother to look for the recipe book, spin-off products, or in fact any nutritional information. On The April 15th Diet you can eat unlimited portions of anything that you want for almost 365 days. Sounds terrific, no?
Then on April 15th of every year you will report to the local post office. After your retina scan and DNA sample pass inspection, you will hand the clerk a notarized copy of your previous year’s income tax returns. You will then step onto a special scale that will measure height and weight, immediately calculating your Body Mass Index. A bar-code sticker will be printed and affixed to your tax return. Then you are done for the day.
Several months later you will receive an envelope from the Internal Revenue Service. They will have audited your tax return and calculated your refund. This amount, however, will be adjusted downwards for every unit of Body Mass Index higher than ideal. Only people who demonstrate sufficient personal responsibility, self-control, and successful results will qualify for a full refund. Incomplete efforts, “trying” or total neglect will lead to incrementally increasing deduction from the funds. Parents are also penalized for the behavior and overweight of their children.
The money saved by instituting this program would be incalculable. Since overweight and obese American will eventually divert money from the healthcare system to pay for their insulin injections, cardiac surgery, dialysis treatments and seeing-eye dogs, it is economically wiser to extract some sort of pre-payment beforehand. Illnesses that affect all people equally (cancer, influenza, broken bones) should be “paid for” by all citizens since they are all more or less at identical risk. However, the concerned citizen of the future might ask his obese neighbor: “You pay for your own ice cream. Why should I share the cost of your medication, hospitalization and nursing care?”
Americans share only two things in common: death and taxes. The fear of premature death is not sufficient to motivate people to lose weight. The possible loss of disposable income, on the other hand, would certainly change hearts, minds and bellies very quickly. Memberships in health clubs would sky-rocket, especially in March. Nutritionists, rather than accountants, would have to work around the clock in early April. Cobwebs and tumbleweeds would surround fast-food stores, and long lines would form at salad bars at the crack of dawn.
Get angry, stamp your feet, write a Letter to the Editor! I know that The April 15th Diet is the worst diet that you ever heard of...but boy would it work!
Usually people respond positively to my gravitas and depth of knowledge. The recommendations I give can make an enormous difference...after all, we are talking about life-shortening, debilitating chronic illnesses, the ones precipitated and worsened by overweight.
Why don’t most overweight or obese Americans slavishly follow the warnings of the medical community? It’s certainly not from lack of publicity: every newspaper and television show seems to have an article or segment devoted to health issues. Yet only 5-10% of dieters keep the pounds off permanently and never revert to their former bad habits. What’s wrong with the other 90%? Aren’t they afraid of death?
Somewhat sheepishly I have often posed to colleagues the hypothesis that there is only one diet that would really work wonders. I call it The April 15th Diet. Don’t bother to look for the recipe book, spin-off products, or in fact any nutritional information. On The April 15th Diet you can eat unlimited portions of anything that you want for almost 365 days. Sounds terrific, no?
Then on April 15th of every year you will report to the local post office. After your retina scan and DNA sample pass inspection, you will hand the clerk a notarized copy of your previous year’s income tax returns. You will then step onto a special scale that will measure height and weight, immediately calculating your Body Mass Index. A bar-code sticker will be printed and affixed to your tax return. Then you are done for the day.
Several months later you will receive an envelope from the Internal Revenue Service. They will have audited your tax return and calculated your refund. This amount, however, will be adjusted downwards for every unit of Body Mass Index higher than ideal. Only people who demonstrate sufficient personal responsibility, self-control, and successful results will qualify for a full refund. Incomplete efforts, “trying” or total neglect will lead to incrementally increasing deduction from the funds. Parents are also penalized for the behavior and overweight of their children.
The money saved by instituting this program would be incalculable. Since overweight and obese American will eventually divert money from the healthcare system to pay for their insulin injections, cardiac surgery, dialysis treatments and seeing-eye dogs, it is economically wiser to extract some sort of pre-payment beforehand. Illnesses that affect all people equally (cancer, influenza, broken bones) should be “paid for” by all citizens since they are all more or less at identical risk. However, the concerned citizen of the future might ask his obese neighbor: “You pay for your own ice cream. Why should I share the cost of your medication, hospitalization and nursing care?”
Americans share only two things in common: death and taxes. The fear of premature death is not sufficient to motivate people to lose weight. The possible loss of disposable income, on the other hand, would certainly change hearts, minds and bellies very quickly. Memberships in health clubs would sky-rocket, especially in March. Nutritionists, rather than accountants, would have to work around the clock in early April. Cobwebs and tumbleweeds would surround fast-food stores, and long lines would form at salad bars at the crack of dawn.
Get angry, stamp your feet, write a Letter to the Editor! I know that The April 15th Diet is the worst diet that you ever heard of...but boy would it work!
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