Casual Friday

A disclaimer before I even get started on this post.

Some of you who know me or work with me will think that by writing this post I am talking about you or even attacking you. I am not. If you’re especially sensitive, don’t read any further.

I am simply writing something that has been kicking around in my head for a long time. Feelings that I have about a concept.

A concept called Casual Friday.

It is fairly common nowadays in companies and facilities and services of all sizes and types to allow employees to wear more casual clothing to work on Fridays. The thinking is, of course, that it’s close to the weekend, things are winding down, people are starting to ¬†loosen up a bit, and that consumers and customers and patients won’t really care one way or the other.

I disagree.


There are several reasons.

One is that one of my major male role models in life growing up, my father, was a manager for a large textile company for most of his working life. I remember Dad wearing pressed, short-sleeved white shirts, a tie, dress slacks, and business-dressy belt, socks and shoes every time he would go to work. Including Fridays. Sometimes on Saturdays. Maybe Sundays after church if something needed checking on. My memory may have dimmed through the years (Mom, maybe if you read this you can provide a reality check for me on this point), but I never remember him going to the plant in a polo shirt or jeans or anything less than his professional “uniform”.

My Dad impressed me, and impressed his work ethic upon me, because he always cared very much about how he presented himself, how he interacted with his people on the floors of the plant, and how he was a role model for the kind of dedication and hard work he expected from all his subordinate employees.

As I grew and went to school and eventually found myself in a medical school environment, it was impressed upon my very early on that one should present oneself as a doctor at all times, not just when on duty, but at the grocery store, in church, and at the football game on Friday night. Part of this was, of course, how one dressed. Somehow, and I’ve written about this before, people can tell that you’re a doctor without your saying a word. I’m still not sure exactly how that happens, but I know that clothing, in certain situations, quietly proclaims professionalism-or not. It’s part of the package, the persona, the training, the projection of who the professional is. It’s the way doctors of my generation were trained.

Also, we were trained very explicitly to observe every little thing about the patient we were bringing back to our consulting room, including their hygiene, gait, clothing, makeup, hairstyle, arm swing, and level of alertness. Would it not be very naive indeed to think that patients would not be checking us out as well? First impressions are huge, especially when you are entering in to a relationship with someone who is going to be asked to tell you about everything from their drinking to their sexual abuse history to their suicide attempts.

Now, fast forward to the present. I see patients every day of the week, including Fridays in the clinics and now via telepsychiatry on some Saturdays and Sundays. Again, it may just be the way I was brought up, but I feel that every patient, no matter which day they are scheduled or how late in the day or the week it is, deserves the same attention to detail, professionalism and interaction that every other patient gets. I had fourteen patients scheduled in the clinic today, a Friday. Are they any less important to me just because I see them just before I am getting off for a weekend out of town? Of course not. Do they deserve the same presentation and professionalism from me that the Monday, Tuesday and Wednesday patients get? In my opinion, yes.

That being said, I do not feel comfortable wearing jeans or polo shirts or flannel to see these folks just because it’s Friday. Sure, I would be more relaxed and probably be more easy going, but is that the way I’m supposed to be on Friday visits with a suicidal sixteen year old or a defiant five year old and his distraught parent?

i have noticed over these last few years that when I dress professionally for the day, just as when I now wear a close-cropped beard that is more white than it used to be, that I get a lot more “yes, sirs” and “no, sirs” than I used to. A function of age and seniority? Sure. Clothing? Probably? Demeanor and confidence? Absolutely. It’s a package deal, remember?

When one does a telepsychiatry consult, all the folks on the other end of the camera see is you from the waist up, or more if you pull the camera angle back some. You could certainly were jeans or even shorts and flip flops for all that matters. Do I do that? No. Why?

Because the other part of all this for me is that when I am dressed for work, I am thinking work-related thoughts. When I am dressed in casual clothing, I’m ready to head for the beach or the football game or dinner with my relatives. It just goes together for me. Again, I think this is due to upbringing, role models, intensive training, and personal choice as my career has evolved. I have a standard uniform now, I’m comfortable in it, and when I have it on I know it’s time to see patients or run meetings or do supervision or write prescriptions or type progress notes. Anything less and I just don’t feel like the doctor is in.

So, Casual Friday will most likely still be around for some time in some fashion in many of the places that we frequent.

Just don’t expect that if you come see me on Friday that I will look much different than I would look if you came to see me on Tuesday.


Just saw an elderly, wrinkled man dressed in a track suit painfully get out of his late-model sports car. He hobbled, with obvious unilateral weakness, to the other side of his car. He then emptied an entire trash bag full of cigarette and cigar butts into the dumpster, winced as he closed the passenger door of his car, then hobbled around to lower himself slowly and painfully into the driver’s seat. I said hello to him and he answered, precipitating a monstrous, hacking coughing fit. He then backed his car out, with that hands on steering wheel every two inches until it’s turned motion, and sped off at fifteen mph.

Sometimes I wish I could turn off the medical training in my head and just see the world like everybody else does.

I’ve been told that I can’t. 

I’ve been told I should write about it.


Weather or Not

When the April clouds roll in, we lift our faces to the springtime rain, drinking it in, feeling the roots grow deeper below and the pop of color above as flowers bloom.

In times of summertime warmth and bright sunshine, we are up and active and happy. Life is easy. It takes little effort. It just feels good. We bask. We glow. We engage.

We fall back in the midst of musty bright color as days shorten and the chilly air of autumn’s kiss brings the goose flesh of knowing. 

When cold winter rain turns to sleet and then the thick midnight snowflakes begin to fall, we hunker down. We search for the familiar warmth of hot cocoa, a flickering fire, and the embrace of the familiar. We know that it’s dark outside. We know that the crack of branches and the black sheen on the roads can mean death. 

We sit tight. 

We trust the warmth. 

We know that spring will come again. 

True love is seasonal. 

Never Up, Never In

So, some observations as I made my way first to Jacksonville and then to Islamorada Key yesterday and today.

This is a holiday weekend, which is why I’m traveling along with several thousand other people on this narrow little strip of highway that juts straight out into the ocean after you leave the security of Miami, Homestead and environs. There is a lot of traffic. I mean red line on the Apple Maps app, bumper to bumper fifteen mph type traffic. And it’s not like you can just blow your horn and go around, unless you have an airboat or a Hovercraft.

It’s enough to make you seethe except for one thing. You’re in the Florida Keys, baby. Keys Disease is already taking over, miles out.




I’ll just watch the sunset.

I did have one flashing thought though, as I sat there and waited to escape the terrestrial gravitational pull of the Mainland.

Even when the traveling is hard, if you never get there, you can’t be there.

Of course it would be easier to stay at home.

Of course it would be cheaper to eat leftovers.

Of course it would be okay to have wild caught salmon from Publix.

But if you never get up and move, change, explore, and discover, you will never experience anything new.

If you never drink the martinis Hemingway drank, you will know less about the man.

If you never experience a sunset in the Keys, you will think all sunsets are the same.

If you never drive all the way to the Point (thank you, Virginia), you can’t say you’ve been to Key West.

In golf, the saying is “never up, never in”.

In life, if you never push yourself to get there, then you can never truly be there.

And if you’re never truly been there, you’ve missed out.

Your life is not as complete as it could be.

Figure out where you really need or want to be tomorrow and get yourself there.

Make your own breaks.

Get to the brink, and then push further.

You’ll see how really good that feels.

Goodnight from the beautiful Florida Keys.

#threewords2015, #breaks, #brinks


I Don’t Always Daydream, But When I Do…

So, I’m eight days and 3 1/2 books into 2015, and I’ve already learned (been reminded of?) several very important things.

Please allow me to share them with you now.

Successful and interesting people:

Actively engage their surroundings.
They do not wait for things to happen to them. They go after things. They take the bull by the horns and wrestle that sucker to the ground.

Have varied and extensive social networks.
They know lots of people. They talk with people. Not to them (that would be the narcissists). They learn from them. They genuinely like them. The go out of their way to engage them.

Read a tremendous amount.
They love books. They read and learn and share and journal and write and read some more. Then they read some more. Then they take a break and read a little.

Have very specific goals.
They know what they want and how they’re going to get there. There is no pussyfooting around. I think most of them have a very keen sense of how much time they have to accomplish their agendas, and they do not intend to waste a minute of the time they’ve been given to make their mark on the world.

Have well-defined interests.
They waste no time on trivialities. They fully immerse themselves not just in their vocation and projects, but in their avocations as well. They know what they like and what holds their attention, and they doggedly pursue it.

Have figured out how they want to impact the world and what their legacy will be.
See above. They figure it out. They plan. They execute. Boom.

Know how to play.
I think every serious, world -changing adult has never fully lost contact with his or her child mind. We are all the richer for that fact.

Give themselves adequate time to think, plan, and dream.
No one can work all the time. We kid ourselves if we think that scheduling every moment of every day makes us more productive. It does not.


I wonder what I’ll learn the last fifty -one weeks of this year?

After I read some more,

And visit with friends and family,

And travel,

And do my best to save a patient’s life,

And daydream a few hours away?

I wonder.


Three Little Words

As Chris Brogan and others have made customary in the blogging world, I offer up my three little words for 2015.

1) Books

I have thought about how I spent my time in 2014 and the recent years before. I found that a lot of my “ear time” was taken up by listening to music, but sometimes even more time was taken up by listening to podcasts. Tech podcasts. Mac podcasts. News podcasts. Productivity podcasts. A lot of time. Like hours and hours. Some of these podcasts are one and a half hours long or longer. Geez.

The fact is that the ear candy that is podcasting is a pleasant diversion akin to mental masturbation. Like the real thing, it feels very good but it’s not nearly as satisfying as a real relationship.

Enter books.

Remember those? Real ones with covers or audio ones on or your collector and distributor of choice. I have always loved books and I used to be an avid reader. Somewhere along the busy byways of life I lost that ability to really get into a good book, to focus and concentrate and enjoy the character development and the plot and the suspense of disbelief. I lost the pleasure I got from reading biographies of great men and women in history. I lost my passion for the many big, colorful, detailed Civil War books that used to litter my desk.

I want that back.

In 2015, I will read. Real books. Audio books. Books.

2) Breaks

Give me a break!

I’ve got news for you, kiddies. Nobody, I mean nobody, is going to give you a break. Not a leg up. Not a moment in time. Not a promotion that you don’t earn by busting your butt.

Now, in 2015, the word break is going to mean two things for me.

One is that I am going to make my own breaks, things that help me get along, move on up, get ‘er done, and make my mark. I’m going to “carp the diem” (Yes, Rob, of course that is for you-Happy New Year!)

The other side of the breaks coin will be the actual breaks that I take to recharge and rejuvenate this coming year. I’ve already had a good running start at this year-long goal in 2014 with my three week, seven thousand mile cross country trip and the several little mini-vacations I took to the coast to relax, Christmas shop and have coffee by the river, just because I needed to and I could.

This year, I intend to travel, see some new places, eat some different food, and enjoy the company of friends new and old alike. Break time is necessary to stay sharp, stay focused and stay happy.

3) Brinks

Now, what is this brinks thing, you’re asking?

One can be on the brink of a new discovery, at the brink as in getting ready to fall off a cliff, or on the brink of a major life-changing event.

I will be at the brink in the coming year, and I know it. Work, career path, relationships, all may see me walking right up to the edge and deciding whether it is a good idea (or not) to step back and think a while longer, to put one toe in and test the waters, or to simply decide that it is time to jump off and see if I can fly.

The rush of adrenaline that comes from pushing yourself to the brink, and then deciding how to negotiate that predicament and come out feeling happier, stronger and more alive, can be powerful indeed.

So, there you have it. My three words for 2015.




Three little words that over the next 365 days will guide me, remind me, and help me to be the best I can be in the new year.

What are yours?


High in the mountains above Golden, Colorado, October 2014. Photo by Chelsea Smith.

New Years Restitution

Well, we have a couple of days left in this year 2014, then it’s on to the next one.

Someone once told me that they did not get this whole celebration of the New Year thing. One day turned into another day, the old calendar was dumped in the trash and the new calendar was hung up on the refrigerator and it was a new year. Big deal. Who cares?

I disagreed then, and I disagree now.

I think that the marker and the milepost that is New Year’s Eve and the resultant blank slate of a fresh new temporal canvas are both very important to us. We can let go of the bad, the mistakes, the regrets, and the clouds of the past year. Then, we can say hello, wave, and acknowledge the entrance of a bright, shiny new 365-day stretch of possibilities and opportunities.

At 12:01 AM on 1-1-15, your canvas will be blank. You may paint on it anything you wish. You may choose bright colors and bold lines and a year of dazzling discovery, or you may choose broad brushstrokes of gray and brown and black, each bleeding into the other to cover the medium from top to bottom with mundane, uniform, depressing muck.

It’s your choice.

One thing I do not like and do not participate in is the public declaration of New Year’s resolutions. I think they are artificial, short-lived, feel-good bandaids for full-thickness burns. We make them, we don’t keep them, and we think we have done our duty to the New Year to do so.


What I will do this year, and I invite you to do too, is to engage in a very pleasant gift-giving to myself, the act of New Years restitution.

What is that, you might ask?

Restitution is 1) the restoration of something lost to its rightful owner, or 2) the restoration of something to its original state.

I have a very good life, I think, but there are many things that I have let slip, consciously or not. I need to make a very active effort this year to restore those things, to give back to myself those things that I need to be active, productive and happy to the best of my ability.

After all, I know (and you do too) that nobody else is going to do that for me. I make the effort, I set the priorities, I do the work, or it just ain’t happening. Simple as that.

Things that I will pay myself back or restore this coming year:

Sleep. We need seven to nine hours of sleep per night. That’s just about a given, no matter where you look it up or how you slice it. I have always deluded myself into thinking that because I went to medical school and work hard and am always on the go, that I do not not need that like all other humans. I have always gotten by on four and a half to six hours sleep and why should that change now? Because it’s not healthy, that’s why. Lack of adequate sleep negatively affects alertness, cognition, eating patterns and weight gain, energy, hormonal balance, stamina, sex drive and mood. Bottom line? Sleep more, live longer, feel better, enjoy your life. My target for average sleep per night this year? Seven hours. Why not nine? I’m a realist. I’ll start with seven.

Quiet time. My job involves talking to people. Lots of people. All day, and sometimes half the night. Up to sixteen hours per day of talking and listening to others talk to me. Then what do I do on top of that? Listen to music, podcasts, watch movies, watch the TV out the corner of my eye at the gym. My days and nights are filled with sounds and voices and stories and noises of all kinds. Now, this is not a bad thing, in my opinion. However, when there is no time left for quiet, no time left to reflect, no time to process and plan and dream and think, havoc will ensue. A rumbling sense of dread and then panic starts, fueled by the inability to get off the merry-go-round and have any down time at all. Like lack of sleep, this is not healthy. I will pay myself back for all the hours and hours of time I spend engaged each day with a few minutes of quiet meditation, reflection and soul searching each day. Every day. I had the time to do that once. I can find it again.

Forgiveness.I have gone through some pretty heavy changes in my life over the last two years. I have made some life-changing decisions, ones that affected not only me but those I love and care about very much. I have said some things that I probably should not have said. I have done (or not done) some things that I probably would do differently if I had it to do over again. I cannot go back and change the past. I cannot undo things. I cannot unsay things I’ve said. I cannot second guess major decisions that were made the best way I knew how to make them at the time with the information, resources, and energy I had. I can, however, forgive myself. I must start there. If I can’t forgive myself, how can I possibly hope to forgive others? I will treat myself better as 2015 starts by letting myself experience forgiveness.

Creativity. I enjoy writing. I enjoy putting thoughts on the page. Always have and probably always will. I have been writing stories and essays and other short works since I was in grade school. I have been blogging since 2007. I will, in 2015, let myself enjoy creativity in any way it presents itself to me. I will try very hard not to be stilted in the way I see the world or the way I convey thoughts, feelings and ideas to others. I will take that next step in the creative process when it presents itself to me.

Relationship. I have let some of my most positive relationships go in the last two years. Whether this is from guilt or fear or shame or for some other reason, I don’t entirely know. It doesn’t matter. What does matter is being in relationship. I have come to see and feel, once again, that this means being in relationship with God, with my family and friends, and with special people who give my life profound meaning and purpose. I have already started to re-gift myself with the wonderful sense of connection and relationship this year, and I want very much to continue that and expand on it in wonderful ways in 2015. As one of my friends told me this past year, we were not made to be alone. We are happiest when we are in communion with others. I am starting to understand that again, and it feels nice indeed.

Spirituality. As I have stated here before, this is not meant to be a religious blog. I do not want to force my views on anyone, and I do not want to proselytize. However, one of the things that I need to restore in my life is my faith. I have thought long and hard about how my grandmothers, my father and mother and others who helped form me into the person I am today leaned on their faith very heavily as they weathered life’s storms during their lifetimes. It is hard to convince myself that it is reasonable to pick and choose which parts of their examples I will follow, divorced from the whole. Spirituality is a gift, no doubt, and it is something that as I get older I see is more necessary to my happiness and stability than I ever thought it was in my youth.

Gratitude. How can we go through life not being thankful? How can we start each day without being thankful for breath, for sight, for the abilities we have? It is easy to think that we are self sufficient and that we have it all figured out. That we need nothing and no one to make it in this world. I will concentrate on restoring active gratitude to my daily life this coming year.

Generosity. This follows naturally after gratitude, don’t you think? When one is thankful for life and all that it gives, it is almost impossible not to share some of that joy with others. That is why I love the Christmas season so much. I love giving gifts and thinking about what would make someone else happy. I have an abundance of riches and really don’t need anything of import, materially, and so it is a lot of fun to share! I will look for ways to be more generous to others this coming year, with my time, my resources and my attention.

Play. I’m already doing a pretty good job with this one, but I could improve, as I guess we all could. Watching my grandchildren is the best prescription in the world for me personally in this area. Little children know how to play! They know how to take whatever is at hand and use their imagination to make it magical. The know how to dream. They know how to throw themselves about with abandon. They know that if they want to be a princess or a super hero that they can do it! All of us adults could certainly use a refresher in how to play.

Exploration. It is easy for us to fall into our own easy, or at least tolerable ruts on a day-to-day basis. We get into a routine, a prescribed schedule and we get stuck there. Again, that’s not all bad, especially if we enjoy very much what we do and how we spend our time. However, I discovered when I was on my seven thousand mile driving trip around the United States that the ability to literally get off the beaten path and explore was the most invigorating thing in the world. To see things one has never seen, to learn new things, to meet new people, all are exciting and life-renewing. In 2015, I intend to continue exploring, visiting, traveling and getting outside my comfort zone. I am going to give myself the gift of peregrination, and restore the sense of wonder that comes with it.

So, there you have a long list of things that I want to restore in my life, or at least fine-tune and experience in deeper ways in 2015.

What do you want to give back to yourself, to restore in your life in the coming year? It will take a conscious effort, it will take work, and it will require a promise to yourself that you will see it through.

I challenge you to make your own list.

Happy New Year to all of you, dear readers. I hope that this one is the best yet for you and yours.