Not Like That

It was the same drink I often order at Starbucks. A venti Americano with three Equals. Simple to make. Simple to drink. Hey, I’m a simple kinda guy. 

Daniel, one of the baristas at the local store, was busy behind the counter as usual. Hands flying, shots brewing, hot water streaming, steamed milk frothing. He’s the kind of guy who memorizes his regular customers’ orders and has them ready by the time they walk in the door. 

He made my drink quickly and efficiently. I didn’t have to wait long. He passed the double-cupped beverage across the bar to me. Well, he almost did. 

He pulled the coffee back, and I heard him say something very softly to himself. 

“No, not like that.”

You see, there was a very small puddle of hot coffee that had sloshed through the hole in the lid and sat there. As coffee does. 

It was not up to Daniel’s standards to pass the first coffee of the morning to me in less than perfect shape. He was not going to put out a product that was less than the best he could offer. 

He deftly removed the lid, quickly replaced it with a pristine white one, and slid it back across the bar to me. 

This action took all of three seconds. It spoke volumes about Daniel’s work ethic. 

Think about what you do, what you say, what you produce today. Think about how you treat people. Think about what you ship. 

“No, not like that.”

Make whatever you do today the very best you can offer. 



Several things have prompted the thoughts about this piece and the writing itself on this Mother’s Day 2015.

Seeing the many glorious pictures of mothers, lovingly posted with comments and reminiscences by children, spouses, grandchildren and friends.

Feeling my age, almost fifty-eight now, and that associated middle-aged angst, quite normal I’m afraid, that we all experience at this time of life. If you’ve navigated it and come out on the  other side, bravo. If you’ve not yet arrived at the rocky shoals, don’t worry. Your time will come soon enough. Don’t rush it.

Feeling others’ expectations and reading others’ thoughts about time and what it means to them, how it affects them as they age.

At any rate, all these tiny bright droplets have coalesced in my brain into a trickling, sun-dappled stream and then a rushing, rapid-filled course and finally into a broad, slow-moving, deep-running river of thought and feeling that, while hard to explain and write down, has burst its sluice and will be written, whether I want it to or not.

Ideas, rushing, wet, powerful,  ideas, will crash through the locks and dams we build to hold them back and carve out their own winding ways towards the ocean. They will not be stopped. Nor should they be.

So, my dear readers, time.


Time may be spent, enjoyed, reveled in, soaked up like sunshine on a spring afternoon, full of promise and tenderness and the expectation of joy that never ends.

Time may be wasted, frittered away on trifling and trivial matters both large and small, things that in the long run mean nothing, but in the short run consume us like fire.

Time may be squandered, absolutely obliterated by the ceaseless worries we give ourselves as gifts, the mental torture that feels like productivity but that disappears like acrid smoke borne off on the chill wind of autumn.

And, yes, friends, time may be used, wisely used, to live life and enjoy all things bright and beautiful and wonderful and good and holy and miraculous. It may bend and slow and wind deliciously through the exquisite waiting for Christmas or the lazy, hazy enjoyment of a summer’s day with catfish dancing on the line and leafy green shade and fluffy cotton candy clouds at end of day, tinged with the pink light of an afternoon well-spent and another grand memory made.

Time is finite for all of us. There’s the rub, isn’t it? This thing called time will end for all of us one day. It is the natural state of things, at least in this physical world that we inhabit now, to be born, to grow, and to die. This stream of consciousness, this awareness, this taking in and processing and living and being, all of it will cease one day. That is the natural course of things, as natural as that slow, relentless roll of river from mouth to ocean.

Yes, time rolls, is fluid, is as slippery and hard to hold onto as that glistening water is if we scoop up a handful of it from Vicksburg or New Orleans or the Gulf of Mexico. It is still the same water, life-giving and nurturing and absolutely necessary for survival, but it has been changed somehow, from north to south, from trickle to rapids to torrent to smooth ocean egress. It has been polished, filtered, imbued with tastes and packed with sediments and particles so small that they cannot be seen by the naked eye. It has been changed with the experience of the ride from birth to death.

Time cannot be controlled, oh no. We fool ourselves daily, dear readers, with our calendars and our schedulers and our theories of time in a box, take it out and wind it up and watch it go. We control time no more than we control our own breathing. We can manage it, yes, I’ll give you that, just as we can make ourselves breathe in and out until the tingling starts around the corners of our mouths and the fingers start to tingle and we know that if we keep doing this that we will soon pass out. We can manage lots of things in this life. We control very few. Time will not be controlled by us, not by anyone. It is fluid, it rolls on, relentless, purposeful and yet with absolutely no certain purpose except to be, to watch, to bear witness to the world that was, the world that is, the world that might be, just around the bend.

Time will end for all of us one day, today or tomorrow or next month or next year or in fifty years. Even so, it will go on, infinitely as far as we will know in our then state of non-being.

We often speak of the past, thinking about it, reliving it, remembering it, dissecting it, wanting somehow to bring back the very best parts of it, the good old days. Some of it we want to change, so desperately. The accident, the diagnosis, the failed love, the loss, the shame, the guilt, the mistakes, oh, the mistakes that if we could just go back and re-do, would change our lives and bring us to that present place called perfect that we all think we need to be.

That’s the fallacy, don’t you see?

There is no past. It does not exist.

There is only the present that was.

We lived it then and it shaped us, just as that rushing river shapes the ground underneath it, carving out a course and direction that even mighty dams cannot alter forever.

We lived our present that was, every one of us. Over and over and over again, we had present moments, opportunities to do the right thing, say something, feel something, reach out, make a difference, change the world. We lived those present moments, as did our great-great-great-great grandparents. We made our choices. We acted, or we did not. Simple as that.

Do not despair that I’ve taken away your memories or your second chances. My words don’t have that power.

Neither do they have the power to give you the hope of a future that will correct your mistakes or bring you happiness.

Because you see, there is also no future for any of us.

There is only the present that will be.

All the worry and the preparation and the mental machinations and the planning and the scheming in the world will not change a thing for me, or for you. I have learned that as I grow older. I have plenty of time, all the time I need, in fact, to get to the present that will be. When I arrive there, I will do my very best to do the right thing, make the right decision, say what needs to be said. But I will not drive myself mad by worrying about how I will get there, whether I will get there.

The only time that exists for me, for you, is this present that we live in today. It is the only thing that is real. It is as real as this hot cup of coffee that sits by my right hand and sends off steam from liquid that will burn my lips just as surely as the sun will rise this morning if I drink it too fast.

The past will not burn me. Neither will the future.

The only time for us, dear readers, is now.

What to do? How to embrace this knowledge that the present that was and the present that will be are things that don’t need our attention? That we don’t need to spend one more second of this river of time rushing past us worrying about how to fix them or change them or anticipate them so that they will be perfect?

1) Embrace the time you are given today. Accept it gratefully and with an open heart and mind. It is the only time you have.

2) Mark it as your own. It does not belong to your memories or your failed expectations or the dreams of others. It is yours.

3) Use it fully. Do not squander a single minute of it. You are not too tired, too busy, too preoccupied, too worried, too important, or too overbooked. You have today. Do something with it.

4) Enjoy it. Immensely. Ridiculously. Over-the-top. Crazily. Like it is the last present day you will ever have. Because it is. Tomorrow it will become the present that was, and it will be out of your reach.

5) When this time is over, relinquish it with the same gratitude that you greeted it with at the start of the day. No anger. No regret. No fear. No sadness. No second guessing. Let it go. It is finished. There will be time enough tomorrow, the present that will be. Enjoy the letting go with as much gusto and gut-wrenching feeling as you enjoyed the gift of time in the first place. It was never yours to keep. Remember that, and you will never again fear letting it go.

My friends, there is only now. Today.

When my time is up, I will be no more. That is as it should be.

My time to make a difference, to live, love, learn, help, to make a real mark on this world, is today.

This post is my gift to you today. Thank you for taking some of your present, your precious time, to read it and to think about it.



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.