My post on kevinmd.com today

All patient lives matter

Decisions

Is it decision time for you? 

Are you deciding on whether or not to take that new job, or if you’re going to move to a new city? Are you starting a new course of study in college? Are you getting into or out of a relationship? Are you agonizing over that new car? 

Are you, perhaps, voting for someone for President of the United States? 

How do you make those decisions? What is your process? What matters to you when you are faced with a choice, a dilemma, a crossroads? 

Some people wear little rubber bracelets. They look down at their wrist, think back to those hours in Bible school or Sunday school class or listening to a beloved minister, then ask themselves, “WWJD?” If they can get to a point that the decision is made based on Biblical principles, they’re good to go. 

If you’re a writer like me, you have to decide what to write. Sometimes it comes easily. Sometimes it is very hard to get anything to pop up behind that little blinking cursor on the screen. I will readily admit that I have written things that I thought were brilliant that were largely ignored. Humbling, that. I have written things off the cuff in a blur of fingers and keys that were read by hundreds of people, when I thought they were awful. I have written things that were hurtful to readers (some of them family members), painful even. I have learned lessons from those mistakes. I have never hurt anyone intentionally with my writing, but hurt them I did, and some of them continue to let me know about it. (I hear you. I really do.) Whenever you make the decision to write, to put things out there, you also make the decision to expose yourself to praise and embarrassment and ridicule and vitriol. 

Of course, the tried and true test is, would I write this and hand it straightaway to my mother and have her read it first?  What would she think? My mother does read some of my blog posts (Hi, Mom), and nowadays I do write with her in mind, even though she is not my “first reader” in my own mind. If I wore a rubber bracelet, which I do not, it would most likely have “WWMT” embossed in purple letters. 

Do you make decisions based on what your spouse, partner or significant other might think? They are no doubt very important to you, and if you care for them deeply, you care what they think about how you make decisions and do things that affect you both. My soon-to-be-wife and I have had several conversations about partnership, what is and how it plays out in a marriage. We care about each other very much, and we will make decisions that affect both of us, together. 

One question that has come up in the news the last week or two asks that if we accept certain things, endorse certain things and make decisions based on those, can we look our children in the eye and explain to them why we did what we did? Wil it make sense? Will it hold water? Will we be embarrassed or proud to teach our children, to be real world examples for them as they watch us move through the landscape that is our wild, wacky world? To be sure, they see what we do, they hear what we say, and they are remarkable imitators. 

Are you true to your own values when you are faced with major or important decisions? Do you evaluate things based on the knowledge you have acquired and the experience you have accumulated over the years? Do you follow the lemmings over Norwegian cliffs, do you run with the bulls of Pamplona, or are you a shark, restless and constantly swimming, afraid that if you pause, if you slow down or if you are still, you will surely drown? 

Do you make decisions based on how they will ostensibly affect others?  Is your sense of altruism the strongest when the time of reckoning comes? Or, do you take the path that is already beaten down with the feet of thousands before you, well marked and easy to traverse all the way to the gates of hell? The road less traveled is sometimes the one that will get you lost, but will teach you the most along the way. And when you arrive at your destination, what a story you have to tell. 

I know that we all come to conclusions differently, and that all of these things might go into the way our minds navigate the rocky shoals of indecision. There are many Sirens on Sirenum scopuli out there, but it only takes one gaping hole in our ship to sink us for all eternity. 

Oh, and please keep in mind that priorities and motivations change, sometimes profoundly, over time. The decisions one makes at fifteen are most definitely not the ones he or she is likely to make at seventy five. 

Lastly, need I remind any of us that the choice not to decide is in itself a decision that may have profound secondary and tertiary consequences not even considered by the poor soul who decides to sit out the hardest minutes of the game. 

How do you decide? 

My Basket of Deplorables

Deplorable: Very bad in a way that causes shock, fear, or disgust. 

Merriam Webster


I don’t need to explain the context for this post. You know what it is. You’ve heard or discussed it already. You have your own opinions about it, and you have feelings that are probably stronger than the opinions. That’s not why we’re here anyway.

This is a mini personal manifesto. Something that has been percolating in my brain since I first heard the phrase “basket of deplorables”. 

Now, I have seen my share of people who are down on their luck, have no jobs, no money, have worn the same clothes for a month, and who have been sleeping outside by the river in a tent for months at a time. I have seen swindlers, mean people, intellectually challenged people, and people with extreme personality disorders. I have seen a lot of people in my career as a psychiatrist. 

None of them I would label deplorable. 

None of them I would label unsalvageable. 

That said, there are some behaviors, concepts, ideas, actions and positions that I would consider deplorable. Deplorables, plural, if you will. 

That is what this post is about. 

This is my own personal basket of deplorables. 

You may agree. You may not. You may think me foolish. You may think me shallow. That is your right. My post. My blog. Read it if you like. Agree if you agree. Dissent and write your own missive if mine spurs your thinking, which I certainly hope it will. 

There are five deplorables in my basket, and six responses that I have to them. No, I am not sure why the numbers don’t match. It matters not. What matters is that these things make me upset, sick, angry, and spur bad thoughts in my head. As any writer knows, this why I have to write about them. 

Let’s get started.

1) Man’s Inhumanity to Man

This one popped into my head first as a general concept. It seriously blows my mind. Why in the name of all that is holy (you’ll see what I did there in a minute) do we feel the compulsion to hurt, maim, slander, torture and kill each other? 

The Crusades occurred from the eleventh to the sixteenth centuries. They were sanctioned by the Catholic Church. One of the main goals? To capture and free Jerusalem from Islamic rule. Thousands died. Now you see what I did there. 

The Holocaust was a particularly brutal time in history when Adolph Hitler’s Nazi Germany exterminated six million Jews from 1941-45. One and a half million of those killed were children. 

On September 11, 2001, four coordinated terror attacks orchestrated by al-Qaeda targeted the World Trade Center and various targets in Washington, DC.  Two thousand nine hundred and ninety six people were killed, including the passengers and crew members of the planes which were basically weaponized, fully loaded with fuel, and souls. Six thousand more were injured. At least ten billion dollars’ worth of property damage was done. I took that attack hard, as we all did. Since I am marrying a career flight attendant in six weeks, I take it even harder now, this many years later. 

In sweet, sultry Charleston, SC, just a couple of hours down the road from where I live, twenty one year old Dylan Roof walked into “Mother Emanuel” AME church, sat quietly through an hour of Bible study, then methodically and brutally murdered nine people. He left one alive to “tell my story”. Dylan wanted to start a race war. I just heard a presentation the other day at a conference by the executive director of the mental health center in Charleston. She could not describe some of the response and recovery stories without crying. Still. The church is still reeling from the profound changes that were thrust upon it by this unexpected and horrific act. 

Sandy Hook Elementary School in Newtown, Connecticut. December 14, 2012. Twenty year old Adam Lanza kills his mother. Then he kills twenty children ages six and seven, and six adults. Then he kills himself. 

Rwanda. From April through July 1994, 500,000 to one million Tutsis were slaughtered by the Hutu majority government in just one hundred days. Seventy per cent of the Tutsis in the country, twenty percent of the total population were killed. 

Sexual abuse of women and children. Something I hear about every day. Three patients told me their abuse stories just today, in a small clinic. This is, of course, in the news right now, much more than we would like it to be, but there it is. It exists. It’s real. It happens. It’s terrible. It leaves lifelong scars. It hurts people physically, emotionally, and leaves scars that others often cannot see. 

Why do we do these things to each other? I live a pretty normal life, boring on some days, exciting on some days, but pretty normal. I would NEVER think about intentionally plotting to kill thousands of people, killing one child, or starting a race war. Individuals do these things. Governments do these things.Races  do these things to other races. 

The first thing in my Basket of Deplorables has to be the absolutely unexplainable inhumanity that we show towards each other. 

2) Man’s Desperate Attempt to Play God

The Rwandan and German slaughters again come to mind, don’t they? How can one person or one group, or one government arbitrarily decide that some other group, with different color hair or skin or culture or religion, must cease to exist? How can they decide to exterminate, marginalized or isolate whole peoples? 

What I like to call “extreme healthcare” at the end of life makes my basket as well, under this category. End of life excesses, exhorbitant costs, prolongation of life when the quality of that life is very poor, and extended periods of resuscitation orders, sometimes with prolongation of pain and suffering, all play into our feeble attempt to play God. We are afraid to die. Even when it is long past time and we know it, and we long for the release that we know will come, we are afraid to die. Therefore, we are afraid to let go. We must maintain control as long as possible. The truth is, the control we think we have is not real. 

We speak of healthcare rationing, death panels, choosing who will get what benefits, who will live and who will die. We exclude. 

We set up classes, we demonize races, we pick and choose based on the things that we did not create, that we do not control, that we cannot change. 

I don’t know if you believe in God or not. If you do, and you think that he has any hand in what goes on in our lives at all, I really do not think that he needs our help. 

3) The Race to the Bottom

This is another concept that is certainly not new, but that has been in the news with the current political cycle. 

We dumb down arguments and concepts and discussions to the point that they are ludicrous. We try not to hurt feelings or step on toes, but in doing so we do not challenge people to think. We don’t tell the truth because it might offend someone. 

We live in the age of the soundbite, the one hundred forty character thought, and the status update. In the not so distant past, in the time of my childhood, we used to watch sitcoms and other television shows that were only thirty minutes long. In that time period, the situation was set, a problem developed, the characters struggled with it, and a resolution was reached, all in the space of a half hour. I used to think that was a stretch. Now, text messages, tweets and status updates tell the story, the constant, ever changing story of modern life in tiny bites, billions of them per day. 

Sometimes the deeper meaning of something we are trying to say gets lost. The nuances of a glance, a pause, a touch, or a chuckle are no longer there as cues. In our race to be fastest and first, the information is flawed and flimsy. 

In our race for the bottom, we are sexualizing everything. Ads for alcohol, clothing, personal hygiene products, cigarettes, cars, vacations and technology are all linked to sexuality in this fast paced world. The youngest, prettiest, sexiest people get the most and the best, or at least that is what you are lead to believe. Now, even our politics and our presidential election in the United States is being fought on a sexualized playing field where past transgressions trump abilities and experience and people are used like pawns in the race to prove who has been the sleaziest and how recently or long ago. Sex is linked to money, power, influence and policy. I’ve got a newsflash for you. Your sexual ability, prowess and attraction is not going to be your strongest suit when you’re ninety years old and can’t zip your own fly without help, much less unzip it. 

Yes, we are racing for the bottom. We are trying to out-dumb, out-sleaze, out-sex, and out-tweet each other more and more every day. 

What ever happened to positivity, wholesomeness, setting of examples, having grand aspirations, and setting lofty but achievable goals? When did we reach the tipping point after which the more negative things became the more  notice they commanded? 

4) Division

By:

Class, income, race, sex, religion, education, sexual orientation, heritage, political party. 

Shall I go on?

A house divided against itself shall not stand. 

And that’s all I’m going to say about that. 

5) Anonymity

We have abdicated our sense of responsibility. 

With the advent of on line personas, avatars, and other ways to be impersonal, we have forgotten how to be responsible for what we say, do, and think. We can set ourselves up to be whoever and however we want to be online. We can lie, present ourselves as something we are not, and promise things we cannot do or give. Have you noticed how many times people want to write scathing commentaries or letters to the editor or op-ed pieces, but do not want their name on the work? Are they really not as convinced as they would like people to think they are? Are they unsure of their opinions? Are they afraid of conflict? 

As terrible as it was, in the days of sword and mace, and later in the time of the Civil War, you could see the man who was about to try to kill you. Face to face. Eye to eye. You knew your enemy and you met him with only that small no man’s land of death between you. 

Nowadays, cowardly terrorists and misguided misfits plot destruction big and small from caves and cabins in the woods. After a horrific event, everyone waits for that tweet or post  or You Tube video that will tell us who accepts responsibility for the act, but we never see them or know their names or faces. 

Hijackers. Bombers. Snipers. Cyber criminals. 

They are often anonymous. They are always cowards. 

So, my Basket of Deplorables contains man’s inhumanity to man, man trying to play God, the race to the bottom, division, and anonymity. 

Do I have all the answers for how to fix this? Of course not. 

Do I have some ideas about where to start, individually as collectively? Yes. 

1) Treat others as you want to be treated, no matter what. Start there. Simple, you say? Too narrow? Try it for one week. One week. 

2) Do not tolerate the mistreatment of others. Don’t tolerate it. Do NOT let it go. Do NOT turn a blind eye. Do not condone it passively, do not ignore it. Do not participate in it. (Billy Bush, are you listening?) Call it out. Make it shameful and absolutely unacceptable. 

3) Let God be God. Listen, the bottom line is, no matter how smart we are now or become in the future, we will NEVER understand everything. Maybe we shouldn’t. Mystery is okay. It really is. We can’t all be in charge. As a matter of fact, as I wrote above, we are often not in charge of nearly as much as we think we are. Let things evolve as they will, learning about the process and enhancing it but not pushing beyond our reasonable limits. Eliminate the artificial caste and class and race barriers that keep us apart. I don’t think that’s what God had in mind when he created us to look differently. When it’s time to let go, let go. We will all die one day. We will take nothing with us. As far as we know, we will control nothing on this earth after we depart from  it. 

4) Enhance life. Build up positive support. Read long form essays and books that take you longer than five minutes to finish. Great ideas take more than a rushing river of tweets to take hold and flourish and grow. Let sex be what it is. Beautiful, fulfilling, communicative, bond-strengthening, giving, sharing and loving. Be an active part of goal setting, building the future, and planning for better days to come. 

5) Look for ways to join groups and activities that are outside of your comfort zone. Learn from those who are different from you. Embrace other cultures. Share ideas. Discuss, don’t just argue. 

6) FInally, be honest. Brutally honest if you must. Sometimes, the emperor just does not have any clothes. Be present. Be yourself. This is what sickens me the most about politicians these days. They are too smooth, too PC, too careful, too practiced. They have lost the ability to think for themselves,make good decisions, and act on them for the good of the country. I want to know you, feel comfortable when I disagree with you, and learn from you. I cannot do that if you are not willing to do the same, if you are always rigid, or if no one but you can ever be right. Tell the truth. Be honest. Think for yourself. Make decisions based on the reality in front of you, not on the fantasy that you wish could be real. 
If we try, I am sure that we can turn my Basket of Deplorables into a Monument of the Meritorious. 

Isn’t it worth a try?          

Singing on the Brain

I love to hear people sing.

Somtimes, when I’m at many desk at work, I hear a co-worker coming down the hall, and she is singing a song, or a thought, or a response to a question she’s just asked herself, or her frustration at something that just happened. She sings when she gets to work in the morning. She sings during the work day. She sings a little song when she closes her door and leaves for home at five. 

My oldest daughter, who still sings, and dances, and acts, started singing as soon as she could talk-maybe sooner. She would sing a pretty little song, complete with gestures or costumes or acting as the case might be, then stop, look up and sweetly ask her audience, “Again?”

People sing as they walk. They sing in the shower. They sing in the car, with the sunroof wide open or the ragtop down, every window open and the music blaring from car speakers or into earphones. They sing from mountaintops. They sing in valleys. They sing alone, in choruses, in ensembles, in opera choruses and in glee clubs. They sing responses to online questions. They sing into their phones, along with their televisions, to their loved ones or in front of millions of live and beamed-in viewers at the Met. 

What do they sing?

Scales. Arias. Rap. Blues. Rock and roll. Torch songs. Ballads. Gospel. Pop. Oldies. Love songs. They scream. They croon. They whisper. They speak. They parrot. They parody. They emote. They let go. They hold back.

Why do they sing? 

To tell us that the times they are A-changin’, like Dylan.

To remind us to love the one we’re with,  like Stills. 

To give us some of that old rock and roll music, like the Beach Boys.

To love us tender, love us sweet, like Elvis. 

To take us to Carolina in our mind, like J Taylor. 

To say goodbye to love, like Karen Carpenter. 

To take another little piece of our hearts, like Janis. 

To remember that the first cut is the deepest, like Sheryl.

Just to say Hello, like Adele. 

To  know that all we have to do is dream, like Glenn.

And….

…because its just something they must, must, must do.

They thrill us, like Michael. 

Why do we listen?

To be distracted. 

To remember how to love.

To forget the pain.

To learn from our mistakes.

To feel happy. 

To relive those magic moments.

To say goodbye.

Singing,  like nothing else in this world, ushers us in, picks us up when we’re down, and gives us hope.

Singing makes us think, keeps us from thinking too much, focuses us, and distracts us. 

Singing accompanies us while we fall in love, helps us make babies, then helps us raise to those babies and, when it is time, helps us to tell them goodbye.

Singing celebrates milestones with us. It soothes us when we cry. It makes us laugh. It makes us proud. It makes us strong, as a nation, and as individuals. 

Singing takes words, notes, melodies, phrasing, and breathing, and turns all of our darkest fears, our finest ambitions, and our strongest commitments into something fearsome, something lovely, something that arches upward and spirals on the air and floats and frees and makes manifest that which we could never in a million years say on our own.

Singing makes us think about yesterday, keeps us fully in today, and never lets us stop thinking about tomorrow. 

Sing. 

Sing a lullaby to your sweet baby.

Sing a love song to your beloved.

Sing your patriotic allegiance to your country. 

Sing praises to your God.

Sing. 

Do the Right Thing

It’s a fine line that we walk as physicians. 

I went into medicine because I wanted to learn about the craft, become proficient at healing disease and easing suffering, and because I genuinely liked getting to know more about my patients and hearing their stories. These reasons for going into medicine as a career and staying in medicine as a vocation have not changed significantly through the last three decades. 

The problem we are faced with pretty often nowadays is this: the demands that patients (and through them insurance companies, pharmaceutical companies, families, and other third parties) make are often at odds with what we were taught to do. I’ll give you a few examples. 

Patients will come to me and ask for a specific diagnosis. Why? Because sometimes their insurance will not pay for a less severe diagnosis (an adjustment disorder versus a major depression, for example), they do not want to be perceived as being in treatment for an alcohol or other substance abuse problem (no matter how valid it is), or they need to be seen as having a particular problem because their attorney told them that it “would look good” for their disability case or other lawsuit. 

Patients will come to me asking, or sometimes outright demanding, that I prescribe a particular drug for them. Telling them that I do not presribe narcotic pain medications in a mental health clinic is easy enough. When they ask for benzodiazepines like Xanax, Ativan, Valium, Librium or Klonopin, the area might be grayer. Some patients might benefit from those drugs or even need to be on them long term, but they are the exceptions nowadays. “If you won’t given them to me, then I’ll just go to Dr. Jones down the street!” they exclaim, thinking that this is somehow a threat to me. Or, “I know that you give them to Ms. X from across town. Why won’t you prescribe them for me too?” 

Direct to consumer advertising on television has not made this any easier, since patients will come in asking to be prescribed powerful antipsychotics for insomnia or pain medication for panic attacks. What they are asking for often makes little sense clinically, but of course since they saw it on television it must be true and I should get out the RX pad. 

Some patients come in demanding a particular kind of treatment that they think makes the most sense for them. Aunt Sara may have told them to ask for it, since of course she took Psychology 101 in college and has the power of the Google search behind that vast amount of training, or they have read about it in Vanity Fair, or a friend of a friend of a friend had the particular treatment years ago and it worked for them. Some will want long term therapy when it makes little sense to drag things out for years when weeks or perhaps months will address the problems at hand. Some will want outpatient treatment when it is quite clear that they need to be admitted to the hospital. Others, already on an inpatient unit, will want to stay there for weeks, when the right thing clinically is to discharge them to an outpatient clinic. Some will ask for “counseling” when it is imperative that they enter drug rehab for a heroin problem that they do not want to acknowledge.  

Some patients want a specific kind of relationship, that is, they would like to consider the doctor their special friend, not their physician. Others like to consider themselves the medical, diagnostic and therapeutic equal of their physician, since they can and do research everything online, sometimes in real time on a smartphone while they are sitting in the exam or consulting room! Some of course want a clinical relationship to move to a friendship and then perhaps an even more intimate relationship, which is never appropriate in my opinion. I was taught, once a patient, always a patient, and I still subscribe to that maxim today. 

It is hard to do the right thing, in medicine and in life.

So what is a conscientious and well-trained and compassionate doctor to do?

Establish a professional doctor-patient relationship first, before doing anything to treat any malady. This means seeing the patient, getting a thorough history, doing an examination as indicated, establishing a diagnosis and coming up with a treatment plan. No shooting from the hip, sidewalk consulting and doing something for a friend. These will come back to bite you. Although some would not agree with me, I have not made a practice of treating my own family over the years either. If my children were ill, I figured a well-trained, trusted pediatrician was a much better option than a slightly frazzled, worried parent who happened to also be a doctor. 

As far as medication treatment goes, I have always been very conservative. If a mother is pushing for a three year old child to be put on stimulants for “ADHD”, I will balk. If a woman pregnant in her first trimester is pushing for Xanax to help her deal with the marital conflict with her husband because of the pregnancy, I will recommend counseling, not benzodiazepines. If someone who is not psychotic is having trouble sleeping, I will be much more likely to give them a two week course of a sleeping pill than put them on the small dose of a major antipsychotic that they heard about on television. What you’re treating, and not treating, is important. Efficacy and potential side effects are important. 

It is very important to tailor the treatment to the illness diagnosed, the symptoms that are being targeted and the outcome that is expected. 

Lastly, as alluded to above, the relationship between doctor and patient must be held to the highest standard of all. It should be professional, respectful, and collegial. We are partners, but by definition we are not equals in the process. You know yourself better than anyone in the world. You have information that you must impart, and I have decades of experience and learning and training that I must share with you in order to help you get better. 

If we are honest and work together, treatment happens, illness is managed, and patients recover. 

It is only then that it is much easier to do the right thing. 

Monkey in the Middle

Keep away.

Monkey in the middle.

Urban Dictionary defines “monkey in the middle” as the person who is in the middle of two fighting sides. This person is friends with both arguing sides and wants to stay neutral but is eventually dragged into the fight, and one of the fighting sides becomes mad at them. 

I will be fifty nine years old next month. I grew up loving to read. I read everything. I was thrilled when the new Scholastic Book Club circular, or anything like it, came home with me, to be lovingly perused and marked up with all the paperback books,  Dell crossword books and dinosaur books that my parents would allow me to order. I was more thrilled when the shipments came in, giving me hours of pleasure like no other activity I enjoyed at the time. I was ecstatic when my parents bought the complete set of the Collier Encyclopedia, complete with annual updates, though I can now come clean and say that I wish they had bought the World Book Encyclopedia instead. Colliers seemed a bit too stodgy to an elementary schooler. 

I simply loved the feel of the page. I loved the color glossy pages. I loved doing crossword puzzle after crossword puzzle. I loved the feel of the spine of a book nestled in my hands, the way new pages stuck together until you riffled them the first time, opening up the whole new world that was hidden in the infinitessimal spaces between the papers. I loved that tipping point that came when you knew by feel, without even looking at the page numbers, that you were just over halfway through a novel, and that it was all down hill from here. A race to the finish, the climax, the denouement, the satisfying completion of a mind journey that could have transported you anywhere in the universe.

I still love to buy books, to keep books, to shelve books that I just know I will read one day (sometimes do, sometimes don’t, let’s be honest). I still like to peruse the colorful pages of magazines, especially when I am tired and just want to kick back and do something familiar, something comfortable, something comforting. 

I am a product of my age, my upbringing, my schooling, the modeling of my parents and mentors and teachers. I am an analog man in an increasingly digital world. 

Now, I love my technology. 

I have bought more iPads that I care to admit to. I have owned every desktop and laptop computer from a Micron to a Dell to an HP to a Radio Shack to Apples. I have lusted after the newest Sony PDA, upgraded to a Treo with a stylus, and was fascinated when I first heard about the marvelous little machine that was to be the first iPhone. “I’ve GOT to have one of those,” I remember saying when seeing the image of the prototype on my laptop screen. I have owned virtually every model of iPhone since 2007. 

I get excited when thinking about moving next month and setting up a new wireless system in the condo. I am already salivating over wireless security systems and what might best serve our needs. I am constantly looking for the next excellent podcast, digital newspaper, newsletter, or blog to read. I love audiobooks. I listen to music on three streaming services, only one of which I actually have to pay for. I watch movies on my iPad, which has more pixels and a much better picture than my widescreen television. 

I am a product of my age. I am a digitally connected man in a world that is watching analog constructs fade slowly into history. 

I am the monkey in the middle. 

I am listening to a fascinating audiobook right now that I would recommend to everyone. The Inevitable, by Kevin Kelly, looks in some detail at where we are headed, and why, in the next three decades. While I do not delude myself into thinking that I will still be around forty or fifty years from now, thirty is definitely doable. I get very excited when I think about the world that my grandchildren will be running, of which I may still be an active, though peripheral, part. The book speaks to the way that society and all its wonderful parts is morphing and continues to change over time, cataloging and saving and curating and dispersing and sharing and annotating knowledge and creativity and thought of every conceivable kind. It also speaks to the generation, MY generation, that finds itself squarely in the middle of two camps, one whose tenets are inscribed on cotton paper, and one whose bits and bytes are blinking and beeping into the future. 

I am friends with both sides. I want to remain neutral. 

It is going to be a fun ride for the next two or three decades, that is certain. I want to keep up, to remain relevant, to learn, to continue to produce and create and to learn to access the new technologies and the new paradigms as they present themselves. I very much want to keep working, to keep helping people through my vocation, to educate myself continually about advances in my field. I want to enjoy music and art and books and the vast amount of information that is the collective knowledge of our increasingly connected world. I do not want to become an old man who is too intimidated to reach out and try something new out of fear or ignorance or apathy. 

I don’t mind being the monkey in the middle, as long as the game of keep away does not turn into a game of dodge ball. 

PurposeĀ 

There are a lot of people telling us 

what to be, 

who to be, 

what to do, 

who to love, 

how to work, 

how to vote, 

what to think, 

what to believe, 

what to revere, 

what to revile, 

what to fear, 

what to exhalt, 

what to say, 

what not to say, 

what to raise up,

 what to despise, 

what to eject, 

what to retain,

what to wall off,

and what to seal in.

So.

Why are YOU here?

What is your daily purpose?

What are your goals?

What do you hope to accomplish tomorrow?

Next week?

Next month?

Next year?

Before you die?

Do you have a manifesto?

Do you really believe in anything, really, or do you love being spoonfed?

Are you a maintainer?

An innovator?

An influencer?

A game changer?

A world beater?

Is your life stagnant, or fluid, or changeable?

Have you already built your own wall?

Who paid for it?

Who are you keeping out, and…

what are you deparately trying to keep in?