Perhaps writing about health matters from the perspective of a cardiologist/bike racer is a little like parenting: At times the message seems less than compassionate, even though it’s born out of concern for others, knowledge and a tincture of middle-age experience.
The many excellent comments on my recent telomere/heart-health post stirred me to write a little more–about perspective and mindfulness.
Let’s just get to the comments and I’ll expand. The first one comes from Carolyn Thomas of the HeartSisters blog.
My hunch is that you are speaking from the perspective of a competitive cyclist, meaning that you enjoy what Dr. Ann Becker-Schutte calls “Healthy Privilegeâ€, and for whom the prospect of patients (never mind AHA presidents) being unwilling/unable to embrace Ornish lifestyle makeovers is hard to comprehend.
Perspective is an important consideration. I like to talk about parallax—that is, how the same image can look differently depending on the position of the lens.
The truth needs to be told about my perspective. It is true that I have been gifted good enough health to race bikes competitively (locally at least). It’s also true that I once was overweight, out of shape and hypertensive. In medical school and residency, I weighed well over 200 pounds. I got that way by eating too much and moving too little. One Sunday, after a Jim McKay broadcast of the NY City Marathon, I went for a run. It felt good. The next day I went for another run. Then I bought a running magazine and a couple of books. From then on, healthy choices became the norm.
Do I have a healthy privilege? Yes, but it started with the choices I made at the busiest time of my life. (In those days, residents had no work restrictions.) It is rare to see a patient my age or older who enjoys a healthy privilege without having earned it by stacking together lots of good choices over years. Luck is important as well.
Another truth: I don’t eat a diet anything close to Dr. Ornish’s. Just because one writes about healthy behaviors does not mean one employs them perfectly. I eat better than the average American. My weaknesses are 1) fast-burning carbohydrates and 2) not stopping soon enough once I start eating. So like all doctors, I’m human just like you. During race season (now), I talk to myself everyday about food choices. It’s a struggle keeping the same pant size.
Andy Bailey’s comment really hit me hard.
They say laughter is the best medicine.
When I face a 60-year-old who was fired because of his age, and his wife has serious medical problems, and his daughter is a drug abuser, and he has to raise two small grand children aged 2 and 4, and his house is being foreclosed, well I tell him not to stress out about stuff, go ride his bike, and shop at Whole Foods and Fresh Market. When he stops laughing, he admits that he really does feel a little better.
Ouch. This comment underscores the power of words, and the importance of tone and clarity. One topic that comes up repeatedly when I chat with my imaginary friend is compassion. Concern for others is at the core of doctoring. Everyday, I tell myself to see the suffering in others. In writing about the importance of making time and being motivated, I don’t aim to patronize or minimize the difficulties of others. Rather, what I aiming for is the teach-the-man-to-fish approach to health. The medical behemoth here in the US likes to hand out fish.
Dr. Nieder’s comment highlighted the notion of intent: (Editor’s note: Dr Nieder authors the thoughtful blog — Family Practice 2.0)
When I see the 298 lb guy who works for corporate America, who calls 18 holes of golf three times a week exercise, is looking for his testosterone shots to somehow make his fat magically disappear and swears he doesn’t eat much, I agree with you. But when I see the single mom with two teenage daughters who works customer service for Humana, who barely gets a vacation and if she has to leave work to care for her sick child, she pays for it out of her “Allowed Time Off†(there goes the vacation) I am agreeing with Andy. While we are waiting for corporate culture to change (ROFL) my patients are not looking to extend their telomeres, they are just hoping to survive one more week. That may not be what you intended, but this is what many of my patients would hear.
Yes, of course, it’s not always that simple to be healthy. I get that. This is why I am a student of all things education and social fabric. Somewhere I read that good education and a strong social fabric form the core of a healthy society. And it follows that if society is healthy, then so are its inhabitants. Visiting places like the Netherlands and Germany reinforce that logic.
Some personal perspective on social fabric: Though I am only half-Italian, I was raised in an Italian family. My grandparents gave a parcel of land to my parents. Mom and Dad built a house there, and my grandparents helped raise us four kids. We were blessed with a safety net. My grandparents (and their families) helped my Mom and Dad. We were immersed in love and support. Lots of the kids I grew up with in Windsor Locks, Connecticut had similar deals. And it wasn’t just a family safety net. Most kids I knew attended the same church, played on neighborhood (not traveling) sports teams and went to the one big school in town. There was a real social fabric. I was lucky.
I was also lucky with education: I grew up a little scared of life. Didn’t you? My Dad convinced me that learning algebra was a metric for success in life; my guidance counselor assured me I wasn’t smart enough to be a doctor; staying on sports teams proved awfully damn hard and low-paying jobs at a young age were tough. One summer during college I worked third shift in a union-controlled frozen foods warehouse. That was educational. Again, I was lucky.
Of course it is right to emphasize that all patients don’t have the same luck I had. I know that, but my words didn’t embody it. It’s something I’ll work on going forward.
I’m grateful to those of you who take the time to write comments. Your words make me look inward and think. That’s a good thing for a learner to do. Thanks.
Perspective means a lot.
JMM
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