Three Self-Portraits (Tiny Hills)

On August 31, I ambled my way to the highest point in Rhode Island: Jerimoth Hill, accessible via a 1/10 mile trail that ascends a whopping ten total vertical feet. (Friends of mine joked – “Surely Federal Hill is the highest point in the state.” Natch.) Having both Mount Mansfield in Vermont and 31 miles of the AT in the previous two weeks, it was a trifle – I was there to tick a box in the list of New England’s highest points.

But it turned out to be a bit more emotional than I anticipated. I sat on the little rock, festooned with a helpful cairn, and snapped the first of what would end up being three self-portraits over the next month. There was a trail book in a steel strongbox on the rock as well, and in it I wrote: “We are not crushed by mountains, but suffocated by tiny hills.”

Today I’m thinking of Carol and another recently deceased seminary friend, the redoubtable Bill Bradford. Bill was known by many as “the badass chaplain,” and he did indeed completely own his chosen vocation. Bill had depths of compassion that most of us will never begin to reach. He often quoted Paul Tillich: “The first duty of love is to listen,” and he was above all else a man who knew how be present to the sick, the poor, the oppressed.  He will be missed.

My portraits: grieving, waiting, pushing back – against the tiny hills.

How Heartbreak Is Like Getting the Flu

(A work in regress.)

How Heartbreak Is Like Getting the Flu

The cold, it rips you unobserved.
The flu, oh, it may pass after a few days
But you want a vaccine for it; care of

someone brighter, an expert in chemistry.
Bodies have a memory, you see
and you keep the little injuries for life;
going out gets that much harder.

The coffee is inert on your sick room table;
it cannot mend, today. It shivers a bit,
(the world is chilly which makes the flu and heartbreak)
under the shadow of that rising wall,
atop a pathway crumbling, un-counseled, far off.

Damask in the silt
Little mice tense in skin
Making nothing from something
A little flu, a little sadness
It will pass in a few days – I aver.

I know nothing of chemistry.

Getting It All By Giving It Away (Free Photo!)

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Free photo of day! (Attribution: “Photo by Jace Paul, 2016.”)

Hello friends,

Whenever we lose a patient on my unit, I try to take a second to whisper, “Thank you.” No, not “thank you that it wasn’t me,” but rather for that person’s life, witness, gifts, and all they gave to the ones they loved.

Maybe it was the sun shower that hit just as I left work, maybe it was the date I went on last night with a girl that made my heart sing, but today, as I came to a field bursting with black-eyed-susies on my hike, I decided to shout my gratitude out loud. I spread my hands wide, let the wind and butterflies twist around me, and just let my voice speak for the mass of my soul: “Thank you!”

Working in healthcare, I see death often enough that it’s honed my sense of urgency about the whole “carpe diem” thing. Perhaps it’s a shuffling of priorities. So much of my life has been spent in the pursuit of Truth that I have often forgot that other aims are more important. Life presents opportunities for us to be right and kind – but sometimes it gives us a choice to only one or the other. Insecure, unhappy, and overly-educated, I have all too often chosen to be Right and not kind. I’m glad that, in recent years, I have learned to be kind more often.

At an in-service for work today, we took the new hires on a tour of the building. Our wonderful Infection Control/Safety Compliance Officer, Jane, stopped to talk about responding to a combative patient. The question was when it’s right to argue with an angry patient, and when it’s better to avoid an argument. When safety or health is at risk, she said, it’s important to be right. But if these concerns aren’t present, it’s better to be kind. If a dementia patient thinks it’s 1945, let them think it. What good will come of trying to convince otherwise?

“As often as possible, choose to be kind over right,” Jane said to cap the conversation.

A patient in a wheelchair, on leave from long-term care (the unit for people who won’t, most likely, ever be going home) suddenly spoke up.

“That’s very good advice,” she said. “I’ve seen people who spent their lives trying to be right and not kind, and let me tell you…they don’t get many visitors.”

We touch down on this earth and barely find our feet before the ground disappears below us. The sliver of time we occupy in the greater lifetime of our cosmos is such a small space within which to move, to learn, to create. How do we want to use that time?

It’s a question that is never fully answered; or one that dips below the horizon of our awareness as we become focused on the immediate, the logistical, and the mundane. I try to bring it forward each day and use it to stay focused on the things that really matter – those virtues and choices that will mean more meaning, more love, and – yes – more friends and loved ones at our side when time runs out. 

My friends, don’t listen to the pragmatists or cynics. Give away the “stuff” you think you need and become rich with freedom and peace. Love wildly and impulsively. Believe in gods or good people or fields stuffed with flowers.

Say it with me: “Thank you.” 

‘One Month Thin’: The Skinny On Surgical Weight Loss

A look at the month following surgical weight loss – and how losing weight improves your life in just about every way.

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Though I’ve shared little about the subject on this blog, I’ve suffered from obesity for the better part of my adult life. I was always fit and trim as a child, and through most of my twenties maintained a healthy weight. It was around the age of 26 that I began to gain weight as a result of a poor diet and infrequence exercise. Hiking – a subject that I have covered here in detail – has been a great help, but like most Americans I’ve never been able to lose weight and keep it off.

By winter of 2014, I reached 260lbs, the highest I’ve ever weighed. Crucially, I’d developed two conditions co-morbid with obesity (as part of a general health status called “metabolic syndrome“): hypertension and high blood sugar. (My triglycerides were also high.) I knew that the combination of hypertension caused by obesity and diabetes was a deadly one; my life expectancy was surely lower than the statistical average for men in America.

I would look at my daughter and wonder if I’d see her graduate from college, get married, or have children of her own. River is clever and sufficiently literate about health and nutrition to know that obesity is a form of sickness. She would say that she wanted me to live to ninety, and I would flinch knowing that my weight and the ailments caused by it made that improbable.

And so it was that I decided to investigate surgical weight loss. The process itself, from an initial orientation to over a year of medical tests, visits with a dietitian, preoperative physicals, even a psychological evaluation, is a fascinating one. It’s something about which I will probably write in the future.

But for now, I’d like to discuss the immediate aftermath of my surgery – a vertical sleeve gastrectomy – and both the expected and unexpected outcomes I’ve experienced.

My surgery was on January 19. For 12 days prior, I had been on a highly restrictive diet meant to shrink my stomach and liver. My grandmother dropped me off at Hartford Hospital, and after checking in with Admissions, I was brought to the OR waiting area. A parade of patient care techs and nursing staff came through to check vitals and keep me occupied with paperwork. The anesthesiologist walked me through the risks of general anesthesia, and had me sign off on a consent form. Finally, my doctor arrived to look over all the pre-op work and see how I was feeling. This would be my final opportunity to back out of the procedure if I so desired.

I knew there were risks. Any surgery comes with them, and if you’re overweight, have diabetes, or high blood pressure, the danger increases. A sleeve gastrectomy also comes with a 0.3% chance of death, usually caused by a rupture in the stomach suture causing sepsis. But I knew this surgery was the right choice. I thought of River and the life that would be mine after all the hard work was done, and with that image I had the courage to say, “Let’s do this.”

The procedure was done in about an hour. Weight loss surgery in all forms is now done laparoscopically, a tremendous improvement on the invasive techniques required a few decades ago. (A laparoscope is a device with a camera. It’s inserted into the stomach, and the surgeon makes small incisions in the abdomen in order to complete the procedure while being able to see with laparoscope.)

I had a two day hospital stay following surgery. The staff on the OR floor – Bliss 8 at Hartford Hospital – were simply amazing. Under their diligent care, I was tested for fluid tolerances (tea, chicken broth, sugar-free popsicles, and water were all I could ingest) and monitored for complications. The ability to stand, walk the floor, pass gas, and urinate were the additional benchmarks required for discharge. Before leaving, I was given a detailed seven-week diet plan and a pile of prescription meds.

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Here’s what I’ve noticed in the month since I left the hospital.

First, my blood pressure began dropping. In fact, it began to drop during the pre-op, low-carb diet. Within two days of discharge, I was getting normal blood pressure readings (<120 / <80). Often, my pressure was too low due to hypovolemia (lack of sufficient blood volume) caused by insufficient hydration. Dehydration is the primary health concern after surgery, and my post-op diet called for 64 ounces of water per day. By three weeks after surgery, my diagnosis of hypertension was rescinded and I was taken off my hypertension medication. A huge win for my health.

For two weeks after surgery, liquids were all I could consume. I mainly drank protein shakes, water, and broths. I tried a number of brands – Atkins, Muscle Milk, Isopure – but to be honest, they all taste like chalk eventually. It may sound like a brutal diet, but another immediate effect of the gastrectomy (and this might seem obvious) is that I don’t feel hungry. At all. There are times, of course, when low blood sugar triggers the notion that I need to eat in my brain, but I never feel the ravenous pangs I felt before. Two weeks on liquids was a cinch.

During the two week liquid diet, I began monitoring my glucose levels. A week before surgery, my fasting blood sugar was 136, and my A1C (a measure of average glucose levels) was 6.5. Following surgery, my blood sugar immediately began dropping – now, my fasting blood sugar is around 70-80, and post-meal it’s 95-105. Perfectly normal.

At week three, I was allowed to add mushy foods – non-fat yogurt, oatmeal, low-fat ricotta cheese, and anything that could be pureed – to my diet. I experimented with pureed concoctions like ground turkey, gravy, and spices (thumbs up), or pureed hard-boiled eggs with paprika and lite mayonnaise (thumbs very much down). In addition to 64 ounces of water, I was to consume 70-90 grams of protein each day. The protein would help with healing and help my body get used to a low- to no-carbohydrate diet. So, the mantra provided by my dietitian was “Always choose protein first.” For the short term, that meant putting vegetables and fruits aside, and eschewing carbs almost entirely.

I began to notice a few other changes in the third and fourth weeks. For example, I had a lot more energy than I ever had before. Whereas once I would only feel rested with 9-10 hours of sleep, now I feel great after 7 or 8. Of course, I was also exercising nearly every day – I’ve hiked more in the past month than in the entire autumn of 2015 – and my resting metabolism was improving – evidenced by a resting heart rate of 65-75 bpm.

I was saving a lot of money, too. I found that halving my estimate of how much food I could eat wasn’t enough; I had to reduce it to a quarter or eighth of the portion that “seemed” right in my mind. (After surgery, the size of my stomach was about equal to a banana, or to a 4oz total capacity.) So suddenly a pound of lean beef lasts a month. A can of broth lasts a week. A batch of chili using the standard recipe needs to be frozen because I can never eat all of it before it goes bad. There was, unfortunately, considerable waste as I adjusted to this new way of eating. I used to shop like a bargain hunter, you know the mindset, the most food for the least price. Now, I look for the smallest servings and the highest quality ingredients. I can afford to get better quality meats and superior organic staples. I’ve completely eliminated processed sugars from my shopping list. I’m also saving money in unexpected ways – toilet paper, for example. (I won’t be too candid here, but suffice it to say that when you eat less, you need the bathroom less, too.) I don’t need to buy antacids – heartburn is a thing of the past.

At week two, I also began taking supplements. Because of the limited capacity of my stomach, I will need to take a daily multiple, B12, calcium, iron, and vitamin D supplements every day for the rest of my life. Getting used to this routine was a challenge, so I began tracking my supplements, diet, exercise, and vitals in a daily log. It’s been tremendously useful for staying on top of my fluid and protein goals, too.

A few cognitive changes related to the weight loss took me by surprise. First of all, my tastes changed. Prior to surgery, I despised mushrooms, but now find myself liking them. Rotisserie chicken or roast chicken used to be a favorite indulgence of mine; now I get nauseous at the thought of it. Fast foods, once a bane to my health and a craving I couldn’t shake, hold no appeal. Mostly I find myself jonesing for salads, fish, and – occasionally – Cheez-Its. But without the hunger pangs, I breeze right by the chips and snacks aisle at the store and think nothing of it.

I found my anxiety decreased and my mood improved. Feeling healthier and more fit brought me an inner peace and joy like I have not felt in my life before.  Prior to surgery, I set up a meditation area in my living room, complete with an indoor greenhouse and small waterfall. These, of course, helped me develop mindfulness practices that aid in keeping my grateful and happy in my life, but the diet and exercise – both tied to surgery – have made it easier still.

So, the big question: has it been worth it so far? I have to give a completely unqualified “yes.” Though I’m 47 pounds lighter, the real victory is the remission of the hypertension and diabetes, two serious health issues that I have successfully treated with the surgery. Prior to making a final decision, I went to a handful of friends who’ve also had weight loss surgery (mostly gastric bypass) in order to ask them if they were happy they had it done. The answer, from all of them, was nearly always the same: “It was best decision I ever made.”

I can now add my voice to their number, echoing their joy for the new life surgical weight loss – and their own hard work – gave them.

 

A Beginner’s Guide to Buying Classical Music

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Venezuelan conductor Gustavo Dudamel. Dudamel has become a rock star of the classical world recently – he conducted the Los Angeles Philharmonic for part of the score to “Star Wars: The Force Awakens,” and will conduct the 2016 Superbowl half-time show on February 7. Image courtesy of pbs.org.

Every Wednesday, my local Salvation Army Thrift store runs a 50% off sale on everything in their inventory. I make it a point to stop in and browse the books and compact discs each week. It’s a lot of rummaging through trash for the odd treasure, but generally a worthwhile effort.

This week brought in an impressive haul of ten mint-condition, world-class classical music CDs  that cost me a mere $0.99 – a price not even Amazon can beat. As I was checking out, the clerk asked if I’d noticed a few other discs of the same genre. “There’s a collection of classical meditation songs and a 4-disc set of Beethoven’s sonatas,” she mentioned helpfully.

She meant well of course, so I simply thanked for her the tip and completed my purchase. I’d seen both of the discs she mentioned, but the meditation CD featured no-name orchestras and Beethoven’s sonatas were performed by an unknown pianist. But her comment reflects the general disposition towards buying classical music: cheaper is better. Make no mistake, there are a lot of cheap classical records and discs out there, and many buyers are tempted by colossal boxed sets selling, if you’ll pardon the pun, for a song. For casual classical listeners, these types of bargain discs are probably quite sufficient. But if you’re serious about classical music, you’ll want to learn how to sort through the many recordings available for the best ones.

Let’s accept the subjectivity of taste as a given. When talking about the quality of music, much will fall into the realm of personal opinions. However, there are generally accepted markers of good vs. mediocre recordings, and they are your guidelines to making sound purchases. To organize these standards and make them easy to remember, I use a rubric of my own design, the CLASS system: Conductor, Label, Artists, Sound, Symphony.

Here’s how each category breaks down.

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The great Leonard Bernstein. Image courtesy of openculture.com.

Conductor: Truly great performances are accomplished not just by skillful musicians, but the vision of the conductor, too. The conductor interprets the composer’s score in ways that dramatically affect the sound, pace, and feel of the performance. A good conductor brings something new to the table, or else interprets the composition in a way that honors the composer’s original intent. The novice classical music fan might think that one performance of Beethoven’s Ninth Symphony will sound the same as any other. This couldn’t be more incorrect. Performances of the same piece can vary dramatically from conductor to conductor, and many critics will find one interpretation divine and another profane.

The most celebrated conductors of classical music earned their status by being consistently talented and unique in their interpretations of different works. They know how to coax the best performances from their musicians, and they show obvious passion and respect for the music they choose to perform. While there are variations of opinions, a few conductors to watch for as you shop are: Herbert von Karajan, Otto Klemperer, Charles Munch, Vladimir Ashkenazy, Pierre Boulet, Andre Previn, Masaaki Suzuki, and Daniel Barenboim. I’m also a fan of Charles Dutoit and Leonard Bernstein – I have yet to hear a Bernstein recording that I didn’t enjoy.

Label: The cost of producing a classical record or CD is – you may be surprised – considerable. Licensing fees and the costs of paying world-class performers account for much of the expense, and rightly so – these costs help fund orchestras and artists and keep classical music, which represents a fraction of a percent of total music sales, a viable genre. So a no-name recording label probably couldn’t afford the best orchestras and musicians, and the resulting performances will likely be poorer for it. Look for respected labels with a proven history of great releases: EMI, Sony Classical, Decca, Deutsche Grammophon, Telarc, and RCA. For budget-priced discs with superb performances and quality, Naxos is a fantastic label which I strongly recommend.

 

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Violinist Hilary Hahn. One of the most acclaimed musicians of our time, Hahn lends her intense, impeccable style to pieces like Korngold’s Violin Concerto in D, Op. 35, a personal favorite of mine. Image courtesy of Deutsche Grammaphon.

Artists: A slam dunk category – this is one of the first things I look for on a disc. If the artists or soloists are no-names or aren’t listed at all, you’re taking a risk of getting sub-par – and in some cases terrible – performances. Because musical prodigies are recognized at a very young age, if the soloist is unknown it’s a sure bet that their talent is average. Always keep your eye out for proven musicians like Hilary Hahn, Sarah Chang, Claudio Arrau, Vladimir Ashkenazy, Alfred Brendel Jasmine Choi, Isaac Stern, Itzhak Perlman, and Yo-Yo Ma (to name just a VERY few). For vocal music, look for the great tenors and sopranos – Placido Domingo, Luciano Pavarotti, Maria Callas, Andrea Bocelli, and so on.

 

Sound: Applicable to any musical genre, this category refers simply to the recording methods and mastering for any given performance. Since you’re unlikely to be able to listen to a record or disc before purchasing, consult the reviews online to get a sense of the recording quality. Some of the greatest performances of classical music were given in the early half of the 20th century and later, so analog recording methods were used and you should keep that in mind. The mastering of the recordings, however, can significantly impact even an analog source, and great performances can be completely ruined if the mix is off (imagine a concerto where the soloists are far off in the mix – I’ve heard it before, and it’s quite disappointing). Modern releases, of course, will have a clarity and immediacy you may not find on older recordings (though some prefer the older analog sound), but even with cutting edge equipment some sound engineers still get it wrong from time to time. For example, I prefer Leonard Berstein’s First Mahler Cycle, recorded in the sixties on analog equipment, over some of the recordings of Gustavo Dudamel’s cycle from just a few years ago. The former has a stronger and more evocative mix, while the latter suffers from a very flat, compressed sound to my ears.

Symphony: As important as musicians and conductor is the symphony performing the piece (for chamber works, refer to the individual artists). Symphonies with platinum reputations attract the highest caliber musicians, and have provided consistently strong performances – some of them for a century or more. If your bargain CD features a performance of Prokofiev’s Third Symphony by the Downer’s Grove Illinois Orchestra, you’re taking a chance that the performances will be poor. Look for the greats: The Royal Concertgebouw Symphony of Amsterdam, the Berlin and Vienna Philharmonics, the London Symphony orchestra, The Chicago Symphony Orchestra, and so on.

There you have it – a quick guide to purchasing the best classical music. As you explore, you’ll start to realize which conductors, artists, and orchestras you enjoy the most, and indeed there is always disagreement over who did which piece ‘best’ or ‘better’ than the rest. Whether online, at the bargain store, or browsing flea markets and tag sales, the best deal is a low price and superior artists, conductors, labels, and sound.

The Demons in Devil’s Hopyard

IMG_1462Sometimes, the trails take you where you’d rather not go. The solitude of the forest, a timelessness arranged by ancient oaks and granite erratics, puts the contemplative hiker face-to-face with history, the moment, the unknown to come. Cut off from technology, compelled by the rhythm of footsteps on living soil, hiking can become a pilgrimage or an unlikely form of time travel. Sometimes, turning a corner on the trail startles us with an insight into where we’ve come from, or where we’re going. It can be exhilarating. And unsettling.

Today, I put myself on a path that I knew would be fraught with demons. The aptly named “Devil’s Hopyard” State Park in Salem, Connecticut is the last hike I ever made with my ex-wife. It was August 2010, and my first time in the park. We set out on a picture-perfect day, accompanied by friends. I had just picked up the latest CD from Spock’s Beard, and I was singing the opening track (“At the Edge of the In-Between”) as we departed from the falls and headed south to the Tablet Rock vista.

We were mesmerized by the splendor of the forest – Devil’s Hopyard is perfectly Tolkienesque in its design. Among massive boulders are gnarled roots and abundant emerald mosses. The high canopy casts light and shadow with ethereal effect. It is a place that feels otherworldly and magical. We took many photos along the way: a sunlit glade, a friend upon a rock pointing westward like an erstwhile Lewis or Clark, goofy faces through the lifted roots of an old tree. At the vista, we set up my camera to snap a photo of my ex-wife, my friends, and I. We stood with our backs to the bright, blue sky. We were smiling and charged with the glow of the day.

This time, I was alone at each of the places where an inauspicious history had been made. At the lookout, I set up my camera to re-create the photo of five years ago. I’m not sure why; perhaps it was another maudlin gesture among many.  But I’d like to say it was a minor means of taking stock of things lost, an inventory of resources and assets squandered or spoiled in the five year span that had elapsed since that special day. I’d like that image to speak the words I need to hear: “Let this be another reason to keep improving.”

I was playing the Spock’s Beard CD again (on my phone, this time), and as I descended toward the trailhead the middle section of “Jaws of Heaven” stopped me stone dead in my tracks. Nick D’Virgilio sang:

I awoke this morning
A lifetime come and gone
The ending of a journey
My destiny at dawn

Yesterday behind me
There is only now
Every circle that was closing
Is opening somehow
And it’s clear to see the reasons
Are woven deep in the wondering.

I had counted on ghosts and demons, but wasn’t for prepared for the tears that came suddenly at that moment. I’d have looked quite a sight, a middle-aged man weeping in a little clearing in the woods, had anyone come across me. But I let the crying run its course, and resumed my journey when it felt right to walk again.

I’m not fond of collecting regrets or wallowing in the sadness of misused past – well, not anymore, anyway. The fact is, I’m at about the midpoint of my life. Acts One and Two have now come and gone, and Act Three is about to begin. I’m sure I will always mourn my possible pasts and rue the mistakes I have made. Depression made a perfect hell out of the first half of my life, and the devastation can’t be undone. The noonday demon, however, is gone – and that is a success that almost balances the ledger as I move forward.

Returning to this place to lay eyes on places I had been with the wife and friends who are now gone was the very essence of a catharsis. In the weeks to come leading to my fortieth birthday, I believe I’ll return to other places of significance to my past – both on the trails and off. Perhaps it’s helpful to make a ritual of our reflections. Maybe looking back is easier, or more fruitful, if it’s done with a reverence that affirms both the temporal immutability of the past and its capability to be an active, living catalyst for change in the present. In the static, immobility of days forever dead we hear the still small voice, urging us to make the next Act better.

Found Art: Kindness Against the Grain

Hi friends!

When I’m not working for The Chronicle newspaper as a photographer, or for the Humanist Connection of Stanford as Community Outreach Manager, or raising a 3-year-old (whew!), I’m working in a residential sober house/HIV AIDS facility as a case manager. Like all social services work, the pay is awful and the results mixed. For each client who achieves sobriety and begins life anew, ten re-use and end up back on the street. It’s absolutely true in this vocation that you have to love people and believe in the essential goodness of our species – or at least our potential to do good given the right circumstances – or you won’t last.

I arrived at work yesterday to find out one of our clients was being evicted. As of today, he’s homeless again. The proper folks over at Admin decided they were fed up with his public racism and violent temper. I’ve clashed with him before over his refusals to peacefully co-habitate with the “blacks” and “blancos” in our facility. He’s been threatening toward me and, due to my soft-spoken and gentle approach with clients (I employ the unconditional positive regard model to care), he decided that I must be gay. Under his breath he often refers to me as the “cabrón,” not knowing I have enough of a grasp on Spanish to understand when he’s discussing me in pejorative terms. But I’ve always maintained my friendly, forgiving disposition with him. It’s hard to be threatening or unkind to someone who unfailingly treats you with dignity.

But my co-workers and the other clients were happy to be rid of him. The mood was jovial when I arrived, with staff and clients talking about “karma” and comeuppance and exhorting me to rejoice that the man who detests me so much is getting his just desserts. Honestly, I’m just sad to see another broken person falling through the cracks.

I remembered something my boss said at a recent staff meeting. A co-worker said that she didn’t understand why this man could be “so manipulative and hateful.” My boss asked in response: “Did you have two parents who loved you? Did you know that you were loved and safe? Because if you did, you had more than this man ever did.”

Late in the evening, he came for his final supervised medication administration. I could tell he’d been worn down by the victorious stares of his peers, the triumphant grins of the staff who were ready to shake him off like dust from their feet.

I shook his hand and told him, “I wish you all the best.”