Time Toxicity

 I was listening to a healthcare webinar a few days ago when the topic of "time toxicity" was introduced. For a long time the medical field focused exclusively on the physiological toxicity of treatments--mainly chemotherapy. The interest was on physical side effects, was the cure worse than the disease?  I remember when the concept of financial toxicity was introduced. A recognition by doctors that there were monetary costs associated with treatments, costs that were sometimes exorbitant. This type of toxicity came with its own set of risks and "side effects."  

Time toxicity is the recognition that medical care takes time; time to travel to offices, time to get tests done, time to meet with doctors. In the case of chronic illness, the amount of time spent managing the illness can be quite high.  Add in the time outside of direct medical care, but spent making decisions about care, researching options, and dealing with insurance and the time can increase dramatically. 

The webinar presenter encouraged medical professionals to think about time when meeting with patients. Can appointments be scheduled differently? Can care be better coordinated? 

I've been thinking about this idea. Outside of medical care, are there other areas where the concept of time toxicity could be applied? Is it really a problem that can be solved? I don't think it is unique to our US healthcare system. Is it an inherent aspect of human life--do some things just take up a lot of time?

I think I've spent more than enough time pondering these questions.

What to do?

 I am devastated each day as I read the news. I am at a loss to explain how national leaders are acting, or, often, not acting. I have personally and professionally directly benefited from many of the areas being slashed. But, more importantly, I grieve for those who don't have the resources to recover, resist, or wait. I feel helpless and hopeless.

In the past I've sometimes felt that my contributions to the world were too small. This was especially true when I saw colleagues and friends spearhead major public health initiatives, start NGOs, or hold government office. In those times, I reassured myself that we each have a role to play, a corner of the world were we do have impact. During these tumultuous times I've tried to remind myself of that thought. A few days ago I reached out to several younger scholars who work in areas particularly targeted. All of these friends are members of the LGBTQ community. Some are former students, some past or present colleagues. I wanted to let them know that I was thinking of them and working, in the small ways that I can, to protest. Each responded with gratitude, but also with fortitude. They are not giving up, they are not abandoning their work. Their  responses gave me a small glimmer of hope.

I've been talking about some of my concerns with my sons. One has recently started his own blog and sent me the link to his latest post. Maybe some of you would like to read his thoughts, too. 

https://larfenwrites.blogspot.com/

Perspective

 I engage in two organized exercise classes. One is a relatively high intensity "boot camp" type class. The other is yoga. 

At the boot camp studio there are posters around the room admonishing us to "give 110 percent," "you're stronger than you think," "play like you are in first place, train like you are in second." The overall vibe is don't try, do, don't make excuses, push, push, push.  We are encouraged to set goals, be ambitious, and always strive to improve.

I've been struck by the contrast to yoga where the instructor says things like, "let go of any expectations of what you should be able to do."  She reminds us of resting poses that "are always available to you."  We are asked to honor where we are today, what we are able to do that day.  In yoga there are no judgements, where you are is where you are. One of my favorite phrases, that I've heard more than one yoga instructor say, is to use props, like blocks, "to bring the ground to you."  The very idea that it is the ground that should be moved, not your body, gives a totally different perspective on how to approach life. 

I once heard a Jewish creation story, that I probably wrote about here years ago, that ends with the statement that you are exactly who you are meant to be. While I enjoy the challenge of building my physical strength and stamina, I prefer to live my life as a yogi.

Crumbles

 I've been going through boxes of old stuff--ticket stubs, cards, photos...and newspapers. Why do we save old newspapers? What is the point?  In today's world all the information on those pages is probably saved somewhere in a digital format, or can be preserved in a digital format.  But, to me, there is something special about holding a physical object.  Someone folded that paper and put it in a paper box, rolled it and threw it on a porch, or stacked it on a stand. How many hands might have touched those pages? What were all the decisions that went into the making of this paper--the writer, the editor, the typesetter, etc.?

Then, there is the other content. What story is juxtaposed with the one I wanted to save? The whole paper tells you something about the world. There used to be these "what was happening the day you were born" gifts you could buy. Historic events, the price of eggs, and the weather were some of the items included. (For some reason the price of eggs seems to be a universal indicator of economic conditions.) Glancing over at the paper laid out on my floor now, I see that you could buy a wringer washer for $69 in 1969.  Who was still buying wringer washers in 1969!!!!

But, newspaper is the worst medium for conservation. The paper is terrible, it yellows and becomes brittle. We usually save them folded up, compounding the problem. They are an awkward, nonstandard size. In the pile I have there are papers sized 23x18 and 25x13.

Often, we save multiple copies of the same paper. Why? Do we think that several of our descendants will want their own copies? Do we think they will be valuable and we are investing in the past? For $70 a company will try to send you a vintage newspaper from the day of your birth. You can express a preference for the newspaper, but if nothing is available, they will send you some alternatives.  Maybe I can sell these after all.

Last class day

Over my many years of teaching I've struggled with what to do on the last day of class. In semesters where there will be a "fact based" final exam, like a multiple choice test, that day can be spent in review. But in other classes, where the final is an essay, or no final at all, how do you wrap up the class? It seems a little silly to go over new material in those cases.  But, what to do instead? 

The first day is easy, review the course requirements, introduce yourself, introduce the class topic. There is a lightness and sense of excitement, on both sides. What will these students be like? How can I engage them? Who is this instructor? What kind of experience will this class be?  There are many pedagogy articles that talk about how to make the first day exciting and interesting.

The last day, even in the best of classes, there is a bit of weariness. Everyone is looking to the future and this class is the past. Students are thinking about the pile of tasks they need to complete before their last exam or project. As an instructor, I'm also thinking of what I need to do in order to clear my slate and enjoy the upcoming break. None of us really want to be in class anymore. 

Are we too old for an end of year party? Could we have cupcakes and games? Next year I'll teach my last last class. I think I'll plan a party.

The sadness of little losses

 Grief over big losses, death, divorce, loss of a job or home, is expected and natural.  Much has been written about it, how it progresses, how it is managed, and it impacts your life. Much less attention seems to be paid to the little losses, a neighbor moving away, a colleague leaving the company, a favorite hairdresser retiring. Today I learned that one of the coaches at my gym is leaving. For a year I've seen her about 3 times a week. We know only the barest outlines of each other's lives, but in other ways we are intimate friends. She has seen me sweat and struggle, encouraged me to push when I didn't want to, offered friendly encouragement and smiles. I know that in a few weeks she will be only a vague, pleasant memory. I suppose the length of that recovery will depend on how well I like her replacement! But, I'm a little sad today that our journey together has ended. 

I was tempted to pin these feeling of loss on aging, but I don't think that's fair. I think back to people who at some point were SO IMPORTANT to me--childhood and college friends, former colleagues, teammates, and teachers. Some of them I wouldn't even recognize today, or possibly even remember. Seems that over our lifetime we are forever letting go. Of course, to bring this back to some positivity, we have the possibility of endless new connections (which we will, some day, have to let go!)

Theodor Billroth

 

 

 I've been working today on a new lecture covering a brief history of medicine for my population class. Reading through overviews of medical advances I happened upon the name Theodor Billroth, a pioneer in gastric surgery--in fact, Wikipedia calls him the founding father of modern abdominal surgery. Two years ago I had a "Billroth II" reconstruction following gastric surgery!  I had no idea that Dr. Billroth first developed these procedures in the 1800s.  While I'm sure there have been advances it does make wonder, what has medicine done since then? 

I was also fascinated to learn that Billroth was a music aficionado and close friend of Brahms. Brahms even dedicated some works to him. I wonder if the surgeons play Brahms in the operating room? If not, they should.  I'll have to ask them at my next visit.

Somehow, feeling connected to someone so well-respected in history makes me feel just a little special.

"In all the spheres he sought to influence, he was guided by a belief in the unity of science and art, and by confidence in his own ability to effect change."  

 

(From Roses, Daniel F. (1989-01-01). "Review of The Surgeon's Surgeon: Theodor Billroth 1829–1894, Vol. 3". Journal of the History of Medicine and Allied Sciences. 44 (2): 251–253. doi:10.1093/jhmas/44.2.251. JSTOR 24633109.)