Pandemic Mode, episode 2

This is the second of what I anticipate will be a weekly update on life during the greatest pandemic in over a century. Because it's clear that's what we'll be living through for the next several months, at least.

The overall story of the last week has been the exponential rise in cases in the US, accompanied by a growing knowledge about the virus and consensus regarding the severity of the pandemic. "Social distancing" is now a universal phrase, and the resultant anxiety has palpably seeped deeper into the collective consciousness.

According to reports, many in Britain are in a state of shock as prime minister Boris Johnson, Prince Charles, and several high-ranking ministers have contracted the virus. Elsewhere, Italy and Spain are continuing to struggle with what is hoped is the peak of the pandemic's first wave. India has completely shut everyone inside for 21 days in hopes of avoiding additional stress on its fragile healthcare system. China, on the other hand, has relaxed some of its restrictions as new cases have plummeted, at least initially.

The sober, wartime mentality was punctured earlier in the week by Donald Trump's relapse into denialism, claiming that he thought the country would be back to work by Easter. Which is less than three weeks away. And which would clearly be catastrophic. His insatiable lust for a return of the bull market of his first three years in office has served to only derange his already-catastrophically-impaired decision-making capacity.

This is mainly mentioned to highlight the utter lack of leadership at the federal level. We are all starting to pay an incalculably steep cost for raising such an incompetent, narcissistic, and irresponsible human being to the office of president. We don't need a great leader. We just need someone who has the basic level of competence to set the right tone for the nation, consult with experts to make some big important decisions, and delegate serious policy-making to competent people. 

A correlate with Nazi Germany comes to mind. Not Trump to Hitler (necessarily), but rather how loyalty was elevated above competence in placing people in power, resulting in a cast of fools trying to making decisions and utterly failing every step of the way. Unfortunately, that's all we've seen the past 2 months from this administration, and all we can expect to see until a new administration hopefully takes power next January.

A silver lining is that half of the states have taken bold steps to stem the pandemic. Though this may be slowing the progress in more rural areas and in a few cities like San Francisco, it clearly has been insufficient in most cities. A week ago, Italy was shocking the world with its  25,000 cases. Today, the US has over 120,000-- 52,000 in New York alone, with skyrocketing numbers in New Jersey, New Orleans, Chicago, Detroit, and elsewhere.

As expected, reports out of New York in the last couple days have started to mirror those coming out of Italy from the previous week. Because of New York's size, the situation has not yet gotten as dire as Italy, but I am certain I will be stating a different case a week from now, when the US will be closer to a million cases and New York in the hundreds of thousands.

Locally, North Carolina just topped 1,000 cases, over half of which are in Charlotte and Raleigh-Durham. Those areas are on shelter-at-home, while the rest of the state will be starting that on Monday at 5pm. Watauga County sits at just 5 cases, and we have yet to see any inpatient cases or local transmission outside of a single household. Watauga Medical Center has barred all visitors except for spouses of delivering mothers and family members of dying patients. All staff are being temperature screened on our way into the hospital each shift. Policies are in place and the COVID ICU and intermediate units are up and running. I am personally caring for the COVID rule-out patients this week, and have been encouraged at the rapid pace of change. After weeks of preparation, we are nearly as ready as we can be, excepting the continued lack of rapid COVID-19 testing capability-- which is by far our greatest limitation in terms of caring for possible COVID patients and conserving PPE (personal protective equipment). If reports are to be believed, responsibility for this lack rests squarely at the feet of the FDA, which delayed all testing development for the entire month of February. But no matter who is responsible, heads should roll. My job and the job of thousands of healthcare providers is markedly more difficult without rapid testing capability. And most importantly, patient care is suffering, even before we have any actual COVID patients in the hospital. 

The dark clouds continue to gather, and the rain has started to fall. But the silver linings remain. Distributed work (ie working from home), a beautiful concept, is starting to see its day in the sun. Service industries are being painfully disrupted, but much will rise from the ashes. People are having to be more intentional about staying connected.  And the world is starting to see the value of competent leadership... and the steep price that must be paid where it is lacking in trying times.

Stay calm and self-isolate on.

Pandemic Mode

Like everyone else, I've been amazed at the pace of change over the past few weeks. Though I've been receiving a flood of COVID-19 emails for the past month, it has not struck home until much more recently. The first in-person impact I recall occurred thirteen days ago, when I found out that a friend's son's highly-anticipated college spring break trip to Ireland had been cancelled. Around that time, I started hearing about universities' plans to extend spring break and possibly go to e-learning for the rest of the semester. The next day, on March 9, my small group met at my house, and though there was some minor conversation about Coronavirus, there was little to no thought that that would be the last time we would meet for months. North Carolina had hardly seen any COVID-19 cases, and Watauga County certainly hadn't. I did start taking action as the medical director of the Community Care Clinic to implement reasonable and recommended precautions, which started changing on a near-daily basis that week. On Tuesday, Mindy and I visited my grandfather at his assisted living facility in Charlotte, not supposing that the facility would be put on lockdown just 2 days later. On Thursday, March 12, I still felt little risk to teaching my 1-day obstetrics course to 11 missionaries at EQUIP Ministries in Marion. I tried to remember to not shake anyone's hands, but that was about it.

That evening, however, I found out that all professional and collegiate sports had been indefinitely cancelled after an NBA player tested positive. I also got an email from my church that all services were being cancelled, and a text from a friend letting me know that the Banff Mountain Film Festival (which would have been today) had been cancelled. On my way back from Marion, I listened to a Sam Harris podcast that raised my concern that the supply chain might be disrupted. After discussing that with Mindy, she started stocking up on supplies. I also started considering the need to cancel my yearly college friends' get-together and other upcoming trips. The following day, I started hearing about schools shutting down, and court was shut down halfway through the day before Isabella's case was heard (earning Mindy's ire after she had sat around court for 1.5 days)

Though I still ran a relay race on March 14, everyone was careful to not shake any hands, and plans for a post-race hangout were scuttled. But even then, Mindy and I decided to go out to eat at a restaurant by ourselves-- where I made sure to wash my hands, of course. Much like my small group a few days earlier, I scarcely imagined it would be the last time I would eat at a restaurant for months. Though that may seem foolish just a week later, a complete restaurant ban still wasn't within my imagined realm of possibility at that moment.

But that was to change extremely quickly. I found out that night or the next morning that all NC public schools had been shut down, that gatherings of more than 100 people had been banned, and that someone in Watauga County had tested positive for COVID-19. When I drove to the hospital on the morning of March 16 after nine days off, I hardly recognized the place. There were traffic cones everywhere and a checkpoint on my way in where I had to show my ID, like a military base. That day, I had to test a patient in whom I could not reliably rule out COVID-19, and more patients like that would come over the course of the week. Preparations for dedicated COVID units swung into high gear, and emergency staffing and other plans were drawn up. The next day, March 17, the restaurant and bar ban dropped, and community life ground to a standstill.

Yesterday, I had planned to meet with a friend here at my house to hang out, but his family had already started to "hunker down." Now that we're both off work for a few days, Mindy and I are starting to "hunker down," too, though there is of course no chance that I will be called off of work. I've realized that I have a duty to avoid having to self-quarantine, since my services may be urgently needed at the hospital in a matter of weeks-- so I should therefore avoid any unnecessary contact with other people.

There are a few things I'd like to say about all this. Obviously, all of these developments are bad for the economy, and it's easy to become anxious about finances. To minimize that, I'm trying to meditate and journal more. And will try to time my entry into the market appropriately.

Secondly, things might get pretty lonely, especially for people who are out of work or who have to work from home. Since I'll still be working, that's less of a personal concern, but I still feel it on my current days off when Mindy is working. But the good news is that Mindy and I have had a lot more time to hang out and work as a team around the house. We've already noticed the relational dividends from the increased quality time.

Furthermore, now that we see cases in Charlotte and the Triangle starting to exponentially rise, it's obvious that all the measures put in place over the past week have been the correct calls. And the naysayers one would come across just days ago have all changed their tune. So kudos to Governor Cooper. I can only imagine that the controls are going to get stricter over the coming days and weeks.

On a larger scale, there's no question that the federal government in general and the Trump Administration and FDA in particular have horribly bungled their response to this emerging crisis. If they had taken the right steps at the right time, we would not have to be waiting for 3-5 days for a COVID-19 test result, and places like New York, Seattle, and San Francisco would not be experiencing the beginnings of a true crisis. I have no doubt that we will experience a catastrophic reckoning from the current administration's incompetence.

Everyone is rightly worried about following the path of China and Italy. With the measures that North Carolina has put in place over the last week, I think it's unlikely we will see that kind of crisis locally, though it's still possible, especially in the Triangle and Charlotte. I'm optimistic that we will be able to flatten the curve, at least moderately. Though the exponential growth in cases over the last week may seem to be telling another story, there is a lag time of several weeks to the effects of our current efforts. Only time will tell if what we are doing is enough.

The best comparison for the past few weeks and the coming months from my lifetime is 9-11. As we all know, the world has never been the same since then. And the same will be able to be said for the current crisis. In the meantime, don't take any unnecessary chances. Stay well, stay calm, and isolate on.

Keto January Recap

Every time I told someone over the last month that I'm following the ketogenic diet, I got a quizzical look and some version of, "Why are you doing that? You don't need to lose weight!"

I get it, people. I promise I don't have an eating disorder. Whether most people realize it or not, the ketogenic diet has benefits far beyond weight loss. These include:

• Improved cognitive function and decreased brain fog
• Improved mitochondrial function
• Conserved glycogen during moderate aerobic activity (70% of VO2 max)
• Improved autophagy and potentially reduced long-term cancer risk
• Decreased insulin release, and thereby decreased systemic inflammation

And that's just the start. I'm excited to see more and more research emerging each year around various other salutory effects of keto-- the list just keeps growing!

Now that I've finished my three-week experiment with it, I have a few personal observations I'd like to share, broken down by week:

• Week 1: lead-in week. Did not check my ketone level. Felt ok. A few headaches. Immediately lost 5-6 pounds of water weight, which is was happened last time I went keto. Started drinking water with salt, lemon juice, and a splash of apple cider vinegar in the morning to replete my electrolytes. Decided to monitor my blood ketone level (using my new Keto Mojo monitor) rather than track my macros, which would have been just too much work this time around. 
• Week 2: mild ketosis (levels 0.5 - 0.9). Workouts were poor since I had no glycogen and was not yet keto-adapted. More headaches. Had to push through this week. But I did notice that I was very full for 6-7 hours after eating my late breakfast of cheesy eggs, presumably the effect of both the satiety that comes from a high-fat diet and the anorexic effect of ketones.
• Week 3: moderate ketosis (level was 1.2 at beginning of the week, then I ran out of ketone strips. Presumably it was at least 1.2 afterwards). Workouts improved as I became more keto-adapted. Headaches decreased and had little brain fog, although I still got headaches if my sleep was disrupted. Gained back about 4 of the pounds I had lost. Felt essentially back to normal. 

Though it's not something I've decided to follow long-term, I do plan to continue the habit of going keto every January-- probably with a tweak each year, to keep things interesting. It's quite possible that this habit alone will extend my lifespan by 5 or even 10 years-- though I'll never know for sure.

So whether you're fluffy, lean, or something in between, the ketogenic diet serves as a master metabolic reset. If you do it right, you'll be glad you gave it a try. Let me know if you do!

2020 Focus

My readings and musings over the last few months have crystallized two deep desires in me. The first is enjoying and being present for each moment. Few things sharpen your appreciation for the moment like a baby, and as I've grown in my understanding of and experience with meditation over the past year, I've come to recognize that the degree of fulfillment in life is largely determined by how undistracted a person is. Frequently entering a state of flow is a necessary condition for the good life. So whether it's feeding a baby at 5 AM or having a conversation with Mindy or swimming intervals in the pool or knocking out notes at work, I try to achieve complete focus on each moment, each appearance in consciousness-- each breath, each stroke, each thought, each interaction, each emotion. Fostering that practice will be the cornerstone of my next year. Mindy can't wait!

I'll also be exploring the subconscious over the next year. Whereas mindfulness meditation completely centers on the contents of consciousness, dream work and active imagination (which I'll cover in a future post) are practices that bring to awareness the deep well of the unconscious. Carl Jung trailblazed this field over a century ago, and by a stroke of luck I obtained an anthology of his work at Boone United Methodist's Fall Bazaar, pictured at the right below. I'm sure I'll post more on this as the year progresses and I have time to work through more of his writings. The middle book, Robert A. Johnson's Inner Work, explores the topics of dream work and active imagination in a practical way, and though I'm only now starting to dig into this book, I'm already excited to share some of the techniques and insights I gain.

As for hobbies, I will of course continue to train for and compete in triathlons, kayak as time, relationships, and rainfall allow, garden, read, and write. I'm also currently eating keto, and plan to dive back into the bongos later in the year. But my most recent passion has been stirred by the third book in the photo, Fiery Ferments-- a fun, practical, and educational exploration of the making of hot sauces and fermented foods that is the perfect marriage of my love for microbiology, gardening, and spice. I can't wait to experience and share the resulting concoctions! Thanks, Michael and Meghan!

Professionally, my work as a hospitalist will morph as Boone's new Family Medicine residency starts up in July. I'll be doing more teaching and precepting (which I love to do), and I've already started doing more bedside ultrasound and procedures (which I also enjoy doing) in anticipation of teaching the residents these topics. I'll also continue providing oversight and and medical care at the Community Care Clinic. 

So like most of you reading this, my life is full of moving parts. Meditation and taking time to silently reflect will continue to help me understand why I act and feel the way I do in each moment, and I'm grateful that mindfulness is enjoying its time in the cultural sun. But a topic far less prominent but no less essential is how to understand our subconscious. The vast well from which the contents of consciousness emerge remains a mystery for most-- but it doesn't have to be that way! I'm excited to start unraveling that mystery, and share what I learn with all you lovely readers. 

Memento mori, memento vivere.

Dan

2019 in Review (and the 2010's!)

The big-picture themes for 2019, as I stated in my blog post preparing for the year, were

"reapproaching the Bible in a new way and generosity of spirit. My goal is to be more empathetic, warm, and understanding by the end of next year than I am now. Though I'll still be reading books and book summaries and posting my reflections, I'll be more focused on the emotional and relational side of life, which is where I stand to grow the most right now. And I hope that, as a result, joy and humor will flow like never before!"

It turns out that, roughly the first half of my year was spent on reapproaching the Bible through various books, meditations, and podcasts (which was great), while I shifted my focus onto generosity during the second half, culminating in accepting a foster baby in December. I also assumed the volunteer position of Medical Director at the Community Care Clinic, Boone's only no-cost clinic serving exclusively uninsured patients. Contemplation and Action! Just what the sages always prescribe. Though I fell short plenty of times, especially in the area of presence and warmth, I can honestly say I grew across most important domains this year.

Mindy and I continue to grow and put down roots in the High Country, and the fostering process has brought us together as a team like never before. We have become more committed at Boone United Methodist Church, and have found a wonderful, supportive small group to be a part of. We also took two big trips, one to Europe and one to Colorado-- which should satisfy the travel bug for years to come!

Triathlon season was a success, and I was able to kayak a few times, though not as much as I wanted. The garden did pretty well, and I found some field mushrooms to eat in our very own pasture and at Mindy's uncle's house in Colorado-- morels, no less. I made some great strides at work, especially in the areas of procedures and ultrasound, completed my leadership program, and helped plan for the new Family Medicine Residency starting in Boone this year.

As I turn my attention to 2020, I want to take a moment to be grateful not just for a full year, but for a wonderful decade. The past 10 years have seen me through medical school, residency, marriage, deconstructions, reconstructions, major travels, a real job, and, to close out the decade... a baby! Though we don't know if she'll be with us forever or not (we sure hope she will be), Mindy and I are offering our foster baby as much love as we can give. And there's no better way to end a decade or start a new one than with that kind of self-giving love. And lots of snuggles.

The Best Thing I Read in 2019

I read a lot of articles, quite a few book summaries, and a fair amount of actual books. I love few things more than digesting a good blog post or quality book. And if I was asked to recommend just one thing I've read over the past year, Tim Urban's series "The Story of Us" on his blog "Wait but Why" would be it-- hands down. Here's the link: https://waitbutwhy.com/2019/08/story-of-us.html

Below, I do explain this picture.

The reasons for this selection are many. First and foremost, the topic is one of utmost importance: the underlying reasons why our society is heading in the wrong direction. Urban deconstructs the psychological, historical, cultural, anthropological, and technological dynamics that have brought us to our current state of affairs-- which by his and most other accounts is the brink of societal collapse. The number of mental models I gained or reinforced as a result of reading this series by far exceeds any other collection of writings in my recent memory. And I can't think of another series with as many "aha" moments as this one. And finally, like most of Urban's writing, it's fun to read. Hilarious, even.

Though a summary would take far too long, a couple takeaways I will mention is that the level of consciousness of individuals, organizations, political commentators, news outlets, political parties, and politicians matters far more than where on the "right/left" spectrum they are. Is their "higher mind" (symbolized by the guy with the turquoise light above) in control? Or is their primitive mind (you guessed it-- the orange flame-carrying blob) calling the shots? Another idea is that confirmation bias, rather than truth, becomes the driving force when the primitive mind takes over an individual or a group, which instigates a feedback loop which becomes ever more difficult to break as time goes on.

Urban isn't actually finished with the series, either. In the two final posts, it seems that he intends to offer his prescriptions for how we can break the cycles that have fractured our society. If you get a chance to read the series up to now, I think you'll be anticipating this as much as I am. Happy reading!

Off-season triathlon training

The past 4 months have constituted my off-season, and as such I've focused on preparation. First of all, I've been able to stay healthy. Secondly, I've undergone a professional bike fitting and aerobar installation, which I'm optimistic will keep my back spasms more at bay on long rides. In an effort to focus my training, I've also picked out the four triathlons I'd like to do next year: one Sprint triathlon, two Internationals, and one Half-Ironman. I also committed to a 6-person 100-mile relay race from Hickory to Boone with my brother David in March. As a result, I've been mostly focusing on inching my run mileage and intensity up over the last 2 months, and am starting to see improvements in my workouts as a result. Just yesterday morning, I had a very nice interval workout on the Appalachian State intramural fields in perfect "Indian Summer" weather.

I've also been more consistent about high-intensity interval training, and have integrated farmer's carries and overhead carries into many of my workouts in an effort to strengthen my upper body and core. I'm hopeful this upper body work will translate to some gains in the water. I've even started developing callouses on my palms from the weights, which has been peculiarly satisfying!

With a new baby in the home, recovery and workout timing has particularly important. As I am able to sleep more on my work weeks thanks to Mindy's willingness to shoulder the baby's nocturnal feedings, I am better able to recover from workouts on my work weeks than I am when I am sleep-deprived on my weeks off. I've also found that a sleep-deprived workout is often hardly worth doing given how sluggish I feel. So I'm squeezing as many work-day workouts in as I can.

True to form, here's the graphical representation of my workouts over the last 4 months. The main takeaway is that I'm starting to run more. Hopefully the other lines will be on an upward trajectory too in my next update!

My Cry From Trumpistan

An unexpected thing has happened over the past year: I've become a political junkie. Like most people, I used to keep track of the primaries once people actually started voting, tune in for a debate or two, and scan an article here and there. But at some point in 2019, I started reading The New York Times and scanning a few other political websites on a daily basis. And though part of me would prefer reading non-political articles and books, I don't see myself getting off of the political treadmill for very long until next November, at the earliest-- but probably much later than that.

The reason I've lately felt so pulled in a political direction is that the post- Cold War world order dominated by America that I've known my entire life is shattering. Dozens of countries all around the world that a decade or two ago seemed on the verge of developing into semi-stable democracies have either plunged back into the darkness of authoritarianism or are teetering on that slippery ledge. Perhaps the most stable democracy of them all-- the USA-- has elected an amoral strongman who daily chips away at our democratic norms, traditions, and laws, one trolling tweet at a time-- who consistently favors murderous dictators over longtime alliances, his own uninformed and twisted judgment to wise counsel, and personal benefit over national security.

And the most mind-blowing thing of all is that, over the past decade, the Republican party has gone from a fairly reputable organization that at least paid lip service to real values like truth-telling, ethical behavior, fiscal conservatism, free trade, humanitarian values, international engagement, and military strength, to a personality cult, the focus of which has consistently undermined every single one of those values. Though Trump's approval rating has stayed under 45% since taking office, a majority of Fox News- watching conspiracy theory- touting rural Republican voters still love him-- despite the fact that everything and everyone Trump touches gets contaminated. Every single politician or bureaucrat who has gotten pulled into his orbit, even the most respected general of his generation, James Mattis, is disgracefully disgorged from the Administration just months later. The pattern is striking in its consistency. Half a dozen of his closest aides are already behind bars, and more are sure to follow. Yet there seems to be no end to the procession of power-hungry dupes ignorant of history willing to bend the knee for a scrap from Trump's table, heedless of their own impending fall. And this is just one of many details of the Trump administration that seem to defy explanation.

Sooner or later, Trump will no longer occupy the White House and Republicans will lose power. Though this should console us on some level, what happens after this transition is actually the most concerning thing of all, because the majority of rural voters in this country will then feel more disempowered than ever. As their 45% share of the electorate dips below 40%, some on the far right may no longer feel that they have anything to lose from taking to the streets in bloody protest. The violence we saw in Charlottesville in 2017 and the surging gun violence of our time may then be viewed as a modest warm-up to the conflagration that followed.

A little less surprising, but just as tragic, is how the so-called Christian right has walked lock-step with the Republican party into amoral oblivion. If we needed a modern-day echo of the 4th-century corruption of Christianity by way of complicity with the Roman Empire, look no further than the late-20th and early 21st- century evangelical-Republican alliance. Though Trump will be out of the picture before too long, the wreckage of evangelical Christianity in America will remain, and will only continue to worsen as long as scientifically obvious facts such as evolution by natural selection, psychologically damaging dogmas such as eternal conscious torment for all non-Christians, simplistic salvation formulas, and a narrow literalist approach to the Bible continue to be defended. The moral bankruptcy of the sanctimonious Christian right will continue to be on full display to all.

In case I needed more cause for concern, the climate crisis is quickly zooming past the tipping point. Yet, beholden to the oil companies and unable or unwilling to reason clearly, one of our two major political parties (alone in the entire world) denies the irrefutable existence of the crisis, the equally irrefutable case that humans are causing it, and the solutions that are truly our only hope of survival. Consequently, Republicans have reversed as many Obama-era environmental protections as they can over the past three years, squandering precious time-- which the planet can simply no longer afford.

Political stability and the Earth itself are slipping from our hands. We are truly declining, more precipitously than anyone two decades ago imagined we could. Nihilist fascism is being effectively exported from Russia while repressive Communism rises out of the East. Our country is descending into Trumpistan, too paralyzed from polarization to even agree on a shared set of facts, much less respond to mortal threats external and internal. And the left, which should be seizing this hour of destiny with moral authority, often seems more interested in enforcing uncompromising ideological purity tests upon its own members. Free speech itself, the backbone of liberty, is suffering as a result. Yet "free speech" of the most toxic and insidious kind has never gotten more play on Facebook that it is getting now. Democracy itself, not to mention the mental health of tens of millions of impressionable teens and preteens, is under concerted attack by Mark Zuckerberg and his ilk.

There are a few bright spots. Young people are leaving the Republican party and certain toxic evangelical churches in droves, progressive Christianity is mounting a comeback, and appreciation for science, secular ideals like pluralism, and humanitarian values is on the rise among millennials and Generation Z. Women continue to be empowered. Equal rights for members of the LGBTQ community is becoming a given. Advances in science and technology are accelerating. Electric cars are on the roads. Cultured meat is hitting the shelves. The ubiquity of plastic is being challenged. Alternative energy is thriving. Heck, wolves and elk are even making a comeback.

But for every one of those gains, I hear a story about heavier deforestation, desertification, and pollution, a new humanitarian tragedy, and a dozen more newly endangered or extinct species. Then the next superstorm hits the Caribbean and another fire consumes the West. So I write this post out of a slurry of resignation, frustration, concern, and yes, a little bit of hope. Hope that enough minds will be changed by reading articles and posts like this one that the ranks of world-saving movements will swell and hate groups will shrivel. Hope that more people will open up to reason, science, and universal love. And hope that humanity can arrest its descent into ruin, if we still have time.