Perspective

anthOny l KOvatCh, m.D.

Braving Through the Transitions

What else is life but a series of preludes to that unknown song, the first and solemn note of which is sounded by Death…So when the trumpet sounds the alarm and calls him to arms, no matter what struggle calls him to its ranks, he may recover in battle the full consciousness of himself and the entire possession of his powers. Les Préludes (“The Beginnings”) was first conceived as an overture to Hungarian composer/pianist Franz Liszt’s symphonic poem, Les quatre élémens (“The Four Elements”). As the 1856 composition developed, it was given a new title, inspired by an Ode from Nouvelles méditations poétiques by the French poet, Alphonse de Lamartine (summarized above).

Franz Liszt was a prodigy and virtuoso on the piano; this was attributed to his massive hand-span. As with his contemporary Sergei Rachmaninov, the speculation now is that the outlying hand size was part of an underlying Marfan’s syndrome.

Since my retirement this past March, I have had to convince myself that, in spite of the claim by the Existentialists that our lives are lived forward but understood backwards, I must develop the courage to “flash forward through the preludes” and understand life forwards. Therefore, I have become preoccupied with “stages.”

Liszt’s groundbreaking composition has four stages: love, storm, bucolic calm, battle and victory. Ironically, sociologists have described four stages or phases (or “preludes”) of the retirement that in the present day and age can embrace about one third of a health-conscious human being’s life span:

1. Vacation phase, focused on newlyexperienced relaxation and freedom.

Lasting about one year, this stage transitions unexpectantly into…. 2. Phase of loss, dominated by boredom, fear, and anxiety. This stage is highlighted by the absence of integral parts of the workplace experience: • routines, even the painstaking ones • relationships, even the difficult ones --sense of identity --sense of purpose --sense of power or control

These loses can contribute to physical decline, cognitive decline (especially memory loss), and depression. 3. A rebound search for meaning in life and ways to contribute through trial and error, and, if successfully negotiated, will produce…

4. Reinvention of the self and rewiring of the psyche. The long-term result is inner peace and a rededication to the service of others.

Sociologists have also concluded that focusing on these psychological transitions throughout retirement is far more crucial to our overall happiness than the preparatory recommendations of financial advisors. In an enlightening and amusing podcast that formed the construct for the above four phases, life coach Dr. Riley Moynes summarizes the process as “Squeezing All the Juice Out of Retirement.”

In order to reverse our sense of loss, some of us pediatricians sustain our relationships with our longtime patients and their parents by participating with them at community events, especially of the athletic variety. I recently discovered a personally uplifting association between the phases of retirement and the four components of a triathlon (TRI).

Yes, a triathlon actually has four preludes leading to the finish line! Although the triathlon (from the Greek) is classified as a “contest of three,” I contend that the “transitions” from swimming to biking and then from biking to running are an integral part of the contest (just like the transitions between the periods of our life). However, unlike life and retirement, the triathlon is a relatively new-kid-onthe-block when it comes to physical challenges and spectated athletic events.(1)

The first TRI took place in 1974 at Mission Bay, California. You can now find a TRI almost every summer and fall weekend in the greater Pittsburgh area. The Youth Triathlon is still a sport in its infancy, and only the bravest of kids attempt one.(2)

Running can make you tired but swimming requires far more energy and stamina; however, biking can be outright dangerous, even to experienced riders. (I’ve witnessed a “wipe-out” at just about every adult TRI I have attended.)

However, transitions must be respected; a matter of precious seconds can be critical in the competition among the elite. For very sub par participants like the author, the transitions are the only element of the race that can “level the playing field”; they have become my favorite parts of the race—when me and the “old yellow bike” that I have depended upon for every TRI can rest together in relative peace apart from the madding crowd. Romancing the bike: this faithful “old yellow bike” has served me so well over the years that I hang my finisher’s medal on it after I cross the finish line!

Another salubrious prerequisite to participation in TRIs for which I am grateful in my transition from full-time pediatrician to the full-time retirement life is the urgency of tuning up my aging body for the challenge. The mind might be the “first thing to go” but loss of muscle mass and tone (sarcopenia) inevitably follows. Furthermore, of the five pillars documented by neurosurgeon and CNN medical correspondent Sanjay Gupta in his textbook for the layman “Keep Sharp”, to be necessary for the preservation of memory and overall cognitive functioning---healthy diet, exercise, rest and sleep, intellectual challenge, and social connectivity—regular exercise is paramount. A large-scale landmark study published in 2015 in the Journal of the American Medical Association(3) showed that longevity and mental fitness were directly related to the cumulative duration of aerobic exercise (even walking) over time, rather than the intensity. The more aerobic activity the better is the rule of thumb, but the minimum requirement is at least 20 minutes per day for 5 days per week. This amounts to a drop of water in a swimming pool for a determined triathlete in training. Simply put, the more we exercise, the more juice we squeeze out of our retirement!

As a pediatrician for 4 decades, another cherished part of TRIs and road races over the years has been the emergence of the children and grandchildren of my peers as solid competition for their elders. This is not at all out of disrespect, but because of the inevitable chain of events: exposure to an adult who values exercise and competition fosters the same in the offspring. Imitation remains the highest form of admiration— whether for an older sibling, a parent, a grandparent, a spouse, or any loved one. In the future, the young will be compelled to reciprocate. …And teach your parents well

Their children’s hell will slowly go by

And feed them on your dreams

The ones they pick, the one you’ll know by

Don’t you ever ask them why?

If they told you, you would cry

So you look at them and sigh

And know they love you.

—“Teach Your Children” by Crosby, Stills, Nash, and Young (1970)---written by Graham Nash

From Page 21

Medical research confirms this association. A systematic metaanalysis published in the International Journal of Behavioral Nutrition and Physical Activity as recently as May, 2020 (4) showed that the clear majority of studies observed a positive relationship between parent and child physical activity regardless of the age of the child, the genders of the parentchild dyad, and the type of physical activity. A classic case in point:

Little Mae (on the far right ) will be joining her 3 older experienced siblings in the races as soon as she can mount a bike—then she will be the second member of the third generation of lady triathletes in the nuclear family to sport the coveted medal!

My contention from anecdotal experience alone is that children whose mothers were elite athletes wind up as the most superior of athletes themselves. Here is the rub: The reflection of a mother’s athletic prowess is never self-evident when they interact with the pediatrician. Furthermore, these unique prototypes are so humble that that they never 22 volunteer this information; you have to dig it up from their husbands, the grandparents, or even the babysitter! Preteen Ellis absolutely “loves” TRIs in spite of a history of severe asthma; he competes with a beaming smile on his face, even on the rocky pavement during the crucial transition from swimming to biking.

I knew from his days as an obstreperous toddler that Ellis would be a fierce competitor, and I was not surprised to learn after the event that the boy’s mother was an Olympic ultra-triathlete who still regularly competes in long-distance swimming. She endorses my mother-child dyad hypothesis:

“Yes, parents tend to encourage activities that are familiar to them. The unknown activities seem harder to navigate. Plus, parents show the most enthusiasm for the activities they themselves did.”

The reemergence of races is a reflection of civilization’s “control” over the COVID-19 pandemic. However, we all know that we are only in the “transition” phase of the race back to normalcy. May all the lessons we learned along the way propel us soberly into the future—aware that we have not yet crossed and may never completely cross the finish line.

I think this off-hand rhetorical comment by the late iconic baseball broadcaster Vin Scully (whose illustrious career included a 67 year “transition” with the Dodgers) says it all:

“Andre Dawson has a bruised knee and is listed as day to day. [pause] Aren’t we all.”

Interestingly, Scully reassured his “friends” (he refused to use the term “fans” because it is short for “fanatics”) in his farewell address to baseball at the age of 88:

“There’s that old saying: squeeze the juice out of life before life squeezes the juice out of you. I will try to squeeze the remaining juice out of life.”

The indefatigable Scully kept squeezing the juice until the age of 94. I will remember him as the patron saint and the “Mister Rogers” of my “transistor radio generation” of baseball junkies.

From my own thinking, I might add: What is life but a series of preludes---a series of transitions through which we all must brave---all leading to that one final act we call the FINISH LINE?

References:

1. http://www.thepediablog.com/2022/08/04/ out-of-the-old-black-bag-28/

“The TRI’s the Thing: Connecting the Generations

2. http://www.thepediablog.com/2013/08/19/ a-showcase-of-courage/

“A Showcase of Courage” 3. Thijs M. H. Eijsvogels, PhD1; Paul D.

Thompson, MD2: “Exercise is Medicine:

At Any Dose?” JAMA November 10, 2015 4. Loretta DiPietro, et al: “Advancing the global physical activity agenda: recommendations for future research by the 2020 WHO physical activity and sedentary behavior guidelines development group” International Journal of Behavioral Nutrition and Physical

Activity Volume 17: 143 (2020)

The author wishes to thank Dr. Ned Ketyer, editor of the Pediablog, for his permission to publish this expanded version of the original article.