MIN.
INSIDE THIS ISSUE : CONQUERING THE WILD • 21ST CENTURY GENTLEMAN DECLUTTER YOUR LIFE • COURAGE & INGRATITUDE • MAN TO MAN
Tree of Memory.
Alzheimers reminds one geriatric physician about what is most important.
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TofC
This quarter’s focus revolves around whole living and new beginnings. From the things we eat to the people we have in our lives it’s all about being in the moment and being mindful of the things that matter most.
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LIV E: Leaving a Legacy
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TECH: Where do we live?
The decisions we make today will define the stories that get told about us.
An unintentional side effect of the ever-increasing portability of technology is that it continues to make inroads into areas of our lives where it offers more distraction and harm than benefit.
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EAT: Cook with 5 ingredients or Less-
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SEE: Travel with less.
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LOVE: Letting go in love.
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F EAT U R E: The Long Goodbye
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I N F O : Conquering Clutter
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F EAT U R E: Small and Simple
Times are tough these days. The rising cost of fuel and food prices are forcing everyone to cut back — ‘foodies’ included.
Dealing with Alzheimers . When roles reverse and you are the one taking care of your parents. A reminder in what’s most important.
Do you realize just how much your clutter is affecting you?
The benefits of learning to appreciate the small and simple things. Who ever said there was something wrong with “smelling the roses?’
Special thank you to Heidi Larsen for her art direction as well as excellent life advice. For my beautiful Grandmother who inspires me everyday- and who allowed me to photograph her. And thank you Adobe for the beautiful program that is Indesign- I love you.
A lesson in packing less and enjoying more.
It’s easy to develop a connection but what happens when those connections become toxic?
“Simplicity is the ultimate sophistication.” -LEONARDO DA VINCI
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LIVE
LEAVING A LEGACY B Y PA U LA D E A N • P H OTOS B Y SA M H A DLOC K
The decisions we make today will define the stories that get told about us.
sions did they make that shaped their story? And what were their underlying reasons for choosing them?
By this, I mean, we are all writing a story with our lives. And it is going to be retold. It can’t not be. We are going to talk about it. Our kids are going to talk about it. Our grandkids are going to talk about it. Our friends are going to share memories about it. And the lives we shape are going to share pieces of it. It is inevitable that our story is going to be told. This is, of course, called legacy. Ultimately, our story is going to be positive, negative, or a combination of both. But there are no neutral lives being lived. People will talk about the positive impact we left or people will talk about the lasting harm we inflicted. People will talk about our presence or they will talk about our absence. But the story of our life is going to be told. How then, can we live a story that we want retold? Consider the impact of these intentional actions:
2. Keep an eye on long-term impact. We are so enamored by the here and now that we often forget to consider the long-term impact of our decisions. But sometimes, the pursuit of pleasure in the short-term holds disastrous outcomes for the long-term. We would be wise to consider both. Always.
1. Look to other stories. We often speak well of others. After all, there are a number of people who have left a positive imprint on our lives and the stories we tell. Look to those people. Their example can help shape ours along similar lines. What deci-
3. Do the next right thing right. Coach Don Meyer, a family-friend, retired as the all-time wins leader among NCAA basketball coaches. His leadership, both on and off the basketball court, is marked by hard work, encouragement, faith, and service. When Don leads, he calls people to “just do the next right thing right.” Ultimately, the very next decision is the only decision we can make right now. Do the right one. 4. Invest wisely. Every hour of every day, we invest our lives somewhere. Invest it into the makings of a story worth telling. Value relationships, service, and good-will to others. Pursue these with your time, your finances, and your efforts. These investments will always shape the arc of your story towards a positive end. And will result in a better story than chasing money.
5. Get some help. It is nearly impossible to live life effectively on our own. There is nothing wrong or weak about asking for help. In fact, if you are struggling in any area of your life (marriage, parenting, finances, lack of direction, destructive habits), there are people who can help or who can direct you towards help. Find some. Not only does pride lead to a fall, it is also quite unbecoming. 6. Listen, listen, listen. Cherish the input of people who care about you. If there is someone in your life warning you about the choices you are making, listen to them. Take their words to heart. They may be wrong. They may be right. But you’ll never know for sure if you ignore their voice. Make humble listening a priority. 7. Change with one small step. Until life is taken from us, change is possible. And it always starts with just one decision to head in a new direction. If you desire to reshape the story of your life, make at least one small change today. Your first step in the right direction does not have to be a big one. The stories of our lives are going to be told. This is inevitable. Let’s make the decisions that lead to the story we want told about us.
DAILY Q U ESTI ON S Life is a journey of discovery. We need to keep
1. What was the best thing that happened to
trying new things every day, no matter our age.
me today? 5. Who is the most important person (or most
What new approach or experience can you try? Consider asking yourself these questions as pat of a daily reflection. Even take some time to record your responses.
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4. What new thing can I try tomorrow?
2. What could I have done better today?
important people) in my life and what am I doing for them?
3. What is the most important thing I must accomplish tomorrow?
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6. What did I create today?
LIFE IS A JOURNEY OF DISCOVERY. WE NEED TO KEEP TRYING NEW THINGS EVERYDAY, NO MATTER OUR AGE. WHAT CAN YOU TRY?
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TECH.
BENEFITS OF A TECHNOLOGY-FREE BEDROOM B Y JO S H U A BE C K E R • P H OTOS B Y SA M H A DLOC K
“Where do we live, and what do we live for?” Our world is changing rapidly. Often times, for the better. Advancing technology provides new opportunity for us to stay informed, connected, entertained, and engaged. Technology is becoming smaller, lighter, and more portable. And these are good things. I fully embrace the opportunity that they provide. But an unintentional side effect of the ever-increasing portability of technology is that it continues to make inroads into areas of our lives where it offers more distraction and harm than benefit. Dinner tables, conversations, and relationships just to name a few. Because of this, it is wise for us to take opportunity to pull back and evaluate if there are areas of our life where technology is doing more harm than good. Is it possible there are areas of our homes that would benefit from the absence of technology (TV, Laptops, iPads, Video games) too? Mindfulness and scientific research seem to support this assumption.
MORE/BETTER SLEEP. The studies on this issue continue to surface on a consistent basis. The more TV people watch before bedtime, the less sleep they get. In this case, studies confirm what we already know to be true: the lure of the screen is just too strong for many to turn off. Additionally, artificial light exposure between dusk and the time we go to bed makes it more difficult to fall asleep and stay asleep.
MORE CONVERSATION. For married couples, some of your most important, intimate conversations will take place in your bedroom during the waning hours of the day… unless of course, the laptop is sitting on your lap instead.
MORE CONSCIOUS REFLECTION. The evening provides valuable opportunity to meditate, evaluate, and assess your day. This examination leads to better learning from our mistakes and growing as humans. It is a far worthier cause than pursuing
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entertainment—and the exchange of it is a foolish transaction.Time to reflect is good. It increases our efficacy, improves the quality of our relationships and helps in the learning process.
MORE/BETTER SEX. Couples who keep a TV in the bedroom have sex half as often as those who don’t. And spouses who choose to interact with one another on an emotional level have better, more fulfilling sex. In other words, there are more stimulating behaviors available in the bedroom than playing Angry Birds.
MORE READING. Light reading in the evening helps many fall asleep faster. But even if it doesn’t help you sleep, the benefits of reading still far outweigh the benefits of mindless technological consumption. Removing the television, laptop, Ipad, or phone from your bedroom will almost always naturally encourage more reading in your life.
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MORE MINDFULNESS IN THE MORNING. Others have covered this topic well: there are good reasons not to check your email first thing in the morning. Additionally, checking Facebook/Twitter before putting your feet on the floor could be argued against with the same rationale.
MORE RELATIONSHIP WITHIN FAMILY. At any age, removing technology from bedrooms fosters interaction. I’m not against the use of technology in our homes, I do it everyday. But rather than retiring to our separate bedrooms for homework, Internet-surfing, television, or video games, keeping technology in the living areas of our homes encourages greater interaction. It also aids in monitoring the online activities of our children.
LESS SLEEP-TEXTING. The fact that our world is experiencing a rise in people sending revealing and embarrassing texts in their sleep ought to give us pause to seriously reconsider these habits.
The idea of a technology-free bedroom is a counter-cultural thought. And for many, the typical response to the idea of embracing it will be met with all the reasons it is simply not possible: “My phone is my alarm clock.” “I need to check the weather in the morning.” “I read on my iPad in bed.” “I have to watch my TV or I can’t fall asleep.” But the benefits of a technology-free bedroom should not be overlooked and dismissed so quickly. Besides, most of our excuses can be overcome with some creative thinking and extra intentionality— which help stand as another important reminder: Technology ought to serve us, not the other way around.
LESS ACCESSIBILITY. Few of us need to live our lives accessible to others at all times of the day. Text alerts, Facebook notifications, Twitter mentions, and emails are often nothing more than distractions that keep us from the world right in front of us. They clutter our mind with nonessential info. Keeping your bedroom as a notification-free zone results in a more peaceful, engaged, calming environment. And it allows space for our minds to separate from the day’s activities. It’s good to separate yourself from the busyness of the world.
action holds some benefit. But if we can intentionally remove these unhealthy emotions from our bedroom, I’ll argue for that any day.
ROOMS SERVE PURPOSES. Rooms serve purposes: kitchens are for cooking, dining rooms are for eating, and offices are for working. The better we define those rooms and their purposes, the more productive they become. Use your bedroom for better relaxation, sleep, and sex by taking the laptops, video games, and televisions out of them.
LESS OF THE EMOTIONS ATTACHED TO SOCIAL MEDIA. The studies are not healthy. People who spend time on social media tend to experience higher levels of envy, loneliness, frustration, and anger. Social media inter-
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E AT
1POT, 1PAN, 5 INGREDIENTS B Y M AT T M OORE • P H OTOS B Y SA M H A DLOC K
Several years ago, I decided to attempt my first marathon. Certainly not the most original idea, as it seems these days running a marathon is on the bucket list for just about every man. Nevertheless, after following a brutal 16-week training schedule, I was confident in my ability to survive the 26.2 mile challenge. That was of course, until I arrived at the starting line. Surveying the crowd, I felt quite out of place in my throwback Saucony shoes, mesh shorts from my high school football glory days, and a T-shirt I purchased on a college spring break trip to the Bahamas. As it was, the rest of my running cohorts were outfitted in the latest and greatest in sports technology. From the all-weather, breathable clothing, to the sports gels and energy bars, to the belts, hats, shoes, and personal hydration systems–I suddenly felt ill-equipped for such an undertaking. The rise of food related programming, celebrity chefs, haute-cuisine, molecular gastronomy, food bloggers, and ‘foodies’ has created a culture that thrives on culinary excess. For example, in some circles it’s no longer acceptable to enjoy a simple Deviled Egg unless it’s been transformed into a BLT Deviled Egg topped with bacon, lettuce, and tomato. Just as that craze catches on someone else ups the ante with a revised version featuring even more exotic ingredients: prosciutto, arugula, and heirloom tomatoes. Of course, both of these creations are delightful, but sometimes it makes me want to say, “Enough is enough!” Just give me a plain ole Deviled Egg, sans the attitude. Times are tough these days. The rising cost of fuel and food prices are forcing everyone to cut back — ‘foodies’ included. With that in mind, I’ve decided to provide 5 minimalist meals that can be put together using just 1 pot, 1 pan, and 5 ingredients. I’m sure some might balk at my simple approach, but that’s okay. Remember, just like my running, I don’t write recipes based on the latest and greatest food trends. Rather, I focus my efforts on providing simple, affordable, and realistic recipes for the everyday reader. Besides, at the end of the day, creating a great meal does not depend upon the number of gadgets or list of ingredients used in preparation–rather, there’s only one thing that really matters . . . taste.
Pan Seared Beef Tenderloin Filets with Smashed Potatoes (Prep Time: 10 minutes. Cook Time: 25 minutes. Serves 2)
2 lbs Red Potatoes, cut into 1” dice • 1 ¼ Sticks Salted Butter • Chicken Stock • 2 6–8 oz Beef Tenderloin Filets Montreal Steak • Seasoning
FOOD ESSENTIALS Olive Oil: from salad dressing tobaking. This oil is a healthy
Sea Salt: One of the most basic, neccesi-
Preheat oven to 425 Degrees F. Next, heat a large pot of water to boiling over high heat; add potatoes. Boil potatoes until fork tender, about 12 – 14 minutes. Drain potatoes and return to the same pot, allowing the steam to evaporate. Add 1 stick of salted butter and about a cup of chicken stock to the potatoes. Using a potato smasher, whisk, or fork, smash potatoes until the ingredients are thoroughly combined and reach your desired preference. (More stock can be added for a thinner consistency). Keep potatoes covered and warm until ready to serve. Meanwhile, melt the remaining butter in a pan over medium high heat. Season steaks with Montreal seasoning and add to pan. Cook on one side, undisturbed for 3 – 4 minutes. Flip steaks and insert pan into the oven until the steaks are cooked to your preference, about 8 – 10 minutes for medium rare depending on the thickness of the cut. Remove steaks from pan and allow to rest before serving. Plate potatoes and serve the filet on the side. Serve.
ties of the kitchen. Helps your savory dishes.
Garlic: from salad dressing tobaking. This oil is a healthy must have .
Black Pepper: With it’s partner salt, pepper is a great seasoning especially for meat dishes.
Whole Wheat Flour: If you’re baking anything you’ll get your money’s worth from this.
A NOTE: about 5 ingredient cooking: Don’t be fooled! Most “5 ingredient” recipes are for just one single dish or side, rather than an entire meal. I’ve taken great care to put together complete, balanced meals that are truly made up of just five ingredients. Get to work!
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TRAVEL LIGHTLY & BE WHERE YOU ARE B Y C O U R T NEY C A RV E R • P H OTOS B Y SA M H A D LOC K
I want to be where I am, not where my stuff is. How to travel with less. When we travel, great time and attention is devoted to our stuff. What stuff should bring? Did we bring enough stuff? Will our stuff fit in a carry on? If it doesn’t, will the airlines lose our stuff? Where will we put our stuff when we get there? How much room do we need for the new stuff we buy when we travel? If I am wandering around a city, wondering if I remembered to bring an external hard drive or extra pair of shoes, I’m missing out. If I’m thinking about something I left in the hotel room on the way to the airport, I’m distracted. More importantly, if on my travels, I am constantly on the hunt for more stuff, I’ve really missed out on what the city, or destination has to offer. In two weeks I’ll be traveling to Portland and Seattle with nothing but a backpack. I know that doesn’t sound like revolutionary news, but if you’ve ever been anywhere with me before, you know that while I want to live with less, I don’t travel with less.
What I think I’ll wish I had packed… • a shirt per day
• cute heels
• yoga clothes
• lotion
• socks
• flat iron
• bathing suit
• hair dryer
• shorts or skirt
• snacks
What’s in your suitcase? I’d love to hear your tips to travel lightly, and any great recommendations to get lost in Portland or Seattle. Email Me at: simpletraveler@ min.com
In the interest of full disclosure, you should know that on past trips, I typically packed two outfits per day (one for day and one for night) plus an additional outfit if I was planning to use a gym, pool or yoga studio. I don’t share that for any other reason than to let you know that minimalism does not come naturally to me. I crave less, but my travel experiences have not reflected that.
WHY I’M GOING… I am creating a new photography collection for One Million for Good called The Cities. I have great images from San Francisco, New Orleans, and Savannah, but want to add a few more, including Portland and Seattle. I will also be meeting new friends, enjoying some solitude, and doing a little aimless wandering. I have great images from San Francisco, New Orleans, and Savannah, but want to add a few more, including Portland and Seattle. How to Declutter, Organize, and Simplify Your Life and it’s smart and gentle. I’ve been inspired by minimalist travel bloggers like Karol Gajda, who only packed this for 500 days, but I can’t really relate to his experience. I’ve packed more make-up and accessories on 5 day trips, then everything he packed for 500. I needed someone taking shorter trips with less to teach me. Enter Francine Jay, better known as Miss Minimalist. I am reading her book The Joy of Less, A Minimalist Living Guide: How to Declutter, Organize, and Simplify Your Life and it’s smart and gentle. .After
reading her Extreme Light Travel routine though, my little backpack is starting to look like a little much. Maybe I’ll lose the black flats and blazer and wear the sweater. Minimalism is awesome. When you travel be where your feet are, enjoy the moment you’re in instead of trying to document each second with a video camera. You’ll get WAY more out of the experience. Your relationships will thank you. Do your back a favor and carry less.
ON THIS TRIP, I’LL… • Board the plane slowly instead of rushing on to make room for my stuff. • Drop my things at a hotel and get out in the city, instead of unpacking and re-organizing. • Make due with what will fit in my pockets, so I can truly embrace each city. • Enjoy a meal without thinking someone might trip
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LOVE
LETTING GO OF SHITTY REL ATIONSHIP S B Y JO S H U A B E C K E R • P H OTOS B Y SA M H A DLOC K
Most of us have someone in our lives who continually drains us. Some relationships are incredibly pernicious. We often develop relationships out of convenience, without considering the traits necessary to build a successful bond with another person—important traits like unwavering support and shared trust and loving encouragement. When a relationship is birthed out of convenience or proximity or chemistry alone, it is bound to fail. We need more than a person’s physical presence to maintain a meaningful connection, but we routinely keep people around because … well, simply because they’re already around. It’s easy to develop a connection with a coworker or a schoolmate or someone who’s always there—even when they’re not adding any real value to our lives. And it’s even easier to stay in those relationships. That’s because old relationships are convenient, and starting new relationships is difficult—it requires work. But so does anything worth holding on to. We’ve all held on to someone who didn’t deserve to be there before. And most of us still have someone in our lives who continually drains us: Someone who doesn’t add value. Someone who isn’t supportive. Someone who takes and takes and takes without giving back to the relationship. Someone who contributes very little and prevents us from growing. Someone who constantly plays the victim. But victims become victimizers. And these people are dangerous. They keep us from feeling fulfilled. They keep us from living meaningful lives. Over time, these negative relationships become part of our identity— they define us, they become who we are. Fortunately, this needn’t be the case. Several actions can be taken to rid ourselves of negative relationships.
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First, you can attempt to fix the relationship. This is obviously the preferable solution (albeit not always possible or worthwhile). People change over time, and so do relationships. You can change how your relationship works—be it marriage, friendship, or family—without completely ditching the relationship. Sit down with the person who’s draining the vitality from your life and explain to them what must change in order for your relationship to work. Explain that you need them to be more supportive, that you
Moving on is sometimes the only way to develop new, empowering relationships. Starting anew, empty-handed and full-hearted, you can build fresher, stronger, more supportive relationships—important relationships that allow you to have fun and be happy and contribute beyond yourself. These are the meaningful relationships we all need. It’s also important to do your part. You too must add value to the relationship. Not by buying gifts or commoditizing your love, but by showing up every day and
IT’S OK TO MOVE ON. YOU OWE IT TO YOURSELF TO MOVE ON. YOU OWE IT TO YOURSELF TO BE HAPPY WITH THE RELATIONSHIPS YOU HAVE. YOU ARE IN CONTROL. need them to participate in your growth, that they are important to you, but the relationship in its current state does not make you happy. Explain that you’re not attempting to change them as a person; you simply want to change how your relationship works. Finally, ask them what they’d like to change about the relationship. Ask them how you can add more value. Listen attentively, act accordingly. Or, if you’re unable to change the relationship, you can end it altogether. This is incredibly difficult, but it applies to any relationship: family, friends, lovers, coworkers, acquaintances. If someone is doing nothing but draining your life, it’s perfectly acceptable to tell them “This relationship is no longer right for me, so I must end it—I must move on.” It’s OK to move on. You owe it to yourself to be happy with the relationships you have. You are in control.
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rigorously exhibiting how much you care, demonstrating your love through consistent actions, continually going out of your way to help the other person grow. You see, both people must do their part to grow the relationship. Only then will both of you be satisfied with the relationship you’ve built. There’s an entire chapter in our new book, Minimalism: Live a Meaningful Life, dedicated to exploring your relationships in a meaningful way, including a discussion on how relationships change over time and a section about how you can re-prioritize your relationships so they add value to your life. With Thanksgiving this week, many minds will be turning to the things they are grateful for. But here’s a twist on the subject not often explored: what do you do when others do not share your attitude of gratitude and your good turns go unappreciated? Our good friend William George
Jordan offers up a veritable cornucopia of powerful thoughts. “The Courage to Face Ingratitude” From The Power of Truth; Individual Problems and Possibilities, 1902 By William George Jordan INGRATITUDE, the most popular sin of humanity, is forgetfulness of the heart. It is the revelation of the emptiness of pretended loyalty. The individual who possesses it finds it the shortest cut to all the other vices. Ingratitude is a crime more despicable than revenge, which is only retturning evil for evil, while ingratitude returns evil for good… Gratitude is thankfulness expressed in action. It is the instinctive radiation of justice, giving new life and energy to the individual from whom it emanates. It is the heart’s recognition of kindness that the lips cannot repay. Gratitude never counts its payments. It realizes that no debt of kindness can ever be outlawed, ever be cancelled, ever paid in full. Gratitude ever feels
the insignificance of its installments; ingratitude the nothingness of the debt. Gratitude is the flowering of a seed of kindness; ingratitude is the dead inactivity of a seed dropped on a stone. The expectation of gratitude is human; the rising superior to ingratitude is almost divine. To desire recognition of our acts of kindness and to hunger for appreciation and the simple justice of a return of good for good, is natural. But man never rises to the dignity of true living until he has the courage that dares to face ingratitude calmly, and to pursue his course unchanged when his good works meet with thanklessness or disdain. Man should have only one court of appeals as to his actions, not “what will be the result?”
It’s OK to move on. You owe it to yourself to move on. You owe it to yourself to be happy with the relationships you have. You are in control.
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THE LONG GOODBYE BY JERALD WINAKUR PHOTOS BY SAM HADLOCK
As a geriatric physician in San Antonio, I’ve spent the past thirty years battling against the gradual decline of my Alzheimer’s patients. Now the disease is stealing my own father.
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ebruary 24, 2006, is my parents’ sixtieth wedding anniversary. My family plans a brunch for them in their home. We are keenly aware that this may be the last anniversary my parents will celebrate together. It won’t be an elaborate party, just a bittersweet one. Seven years earlier, my father was diagnosed with Alzheimer’s disease, and he has gone steadily downhill. At 87 years old, he is now a prisoner of his mind. His agitation and paranoia arise from distorted memories, nightmares he can no longer separate from reality. A few days before the brunch, my mother calls me in a panic. My dad is bellicose and paranoid, accusing. Summoning Yiddish profanities he has not uttered in 75 years, he curses at Yolanda, the caregiver who holds everything together in my parents’ household. He will not be bathed or shaved. He will not eat, refuses his medications. He is raving. “Dad,” I say when I visit their house that afternoon, “what is it? What’s wrong?” “I want to go home. Please, take me home!” “But, Dad, you are home.” “I don’t know where I am. Please, Jerry-boy, take me home. You know the way. . .” “I don’t know where else to take you, Dad. You’ve lived here for twenty-nine years.” “You go to hell! You’re in with them!”
THE EXPECTATION OF GRATITUDE IS THE ALLOY OF AN OTHERWISE VIRTUOUS ACT. IT EVER DULLS THE EDGE OF EVEN OUR BEST
There is no walking away now. He is an abandoned child. He searches for his boyhood home on Boarman Avenue, in Baltimore, or perhaps our first family home there, on Forest Park Avenue. He hears voices but can’t decode what is being said, and his mind assumes the worst: My mother is insulting him, planning to run off; his sons are belittling him, his mother scolding him, his older brothers and sisters teasing him. He is lost, with no father of his own to turn to. I see that he has wet himself; a dark ring marks his place on the couch. As a geriatric physician in San Antonio for the past thirty years, I have been through this before. I have been cursed, spit on, bitten, and punched by demented old folks over the decades. A poor woman threw a
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AS A DOCTOR, I KNOW WHAT TO DO; AS A SON, I AM UNCERTAIN. THERE IS NO WALKING AWAY NOW. I AM TERRIFIED BUT MY MOTHER NEEDS ME. shoe at me when I stepped inside her hospital room. The day before, she thought I was the devil. As a doctor, I know what to do; as a son, I am uncertain. So I assume my doctor role, retreating into the armor of my starched white coat. I walk to the kitchen and check his daily pill slots to make sure he’s been getting his regular medications. Sometimes my mother, unable to see due to macular degeneration, inadvertently leaves pills in the plastic containers I fill every couple weeks. But everything seems in order. The pills are often as much a part of the problem as the cure. My father takes eight medications a day; my mother, who is 82, fourteen. They are both on vitamins and minerals, blood pressure medications, diuretics, and cholesterol-lowering drugs. My father also takes two pills for his heart. My mother takes drugs for her diabetes, a thyroid disorder, osteoporosis, and depression. This is not unusual for folks their age. I spend my doctoring days prescribing medications for my patients, reshuffling the ones they’re on—a tiny dose change here, a retiming of administration there. By now I have written or refilled hundreds of thousands of prescriptions, but my constant goal is to cut back on medications, stop them altogether if I can: Less is usually more. Every geriatrician knows this. Looking through my father’s pills, I recall a patient of mine,
Lilly, a woman who first came to see me carrying a brown paper shopping bag crammed with pill bottles—at least forty different drugs prescribed by a dozen physicians.
made. But she improved significantly when, after some lab work and many more hours of listening, I was eventually able to whittle her medication list down to three.
“This one’s for the high blood,” she had said, “and this one’s for the sweet blood, and this one’s for the low blood. These three are for my bad knees, and this one’s ’cause I’m sad a lot, and this one’s ’cause I don’t sleep too good, and this one’s ’cause I’m tired all the time. I can hardly keep ’em straight, but I got a big list at home tacked to the wall, over the phone in my kitchen. Last month the company cut off the service when I couldn’t pay the bill. All these medicines and still I feel so bad. That’s why I come to you now. That and all these other troubles.” She had handed me a list of symptoms, pencil-scrawled on a ragged piece of paper.
Prescribing for the elderly is complicated. They don’t metabolize drugs at the same rate as younger, healthier patients. The main workhorses of drug excretion—the liver and kidneys—decline in function with age, as do all our organ systems. The elderly, like my parents, are often on multiple drugs (including over-the-counter preparations the doctor might not even know about), and the incidences of unforeseen interactions begin to mount. We know so little about these interactions. Indeed, the pharmaceutical companies are infamous in geriatric circles for not including our elderly patients in drug trials.
I spent two hours with Lilly, hearing one story loop into another: bad marriages, kids in jail, ER visits, surgeries, strange diagnoses mostly self-made. I knew what was happening to Lilly, what happens to many people like her in a medical encounter. The physician begins to drown in a sea of conflicting information, feels powerless to alter the circumstances of this person’s life. A wave of helplessness washes over doctor and patient both, and he reaches for his prescription pad. “Here, try this,” he says. “I think it will help.” Then he steps into the hall, picks up the next chart, and moves on, hoping the drug he has prescribed helps but doubtful it will. I could not change the circumstances of Lilly’s life, couldn’t make up for her poverty or lack of education or the poor choices she had
These days, between the Food and Drug Administration and Big Pharma, I hang suspended in a netherworld of prescribing angst. The FDA
1/3 People will develop alzheimers.
80% Cannot afford the medical costs surrounding the disease.
6 The number of years alzheimers patients live after a heavy onset of the disease.
65% PRESCRIBING FOR THE ELDERLY IS COMPLICATED. THEY DON’T METABOLIZE DRUGS AT THE SAME RATE AS YOUNGER
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The percentage of patients who are without an immediate family member to care for them.
Left: Dad at the party celebrating 60 years of marriage with his mom. He was discouraged after mother’s comment about not remembering most of those sixty-years. Right: Mother and father a captured memory from a time that she will never remember.
has pulled more than twenty drugs off the market in the past two decades, drugs they first assured me were safe to use but then ended up damaging livers or kidneys or hearts. I have always tried to protect my patients, wait if I possibly can for aftermarket studies to bring more data to light. It is one thing, I tell my patients, to judge a drug’s benefits and risks after it has been given to a few thousand patients in clinical trials; it’s quite another after it has been prescribed to hundreds of thousands upon its general release. In the parlance of the technology and pharmaceutical industries, doctors like me who are cautious, who do not immediately jump on the company bandwagon every time it trumpets its “latest and greatest” product, are known as “slow adopters.” Now these industries have figured out a way to circumvent my judgment should I fail to join the chorus of cheerleaders for their newest breakthrough. On television, in magazines, they promise an end to arthritis pain, a good night’s sleep, a cure for incontinence, a firm erection. My phone rings off the hook with patients who worry that I may have blocked their path to the Fountain of Youth when I decline their drug requests. Some even change doctors. I have no sympathy for Big Pharma. I resent its intrusion into the doctor-patient relationship, resent the constant introduction of new—often rushed—products into a marketplace crowded
with me-too drugs. Big Pharma is right where it has always wanted to be—smack-dab in the middle of my decision-making process as it tries to influence consumers who also happen to be my patients. And yet here I am, in my parents’ home, rummaging through a basketful of medicines I take down from a high shelf. This is where I store the unused pills—all the psychoactive drugs prescribed by my father’s physician for his recurrent bouts of anxiety or agitation, for his depression and his insomnia, for his memory loss and lethargy, for his confusion and paranoia, for his belligerence and sadness. I take down a dozen orange plastic pill bottles with white, almost-impossible-to-remove lids. My father’s name is on every label: Some are six months old, some several years. We have been dealing with this for a long time. Haloperidol and risperidone. Olanzapine and quetiapine. Paroxetine and citalopram. Alprazolam and trazodone. Donepezil and rivastigmine and memantine. Organic molecules, various combinations of carbon and hydrogen and nitrogen, oxygen and sulfur—the atoms of which we are all made—bioengineered to slip across the bloodbrain barrier, to stimulate one receptor or block another, precipitate a rush of ions through neural membranes, flood synaptic gaps with potent neurotransmitters, flip a switch here, throw a breaker there, block a surge somewhere else.
Birth
75years
Childhood, Teenage and formative years, most vivid for Mom
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38-40
45-60
Short-term Memory
I settle on the bottle of risperidone. Although I am reluctant to use this drug—any drug—in treating my father, I know that he has taken it before with success. It has worked. It has settled him down, albeit with an added degree of cognitive impairment. My hope is that by continuing to use this drug judiciously, I can maintain the status quo and keep my father at home for a bit longer, delay the decision to relegate him to a long-term facility where I know he will only deteriorate faster. I bring my father a bisected tablet and a cool glass of his nutritional drink. “Here, Dad, take this. I think it will make you feel better.” His eyes, still wild, stare at me. “What’s this for?”
“Dad, you’ve got shpilkes,” I say. I use this Yiddish word, retrieved somehow from my own memory, because my father has lately been interspersing his speech with snippets of this language, his mother tongue— the mamaloshen—the first words he ever heard and therefore the last ones to abandon him. He smiles. “Az ich habe shpilkes,” he says. And he swallows the pill. “For the shpilkes,” my mother and Yolanda tell him when it is time for the next dose. Before
long he is back to his usual demented but pleasant self. This time I have made the right decision. Three days later, on my parents’ anniversary, those of us who love them assemble in their home. My wife brings a dozen yellow roses and arranges the table. My brother stops at the grocery store for a side of sliced smoked salmon, some cream cheese, a few tomatoes, and a red onion. I drive over to the bagel bakery, and pick up a dozen—onion, poppy seed, and sesame—just out of the oven. It is a small gathering. Family-oriented to the point of insularity, my parents have made no close friends in all the years they have lived in San Antonio. Everything is ready, and I wheel my father into the living room. “What’s the fuss about?” he asks as he enters, seeing all these faces he recognizes but cannot place. For a moment he is frightened. “Dad,” I say, speaking into his good ear, “today is a special day. You and Mom have been married for sixty years.” He searches for my mother’s face in the small crowd around him.
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MIN. | SPRING | 20
NO BETTER WAY TO SIMPLIFY THAN TO GIVE
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CONQUERING CLUTTER
ADD / ADHD “Attention deficit disorder, de-
1.
pression, chronic pain and grief can prevent people from getting organized or lead to a buildup of clutter.�
2.
Cleaning professionals say that getting rid of excess clutter would eliminate 40% of the housework in an average home..
1. It costs an average of $10/square foot
3. A 12-ft wall could be built from LA to
to store items in your home.
NYC with paper thrown away annually.
2. One family can save approximately 3
4. 80% of papers that are filed are nev-
trees per year by recycling newspapers. Four feet of a paper stack is equal to one tree. SAVE THE TREES!
er referenced again. - Record-keeping constitutes over 90% of the activity within offices
MIN. | SPRING | 22
5. Using the correct organizational tools can improve time management by 38%, according to Mobile Technology Products.
Chronically disorganized people keep all books and magazines purchased. The average American buys 668 books and 9,000 magazines annually. That is equivalent to a small town library in the U.S. in one person’s lifetime.
3.
5.
4.
Statistics provided by the National Association of Professional Organizers (NAPO)
“Have nothing in your houses that you do not know to be useful or believe to be beautiful.” -William Morris MIN. | SPRING | 23
MIN. | SPRING | 24
FINDING JOY & BEAUTY in the small things
Finding Beauty in Life By Libby Anne Sometimes I feel down. There are a variety of reasons for this: a tough day at work or school, a flare up in my relationship with my parents, lack of sleep, gloomy weather, etc, etc, etc. Once upon a time I would have solved my down feelings by spending time reading the Bible and praying, by remembering what Christ did for me and reminding myself that heaven awaits me, and that the Bible urges us to be joyful. I might even have reminded myself that Debi Pearl says that women should be cheerful no matter how they feel. But today, I no longer believe in God, and I certainly no longer listen to anything Debi Pearl teaches. So what do I do when the world feels gloomy and my life seems shut in? Several things, actually. Four, to be exact. First, I remind myself that family and friends matter more than personal achievements, and that I can’t be the best at everything. All I can do is try my best, and not lose sight of what’s most important. It’s easy to remember this when I come home to a happy smiling toddler, and a husband who adores me. I remind myself that while good work well done brings a good feeling, achieving some sort of idolized success doesn’t automatically bring happiness. In other words, there’s something to be said for being content, and just being. Sometimes I think we run so fast on our treadmills that we forget to enjoy the present in all our looking towards the future. We forget to stop and see the smaller joys in life. I think children, especially young children, remind us of this. Sally laughs out loud when her daddy comes home, or when she gets to wear her rain boots to splash in puddles, and finds great joy in playing with clay or coloring with markers. These are life’s simple joys, and it’s so easy to miss them as we are hurrying to an appointment or feeling the need to clean up the kitchen or finish an assignment. But what is life but an accumulation of these simple joys?
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And what do we miss when we overlook what is right in front of our eyes, or sitting at our feet, or held in our hands? Second, I focus on the good in humanity. There’s so much ugliness and pain in the world that it can be overwhelming sometimes. The number of people who starve each day, the existence of war and discrimination, the continuance of religious persecution in places like Saudi Arabia or Iran, the number of children who grow up in dire poverty…while there’s something to be said for motivating ourselves to action, dwelling on these numbers and statistics can be quite a downer. The truth is, in many ways, our world is a very depressing one. And that’s what I think it’s important to remember to find beauty in humanity. There is beauty in love and compassion, in potential and in cooperation, and in acceptance and a yearning for freedom. There is beauty in leaders who advocate for humanity or human rights, and in neighbors who lend each other a hand. There is beauty in the potential of young children, and in the potential of human movements to make a difference. There is beauty
Sometimes I think we get moving s we forget to stop and just be. We fo without a racing mind, or to simply wafting in the window.
STEP OUT INTO NATURE. WALK INTO A FOREST OF A GLADE OF TREES, BREATHE DEEPLY, AND JUST SOAK IT ALL IN. THERE’S SOMETHING PEACEFUL IN IT.
in our desire to make the world a better place and to agitate against injustice. There is beauty in humanity. Third, I step out into nature. I walk into a forest or a glade of trees, breathe deeply, and just soak it all in. I don’t know what it is about nature, but there’s something so peaceful and calming in it. I imagine the trees sucking up water from their roots, the leaves absorbing sunlight, the grass growing and the microorganisms in the dirt breaking down dead leaves. Everything in a given ecosystem works together so perfectly, so musically. As I stand there in surrounded by trees, my toes curled in the grass, I imagine myself as a part of this circle of life, somehow at one with the other organisms that surround me. Someday I will die, and my body will decay and my matter will go on to become part of something else. This, this beauty, this circle of life, this will go on, with me a part of it. Thinking about this actually gives me a sense of immortality and at the same time reminds me how little my individual life matters, just a drop in the bucket. But I am part of something bigger, a life cycle that existed before me and will go on without me, a planet that fairly pulses with life and vividness. All I can do is work to improve my little part of it while I am here, and do my best not to cause harm to it or pass on problems to future generations of living things.
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Fourth and finally, I meditate. Sometimes when my head is full of fuzz and my thoughts are muddled, the best thing I can do is clear my head, take a deep breath, and relax. Sometimes I meditate on nature, sometimes I meditate on tarot cards, sometimes I meditate on sayings I find inspirational. I find that it is helpful to push away all the difficult thoughts and focus one one thing to the exclusion of all else, or sometimes on nothing at all. I also find that mediation can help me be a better person by helping me to realized what has been going on lately and what I can do to make things go more smoothly in the future. Meditation also calms me and makes me feel more ready to take on what life has to bring. Sometimes I think we get moving so fast in our fast paced world that we forget to stop and just be. We forget what it is like to sit in silence without a racing mind, or to simply sip tea and smell the summer air wafting in the window. We forget how to be still, or how to be calm. We forget what it is to climb off the treadmill of life and just be. And sometimes, it’s important to remember how to do that.
so fast in our fast paced world that orget what it is like to sit in silence y sip tea and smell the summer air
I think everyone develops these sorts of little ways to cope in a busy world with a myriad of demands and concerns. I think anyone, religious or not, can be down and grumpy while others in the same circumstances are happy and full of life. I think managing your stress and the weight of concerns and demands put on you is important. I think remembering what is most important in life, and finding beauty in life, and taking time to invest in yourself, is crucial. There is something to be said for inner peace, inner joy, and inner contentment. I’m not staying we shouldn’t strive to make our world a better place and grind against injustice, but rather that if we focus only on that fight we run the risk of losing our sanity. One last thing. Sometimes it’s okay to feel down. Sometimes it’s okay to feel overwhelmed. Sometimes it’s okay to feel like life is tough. Growing up, I faced the imperative of being happy. After all, why wouldn’t you be happy when Jesus died for your sins and God himself wants a relationship with you? I remember feeling like there was something wrong with me if I felt down, like I must not be a good Christian or a good person. But the truth is, there’s nothing wrong with feeling down now and then. While you shouldn’t, of course, let down feelings dictate your life and debilitate you, there’s no mandatory rule that you must feel happy one hundred percent of the time.
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EVE RYO N E
D EVE LO PS
THESE SORTS OF LITTLE WAYS TO COPE IN A BUSY WORLD WITH AMYRIAD OF DEMANDS AND CONCERNS.
MIN.
“One of the advantages of being born in an affluent society is that if one has any intelligence at all, one will realize that having more and more won’t solve the problem, and happiness does not lie in possessions, or even relationships: The answer lies within ourselves. If we can’t find peace and happiness there, it’s not going to come from the outside.” 1943. Tenzin Palmo
MIN MAGAZINE | SPRING