Point Your Feet Downstream and Smile!

December 8, 2024

David E McCarty MD, FAASM (but you can call me Dave)

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A bit of paterfamilial advice and a forgotten Broadway tune can help us navigate some pretty rough water…

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In memoriam: Terry McIntire McCarty 7/16/1940 – 11/19/2024

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It’s been a long time since I’ve contributed to this blog.

The past few months has brought quite a bit of “white water” in my personal journey down the proverbial river with my family. I guess I’ll start with the fact that we hit big rapids on November 19, when we unexpectedly lost my father, Terry M. McCarty—”the Ter-Bear”—to a sudden cardiac event.

What was ironic was that Dad was in the process of making a full recovery from a rather dramatic brain surgery he’d undergone on September 4th. See, for years, unbeknownst to us, a large baseball-sized meningioma had been slowly growing in the left frontal part of his head, slowly smashing his brain down to about 60% of its regular size.

Hilariously, considering I’m his Sleep-Doctor-Son, Dad’s only symptoms were difficulty sleeping at night, and an increasingly problematic tendency to doze off in the daytime. LOL, universe!!!! :)

After his surgery on September 4, he was practically comatose. We could get him to wake up for a few minutes to eat, and we’d remind him to put his eggs in his mouth. Then he would go back to sleep.

However, true to his miraculous love of life, my Dad rallied. Over the next several weeks, his brain slowly expanded, and slowly…slowly…slowly, we all got to see him come back to life.

He started making more jokes. He started helping with chores and cooking.

A week prior to his death, he was doing well enough to start driving again. He and my mom drove to my house for Sunday Community Supper, just like old times.

The Ter-Bear was back!

When Dad died, he was behind the wheel of his car, which I thought was kind of cool. Out on a nonsense errand, really. Just out for a drive on a beautiful Boulder day. The Ter-Bear didn’t leave his mortal coil in some beeping, smelly, chafing, inhumane hospital bed. It was the opposite! Our Ter-Bear passed to eternity as the master of his own destiny, with his hands on the wheel of his own vehicle, with his bride by his side.

I’ll also say that I’m grateful it happened when the car was stopped, when he was just backing out of a parking place.

See, the Ter-Bear’s heart attack fortuitously happened, with his foot on the brake.

It occurred to me that it all could have happened about four seconds before, and there would have been no kerfuffle at all. The fact that it happened when it did, right after he had backed his car out into a very busy and congested parking lot was what made the world take notice.

For a long, long, long time.

See, Dad fought against traffic his entire life. His idea of Hell was a traffic jam in Los Angeles on a hot summer day. Having said that, I have this idea that holding up traffic for four hours at the Boulder Medical Center parking lot was the Ter-Bear’s idea of an exit-interview practical joke.

Good one, Dad! Hilarious! :)

Paterfamilas

This is the cartoon I drew for Dad, for Father’s Day 2022, the year after we lost Kim. I’m sure glad I did. He had it framed above his desk.

The Ter-Bear, in his natural habitat, at his birthday party in 2022, age 82.

It's on account of thinking about Dad that I keep thinking about some Paterfamilial advice that he gave me, back when I was small, and we were camping in Yosemite National Park.

I remember we had a great view of Half-Dome from our campsite, and there was a fast-moving, mostly knee-deep river that swept right by our tent. I had just joined the Whittier Aqua-Hawks swim team the summer before, though I wasn’t a very good swimmer yet. I just loved being in the water. I loved the way I felt when I was floating and the noise of the world went away.

Dad knew that. He knew it was going to be impossible to keep me out of the river.

So, he just told me how to deal with it.

I remember he grabbed both my shoulders and gave me an intent look. He told me all about the power of the water, and how it was too powerful to fight against. He told me if I lost control, that I should just lie back, point my feet downstream, and enjoy the ride—like it was a rollercoaster or something. He told me I could use my hands to steer myself to a gentler spot, where I could clamber out.

Of course, the water was mostly knee-deep. And some of the rocks were slippery. So, when I fell into the river that afternoon, I did just what he said.

And it was one hell of a ride!

Looking back, I see now that he gave me a narrative that allowed me to think outside of the panic, passing into the joy, despite the circumstances. Despite the rapids.

Anyway, I keep thinking about that advice, now that I’m here in some pretty white water.

Heck, aren’t we all?

“If you fall in the river, point your feet downstream…and SMILE!” —Terry M. McCarty 7/16/1940 — 11/19/2024

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Lately, like everybody else with a pulse and an internet connection, I’ve been thinking a lot about the terrible tale of The Masked Gunman and the Billionaire Insurance CEO, Brian Thompson. The part I found eye-opening was the social media response, which was so joyously and ruthlessly hateful. According to CNN, a Facebook post by UnitedHealth Group expressing sadness at Mr. Thompson’s death received 62,000 reactions.

Of those, 57,000 were laughing emojis.

For my fellow English majors out there: that’s roughly 92% of a large group of humans, expressing glee at the demise of a fellow human.

Think about that, for one…relaxing…breath.

Now: let’s talk! I mean…what is going on?

Have we humans all gotten THIS hateful, THIS spiteful, THIS mean-spirited?

As I pondered this electronic fountain of bile and finger-pointing hostile glee, I saw at once that this rage is familiar territory for me. I still remember the tremulous, white-hot rage of the patient who inspired the character of “Robert,“ the star of our first season of Empowered Sleep Apnea: THE PODCAST. From the lens of this man, the entire system had been set in motion to deceive him, process him, and deprive him of his money.

It was clear he’d affixed on the idea that the system was not looking out for him--and he was furious about it. When I met him, he was practically purple with rage, and was twitching for a fight.

His was the rage of the disempowered.

In The Case of the Murdered CEO, the rage was literally inscribed into the bullet casings with the language of estrangement and accusation: DENY. DEFEND. DEPOSE. All of it an eerie echo of the title of the 2010 book by Rutgers Law professor Jay Feinman: Delay, Deny, Defend: Why Insurance Companies Don’t Pay Claims and What You Can Do About It.

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This is the rage of the disempowered.

This is what one man in a hoodie chose to do about it.

This is the rage of the disempowered.

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The word that keeps coming back to me, like the deathless cat in the vampy song The Cat Came Back, is DISEMPOWERED.

This is the rage of the disempowered.

Life-Fans: I won’t lie. Like many of my colleagues, I’ve been caught on the stupid end of waiting on the telephone, seemingly endlessly for a “peer to peer“ review that will ostensibly allow a patient access to some needed diagnostic service or treatment. Equally vexing is having to drop everything one is doing to take a call on their timeframe, otherwise lose the chance to help the patient. It’s positively crazy-making.

It’s worse than the cable company.

One time, an insurance company kept me on hold for four hours, so that I could speak to one of their pharmacists to get “approval” for a medication the patient had been taking, via that same company, for the previous three years. It was an errand for one of my patients with narcolepsy, a nice young woman who needed a refill of modafinil for a holiday weekend, when she would be with her family, and was hoping to remain awake for the festivities.

At that time, modafinil was still pretty new and for some patients with daytime sleepiness, it was a practical miracle. The problem was that it was expensive.

So, there were these…roadblocks.

Anyway, the punchline to this story is that I stayed on that darned phone call for four hours, the phone cradled in my neck the way you did back then, and I sat there reading my sleep studies. I persisted, I got the drug approved, and the patient got to spend a nice holiday with her family, not falling asleep in her egg-nog.

But, then, there’s Karma.

In true “Lazlo Letters” style, I posted an invoice for my time as a consultant to their internal pharmacist, arguing that the information necessary for approval had been received when the drug was first approved (i.e.: we’d already validated the diagnosis with appropriate testing, and this was on file with the insurance company), and the physician’s authorization for continuation of the drug was evident on the prescription I had hand-written and faxed.

My reasoning was that they must need a specialty consultation from me, for some sort of internal process, which was just A-OK with me, but they’d need to pay for my time! :)

I billed them at a rate of $250 per hour for my time, I created an invoice on my official letterhead and saved it to a JPEG file, and I posted my invoice to their Facebook page.

The stunt went mildly viral. Some VP from the insurance company called and left a message for me to call back, but I was too chicken to do it. A couple weeks later, a medical student whom I hardly knew spoke up in one of my lectures and congratulated me for holding The Man accountable.

The point is—ultimately, the whole showdown was beginning to feel like what I’ll call “rationing through inconveniencing.“ And—all joking aside—it saps the very soul from one’s body. At the end of a hard day, it’s difficult to believe that they’re not doing it all on purpose. Just to MAKE you give up.

Because if YOU give up, it’s cheaper for THEM.

That’s when the rage kicks in.

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When I was a senior in high school, I was in our scholastic musical theater production of GodSpell, which was a Broadway musical version of the book of Matthew, he of the New Testament fame.

Believe it or not, I played Jesus :)

For those who don’t remember GodSpell, it was a beautiful little play about some pretty big things, with a few pretty good songs, and it was all about Jesus Christ and the lessons that he taught, with the characters portrayed as child-like emojis. It was starry-eyed and weird, in a 1975 sort of way—all post-hippie and trampy clothes.

The Album that didn’t have the song that I’m talking about in this essay.

It was as if the Gospel of Matthew had been re-imagined in Mr. Rogers’ Neighborhood.

Anyway, there’s a song from that play, a song called “Learn Your Lessons Well” and for some reason, that darn song has been playing in my head, which is weird, because I haven’t given much thought to that soundtrack in about four decades, beyond the fact that I recently ran across the movie adaptation soundtrack album on vinyl at a used record shop, and I bought it out of nostalgia.

That song’s not on it.

At first, “Lessons” sounds like old soap—when it begins, it’s a revival song, lobbing an admonishment to read scripture the way an old nurse might command a room of orphans to eat their vegetables.

The song develops into something beyond a Sunday School finger-wagging though, transforming into a more thoughtful meditation on what we choose to learn from the world around us. Ultimately, it’s a reminder to be mindful of what we choose to see in our complex world…a world comprising many truths, all simultaneously valid…a world of siloed thinkers, all shouting and not hearing.

Terrible contrast and terrible emotions cause us to turn internally, to reflect on what’s happened, to decide on new directions. The song reminds us that what we choose to concentrate on ultimately changes what we become, which ultimately changes what we feel compelled to do.

So: here’s the question, Life-Fans! To what shall we turn our eyes? Shall we move forward on an economy of fear? Deeper into darkness?

If we aim to learn our lessons well, I ask this humble question:

What lesson SHOULD we learn from this terrible tragedy?

In other words: What’s the way forward? Should we place our insurance executive colleagues in bullet-proof cages? Should we rail against gun violence? Shall we blame the system still further, for its neglect of mental illness?

Or is there a different lesson to be learnt? A solution beyond the rage?

The plaintive bridge of “Lessons” is musically very different from the rest of the piece, more spooky and ethereal. The lyrics intone:

For if your eye is sound…your whole body will be filled with light.

…your whole body will be filled with light.

They repeat that bit, like a mantra. Like it might be important, which it arguably is.

It’s basically directly lifted from Matthew 6:22-23, which is taken from what I’m told is one of the most impactful books in the world.

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The question then, perhaps, is what does that path of lightness look like? Intuition guides us toward compassionate exploration.

And—let’s face it!—as usual, Life-Fans, all of this think-muggery is just a frilly prologue for a cartoon, which this time features a simple poem written on a rather mucky bit of wall.

A simple poem, for a time when we’re all in for a bit of rough water.

<<kersplash!!>>

<<Bubble! Bubble! Bubble!>>

Hang in there, friends!

Or, as the Ter-Bear would put it: Point your feet downstream, and smile!

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Dave McCarty, MD FAASM

Boulder, Colorado

12/8/24

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Ps:

EMPOWERMENT SAVES! :)

…like a mantra…

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Point Your Feet Downstream and Smile!

Paterfamilas

Empowered Sleep Apnea presents: SHOCKING

“AHA!”