How Much Is Too Much?

There is joke among doctors, "What is an alcoholic?" "Someone who drinks more than his doctor."

Recently, a friend was injured when he fell following an evening of drinking. While his injury was fairly significant, thankfully there shouldn't be any long-term physical sequelae. This isn't about him.

What has been fascinating [is that the right word? Interesting? Challenging?] has been the ripples of responses within our circle of friends. There are all varieties of drinkers amongst my friends. Some barely drink at all. Some drink fairly impressive amounts on a regular basis. A few have discriminating tastes, and they take pride in their knowledge of variety of wines, crafted cocktails, and high end beers. Others have palates which are not so picky. Equally diverse has been the reactions following our friend's injury. Some barely acknowledge that anything happened. Some have considerably curtailed their own drinking, whether consciously or not. It seems like a few have even doubled down and picked up the pace.

Which leads me to the question I posed in this post, "How much is too much?"

As a physician, I've often struggled with this question. In rehabilitation, we often care for people who have had serious injuries caused by alcohol, as consequences of their own drinking or someone else's. I've care for people with head injuries, spinal cord injuries, severe fractures, liver failure, and burns. With each patient, I am stunned how quickly a life can change in a moment of bad judgment. After such an injury, however, my role is fairly clear cut.

What to say to people who haven't (yet) been affected? In my outpatient practice, it is fairly routine to ask people about smoking and drinking habits during an evaluation. These are people who may be coming to me for neck pain, tendon problems, sports injuries, or arthritis. What should be my flag to act on the information I collect and express concern about alcohol?

One might think that there is consensus among the healthcare professions about guidelines for alcohol consumption. I'll be the first to acknowledge that I am not an expert. There are guidelines which indicate amounts that may be beneficial for one organ systems, but often they conflict with guidelines for amounts that could harm a different organ. There is disagreement about how guidelines should be adjusted for gender or body weight. Genetics can influence how well people process alcohol, and they seem to influence who is at risk for addiction. Honestly, even if I knew how to weigh all of these different factors, I don't think I could effectively do that during a clinical encounter when I'm supposed to be treating knee pain.

I have equal confusion in a social context. There often is not a good correlation between the people who drink a lot and the people who suffer consequences from drinking. That makes it hard to rally support to intervene, when the people needed to help with an intervention may actually drink more than the person who really has a problem. Then, there is not even great agreement about what constitutes the best help: programs that advocate abstinence or ones that focus on harm reduction? Programs that are professionally based or community-volunteer led?

I really struggle with this both professionally and personally. I want to be a good physician and a good friend. I want to be an effective resource and advocate. How do I distinguish who needs help from those who are simply enjoying a vice responsibly? Then, how do I help? I know there are no easy answers to any of this. I have been struggling with the questions of how alcohol (and other substances) fit within a social milieu since college. It just feels more acute, more emotional, right now having had a friend get hurt.

Revisiting Degrees Past: Embracing the Bard

Between my recent immersion into design and my ongoing endeavors in medicine, I sometimes forget that I have scholarly interests beyond those domains. My undergraduate degree was in English. My focus within the major was linguistics, though getting an English major does require a fair amount of reading and writing. When I dabble in my language interests, I still tend to gravitate towards linguistics. I love learning about the history and structure of our language. As a descriptive grammarian, sometimes I smugly snicker at how wound up people get at perceived lapses in grammar.

While I still fancy myself an avid reader, I haven't delved much into the classics lately. That has changed in a wonderful way. I have become reacquainted with the Bard. In the last few weeks, I have had four exposures to Shakespeare, and once again I am hooked!

Part of my job involves caring for performing artists. I have had the pleasure of working with some of the actors from the Chicago Shakespeare Theater, a regional Tony winning company that is one of the gems of the Chicago theater scene. A few weeks ago, the company manager gave me a behind the scenes tour of the theater. What a thrill to see how all of the elements of a great production are pulled together, from concept to details. That evening, I returned to see Henry VIII. With all the recent fascination with Elizabeth I, it was great to see a glimpse into her father's life, from the perspective of a piece written so soon after her reign. While I knew the story from history, it is so much more raw on stage.

One of my neighbors is an actor and comedian, and he has been encouraging us to join him to see the Improv Shakespeare at the Improv Olympic. Generally, I'm not a huge improv fan, but I do love doing things with this neighbor. From a title thrown out from the audience, the five member troupe fashioned a Shakespeare-esque play. The language was remarkably similar, including long stretches of rhyming couplets. There were many characters; even the minor characters were distinct. I was amazed at how well they adhered to the typical structure of the acts, with multiple storylines woven throughout and coming together. I loved it so much, I plan to return next week with an out-of-town guest.

Last night, we returned to the Chicago Shakespeare Theater to see Othello: The Remix. This was Othello retold in a hip-hop setting, using hip-hop language and verse. Again, I'm not a big hip-hop enthusiast. I was blown away. While the story was set in the hip-hop recording industry, it was instantly recognizable. The story structure stayed true to the original, but it still felt fresh. It was some of the most innovative theater I have seen in a long time.

I'm itching to see more. However, I need to remind myself that it is not just Shakespeare that has me so excited. I adore having my love of the liberal arts awaken in me. It is one more side, one more world, for me to continue to explore.

Lovin' the (Indigo) Girls

A few weeks ago, I had the opportunity to see the Indigo Girls at Ravinia Festival. I think this was the fifth time I've seen them. The first time was about 25 years ago, while I was still in medical school. My cousin Debbi, who also lived in Nashville at the time, took me to a concert in the gym at Vanderbilt. It was love at first sight. I bought Strange Fire and Indigo Girls right away and drove my roommates nuts as I listened to the albums over and over. I was outraged in 1990 when the tone-deaf morons at the Grammy Awards gave the Best New Artist to Milli Vanilli (as if anyone considered them an 'artist') instead of the Indigo Girls...only to strip MV of the award months later when it was discovered they didn't actually sing.

The Indigo Girls, however, saved their outrage for more important things. It makes it so much easier to lay down money for an album or a concert when you know that the artists are tirelessly working, both on and off stage, for important causes.

What has kept me a fan for all these years has been the music. Songs like The Wood Song, Watershed, and Get Out The Map have been compasses for me, both for staying on track and appreciating hardships and detours. I've pulled wisdom about relationships from Power of Two and Keeper of My Heart, among others. Above all, I have learned to maintain a balance between heartfelt earnestness and the ability to step back to smile and wink at the self-same earnestness.

So, thank you Indigo Girls. I look forward to continuing our journey together.

A Magic Drop of Coffee

I love coffee. I truly do. While I definitely have some preferences about region and roast, I am nowhere near as picky or snobby about coffee as I am about other delectable beverages, such as beer or gin. Hot or cold, just add a little dash of cream and I'm good to go. I love the taste. I love the aroma. I love the pick-me-up.

This, however, is not a post going into all the ins and outs of coffee. There are tons of posts all over the internet which could provide a much better education. Whole books are written on the subject. There is no way I could add to that knowledge. Frankly, I don't even care that much about it.

I just want to acknowledge that there is something magical about coffee, especially that first drop. I am amazed how I can be plodding through a morning, still in a daze, and that first sip of coffee just perks me right up. I am more alert. I am enchanted by its appeal to my senses. My attitude is adjusted. My world is realigned. All of that comes with the first sip. I know that the caffeine cannot already be in my system. Even if it did absorb that quickly, the dose from one sip would be homeopathic. Something in the mystical nature of coffee, wrapped up in its complex history and mystique, alters me each morning.

I do love coffee.

Balcony Design

Rob and I used to have our balcony set up with a cute bistro table, but winters took their toll, forcing us to get rid of the table a few years ago. For a variety of reasons/excuses, we never got around to fixing up the balcony. This year, we were determined to use the balcony again.

I decided to take it on as a small design project. We wanted a seating area, but agreed that a table for dining wasn't a must. Rob wanted flowers for gardening, and I wanted to grow herbs for cooking. So plants became an important part of the design, both aesthetically and programmatically. I wanted the balcony to feel like an outdoor room, so it was important that the design of the balcony fit with the design of the adjacent dining room. I used the plantings to focus the line of sight to nearby trees and the sky. A rug pulled the space together. We now feels like we have an additional 50 square-foot room in the condo!

Unused balcony

Plan and Elevations

Proposed Layout

Proposed Design - View from Dining Room

Proposed Design - From Outside

Dogs helped with the planting.

Furniture and rug in place.

 Ricky is welcoming the Buddha.

Adding a second tier of planting.

 Training vines up the walls.

The balcony is ready.