Deferred Maintenance

crispydoc Uncategorized 6 Comments

Maintenance is a requirement and not a luxury by definition.

Proper maintenance reduces the rate of depreciation of an asset like real estate by slowing the approach of entropy.

Dilapidation is delayed if undeterred.

Increasing control over my time has better enabled me to address the long-deferred maintenance of my health in a number of ways.

I am not making the cover of the FI Illustrated swimsuit edition any time soon. Save the "Hulk Smash" pectoral pictorials for Mr. Money Mustache, who spent his youth driving a muscle car while weight-lifting to get ripped.

I'd regard "sinewy" or "stronger than he looks" as high praise.

At my ten year college reunion everyone seemed to want to talk about their Ironman. It took a while for me to realize they were not referring to a Casio watch.

Start Where You Are With What You've Got

Not to say I did not participate in some form of athletic effort along the way. As an undergraduate, my freshman roommate introduced me to Lacrosse, a sport I'd never seen until then. I liked it enough to join the "B" team.

Since I was a Sunday School teacher for third-graders through most of college, and games were played exclusively on Sundays, I missed every Lacrosse game but one. (When I say I live on the edge, I'm referring to the tangent between Venn diagrams for jock and nerd.)

I also begin lifting weights during college, just enough to feel comfortable in my body. The apex of my lifting career was going to the same on-campus gym long enough to buy my brother a t-shirt that read, "I'm not real smart, but I can lift heavy things" and have the staff member selling the shirt feign familiarity in seeing me around the place.

Let's Get Physical

Another great moment in college athleticism was my first day as a newbie in a spring quarter water polo class that started at 10am. Given the late start time, I enjoyed a large and leisurely breakfast before heading across campus.

The class was taught by the men's water polo coach, an intimidating and sunburned man fond of mirrored highway cop sunglasses named Dante. During my college years, we had the #1 NCAA ranked team. He wasted no time getting us into shape by inviting us to tread water for 10 minutes with our hands on our heads.

After five minutes, I discreetly swam to the side of the pool, walked to the edge of the chain-linked fence surrounding the area, and parted with aforementioned large breakfast before re-entering the water a humbled man.

In med school, I took up swimming and felt proud of three times a week commitment during lunch break. My sense of self was only slightly punctured when one of the female lifeguards I was friendly with at the gym diplomatically suggested a beginner class could help a "swimmer with my skill set."

Med school intramurals required non-marking soles for games of "Towerball" (a strange but enjoyable UCSF tradition), and I was not about to drop money on designer shoes. My under $20 Big Five white leather game shoes prompted a classmate (and future surgeon) to remark, "You must have had to beat up a pretty big nurse to score those shoes."

Somewhere Over The Rainbow

Med school, residency and young attendinghood were always associated with a "When I reach _____ then I can start to ____" approach.

Eating right was defined as something that required more than the addition of hot water.

Making activity a central instead of peripheral part of my day was a far-off good intention.

Cutting Back Let Me Start Living Tomorrow's Better Lifestyle Today

It's been a pleasant turn of events that every day I don't work in the emergency department begins with some sort of activity:

  1. Cycling the hills in my coastal neighborhood shortly after dawn, before cars take to the road.
  2. Lifting weights with the used bench press and barbells I bought off craigslist a couple of years ago for 2/3 the cost of the annual gym membership I dropped soon after.
  3. Bodyboarding or surf kayaking at my local breaks if conditions are favorable.
  4. Hiking with friends who have similarly flexible schedules.
  5. A half hour of sit-ups and push-ups on days when motivation is lacking.

We've All Experienced Our Version Of Garbage In, Garbage Out

The food component has developed in tandem with the exercise.

Without realizing it was happening, I've become a parody of a Californian in my diet.

Every morning starts with a bowl of chia, muesli and fresh berries soaked overnight in soy milk, followed by a stovetop triple espresso consumed black, ideally while reading an article from the New Yorker.

Lunch is a black bean burger with avocado slices and a little BBQ sauce, all wrapped in a tortilla, followed by Greek yogurt with fresh fruit and cinnamon. The best part of lunch? I get to share it at a leisurely pace with my wife after a morning spent on task accomplishment.

All of this is chased with another stovetop triple espresso, followed by a power nap or a quiet moment deeply listening to one of Vagabond MD's endorsed Grateful Dead concerts.

We've increased our repertoire of plant-based dishes, including Moroccan eggplant, Tofu and vegetable stir-fry, a lentil and spinach curry, veggie sushi, and a wonderful spicy southern African dish I've previously written about.

I'll even grill some salmon for fish tacos, or pan fry tilapia in a white wine and lemon caper sauce for dinner.

I pay more attention to what I eat.

I've had Eating Animals by the author Jonathan Saffron Foer sitting on my bookshelf for several years. I finally started reading it last week, feeling like I might be ready to at least try a pescaterian approach and cut out other meats on a trial basis.

Seeing my friend Dr. McFrugal routinely prepare delicious plant-based fare gives me hope that I might follow suit over time.

Reality Check

We've all seen our version of the young smoker in denial: She firmly believes she'll remain healthy and active until dying in her sleep with precisely X number of years shaved off her life only at the very end because of her unhealthy life choices.

She can't envision the gradual decline that awaits, the canister of oxygen she'll tote along that final decade, the inability to dance at a wedding.

As physicians, we live with our own denial. We ask our patients to do as we say, not as we do.

Maybe this is your moment to cut back clinically and start addressing the deferred maintenance your health demands.

Because if not now, when? If not you, who?

Comments 6

  1. The rigors of medical training often do a number to most individuals who pick up bad habits during this time.

    With long hours and intense training a lot of people take solace in junk food which is typically cheaper and easier to get. My father even picked up smoking during his medical school years.

    All this puts a toll on your body and if you neglect it you will indeed shorten the length and decrease the quality of life.

    1. Post

      There’s a drawer of candy in the ED that qualifies as the ultimate attractive nuisance to undermine health. I have no doubt you know of a radiologist equivalent.

      I’ve been bringing my own meals to work for 15 years and never regretted both the saved money and the better quality of food.

      I used to have an old radio commercial for Lucky Strikes that preceded a favorite Cole Porter tune. In it, the actress touted that more doctors smoked Lucky Strikes than any other brand of cigarette.

      My great uncle, a physician who died in his 90s, insisted to his dying day that the tobacco in his beloved cigars did not cause cancer; rather, it was the additives to tobacco that were dangerous. I imagine your dad (like my great uncle) was simply a product of his time.

  2. “Eating right was defined as something that required more than the addition of hot water”

    This is hilarious. I fondly remember my med school diet, which consisted mainly of $1 frozen meals wrapped in a tortilla, then grilled on the George Foreman. It really wasn’t so bad!

    I see a lot to aspire to in your current routine, both physically and diet related. I think as a first step I’m going to adopt your breakfast. It sounds delicious!

    — TDD

    1. Post


      I still wrap the stuff I enjoy in a tortilla, it’s just more likely to be green and fresh (avocado or roasted brussel sprout tacos, anyone?) than defrosted.
      Age has brought certain routines I enjoy, and I’ve come to cherish those morning rituals as a precursor to both productivity and deliberate leisure.
      Maybe as another new age sensitive Californian we share a set of susceptibilities?

      Appreciate the support,


  3. I was “eating healthy”. It made me sick. I switched to a Carnivore diet and have regained my heath from a dietary perspective. The only thing you need to live is water fat and protein. The carnivore diet is the solution to metabolic syndrome and diabetes.

    Be careful as you age regarding exercise. Over doing it leads to injury and there’s no future in being injured. I’ve treated many 45 year olds who suddenly had a burst of athletic prowess, and just as suddenly had a torn meniscus or impingement or disk herniation. Certain joints are designed to wear out like the knee and the spine and the acromnion area. Planks and plank variants are far superior to sit-ups. Exercise needs to be very regimented and it’s best to keep a log. There are a billion phone apps for that purpose. Perfect form is the key. Once perfect form is violated the set is over. It’s the last rep or two beyond perfect form that causes injury. Discipline will save you lack of discipline will take you out. The best gauge of progress is not the joker next to you, but a comparison of what you did yesterday and last week and last month

    1. Post


      I appreciate the caution and eyes wide open approach to any novel diet. These are food preferences I’ve been gradually adopting over time instead of some great pivot. I suspect I am likelier to have cheat days while traveling if I come across a compelling kebab.

      Regarding exercise, I am more weekend treaty negotiator than warrior. The incremental approach to exercise nudges that can be done regularly, in a consistent and time-efficient manner, has started to replace the infrequent attempt to reassert the lost vigor of youth.

      Your point is well taken about tracking performance, something I have avoided and need to incorporate into my routine if maintenance is ever to evolve into improvement.



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