How to break up with your phone, Double Arrow Metabolism edition, Day Nine

It's the second day of Changing Your Habits week here at Double Arrow Metabolism. This post is late because I was too busy yesterday, on the real day nine. But that doesn't mean I'm not enthusiastic for launching headlong into the Life-Changing Magic of Tidying Apps. I've really been looking forward to this one. As you read at the beginning of this project, I've long had an overly-complicated system for sorting apps into a single screen and into a "Misc" folder. The use of an app over a period of time determines its promotion or demotion (or even deletion altogether).

My new life coach Catherine Price tells me to sort my apps based on 1) their potential to steal my attention, and 2) their potential to make my life better:

1. Tools, like maps, my password manager, my banking apps, and the phone itself, are the only apps allowed on my home screen. 

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2. "Junk food" apps, like Safari, email, and shopping apps, go on page 2. 

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3. "Slot machine" apps, like social media, games and shopping apps, are to be deleted. This is confusing, since shopping apps were slotted (see what I did there?) for page 2. I decide to keep the Amazon app on page 2. I don't really have any other slot machine apps to deal with. 

4. Clutter is to be deleted, since that's how I tend to manage clutter in real life. So long, QR reader I haven't used in years. Goodbye, system-delivered Apple apps like Home and iTunesU.

5. Utility apps, like Find iPhone, go to the third page. So do Dropbox, Garmin Connect, and ride-sharing apps. 

6. The undeleteables, that collection of system-delivered apps like Clock, Wallet, and Health, go to a Folder of Shame on page 3. 

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Meh. I don't know about this. My device is far, far more cluttered than I would like for it to be. But I want to be coachable, so I'm going along with it. Luckily, Catherine throws me a bone here. She labels folders "a force for good," and I agree. They change the opening of an app from a reflex to an activity. You have to seek out the app to open it if it's buried in a folder. So I decided to replace page 3 with a folder that can go back to page 2:

That's better. 

That's better. 

That took forever.

Finally, Catherine recommends curating my menu bar to the utility apps I use most often. Done. Then the big one: Grayscale. I'd show you a picture, but even a screenshot of my phone comes through as color when I send it to another device. But here's an example from the web:

It's like that.

It's like that.

I have some anxiety about being able to take pics or look at pics in grayscale, so I decided to defy Catherine a little and set up a triple tap to toggle back and forth between grayscale and color. I found the instructions here. Now, by simply tapping the home button three times, I can toggle back and forth. This feels good. 

How to break up with your phone, Double Arrow Metabolism edition, day eight

It's Week 2, Changing Your Habits!

In which Catherine tells me that my smartphone is an emotional and physical cue for me to reach for it when I'm bored (my lizard-brain response to boredom) so that I can not be bored anymore (my reward). And the way that response is hard-wired into us can't necessarily be eliminated, but it can be modified. 

That brings us to today, Day 8: Say "No" to Notifications. Catherine points out that our phone notifications are a little like the ringing bell in Pavlov's dog experiment. We are so preoccupied with the next notification that we are driven to distraction when we're even near our phones. I agree with her that this may be the reason I used to get phantom buzzes from my phone all the time. 

So today's the day that I eliminate all push notifications from my phone, except for phone calls and (if I want, and I don't) messaging apps and my calendar. So to clarify: I will only get notifications from my phone ringer and my calendar (and, as previously mentioned, RubiconMD). Catherine says that since those notifications represent a chance for interaction with a real-life human, we can leave them on. Agreed. Done. Done weeks ago, actually. But it felt good then, and I don't regret it. 

How to break up with your phone, Double Arrow Metabolism edition: Days Six and Seven

Saturday's (Come back to [real] life) assignment: Get back in touch with what makes me happy in my offscreen life. I'm asked to complete an exercise:

  • I've always loved to...ride my bike
  • I've always wanted to...publish something non-academic
  • When I was a kid, I was fascinated by...reptiles
  • If I had more time, I would like to...write more
  • Some activities that I know put me into flow are...none. Ever. Don't get me started.
  • People I would like to spend more time with include...friends from college

I'm supposed to make a list of specific fun, off-phone things to do in the next few days. Here goes:

  1. Visit the Monet to Matisse exhibit at the Wichita Art Museum
  2. Volunteer for Bike Walk Wichita
  3. Meal plan for the week
  4. Ride my bike every day
  5. Visit the herpetarium at the Sedgwick County Zoo

Sunday's (Get physical) assignment: Make some time to get back in touch with your body by doing something physical and enjoyable. I plan to commute by bike to my volunteer activity with Bike Walk Wichita today. Two birds, one stone.

The second assignment is to buy an alarm clock so as to more effectively banish my smartphone from my bedroom. I've been thinking about doing this for a while. My trusty, rusty old clock radio from college has been commandeered by my daughter, so now when I wake up in the night I can't tell what time it is without looking at my phone. My beloved George Nelson clock is hard enough to read during the day:

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I'm not super-pumped about the style of the normally reliable Wirecutter's top pick, so I'll add "shop in-person for a clock radio" to my list of non-phone activities for the weekend. 

How to break up with your phone, Double Arrow Metabolism edition: Day Five

Today's instruction from Catherine is to delete all my social media apps. Since I don't have any social media apps on my phone to delete (I'm not counting Strava), I moved immediately to the second instruction for today, Day Five of Technology Triage, which is to download and use a password manager. I've been using Keeper for years, so I'm good there. Ironically, I've worried that Keeper is one of the apps that keeps me attached to my phone. So be it, I guess. I have hundreds of passwords, and I can't see myself going back to pencil and paper for them. Finally, she recommends that I spend some of my newfound phone-free time with friends and family. So I'm going out to dinner tonight with my wife and some friends. On my way out, I thought I'd share a couple breakthroughs from today:

First, I was a few minutes early to the student capstone presentations for the University of Kansas School of Medicine-Wichita's Population Health in Practice course. Today I leaned into my boredom. I sat without checking my email or looking at Vox. I was super-creepy with all the eye contact. I didn't even start this blog post, in spite of the presence of the app on my phone. Don't get me wrong; I made notes. But I wrote them on paper, which is somehow less off-putting (I think) than tapping away on a device. 

Then this afternoon, I was in a meeting with a clinic administrator and my phone buzzed in my pocket. I knew it was either a new e-consult, a calendar appointment, or a message from Moment, since those are the only apps that have notifications enabled. In the past, ninety-nine times out of a hundred, I would have taken my phone out of my pocket. I would have tried to be discreet, but I think in reality my discreetness has historically come off more as "drunk high school kid tries to play it cool with his parents." Not today. I left the buzzing device in my pocket, finished the meeting, and walked all the way back to my cubicle before checked the messenger and completed the e-consult.

 

How to break up with your phone, Double Arrow Metabolism edition: Day Four

Day 4 of Technology Triage is "Take Stock and Take Action." Today's instructions from Catherine Price: 

1. Look at the results from my tracking app.

  • How many times per day did I pick up my phone?
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  • How much time did I spend on it?
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  • How does this compare to my guesses?

Like I said on day one, I thought I would spend about two hours a day on my phone and pick it up about 40 times a day. Considering the Hawthorne effect I thought I detected, I'm probably pretty close on my estimate for time, but I underestimated how many checks I would have. 

  • What, if anything, surprised you?

I'm surprised at how much my phone is integrated into my daily life. Watching the Olympics with my daughter, I wonder: how many medals have athletes from Kazakhstan won in the Winter games? And just like that, I have my answer:  

33. The answer is 33. 

33. The answer is 33. 

It's so automatic. My phone is an extension of my brain. Or *shudder* a replacement for part of my brain.

2. Notice what I've noticed

  • What did I notice about how and how often my phone interrupts me or does something to grab my attention?

The only alerts I get are from Moment, which Catherine asked me to download, and from RubiconMD, which I get paid to provide services through. So I don't get a lot of interruption per se, but my phone is a constant presence. It's like having someone in the room watching me. I always know it's there, even if it's not making noise or flashing lights. 

  • How did these interruptions make me feel?

I like the interruptions that give me the opportunity to help someone out or make money. The Moment interruptions are as annoying as any other interruption. Once this experiment is over, Moment is dead to me. I get no energy from them. I don't get the buzz that some people talk about. I don't feel loved or wanted. They're just noise, like a kid from the backseat asking for ice cream. 

  • What did I notice about how I feel emotionally or physically before, during, and after I used my phone, and during times when I was separated from it? Relaxed, tense, excited, anxious, or other?

Guilt. I feel guilt for using my phone instead of doing something else. I feel like someday I will die, and all I'll have to show for a huge chunk of my waking hours on earth is having had my face buried in a device explicitly designed to draw my attention. In the dopamine-cortisol spectrum, I'm pure cortisol. 

  • What did I notice about the moments when I felt you was in a state of "flow"?

Sigh. I hate hearing about flow. I've never felt flow a moment in my life. Enough with flow. 

  • How did I feel when I saw other people on their phones?

Phones seem to be the modern tool to express "presenteeism," that phenomenon when people from work try to impress you with how hard they're working. That 2 am email you got from a co-worker? Pure presenteeism: "Look at how hard I'm working. The 40-hour workweek can't even contain me!" I don't like it. Rest and downtime are a feature of efficiency, not a bug. And it works the other way, too. People who should be time-efficient at work instead can spend time on their phones and pretend it's work-related. So, needless to say, I don't feel great about seeing other people on their phones. The fact that I've personally committed every sin on that list does not help. 

  • Putting all this together, what patterns did you notice? What, if anything, surprised you?

I noticed that my phone probably keeps me from ruminating on deep problems. I jump right to a solution, a la Kazakhstani medals. I seemingly cannot have a bowel movement without contaminating my phone with coliform bacteria. 

3. Create my first speed bump. 

Catherine asks me to start thinking about WWW, for What For, Why Now, and What Else. She recommends putting WWW on my lock screen as a reminder. This is the third different lock screen she has recommended, and the second one I've declined. #whatdoyouwanttopayattentiontoforever

How to break up with your phone, Double Arrow Metabolism edition: Day three

Today's imperative is to Start Paying Attention. We're still in the Technology Triage, which seems to be a set of steps toward mindfulness about phone use. I've been instructed by Catherine to take notice of:

  • Situations in which I nearly always find myself using my phone.

Honestly, the most consistent place I use my phone is the bathroom. People used to take the newspaper in there. Now we take our devices. I don't have to tell you that, on reflection, this is a disturbing habit. We have studies of the general uncleanliness of white coats and stethoscopes. I have little doubt that my phone is an equally dangerous fomite. At least the literature says so. Because here's the deal: I'm a religious hand-washer. But I never, ever wash my phone. I may take the cover off once in a while to wipe off visible dirt, but even that procedure is purely cosmetic. I'm not going for any kind of deep clean. And I damn sure don't do it after the bathroom on any consistent basis. And the phone touches my face!

  • Note the first time in the morning and the last time in the evening that I typically look at my phone.

I looked at my phone about an hour after waking up this morning to see the weather. Well, that's not completely true. My phone was my alarm clock, so I turned off the alarm, if that counts. And I hit play for an hour while I Zwifted and showered. But I didn't get past the lock screen, which is what Medium counts as opening my device, until about an hour after waking.

  • How my posture changes when using my phone.

Meh. Not much. Like I've said before, I don't get the physical manifestations of phone overuse. It's just like reading a book for me. And I don't text enough to get smartphone thumb. 

  • My emotional state right before I reach for my phone (for example: bored, curious, anxious, happy, lonely excited, sad, loving, and so on).

Well, it's sure as hell not loving. I don't even know what that means. It's definitely bored. B-O-R-E-D. Escape from boredom is the #1, 2, 3, and 4 reason I reach for my phone. #5 is probably curious. I want to know if say, Tessa Virtue is a made-up name (it's not, by the way), so I reach for the old accessory brain and have at it. But maybe curiosity is just an excuse for reaching for my security blanket. 

  • My emotional state right after I use my phone (do I feel better? Worse? Did my phone satisfy whatever emotional need caused me to reach for it?)

Lately, thanks to Catherine and Medium, my primary feeling is guilt. I know they're watching, and I know I've let them down. If I catch an important email, or if I do a RubiconMD consult, it's relief with some satisfaction mixed in.

  • How and how often my phone grabs my attention (via notifications, texts, and the like)

Almost never. Like I've said, I shut all that off long ago. Any beep or buzz I hear now I assume is an Amber Alert or a tornado warning. 

  • How I feel when I'm not using my phone--as well as how I feel when I realize that I don't have my phone. The point here is to start to become aware of when and how your phone triggers my brain to release dopamine and cortisol--and what I feel like when that happens.

I feel fine, great even, when I'm not using my phone. But I have to admit that realizing I don't have it causes significant stress. My phone is a wedding ring item, and I feel uneasy with it too far away from me. I can't explain why. I don't have a job anymore that relies on prompt return of urgent pages or calls. I wonder: could this be a cause of false positive testing for Cushings? That is, could phone-related stress cause a robust enough cortisol response to bump someone's urine free cortisol level or bedtime salivary cortisol level? The 30-second Pubmed search I just tapped in was unrevealing.

  • Moments--either on or off my phone--when I feel some combination of engaged, energized, joyful, effective, and purposeful. When that happens, notice what I'm doing, who I'm with, and whether my phone is involved. 

Today I gave a webinar on team-based hypertension strategies. My phone was nowhere to be found, obviously. I like public speaking, and I like the topic, but I didn't really feel flow. In fact, I'm not sure I've ever felt flow in the Mihaly Csikszentmihalyi sense. (yes, I had to Google his name for spelling) I get annoyed that so many self-help books beat the drum of "flow." Because I feel like even the things I'm good at require constant care and feeding. I never enter a state of easy, undistracted "flow." Maybe I just misunderstand the concept. But back to the webinar: I was (virtually) with people who were interested in the topic. The talk had a clear purpose. It felt great. 

  • How and when other people use their phones--and how it makes me feel.

Rage. Rage. When I'm trying to carry on a conversation with someone and he or she pulls a phone out of a pocket, I feel like some sacred space has been violated. Worst of all, I know I've done it to other people in the past. 

  • Lastly, choose several moments in my day when I seem to pick up my phone the most often, and see if I can identify a consistent trigger that makes me repeat the habit.

Pooping. Almost always pooping. 

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I don't have to check my phone at work because I sit in front of a computer all day, and the computer has 99% of what my phone would tempt me with. This isn't a good thing. It just is. 

  • Finally, Catherine recommends a "phone meditation" exercise. She tells me to take out my phone and hold it without unlocking it. I'm supposed to note any changes in my breathing, posture, focus, or emotional state. 

I feel nothing. 

  • She says to unlock the phone and open an app I use frequently, then scan myself for changes. 

I open Safari to see the score of the Kansas State-Texas men's basketball game:

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I feel relief that the 'Cats (EMAW) aren't sabotaging their NCAA tournament chances against the bottom half of the Big XII. Otherwise, I don't feel much. Scratch that. I feel guilty because I'm racking up time on Moment in the process of completing this exercise. *shakes fist at Catherine*

  • Then, I'm supposed to put a reminder on the phone to tell me I'm doing something with it when I reach for it. Catherine says this can be another wallpaper that says "Why did you pick me up?" (this book is really optimistic about wallpaper), or it can be a physical gadget to feel on the outside.

I choose one of my daughter's hair bands. I'd take a picture of it wrapped around my phone, but my only camera is my phone. So you'll have to see it in your mind's eye.

  • Finally, finally, Catherine tells me to put my phone away and see how I feel. 

Ahh. I'm in the clear with Moment for the night. That feels good. 

How to break up with your phone, Double Arrow Metabolism edition, Day Two

Today (Tuesday) is my chance to "Assess my Current Relationship" with my device. I've been instructed to answer the following questions:

1. What do you love about your phone?

I like podcasts. A lot. I don't subscribe to many of them, but the ones I like, I really like. An hour of Zwift time with a podcast in my earbuds is a very, very good way to start the day. Not as good as riding outside, earbud-free, but still.

I also like my calendar. I remember my pre-smartphone days, barely, when I lugged around a thick planner full of crossed out appointments and smudged eraser marks. I graduated to a Palm Pilot in my third year of medical school, and it transformed me. I put surgical schedules and hospital rounds in the calendar and missed or was late to a tiny fraction of them. I am much more reliable as a result of Google Calendar. It may have come at the expense of some part of my brain that would normally be keeping track of my schedule, since my first instinct at the thought of any new obligation or appointment is to put it on my calendar. But on net, the effect seems very positive.

I love doing RubiconMD consults, and my phone helps me get them done. Mostly, it makes me get to a computer to do them, since I don't love the RubiconMD app, but it alerts me reliably. RubiconMD makes me feel like a real doctor, even on the days when I'm doing things that aren't particularly doctorly, at least in the classic sense. I'm not sure I'd have that opportunity sans smartphone.

Finally, I love the idea of having the world's knowledge in a rectangular piece of glass in my pocket. When I watch period movies set pre-smartphone, I want to take an iPhone back in time to the poor detectives and academics.

2. What don't you love about your phone?

I despise notifications. They are the most intrusive thing I've ever encountered, save for 2 am blood glucose calls from the hospital. But back in my days of 2 am glucose calls, I was at least getting paid for the work. Notifications don't pay squat. They're the absolute worst. I've disabled almost all of them. 

I hate that people don't have silly arguments anymore. In college, we settled more than one argument in the dorm by using a neighbor's almanac(!). Phones have destroyed the free-wheeling, ridiculous tavern-style arguments people used to have. Everything is too available now. People don't think about their answer to the problem as much as they think about what somebody else's answer to a problem might be. I think half the amateur economists on the web just go to Tyler Cowen's website and see what he has to say about a problem, then pretend they made up the answer.

I wish people still made plans. Once upon a time, if someone didn't show up for a movie or a dinner date, we went looking for him or her, since we suspected something bad had happened. Now, with texting, people are so squirrelly that I only half-expect anyone to show up for an appointment we've made. Plans mean less than they used to. I can't imagine trying to date in the smartphone era, even without Tindr and its cousins.  

3. What changes do you notice in yourself--positive or negative--when you spend a lot of time on your phone? (Depending on how old you are, you can also ask yourself if you've noticed any changes since you got a smartphone to begin with)

I don't notice any of the physical manifestations that some people talk about. My phone doesn't make my neck hurt. I suspect I read enough already that my phone doesn't change my position much. I'm doomed to have a stooped neck someday. I don't text enough to get the thumb pain I've heard described. I have noticed my eyesight getting worse the last couple of years. Some of it is surely due to nighttime insomnia reading of my phone. (some other fraction is probably due to my advancing [but still young! still young!] age)

But if I let myself get too attached to my phone, I feel like I'm over-caffeinated. I can't focus. I can't feel. I try to drown every little negative thought with another click through my favorite websites or my email. It doesn't work. I stop observing my surroundings. I feel like I miss things that I should be noticing. 

But to be honest, I'm more annoyed with other people's phone use. When I see a family at a restaurant and three-fourths of them are on their phones, I want to slap the phones out of their hands, Dikembe Mutombo-style. Maybe it's because I know I sometimes look as bad as they do. FWIW, I've never actually committed assault on a phone user. But I've definitely fantasized:

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In the process of finding that gif of Dikembe, I stumbled across this one. I don't know what he's disgusted with, but I hope it's his phone:

4. Imagine yourself a month from now, at the end of your breakup. What would you like your new relationship with your phone to look like?

I'd like to leave my phone in the car during most of my trips into a place where I expect to either watch or listen to something I've paid for, or into places where I expect to interact with others. I want to no longer feel phantom buzzes. I want to be freed from pre-movie warnings to silence my phone. I want to have the same relationship with my phone that I have with the pliers in my toolbox: I know they're there, but I use them only when I have a task that I need them for.

5. What would you like to have done or accomplished with your extra time?

I like to write. I like public speaking. I'd like to do more of both. I'd like to set an example for my kids that screens aren't the only pastime worthy of our attention. I'd like to ride my bike more. 

6. What would you like someone to say if you asked them to describe how you'd changed?

"The last time we talked, you made me feel like the most important person in the room."

7. Write your future self a brief note or email describing what success would look like, and/or congratulating yourself for achieving it.

Dear Dr. Moore (I didn't do nine years of medical training to call myself "Mr."),

Congratulations on becoming human again. While our cyborg future may be inevitable, with cardiac implants and insulin pumps and brain dust and the like, we shouldn't have to sacrifice our attention or our humanity in order to achieve great gains in health from technology. I hope you're enjoying your extra hour a day. I hope you're using it to do something that makes you a better person and maybe makes the world a 0.00000000001% better place. I hope you can have a conversation without peeking at your phone. I hope you don't feel phantom buzzes in your pocket anymore. I hope your kids don't think that "acting like a grownup" means being glued to a phone non-stop. 

Sincerely,

Justin

How to break up with your phone, Double Arrow Metabolism edition, Day One-point-one

It's Monday. Which means it's now officially Day One of Technology Triage Week. You'll remember that last Thursday, knowing that my phone use would be a little janky and un-representative of my typical use for a few days, I downloaded Moment and allowed it 1) to know my location, and 2) to send me notifications. The early download was meant to give me a more robust baseline data set. I predicted that I picked up my phone forty (40) times per day, and that I would be on it for about two hours a day.

I was worried that time on Strava would count toward my overall use. This would have made a dent, since I did some Dirty Kanza training with my son over the weekend:

Don't worry: that alert badge is disabled on my homescreen.

Don't worry: that alert badge is disabled on my homescreen.

Strava thankfully doesn't count. That's a relief.

I was also relieved to see that podcasts don't seem to add to any time on the device. I get them for free. Yay! Even though they might not be good for me, either!

As you can see, I came in well below my projected time:

Not. Even. Close. 

Not. Even. Close. 

Catherine Price, the author of How to Break Up with your Phone, told me not to change my behavior, but to just be myself and gather data. That did not happen. I gathered data. But I gathered data that I suspect radically underestimates my true phone usage. In other words, these numbers come with a big, big asterisk: I started seeing changes in my behavior about a nanosecond after activating the app. Anyone who says that adding a tracker to their phone doesn't change habits is lying. This is Hawthorne Effect, big-time. Saturday I was at the library to check out a book, and I was actually hesitant to look in my phone's password app to log into the library's card catalog because I didn't want to add to my phone time on Moment. I thought I needed to disable whatever the feature is on my phone that causes it to turn on when I move it because it makes me self-conscious to see the screen light up when I take it out of my pocket to put it on the charger. Where I used to just stick my phone in my pocket and not pay attention to whether the motion detector had turned it back on, now I quickly tap the button to turn it off, and I confirm a dark screen before I put it away. But then I figured out that the screen lighting up like that doesn't seem to add to my Moment minutes. Whew. 

I was even nervous even going into the Moment app to get the screenshot above. I didn't want to inflate my time. You want to see what's under those "Insights" and "Coach" tabs? So do I. All I can tell is that I'm checking my phone about 25 times a day. But there's no way I'm swiping around the app, wasting my hard-earned phone time on that junk when I could be reading Andrew Tillin's account of how cycling saved him during a marriage separation.

Which leads me to neurotic point number two (or higher; I've honestly lost count): here I sit, tapping out this blog post without (much) guilt while my phone is several feet away from me, dark. I'm afraid I'm just shunting phone time into computer time. In the last couple days I feel like I'm spending more time on the computer since I'm self-consciously avoiding my phone. I almost need a separate chrome extension to track how much time I'm spending on my home and office computers. In other words, it's not just my phone that's a problem for me. I have a problem with screens in general. And I don't know how to track my home computer use since my kids use my home computer to do schoolwork and watch TV. Argh. 

But maybe all this faulty data represents progress. After all, I wasn't worried about Big Brother Moment judging me before Thursday, and I undoubtedly used my phone more then (I'm guessing my real baseline data easily doubles what I'm recording now). So if my mental health holds up, maybe I'm doing something right. I guess. Maybe. I don't know. 

Tomorrow is Day 2 (Tuesday): Assess your current relationship. It's time to come clean to my phone and tell it how I really feel.

How to break up with your phone, Double Arrow Metabolism Edition: Day One

Anyone who has come within ten feet of this blog knows that my relationship with technology, social media, and my smartphone is, shall we say, tumultuous. So I came to read Catherine Price's book How to Break up With your Phone the way I suspect a lot of people do. I've been stewing about my attachment to my phone for a couple years now, and I've made steps to decrease my use:  

I have essentially no social media presence. I've worked to make my phone less desirable. I tried putting it in grayscale, but it made my calendar too hard to read. I developed an unnecessarily complicated strategy for deleting apps. The ones I use monthly or more, I keep on the home screen. The ones I don't use monthly get demoted to the "Misc" folder, where they are in danger of being deleted if they don't get used in a certain amount of time. Any app in the Misc folder that gets used two months in a row gets moved to the home screen. Like I said: complicated. But the system has resulted in a pretty austere home screen:

Just me, Atul, and Tracy. No big deal. 

Just me, Atul, and Tracy. No big deal. 

I've turned off all notifications, audio and visual, with a couple exceptions: I can still see text messages when they come through, but they make no noise. I still have notifications enabled for RubiconMD, an app I use for peer-to-peer consultations with other docs. I want to make sure I know when those come through. My phone still rings when I'm called, but any texts or calls I get that are robocalls or from a telemarketing source get immediately blocked. 

So the big things that I end up using my device for are texting, the calendar, my task list, and old-fashioned telephonery. I also use Strava for recording cycling mileage, but much of my data in it comes via my Garmin or via Zwift. I don't use the phone as my primary GPS very much. I'm not much of a photographer, so I don't really need my phone around for pictures. I also listen to an hour or more of podcasts per day, but I'm not sure that counts. 

But I still find myself excruciatingly drawn to my phone. I use it for my alarm clock. I tap the screen to check what time it is during nocturia rounds. I tap my pants pocket to make sure it's there before I leave the house.

So I bought the book. Catherine is a very accomplished, competent science writer, and it shows. The first half of the book is mostly a recap of the greatest hits of the evils of constant connectivity, referencing expertly many of the books and articles I've posted or talked about here in the last year. She leaves out Cal Newport's Deep Work, one of my favorites, but hits other work by Nicholas Carr and Jean Twenge that are equally good. After the review she gets down to the nitty-gritty of detoxing, outlined in a 30-day plan.

Week One is "Digital Triage."

She says to take notes. Done. And digitally, even! Extra computer karma for me. She also says to invite friends to join in (no thanks; I'm too shy and too much of a loner for that kind of thing). She says to answer a question ahead of time:

What do you want to pay attention to?

Answer: I want to pay attention to long-form literature and journalism. I get more joy out of a well-written book than almost anything. It can be fiction or non-fiction. I like both. I also love, love, love magazine articles. I can take or leave newspaper articles or cable news.

I also want to pay more attention to my kids. I'm not a distant parent, and we have pretty firm rules around the house for when devices can be on. We never have devices at the dinner table, for instance, and electronics of any kind, even the radio, are verboten during meals. But even with those rules I'm frustrated at how often I'm distracted from my kids by my phone. I like my work, but I long to solve problems that can't be solved from a computer keyboard, and my kids are a deep vein of this kind of problem. 

Catherine says to use the lock screen on his or her phone as a reminder. Done:

So long, Dr. Gawande. 

So long, Dr. Gawande. 

She says to schedule my phone breakup, ideally starting on a Monday, and to put it on my calendar. I'm typing this on a Thursday, but I'll be on a brief vacation over the weekend, which may affect my phone use under even normal circumstances, so I want to have a larger dataset to work with. Which brings me to:

Day One: Download a Tracking App

Before I actually download the app, though, she tells me to answer a couple questions:

1. How many times a day do you think you pick up your phone?

I'm going with forty. Four-zero. 

2. How much time do you estimate that you spend on your phone per day?

I know from reading the first half of her book that the national average is about four hours a day(!). I'm nothing if not slightly above average, so I'm going with two hours. Still a shocking amount of time, but at least it's not long enough to complete a medium Tour de France stage. 

Catherine recommends Moment. In the spirit of not spending a bunch of time on my phone trying to find an app to keep me from spending so much time on my phone, I downloaded it. Then, to show how committed I am to this process, I allowed it 1) to know my location, and 2) to send me notifications. Those are privileges that almost no other app gets. And, just to get my rationalization off to a good start, I spent an inordinate amount of time setting up the app and screenshotting for this post. So this afternoon might be an outlier. We'll see. Catherine says not to change my behavior. Just be myself and gather data. Since I'm on quasi-vacation the next couple days, I'm going to wait til Monday to publish this just to make sure my initial data doesn't represent any kind of statistical anomaly. See you then. 

Why are there fewer posts on here than there used to be?

In the New Year, I've been trying to severely curtail my internet use. A side effect of this has been far fewer posts on this blog linking to articles or papers or videos that I've found interesting.

This is the next brick in a path I've been headed down for a while now. When I was a first-year med student, a classmate of mine was famously addicted to her flip phone. It would buzz and ring through lecture, and people would give her the stink eye, and as soon as the last Powerpoint slide clicked off the last reaction in the Krebs Cycle, she would bolt from the room and start making calls like a Wall Street veteran. Like Dan Akroyd in Trading Places. What would she have been like if she'd had a smartphone? Well, we know what she would've been like, because most of us are exactly where her trajectory was headed, and we're doing it with almost no social stigma. She would've answered all those calls with texts, right there in the lecture hall, and she would've checked multiple social media accounts to boot.

Needless to say, I was not an early adopter of social media. Once I had a couple accounts, I quickly found that social media made me act differently than I do in other situations or media. The act of trying to market myself for "likes" or "pins" on a platform of someone else's design was an act perfectly designed to produce insincere, awkward content. And thought I'm generally sincere, or at least I try to be, I'm somewhat socially awkward. That is, I'm awkward enough without someone else's help. I found that the effort I put into social interaction on platforms like Facebook and Twitter didn't enrich me. If anything, it impoverished me. It made me feel bad.

I was mystified by people's willingness to give up all the same information that we try so hard in the medical world to keep private. Facebook in particular seemed to be engineered specifically to tweak my smoldering social anxiety. It tried to choose my "friends" for me. But as I accumulated hundreds of "friends," the value of real friendship seemed to be degraded. And the privacy. Lordy. The day I put it to sleep came on my birthday a couple years ago. In spite of my almost religious tending to social media to keep details like the date of my birth off of them, people knew. Just like Wolfram Alpha knew. And I didn't want them to know. So I deleted it.

A year or so ago, I read Cal Newport's book Deep Work as part of a book club. I was still wading around the fever swamps of Twitter at the time, because I thought it was good to stay engaged for work. It wasn't completely by choice. I had suspended my Twitter account at one point, but then I'd applied for work with a company that used Twitter for much of its internal non-secure messaging. So during my grace period with Twitter (they give you a chance to come back for a month after you delete your account. Surprise!), I re-activated the account.

The discomfort with it remained. I started to talk about social media in less-than-flattering terms in posts a few months ago. Then I paused. I thought maybe I was being stereotypical: the middle-aged guy yelling at younger people to get off my digital lawn. But I kept some thoughts in draft form while I thought it over. I even considered getting a Facebook page for Double Arrow Metabolism, just to drive a little more traffic.

When the 2016 presidential election happened and I got glued to the daily outrage of social media as it responded to a shifting political landscape. I was left with two options: 1) master the software, or use it in such a narrow sense that it didn't control me, which seemed unlikely. I'm a reasonably smart guy, but my reptile brain can't outsmart thousands of computer engineers. Or 2) kill the software and get to know myself better. I don't mean blow up Twitter; I mean kill my interaction with it. I chose #2, eventually. I feared it would hurt business, or make me less knowledgeable about the world.

Then I read Newport's "any benefit" argument: we stay on social media because we can't bear the thought that there's some unknown, as of yet unseen benefit to it. In other words, what will we miss out on? It reminded me of what my parents lovingly called this the "unsmelled fart rule" when I was a kid. I'd be told to go outside, away from the party, and when I objected, I'd be asked, "What's the matter? You afraid somebody's gonna fart and you won't get to smell it?" That's exactly what I was afraid of with Twitter. But after I read Newport's book, I just quit. And it hasn't made a bit of difference in regards to my knowledge about the world. If something bad happens, I'm going to hear about it, social media or not. 

So I've been off social media for a little over a year, I think. Scratch that-it's not completely true. I still have a Strava account, albeit with no notifications enabled. And I still have a LinkedIn page. LinkedIn is like social media status post fun-ectomy, though, so I don't really count it. I even experimented briefly with Figure 1, but I didn't think it was useful. If I'm going to look at cases, I want to either get money or CME credit in return. Figure 1 provided neither.

But it wasn't just awkwardness or privacy concerns that bothered me. It was a gnawing sense of unease. And I couldn't quite put my finger on what bothered me until I read Andrew Sullivan's piece about the phenomenon a year or so ago, "I used to be a human being."

"Every minute I was engrossed in a virtual interaction I was not involved in a human encounter. Every second absorbed in some trivia was a second less for any form of reflection, or calm, or spirituality. 'Multitasking' was a mirage. This was a zero-sum question. I either lived as a voice online or I lived as a human being in the world that humans had lived in since the beginning of time.

And so I decided, after 15 years, to live in reality."

Time on social media, and now to some extent time on the internet, was taking away from time in the real world. You might be pointing out right now the apparent hypocrisy of the position I'm in the process of staking, since you're currently reading these words from a screen. Why, you're asking the screen (and by extension me), do you spew forth on this blog if you're so against public sharing? Fair point. But my content has decreased. And whether you like what I have to say or not, I don't make money off of it, even though I do make money off the consulting work that sometimes makes a guest appearance on the site. And I don't spend a lot of time looking at the analytics on my site to see how many of you are reading. So this particular shout into the void is my way of getting what I consider my fairly radical beliefs about health out into the world. But I figure the people reading this blog have at least a passing interest in me or in what I have to say. If you're here, I've in some way earned your eyes on this page. Artificial intelligence did not move Double Arrow Metabolism higher in your feed. So sure, I'll share with you, like the authors of some of my favorite blogs share with me:

Velominati, Kottke, Study Hacks, Wait But Why, Slate Star Codex, Mr. Money Mustache, Red Kite Prayer, Marginal Revolution

But I won't share with a thousand people who caught wind of my birthday through a complicated algorithm and are only posting about it because said algorithm makes it easy to do and makes them feel bad if they forget. I want to generate content that--good or bad--takes me longer to write than it takes you to view. Call it anti-Twitter.

So the fact that I'm not posting as many links is dual purpose: it keeps me off the internet, and it keeps me from turning this site into something I didn't set out for it to be. If what you want is a bunch of interesting links, many, many websites serve that purpose better than this one. One of them is Twitter. But Twitter has a fatal flaw in that it has no end.

Comedian Aziz Ansari, a guy who it turns out was a creep on a date, but who literally wrote a book on how technology has changed romance, has this to say:

"I’ll say, the times where I haven’t read that stuff, the stuff that I normally read on the Internet, just nonsense blogs or whatever, the next day I’ve felt like I’ve missed nothing...Cause you’re not reading it for the information. What you’re reading it for, and this is just my personal theories about this stuff, what you’re reading it for is a hit of this drug called the Internet...Like, here’s a test, OK. Take, like, your nightly or morning browse of the Internet, right? Your Facebook feed, Instagram feed, Twitter, whatever. OK if someone every morning was like, I’m gonna print this and give you a bound copy of all this stuff you read so you don’t have to use the Internet. You can just get a bound copy of it. Would you read that book? No! You’d be like, this book sucks."

Again, Ansari, a comedian whose job seems to have been created in a laboratory to achieve maximum benefit from social media, had this to say to Stephen Dubner of Freakonomics before adopting his new social media, internet-lite life philosophy:

"I never read anything. I’ve never read all these novels that are like these beautiful stories that have continued to have a resonance with people for so many generations, like beautiful works of art that I could read at any point. But instead, I choose not to read them. And I just read the Internet. Constantly. And hear about who said a racial slur or look at a photo of what Ludacris did last weekend. You know, just useless stuff. It’s like, I read the Internet so much I feel like I’m on page a million of the worst book ever. And I just won’t stop reading it. For some reason it’s so addictive."

Aziz quit the Book of Internet. The Book of Internet is a shitty book. Double Arrow Metabolism will not be a chapter. 

Since my departure from social media and my sharp reduction in internet consumption in general, I haven't come across much to change my mind. I read Jean Twenge's Have Smartphones Destroyed a Generation? I read John Lanchester's A Criticism of Facebook. They reminded me of a teaching course I attended at Beth Israel in Boston in roughly 2009, when "teaching the 'millenial learner'" was already a hot topic. They were different than Gen Xers and Gen Yers, we were told, in that they hadn't been quite so "latchkeyed" (a term d'art for what some might consider excessive babysitting as a symptom of absent parents). They also were perceived to want more of a personal touch in their instruction; more feedback. But Twenge notes that in her data, something shifted a few years after my teaching course on millenials. It was in 2012, the year that smartphone ownership in America surpassed fifty percent. So she calls the group at the tail-end of millenials the "iGen." Smartphones and social media have been ever-present in their lives. They've never known a world without tablet devices. Three out of four of them own an iPhone. 

Rusty's Last Chance, a landmark bar in the Aggieville district of Manhattan, Kansas, was a beacon to Kansas State University students and nearby Fort Riley soldiers for decades, but it closed in February of 2017. Bars and restaurants close all the time, but I cannot help but think, based on my experiences in going back to Manhattan in recent years, that students' taste for virtual contact over the real thing didn't have something to do with it. I'm still volunteer faculty at the local med school, and one of the criteria we're expected to evaluate students--med students! Adults!--is their willingness/ability to stay off their phones during sessions.

At this point, if you're still reading, maybe you're ok with all this. Maybe you don't think your time is worth that much, and maybe you've heard if you aren't that bothered by an algorithm guiding you away from your true self, and maybe then that information you've paid to give up is used to reduce you to a set of numbers or yes/no questions that define you, just as medicine so imperfectly tries to define you by race, body mass index, blood pressure, and soon your genetic "fingerprint." After all, teen pregnancy is at an all-time low, and teens' addiction to their phones surely has something to do with that. It's hard to impregnate someone if you're spending your weekends in your bedroom scrolling through Snapchat. And kids are physically safer than ever; it's hard to die in a drunk-driving accident from the comfort of your bedroom, and I've never seen a drinking game whose rules involved immersion in tindr (but, come to think of it, I'm sure it exists). Psychologically, though, kids may in trouble. Twenge notes that since 2011, depression and suicide have "skyrocketed." I'm not sure this is true. I'm too exhausted by the internet right now to go and find the primary data. But it doesn't take a social scientist to watch toddlers engrossed in YouTube Kids at the grocery store and deduce that we're in the middle of a profound change. We're running an uncontrolled experiment on ourselves and our kids.

So how should we handle smartphones with our kids? Based on no empirical evidence whatsoever, my wife and I have decided that 1) our kids will not have their images posted on social media other than in extremely rare circumstances (nobody wants to be the guy that torpedos an entire birthday party, after all). And our kids, upon entry into middle school, will have access to a good, old-fashioned cell phone. But if they want a smartphone, they'll have to earn the money for it themselves.

At home, we try to enforce what I'll call the "White House" rules. I don't know how the White House handles the issue precisely, but I'm fairly certain that unsecured cell phones are a no-no in the White House. So, like a Jack White or Chris Rock or Dave Chappelle show, people are asked to put their phones away upon entering. So I follow the same rules: when family members come into my house, they put their phones in a central location, and we go about our business. 

In case this all just sounds like so much "get off my lawn"-style old man grouchiness, I engage with technology. I help docs run their electronic medical records more effectively and efficiently. I listen to podcasts in my free time. But I can listen to podcasts while I accomplish other things. And EMRs, at least in theory, have value beyond the immediate. 

Sigh. So that's the story. Expect fewer posts on this site than there used to be, because I'll simply have less to post, because I'll have spent less time on the internet than I once did. But I'll probably keep my smartphone. I like the calendar.

Just minutes a day

Remember the proliferation of exercise gadgets in the 1990s? You had the knee squeezer:

The sit-up machine: 

I don't see how this is better than a sit-up.

I don't see how this is better than a sit-up.

The aluminum pretzel:

I'm sensing a theme here...

I'm sensing a theme here...

And many, many others. What they all had in common (in addition to being highly inefficient ways to part you from your money) was their promise to turn you from "before" to "after" in some small period of time daily, usually under 30 minutes. 

Newsflash: doing anything--anything--physical for 30 minutes a day is going to help you out. It doesn't have to be a gymnastics routine. Hell, try doing push-ups, planks, and crunches for 30 minutes a day. It's a lot of work.

 

Both pictures are "after." Where can I buy those shorts? Rowrrr.

Both pictures are "after." Where can I buy those shorts? Rowrrr.

But that's all an aside. Here's the thing I'm really thinking of today: I’m not sure how may times I’ve had a parent or grandparent of young kids tell me how much physical activity he or she gets as a result of “chasing around a two-year old.” I’ve always been suspicious of the claim. Don’t get me wrong--parenting, especially at the toddler phase--is exhausting. But it tends to be exhausting in the way a stakeout is exhausting, mostly from monotony and sleep deprivation. It’s emotionally taxing because of the lingering self-doubt about the quality of your parenting and the everyday small decisions you fear will lead to some real harm if made improperly. Physically, it never seemed demanding at all with my two kids. There was some lifting, sure. But most of the parents I see in public with their kids are sitting somewhere gazing into their smartphones. It’s the kids who are doing all the physical activity. The parents are unlikely to take twenty steps in an hour, it seems. [note: none of this cynicism applies to daycare workers, most of whom really hustle]

Obviously I’m a little jaded. As I write this, I’m sitting in a fairly spectacular local park, taking part in a fundraiser. I can see eleven parents from my perch at a picnic table (at least I think they’re parents. They’re sitting adjacent to the playground with small children zipping between them. Oh, and there are 12 if you count me). Of the 12, twelve are either writing (that’s me), texting, or eating. Zero are interacting with children in any physical way. In an unusual turn of events, I’m actually primed for some moral superiority, since the kids and I got here by bicycle, in the #familypeleton, so I have the ~3.5 miles to the park and the 3.5 miles home on my side. That's enough self-congratulation for the day. My point is, being with your kids might bring you joy most of the time, but it won't bring you physical activity unless you do it self-consciously, just like any other activity. 

What got me thinking of this is the fact that I’ve had innumerable conversations with people about physical activity over the last decade in which one or both of us advocated for “Simple strategies to add physical activity to your routine!” These discussions were often irrationally enthusiastic about the awesomeness of parking at the far end of the parking lot, or substituting a rake for a leaf-blower, or using a whisk instead of an electric mixer. You get my drift, I hope. Here’s the problem: it’s almost all bunk. Desperate, depressing bunk. And I say this as the person who has on many occasions been on the giving end of this advice. Now, before Blue Zones fans come at me with pitchforks and torches (both good ways to “Add physical activity to your routine!”, by the way), let’s perform a little thought experiment.

 

Let’s imagine that you wake up from a routine surgical procedure to find a doctor solemnly standing over your bed.

“Justin, I have some bad news,” she says as she pulls up a chair. Your name is Justin in this dream, by the way.

“Your appendectomy went fine. You’re going to heal right up. But you had a rare complication of the anesthesia, and it appears you’re now paralyzed from the neck down. The good news [doctors always try to segue into the good news as quickly as possible, amiright?] is that you’re still able to breathe on your own, so you shouldn’t have any trouble talking, and you won’t need a ventilator.” As you try to shake off the last remains of the sleeping medicine, and as your spouse softly weeps at your side, the doctor goes on. “But you won’t be able to do any intentional physical activity beyond breathing, talking, smiling, and blinking.” She then explains that the condition is likely permanent, at least as permanent as you are.

As you let this news settle over you, what will you miss? Will you miss your thighmaster or ab cruncher or aluminum pretzel time? I hope not. But if so, that's cool. Will you miss mowing the lawn? Maybe, if you’re one of the guys Lowe’s advertises to in the springtime. Will you miss using a whisk? Well, I guess, insofar as you’ll miss cooking in general. (note: Julia Child has a great old clip in which she talks about how normal cooking should lead to the cook getting sweaty. It’s awesome. You should look for it. I'd link it, but I can't find it, and I'm in a hurry.) But I’m willing to wager that the walk across a shimmering, sweaty, oil-stained parking lot upon which you’ve intentionally parked your automobile far, far from the entrance to the big box store is something that approximately zero percent of us would miss. Zero percent of responders to this scenario would miss running a vacuum cleaner, or washing their tile floor by hand, or any of the 1,000 other “strategies” I’ve heard in this regard.

What would you miss? Dancing with family at weddings, maybe. The spray of water on your face as you waterski. I’d desperately, achingly, miss my morning cycling route that takes me through the sunrise in summertime and through a crystal wonderland in the winter. I know this because I've been sick lately, and I fear the cold air would make me sicker. I’d miss the bike ride to school with my kids. I’d miss the competent, reassuring thud of a frisbee into my outstretched hand. I’d miss the brace of cool water against my face the first time I dive into a pool in the springtime. I’d miss...nothing at all related to parking.

Here’s my point: Movement isn’t just a utilitarian product of 85 million years of evolution. It isn’t just a means of getting from point A to point B. It is a source of joy. So, sure, park at the edge of the Target parking lot. But even better, leave your car at home and find joy in the 30-minute bike ride or hour walk to the store because it brings you joy, is good for the planet, and it saves you money. Instead of burying your face in your smartphone while your kids play, take pleasure in helping your kids hunt fireflies or throw snowballs or walk around the neighborhood for 30 minutes in the evening. Take a big step, not a small one. Move because it makes you feel good, not because it adds steps to your FitBit.

 

On this day in 1980 recombinant insulin was first given to an American.

From The Louisville Courier-Journal: 

WICHITA, Kan. Synthetic human insulin was injected into a 37-year-old Wichita homemaker yesterday at the start of the first long-term study of the new. product. Sandy Atherton, a recently diagnosed diabetic, became the first diabetic., to receive the insulin, which is made with recombinant DNA. She led a test group of five patients. They received the insulin from Dr. Richard A. Guthrie of the University of Kansas School of Medicine-Wichita. A total of 50 patients eventually will take part in the test. A smaller evaluation was done in Europe on healthy people earlier this year. Guthrie said the product is identical to insulin produced in the human body but lacks the impurities of insulin' extracted from cattle and swine pancreases. An. estimated 1 million American diabetics need daily insulin shots to stayalive. The disease is caused by a deficiency of insulin, the hormone-like substance that controls the level of sugar in the blood. A few diabetics become severely allergic to impurities in regular insulin and their allergic reactions can even be fatal, Guthrie said. The recombinant DNA insulin, made by Ell Lilly and Co. in Indianapolis, was developed in 1978 by Gen-entech Inc. of Calif. Scientists took the gene for human insulin and inserted it into bacteria, causing the bacteria to become like tiny factories manufacturing the vital hormone. However, biosynthetic insulin is not the only non-human source of pure human insulin. A Danish firm recently announced a new process that makes human insulin out of pork insulin by changing its chemical structure. 

Are friends for hire a solution to loneliness?

Just out of college, one of my friends quit his good-paying, stable job at a big midwestern company to start a "jack of all trades" handyman business. He and another of our college friends mowed lawns, rebuilt decks damaged by tornadoes, repaired drywall, fixed sprinkler systems, and did other odd jobs. General handyman stuff. 

One day he was called to a house to change light bulbs. This was a common call; it was easier for people to call him than to get their own ladder and defy death above a stairwell. When he finished, the elderly lady who'd called him offered him a glass of water and a seat while she paid the bill. 

"How much would it cost to have you here weekly?" she asked. Again, this wasn't an uncommon request. Many people kept him on retainer and had him come by periodically to do little jobs. My friend eased into his spiel about the packages he had available, and what services were available at each price point. 

"No, no," she said. "How much would you charge just to come by and talk?"

I don't know what happened after this. Every time I heard him tell the story it ended there with all of us groaning about how sad it all was. How sad that an old lady was so lonely that she was willing to give money for company. The reason I bring the story up at all now is that I just read "How to Hire Fake Friends and Family" by Roc Morin in The Atlantic. 

"[Ishii Yuichi]'s 8-year-old company, Family Romance, provides professional actors to fill any role in the personal lives of clients. With a burgeoning staff of 800 or so actors, ranging from infants to the elderly, the organization prides itself on being able to provide a surrogate for almost any conceivable situation."

Some details are heart-wrenching: single moms hiring men to pose as Dad so they aren't discriminated against. Some of them are creepy: one of those single moms has never broken it to her daughter that Yuichi isn't her real dad after eight years. Some of them are downright strange, like this example of surrogacy that seems right out of an Uday and Qusay tale:

"Usually, I accompany a salaryman who made a mistake. I take the identity of the salaryman myself, then I apologize profusely for his mistake. Have you seen the way we say sorry? You go have to down on your hands and knees on the floor. Your hands have to tremble. So, my client is there standing off to the side—the one who actually made the mistake—and I’m prostrate on the floor writhing around, and the boss is there red-faced as he hurls down abuse from above."

Because of the "Romance" in the company name, I suppose, and to head off the inevitable comparison to prostitution, no, Yuichi and his workers do not provide sex. He claims that they aren't even allowed any physical contact besides hand-holding.

I've written several times in the short life of this blog about the dangers of loneliness. I've spoken about it even more. So this post isn't meant to poke fun at the sometimes bizarre social norms like this that crop up in Japan. They may only be bizarre to my western eye. After all, much of what we do in medicine, particularly in palliation, boils down to the act of being present for a person. And sometimes that's the hardest thing of all. My friend didn't take the lady's money for his company. But even if he had, I think we could argue he'd earned it. 

In the words of Yuichi himself, "It feels like work to care for a real person."

Jump

Those people look scared, don't they? Hard to blame them. I bet you're scared, too, if you're somewhere below a "1" on the Double Arrow Metabolism Wellness Index. I don't blame you. I've been there. You creep up on middle age and watch a couple close friends or family members get sick or die, you get a little disgusted with what you do for a living, you start to search for meaning. But you also can't help but cushion the hard bedrock of that dread and regret with things: donuts or steaks or a new car or a bigger house because "you can't take it with you."

But those things won't make you happy. You know what makes people happy? Mastering something. Autonomy. Friendship. Not stuff. Think of the courage on display at the average grade-school talent show. The kids have just begun to feel self-conscious, but it hasn't yet shaded out the old-fashioned fear of separation from the safe anonymity of the crowd. But they get up there and show a skill they've practiced, and they walk of the stage smiling. That's what it feels like to take control of your life. 

I know this sounds angry. But it's not. It's just honest. It's honest to what I believe are essential truths. Happiness runs along a path that you set, not a path that the big pharma companies or the food companies sets for you. So with the New Year creeping up on you, what are you going to do? Make another New Year's resolution to do some meaningless thing like "just park as far from the door of Wal-Mart as you can"? 

No. 

I'm an anti-incrementalist. The proper advice, if delivered by a physician being intellectually honest (that's me) about what would be best for a patient looking to be healthier and happier would not be to park further from the Wal-Mart entrance, but would go something like this: Leave the car at home. Don't go to Wal-Mart at all. But if you do, walk there, bike there, or bus there. The trip will be good for your body and your mind, and the lack of a fancy gas-powered wheelchair will keep you from buying a bunch of crap you don't need and spending money you'd be better off saving. And that will keep you from worrying about retirement or working extra hours (or years) at a job you don't like to pay for all the crap you just bought.

Walk to the store with a list of items that you settled upon after appropriately scolding yourself for almost falling into the consumerist trap that purveyors of early-twenty-first century crap want to snare you in. Use the list to buy those things, then walk out and walk home. Or bike or bus. If you don't think you can get home with the amount of groceries you need, get on Craigslist and buy a bike trailer.

Here's one that I found in ten seconds that you could undoubtedly have for $50 or less (or one tank of gas for the adult Tonka Toy)

Here's one that I found in ten seconds that you could undoubtedly have for $50 or less (or one tank of gas for the adult Tonka Toy)

My rig on a day when my kids had let their hedonic adaptation get the best of them and hadn't ridden to school. I delivered their bikes so they could ride home. 

My rig on a day when my kids had let their hedonic adaptation get the best of them and hadn't ridden to school. I delivered their bikes so they could ride home. 

Do you live too far from Wal-Mart or Super Target to walk, bike, or bus? Find a closer store. Chances are it's smaller, and they'll work harder for your business. Can't find one at all? Move. Move to the smallest house you can find that's within human-powered range of your job, a grocery store, and a park or university campus. The average new home in 1950 was under 1000 square feet (and the average family aimed for six people under that roof).

There. There's one item for your 2018 resolution. What else can we come up with that will make you happier?

1. Delete your social media accounts. If that's too drastic, delete the apps off your phone and make yourself go to the website. That's all the incrementalism you'll get from me. 

2. Go through your email inbox and unsubscribe to every non-essential mailing list. Modern email managers make this easy. This includes all the "discounts." They're a scam. Do you think you'd be sad if you didn't get your daily discount flier from Bed Bath and Beyond? 

3. Stop between the mailbox and the house every night and recycle every piece of mail that isn't a bill or a letter from a loved one or a magazine that you're actually looking forward to reading.

4. Stop reading this blog. Go hug a kid and offer to take her outside to play frisbee or go for a bike ride or memorize lines of Shakespeare together or pitch a tent.

5. Decide what you want to get good at and work toward mastering it. Enroll in lessons. Set aside time for practice. Now that your fifty minutes of daily Facebooking is freed up, you'll have more than enough time.