Author: Maria Yang, MD

Categories
Lessons Nonfiction

Thanks, Speedy Old Man.

When I lived in New York, my then boyfriend and I ran races with the New York Road Runners. Boyfriend was a much faster runner than me, but, given the literal thousands of other runners in each race, there were always people faster than him… including an elderly man.

One of the people who consistently finished ahead of Boyfriend was a man who was 30 years older than him! We’ll call this person Speedy Old Man. Sometimes Boyfriend was quick enough to finish seconds behind Speedy (Old Man), so we eventually learned what he looked like. (To be fair, this wasn’t hard: The wrinkles in Speedy’s skin and his thinning white hair exposed his geriatric status.) Speedy became both a target and an inspiration: Could Boyfriend outrun Speedy this time? (No.) Or next time? (No.)

We automatically started checking Speedy’s race times after looking up our own. Speedy ran a lot of races! He was nearly always the fastest person in his age group! (Can you believe that he had competitors???) What a marvel: Speedy was prolific, persistent, and a paragon of successful aging.

In addition to leaving us in the dust, he left us feeling inspired.

Boyfriend became Husband, and then we moved out of New York. Despite living on opposite coasts, we still thought of Speedy whenever the New York City Marathon made the news or when the YouTube algorithm introduced us to elderly athletes.

We recently watched elite international runners race the rainy New York City 5th Avenue Mile. (The winner of the men’s race finished the mile in less than 3 minutes and 48 seconds!) This made us wonder about Speedy: Was he still running? (Was he still alive?)

The New York Road Runners race archive revealed that his last race was in early 2020. He was in his mid-80s! His age group ranged from 80 to 99 years old; he placed 3rd at a pace of about 12 minutes per mile! Incredible.

But what happened? There have been races since early 2020, but many other things had happened since then. Was he still running? (Was he still alive?)

After some sleuthing, I found his e-mail address and, pushing my reluctance aside, pressed send after writing this note:

My name is Maria Yang and I live in Seattle, Washington. I am writing to thank you for inspiring my husband and me.

We’ve never met, but my husband and I have “known” you since 2008 or so. At that time, he and I lived in New York City and routinely ran in NYRR races. My then boyfriend and now husband was consistently impressed / playfully irked that you consistently beat him in NYRR races, given the 30+ years of difference in age. 

Since then, both in New York and since moving to Seattle, we have periodically thought of you. We enjoyed the idea that you were still running and inspiring people of all ages with your running and speed.

Today we watched the NYC Fifth Avenue Mile race on YouTube, which made us think of you again. We looked up your results on the NYRR results page (sorry that this is creepy behavior; we also found your e-mail address here) and were amazed with your results from your races in 2019 and 2020. We hope that we ourselves will still be running and racing when we are in our 80s. 

We hope that you and yours remain healthy and well. Thank you for offering a valuable perspective on successful aging and for the inspiration you offer to runners of all ages and abilities. Your influence is transcontinental! 

No automated e-mail bounced back to tell me that the address no longer existed. I released any expectations of a response–I just wanted to thank him.

I squeaked when I saw Speedy’s name in my mailbox. Two days had passed and he had sent a response!

Maria: Thank you for your email. Although I can no longer run, I do aerobics and strength training as much as I can. I believe that this has really helped me in my life. My last race was a 5K [in early] 2020. Although I was in the last corral and finished behind almost everyone else, I really enjoyed doing it. Speedy Old Man

He wasn’t running, but he was still alive! And was willing to respond to a stranger on the internet!

I immediately forwarded this to Husband and, when we saw each other later that day, we beamed. What a gift.

One of the later reactions I had to Speedy’s e-mail was sadness and anger. I don’t know why he can no longer run, but it seems likely that the pandemic was a contributor. Maybe he got infected with Covid in 2020. Maybe he became ill with something else and couldn’t access medical care because of the pandemic. Maybe, like one of my beloved family members, he became deconditioned and his mobility drastically declined.

The pandemic has taken so much from so many people.

I learned this lesson upon the death of my mother, though the pandemic reinforced it: If you want to thank someone, don’t hesitate. Thank them as soon as you can. Tell them what they mean to you, what they did that you appreciate, how they have made your life better. Time is short. If you wait, you may never again have the chance to offer the gift of your attention and thanks.

Thanks, Speedy Old Man.

Categories
Homelessness Nonfiction Policy Public health psychiatry

Age and Vulnerability.

She was unprepared: One woolen blanket was wrapped around her shoulders. The other one was spread out so she did not have to sit directly on the ivy and weeds crawling across the hillside. A nylon sheet was rumpled by her side. Behind her was a pushcart that held a thin roll of garbage bags and a small empty cardboard box. There was no tent or sleeping bag. Though there were other people higher on the hillside, there was no one within earshot.

Most of the pages in her notebook were blank. The pen ink was bright turquoise; her penmanship was small and neat.

Small metal studs adorned her ears and a chunky chain was around her slender neck. Her hair was dyed an unnatural color and showed no signs of fading. The only hints that revealed that was not brand new to the hillside were the dust on her fashionable sneakers and the dirt that was collecting underneath her short fingernails. She also said that her phone had run out of charge.

She is not yet 20 years old.

I don’t expect that they are still alive, though I still think of them even when I’m not visiting New York City.

I met her when she was in her mid-60s. She never told us where she slept, though we reliably found her at the ferry terminal. Her fingers moved the needle and thread with ease to close the hole in her sock. She kept spools of thread in a plastic container that sat on the bundle of clothes she packed into her pushcart. Despite our best efforts for over two years, she never accepted housing: “The aliens will exterminate me if I go inside.”

I met him when he was in his 70s, or so we thought. No one knew his birthdate; he never shared this information. He buried himself between mounds of full trashbags or folded himself into cardboard boxes lining the curb. On the few occasions he spoke, the thinness of his voice—sometimes so faint that it seemed that only wisps of his speech reached my ears—betrayed his age.

Back here in Seattle, as elsewhere, there are people in their 70s and 80s who live outside or in shelters.

People under the age of 25 who are on their own and homeless are called “unaccompanied youth”. They are “considered vulnerable due to their age”. These unaccompanied youth make up about 5% of the homeless population in the US.

As the US population ages, people who are homeless are also aging. A study of homeless people in California found that 47% of all homeless adults are 50 years of age or older. Even more alarming, nearly half of all homeless people over 50 years of age first became homeless after they turned 50 years old!

Why do we consider “extremes” of age (though being in your late teens or your 70s is not actually “extreme”) as a factor that contributes to vulnerability when homeless? If you’re a 51 year-old man and you don’t know where you’re going to sleep tonight, doesn’t the variable of not knowing where you’re going to sleep tonight automatically make you vulnerable? Sure, you may have the size and mass to successfully defend yourself if someone attacks you or the ability to endure nighttime temperatures, but is that really where we’ve set the bar for vulnerability?

Categories
Consult-Liaison Medicine

Analysis of How a Baseball Team Responded to Alcohol Misuse.

Three glasses of alcohol with ice cubes in the foreground.

Related to my ongoing efforts to be a better spouse by learning more about baseball: On August 1, 2023, New York Yankees pitcher Domingo Germán was reportedly intoxicated from alcohol and ended up “flipping over a couch and smashing a TV” in the team clubhouse.

The New York Post further reported that he

was held in a sauna as the team tried to get him to sweat out the alcohol.

He was then placed in a team nap room as team security watched over him, but it’s uncertain when he left Yankee Stadium.

The Post also reported: “Witnesses determined that Germán was under the influence of alcohol and did not appear in control of his emotions.”

Germán ultimately “[sought] treatment for alcohol abuse”. Other outlets reported that he voluntarily went to residential treatment and will not play for the Yankees for the rest of the season.

Let’s discuss.

Humans do not “sweat out” alcohol. We each have an amazing organ called the liver, which is the primary organ that metabolizes alcohol. Enzymes in liver cells break down the alcohol so it is no longer toxic. (… though some groups, like some East Asians, may have a bum version of this enzyme, called aldehyde dehydrogenase.) Though skin is the largest organ we have, it does nothing to make alcohol leave the body faster.

Note that even pro-sauna sites discourage people from using saunas to sober up.

Putting Germán in a sauna could not help him get sober faster.

Livers work at their own steady pace to clear alcohol. The enzymes that break down alcohol do so in a “linear” fashion, meaning that the same amount of alcohol leaves the body over time. It doesn’t matter how much alcohol is in the body.

In the United States, the legal blood alcohol level is 0.08%, which means there are 0.08 grams of alcohol in 100 milliliters of blood. Because decimals require more precious brain power, we can convert that to 80 milligrams per deciliter of blood. And we’ll abbreviate that even more and just use the number 80 when talking about blood alcohol concentration.

Because livers break down alcohol in a linear fashion, we can talk about blood alcohol concentrations decreasing by a fixed number per hour. While in training, jaded and cynical health care professionals taught us that anyone who comes into the emergency department intoxicated with alcohol has an alcohol problem.

“Their blood alcohol level will drop 30 points an hour,” they said. This means that if someone came in with a blood alcohol concentration of 200, their blood alcohol level would drop to zero in about seven hours.

This rate is likely an overestimate. While it is true that people who routinely drink large amounts of alcohol will have livers that will metabolize alcohol faster (because, remember, your amazing liver is looking out for you and wants to get that toxin out of your system as soon as possible), most livers aren’t breaking down alcohol at 30 points an hour. This paper suggests that most people metabolize alcohol anywhere between 8 and 32 points an hour.

Putting Germán in the nap room did not help his liver work faster, but at least gave his liver a quiet space to do its amazing work.

No one is “in control” of their emotions. Emotions happen. They often give us valuable information about ourselves and the world around us. We are more likely to have some control over our behaviors. There seems to be a conflation of “emotions” and “behaviors” in baseball (see “Mariners’ Jarred Kelenic breaks his foot kicking a water cooler, makes emotional apology to team“.) They’re not the same thing. You may feel anger at someone, yet restrain yourself from punching them. Or frustration with yourself, but not drink alcohol or kick something.

Dr. Viktor Frankl shared wisdom about this:

“Between stimulus and response there is a space. In that space is our power to choose our response. In our response lies our growth and our freedom.”

Sure, emotions might cram into that space between stimulus and response, but a gap can appear where we can choose what behavior to do next.

“Voluntary” entry into residential treatment for alcohol misuse doesn’t mean there wasn’t coercion. Indeed, people may not be forced into rehab, but there might be conditions (e.g., if you don’t go into rehab, we’re kicking you off the team; or “interventions”, as John Mulaney described in his stand up special). To be clear, I have no idea what happened: Maybe there wasn’t any coercion at all. The timing just seems… curious.

If Germán actually entered treatment on the day reported, that’s remarkable (though not surprising): For people or corporations with gobs of money, you can pay for quick access. For people who don’t have money, it often takes weeks or months to enter residential treatment for substance use.

This was perhaps the most jarring aspect of the story for me: Where were the doctors? Sports teams have psychologists, physicians, and other health care professionals. Did they not know about his reported intoxication and behavior? Any one of them could have stopped the nonsense of sauna “treatment” and promoted rest, hydration, eating, etc. If they knew and didn’t do anything, that’s worrisome: What got in the way?

If they didn’t know, I’m not sure if that points to problematic team dynamics or stigma. Alcohol misuse and alcohol withdrawal can cause literal disease and death. Did the team want to hide Germán’s substance use from the team doctors? Did team members simply not recognize that alcohol misuse is a health problem that responds to psychological and health interventions? Did the team health care professionals view alcohol misuse as outside of their purview?

Although deaths from opioids (especially fentanyl) are getting a lot of attention these days, way more people suffer injuries and die from causes related to alcohol. I hope that Domingo Germán and anyone else who has alcohol overtaking their lives will receive useful support and won’t be relegated to saunas and other bunk interventions.

Categories
Homelessness Reading Reflection

Words and Sounds.

The reason behind my recent silence here is I am attending to a beloved family member whose health continues to deteriorate. Surely other medical professionals have written about the difficulties of our roles and responsibilities: We are not (and should not be!) doctors or nurses for the ones we love, though it is difficult to push the professional knowledge out of our minds. Sometimes (often?) it doesn’t feel like love is enough, even as we realize that our professional knowledge isn’t enough, either.

I have spent most of my career working with people experiencing homelessness. I don’t recall newspapers and other media writing about this topic as much as they do now:

Homelessness is a federal problem. Was there ever a time when the feds tried to solve the problem of people having no place to live? What is the history of homelessness in the US?

Well, there’s actually a FREE, short paper (it’s an appendix!) from a long report about permanent supportive housing with the title “The History of Homelessness in the United States“. That article led me to the book Down and Out, On the Road: The Homeless in American History. I’m about 80 pages in and, so far, it’s not encouraging. The arguments and opinions about homelessness from 100 and 200 years ago are similar to what we hear now in 2023 (deserving vs. undeserving poor, work tests, etc.). I’m hoping the author will describe the intersections of homelessness (“vagrancy”) and health, including substance use (alcohol? opium?) and mental illness.

If this problem were easy to solve, we would have already solved it… right?

The inimitable Ed Yong is leaving The Atlantic! His stellar writing about Covid over the past three years were invaluable to me: Not only did he provide meaningful analysis about how Covid was affecting individuals and populations, but he also accurately captured the horror of what was happening.

In his recent newsletter, he shared the following:

… I want to double down on my journalistic values: not only describing what is happening but helping people actually make sense of it; bearing witness to suffering; speaking truth to power; revealing wonder in the obscure; and pushing for a more just and equitable world.

He has succeeded in adhering to his values (and received a well-deserved Pulitzer along the way). This has prompted me to consider what values I hold in my writing. (Are the values I hold in my professional role transferrable to my writing? Is writing part of my professional role? Why am I mincing my life into roles when they are interconnected, as per the first paragraph of this post?)

Let’s end this post with some lighter fare:

  • 15 Relaxing Mario Jazz Medley (just go listen)
  • If you’ve seen the Barbie movie: I know most people are fawning over the song “I’m Just Ken”, but “Push” is the underrated gem. I’ll never hear the word “granted” the same way again.

Categories
Nonfiction Observations Seattle

The World’s Largest Baseball.

The "back" of the "World's Largest Baseball" at the MLB All-Star Play Ball Park in Seattle.

For those of you who read my last post, I have an update: I saw the World’s Largest Baseball!

In addition to sharing my impressions about this artifact, I will also shout into space my opinions about Play Ball Park, where the World’s Largest Baseball currently resides. (Important context: Because this giant ball was in the free portion of Play Ball Park, that is the only part of the park I visited.)

Access. I will, no doubt, go on for way too long about access to Play Ball Park. (This is an excellent example of attentional bias. Because of the work I do, I am often thinking who can and cannot access care. I regret to inform you that I am now going to carry on about access to the World’s Largest Baseball.)

In order to enter Play Ball Park, you must download an app so you can show a QR code on your phone to the gatekeepers.

  • What if you don’t have a smartphone?
  • What if you don’t have a robust data plan with your cell phone carrier? (MLB does not provide clear orientation about how you must have this app. A lot of people who wanted to enter the park ended up loitering outside the gate to download the app and complete the questionnaire—more on that in a moment. If MLB made it crystal clear on its website that you need this app to access any part of the park, even the free portion, people could have gotten this app somewhere with WiFi.)

The app asks for your name, date of birth, home address, and contact information. Sure, you can lie, but I’m just speaking to the principle here. Why does MLB need to know this information? (You and I both know why, but just indulge me.) Must I share this data when I just want to see a giant baseball? (I’m turning into that Old Person who is paranoid about sharing personal information… even though I maintain a blog that allows me to shout into space.)

To be fair, most, if not all, people who go to Play Ball Park have a smartphone. And most people in this area have home internet access (per the US Census, over 93% of King County households have a subscription to broadband internet), so most are familiar with apps and their data-gathering ways.

The World’s Largest Baseball is not a true baseball. It has a diameter of 12 feet and there are numerous autographs from baseball luminaries on one side. (The photo accompanying this post shows the “back” of the baseball.) Guests are not permitted to touch the baseball or sit on the base. It looks like it is made of metal or other hard material. The red stitching appears to be plastic bumps that are attached to the surface. The panel on the “side” of the ball is secured with bolts and nuts that are painted baseball white. The ball does not appear to be a complete sphere; it looks like the bottom of the ball is flat so it sits flush inside the red base.

Even though the World’s Largest Baseball is a fraud, I still took a photo with it. Who knows when I will see an enormous fake baseball again?

Two Clydesdale horses in separate cages adorned with red Budweiser trim.

The Budweiser Clydesdales were in cages. They are large horses. I don’t know if they ever come out during park hours. Few people were looking at them. This entire situation made me sad.

The author standing behind a life-sized cutout of Mariner Julio Rodriguez; both are smiling.

Fake ball, real smiles? (Julio was the only cutout who was smiling.)

There was a significant police presence in and around Play Ball Park. David Gutman with the Seattle Times wrote a thoughtful piece about the “two Seattles on display as thousands attend MLB All-Star festivities” that has relevance here. Seattle Police was out on foot, on bikes, and in vehicles. It’s been a long time since I’ve seen so many law enforcement officers; it’s not often that we’re surrounded by so many people carrying lethal weapons. It’s not that I felt more or less safe; it was just unsettling to see the amount of firepower amidst a sea of baseball jerseys.

The trains were packed this afternoon for the Home Run Derby. For a few moments, I was transported back to the New York City subways: Standing room only, holding onto poles and straps in awkward angles, and taking shallow breaths to cope with body and breath odors. However, people here were only passive-aggressive (“it would be nice if people moved down more”) versus just plain aggressive (“MOVE, PEOPLE”). I did not need to throw my elbows to escape the train when I got to my stop.