Summing Up My Summer

“But that's the glory of foreign travel, as far as I am concerned. I don't want to know what people are talking about. I can't think of anything that excites a greater sense of childlike wonder than to be in a country where you are ignorant of almost everything. Suddenly you are five years old again. You can't read anything, you have only the most rudimentary sense of how things work, you can't even reliably cross a street without endangering your life. Your whole existence becomes a series of interesting guesses.” 
― Bill BrysonNeither Here Nor There: Travels in Europe


Been spending the past weeks writing here in the mountains surrounding Asheville.  For now I will publish some of the images from the short time I spent in and around Hanoi.

Back from Spain

Back in the United States.  It's wonderful here.  


Have mostly slept for a day and now am faced with a lot of administrative things that have built up in the weeks I've been gone.

The Camino de Santiago was better than imagined, many stories and images to follow.  Many people I'm blessed to have met.   Southeast Asia and Scandinavia had their own magic.  I have a remarkable life.

More to come.  Just wanted to say 'hi'.

I was fishing tonight after clinic and a guy rode up on a horse and asked me how it was going.

"Many men go fishing all of their lives without knowing that it is not fish they are after."

-H.D. Thoreau 

On Focus

29 April 2014


We live at a wonderful, amazing, stimulating time.

Our careers.  Broadband.  LTE.  Always on.  Hiking clubs.  Productivity.  Running magazines.  Tumblr.  Text editors.  iMessage.  NPR.  


For the contrast it offers, I love having lived my life with one foot in two generations.  I grew up with 2 or 3 favorite shows on a 7 channel no-remote black and white television.  We had a rotary telephone.  I played alone or with friends until sunset down the street or in the woods.  And now I am a young professional with an iPhone, a Kindle library, frequent flier clubs, and digital cameras , image processing, and publishing.  My stethoscope can amplify a human heartbeat by 18 times and eliminate all extra sounds in the room.  An amazing leap in a short lifetime. 

But given our good fortune, I think a lot of people my age struggle daily with an issue difficult to identify.  We have too much access and too many options.  

I watched the Eric Steel documentary Kiss The Water the other day- instantly, through iTunes, on Apple TV of course.  I was moved by the story of a Scottish woman, Megan Boyd who dedicated her life to the craft of tying fishing flies.  And not just general trout or bass flies- only salmon flies.  She did this from sunup to sundown in a riverside home with no running water or electricity.  She would go to the local community center for dance classes once a week and would go on a hike every Sunday so clients couldn't find her on a day of rest.  That was her whole life and she loved it.  She was so good at what she did she was awarded the British Empire Award by Queen Elizabeth II.  

The movie is very PBS in it's documentariness, with many meditative pauses, gorgeous animated interludes, and a thoughtful score  telling a clearly told story.  It was a brilliant setup for reflection.


Several days later I read Frank Chimero's essay No New Tools- via Flipboard, rebroadcasting Twitter, digesting Tumblr and saved to Pocket of course.  In the essay he discusses the need for new systems versus new apps and a commitment  to not reaching out and sampling every new digital tool that becomes available to get your writing, publishing, image editing or communicating done.  

And I've been reading too much Hemmingway lately with those damned crisp, distinct sentences.

I grew up reading the story of country GP's- family doctors of old who settled into a community for the next 30-50 years delivering generations of children, setting the fractured bones the children they delivered.  They spent their yearly 5 day vacations on a lake within hours of their town and dedicated themselves whole-heartedly to their community and their craft.


Young doctors today are focused on our debt, building families, vanishing retirement strategies, maintaining a 'balanced life' with hobbies and friends, and are rewarded with careers as short as 6 to 11 years due to burnout and depending on our specialty.  Look at me-  an extreme example of professional ADHD- somebody whose medical community changes every 3 months to a year as the next adventure or mission calls.

Many of us on the webspace are consumed with minimalism, simplification of our material lives, and a thoughtful examination of our existence.  But I think the tools that allow us to do this, specifically the digital ones, can cloud our focus and distract us far worse than those things that are at best boring and at worse deleterious to work: a typewriter, a paper medical record, a notebook and pen, or the same coffee brand and percolator for twenty years.

I am grateful beyond imagining for the tools and resources available to me today.  But I'm also happy for some recent incentives that are giving me pause and making me reconsider focus and condensation in my profession, my art, and  my hobbies.  How can I increase mindfulness and purpose as a physician, a writer, a photographer, a hiker, a traveller, a fisherman, a cyclist?  How do I pare down the meaninglessness and immerse myself while living in the digital information age and taking advantage of these wonderful resources?  I need to make sure the answer isn't a new meditation timer on my iPhone, another productivity Audible book,  or a new hobby.  Hopefully it can be reflection, discussion with my loved ones and peers, and being honest with myself while living an examined life.


All images by Em Cooper from Kiss The Water - A Love Story by Eric Steel.  Rent it or purchase it on the iTunes Store here.

Read Frank Chimero's - No New Tools here.

John Gierach on Running Wild


"Chances are you’re raised in the country or in a small town surrounded by country: someplace where you can easily walk or ride your bike to the edge of what until recently had been the known world, and then on into the fields, woods and creeks beyond. Some of this is private land and you occasionally have to crawl through a barbed-wire fence to get on it, but the niceties of ownership are left to the adults to sort out. To a kid, it’s all just unpopulated and there to explore. The first time a farmer yells at you for trespassing, you honestly don’t know what he’s talking about.

You’re equipped for this wilderness with a hand-me-down folding knife and the Army-issue compass your father brought home from World War Two. The weight of these items in your pocket feels comfortingly substantial; although you understand only in a theoretical way that the compass is some sort of insurance against getting lost. You haven’t yet learned the hard lesson that it doesn’t matter where north is if you don’t know which direction you came from. In addition to the knife and compass, you have a cane fishing pole with a line stout enough to land a tarpon, as well as a slingshot that seems potentially lethal but maddeningly inaccurate. You also have a crude homemade spear that you keep hidden because you know Dad will ask what you plan to do with it and you won’t have an acceptable answer. Taken together, these items constitute the beginning of a lifelong fascination with the tools of sport. You experience the kind of freedom that will be unknown to future generations.

This is the 1950s, when kids are still allowed to run wild as long as they’re home by dark. It’s also a time when low-grade delinquency—like trespassing, truancy or the odd fistfight—comes under the heading of “boys will be boys.” You might get scolded or spanked, but you won’t have to undergo counseling. Like all children, you take your play as seriously as any young predator."

-John Gierach

All Fisherman Are Liars