When I recently submitted an article to Stat News, one of the first questions was straightforward:

“Was this written by you or by AI?”

The answer turned out to be more complicated than I expected. Of course, AI can write a term paper. But I don’t like it. I like my own voice.

The ideas are mine.

The stories are mine.

The opinions are mine.

The first draft is mine. Dictated.

But AI is almost always somewhere in the process.

Not as a ghostwriter.

More like an editor who never gets tired. ‘I like this part. This part is weaker.’

It is hard to avoid news about AI these days.

Every week brings another prediction.

Millions of jobs disappearing.

Massive data centers consuming enormous amounts of electricity.

Businesses racing to figure out how to use AI.

Investors trying to figure out who will win and who will lose.

I understand the concern.

If I were twenty-five years old and deciding on a career, I might view AI differently than I do now.

But at this stage of my life, I am less interested in predicting the future than I am in understanding what is happening.

I’ve always been quick to experiment with new things, so I started trying everything I could get my hands on.

Claude.

Gemini.

ChatGPT—or just “Chat,” as I call it.

DeepSeek.

Grok.

One thing I noticed right away is that they don’t feel exactly the same. Each has its own personality and style. Some people will prefer one over another. The only way to know is to spend some time with them.

Before I go any further, I’ll get something out of the way.

I realize AI has the potential to do disruptive things.

Harmful things.

But every major technology arrives carrying both possibilities.

When the internet appeared, many people assumed it would become little more than a giant delivery system for pornography.

Social media was supposed to make us more connected. Instead, we discovered that isolation can sometimes be a more profitable product than connection.

Atomic physics gave us both atomic energy and atomic weapons.

Science rarely pauses to ask permission before moving forward.

AI is global.

I’m not going to stop it.

Neither are you.

So my approach has been simple.

Understand it.

One thing that surprises me is how many people think they need training before they can use it.

A friend recently told me she wanted to try AI but hadn’t finished the course she was taking yet.

I laughed.

Not at her. At the moment.

Because I’ve heard versions of that concern from a number of people, especially older people.

They worry there must be a right way and a wrong way to talk to it.

They worry they’ll ask the wrong question.

Or somehow break something.

I always think of my mother.

For thirty years I tried to get her to use email.

Then texting.

Her answer was always the same.

“No. I’ll break it.”

Of course she wasn’t going to break it.

And you aren’t going to break AI either.

Sometimes I think people imagine a warning message popping up:

USER FAILED TO PROMPT CORRECTLY.

PLEASE RETURN TO PROMPT SCHOOL FOR REMEDIAL TRAINING.

The reality is much simpler.

Just talk to it.

Use your own voice.

That was my entire strategy.

I started by telling it about myself.

My education.

My family.

My hobbies.

The books I enjoy.

The movies I enjoy.

The things that interest me.

The things that annoy me.

I even told it how I wanted it to respond.

Don’t flatter me.

Don’t tell me something is good if it isn’t.

If we’re talking politics, don’t simply agree with me.

Challenge me when appropriate.

Be as neutral as possible.

Those instructions have occasionally been annoying. Sometimes I would prefer my opinions be applauded.

But they have also forced me to reconsider ideas that I once held very confidently.

And that is where AI became interesting.

Not because it had answers.

Because it provided structure.

History was where I noticed it first.

Questions that had floated around in my head for decades suddenly became easy to explore.

What was the Middle East like before World War I?

How did the Crusades look from both sides?

What were people actually thinking during the Cold War?

Why do conspiracy theories spread?

One question led to another.

Then another.

Then suddenly it was one in the morning and I was reading about dinosaur evolution.

I grew up knowing maybe five dinosaurs.

Now I can spend an hour learning about species discovered within the last decade, where their fossils were found, and how 165 million years of dinosaur dominance eventually gave way to a tiny mammal lineage that produced humans.

Those rabbit holes are hard to leave.

Cooking was next.

I use AI for recipes several times a week.

I can tell it I have leftover pork, peppers, rice, lentils, and a refrigerator full of sauces.

Within seconds it gives me three dinners.

But the bigger change is that it helped me become a better cook.

I stopped obsessing over measurements.

Instead I started thinking about balance.

Acidity.

Sweetness.

Texture.

Brightness.

Depth.

The machine wasn’t just giving me recipes.

It was teaching me how to think about cooking.

Then came writing.

Like everyone else, I was tempted to let AI write for me.

That experiment lasted about two weeks.

The problem was simple.

It didn’t sound like me.

It sounded like AI.

So I changed approaches.

Now I dictate.

I talk.

I wander.

I repeat myself.

I start a sentence, abandon it, and start another one.

Then I ask the software to clean things up without changing my voice.

Remove repetition.

Delete the false starts.

Keep the rhythm.

Keep the personality.

The result still sounds like me. Like conversations I used to have with patients.

Just a version of me that gets edited by someone who never gets tired.

The most interesting change, though, has nothing to do with history, cooking, or writing.

It has to do with understanding people.

The longer you use one of these systems, the more context it accumulates.

Late at night I might ask why one of my children reacted strongly to something that seemed perfectly reasonable to me.

Or why younger generations view certain issues so differently.

The answers aren’t always correct.

But they often introduce perspectives that would never have occurred to me. Why one of my kids was annoyed by a joke I shared from Richard Pryor.

In that sense, AI is less like a therapist and more like a mirror with a thousand angles.

It doesn’t tell me what to think.

It shows me possibilities I hadn’t considered.

Every headline seems to focus on jobs that might disappear.

Maybe some will.

But professions have a habit of adapting.

The routine work—collecting information, organizing it, summarizing it, moving it from one place to another—will certainly become easier.

The harder question is what people do next.

My guess is that there will be greater value in seeing patterns.

Understanding context.

Looking at a spreadsheet and recognizing what matters.

Reading a scientific paper and understanding where it fits into the bigger picture.

And perhaps that’s why AI appeals to me so much.

I’ve never been particularly interested in categories.

I’ve always been interested in connections.

One of my favorite old sayings is that specialists learn more and more about less and less until they know everything about nothing, while generalists learn less and less about more and more until they know nothing about everything.

I’ve always belonged closer to the second group.

My career wandered through neuroscience, anesthesiology, psychiatry, addiction medicine, investing, writing, history, and whatever else happened to catch my attention.

What I eventually realized is that AI is surprisingly good at connections.

Not just retrieving information.

Connecting information.

Holding multiple perspectives at the same time.

Helping me see relationships between things that I might otherwise have considered separately.

People often describe AI as a search engine.

That isn’t how it feels to me.

It feels more like a thinking partner.

Not a human mind.

Not consciousness.

Not wisdom.

But a system capable of holding more perspectives simultaneously than I can.

Enough perspectives that it sometimes helps me notice the limits of my own.

Whether that realization makes you excited or frightened probably depends on your temperament.

For me, it does both.

I come home and give my wife a full report.

Good talk with the butcher.

Woman near self-checkout.

Guy in produce with extremely strong opinions about tomatoes.

There’s a guy in the meat department who always yells “Hey Doc!” when he sees me.

I always stop and talk with him for a few minutes if he isn’t busy.

And there’s always something unexpected.

Yesterday the woman usually behind the butcher counter was over in produce selling seafood.

We ended up having a short discussion about crab legs.

Specifically, how frustrating it is to spend fifty dollars on crab and end up with three bites of meat after half an hour of excavation work.

She agreed.

I skipped the crab.

Honestly, shopping for me isn’t really about the shopping.

It’s about the mission.

A mission without enemies.

Just some scattered civilians.

I establish a base camp with my cart at the end of the aisle.

Then I head out alone on reconnaissance.

Fast movement.

Minimal exposure.

Walking past civilians.

Women moving slowly down the aisles, scanning shelves left to right.

Different rhythm entirely.

Scanning shelves.

Moving jars aside and looking behind them like I’m searching a jungle trail.

Surely there’s another jar of my favorite Kalamata olives hidden back there somewhere.

Then back to camp.

Recheck the assignment sheet.

Proceed to the next objective.

On my final mission, I spotted something ahead of me in the aisle.

At first I couldn’t quite figure out what I was looking at.

About six feet tall. Thin. White plastic.

Moving in tight little loops like he’d misplaced something important.

Halting.

Turning slightly.

Backing up.

For a moment I had the strange sensation that I’d been asleep for a hundred years.

Then he stopped in front of the liquor department.

He seemed uncertain whether to go in or keep moving.

I could relate.

I stood there for a minute and watched him work.

He seemed about right.

Moving past something.

Stopping.

Backing up.

Turning in a circle.

I’ve done that myself many times.

Especially lately.

When I noticed Taggie, he wasn’t pushing anything.

Still… he moved like a guy.

Like one of us sent into the store to find something with only partial information while our wives stayed home doing… whatever it is they do on Sunday mornings.

A little farther down the aisle, I spotted a woman in the standard peacekeeper uniform.

Green Festival Foods shirt. Name tag.

Our eyes met and, for some reason, we both started walking toward each other.

“What the hell is this thing?” I asked.

“Oh, that’s Taggie,” she said. “He scans the shelves and tells us what needs to be restocked.”

Definitely a he.

Why did I think that?

No idea.

Probably some deeply buried sexist algorithm running inside my own brain.

Still… he moved like a guy.

One of us.

As we talked, I found myself studying her face a little.

Waiting for some flicker of concern.

After all, this six-foot tube with a camera was literally rolling around learning parts of her job.

But she just smiled.

A big, easy smile.

She didn’t seem threatened at all.

Taggie wasn’t competition.

Just another coworker.

Someone else who deserved a good job.

After talking with the peacekeeper, I wandered back toward self-checkout.

Passed other peacekeepers standing patiently behind their counters.

For whatever reason, I prefer my lazy self-scan friend.

Picked up my bags.

Smiled at the peacekeepers near the exit.

“Thank you. Come again.”

The sun hammered my back as I dragged the water cart across the Grand Avenue bridge—three hundred pounds of sloshing water in a forty-gallon drum welded to a go-kart base. Let the guy who built it try pulling it across town.

It was summer after freshman year at Carroll College. My job was planting flowers and trimming bushes for downtown businesses. Each morning was the same: retrieve the cart, fill it, pull it through downtown. And sweat. Always sweat. Four more days until I’d see Mary.

Damn, is it always this hot in May? I should’ve worn shorts. But this breeze—finally—wasn’t bad. I felt sweat drip down my back as I dragged the cart toward the riverfront parking structure, where I remembered a shady gap between buildings. I ditched the metal beast and slipped down to the water’s edge. Shade.

Two junior high kids were smoking a joint in the shadows. “What’s up?” I asked. They vanished. I had the darkness to myself. The river was high—normal for May. I sat on gravel, taking in the smell: mildew, concrete, and something acrid. I loved rivers. Even the stink felt familiar.

And then, a thought: What if someone needed saving here? The swirling current, the shadowed concrete, the echo of cars overhead—it felt like a place where something bad could happen. Would I go in? The question came with a chill. Not wondering—preparing.

Moments later, a sound cut through the quiet. A siren? A scream? Something was moving fast in the current. Too small for a raft. I stepped toward the edge and saw… a bundle? Clothing? A head bobbed up, then disappeared. A woman’s face.

No time. The river narrowed past the bridge into woods. If she got there, no one would see her. I sprinted along the bank, stripping off shoes, yanking down jeans. Calm now, weirdly calm. Like I’d done this before.

I dove from a concrete slab into the cold. It hit like steel. My chin went under. The water smelled like metal and strawberries—a trick from the sewage plant downstream.

She was thirty feet ahead. I swam hard, legs kicking shallow, fingers brushing past invisible junk—wire, shopping carts, maybe a snapping turtle. I grabbed her coat.

Her eyes were wide, mouth half-open. She clutched me with both hands. I pushed her off gently and held her coat instead, towing her with a sidestroke. The trestle passed overhead. Ground rose beneath my feet. We made it. I dragged her to shore.

Her face looked like The Scream, but with foam and bubbles. Was she breathing? Something blocked her throat—dentures, slick and hard. I pulled them out and tossed them. A breath. Faint, but real.

Across the river, some kids watched. “Get help!” I yelled. They vanished. Minutes later, sirens.

Firefighters and medics arrived with a stretcher. “We got it,” one said. He listened to her chest, rolled her onto the board.

I stood there in bright red briefs.

“Can I find my pants?” I asked.

“Questions first,” said the officer.

We walked upstream to my clothes. Why red today? I thought. My T-shirt said “Beloit’s Largest.” Great.

No one got a photo. But the story spread. “Hey, it’s Beloit’s Largest!” people said in bars. A little attention never hurt.

My boss gave me a ride home. “You did a good thing,” he said. The second most sincere thing I heard.

The first was from the woman herself, weeks later. Tiny, maybe eighty pounds. “Thank you for saving my life,” she said.

My parents were stunned when I got home early. Dad called the radio station. “They want you on the air!” he said, handing me the phone.

I mumbled: “I saw a woman drowning and jumped in the river.” That was it. Thirty seconds of fame. I had no idea how to be a hero.

Later, Kent and I smoked a joint at Leeson’s Park. “It was so messed up,” I said.

“So fucked up,” Kent replied, exhaling slowly.

A couple newspaper guys found us. My parents told them where to look, they said. We led them to the spot. In the days that followed, articles ran with headlines like Maintenance Man Rescues Woman from River and Valor and Selflessness Are Not Dead. One paper showed me with a stoned grin under my afro. Maintenance man? Better than college student.

For weeks, I wondered about that earlier thought—the premonition. Did I hear her somehow? No, too much time between. But I promised myself: Always remember what happened.

She was schizophrenic, they said. Known for yelling at women outside the grocery store. Some said it was a suicide attempt. Others said she wanted to see if she could swim.

I got some “hero” treatment downtown. But admiration faded. Then came the judgment.

At the hardware store, a guy loading mulch into his truck said, “You risked your life for a crazy BLACK woman?! What were you thinking?”

Outside the bank: “I bet you were surprised by what you saved… couldn’t you let her drown?”

These weren’t outliers. They were neighbors. Churchgoers. Good people—supposedly.

I watered flowers and kept my mouth shut. But I learned something that summer. Heroism isn’t rewarded for what you do, but for who you do it for. And sometimes, the world decides it wasn’t worth it.

But she thought it was. And that was enough.

https://kevinmd.com/2026/05/your-doctor-saved-your-life-but-wont-return-your-call-podcast.html

Not what I learned about medicine.
What I learned about everything else.

Overnight call in Philadelphia.

Work all day.
Run all night.
Maybe a couple hours in an OR.
Then work the next day.

The call came from high up in the MICU.

A senior resident.

“I need you to come intubate someone.”

I put on my long white coat.

Thick cotton.
My name stitched above the pocket.
A pocket that would eventually surrender to ink stains even bleach couldn’t touch.

In medical school we had short coats.

Those always felt like they belonged at a golf dinner.

The long coat meant something else.

At University of Pennsylvania, the anesthesia residents wore them.

I pulled it over my scrubs and went upstairs.

She was waiting in the center of the ICU.

“We need you to put a tube in that guy,” she said, pointing.

I walked in.

“How are you doing?”

As an anesthesiologist, you learn to do two things at once.

Talk—and scan.

IV access.
Monitor.
Work of breathing.
Can he finish a sentence?
Is he sweating?

He looked comfortable.

“I’m fine,” he said. “Who are you?”

BP normal.
Heart rate under 100.
Warm hands.

“Are you having trouble breathing?”

“I don’t think so. Why would someone say I was?”

“I’m just figuring things out,” I said.
“Your doctor thinks you might need some help breathing. You’d be sedated. A machine would do the work.”

He stiffened.

“I don’t want to go on a machine. Who said I need a machine?”

“It’s okay. We’re still looking at things.”

“Don’t put me on a machine.”

Now he looked scared.

“I’m fine.”

“Let me talk to your doctor.”

Back at the desk.

“He doesn’t want to be intubated,” I said.
“And honestly, he doesn’t look like he needs it.”

“He’s been going downhill all day,” she said.
“It’s one in the morning. I don’t think he’ll make it until morning. We need to deal with this now.”

“He doesn’t want it,” I said.
“You can let me know if you talk him into it—but right now it feels like an assault.”

“I didn’t call you up here for a debate,” she said.
“I just need you to put in the tube.”

“That’s not my job.”

“If you don’t do it, I’ll call my fellow.”

“Go ahead. If you want a discussion, I’ll call mine too.”

Mine was in the hospital.

Hers was at home.

He showed up in minutes.

Calm.

On the phone with her fellow.

Every so often, he glanced at me.
A small smile.

He handed her the phone.

“Let’s go.”

We walked to the elevator.

On the way down, we both stared straight ahead.

But I could see it—the hint of a smile.

“They’ll call if they need you,” he said.

I felt it then.

Relief.

Support.

A quiet sense that I had done the right thing.

“I’m sorry to wake you,” I said.
“Thank you for coming up.”

He looked at me.

Not smiling now.

“Yes,” he said.
“He didn’t need to be intubated.”

The doors opened.

We stepped out.

Turned in opposite directions.

And then he added—

“Next time, it might be easier to just put the tube in.”

Before you roll your eyes—stay with me.

Look at a map of the Persian Gulf.

Today it’s water. Tankers. Tension. A geopolitical choke point.

But 20,000 years ago, during the last ice age, it wasn’t water at all.

It was land.

A broad basin where the Tigris and Euphrates likely flowed together—spreading into wetlands, marshes, and freshwater lakes.

Not a fantasy.

A real place.

A place where life might have been just a little easier:

• reliable water

• animals moving through

• edible plants

• a kind of natural stability in an otherwise harsh region

And then the world warmed.

Ice melted.

Sea levels rose.

Not in a single, biblical moment—but slowly, relentlessly.

The ocean pushed in, inch by inch, year after year.

If people were living there—and it would be surprising if they weren’t—they would have watched it happen.

But they wouldn’t have noticed it first in the horizon.

They would have noticed it in the water.

Freshwater turning brackish.

Marshes that once supported life starting to fail.

Plants thinning out. Fish changing. Soil losing something you couldn’t quite name.

The same place—but no longer working the same way.

And that’s where something deeper begins.

Because when a world that used to sustain you starts to resist you—when food is harder to find, when the land feels less generous—people don’t think in terms of sea levels or saltwater intrusion.

They look for meaning.

Something must have changed.

Something must have gone wrong.

Something—or someone—must be responsible.

Genesis describes Eden as a place where one river becomes four—two we can still point to on a map, the Tigris and Euphrates, and two that seem to have disappeared into history. That’s usually where people stop. But if you imagine a time when the Persian Gulf wasn’t water but land—a wide basin where rivers spread, merged, and shifted—the description starts to feel familiar. Not like a diagram. Like a recollection. The kind of thing you’d say if you were trying to describe a place that once made sense, but no longer exists.

I’ve always been drawn to the idea that our oldest stories might carry echoes of real events.

Not proof.

Not literal history.

But memory.

A fertile land between rivers.

A place lost.

A sense that something important slipped away.

And maybe something else, too.

The feeling that the world had turned on you.

That something had been taken away—not suddenly, but steadily—and for reasons you couldn’t fully understand.

It’s not hard to imagine how that kind of experience might become something more than observation.

How it might become narrative.

How it might, over generations, take on the shape of judgment, of consequence, of a world that no longer behaves the way it once did.

We like to draw a clean line between science and story.

But they’re not as separate as we pretend.

Science reconstructs what happened.

Story preserves what it felt like.

And sometimes—if you look closely—they’re pointing at the same thing.

Only one is measured in meters of sea-level rise.

The other is remembered as paradise lost.

What do you think?

Do ancient stories sometimes preserve real events in disguised form?

Or are we just very good at finding patterns in coincidence?

It’s set in the 1950s, and for some reason that pulled me straight back to my dad.

We always had a ping-pong table in the house.
From as early as I can remember.

Dad was good.
Not just “dad good”—actually good.
He held the paddle differently. Put spin on the ball in ways I couldn’t read.

I still remember him in the basement.

The way he could send the ball back on a sharp diagonal—
then kill it with spin so it hit my side and just… stopped.
Dead.

His arm stretched out.
Eyes locked in.

The same look he had when I watched him play handball from the balcony.
Focused. Intent.

He wanted to win.

He let me win, sometimes.

You could always tell.

I didn’t think much about it at the time.

Apparently, ping-pong was a thing before I was born.

Lying in bed, I started thinking about his life.

He was born without a father.
Abandoned.

Hungarian.

For most of my childhood, I thought I was half German.
That’s what I was told.
I didn’t learn the real story until I was sixteen.

When I was young, we watched movies together.

Monty Python and the Holy Grail.
To Kill a Mockingbird.
The Bridge on the River Kwai.

All before I was ten.

That was our language back then.

Then I was gone for ten years.

When I came back, something had shifted.

We didn’t fight at first.
It was quieter than that.

We just didn’t understand each other anymore.

In 2008, it finally broke open.

A real fight.
The kind that leaves a mark.

We didn’t speak for a couple of years.

After that, we reconnected—but only on the surface.
Polite. Careful.
Not the same.

He died in 2013.

Things make more sense now.

I never gave him enough credit.

He raised me without ever having a father himself.
No model. No template.

And his life… was different.

World War II.
Infantry in France.
V-E Day in Paris.

All of that sat there, just under the surface.

We never talked about it.

I think now about how we might talk.

What I would ask.
What he might say.

It feels obvious that we would connect.

But that’s probably not true.

At the time, I couldn’t understand him.

And he couldn’t understand me.

That’s not unusual.
It’s probably the most common story there is.

Still—

I wonder.

What if I had been a little wiser?
What if he had been a little more patient?

I miss watching movies with him.

By the mid-80s, the work was done.
Or close enough.

Now it had to become a thesis.

On a trip back to Wisconsin, I went through my mother’s things.

Before she met my dad, she taught typing and shorthand. She still substituted now and then at my high school. In college, she typed a couple of my papers for me. A dollar a page saved.

Manual typewriter. Heavy keys. No forgiveness.

Too much pressure and a letter would come out darker than the rest, sitting there in the middle of a word like it didn’t belong.
She noticed those things.
I didn’t. Not until she pointed them out.

I took her books back to Rochester.

At night, I worked through them.

Hands positioned just so.
Eyes forward.
No looking down.

Two fingers at first, pecking back and forth. Then more keys, more reach, until the keyboard started to feel less like a puzzle and more like a place you could move around without thinking.

Around the same time, I bought a Macintosh 128K.

It didn’t push back.
You could hit the keys as hard or as lightly as you wanted. It didn’t care.

I loaded Microsoft Word from one of those thin disks. The whole program fit on one side. That alone felt like a trick.

Then came the typing program. And the game.

Letters falling from the top of the screen, faster and faster.
Miss one and they stacked up.

Like a stripped-down version of Space Invaders, but aimed directly at your fingers.

By the time I was writing the thesis, I could keep up.

Mistakes barely registered.
Backspace and move on.

No white-out. No pause. No starting over.

The thesis went over a hundred pages.

I built it ten pages at a time. Each file its own little container.
Save.

And then wait.

The machine would grind for five, sometimes ten minutes. Enough time to step outside, get coffee, walk half a block and back. You didn’t stand there watching it. That would have been ridiculous.

Printing was the problem.

I had a dot matrix printer. It chattered and sang and spit out pages connected end to end, perforated edges with those little holes running down both sides.

I tried to picture that stack bound and sitting in the university library.

It didn’t quite work.

Nancy fixed it.

She was working at an advertising agency. One night we went in after hours.

They had a laser printer.

No noise. No tearing edges. Just clean pages sliding out, one at a time, like they already belonged somewhere official.

I handed in the thesis.

Stacked, clean, permanent.

Now I watch people type on their phones.

In all of my mother’s books, all those careful instructions about posture and precision, there wasn’t a single line about thumbs.

Not once.

Except the space bar.
That was their whole job.

It was one of those awkward spots where three roads intersect, with cars coming from too many directions at once.

I was chatting with the pleasant guy at the checkout when a man on a bicycle rode past.

Then—bam.

A woman’s voice from outside: “Somebody call 911!”

I looked out and saw a man on the ground in the middle of the road.

People were already running toward him, so I ran out too.

A woman about my age had just arrived.
“I’m a doctor,” I said.

“I am too,” she said back.

That made me laugh, just a little.

I was closest to the man’s head, so I bent down and started asking questions.

“Do you remember your name?”
“Can you tell me your name?”
“Do you know where you are?”

Before I got very far, another woman’s head suddenly inserted itself between me and the bike rider.

“Where does it hurt?” she asked.

Then she looked up at me.

“I’m a nurse,” she said.

At that point I stood up and caught the other doctor’s eye for a second. The man was talking. People were there. Flashing lights were already coming from all directions.

So I stepped back.

Then I walked back into the dollar store.

Later, after dinner, my wife and I were driving home, and I said that if I’d really been thinking, I should have videoed the whole thing.

I could have gone viral.

Since I started TikTok, that’s become a running joke between us.

But the funny thing is—I didn’t even think of it at the time.

Not for a second.

There was no moment where I reached for my phone and stopped myself.
No internal debate.

Just a man on the ground, and people moving toward him.

And then I realized something else.

Nobody in that small group surrounding the injured man had a phone out.

Not one.

That struck me.

Because so many clips now look the same—people standing at a distance, arms extended, filming whatever is happening in front of them. Sometimes helping, sometimes not, but always recording.

And I caught myself wondering:

What flips that switch?

When does something become content… and when is it just something you step into?

When I was younger, people used to talk about the future—about video phones, about being able to capture anything, anytime.

I never imagined we’d all end up holding them like this. Arms out, watching life through a screen we’re actively creating.

It still looks a little strange to me.

I think back to ferry rides to the Statue of Liberty in the 1980s.

There was always someone with a camcorder pressed to their eye the entire trip.

A sailboat would pass. The light would hit the water just right. The skyline would open up.

And there he’d be—watching all of it through a rectangle.

I never knew who to feel sorrier for.

Him, for missing it.

Or the family members who would someday be expected to sit through the tape.

Things change without much notice.

Then one day you look a little closer and realize they haven’t changed as much as you thought.

The devices are different.

The instinct might be the same.

Capture it. Save it. Prove you were there.

Even if no one ever watches.

By the time we were getting close to Fond du Lac, I had one last thought.

Even with all the flashing lights, a man lying next to a bicycle in Menomonee Falls probably isn’t going to go viral.

Not enough distance.
Not enough spectacle.

Too close, maybe.

Too real.

And I’m not sure if that’s reassuring—

or if it says something about what we’ve decided is worth watching.

( BTW Tiktok: https://www.tiktok.com/@doctor.j.1 )

The problem wasn’t that it missed the future.

It was that the present worked too well.

Until the environment changed.

It filed for bankruptcy in 2012.

Corning is still here.

Not because it was faster.

Because it didn’t depend on the river staying the same.I was reading about Corning Inc.—how demand for fiber optics is rising again with AI.

It brought me back to Rochester.

When my wife and I lived there, we drove past Corning’s headquarters a number of times. There’s an entire town named after it. They’ve been around since the 1800s.

But Corning wasn’t the story in Rochester.

Eastman Kodak was.

Every year the newspaper reported Kodak bonuses. People waited for them. Planned around them. Even medical students paid attention.

My wife and I bought our first kitchen table that way—someone upgraded after a banner bonus year, and we picked up their old one. Until then, we ate on the floor in front of the TV.

Rochester was tuned to Kodak.

My wife’s first apartment was a half block from the George Eastman house.

In the 1980s, Kodak looked untouchable. A blue-chip company printing money from film. They had even invented the digital camera in the 1970s—but never really pursued it. It threatened the business that was working so well.

So they kept going.

Film. Slides. Projectors. Carousels.

It all fit together.

Corning was different. Less visible. A company that started with light bulbs and, over more than a century, kept finding new uses for glass—cookware, lab equipment, fiber optics, screens.

Same material. Different worlds.

I think of Kodak as something like a salmon.

Swimming upstream, producing enormous numbers of eggs—year after year. Predictable. Massive. It works beautifully, as long as the river stays the same.

Corning feels more like a possum.

Not especially impressive. Easy to overlook. But adaptable. Comfortable in different environments.

And when things get bad, it has a move.

It goes still.

After the dot-com collapse, when the world was flooded with unused fiber optic cable, Corning didn’t roar back. It waited. Played dead, in a way, until the conditions changed.

Kodak kept running its cycle.

Until the environment changed.

It filed for bankruptcy in 2012.

Corning is still here.

Not because it was faster.

Because it didn’t depend on the river staying the same.

I remember the first time I shook hands with one of my dad’s friends.
His grip was firm. Mine tried to be.

It felt like a transaction. Even as a kid, I knew it mattered—though I couldn’t have said why.

Over the years, I’ve probably had hundreds of handshakes I barely noticed. Firm. Limp. Damp. Usually I didn’t notice. Sometimes I did.

That’s the way with things that are everywhere—you only see them when they’re gone.

And now they’re mostly gone.

We went through phases.

The high five—Down low… too slow… slap it back, Jack.
There was choreography to it. Rhythm. A shared joke.

Then came that strange era of personalized greetings—finger taps, shoulder bumps, little improvised dances. Oddly satisfying if you found someone who knew the same sequence. Like discovering you spoke the same tiny dialect.

Then fist bumps.

Fist bump?

What exactly are you learning from a fist bump?
Has anyone ever debated the proper firmness of a fist bump? The duration? The angle?

A handshake told you things.

Not everything—but something.

There’s wiring behind it.
When two people shake hands, the brain is taking in pressure, temperature, timing—making judgments before a word is spoken.
A small bump in oxytocin, maybe. Just enough to nudge things toward connection.

For men especially, it was a small, contained contest.
Who squeezes first. Who holds a beat too long. Who yields.

You still see it play out on TV. Donald Trump has turned it into theater—those prolonged, slightly aggressive grips where the other person looks like they’re trying to escape. Watch him with Emmanuel Macron and you can practically see the negotiation happening through their hands.

But I don’t think we’re teaching it anymore.

Sit in a restaurant bar and watch people meet. There’s a lot of waving. Some nodding. Occasionally a half-hug that no one commits to.

But not many handshakes.

I understand the appeal of the wave.

It has advantages.

You can do it through glass.
Across a highway. Two palms pressed to opposite windows—usually initiated by someone’s seven-year-old for reasons no one fully understands.

And there are… other waves you can see through glass.
Those tend to involve fewer fingers.

The wave, it turns out, has range. A wave says “I see you.”

But even with those advantages—and even after everything we went through with COVID—I still find myself missing the handshake.

I’m a press-the-flesh guy.

The handshake says “now I know you.”

And one of these days, my grandson and granddaughter are going to learn it. Maybe from me.

Not perfectly at first. A little too soft, maybe. Or too quick.

But they’ll learn.

Because there’s something in that brief moment—skin, pressure, eye contact—that says more than a wave ever will.

Look into it, get a score.

No clinician. No exam. Just a number.

That moment stuck with me, because it captures something that’s quietly changing in medicine: patients no longer need us to begin the process.

We’ve built a world where people can generate enormous amounts of health data—sleep scores, heart rate variability, recovery metrics—often without ever involving a physician.

That changes things.

Not dramatically, all at once.

But enough to raise a question that doesn’t have an easy answer:

If patients can measure, track, and even interpret their own health…

what exactly is the physician’s role now?

I wrote about that here:

👉 Read the full piece on KevinMD

Curious what you think—especially if you’ve found yourself trusting a device more than your doctor (or vice versa).

Within seconds, markets reacted. Stocks jumped. Relief—instant, reflexive. No pause to ask whether a deal actually exists, or whether it ever will.

Information hits. Money moves.

Markets don’t wait for truth. They move on belief—real or not.

I like to compare across time, because it exposes what’s changed—and what hasn’t.

Right now, in Iran, the most connected people likely saw Trump’s comment immediately. VPNs, satellite feeds, Telegram—it gets through within minutes.

But then the signal hits a different layer.

People who have spent decades listening to competing narratives:

• America says one thing

• Iranian leadership says another

And then there’s a third layer.

I found myself scrolling through The Times of Israel, thinking I’d get a clearer picture.

Instead, it split things even further.

Now it wasn’t two versions of reality.

It was three.

And somehow, that didn’t clarify anything.

It just made the uncertainty more precise.

So the question isn’t what was said.

The question is:

Which version of reality do I trust?

And that takes time.

I think about the end of World War II.

Japan surrendered. The emperor spoke. The war was over—on paper, instantly.

But in remote areas, fighting continued.

Some units never heard the message. Radios were gone. Supply lines broken.

Others did hear.

Leaflets dropped from the sky. Announcements in unfamiliar voices.

And they thought:
This is a trick.

So they kept fighting.

Not for hours. Not for days.

For weeks.

We tend to think the past was slow because communication was slow.

That’s only half right.

Back then, the problem was getting the signal.

Now, the problem is something else entirely.

Now the signal is everywhere.

Too fast. Too loud. Too fragmented.

I can open my phone and find ten different explanations for the same event:

• One says a deal is imminent

• One says it’s political theater

• One says it’s manipulation

• One says it’s already failed

And if I’m honest, I can choose the one I like best.

No one forces it on me.

Which somehow makes it more powerful.

And I can feel it in myself.

I’ve been careful with my money since all of this started. Sitting back. Watching.

But the moment I saw markets jump this morning, I felt that familiar pull—

Maybe I should get back in.

That’s the reflex.

That’s the system working exactly as designed.

And the uncomfortable part is this:

I’m old enough to know better.

I’ve seen enough cycles to recognize the noise—
the overreactions, the confident narratives that dissolve a week later, the way certainty shows up right before it disappears.

And still…

there it is.

That urge to act on something that may not even be real.

We don’t call it propaganda anymore—not in the traditional sense.

It isn’t always coming from a single voice.

It’s decentralized. Crowdsourced. Algorithmically amplified.

But the effect isn’t that different.

The deeper realization, at least for me, is this:

Access to information hasn’t changed belief as much as we think it has.

A hundred years ago:

• Information arrived slowly

• But once it arrived, people tended to accept it

In 1945:

• Information arrived late

• And sometimes wasn’t believed

Today:

• Information arrives instantly

• And belief fractures in real time

So in spite of everything—
the speed, the screens, the endless stream of updates—

It’s not clear we’re that different.

There have always been:

• people who believe

• people who doubt

• and people who wait

The world doesn’t change when information arrives.

It changes when enough people decide
that the information is true—

or at least act like it is.

It’s about something I’ve felt for a long time but didn’t fully understand until I stepped back from practice:

At some point, medicine stopped behaving like a profession
and started behaving like a bureaucracy.

That shift is subtle at first.

You still wear the same white coat.
You still see patients.
You still make decisions.

But over time, something changes underneath.

Judgment gets replaced by compliance.
Responsibility stays with the physician—but control moves somewhere else.

And once you see that clearly, a lot of things that used to feel confusing start to make sense.

This isn’t nostalgia.

It’s a description of the system we’ve built—and the world it creates for both doctors and patients.

Here’s the piece:
https://kevinmd.com/2026/03/why-modern-medicine-feels-more-like-a-bureaucracy-than-a-profession.html

If you’re in medicine, I think it will feel familiar.

If you’re not, it might explain why your doctor seems a little different than they used to.

That realization surprised me.

The feeling caught me off guard one afternoon while I was lying on a massage table, half asleep and thinking about how grateful I felt to be in my 60s.

Years ago I wouldn’t have expected that.

In fact, when I was younger I assumed this decade of life would feel very different. I imagined worrying about death, or grieving the things I could no longer do.

Instead, the opposite has happened.

Part of what made the realization so strange is that during my years in medicine, I watched many people approach the end of their lives.

What surprised me most wasn’t fear.

It was the calm.

Even when they knew the end was approaching, many patients carried themselves with a quiet dignity I didn’t have in my 50s. Some were younger than I am now. They smiled. They talked about ordinary things. There was often a peacefulness that seemed to arrive quietly near the end.

For years I wondered where that calm came from.

Now, in my 60s, I’m starting to understand it.

The first gift is reflection.

Not just more experiences to reflect on—but actual time to reflect.

In my 30s and 40s I was always on a mission. There was always something urgent waiting: raising children, worrying about children, paying bills, wondering if I would ever save enough money to make it to my 60s.

Life felt like a series of hills that always needed climbing.

And there was always another one ahead.

Now much of that noise is gone.

And the silence it leaves behind is surprisingly peaceful.

The second gift is freedom.

There’s nobody to report to anymore.

Well… almost nobody. I still report to Nancy—but she’s not a bad boss.

And of course I report to my children. But the older I get, the more interesting that relationship becomes. I’m learning who they are as adults, and how their world differs from the one I grew up in.

The best part is realizing there’s very little chance any of them will fire me as their father.

That makes the whole job feel lighter.

When you’re younger, none of this seems very relevant.

In your 30s and 40s you’re moving fast. Careers, children, bills, responsibilities — life feels like a series of hills you’re always climbing.

If someone had told me then that my 60s might be the most peaceful decade of my life, I would have assumed something had gone terribly wrong.

But time does something subtle.

It sands down the rough edges.

Slowly, almost without you noticing.

Another unexpected gift of the 60s is something I never thought about when I was younger: a long marriage.

Nancy and I have now been married for more than forty years.

By that point, most of the unnecessary arguments have already been argued.

That doesn’t mean marriages suddenly become perfect. No marriage sails forever on smooth water.

But after enough years you begin to recognize the storms earlier.

You see the clouds forming on the horizon.

And you learn to adjust the sails before they arrive.

Sometimes that means laughing.

Sometimes it means saying less.

And sometimes it means realizing the argument itself isn’t important anymore.

Another thing that changes with age is perspective about hardship.

By the time people reach their 60s, most have been through something difficult. For some it’s losing a career and rebuilding. In my case it included a brush with death that quietly changed how I see the world.

Yesterday at physical therapy I spent a while talking with a man named Billy. Today happens to be his birthday. He looked to be in his 80s.

He told me he had ended up there after nearly dying from sepsis. The illness had taken much of his muscle strength, and he was slowly working to rebuild it.

What struck me most wasn’t frustration.

It was how peaceful he seemed about the whole thing.

He talked about getting stronger again, one small step at a time, as if that was simply the next chapter of life.

He told me he still lives at home with the help of his wife, who he said was younger than him.

We joked about how lucky he was.

A few minutes later his wife came to pick him up.

She looked about the same age.

So naturally I went over and talked with her too.

When I left physical therapy that day, I remember walking out of the building feeling unexpectedly light.

I’ve noticed something related watching my mother grow older.

My mother was always a warrior.

She was the one who woke up if the hallway floorboard creaked because we came home too late. She carried the small worries of life the way some people carry a full backpack.

Now her memory isn’t what it used to be.

Right now the biggest issue is a broken arm. When she moves it, you can see the pain on her face.

But when she’s sitting still, the pain disappears.

And thirty seconds later she’ll sometimes ask, almost casually,

“Why does my arm hurt?”

It’s a strange thing to watch.

The pain comes and goes with the moment, but the worry about it doesn’t stay.

In a way, some of the burdens she carried for so many years simply don’t linger anymore.

Looking back, life begins to resemble a graceful arc.

Some people move along that arc smoothly.

Mine was… choppier.

But with enough distance, even the rough parts start to make sense.

And somewhere along the way you realize something surprising.

The things you once feared about getting older were never really the point.

Which may be why those patients I watched years ago seemed so calm.

They were already arriving at a place I hadn’t reached yet.

During that massage, while I was half asleep and feeling grateful for the strange peace that seems to come with this decade of life, an old song kept drifting through my head.

And for the first time, I understood it a little differently.

Don’t fear the reaper.

The happiness comes from gratitude now.

My wife received their replies.

I didn’t.

I had just switched cell carriers, and somehow the messages simply vanished somewhere in the machinery.

Eventually, with the help of AI, I discovered that resetting the network settings on my iPhone fixed the problem. Instantly the missing messages appeared.

But the experience made me wonder:

Why can’t we just stop inventing new things for a couple of years and focus on making everything work correctly?

I briefly considered writing to Donald Trump and suggesting an executive order:

No new inventions until 2028.

Just fix what we already have.

Yesterday I had been building a new website for my old medical practice.

You can find it at unscriptedpractice.com.

Or you can go to one of my old sites—like fdlpsych.com—and it should redirect you there.

I built much of it myself, with the help of AI.

Twenty years ago I had dozens of websites out there, all built before AI existed. I did most of them on my own. I got help from coding forums, but I knew enough HTML to understand what the code was doing and how to change it.

Back then I could also manage DNS settings, connect to databases, and run a forum using phpBB.

Those early efforts eventually led to me being noticed by the New York Times, which was a thrill.

Working on this landing page yesterday took a long time.

Everything is different now.

But this time I had AI to help answer questions.

And something interesting happened: some of the old knowledge came back.

That was reassuring.

Several years ago I went through deep hypothermic circulatory arrest during surgery. Every now and then I wonder whether that experience quietly erased a few things.

But while working on this site, pieces of the old knowledge resurfaced.

Apparently not everything.

Some systems, it turns out, survive a shutdown better than you expect.

The texting problem sent me down a small rabbit hole.

A few years before January 1, 1983, universities and government agencies connected to the early internet were told they would have to adopt a new networking standard called TCP/IP.

If they didn’t switch by the deadline, they would simply lose access to the network.

And on that day, the switch happened.

The modern internet was born.

Sometimes systems need a moment when everyone agrees:

Enough layers. Start clean.

There are examples of the opposite approach too.

When Boeing introduced the 737, they didn’t constantly reinvent the airplane. Instead they kept refining the same basic design over decades.

Pilots already knew how to fly it.

Mechanics already knew how to fix it.

Airlines loved the reliability.

Printers went the other direction.

Different manufacturers introduced different drivers, cartridges, connections, and protocols. The result was a tangle of systems that often struggle to talk to each other.

Anyone who has fought with a printer over the years understands the feeling.

Sometimes you just wish someone would announce a pause:

“Stop. Nobody invents another printing protocol until the existing ones work.”

Phones and internet systems today feel similar.

Companies constantly introduce new features to compete with one another.

But those new features must still work with older devices and older systems.

The result is a kind of technological polypharmacy: layers of protocols stacked on top of each other.

Eventually something stops talking to something else.

And you end up resetting your phone just to receive a text message from your children.

There’s a parallel to medicine too.

Young physicians are trained with the newest information.

Older physicians provide the bridge between what used to work and what is emerging.

Progress needs both.

But occasionally every complex system could use a pause.

A moment to make sure the foundations still hold.

So if you visit unscriptedpractice.com and something doesn’t work, please let me know.

Assuming, of course, that the internet successfully delivers your message.

After all, we’re living in the era of constant innovation.

Which means sometimes the most advanced technology in the room is still the reset button.

And occasionally the most advanced troubleshooting technique is still:

Turn it off.

Turn it back on.

Nothing dramatic.
No crisis.
No near-miss.

But my fingers are warm again — for the first time in months.

And I’m sleeping better than I have in a long time.

Those aren’t headline outcomes.
They’re not the things medicine congratulates itself for.

They’re just… noticeable.

Modern medicine is very good at preventing death.
It’s less good at noticing when life becomes slightly smaller.

When I was put on metoprolol, no one mentioned that cold fingers might come with it.
Or that my skin might feel oddly chilled even in a comfortable room.

Metoprolol is a perfectly good beta blocker.
But like many in its class, it leans toward peripheral vasoconstriction — tightening the tiny vessels in the hands and feet.

It wasn’t negligence.
It wasn’t ignorance.

It just wasn’t important enough to talk about.

We talked about the big things:

Heart rate.
Blood pressure.
Risk reduction.
Outcomes that fit on a graph.

So I adapted.

Extra layers.
Hands that didn’t feel like mine.

A quiet assumption that this was simply the price of doing business.

That’s what modern medicine teaches you to do:

triage your own discomfort.

Patients learn to self-triage what parts of their life are worth mentioning.

You get a short visit.
You prioritize survival.

You leave the “minor” things unspoken — not because they don’t matter, but because there’s no room for them.

Later, almost accidentally, I learned about nebivolol.

A beta blocker that still slows the heart — but uniquely promotes nitric-oxide–mediated vasodilation instead of tightening the peripheral vessels.

Less peripheral constriction.
Less cold.

I switched.

And without ceremony, my body noticed.

Warm hands on the steering wheel.
Fingers that didn’t feel like someone else’s.

Sleep that arrived without effort.

That’s the part that stayed with me.

Not the pharmacology.
Not the cleverness of the molecule.

But how easily months of daily discomfort could have been avoided — if there had been time to talk about something that didn’t threaten my life.

For years, as a psychiatrist, I met new patients with medication lists that made me wince.

Three antidepressants.
Two mood stabilizers.
A benzodiazepine.
Something for sleep.
Something else for the side effects.

I used to wonder — honestly — how anyone let this happen.

I understand now.

It happened one reasonable visit at a time.

Each decision made sense in isolation:

Let’s just help you sleep.
You’re stable — let’s not rock the boat.
We don’t have time to taper today.
We’ll revisit this later.

Later rarely comes.

The system rewards adding medications.
It quietly punishes taking them away.

Stopping a medication takes time.
Explaining why takes even longer.

And if something goes wrong later, subtraction is harder to defend than addition.

So the list grows.

And patients learn, very quickly, what kinds of suffering are worth mentioning — and which ones are not.

You save your time for the big things.

You tolerate the rest.

That’s why I’ve been feeling a little like Rip Van Winkle.

Not because I’m nostalgic.
Not because I’m romanticizing the past.

But because I practiced medicine in a way that insulated me from what healthcare has become.

I saw two people an hour.
Three, the past few years when everyone was doing well.

I got to know them over years.

Little things mattered — because memory mattered.

Side effects weren’t trivia.

They were clues.

Now, sitting on the other side of the desk, I feel the wall.

Not a cruel wall.
Not an uncaring one.

A procedural wall.

The system isn’t designed for back-and-forth.

It’s designed for problem-solving.

For decisions that can be documented cleanly and defended later.

There’s very little space for a sentence like this:

“Nothing is wrong, exactly.
But my life has become a little smaller.”

Those conversations take time.

They require continuity.
They require someone who remembers what you were like before.

My point isn’t that medicine is broken.

It’s that it has narrowed its field of vision.

We talk — rightly — about the things that might kill us.

But we’ve lost much of our ability to talk about the things that quietly erode daily life.

Cold fingers.
Restless sleep.
Low-grade discomfort that never triggers alarm, but never leaves either.

They don’t show up on outcome measures.
They don’t justify long visits.

And yet — they matter.

I didn’t realize how much they mattered until they were gone.

And that, more than anything, is what surprised me.

Not the side effect.
Not the solution.

But how little room there was, in modern medicine, to notice the difference.

Modern medicine saved my life long before this visit.

But this week it reminded me of something smaller —
and in its own way, just as important.

Warm fingers.

And the realization that the little things matter more than we remember.

In October, the 35-year-old ashes flared into a uniform gold. Not orange like maples — gold. The leaves shimmered against a hard blue sky, and when the wind moved through them, the whole canopy flickered like light on water. The woods beyond held shade and that faint, dry whisper of leaves turning over themselves.

Time passes, and things change.

Most of the ashes are gone now. Only the trees in front of my house and my neighbor’s remain. Years ago, when the emerald ash borer was still a rumor moving west, I placed letters in mailboxes explaining that soil treatments or injections were cheaper than cutting down dead trees. One neighbor tried for a year before giving up. The man next door still treats his, as do I. But two yards of trees can’t recreate a cathedral.

In the summer of 2021, I began stopping near the cul-de-sac while my wife continued ahead. I would stand there, hands on hips, pretending to admire something in the distance while I waited for my breathing to settle. No big deal, I told myself. I was sixty. My frame hadn’t changed much since high school cross-country, but youth has a way of slipping out quietly.

By the next summer, I cut the loop in half. Conversation thinned because I couldn’t string more than a few words together without pausing. Sometimes I would start a sentence and lose the word I needed, as if it had stepped just out of reach. Climbing the stairs at home required a stop halfway up, one hand on the railing, listening to the pulse in my ears.

In April, I asked for a chest X-ray. Normal. The breathlessness worsened anyway. I dreaded forgetting something upstairs because it meant five minutes of standing still afterward, waiting for my lungs to catch up.

Eventually, I agreed to a stress test.

I lasted two minutes.

The nurse practitioner clipped a pulse-oximeter to my finger. Eighty-three percent. The room shifted. Faces changed. What had been routine was no longer routine.

The next day I had a calcium scan. No coronary calcium — reassuring in one sense, but it didn’t explain why walking across a parking lot felt like hiking at altitude. Then came the phone calls. I needed to be at the clinic immediately. Not later in the afternoon. Now. I shouldn’t drive. When I arrived, a nurse met me at the door with a wheelchair and steered me down a hallway that smelled faintly of antiseptic and warmed plastic.

By evening, I knew that a large mass was blocking most of my right pulmonary artery.

I started Eliquis. More tests followed. A cardiologist asked his assistant to listen for a gallop rhythm. For months I had wondered why my laptop seemed to bounce against my abdomen when I rested it there; I learned that my right ventricle had enlarged enough to make that movement visible.

Then my pulmonologist said, almost casually, “You need to get to San Diego.”

I remember thinking he had overreacted.

That was the summer we walked through ashes — the trees thinning along the road, and something inside me narrowing just as quietly.

I needed to set that up to add attachments. Set it to the lowest number allowed.

And everything here is also readable for free.

Second note.

If you’re reading me here, you’re seeing me unfiltered.

I’ve never been very good at crafting a polished external persona.

Part pride.
Part regret.

For decades I wrote science.

Science writing is structured, disciplined, almost architectural.

• This is what I will show you.
• Here is the evidence.
• Here is why it matters.

Clean. Controlled. Conclusive.

Memoir is different.

So is narrative.

So is whatever this is becoming.

Lately I’ve been re-watching films I loved years ago — and noticing something new. What once felt like a caper now feels like moral architecture. Conflicting values. Quiet choices. Structural tension underneath the surface.

When you start seeing structure, everything changes.

A violent scene next to a baby.
A dog beside a body.

Nothing is accidental.

Writing works the same way.

I’m learning that in real time.

If you look me up on PubMed, you’ll see the old version of me — formal, structured, precise. If you scroll back 20 years in my blog, you’ll see more of that voice.

What you’re watching now is transition.

Experimentation.

Occasional overreach.

This is where I push the edges a bit and see what happens.

The memoir will take time.

But this space —

This is the workshop.

The sandbox.

You’re watching the evolution as it happens.

And honestly,

that makes it more interesting for me too.

Or maybe evening. The timing is gone.

I remember holding pressure on a groin.

A little irritated.
Why wasn’t he anticoagulated first?

Fifteen minutes. Still bleeding.

Let’s make it thirty.

The ICU had its own smell.
Sterile. Cleaning fluid. Plastic.

And by then I knew the smell of blood.

The TV was on.

CNN.

Bush Senior has invaded Iraq.

Explosions. Tanks. Green light in the dark.

The sound was probably off. I would have been reading captions. If there were none, just watching.

A man moving his mouth into a microphone without a voice.

Behind me, the steady beeping of monitors.

And under that, a low current of anxiety.

Because this was live. Or closer to live than I had ever seen.

That night Nancy and I stood in our Philadelphia apartment in front of the television. Not sitting. Standing.

Looking at each other.

Wondering what this meant for us. For our new son.

All of that came back this morning.

Another invasion.

Images from minutes ago.
Statements from Russia and China and Saudi Arabia.
An explosion in Qatar.
Missiles toward U.S. bases. Toward Israel.

I’m writing this on a Saturday morning.

In real time.

Not sure where this goes.

I think about my dad in World War II. Letters.
Vietnam — images screened before release.
My wife’s father in Korea.

They waited days. Weeks.

We refresh.