It brings the family together, and everyone prepares their favorite family recipes. Some recipes are a family institution. God forbid that anyone would change the green bean casserole.

But every family has its Hatfields and McCoys. Ours happens to be the spices in Grandma Olson’s Spice Cookies.

Grandma’s recipe didn’t specify the amounts of the spices. She just listed them: Cinnamon, Allspice, Clove, and Ginger. And the flour was “enough to roll out.”

My version says 1 teaspoon cinnamon, ¼ teaspoon of allspice, ¼ teaspoon of cloves, and 1 teaspoons of ginger. The amount of ginger has been crossed out and overwritten. Twice. Another handwritten version says ¼ teaspoon each of allspice, cloves, and ginger. Everyone seems to have their own version of the recipe.

Mine is the right one.

Grandma enjoyed a good joke, and I can almost see a smirk on her face. Were these family arguments her way of not being forgotten?

The Original

I had the original, coffee-stained recipe, written in Grandma’s shaky handwriting. I’ve now passed it on to my granddaughter, Josie. You’d think I’d given her a winning lottery ticket.

When I pulled out the recipe to carefully prepare it to send to Josie, I turned it over. It was written on the back of a scrap of paper from a paid-off bank loan to my grandfather, Oscar A. Olson.

Nothing on the farm in the 1940s and ‘50s was wasted.

Both sides of that paper are a fascinating glimpse into the Olson family history. The amount of the loan isn’t visible, but it must have been less than a couple of hundred dollars. My father’s entire farm income reported for his taxes in 1943, the year I was born, wasn’t much more than that.

But are we really arguing about spices?

What we’re really arguing about is a family memory.

All memories are sifted like the spices through our own experiences. And then we roll them out.

Loren’s Slight Refinement

When I was married to my wife, Lynn, she hated that recipe. But it wasn’t about the spices. It was about raisins.

The recipe calls for ground raisins, and Lynn put them into a cast-iron meat grinder affixed to the counter. The raisins bound up the grinder, and when they were extruded, they looked like sludge.

My husband, Doug, won’t attempt making the cookies. Perhaps that’s why my marriage to him has lasted longer than my marriage to Lynn.

Making them has defaulted to me.

I solved the raisin problem by mixing some of the flour with softened raisins and grinding them in a food processor. It’s a small improvement, but one which would have horrified my grandmother.

Unwelcome “Improvements”

Ice cream has produced similar disputes in our family. On this, my sisters and I agree.

The original Olson Family Ice Cream recipe calls for four cups of milk, 2¾ cups of sugar, three cups of half-and-half, two tablespoons of vanilla, and five cups of heavy cream.

This, I am convinced, is the perfect recipe.

It was always prepared in the stainless-steel canister of a hand-cranked, White Mountain freezer. As a child on the farm, the ice was chopped from the livestock tank.

The younger cousins started cranking, spinning the handle easily. Then the adolescent boys took over, behaving as adolescent boys do, and brazenly turned the crank to show off their muscles. As the ice cream began to harden, the humbled teens slunk away and turned it over to the men to finish.

I loved how the men and boys surrounded that freezer, telling family stories. Women never cranked it. They prepared the ingredients. Everyone accepted this division of labor.

Doug, my husband, is clearly not blood.

The White Mountain freezer sits rusting in the garage. His Cuisinart Ice Cream Maker hums alone in the kitchen, churning some “improved” recipe he found on Instagram.

I suppose that is what all families do.

The world changes. Recipes change. And so does our definition of family.

Memories and Recipes Are Reconstructions

No one knows exactly how Grandma Olson made those cookies. We only know we all loved them.

We think of a recipe as a set of instructions, but recipes, like memories, are approximations.

Recipes are corrected, altered, and improved. So are our family stories. And sometimes extra spice is added.

When someone tells a family story, someone always interrupts to say, “No, that’s not really how it happened,” or “You left out the best part.”

With memories, there are no handwritten instructions on a recipe card. We reconstruct them from family stories, old photographs, and old handwritten recipes.

I didn’t give Josie the recipe so she knows how to bake Grandma Olson’s cookies.

I gave it to her so the argument will be continued.

Someday, I won’t be there to advocate for the right amount of ginger. Someone else will decide. And that is as it should be.

Recipes were never ours to own.

Neither are our memories.

We are but the stewards who preserve them for those who follow us.

Grandma Olson’s Spice Cookies

Also known as Loren’s Favorite Cookies

Why I Keep Making This
Not only do I love eating these cookies, but the smell of the spices when baking them takes me back to my childhood and Grandma Olson’s kitchen.
In Grandma Olson’s handwritten recipe, she didn’t specify amounts of each spice. This continues to be a source of considerable debate among her descendants.
Her recipe was written on the back of a scrap of paper, torn from the back of a bank loan to Grandpa Olson. Nothing was ever wasted.
She also didn’t specify how much flour, just “enough until it feels right to roll out.”

Equipment: Stand mixer and food processor

Makes: two dozen, depending on the size of your cookie cutter

Prep Time: I reserve half a day from start of finish frosting the last cookie.

Ingredients:

1 cup of Lard

1 teaspoon salt

2 cups brown sugar

1 ½ teaspoons baking soda

3 eggs, separated

1 teaspoon cinnamon

2 tablespoons of sour cream

¼ teaspoon clove and allspice

1 cup of ground raisins

¼ - 2 teaspoons of ginger (Depending on which Olson you ask)

1 cup of chopped walnuts

2 ½ cups flour + ½ cup

Instructions

1. Grind raisins in food processor along with ½ cup of flour. (Soak raisins first to soften.)

2. Chop the walnuts.

3. Using the whisk on the mixer, cream together the lard, brown sugar, egg yolks, and sour cream.

4. Whisk together the flour, salt, soda, and spices.

5. Add raisins and walnuts to dry mixture and whisk together.

6. Using the paddle blade on the mixer, gradually add the dry ingredients to the wet ingredients.

7. Add more flour as necessary, “to make it feel right.”

8. Divide the dough in half and make each half into a ball. Place the ball in a zip-lock bag and flatten into a disk.

9. Chill overnight in the refrigerator.

10. Preheat oven to 375 degrees.

11. On a floured surface, roll out the dough to about ¼ inch thickness.

12. Cut out cookies and place on parchment paper.

13. Bake for about 9 minutes, until lightly browned on the edges.

14. Cool on a baking rack.

Frosting

1. In the bowl of the mixer fitted with the paddle attachment, combine one pound of confectioner’s sugar and the reserved egg whites.

2. On low speed, add about ½ cup of water, drop by drop.

3. Continue to mix icing until it holds a ribbon trail when you raise the paddle.

4. Add enough water to make it easy to spread the frosting across the entire surface of the cookie.

A Few Notes

· The important trick: Grinding the raisins in a meat grinder was a minor contributing factor in my divorce from my wife. Adding flour to the raisins and grinding in a food processor reduces conflict in a relationship.

· Substitution: Crisco for lard but Grandma would not be happy with your choice.

· Storage: They freeze well but usually don’t last that long in our house.

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“Hello, good friends.”

Wynn Speece, “Your Neighbor Lady,” spoke to my mother from WNAX in Yankton, South Dakota, as my mother washed the disks from the enameled, olive-colored De Laval cream separator that she’d just used to separate the cream from the warm milk that my father had brought in from the barn.

“Hello, Wynn,” my mother responded as if Wynn were joining her for coffee across the oak table in the kitchen of our farm home in Cedar County, Nebraska.

My mother was ready for a break. She had prepared my father’s breakfast of bacon, eggs, and fried potatoes and then separated the cream from the milk.

Separating cream was one of my mother’s most important jobs on the farm in the 1940s. Some of the cream would be churned into butter, but butter was used sparingly. Lard was more economical. The majority of the cream was taken into town on Saturdays and sold to the creamery. The money was used to pay for the few grocery items that weren’t produced on the farm.

As my father poured the warm milk into the hopper of the machine, my mother stood and began cranking it. The disks inside spun rapidly, throwing the milk to the outside and drawing the cream toward the middle.

After the raw milk was separated each morning and evening, my mother took the machine apart and carefully cleaned each disk. A poorly cleaned separator could lower the value of the cream that was sold.

The household needed that money, and the Neighbor Lady provided tips on how to make the most of that small income.

Everyone’s Neighbor Lady

“Your Neighbor Lady” was a remarkably important friend to women in North and South Dakota, Nebraska, Minnesota, and Iowa in the 1940s and 1950s. Most of her listeners were farm women, and for some of them, she may have been the only adult woman’s voice they’d heard in several days.

Speece knew her audience, and she spoke directly to them. She created a relationship with them through bits of everyday conversation. Her program included kitchen-tested recipes, household hints, and cleaning advice, but the recipes were almost secondary.

She published an annual Neighbor Lady recipe booklet. Her booklets included household tips like this “Good Deed Dollar Winner”:

To make your broom last longer, dip the broom into boiling soapsuds for a minute or two each week.

Recipes included meat-extenders like “Eggburgers” or “Soybean Special.” Sometimes, the only protein available on the farm to feed our family of six was either eggs from our chickens or a squirrel or rabbit my father shot.

My mother cherished those suggestions for stretching every dollar on our hardscrabble farm.

Everyone needs a good neighbor like Speece. She showed up every day for a remarkable 64 years.

Life Became More Difficult

Like most farm wives, my mother learned to cook and bake, garden and preserve, feed threshing crews and unexpected guests. Hard-working farmers ate breakfast, dinner, and supper of meat and potatoes. Twice a day, hard-working farm wives took lunch of sandwiches made of home-made bread, pie or cake, and cold drinks to the men in the fields.

By the age of twenty-eight, my mother was doing it all while raising four children.

Then my father was killed by a team of runaway horses.

She tried to hold everything together on the farm for another year, but realized she couldn’t do it. Under orders from Aunt Sophie, we moved in with my recently widowed grandfather.

We weren’t eligible for public assistance, and even if we had been, my mother would have been too proud to accept it. She had to find work to support us. She found office work that required working six days a week, 8:00 a.m. to 6:00 p.m.

On Sundays, she taught Sunday School at one of the five Lutheran churches in Dixon County, Nebraska.

Food preparation was sustenance, not pleasure. There was no time for hospitality.

We were always fed. Kraft Mac and Cheese. Grilled cheese sandwiches with Campbell’s Tomato Soup. “Goulash,” which was mostly pasta, tomato sauce, and burger. Tuna casserole, which we called “Toodles and Nuna.” On Sundays, it was pot roast with carrots, potatoes, and onions.

When my mother was too busy, food preparation fell to my sister who was barely a teenager. My other sister and I became self-sufficient in preparing our noon meals of peanut butter and jelly or cheese sandwiches. Occasionally, we cheated and ate sandwiches of white bread, butter, and sugar.

Delightful Recipes

After my older brother, Lefty, became paraplegic in a car accident, my mother was stretched even thinner.

When my mother accompanied Lefty to New York City for his rehabilitation, my older sister, still in her early teens, managed our household. Meals were simple but sufficient. The only baked goods were Emma Harding’s cinnamon rolls and Aunt Annie’s cookies.

After Lefty and my mother returned from New York and my sisters went away to college, our meals remained simple.

My mother began accumulating a few recipes at funerals and church suppers. The majority of the recipes were simple and had “Delight” somewhere in the title.

The delight seemed to be that women were released from a burden. Most of the women who exchanged those recipes came from farm backgrounds where food had to be produced.

Cooking was a responsibility; finding joy in it was a foreign concept.

Salads often were made with Jell-O. Desserts were things like how to modify a yellow cake mix into something special.

Cooking was necessity.

Baking was indulgence.

Expecting the Unexpected Guests

As my mother aged, meals became increasingly simple again: soup and sandwiches, oatmeal, and cottage cheese.

For my mother, there was never any real joy in the process of cooking or baking. Food was either to provide nourishment for the family or something to show love for family and friends.

Sunday afternoons were for friends. No one called ahead to say they were coming. Unexpected guests were never totally unexpected. And if you dropped in on my mother, she would always insist you stay for supper. She would pull a meal together from what appeared to be a bare cupboard. No one complained about what they were fed.

My favorite guests were my father’s brother and his wife, Uncle Glen and Aunt Janet. They provided a window into the life I could have lived if my father had not died. I could almost picture my father sitting at the table with all of us, reminiscing about life on the farm.

It was never about what was on the menu. It was always about the people with whom you ate.

Soup v. Stew

My mother always prepared oyster soup for Christmas Eve, a very common Midwest tradition. She would boil the oysters down to the size of raisins—apparently so you could swallow them without chewing—and add them to skim milk.

My husband is an excellent cook. He can spend hours reading cookbooks.

When I took Doug home the first time for Christmas, he was not impressed. Soup and stew were distinctly different.

After dinner, he said,

“Martha, how about I fix the oyster stew next Christmas.”

My mother was not offended and happily agreed.

The next Christmas, Doug started with cream, and then added potatoes, celery, onions and scallops. Finally, he threw the oysters in just as the stew was about to be served.

I overheard my sister-in-law saying,

“Did you see what he’s doing with the oyster soup?”

For the remainder of my mother’s life, Doug prepared the oyster stew.

Food Is More than Survival

As children, we ate what was prepared or fixed for ourselves. I don’t remember anyone ever complaining about it.

Food was survival. Feeding people was love.

As I grew older, “Supper” disappeared from our vocabulary, and “Dinner” moved from noon to the evening meal. I had more choices, and my palate expanded, although I never wanted to prepare meals for myself.

As Doug and I have grown older, our meals have become simpler. We have grilled cheese sandwiches and tomato soup, though now we use a better cheese and Progresso soup.

Guests, however, will get peach posset with ice cream made in our Cuisinart ice cream freezer.

My mother cooked out of necessity to feed people, but she taught me that feeding people is an act of love.

Doug cooks because of the pleasure of cooking and the joy in seeing how others appreciate something special.

I’ve learned to bake, although I don’t do much of it anymore. The cinnamon rolls are my first stop at the Iowa State Fair.

Baking is about abundance and indulgence. I learned to make the things that were never a part of our meals when I was growing up. Baked goods were an abundance that was unavailable to me as a child.

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The stories on What Keeps Me Awake are usually my own, but paradoxes belong to all of us. That’s why I’m occasionally inviting writers whose work captures the tensions, contradictions, and unexpected truths that make us human.

is one of those writers.

His essays make me laugh out loud, occasionally bring tears, and always make me think deeply long after I’ve finished reading. He captures the absurd and the profound in the same moment. It serves him and his readers well.

As we finished our collaboration on his essay, I asked Scott how it feels to be sixty years old.

He responded,

Like childhood plus wisdom.

You’ll see that in his writing.

Read Scott’s essays.

Then do yourself a favor and subscribe to his publication.

— Loren A. Olson, MD

Guest Essay

Not Yet Invisible

On wanting to be wanted at sixty

If you’ve dabbled with Buddhism, as I have, you know desire has a bad reputation. It’s said to be the root of suffering, and renouncing it is supposed to bring us closer to peace.

If you’ve recently turned sixty, as I have, you may also know desire is not especially interested in being renounced.

Mine certainly isn’t.

For me, desire keeps showing up like a stalker, taking selfies on the front lawn, asking:

Am I still, well, desirable?

To my wife? My friends? The world?

Is there something in this version of me—older, thicker, slower, increasingly moisturized—that others might want to get closer to, admire, invite, touch, hire, read, or choose?

Because I lift the weights. I play pickleball. I swallow the creatine. I am doing my part. I joust with AI, read the latest fiction, and pore over the New York Times. I remain engaged. Still here.

Vital? I like to think so.

Because I still desire to be desired in all ways. Intellectually. Sexually. Interpersonally. Artistically.

It’s a lot.

In the chorus of “I Want You to Want Me,” the rock band Cheap Trick understood long before I did that wanting to be wanted is one of the more embarrassing human conditions. The song makes it sound exuberant, almost comic, a little sweaty, and teenage.

“I’m begging you to beg me.”

Sheesh. Settle down, guy.

At sixty, the same wish can sound less like a chorus and more like a medical symptom:

Sir, there’s no easy way to put this. You’ve developed chronic neediness.

Last week, during a pickleball game, my opponent cut off my drive and sliced a drop shot, catching me flat-footed at the baseline. I bolted forward, still loyal to an outdated scouting report on myself.

Feet don’t fail me now!

In my mind, I was already there, sliding into place like Ben Johns, widely considered the greatest male pickleball player ever.

I saw myself charging with the old animal quickness, flicking a perfect winner through the center of the court while my opponents’ paddles waved helplessly at the air.

This is one of the small luxuries of aging: the mind still runs the highlight reel at full speed.

The actual video is far less forgiving.

What really happened: I staggered forward stiffly, arrived late, and barely managed to tap the ball. It dribbled into the net with the finality of a disquieting diagnosis.

And yet even this did not inspire me to surrender desire.

If anything, I remain hopelessly attached to improving my provisional 4.2 rating to a resounding 4.5. No one should look to me for spiritual leadership.

I am a relentless striver.

So it is in marriage.

I want my wife to gaze at me as if I’m the same twenty-something goofball who first won her affections—the one with the skateboard, the discernible abdominal muscles, and the aura of youthful invincibility.

That guy, but with some appealing gray highlights and a far more promising bankroll.

This is not entirely fair to her. I am not that guy, just as she is not that wild-haired girl who wore the same sweater every weekend.

But since when is love fair?

My wife remains, after decades together, something of a delicious mystery to me. Now, as we edge uncertainly toward retirement, she spends long stretches on her phone or computer. She is also taking more workout classes and reading more books than ever.

What troubles me is not that she is hiding from me. It is that she may not be. It is possible she would simply rather be looking elsewhere.

It is possible that my company, once exciting, has become familiar in the way furniture becomes familiar: useful, occasionally appreciated, rarely studied, and perhaps starting to smell like the dog.

Of course, I am no innocent. I spend a great deal of time alone, writing poems and essays she does not seem especially interested in reading.

I have cultivated solitude so successfully that it seems ungracious to complain when she leaves me to it.

Still, I want to be wanted.

Sometimes I walk into the room where she is reading or otherwise engaged, intending to ask about dinner or health insurance, and find myself hoping, absurdly, that she will look up as if I have interrupted something less interesting than me.

Often, she does look up. Kindly. Briefly. She pushes a smile to her lips. Then we return to our separate screens, married and alone in the modern way.

But there are also times when she finds me tucked into my corner of the bed or couch and collapses across me with the familiarity and ease that can come only after the long journey we have taken together. We nuzzle and tickle and wrestle like our bones aren’t becoming brittle.

I live for those times.

Marriage is not the only place I want to be chosen.

I have redoubled my desire to be a writer—a real one. The kind who is discovered, praised, published, envied a little by the right people, and misunderstood by the rest.

I want it even though I know wanting it is unbecoming. I want it even though I suspect the literary world has no shortage of late-middle-aged men hoping their sensitivity will finally be recognized as genius.

And while I’m apparently making impossible requests of the universe, I want my parents to be restored to perfect health, my sons to be emotionally unharmed, and everyone I love to be safe and immortal.

I have needs so big the universe has no choice but to laugh. Sometimes I laugh along with it. Other times tears arrive like weather.

No umbrella is big enough for what’s coming.

Desire begins with the body and quickly becomes metaphysical.

At some point, the wanting can become our whole personality.

I want one more convincing season of being visibly alive. Ten more. Thirty more!

Apparently the Buddhists are right to be concerned. Though they draw a line I’ve been ignoring.

There’s the wanting that can’t be satisfied by getting what it wants. The Buddhists call it thirst. So, it turns out, do the kids.

And there’s the wanting that gets a person out of bed, onto the cushion, across the room toward someone they love.

One is a hole. The other is an insistent coach. I contain both. Sometimes I’m not sure which one is talking.

But desire is not the only thing lingering on the doorstep. Fear is there, too.

I live in fear of being pitied. Not rejected, exactly. Pitied. I fear the softened gaze, the careful tone, the small mercy extended to a man who still imagines himself formidable while others have begun, privately, to revise him downward.

Nice try, buddy. You almost got it.

Pity is the opposite of desire.

What I do not know how to survive, at least not gracefully, is becoming an object of tender dismissal.

I want someone to notice my limitations without deciding they’re the main story.

I want someone who’s watched all the seasons before this one and still chooses to tune in.

I am sixty.

I am slower than I was. My hair lacks luster, and I can’t remember anyone’s name unless I met them before 1993.

I am still vain. Still hungry. Still afraid of pity. Still hoping my wife will look up and see, if not the young man she married, then at least the man who has been trying, in his imperfect and often self-absorbed way, to remain visible to her.

Every bit of this suffering is my own creation, an oversaturated filter that makes life more vivid if a little less real.

And no, I am not ready to renounce it.

Not the part that wants her to collapse across me on the couch. Not the part that wants my parents restored and my sons unharmed.

The 4.5 rating I could probably let go.

So for now, I will keep walking into the world, hoping to be seen. To be wanted. To be chosen.

Not pitied.

Not yet.

Author’s Bio

Scott Hess is a longtime Chicago advertising executive and an even-longer-time writer.

An undergraduate poetry major, he has somehow managed to support a family while continuing to write poems, essays, and fiction.

Last summer, he served as Billy Collins’s workshop assistant at the Southampton Writers Conference, where he made the former U.S. poet laureate laugh more than once.

Want to see more of Scott?

Check out Scott Hess’s essays and like, comment, or subscribe.

I had some doubts that such a determination was even possible. But the bigger problem was I wasn’t entirely sure about myself.

In the spring of 1971, I sat alone in my room in the Bachelors Officers’ Quarters (BOQ) at Naval Air Station (NAS), Sigonella, Sicily, contemplating what a senior officer had asked me to do:

“I’d like you to see a young sailor to figure out if he’s really a homosexual or if he’s lying about it just to get out of the Navy.”

During the Vietnam era, claiming to be gay was just one of the ways desperate young men tried to get out of the military.

My knowledge of homosexuality was limited to what I had been taught: the military, the psychiatric profession, and most of American society all agreed that a homosexual was considered unfit. Even an admission of same-sex desires was grounds for discharge.

I didn’t feel qualified to make that determination. I wasn’t certain anyone could. The distinction mattered because it determined the kind of discharge a man received, a decision that could affect his benefits, his employment, and the rest of his life.

But it wasn’t my professional competence I was worried about.

Hidden Risks

I was the Flight Surgeon for an anti-submarine patrol squadron that left Brunswick, Maine, during a blizzard in early January of 1971 for a six-month deployment to NAS Sigonella.

Twenty-five miles away, Mount Etna dominated the eastern skyline. We had been warned that an eruption could damage aircraft and cause breathing problems for the men. The volcano had been inactive, so it was easy to dismiss any tremors.

For years, decades, sometimes centuries, nothing appears to happen with a volcano.

The landscape looks stable. People build houses and cities on top of it. Life goes on.

On April 5, 1971, Mount Etna split open.

The fissures opened near the summit, and lava began to flow down the mountain. Steam and ash rose above it. All of it was visible from NAS Sigonella.

The mountain that had looked like a solid and permanent part of the landscape when we arrived had become an event. It continued erupting throughout our remaining time in Sicily.

What had looked dormant upon our arrival had suddenly revealed the turbulent forces that had been building below the surface.

esprit de corps

I was a good officer.

The military wanted men who were disciplined, dependable, loyal, and emotionally controlled. I was all of those things. I was committed to the men in my squadron, often beyond my own comfort.

I loved that the men called me “Doc,” and included me in their activities. They invited me to fly with them on their training missions when I was available, and when you’re the doctor for a squadron of 250 flight-ready men, the professional responsibilities weren’t demanding.

My commanding officers trusted my judgment.

I fit in. I belonged.

From the outside, things appeared stable.

Beneath the surface, there was turbulence.

Light Duty

NAS Sigonella was a small Navy installation that supported anti-submarine patrol squadrons that rotated in and out about every six months. Like the small town in Nebraska where I grew up, everyone knew everyone’s business.

Catania, a city of about half a million, was about twenty minutes from sleepy NAS Sigonella. In Catania, sailors could disappear into the anonymity of the city. Mount Etna was Catania’s silent partner, always there, threatening to assert its authority.

My office on the Navy base was in the Dispensary, which provided primary care to about one thousand active-duty military personnel and their dependents. It was staffed by a couple of General Medical Officers and a dentist, all about my age, a few nurses, and a small group of Hospital Corpsmen. No one had made the military a career choice.

Every day during sick call, I saw a few minor problems for a couple of hours. Flight personnel treated me warmly outside the Dispensary but avoided me inside. They knew I had the power to “ground” them if the situation warranted it, and those men loved to fly. After sick call, my day was free.

It was sunny nearly every day, and I had lots of time with not much to do. The military years were my gap years, but they came with guilt. I felt lucky to have this assignment, but I couldn’t fully enjoy it. My wife was back in the States, awaiting the birth of our first child, which she would deliver alone during our first winter in Maine. Many of my Flight Surgeon colleagues were in Vietnam sorting casualties.

Sleeping Naked

One of the General Medical Officers stationed at the base stood out from the rest of us. He spent his free time running in skimpy jogging shorts and no shirt. The pilots in my squadron often commented that he was “light in his Nikes” as he did extended stretching exercises on the lawn outside of the BOQ after his runs.

Dr. “Nike” and I spent a lot of time in the Dispensary chatting about our common experiences. He was a single man and lived in Catania. One day he asked,

“Hey, Loren. How about going to dinner with me tonight in Catania?”

Bored with the food and the slot machines in the Officers’ Club, I readily agreed.

He picked me up after work and fought the crazy traffic of impatient Italian drivers. We ate one of the best Italian dinners I’ve ever had in his favorite restaurant. The waiter kept refilling the carafe with Etna Rosso, the local wine.

After dinner, he asked me if I’d like to see his apartment, and I agreed. At his apartment, he said,

“I’m too drunk to drive you back to the base. Would you mind staying here?”

It seemed like a good idea.

Then he said,

“The maid hasn’t changed the linens in the guest room. Is it okay if you sleep in my bed?”

I agreed.

As we prepared for bed, he took off all of his clothes, and I saw a well-tanned, muscular, and fit young man, standing naked across the bed. Then he said,

“I always sleep naked.”

After he got in bed, I climbed into bed in my tighty whiteys.

I lay on my back in bed, wondering What have I just agreed to?

I was drunk enough not to have given much thought to it, but sober enough to recognize the danger.

I didn’t sleep much that night. I remember lying on my back with my arms at my sides as if they were zip-tied to the mattress.

I don’t know if I was afraid of what he might do. Or what I might do.

Were there forces building inside him?

Inside me?

Or both?

Not All Risks Were Hidden

If he had come on to me, I could have said I wasn’t interested. It would have been awkward and embarrassing, but “No harm, no foul.”

But I wasn’t afraid of him.

What I feared was that I wanted him to touch me.

I had to examine my own feelings with the same scrutiny I was being asked to apply to that young sailor whose sexuality I was asked to confirm. I was a physician in the U.S. Navy. I was expected not only to enforce the military’s medical and psychiatric standards but to live under them myself.

Had we acted on what I now believe was a mutual attraction and it had become known, the consequences would have been severe. We could have faced court-martial, loss of our medical careers in the Navy, separation from the service, and possible loss of our civilian medical licenses.

And if that wasn’t risk enough, it could have cost me my marriage and access to my daughter who was soon to be born.

Squared Away

The next morning, he put on his Navy uniform, and we left early so I could go to the BOQ and put on mine.

Everything was neatly squared away.

But I had to accept that my desire was sitting across from me in a Navy uniform.

As we drove to the base, we joked very superficially about our drunken evening together but not about sleeping naked in the same bed.

Back on the base, Navy Regs were once again in charge of our lives.

I began to put distance between Dr. Nike and me. I thought again about the examination my commanding officer had asked me to do. I tried to focus on plans for when my wife and newborn daughter would join me in Italy.

I had more sleepless nights wondering about how little separated me from that young sailor.

Everything that made me a good officer in the Navy made it easier to deny what was happening inside me.

The Navy once asked me to decide whether another man was telling the truth about who he was.

Mount Etna hadn’t suddenly become a volcano.

It took me another twenty years to answer the same question for myself.

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Delicious

adjective

Highly pleasing to the senses

If you’d told me that someday someone would look at my body and call it “delicious,” I’d have accused you of making fun of me.

I’d never thought of my body and delicious in the same sentence.

When Did I Go Bald?

When my stylist asked how I wanted my hair cut, I always said, “Make me look like Anderson Cooper.”

She’d cut my hair very short on the sides and then leave a little brush of longer hair across the front. I’d pay her, give her a nice tip, and leave feeling good about myself.

After my last haircut, I came home and looked in a mirror. Then I said to my partner, “I don’t like the way she cut my hair this time.”

I looked again in the mirror, more closely this time.

There wasn’t much hair to cut.

It wasn’t as though I didn’t know my hair was thinning. I once sunburned the back of my head.

It wasn’t because I find bald unattractive. The shock was something else entirely.

The image of myself that lived in my head still had an Anderson Cooper haircut.

The man I saw in the mirror looked more like Stanley Tucci.

I didn’t recognize the man I saw.

Body Audit

What happens when the body you’ve always known begins to disappear?

The backs of my hands resemble bread mold. I once prided myself on not having as many “liver spots” as my contemporaries. I felt as if my body had resisted paying the price for the accumulating years.

Occasionally, I discovered a hair in my eyebrow that was long enough to reach my earlobes. And I found ugly, black ones that looked like fishing lines. I had hair in my nose and ears to contend with that wasn’t there when I was younger.

Chest hair grew as if I’d bathed in Miracle-Gro.

Every hair seemed like evidence for the prosecution.

When applying deodorant after a shower, I began to see that the skin on my forearms was wrinkled like crepe paper, and the skin over my triceps sagged like a wet swimsuit. Any desire for a tribal tattoo disappeared. I no longer wanted to call attention to those parts of my body.

The thick body I once had didn’t introduce itself before I introduced myself.

No wonder old people feel invisible.

I was hiding in plain sight.

I’d already accepted a guilty verdict.

Sitzpinkler

There’s something wonderfully ironic about it: as young men, many of us stood to pee because that’s what “real men” did. As older men—because of enlarged prostates, balance, or simply convenience—we often rediscover the virtues of sitting down.

When you sit down to pee, in German it’s called a sitzpinkler. In Germany, it’s considered considerate and cleaner. In America, it’s often seen as a betrayal of masculinity.

Standing up to pee is a complex series of tasks that all take time, especially as one ages. Following my treatments for bladder cancer, the time allowed for that operation collapsed. I’d rush to the bathroom, adjust my clothes as I ran, and plop down on the toilet seat.

I had a fresh understanding of why women make a big issue of putting down a toilet seat.

Peeing is usually a private affair. No one was there to observe if my masculinity took a hit.

Now, the urgency has diminished but I still sit to pee. In private.

Sitting down to pee wasn’t surrender.

It was an adaptation.

Baldness wasn’t the problem.

Sitting down to pee wasn’t the problem.

The problem was I confused adaptation with defeat.

Slow Sex

By the time men reach my age of eighty-three, we’re somewhat more comfortable admitting we’ve experienced erectile dysfunction. The worrying, however, began decades earlier.

Erections never follow orders.

As teenagers, they happened at embarrassing moments when we didn’t want them. As older men, they don’t happen just because we want them.

As older men, erections also lose some of the importance we once attached to them.

A growing prostate impedes ejaculation. Some men worry their partners will think they’ve just faked an orgasm.

Erections may come and go even while lovemaking. Everything you do to try to force them to return backfires. Nothing kills an erection faster than thinking

Will I ever have a good erection again?

As I’ve aged, I’ve had to adapt.

Slow sex is best.

What helped was to return to being present in the moment. When I moved out of my head and refocused on touch, physical closeness, and intimate conversation, erections often returned.

Sex became about presence and pleasure, not about performance.

I had to let go of the hope that sex could be like it was when I was thirty.

What I discovered was that when I let go of the pressure to perform, intimacy deepened. I found that sex in late life could become something even better.

A Case Against Myself

Through the years, I resisted accepting the facts that my body was doing what bodies do. I could either continue to appeal the verdict, or I could make peace with it and learn to adapt.

One of my biggest fears about aging wasn’t the fear of decline; it was a fear of being less desirable. Desire for another doesn’t disappear, but our body doesn’t want to cooperate. Our culture worships youth and the gym-fit body, and I didn’t have either.

But when did I first begin to believe that no one could find me desirable anymore?

Like losing my hair, it didn’t happen all at once. It happened little by little as I saw the changes I could no longer deny.

I was trapped in a paradox: I wanted to be invisible, but I didn’t want to be ignored.

But something happened that changed everything.

One day while staying at a gay resort, I was walking back to my room. A man who was probably thirty years younger than me came walking toward me.

As we met on the sidewalk, he put his finger under my chin, ran it down to the nether regions, and said, “Delicious.”

We both kept walking in opposite directions.

My first thought was

Does he see what I see every day when I look in the mirror?

I didn’t ask him, of course. But the obvious answer was he didn’t.

It took me years to understand that I had built a case against myself. I had been seeing myself through my own fears.

He wasn’t mistaken.

I was.

My skin still looks like crepe paper and will keep me out of tattoo parlors. I’m a Sitzpinkler. My erections remain as unpredictable as Iowa’s weather.

None of that has changed.

I had built a case against myself.

A young stranger offered a single word.

Delicious.

It overturned the verdict.

Being called “delicious” wasn’t a compliment.

It permitted me to write a different story about the old man I see in the mirror.

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I thought you’d want to know that Dad died last night.

I was shocked. Sad, of course, but it went beyond sadness. It felt strangely personal.

For years, people had confused Bruce and me.

I was surprised by how much his death unsettled me. It affected me in ways the deaths of other family or friends hadn’t.

It wasn’t only that we resembled each other physically. Our lives had taken such similar shapes that they seemed to cast the same shadow.

What happens when someone dies whose life resembles yours so much that you are frequently mistaken for one another?

Shattering the Stereotype

I first met Bruce in the mid-1980s at a support group for gay fathers. Bruce and I had each fathered two children during our marriages. We had both decided to come out in our early forties.

We shared the same stocky build, but most people would agree that our bodies were the least interesting thing about either of us.

We were born four days apart in March of 1943. We even both had sisters named Marilyn.

The gay fathers support group was an important part of my coming out. Bruce and the other fathers in the group were men who were heavily invested in maintaining a relationship with their children.

Some joined the group over guilt about leaving their families.

Others were dealing with the shame of having deceived their spouses and families.

Like me, many of the fathers had been accused of destroying their children’s lives.

One irony was that many of us still loved our wives, albeit not enough in the ways marriage requires. Many considered their spouses their best friend.

All of us were there to figure out how to be the best father under difficult circumstances.

We were all trying to figure out how to be gay fathers during the height of the HIV/AIDs epidemic and a world that told us we all deserved to die.

But the most important change for me was to see a diverse group of men who didn’t look like the stereotype of gay men that I’d held in my head for forty years. It was profoundly normalizing.

Coming Out as Gay in Midlife

I had read the books on coming out.

They suggested that as a child you felt a sense of difference. Check

You felt shame and guilt about same sex desires. Check

You finally came to the recognition that you were differently normal. Check

But the books all suggested we’d complete the process in our mid-twenties. Bruce and I were in our early forties.

When I was promoting my book, Finally Out: Letting Go of Living Straight, I heard the same accusations over and over:

How could you not know you were gay? You have no balls. You were hiding behind the skirts of your wife.

Those accusations came mostly from gay men who’d come out earlier in their lives. They seemed to believe they were the only legitimate gays. It felt as if those of us in the gay fathers group were the stepchildren of the gay community.

Bruce and the other gay fathers helped me understand that there was no formula for how to be gay. There was no handbook or dress code.

I was closer to Bruce than to other fathers because we both had so much in common. Bruce and I talked about the guilt we felt, the challenges of being the non-custodial parent, the financial impact of the divorce and child support. We shared some anger that our being gay was seen as the only fuse that detonated the blast that destroyed our families.

We danced together at the clubs, shared a lot of meals, and spent slow time together.

We shared holidays to avoid being alone.

A Dangerous World

One other death similarly unsettled me, although not as deeply. Ken was another father in our support group. Ken was my age and also had two daughters, but Ken and I hadn’t connected in the way I had with Bruce.

One Sunday morning in 1987, I got a phone call from Bruce.

Ken’s dead.

Ken was stabbed to death the night before by two men he’d hooked up with on Des Moines’s “gay loop.” Why it happened will never be known.

After Ken’s death, Bruce and I wondered,

What kind of world have we come out into?

Our Final Goodbye

The last time I met with Bruce, we had lunch on the patio of the Des Moines Art Center.

Over chicken salad croissants and with a glass of wine, we reviewed the lives we had shared and the lives we’d lived apart. We talked about what lies ahead.

“Can you believe we’ve lived to be eighty-three?”

“I know. We’ve lived through some shit together, haven’t we?”

As we left, we both said,

“We should do this more often.”

Bruce was the proof we had both made it to old age successfully.

We’d conquered a lot of the same challenges and many that were unique to each of us. We both knew that we loved our children and they still loved us.

The sunlight is still here.

Bruce’s shadow has gone.

Without His Shadow

Bruce died before I did.

It feels as if death has moved closer.

Bruce was more than a friend.

Sometimes we lose people who closely witnessed our lives. Without them, we may even begin to doubt our own story. Bruce was one of the few people I’ve known who walked most of the same paths I’d walked. Many of them we walked side-by-side.

As long as Bruce was alive, I knew there was someone who deeply understood what it had cost us to be who we became.

I didn’t just lose Bruce.

I lost one of the few witnesses to my life.

When he died, I lost a voice that said,

Well done.

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The stories on What Keeps Me Awake are usually my own, but paradoxes belong to all of us.

My guest writer, Dr. Frank J. Infurna of The Science of Midlife, writes about the paradox of fatherhood in The Child I Expected and the Child I Met.

When I asked him if he would write for this guest series, he wrote back that he would “absolutely focus on fatherhood” from a personal perspective.

Boy, did he deliver!

Is there any parent who hasn’t asked, “What am I doing wrong?”

— Loren A. Olson, MD

Guest Essay

The Child I Expected and the Child I Met

Every child arrives as their own person.

Our greatest task as parents is not to mold them into the child we imagined, but to become the parent they need.

Before my oldest son was born, my wife and I spent a ton of time planning his room.

We picked out a crib, chose a theme, and hung decorations in the perfect spots. Every detail felt important, as though preparing the room was somehow preparing us to become parents.

What I don’t remember as much is the time spent thinking about the type of child he would be.

Meeting your child

From reading the parenting books, I assumed children were mostly shaped by how they were raised. Be loving and supportive, show them patience and consistency, and show up every day. Do those things, and everything else would fall into place.

Then, my son arrived, and within four months, so did the COVID-19 lockdown. We built a ship that we thought was headed towards calm waters. We were a cohesive team with lots of love to give and we thought that was enough.

When the storm of COVID hit, we battened down the hatches, seeking shelter in this new ship we built as a family of three. Our world felt small, suffocatingly small. And the littlest crew member was unpredictable and exhausting.

My wife and I were suddenly trying to balance two full-time careers while raising our first child entirely at home. We were fortunate in ways other families were not. My in-laws lived locally, and my parents would visit for extended periods. They spent countless hours helping us through those first months and years. Without them, I honestly don’t know how we would have managed.

During this time, parenting became something different from what I had imagined.

Not harder in the way people warn you about, such as the sleepless nights, diapers, and constant exhaustion.

Harder, because I slowly realized that children arrive with themselves already inside them.

You don’t choose your child’s temperament. You don’t choose whether they are cautious or fearless, quiet or exuberant, flexible or intensely determined.

You simply meet them.

What no one told us

My son was born with a fire that burned beautifully at times, filling us with light and purpose. But his intensity was terrifying and at times I was worried he’d burn us all into ash. That fire led him to walking at eleven months and determined to do everything himself.

There was an intensity to him that was impossible to ignore and equally impossible to keep up with. Relationships with friends. My relationship with my wife and our identities. Nothing seemed safe from his fiery touch.

As he grew older, that intensity became something else. When he became upset, he didn’t just cry, he unraveled. The smallest disappointment could become a full-body storm that we needed to find the energy to withstand. Was our ship built strong enough to withstand this? When everything seemed to be in disarray, I looked around and saw other parents who were content on their boats and not describing anything close to our experience.

We bought more parenting books, listened to podcasts, and followed the advice of “parenting experts” on Instagram. We tried the strategies that worked for other parents, and nothing was working for us.

There was one afternoon that I’ll never forget. He became so overwhelmed that he retreated into the bathroom, screaming and crying on the floor. Every time we tried to comfort him, his distress grew bigger, so eventually we backed away and gave him space.

Hours later, he fell asleep.

My wife and I looked at each other with enormous relief. However, when he woke up, he continued the same tantrum, exactly where he’d left off two hours earlier.

I remember thinking,

What are we missing?

At first, the question was about him. Eventually, it became about us.

Are we doing something wrong?

That’s the question I suspect almost every parent asks when life refuses to match the picture they had in their head.

Are we doing parenting wrong?

It took us a long time to stop asking the wrong question. For a while, every difficult day ended the same way.

What are we doing wrong?

I find it remarkable how quickly parents internalize responsibility. Children don’t come with instruction manuals, so when something isn’t working, it’s natural to assume the problem must be you.

We found ourselves in this cycle of thinking:

Maybe we weren’t being consistent enough.

Maybe we were giving in too often.

Maybe we weren’t giving enough consequences.

Maybe we weren’t patient enough.

Every parenting book seemed to promise that if you found the right strategy, your child would respond accordingly.

We tried more than I can remember. Some helped briefly, but most were useless. The tantrums kept coming.

As our son grew older, they also grew bigger. He became stronger, and helping him through those moments became physically and emotionally exhausting.

We were asking the wrong questions

Our second son being born changed how we saw everything.

We saw early on that his temperament was completely different. Where his older brother met the world at full volume, he moved through it with a quiet steadiness. He handled disappointment differently, was able to recover more quickly, and seemed able to regulate emotions in ways that had been difficult for our oldest.

My wife and I looked at each other and thought,

Maybe this isn’t about our parenting.

That realization didn’t make things easier, but it did replace guilt with curiosity.

Instead of asking, “How do we stop these behaviors?” we started asking, “What is our son trying to tell us?”

That shift changed everything.

The diagnosis

When we met with our pediatrician, she suggested occupational therapy. We committed to it, hopeful that we had found the missing piece. The therapist was thoughtful, caring, and gave us strategies we worked hard to implement at home.

Our everyday life didn’t change much. At this time, our son was five years old, and we felt as though we were running out of ideas.

We met with a developmental pediatrician, who felt he showed signs of ADHD and oppositional defiant disorder but hesitated to make a diagnosis because of his age.

Before we left, my wife asked one more question,

“What about autism?”

It was another possibility we hadn’t considered. The developmental pediatrician wrote us a referral, and we immediately scheduled an evaluation. I remember going through the questionnaires, observations, and interviews, wondering what they would see that we couldn’t.

At the fourth and final appointment, the doctor gently explained that our son met the criteria for autism spectrum disorder.

Two truths

Honestly, at that point in time, I knew almost nothing about autism. My understanding was shaped more by stereotypes than by reality.

I quickly learned that autism isn’t one thing. It’s a spectrum of ways people experience and interact with the world. No two autistic individuals behave exactly the same.

For our son, the diagnosis was about his difficulties with social cues and emotion regulation. The intensity we’d witnessed since he was a toddler suddenly had a framework.

Nothing about him changed that day; only our understanding of him did.

The understanding didn’t immediately bring relief. Instead, it brought grief.

Not grief because of who our son was.

Grief because we realized how long he’d been struggling to navigate a world that often asked him to do things that were difficult for him.

Grief because we wished we’d understood him sooner.

Grief because we knew parts of his path would be harder than we’d imagined when we were decorating that nursery years earlier.

Two things became true at the same time:

1. He is the same little boy who we have loved every day of his life. A label does not dictate who he is or his potential. The fire inside him can be controlled, and in the right environment, he can thrive and bring light to those around him.

2. Our son does not fit the mold of the person we expected to meet when he was born, with the future we imagined for him quietly changed.

Learning to hold both of those truths at once may have been one of the hardest parts of being his father.

We’ve got this

Nearly a year has passed since the diagnosis. There are still difficult days and moments when our son becomes overwhelmed in ways that are hard for him and for us.

Parenting him still requires more patience, flexibility, and creativity than I ever imagined when I first held him in my arms.

I’m also happy to report that life is very different (in a good way).

Soon after his diagnosis, we began working with an ABA therapy team. [Applied Behavioral Analysis is an evidence-based therapy for autism.] In those initial meetings, something happened that caught both my wife and me completely off guard.

They looked at us and said,

“We’ve got this. We’re going to help your son, and we’re going to help your family.”

It was the first time in years that someone didn’t simply offer another strategy or another worksheet. They offered hope. My wife and I cried because, for the first time, we felt like we weren’t carrying it alone.

ABA calmed the storm outside of our ship. It allowed others to come in and help us navigate his challenges. We weren’t alone. Now we have a fleet of ships around us we can call on for support.

They were right. Our son is thriving.

He’s preparing to start first grade at the Montessori school that has embraced him for who he is. He continues to surprise us with his curiosity, determination, kindness, and yes, the same fire that first caught our attention when he was barely a year old.

That fire never needed to be extinguished. It just needed people who understood how to help him direct it.

Looking back, I smile when I think about all the time we spent decorating his nursery before he was born.

I thought I was preparing a room for my son. I had no idea he was preparing me.

Parenting is about learning

Developmental psychologists often talk about how parents shape children. We spend far less time talking about the opposite.

Children are constantly reshaping us by exposing our assumptions and challenging our patience. They reveal strengths we didn’t know we possessed and insecurities we didn’t know were there.

Parenting has done all of this for my wife and me. Our ship has burn marks. It’s full of patches to keep the sea from getting in and sinking the ship.

But I look around and no longer check for a lifeboat. I trust that we have what we need for the voyage ahead. His fire brings warmth, light, and joy to our lives.

Before becoming a father, I thought parenting was about teaching. Now I think it’s just as much about learning:

Learning to let go of the child you imagined so you can fully embrace the child standing in front of you.

Learning that comparison is rarely helpful because every child is writing their own story.

Learning that asking for help is not an admission of failure but an act of love.

Most of all, learning that your child does not need to become someone different to be worthy of your deepest admiration.

---

An unimagined life

Four months ago, our daughter was born. Now our house is louder than ever. I watch my six- and four-year-old sons dote on her, making faces to coax out a smile or gently holding her tiny hands.

I go to bed almost every night exhausted in a way I never understood before becoming a parent.

I can’t remember a time when my life has felt fuller.

If you had shown me this life when I was assembling that crib years ago, I probably would have focused on the challenges, like the uncertainty, appointments, diagnosis, and sleepless nights.

Today, those aren’t the first things I see.

I see a boy who has taught me that understanding is more powerful than expectation.

I see a family that learned it was okay to ask for help.

And I see three children who, in completely different ways, are teaching me every day that becoming a parent was never about raising the children I imagined.

It has always been about loving the children I was given.

I don’t know what the future holds for my son. I suspect no parent ever truly does.

But maybe that’s the point.

Perhaps parenting isn’t about preparing our children for the future nearly as much as allowing them to prepare us for a life we never could have imagined.

Author’s Bio

Dr. Frank J. Infurna is a Professor of Psychology at Arizona State University. His Substack newsletter, The Science of Midlife, explores the psychology of midlife, resilience, caregiving, and relationships through research, storytelling, and personal reflection. He is currently writing a book titled, The Real Midlife Crisis, that will be published in 2027.

He describes himself as hard-working, generous, and a realist who does his best to see the glass half-full.

Dr. Infurna wrote:

“Writing this essay allowed me to reflect on the arc of my parenting journey. Parents often get caught up in the logistics of daily life and rarely have the time to reflect like I was able to in this essay.

“Parenting has shaped me in ways I never could have imagined.

“I’m also grateful to have a wonderful wife who is supportive, loving, and caring. There’s no one else I’d rather be on this journey with. I love her and our life together.”

Check out Dr. Infurna’s essays and like, comment, or subscribe.

Dr. Infurna's Essays

After I heard two psychiatric colleagues rave about their experiences working there, I parked New Zealand on my list of wished-for-but-impossible dreams.

I wasn’t looking to climb another step up the career ladder. I didn’t need the income. And I was drawn to a chance to work in a multi-cultural world, much different from my own in Des Moines, Iowa.

I wanted to say yes.

Then my mind did what our minds so often do.

It’s eight thousand miles away. The flight takes more than twenty-four hours. My children won’t like it. I’ll miss my grandchildren. Am I too old to practice medicine? Can I get licensed? What if I get sick? Or injured? Doug will never agree. I’ll miss my dog.

Within minutes, an exciting possibility had become a catalogue of reasons not to go.

Anxiety can make an opportunity feel like an irresponsible decision.

How? Not Why?

I started retiring from psychiatry in 2013 and didn’t finish until twelve years later. I wasn’t ready to end my psychiatric career at seventy. I began working part-time as a consulting psychiatrist. I loved my work even more when I could choose when, where, and how much I worked.

The evening after Lucy called, I hesitantly said to Doug, “A recruiter called about working in New Zealand…”

Unexpectedly, he responded, “Oh? Really?”

I let his response sit there for a moment, and then I said, “But it’s for six months, and you couldn’t come for that entire time…”

He replied, “But I might be able to come for a few weeks.” After a beat, he added, “Twice.”

Doug was accustomed to my hairbrained ideas. He was a little like my mother and often asked “How?” rather than “Why?” After all, they’d both supported my idea to start farming with no experience and to move a house fifteen miles to that farm.

COVID Killed My Dream

I worked with Lucy and settled on a six-month gig starting in November of 2020. I had my position and housing, my New Zealand medical license, and travel plans.

Then Lucy called.

“I have some bad news. Because of COVID, before you can work here, you will have to quarantine in a hotel room for two weeks. You will only be allowed one hour a day to go for a walk in the parking lot.”

I thought

I endured survival training in the U.S. Navy. I can do this, too.

I told Lucy, “I still want to do it.” Lucy was to call me a few days later with my travel plans.

When she called, she said, “The Medical Council has decided not to go through with this.”

I was just short of being despondent.

A Fallback Option

Shortly after that disappointment, another recruiter called with an invitation to work in the U. S. Virgin Islands. “Because of COVID, you’ll need all your shots and be tested three days before departing. Their military will take your temperature upon arrival and check your documents. If you don’t pass, they’ll send you back home.” She’d anticipated the arguments against it.

I didn’t even ask Doug. “I’ll do it.”

For several months, I flew wearing a mask, back and forth to the Virgin Islands, where I covered an inpatient psychiatric unit for seven days. I wrote my second book, No More Neckties, in a coffeehouse on the beach.

After the major threat of the COVID epidemic had passed, Lucy called again. I said, “I’ll do it for three months, not six.”

At the age of eighty, I began two periods of several months each working in New Zealand. Now, it’s the only medical license I have.

Opportunity Loss

The real cost of a lost opportunity isn’t simply a plane ticket or inconvenience. It’s everything that never happened because we chose safety.

Looking back on my life, New Zealand wasn’t the only opportunity I nearly missed.

What I realized was how frequently my imagination mistakes fear for wisdom.

Often, we’ve made the outcome of our decisions seem so awful that the reality will almost certainly be better than what we imagined. I did that with New Zealand. I’d also done that with coming out as gay.

Most of us assume the greatest risk is saying yes. We feel overwhelmed by doubt. But the greater loss may be saying no.

Most of us calculate only one side of the equation:

What might I lose if I say yes?

We rarely ask:

What might I lose if I say no?

That second question is opportunity cost.

Opportunity Cost

Economists define opportunity cost as the value of what you give up when you choose one option over another. But minds aren’t objective. We overestimate risks, magnify losses, and discount future benefits.

Had I declined the contract in New Zealand, I wouldn’t merely have stayed home. I would have missed the realization that retirement didn’t need to be an ending at all.

I would never have met the people I met, experienced cultures vastly different from my own, driven over those mountains on the wrong side of the road, or discovered that new beginnings don’t belong only to young people.

None of those would have felt like losses because I would never have known they existed.

The greatest losses in life are often invisible because they are the lives we never lived.

What opportunities are you talking yourself out of because you imagined the worst?

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I can’t argue with any of that advice.

Substack is filled with instructive articles on aging and fitness. Dr. Howard Luks writes some important articles on midlife fitness as preparation for aging well. He keeps returning to one simple message: Build strength and preserve our bodies so we can remain independent.

I find myself nodding in agreement.

But as an 83-year-old retired psychiatrist, I find myself asking a different question.

What are we preparing ourselves for?

Getting strong is not enough

Physical fitness doesn’t give life meaning. It gives us the capacity to continue living meaningfully.

If you live into your eighties—as I have—what kind of life are you hoping to have? What will give your life meaning after your career plateaus, your kids leave home, and the roles that defined you begin to fade away?

But becoming obsessed with preparing our bodies isn’t enough.

What are we doing to prepare our minds?

The Promise of Exercise

For twenty-five years, I farmed with my husband. We had a very large garden and grew our own food. We cut, stacked, and burned wood for heat. We manhandled livestock. I didn’t need a gym.

When the work became too much, we moved into a suburban townhome. Life changed.

I’m a reluctant exerciser. I love the feeling I have after a workout; I hate the feeling I have before I leave for the gym. Farm work had an immediate payoff. Exercising at the gym holds only a promise.

But I go to water aerobics because I know Dr. Luks is right.

Integrity vs. Despair

Dr. Luks has one central theme: Build strength! I don’t disagree, but as a psychiatrist, I must ask, “For what?”

Erik Erikson believed that every stage of life presents us with binary opposite challenges. The task he describes for midlife is “Generativity vs. Stagnation.” For late life, it is “Integrity vs. Despair.”

I doubt that Erikson ever intended to suggest our lives are neatly segmented into different stages. I certainly don’t believe that my life permanently leapt from one stage to the next. But I think he was onto something.

Dr. Luks recommends that we build strength in midlife to prepare us for a better late life. Erikson builds on that framework. He believed that preparing for old age isn’t just about our bodies. Beginning in midlife, Erikson argued, we also should equip ourselves psychologically and spiritually.

Erikson suggested we turn our attention toward generativity—the desire to leave the world better than we found it.

It is not about what you have, but about what you give—to mentor, create, nurture, and leave something of ourselves behind.

Although Erikson associated it with middle adulthood, I have come to think it may be life’s final vocation.

Many people in their seventies and eighties are more generative than they were in their fifties. In fact, many of them suggest that retirement has created more opportunities for it.

I also know some for whom the opposite is true. The opposite of generativity is stagnation, feeling life has narrowed. Despair arises when people become overwhelmed by regret, bitterness, or the belief that it is too late to become the person they hoped to be.

Retiring retirement

I practiced psychiatry until I was 82, and I was frequently asked, “When are you going to retire?”

Every time I was asked that question, I hesitated before responding.

The word retirement never fit me very well. It comes from the idea of withdrawing— removing oneself from active life—usually because of age.

Being retired sounds suspiciously like being tired all over again. It’s like a terminal condition from which one cannot recover. It suggests to me slowing down, stepping aside, and consuming rather than contributing.

Fuck that!

Once you’ve done all those things to make your body capable, what’s it capable for? Were we only preparing our bodies so we could withdraw from an active life?

When asked who I am, am I to answer, “I used to be a psychiatrist,” as if my entire identity is in the past tense?

I’m known for hating long introductions. I’ve done a lot of public speaking, and I was frequently asked for my “bio.” I have a junk drawer full of awards, but if people come to hear me speak, I figure I must deliver something meaningful. They’re not going to remember my resume.

And after I’m gone, I don’t want to be remembered for having a fifty-year award from the American Psychiatric Association. I want to be remembered for contributing to making life better for others.

I want to approach late life as if it is still unfolding.

Repurposing a life

Late adulthood isn’t the end of generativity; it is one of its richest expressions. At age sixty, I planted over 7,000 12-inch seedling trees on our farm in Madison County, Iowa. I never expected to see them grow to the mature trees they are today.

At eighty, I learned to knit. I’m finishing a third sweater for a grandchild’s graduation, and I’ve entered into discussions with the fourth about her choice of pattern, colors, and yarn. I’ve knitted hugs into every stitch.

I practiced psychiatry because I wanted to help people avoid despair and seek integrity. Now, that is what motivates me to write.

We retire from occupations and paychecks. We don’t retire from purpose.

Generativity isn’t about having a job. The end of paid work isn’t the end of meaningful work. After sixty, I wrote two books. But what matters more to me is that every essay I write adapts what I learned about psychiatry to another purpose.

Authenticity has become the buzzword of this era.

Perhaps we should be talking more about integrity as Erikson defined it. He believed that integrity develops when a person can look back on life with acceptance, recognizing both successes and failures, and still say:

This has been my life, and I own it.

But integrity isn’t passive. It means accepting our imperfections, finding meaning in our suffering, and nurturing a connection to others.

Integrity means planting trees because we care about the future, even if we won’t live long enough to see them mature.

It’s time to retire the word retirement. Retirement can end a career, but it need not end our contribution. We’ve retired from a regular paycheck and perhaps a profession. But we don’t have to retire from curiosity. Or service. Or creativity.

Retirement isn’t withdrawal. It is a time of transitioning from achievement to legacy.

It frees us to ask a more important question: not “What did I do?” but “What am I still capable of giving?”

My father’s early death and my mother’s enthusiasm for life encouraged me to wring everything I can out of my life. As my brother, “Lefty,” wrote, “I want to be thoroughly used up when I leave this earth.”

Stop asking,

“Are you retired?”

Instead, ask,

“What’s next? What are you able to give back?”

The first half of life asks,

Who am I becoming?

The second half asks,

What of myself am I now called to give away?

What keeps you awake at night?

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One person believes the paper should come over the top. The other believes it should come from underneath. Neither can explain why this matters so much, but both are convinced the survival of civilization depends on it.

I just don’t get it. There’s only one right way to hang it.

Even hotels know that you have to hang it over the top so housekeeping can fold those pretty little triangles into the free end of the roll.

I try not to make a big issue about it—but I do fix it in other people’s homes when it’s hung incorrectly.

Fortunately, my partner agrees.

Bath Towels and Fitted Sheets

We also agree about bath towels. They’re folded lengthwise in thirds, folded, and then folded again.

But fitted sheets deserve their own consideration. If fitted sheets didn’t work so well, I’d be convinced that they were invented by someone who hated humanity. In every couple, one person folds fitted sheets while the other wads them into a ball and throws them into the linen closet before witnesses arrive.

Martha Stewart taught me the proper way to fold them, but my partner is of the wadding persuasion. We found a compromise. We pull them off, wash them, and put them back on the bed.

Some things are just not worth fighting over. Fitted sheets and toilet paper are issues that don’t need fixing.

My husband and I save our major disagreements for the really big issues. Like T-shirts.

We disagree about the correct way to fold them. He has his way; I have mine. I’ve relented. I fold his the way he likes them. But he will only fold mine his way. He can be stubborn like that.

So, we still fight about T-shirts.

Underlying all those minor disagreements is the real issue: Who has the power in the relationship to make the decisions?

Most arguments aren’t about towels and toilet paper. They’re negotiations about whose preferences matter.

Gender Differences

Learning to live with a man forced me to rethink assumptions I’d made when I was married to my wife. Early in our relationship, she and I never discussed any of those issues. It was the early 1970s, before feminism really took off, and folding things was all women’s work.

Many of the things we considered “natural abilities” were really expectations we had accepted without question.

When I was married to my wife, she claimed she couldn’t balance a checkbook. After our divorce, she inexplicably could have passed the CPA exams.

But that all changed when I married my husband. There were no expectations based on gender. Most of our decisions about who does what were based on who does them better.

A refreshing concept.

Remote Controls and Restaurants

Relationships aren’t built on resolving major issues. Most of us discarded suitors for those things before we got too far into the relationship.

Relationships are built on how you deal with the minor disagreements, like who’s in charge of the remote control.

If I have the remote control and land on a movie I want to see, my husband always says, “We’ve seen this before.”

I respond, “I don’t remember it.”

He retorts, “You never do!”

And he’s right. He remembers every plot twist from every movie he’s ever watched. I never remember. For me, watching a movie I’ve seen before is like watching its premiere.

And yet, I’m suspicious. “We’ve watched this before” may well be an excuse to pass on a movie he doesn’t want to see.

Restaurants present some of the biggest challenges to our relationship. I ask him where he wants to eat, and I get the dreaded response, “I don’t care.” I run through a list of options until I land on the one he always wanted to go to.

Fix Only What Needs Fixing

The longer I live, the less I believe successful relationships depend on perfect agreement.

Solid relationships are based on love that grows out of patience, humor, and compromise. When people imagine compatibility, they think about the big things: politics, religion, and money.

But the real test of a relationship is whether two adults can peacefully coexist despite fundamentally different beliefs about toilet paper.

My husband and I have learned that most household disagreements are never really about towels or restaurants. They depend on something harder: accepting that another person can be intelligent and loving while being completely wrong about fitted sheets.

Our relationship has worked for four decades because we love each other and agree on major issues. And we continue to choose each other despite our completely incompatible standards for how to fold T-shirts.

Love asks us to make room for differences that don’t need fixing.

After forty years, my husband and I have learned that some disagreements are not problems that need solving. Restaurants, remote controls, and toilet paper are stand-ins for this deeper question:

Can I live with someone whose preferences make no sense to me?

A shared life is not built by winning arguments. It is built by deciding that the person matters more than being in charge of the decision.

Our toilet paper goes over the top.

The fitted sheets don’t get folded.

But I will never give up on the right way to fold T-shirts.

What keeps you awake at night?

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As adults, my sisters and I once discussed how, as children, we studied fathers in other families to try to figure out exactly what fathers did.

We were all so young when our Dad died that none of us could clearly imagine how a father might have fit into our family.

So, we built him backwards, assembling a collage from fragments of fathers we observed in other families.

We have only a few photographs of my Dad that confirm his existence, but memory works differently from photos. A collage reveals its seams. It is assembled from fragments that are selected but never fully explained.

Constructing a Father

In a collage, the viewer completes the work.

The fragmentation was the message.

I drew upon those fragments of fatherhood as my model for being a husband and father. The image contained raw edges and contradictions, and none of it fit well together. It held grief alongside idealized intimacy.

Equally important were the fragments I never selected at all.

The collage would have contained images of well-tanned farmers and baseball players, but none showing anger. Handsome men with well-toned bodies, but none with thick-waisted or soft bodies. There would have been no trace of a gentler masculinity. The men wore ball caps, not earrings.

I chose men of faith, not men with doubt. Fathers embracing children, not scolding them. Men admired by women and adored by their children.

In every respect, the collage was not a portrait of fatherhood; it was an advertisement for it.

The collage became less a memory of my father than a template for myself.

Re-parenting Myself

I carried that image into marriage and the start of a family.

My daughters were born in the 1970s, and the women’s movement reshaped my image of fatherhood. Fathers were expected to be less career-driven, emotionally present, and involved at home.

I was determined to get it all right. A father who got up with the infants during the night. One who changed blowout diapers. I’d be there for church. Piano lessons. Soccer practice. But I was also going to be the best damn physician I could be.

I was going to build a home even though I wasn’t a carpenter and had a confusing blueprint.

I was going to give my daughters everything I never had.

Looking back, I wasn’t only raising children. I was trying to raise the fatherless boy I had once been. I was going to parent my own grief.

The Burden of Perfection

One summer day, I was cleaning out the winter’s sheep bedding from the barn on our acreage in Maine. My wife was away for the weekend, so I was the sole parent for our daughters, who were two and five.

It was constant questions:

How do bumble bees fly?

Why do you put sheep poo on the garden?

I’m hot. Can we have a Popsicle?

I remember sitting on a bench while Popsicles melted down their chins, and I thought,

I have not had one complete thought today from beginning to end.

The collage came to mind, and I had another thought.

I can be a good parent for six hours a day. Maximum. Beyond that, I’ll still be a parent, but I don’t promise to be good at it.

I was stretched past my limit. I had started a new psychiatric practice, I tried to be a gentleman farmer, and I was committed to being a great Dad. I felt compromised in all three areas.

I realize that every woman who reads this is going to think, It’s ALWAYS been like that for women. But I’d never taken a close enough look at the collage women construct.

The Fragmentation Was the Message

But why was I doing all of this?

Did my children need it? Was I competing with my father? Was I trying to prove to my mother that I was as good as he was? Did I need it to satisfy some selfish, ego-driven goals?

The answer is yes, to all of those.

And what image was I leaving my children?

Children don’t need perfect parents. Their healthy development comes through accepting their parents’ imperfections.

Mine were fairly obvious.

Parents also need to be real. As I grew older and became more real, it wasn’t always comfortable for my daughters.

Eventually, I realized the collage was never meant to define me. It was fragments. Idealized. Not real life. The distance between the father I imagined and the person I actually was became impossible to ignore.

Good parents stay. I left.

For years, I believed staying was the measure of a good parent because leaving was what had happened to me. My father had no choice. I did.

No Regrets

I try to live without regret. I believe that I usually made the best decisions I could make with the information I had at the time.

I don’t regret leaving my wife; I can justify that decision. But what I struggle to justify is that I left my kids to become the “non-custodial” parent. I feel guilty about the pain I caused them.

There is another layer to this story that many people never see. When some fathers come out as gay, they are often cast as selfish, narcissistic men who abandoned their families in pursuit of their own happiness. Certainly, some parents act irresponsibly.

But many gay fathers love their children deeply and remain committed to them. They spent years trying to balance honesty about who they were with their responsibilities to the people they loved.

The stereotype is simple; the reality is usually much more complicated.

Many of us have carried not only the loss of daily contact with our children, but also the burden of being portrayed as villains in a story that was far more painful and complex than others understood.

I know the pain of not having a father.

What children need is not perfection, but a parent who stays. One who repairs damage. One that persists even when they fail.

I know I have disappointed my daughters. Sometimes, they have disappointed me. But our disappointments weren’t failures.

When we lose someone early, we often spend years filling in the missing pieces. We build stories, ideals, and expectations from fragments. Sometimes those constructions help us grow. Sometimes they become standards that no human being can meet.

The challenge is not to become the collage. The challenge is to live honestly with the missing pieces.

They didn’t need me to be the parent I strived to be. They needed me as I am.

Imperfect.

Good enough.

Many of us grew up without fully knowing someone who shaped us.

If you grew up with an important absence, what fragments did you use to fill it in?

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I spent much of my life trying to resolve paradoxes. I wanted grief to end, shame to disappear, relationships to make sense, and family wounds to heal. Instead, age has taught me that many of life’s deepest truths arrive as contradictions we cannot solve.

I write about loving people who wounded us and grieving people we never fully knew. About growing older while still discovering who we are. About shame that isolates us and honesty that sets us free. About loss that breaks our hearts and love that somehow survives.

The stories on What Keeps Me Awake are usually my own, but paradoxes belong to all of us. Occasionally, another writer explores those same tensions from a different vantage point. Their story is not mine, yet I recognize myself in it.

Today’s guest essay by is one of those stories, and I am honored to share it with you.

— Loren A. Olson, MD

Guest Essay

Two Things Can Be True

Tomorrow deserves consideration.
Today deserves inhabiting.

For much of my life, I treated these ideas as if they were in conflict with one another.

The more responsible I became, the more I believed I should be focused on what came next. Planning felt productive. Preparation felt wise. Looking ahead felt like the mark of someone who had their life together.

Presence, on the other hand, felt like something I would get around to later, after I had accomplished enough, achieved enough, or secured enough certainty about the future.

I have always been a planner. Part of that is simply my personality. Part of it comes from my profession. As an emergency physician, I spend my days anticipating possibilities, assessing risks, and preparing for outcomes that may never occur.

Thinking ahead is not only useful—it is necessary.

But if I’m honest, my relationship with planning has never been entirely professional.

Like many people who have experienced hardship, uncertainty, or trauma, I learned early on that preparation can feel like protection. If I thought far enough ahead, anticipated enough variables, and developed enough contingency plans, perhaps I could avoid being caught off guard. Perhaps I could create some measure of certainty in an uncertain world.

Well, the problem is that life has never agreed to those terms.

No amount of planning guarantees clarity. No roadmap eliminates uncertainty. No carefully constructed vision of the future can prevent life from surprising us.

Sometimes we play with Barbie dolls when we are little and think about getting married and having a baby by twenty-two. Only to reach twenty-two and think, well, that certainly was a silly thought. Either we grow up, learn more, and change the plan, or we don’t have a plan for every twist and turn handed to us.

Eventually, every one of us reaches the edge of what we can predict and must take a step forward anyway.

The older I get, the more I realize that many of the most meaningful parts of my life emerged from circumstances I never could have planned: The people who changed me. The opportunities that redirected me. The lessons that shaped me. Even some of the experiences I spent years wishing had never happened.

At the time, many of those moments felt like mistakes.

Now they feel like necessary chapters.

There are certainly decisions I would not make again. Relationships I stayed in too long. Situations I would navigate differently with the wisdom I have now. Earlier versions of myself sometimes make me cringe when I look back.

But I have stopped wishing those versions away because every one of them brought me here.

Every imperfect decision, every heartbreak, every detour, and every season of uncertainty contributed something to the person I eventually became.

And if I’m being honest, I had to survive some bad relationships before I could recognize a good one when it arrived.

Or, as Ariana Grande so eloquently put it:

“Thank you. Next.”

Humor aside, there is a profound truth hidden in that sentiment.

Every ending taught me something.

Every disappointment revealed something about myself. Every relationship, whether it lasted or not, helped clarify what I valued and what I was willing to accept. Had everything unfolded according to my carefully constructed plans, I would likely be living a very different life from the one I have today.

And I am not convinced it would be better.

That realization has changed the way I think about the future.

For years, I believed the goal was certainty. Now I think the goal is trust.

Not trust that everything will work out exactly as I hope. Life has repeatedly demonstrated that it won’t. Rather, trust in my ability to navigate whatever comes next. Trust that uncertainty does not automatically mean danger. Trust that I can handle outcomes I cannot yet imagine.

Working in emergency medicine has reinforced this lesson more than any book, podcast, or self-help framework ever could. Every shift reminds me that life is simultaneously more fragile and more resilient than we realize.

Tomorrow is never guaranteed, and yet people continue to endure extraordinary hardship, adapt to circumstances they never imagined, and rebuild lives that once seemed irreparably broken.

If there is one thing my patients have taught me over the years, it is that human beings are remarkably capable of navigating uncertainty, even when they do not believe they are.

The lesson I carry home from those experiences is not that planning is futile. Quite the opposite. Planning matters. Goals matter. Preparation matters. The future deserves our consideration. What I have come to question, however, is the assumption that preparation alone is enough.

Because there is a subtle difference between preparing for your life and postponing it.

I think many of us spend years doing the latter without even realizing it. I certainly did. We convince ourselves that we will finally relax after the next promotion, enjoy ourselves once things settle down, or allow ourselves to be happy when we reach some future milestone.

We tell ourselves that life will begin after we find the right partner, move to the right city, make enough money, buy the house, get married, have children, or accomplish whatever goal currently occupies our horizon.

(To my fellow medicine folks, don’t you dare wait until you are done with your training to live your life).

But life has a habit of moving the finish line.

There is always another objective to pursue, another problem to solve, another future version of ourselves waiting somewhere in the distance.

Meanwhile, the life we claim to be building continues unfolding quietly in front of us. It unfolds in morning coffee shared with someone we love, in conversations that subtly change our perspective, in walks we almost didn’t take, and in ordinary Tuesdays that seem entirely forgettable until years later when we realize they belonged to a season we would gladly revisit if given the chance.

A number of years back, I converted all my parents’ old VHS tapes of us as children into a flash drive. In watching back years and years of films, I realized that I didn’t care to watch the recitals, choir concerts, or graduation ceremonies. I found myself watching the mundane moments. Us eating breakfast together, playing in the yard, sliding down snow banks on boogie boards.

The truth is that we rarely recognize the most important moments while we are living them.

We identify them in hindsight. Looking back, we suddenly see that what felt ordinary at the time was quietly shaping the trajectory of our lives. The relationship that taught us what we needed. The failure that redirected us. The difficult season that developed a resilience we would later depend upon. The choice we agonized over ultimately led us somewhere we never expected to go.

Perhaps that is why I no longer believe the challenge is choosing between the future and the present. The challenge is learning how to honor both.

It is learning how to plan without becoming consumed by planning, how to dream without becoming trapped in anticipation, and how to work toward tomorrow without sacrificing today.

Two things can be true.

The future deserves consideration.

The present deserves participation.

One does not diminish the other. In fact, I would argue they depend on each other.

The future is shaped by how we live today, and today’s experiences often make sense only when viewed from the future.

Both are necessary.

Both matter.

Because one day, the future we spend so much time preparing for arrives. When it does, it arrives quietly. It arrives disguised as an ordinary day. It arrives as today.

The question is whether we will be present enough to notice.

Author’s Bio

Dr. Landon Eggleston is a popular author who writes on Substack under the name Clear View. She covers topics about staying present, building resilience, and aligning one’s life with purpose.

An Emergency Room physician in Chicago, she describes herself as “very analytical in nature” while acknowledging a paradox of her own: “I actually make most decisions on intuition.” She is a detail-oriented and original thinker with a gift for noticing what others often miss.

As she puts it:

“I am on a persistently endless journey to live the most meaningful life I can without letting one second of this one wild and precious life pass by.”

Dr. Eggleston’s writing continually challenges and inspires me. Her work explores many of the paradoxes adjacent to my own, and I am grateful that she agreed to contribute to this series.

Check out Dr. Eggleston’s essays and like, comment, or subscribe.

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My mother had her first stroke during the National Anthem at a University of Nebraska football game.

In the emergency room at Bryan Hospital, my stepfather told the doctor, “I held her up during the National Anthem. I probably should have called the paramedics right away.”

The doctor responded, “At a Nebraska football game, most people would have waited until the end of the game.”

Singing to the Doctor

My mother had aphasia, so she couldn’t report to her doctor how she was doing. She discovered, however, that she could sing. Each morning, she sang her progress to the doctor to the tune of “Row, Row, Row Your Boat.” Neurologist Oliver Sacks, in his book Musicophilia, wrote about how language and music are processed differently in the brain.

Her stroke didn’t cause other physical disabilities. As was her style, she worked hard with her speech therapist to recover as much as she could. She would shake her head in disgust as she struggled with persistent word-finding difficulty. Sometimes it became a game of twenty questions to help her find the word she was looking for.

It was during this recovery period that I first saw her as becoming old and fragile. I was not ready for it. The family began to live with the fear of “When will this happen again?”

She was a tough woman; she’d lived through more difficult challenges.

Was this all a dress rehearsal?

Although my siblings and I had steeled ourselves for loss, we were given a reprieve. She returned to playing the organ and directing the choir at Salem Lutheran Church in Wakefield, Nebraska.

Each family event grew in importance. We all had an awareness that it might be the last. The stroke that threatened to take her away taught us how to celebrate the time she was still with us.

Medical Decision Making by Proxy

One thing did change. All four of us had separate, difficult discussions with my mother about end-of-life decisions. As hard as it was for us to imagine the loss, she seemed to welcome the conversations.

My mother asked me to be her proxy medical decision maker. I am a physician; it all seemed logical and was welcomed by my siblings.

I didn’t realize that end-of-life decisions are more emotional than medical. Medical decisions tend to be more straightforward. The questions I faced were ones that no amount of medical training had prepared me to answer.

The burden of those decisions was lightened by the fact that all four of us children had discussed her values, wishes, and beliefs with her.

Decisions would be made on the basis of the possibility of a return to meaningful function, limiting prolonged suffering, and not delaying an inevitable outcome.

Most of all, they would be made to assure her that she would die with dignity.

Is This Your Final Decision?

Several years later, the massive final stroke happened.

As I entered the hospital, even before seeing my mother, the doctor cornered me with some questions:

Do you want a DNR order?

Yes

A breathing tube?

No

Antibiotics?

No

A feeding tube?

Definitely No

IV fluids?

I hesitated, and then No.

Each question became increasingly more difficult. Each answer felt less like making a medical decision than closing a door that would never open again.

One question wasn’t asked that should have been. What about pain medications, even though they might hasten her death?

I worked through those decisions with the doctor. I knew each decision I made was made with the full support of my brother and sisters.

Each decision was made with love, but with a feeling of loss. Were we just giving up?

We all agreed that our final and most important act of caring was one of letting my mother go in the way she wished and with her dignity intact.

As I thought through these decisions, I was also thinking, How would I like to live my final moments?

Her Pain Was Physical

I agreed to sit with her overnight. Each night, I sat there and watched the urine in her bag grow darker as it became more concentrated. She allowed me to swab her mouth with one large, moist cotton swab; she always refused the second one.

Although she had no speech, her mind seemed intact. She seemed very aware of her prognosis.

One night, she was writhing in what appeared to be pain. I couldn’t localize it, but she was very distressed. I called the nurse.

“My mother needs something for pain.” She said she’d call her doctor.

She returned with an injection. I asked her what it was, and she told me it was haloperidol, a medication I’d used frequently for schizophrenic patients, and one which is used routinely in emergency rooms to calm agitated patients.

I exploded, uncharacteristically. “She’s not crazy! She’s in PAIN!”

She returned with an injection of morphine. I kept my mouth shut, but I wondered, Why are some primary care physicians so afraid of making dying patients into addicts?

Today Is the Day

One morning, as the family arrived for the family change of shifts, Sister Margaret greeted us. “I think today is the day.”

My mother’s breathing had become erratic, and she slipped in and out of a coma, more in a coma than out of it.

Grandpa Marvin, my stepfather, who was in his nineties, suddenly appeared. He hadn’t driven a car in years, but drove the ten miles to the hospital.

Everything seemed to be in place. We called the minister.

We entered her room, where a large bouquet of tulips sat on her nightstand, highlighted by a stream of sunlight. My husband, who loved my mother, had sent them with me.

The minister arrived, greeted the family, and then began the Lutheran equivalent of the last rites. He read the 23^rd Psalm. He prayed. And then led us in the Lord’s Prayer.

Our Father, who art in heaven. Hallowed be thy name. Thy kingdom come…

At that moment, my mother woke up, bright-eyed, a smile on her face and a wink in her eye, as if to say, “Not yet.”

Decisions without Algorithms

The essential question at the time someone is dying is not “What do we want?” It is “What do they want?”

After my mother’s passing, I returned to Des Moines and my psychiatric practice. One of my first patients was a man in the late stages of HIV/AIDS. I asked him whether he had discussed end-of-life decisions with his loved ones.

He said, “I don’t want nothing. Except a feeding tube. I don’t want to starve to death.”

Perhaps the easiest decision I had made in my mother’s care was to deny the feeding tube. It was the last thing he wanted to give up.

A thought flashed through my head: Did I just starve my mother to death?

But there is no algorithm for these decisions. These are always ethical choices rooted in the values of the person who is dying.

I was fortunate that my family and I had had those discussions with my mother, and she had seemed to welcome them. I think many old people or those with terminal conditions would like to have those conversations. But they are often avoided.

The patient may not wish to upset the family. The family may not want to face the reality of the loss. Families can have serious differences of opinion.

If the conversation is very difficult, sometimes it can be held in a third-person way, speaking of the circumstances of someone else’s death. In worst cases, an ethics committee may need to be called to help make an objective decision based on medical findings as well as patients’ wishes.

The burden of end-of-life decisions is that there are rarely perfect choices.

Love asks something difficult of us: When does holding on serve our interests more than those of the person we love? Eventually, we must learn how to let them die with dignity.

The Queen of Hearts

At the end of every big family meal, after the plates were cleared, my mother would bring out a deck of cards. Everyone groaned but knew we couldn’t avoid playing Hearts and that she would keep score.

My mother was competitive in the softest possible way. She would always sarcastically apologize as she trumped a trick you were counting on. This was at its worst when she dumped the Queen of Spades on that trick with a smile and a wink.

It was the same expression I had seen during the Lord’s Prayer on her last day on earth.

Has it been difficult for you to have these conversations with loved ones? What made it so hard?

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I want to be thoroughly used up when I leave this earth.

The note could have been his biography.

Today would have been Lefty’s 90th birthday.

Lefty was seven years older than me. I wrote about how my father seemed like a saint to me. Lefty was another one.

Lefty became quadriplegic at age sixteen as a result of a car accident. But he never showed any bitterness about it.

Lefty loved the Brooklyn Dodgers. He received rehabilitation care in the mid-1950s at New York University Hospital under the care of Dr. Howard Rusk. Dr. Rusk insisted that his patients remain engaged in the world despite their disabilities.

Dr. Rusk told Lefty something like this:

If you want to go to a Dodger’s game, and you shit yourself in public, you just shit yourself. But at least you got to see the Dodgers play.

Lefty went to Dodgers games while lying on a gurney.

I wish I had remembered Dr. Rusk’s admonition when I pissed myself while waiting for my prescriptions at CVS in Target.

I once asked my mother, his primary caregiver, if he ever complained about his injuries. She said all he ever admitted to was having a dream that his baseball glove kept falling off.

Lefty lived Dr. Rusk’s advice.

He graduated from college magna cum laude while working full-time, built his own accounting business, served for 20 years as mayor of our hometown, was a sports reporter and photographer, and was active in Salem Lutheran Church. He drove his own van.

He loved to travel, first with my mother, then later with his wife, Sylvia. They traveled throughout the United States and internationally. They even met Britain’s Queen Mother. He once rode a raft down a river in the Caribbean, strapped to the raft because he had no control over his body.

Lefty put me through college.

Sometimes he shit himself.

He loved me even when I—metaphorically—shit myself.

Years later, when he was being recognized for all he’d achieved, in his thank-you speech, he quoted from a prayer that could have been a brief summary of his life.

One verse stood out to me:

I asked for health,

That I might do greater things,

I was given infirmity,

That I might do better things.

The prayer ends with these words:

I got nothing that I asked for,

But everything I had hoped for,

Almost despite myself,

My unspoken prayers were answered.

And the prayer ends with these words:

I am among all men, most richly blessed.

---

I didn’t write this essay simply to memorialize my brother.

Sooner or later, life always humbles us. Our bodies challenge us, marriages fail, and we lose jobs. We don’t get the future we imagined.

Sometimes, we shit ourselves.

The larger question is, are you just going to sit there in your shit and wait for someone to rescue you? Or are you going to clean yourself up and get on with living the life you were meant to live?

With Dr. Rusk’s guidance, Lefty chose the second path.

He wanted to be thoroughly used up when he left the earth. No one doubts that he succeeded.

Will you?

Every story that’s ever been written about Lefty ends with this: He has two sisters and a brother.

—Loren

What single sentence would capture your life?

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I have only three memories of my father; I don’t trust that any of them are real.

All Memories are Approximations

At three years old, memories are only beginning to form.

They are fragmentary, reconstructed, and influenced by family stories. No doubt mine are embellished by the way I need to see my father.

But I need these memories to be true.

I need something of him.

Two Memories to Keep

My favorite image is of my father milking the old Guernsey cow that my grandfather Koester had given my parents as a wedding gift. When he finished, he hoisted me onto his shoulders. I nearly bumped off his old, beat-up brown felt hat as he bent to pick up the enamel bucket that contained the fresh milk.

There was a tenderness in his touch as he milked that old cow with his head tucked into her flank. He might have soothed her with a mixture of warmth and teasing. Each pull on the teat produced a “swoosh, swoosh” as the stream of milk pierced the creamy head in the bucket. Occasionally, a stream of milk was squirted at the cats. Or me.

The disagreeable odors of the barn wrinkle the noses of city folk, but farmers find them reassuring. The smell of the cow’s flank reminds me of a freshly bathed baby’s bottom. The smell of freshly stacked, maturing hay was blended with the earthy and fertile aroma of fresh manure.

With one hand on the bucket and another hand on my leg to keep me secure on his shoulders, we began what seemed to me like a long trip from the barn to the house.

My father carried the milk to the house, where my mother used the “separator” to separate the milk from the cream. The milk fed the family, and what was left fed the pigs. Some cream was churned into butter. The remainder was taken to town on Saturdays and sold to the creamery for grocery money.

My second memory is of riding in a horse-drawn, wooden wagon, as my father, my Uncle Glen, and their friends walked alongside, picking corn by hand. I stood at the end of the wagon watching them throw it into the wagon. I’d giggle as an occasional ear of corn was tossed in my direction.

One Memory to Forget

The final memory is one I’d like to forget.

I can see my father’s casket in the corner of our farmhouse living room, as was the custom in rural Nebraska in 1946. In my mind, it was covered in a blue, paisley-like fabric and surrounded by Mason jars filled with gladiolas and other garden flowers picked by the farm wives who arrived with their husbands in car after car.

It wasn’t uncommon for us to have visitors, but my young mind couldn’t comprehend why the party never started.

Time distorts our childhood memories.

None of these things may have happened, or at least not as I remember them.

Memories do not preserve the past; they recreate it. That's why two people can remember the same moment and tell entirely different stories.

In my childhood memory, the barn was a large red building a long walk from the house. Years later, I visited the old farm. The barn was much smaller and much closer to the house than I remembered. A man’s strides are much larger than a child’s.

Nearly eighty years later, I asked my 95-year-old Aunt Janet about them.

I cried when she responded,

“Loren, these things could all be true.”

When I described the casket to Aunt Janet, she said, “I think it was grey, but the rest is probably true.”

There are no photos. No one would have described that to me.

No one could have told me what to feel.

Saint Daddy

As a young boy, I often asked my mother to describe my father to me. She’d always begin by telling me how handsome he was. Then she’d add, “And he was a very good dancer.”

She’d tell me how she fell in love with him while he played the saxophone in the “Olson Family Band” at house dances on weekends. Uncle Ralph played the fiddle, and Aunt Vivian played the piano. None had had formal music training.

Then she’d go on to tell me how much he loved baseball. When families got together, the men improvised a baseball field in the pasture. They’d play pickup baseball as women prepared the picnic. My father wouldn’t allow alcohol.

My mother and dad worked tirelessly to eke out a hard-scrabble existence on the 160-acre farm in Cedar County, Nebraska. He was active in the Grange, and he often wrote essays for farm newsletters. She bragged about what a good writer he was, even though his father had allowed him to have only an eighth-grade education.

Boys were needed on the farm; the basics of reading, writing, and math were considered enough.

She always ended by telling me that one thousand people showed up for his funeral.

One thousand people.

The largest anyone had ever seen.

She never talked about how she felt as a 28-year-old widow with four young children.

I enjoyed hearing these stories. But they felt incomplete. Could anyone be this perfect?

Saints make terrible role models for those who survive them.

Years later, I asked my cousin, “Gaylund, I need some dirt on my father so I can make him human.”

He responded, “As far as I know, no one ever said anything bad about him. Maybe only that he was a little arrogant.”

I needed something darker, but I never got it from anyone.

I wanted evidence that he had failed.

At something.

Did he ever make tasteless “Dad jokes?” Was he ever unavailable? Did he have a temper?

How many people do I have to have come to my funeral to prove I measured up?

All memories are approximations. What we remember says as much about who we became as it does about what actually happened.

What memory from your past has changed meaning over time?

I’d genuinely like to hear from you.

—Loren

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During the final year of my psychiatry residency, a supervisor assigned us to write our own epitaph by answering a single question:

What is the worst thing that could be said about you that would still be true?

My answer came immediately:

He was almost a good father.

I Needed to be the Perfect Dad

My father was killed in a farm accident when I was three years old. I have no memory of his voice or his laugh. No one would tell me his faults to make him more accessible.

My father’s name was Alva Harold Olson, and he signed it Alva H. Olson. As a boy, I claimed the name Loren Alva H. Olson, though the H was never mine. Now I insist on Loren A. Olson. Don’t forget the A; I guard it carefully. That initial is one of the few remnants of him that remain in me

I cherish the three memories I have of him, although they may be only visions I’ve created from stories I heard.

All memories are reconstructions, approximations of the life we lived.

I studied my uncles and my friends’ fathers, splicing together snippets to form an ideal of the perfect dad.

Being a good father was never a role to be played. It was more than a moral obligation; it was a spiritual imperative. It was a responsibility I couldn’t fail.

Losing My Balance

When my daughters were two and five years old, my training demanded sixty- to seventy-hour workweeks. To help pay off medical school debt and buy our first home, I also moonlighted in emergency rooms.

One evening, after 36 hours with no sleep, I came home exhausted and sat down behind a newspaper. It was a flimsy barrier between my fatigue and the demands of parenthood.

My younger daughter climbed onto my lap, pushed the newspaper down, and placed one hand on each side of my face.

Her tiny hands carried a strong message:

You will pay attention to me. Now.

Later, when I complained to my wife about how exhausted I felt, she responded without sympathy:

“I suppose you think I’ve been having a blast around here all day!”

---

Delaying the Good Times

I commuted forty minutes each way from our home in Brunswick to Maine Medical Center in Portland. During those long drives, I repeatedly heard Harry Chapin’s Cats in the Cradle. The song accused me of everything I feared when I wrote that epitaph.

I felt punished by the lyrics that I seemed to hear on every trip:

“When you coming home, Dad?”

“I don’t know when,

But we’ll get together then,

You know we’ll have a good time then.”

My love wasn’t absent; it was postponed.

I told myself the sacrifices were temporary, necessary for the future my wife and I envisioned. But the most devastating lyric comes late in the song when the father finally has time and discovers that his son no longer does.

“When you coming home, son?”

“I don’t know when,

But we’ll get together then, Dad.”

---

Only One Door Left

As I reflect on my eighty-three years, I see that life was never a straight path but a succession of choices.

Author Wally Lamb wrote in She’s Come Undone about how we enter a room and are confronted by a series of doors. We choose one and walk through it into another hidden room with more doors. Then we choose again.

As I grew older, each successive room had fewer doors.

Now I have entered the final room; there is only one door. And the door behind me is locked.

The room is silent.

There are no more decisions to be made. I am there with nothing more than my life.

The room houses all my fears.

Did I choose the right doors?

Did my ambitions interfere with being the father and husband I promised to be?

How could I have betrayed my family when I chose to live openly as a gay man?

Beneath them lies the biggest question:

Was I a good enough father?

---

When is Almost Enough?

Before I walk through that final door, I wonder,

Have I fully become the person I was meant to be for the people I loved?

Was I almost honest? Almost brave? Almost available? Almost a good husband and father?

As I walked through those doors, I always believed, There’s still time. But now I ask, Did I wait too long?

And then, Will my children grow up just like me?

---

Time is Finite

The saddest relationships are not loveless ones.

They are built on postponed tenderness and the assumption that there will always be more time.

I once thought the worst true thing that could be said about me was:

He was almost a good father.

There’s only one more door. No do-overs. Behind the last door, will I find regret, or satisfaction that I was imperfect and yet good enough?

Now, I wonder if the deeper tragedy is how many people will walk through the final door, believing love only counts if it was given perfectly.

—Loren

This is the last of a three-essay series on what happens at the doorknob.

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After twenty-five years, a patient waited until the last thirty seconds of her therapy to reveal that she is a lesbian.

I waited a long time, too, to accept that I am gay.

The Myth of Santa Claus

I’m often asked how I could not know I was gay until I was forty. I respond by asking, “Did you ever believe in Santa Claus?”

In a nutshell, here’s the belief:

• Someone is watching.

• Your behavior matters.

• Goodness will bring rewards.

A very young child believes the myth of Santa Claus without question. Adults encourage it.

As the child gets older, questions emerge. But the people they trust don’t offer the truth, and the promised rewards are too good to give up.

And then one day, the child can no longer reconcile what they see with what they once believed.

Accepting that I am gay was very much like this. For me, that happened with a kiss.

But first, the back story.

The Price of Silence

At 7:00 a.m. on a cold winter morning in 1987, I sat in a windowless room in the hospital cafeteria. I had just become the Medical Director of Psychiatry at a large healthcare system in Des Moines.

About fifteen physicians—fourteen men and one woman—representing different specialties, were called together to discuss enrollment criteria for a new HMO.

The woman from the insurance company, who led the discussion, said, “I think we’ve found a question we can ask to determine if someone is gay. That way we don’t have to insure them for HIV.”

One physician responded, “What’s the question? Do you like to take it up the ass?” A few physicians tittered.

I sat there stunned, unable to respond. I didn’t laugh—though earlier in my life I might have. But I couldn’t make myself speak.

I needed that job.

I knew what breaking that silence could cost me.

I’m not a Deviant

In the early 1960s, I was an undergraduate at the University of Nebraska. The biggest social issue on campus was whether a Black man could pledge an all-white fraternity.

He couldn’t.

No one was openly gay. The only references to homosexuality came as jokes, comments designed to shame someone who didn’t fit the norm of what was acceptable. I forced a laugh, too.

In medical school at the University of Nebraska in 1964, we had one Black man, one Asian man, and one nun in the entire student body of four hundred. Eight of the ninety-six students in my class were women, the most women ever in one class.

Gay people were invisible. The term LGBTQ didn’t even exist yet. Disclosure could lead to losing your job, being arrested and institutionalized, or worse.

The Diagnostic and Statistical Manual of Mental Disorders (DSM-I) was first published in 1952. Homosexuality was classified—along with pedophilia—as a sexual deviation. Same-sex attraction was a symptom of pathologic sexuality.

I wasn’t pathological. I wasn’t a deviant. That couldn’t be me.

DSM-II was published in 1968, the year I graduated from medical school. DSM-II remained in effect until 1973.

Homosexuality was explicitly listed as a mental disorder.

After a heated debate and the testimony of Dr. John Fryer, the American Psychiatric Association voted to remove homosexuality as a mental disorder in 1973.

But it remained a disorder in the minds of most Americans.

Fifteen years after homosexuality was removed as a disorder from DSM-II, three-quarters of Americans continued to believe same-sex relations should be illegal.

The risks were real.

Questioning the Myth

In 1969, I entered the U S Navy as a Flight Surgeon. During Vietnam, some heterosexual men claimed to be gay to get discharged.

One job I had was to determine if these young men were lying or telling the truth. Both would be discharged, but gay men were discharged with a General Discharge under Honorable Conditions. Those who lied were given a Dishonorable Discharge.

Many men in the military were unhappy about having been drafted. Drugs and alcohol were abused as a way of coping.

One handsome young Corpsman frequently made references to smoking marijuana. Curious, I asked him to come over when my wife was away.

A naïve-user, I became very high. I hadn’t allowed myself to see that I found him sexually attractive. Unleashed, my mind raced to places I’d never let it go.

I was a married man, a physician, high, with a young enlisted man. I wanted to have sex with the young corpsman. My life felt one step away from imploding.

I could see that Santa Claus was wearing a fake beard, and I didn’t like it.

I clung to the myth.

“An Intellectual Curiosity”

In 1973, I left the Navy and entered my psychiatric residency. It was the same year homosexuality was removed as a disorder.

“Ego-dystonic homosexuality” was still diagnosed if a person was distressed about their sexual orientation.

I clung to my binary belief: You were gay or straight, no room for questioning or curiosity.

During my residency, I read Humphrey’s Tearoom Trade, a controversial study about anonymous sexual encounters between men. Many of these men were married, employed, and identified as heterosexual.

Humphrey’s work has been widely criticized as unethical for deceiving his research subjects about his role as a research observer.

I was intrigued by the book, but I saw myself as an observer, not a participant. I had a wife. Children. My life made sense.

I wasn’t like them. I saw no visible references to happy, well-adjusted gay men.

Increasing Visibility

In 1987, a colleague threatened to “out” me to my boss.

I went directly to my boss and told her I was gay. She reassured me they already knew when they hired me. And then she asked, “Why is it that more men like you are coming out?”

I had no answer.

Now I know: increased visibility. Not more people, just more people willing or forced to be seen.

Silence = Death

HIV made becoming visible a necessity.

The first report from the CDC about AIDS was in 1981. By the late 1980s, tens of thousands of Americans had died.

In that meeting in the hospital cafeteria, I felt trapped between the need to be visible and the need to protect myself.

Stigma and fear shaped everything. Half of Americans blamed AIDS patients for their illness and said they would avoid all contact with gay people.

People didn’t realize how many closeted LGBTQ people they already knew.

Public fear led to discrimination in housing and employment. And who would receive healthcare.

President Reagan did not publicly mention AIDS until 1985. Federal response was slow. Activism filled the vacuum.

Signs of “Silence=Death” became more than a slogan.

The consequences of exposure became less than the cost of invisibility.

A Kiss Made Me Gay

In the mid-1980s, my marriage was unraveling. I began to feel isolated and alone. I wanted some intimacy and tenderness.

I decided to have an affair. I didn’t expect it to be with a man.

Up until then, I had treated my same-sex interest as an intellectual curiosity. I was just an observer.

“I just want to experience this once,” I assured myself.

I approached a man I’d met at the gym with the thought that this would be a one-off thing to satisfy my curiosity. Observer, not a participant.

I hadn’t planned on him kissing me. But when he did, confusion left, and the myth was shattered.

I loved that kiss too much.

Silence Has Its Price

When people ask, “How could you not know?” the answer becomes clearer when I put my life in its context.

What looks like blindness, or much worse, as deceit and betrayal, was an adaptation.

Were the risks as real as I imagined? Perhaps not. But I had no framework to imagine a different life.

I wasn’t afraid of the truth. I was terrified of what it would cost.

I waited until I was at the doorknob of my career to feel safe.

And now I stand at the doorknob of my life.

The myth is gone.

I am at peace with that.

—Loren

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Throughout my fifty years of practicing psychiatry, I have seen this axiom proven over and over.

Bobo the Clown revealed her deepest secrets with her hand on the doorknob, twenty-five years after I first saw her.

It took years for me to share my secret, too.

Bobo’s Last Thirty Seconds

One of those people was a woman in her early seventies whom I had seen for about twenty-five years. She had long-standing difficulties with depression that had exacerbated in midlife.

When we first met, she was very fragile. She had all of the symptoms of a Major Depression, most likely aggravated by menopause. She considered ending an emotionally empty relationship with her husband, but feared being alone.

DepositPhotos

Her primary joy came from dressing as Bobo the Clown for children’s parties.

Over time, with antidepressants and years of therapy, she improved, but she frequently expressed sadness about a life not lived.

In later years, we met only every few months—brief check-ins, medication renewals, and a chance to catch up on the shape of her life.

She began our final session by saying, “Dr. Olson, I read your book!” In Finally Out: Letting Go of Living Straight, I had written about having come out as gay in my early forties.

She added, indignantly, “You told me a lot more than you need to.” Then she demanded, “Why did you do that?” I couldn’t tell whether she was disgusted by learning my truth or if she felt betrayed that I’d never revealed it.

I felt defensive and stammered as I responded, “I wanted to be honest about my life in hopes it would help others who struggled with the same issues.”

And then I added, “I couldn’t have written that book earlier in my career. I had to wait until it felt safe.”

A career doorknob revelation.

After we reviewed our work together, she stood slowly and moved toward the door. With her hand on the doorknob, she looked back at me and said, “I’ve always thought I was a lesbian.” Then, quickly, she was out the door.

I stood at the door, stunned. I would never see her again.

I’ll never know whether knowing my secret made it harder or easier for her.

My Last Sessions

That final visit often brings up how patients have dealt with other losses in their lives. I hadn’t expected that it would stir up feelings about my own losses.

Retiring was painful for me. Even with careful boundaries, I had become attached to my patients.

When I retired, I was saying goodbye to people who had shared the darkest moments in their lives.

It was my last thirty seconds with each of my patients, too.

What I told them was this:

You will take me with you.

In the future, you can have conversations with me in your head. You can ask yourself, ‘What would Dr. Olson say about this?’

You will probably know the answer.

I took them with me, too.

My Last “Last Session.”

I first saw “Betty” when she was sixty and nearly house-bound from symptoms of Obsessive-Compulsive Disorder.

She was ninety-five at the time of our last visit.

I had treated Betty with an MAO-Inhibitor—a rarely used, old antidepressant. Her transformation was dramatic. She moved from a life of isolation to become the unofficial social coordinator for her senior living facility.

Other physicians hate MAO-I medications because they complicate their treatments. I had many fights with her other doctors about why, after so many treatment failures with other medications, Betty needed to remain on the one I’d prescribed.

Betty was my final patient on my last day in the office. Her daughter brought her in. She pushed her walker as she entered my office. After she sat down, her daughter put the seat down on the walker and covered it with a tea towel.

They had called the office ahead and asked my office manager, Cathy, to put on some coffee. They brought a cake, balloons, and a beautiful card that I still have. A handwritten note in the card said, “Thanks for giving us back our mother.”

As she left my office, Betty cried.

Her daughter cried.

I cried.

As I ushered her to the door, Cathy was at her desk, crying.

A Final Revelation

Looking back, I can see now that writing Finally Out was my final revelation, a way of leaving something behind after the office door closed for the last time.

It was finally safe.

When I left my wife in 1986, I took a job as Medical Director of Psychiatry at a large medical center in Des Moines, Iowa. One of my responsibilities was to deal with some unethical practices of two psychiatrists.

One day, as I arrived on the psychiatric unit, I was met by the social worker. She said, “Dr. Olson, Dr. [name withheld] is on his way to the hospital administration to tell them you’re gay.”

Throughout my training, homosexuality was labeled a “pathological deviancy.” Even though it was removed from the Diagnostic and Statistical Manual of Mental Disorders in 1973, deviancy was not erased from people’s minds.

In 1986, it was still a risky time to be a gay physician. Very few physicians were openly gay, and certainly not ones in leadership positions. My being gay was a secret I had closely guarded.

I had good reasons to keep this secret. I had huge alimony and child support payments, and I needed that job.

I called my administrator and said, “Sharon, I need to talk with you right away.”

As I sat down with her, I nervously said, “Sharon, I need to tell you something. I’m gay.”

She responded, “Loren, we knew that when we hired you.”

Years and years of bottled-up fear drained from my body.

It’s Not the Words

We don’t hide secrets because we’re being dishonest. We hide them because truth has consequences. They become speakable only when it feels safe. Or sometimes, when time is running out.

We were told during my training that healing in therapy rests on three things: genuine warmth, accurate empathy, and unconditional positive regard. I don’t remember being told how long that can take.

I spent years trying to earn my patients’ trust. I told them I would make mistakes, but I would never intentionally harm them. It wasn’t the words that mattered.

What mattered was proof, over time, that I was trustworthy.

For Bobo the Clown, trust didn’t come easily. I hope that, having read Finally Out, she knew that I understood and accepted her. With Betty, trust had come more easily because her renaissance came so quickly.

When Sharon said, “We knew that when we hired you,” she was warm, empathetic, and accepted me as I am.

Trust isn’t given. It’s earned. Sometimes it takes years.

For Bobo the Clown, that took twenty-five years, with her hand on the doorknob for the final time.

—Loren

This is the first of a three-part series on revealing our secrets.

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Shame and Belonging

For some of us, it started with something as ordinary as the jeans we wore. Jeans that marked you as different. It was not just embarrassment. It was an instruction. A lesson in how shame shapes belonging.

Mike wrote:

“Everything in this post spoke to me. Everything. One thing I’ll never forget is being the fat kid of the neighborhood, having to buy clothes from the husky department.”

James Farren Hickey wrote about the consequences:

“I wore husky jeans for most of my childhood. One day my mother told me that if I lost weight I could wear ‘normal’ boy jeans.

So, I stopped eating and became anorexic.”

For others, it was a joke that didn’t land.

Karthik Ramanan V. Gurumurthy

“That moment on the road… when he said, ‘that was so fucking gay’ and burst out laughing. So did the others…my fingers tightening in shame around the handlebar of my bike… that was the first time I thought: ‘There’s no way I can be myself.’”

These aren’t just memories. Rules weren’t explicit, but they were clear.

We learned the rules by breaking them. And being shamed for it.

The Lesson

Mercer captured the core insight with striking precision:

“What most people miss about male loneliness is that it does not start with a decision to close off.

It starts with a lesson… ‘feeling out loud will cost you something.’”

---

The Speed of Shutting Down

The story about my grandson resonated with Mercer. He also noted how quickly boys learn to edit themselves:

[The story about your grandson] is such a precise example and that is what makes this piece work.

“The speed of that shutdown is what makes it so devastating.”

This isn’t gradual. The door slams shut. Often, for good.

The Lesson is Carried into Adulthood

For some, time has softened the lesson, although never erased it.

Peter Robertson wrote:

“As I’ve aged, the joy and comfort of self-acceptance far outweighed any need for validation. I also learned that most adults don’t care as much about things we suspect they do.”

Scott Hess commented:

“As I’ve gotten older… I’m no longer afraid to be the vulnerable one.”

And a parent, Jan M. Flynn, shared:

“I have two grown sons… They’re wonderful men with happy marriages now, but I am not okay with the price they’ve paid.”

---

When It Becomes Safe

There is both hope and grief here.

Hope for growth, but an accounting of what it takes to get there.

Scott Hess has found this among his gay friends:

“Gay men often are much more willing to be emotionally vulnerable and real than straight guys.”

Most men, but gay men in particular, have confronted shame directly.

They have no willingness to live inside it again.

The Lingering Question:

Ann raises the question:

“I sense the deep pain but not sure how to reach, support, and connect in a meaningful way.”

This may be the most important response of all.

It is not a reflection but a challenge.

Perhaps you’ll find some ideas here.

The Loneliness of Men

Graham J McDougall Jr

“An insightful essay based on personal experiences we men have experienced. Thanks.”

Not one reader described choosing isolation.

They described how learning it and its consequences.

Male loneliness doesn’t begin in isolation.

It begins in those moments where connection is conditional.

Male loneliness is learned.

Often quickly.

Most often through shame.

—Loren

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This is the final piece in a three-part series—about losing control, telling the truth, and what it means to finally be known.

First, I needed help managing my body. Then, I needed help learning how to adapt.

Finally, I had to face something I couldn’t manage at all: how I was seen.

I grew up in a small town in Nebraska, where everyone looked alike, thought alike, and believed alike. I wanted to fit in.

I once believed belonging was something I could earn. I monitored my behavior and censored what I said.

Fitting in is never belonging.

No one sees all of me. Some of it I hid even from myself.

What happens when you can no longer manage how you are perceived?

When that buff, young man in the locker room at the Y saw me struggling to put on my Depends, I felt a flash of terror.

For me, he was everything I wasn’t: competent, self-contained, independent. His well-defined muscles were proof of his strength.

I was an old man who couldn’t get his foot out of a pair of backwards Depends.

But what if I can’t control my bladder? When I lost control of my body, I adapted.

When I couldn’t process the information about these changes, I relied on someone else.

I had no control over what he thought about me.

Our identity isn’t carved on a stone tablet

Although we have a core identity, we present ourselves differently across the different roles in our lives. I am a man, a father and grandfather, a husband, a physician, and a best friend.

I am an advocate for old people, hoping to show our value by making us more visible. But are we acceptable only if they run half-marathons, drive ourselves to our doctors’ appointments, and hide the fact we need Depends?

To be accepted, must those of us who are old need to hide the ways we struggle?

Did that young man at the gym see me as I saw myself?

Was I seeing myself as I was—or the way I feared the world saw me?

I didn’t fail his standard.

I failed mine.

Filling in the Blanks

Being a physician demands more than knowledge and dedication to caregiving. We are trained to assess, diagnose, and explain things that carry a heavy burden while showing empathy and maintaining composure.

It demands that we balance being authentic and fully present—being human—with maintaining professional distance and control.

Control is necessary.

Control is rewarded.

When I trained in psychiatry in the early 1970s, residents were told not to have personal photos in our institutional-looking offices. We were told to address all patients as Mr., Mrs., or Miss regardless of their age; using “Ms.” was just introduced as an alternative.

At the same time, we were told that healing came through genuine warmth, accurate empathy, and unconditional positive regard.

I learned to manage a crisis. I could sit with a patient’s anxiety and uncertainty.

What I could not stop was calculating how I was being seen.

I broke away from that rigid model when I opened my first office in our old sea captain’s house on the coast of Maine.

Once, during a session, my two-year-old daughter opened the doors to my office and climbed onto my lap. My patient just kept talking.

She wasn’t concerned about my life; she was only concerned that I maintained my focus on her life.

I was good at hiding my identity before I became a physician. Being a physician amplified it.

We learned in psychiatric training that when our patients don’t know too much about us, they fill in the blanks from their own experiences. That’s exactly what I had done with the man in the locker room.

The more we know, the fewer blanks remain. Much of our training as therapists is about determining where those boundaries belong.

But the heart of therapy is helping our patients understand that we can never be all they want us to be.

No one can ever be all that someone wants us to be.

Exposure is getting caught; visibility is a choice

When I was in my urologist’s office, I was focused on my diagnosis. But something else was happening.

I was presenting myself to him as a colleague rather than as a patient. I wanted him to see me as a part of the inner circle, not as someone as fragile as I felt.

Underlying that was shame—an old pattern rooted in discomfort about my body—not so different from when my football coach said I had “tits.”

I talked openly with my partner. That was as it should be.

It was different with my best friend, Phil. I knew Phil had a choice. Was our relationship strong enough for me to tell him the truth without minimizing or hiding?

I began, cautiously, to let him see what I had been trying to manage alone.

Exposure is getting caught with your foot tangled in a Depends.

Visibility is a choice. It is a risk.

It is also the foundation of a meaningful relationship. It is the assurance that if I asked, my partner or Phil would go with me to my doctor’s appointments.

We become visible when it’s safe. Or when it’s getting late.

I had been there before.

When my wife confronted me about being gay, I hesitated a long time before responding. In that moment, I knew either I could lie or that my life would change completely.

There is no coming back from saying, “I think I might be gay.”

You lose control over how people will judge you or how that truth is shared. There are no do-overs.

I wrote a book, Finally Out: Letting Go of Living Straight. I knew when I published it that my patients would learn things about me I had long tried to protect.

One patient was a woman I’d treated for Major Depression for about 25 years. When I closed my practice to retire, she came in for her final visit with me. She said, forcefully:

“Dr. Olson, I read your book. You told me more than I needed to know. Why did you do that?”

I told her I now felt it was safe to be honest about my life had taken in the hope that others would find their way through their own.

When we had finished her final visit, she stood, went to the door, and with her hand on the doorknob, she turned back and said,

“I’ve always thought I was a Lesbian.”

After years of working with her, she chose to be seen.

Magnifying the negative

It is an illusion that identity is something we can construct, curate, and control.

Losing control risks more than discomfort.

After coming out as gay, my marriage to my wife ended. I lost a major promotion. Some friends rejected me. Others I never let get close enough to know.

I learned to anticipate the worst, to magnify the negatives, and minimize the positives. I could imagine the negative consequences of being seen, but not what might be gained.

What I feared others would see was already visible to me.

The effort to control what others saw fractured me.

I spent much of my life managing how I was known. I adjusted. Edited. Withheld.

It worked until it didn’t.

But the life I have now did not come from regaining control.

It came from giving up my need to control it.

What I lost was how I wanted to be known.

But I gained the freedom from trying to manage it.

—Loren

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