A couple days before, I notice that it’s coming. I think about it the night before. In the morning I remember that I have it scheduled near the end of my day.

I drive in with the top down on my convertible and pull into my usual spot along Main Street. The building is an older brick structure filled with yoga studios and similar businesses. I take the elevator—or the stairs if I’m up to it—three stories up, where I’m greeted by the smell of scented candles and aromatherapy.

As I approach the room, I hear the music.

And of course there’s a welcoming therapist who greets me with a smile and almost seems happy to see me.

I learned a long time ago how important that is to me. I need to believe that the person giving me a massage has positive feelings toward me—that she’s comfortable with me and happy I’m there. I couldn’t relax otherwise. What good is a massage from someone you think would rather not be touching you?

Maybe that’s part of the massage too. Before her hands have even touched me, my brain has already started deciding what their touch is going to mean.

I like the curtains over the windows. I didn’t mind looking out over the city when I first started coming here, but at some point I suggested that it might be nice if the room could be darkened. It’s nice thinking maybe I played a role in that.

During the massage, I do my best to focus on her hands.

My mind wants to pull me away.

After a couple minutes I notice that, once again, I haven’t been paying attention at all. My mind is wrapped up in some issue from the last couple days.

I bring it back.

At one point I realize she’s pressing against my hip. For a moment I hadn’t even known she was doing it. The pressure was there. Presumably all the signals were there. But somehow, for me, it wasn’t there.

Then it was.

I notice the music, a light piano melody that speeds up and slows down. A little serious, then more playful.

I focus back on the massage and something interesting happens. My mind connects the music to the pressure. Light music creates light pressure in my mind. When the music becomes more serious, somehow the pressure feels more serious too.

Are her hands warm?

Yes. Absolutely.

Warm hands that were just hands a moment ago.

How does that happen? I wonder?

Well, I’m certainly not going to think about that now.

Such thoughts would be better later, at home. Thinking about neuroscience is a pretty good way to ruin a massage.

For a while I manage to stay with her hands.

Then I’m pulled out of it. She has moved to my feet.

That’s usually the end.

All right, I remind myself. Only 60 minutes today. I really prefer 90, but you take what you can.

So I pay attention.

Her hands move down my shins and then hold my toes tightly, with a gentle pull. Her hands move to my ankles. She lifts my legs and moves them slowly back and forth. I feel the muscles along the sides of my body stretch first in one direction and then the other.

Then she sets my feet back on the table.

Soon I’m dressed again, standing in the same pleasant-smelling room where I started. The music is still playing. The candles and aromatherapy have presumably been filling the room the entire time.

For most of the last hour, I hadn’t smelled them at all.

After I got home, though, I did start thinking about what had happened.

And I did some reading.

Neuroscience has changed enormously in the forty years since I studied it. Back then I learned cranial nerves and afferent pathways and sensory tracts. The picture seemed almost ridiculously simple: information comes in from the outside world, travels along a pathway, and somehow the conscious mind receives it.

The modern picture is much messier.

There isn’t a little observer sitting inside the brain receiving an accurate report from the outside world. Sensory information is being processed even as it arrives. Some signals are amplified. Others are suppressed. Attention changes what gets priority. Expectation and memory matter. Regions including the insula and prefrontal cortex participate in networks that combine information about the outside world with information about the body and with whatever the brain has decided matters at that moment.

And the traffic doesn’t travel in only one direction.

Higher brain regions send signals back toward areas doing sensory processing, changing how incoming information is handled. What I experience affects what my brain pays attention to next, which changes what I experience next. This happens continuously and extraordinarily quickly.

So the pressure against my hip could be present without becoming part of my conscious experience.

Then suddenly it was.

Her hands could be warm the entire time without warmth being particularly important to me.

Then I asked myself whether they were warm.

And there it was.

The room smelled exactly as it had when I walked in. Yet for much of an hour, as far as my conscious experience was concerned, that smell barely existed.

That leaves me wondering about everything else.

How much of the world goes by that way?

I’d like to think I notice the important things and screen out the things that don’t matter. But much of that sorting happens before I have any conscious say in it. My attention gets pulled toward a worry, a sound, a memory, a thought. Ten minutes later I realize I’ve barely noticed where I am.

But I can also move my attention.

At least sometimes.

I can bring myself back to the music. I can notice pressure against my hip. I can ask whether a hand is warm and suddenly discover that it is.

So maybe the question I’m left with isn’t how accurately my brain shows me the world.

It’s how much power I have to decide which parts of the world I notice.

Probably less than I think.

But perhaps more than none.

And that seems worth practicing.

I spend some time on TikTok these days. Apparently, I have discovered the 30,000 people across the world who have a little interest in science. But it’s hard to spend much time there without also seeing posts by people who are angry and miserable. Sometimes it’s just a sentence on a black background:

Everything is horrible. We need to tear everything down.

I am always a little surprised when I come across those posts because, from where I’m sitting in rural Wisconsin, things don’t look all that bad. Even when I drive into town, I don’t see evidence of some great societal collapse.

Being me, of course, I wanted to look into it.

The pessimism gap

I remember the Bicentennial in 1976. Everyone my age, I suspect, remembers it. It was hard not to notice: new coins, flags everywhere, excitement on the news every night. So much excitement that even someone with a new driver’s license couldn’t help but notice.

The scientist in me wondered whether things really have changed—and why.

So I started with a simple hypothesis: People are complaining because things really are much different now. Much worse.

People on TikTok often talk about how good we Boomers had it. Maybe we did.

The first thing I wanted to know was whether the sentiment I was seeing on TikTok extended beyond TikTok. It does.

The University of Michigan has measured consumer sentiment for decades, using questions about personal finances and current and future economic conditions. The most recent reading was about 51, which is a bad number. During 1976, the index was generally in the 80s.

So at least I had established something: People really are extraordinarily pessimistic about the economy today compared with people during the Bicentennial.

Now I wanted to know why.

The obvious explanations don’t quite work

I started with the obvious things.

Unemployment averaged well over 7 percent in 1976. Today it’s closer to 4 percent.

Thirty-year mortgage rates averaged almost 9 percent in 1976. Today they’re somewhere in the 6 percent range. Neither sounds particularly appealing, but that certainly didn’t explain why people felt so much better in 1976.

Inflation was considerably higher then than it is now. Gasoline was expensive too—not that far from today when adjusted for inflation. And Americans had recently experienced something that seems almost unimaginable today: actual fuel shortages, with cars waiting in lines at gas stations.

Maybe the answer was recent history. After all, we went through COVID only a few years ago. Perhaps there is a lingering depression after everything the country experienced.

But then I thought about 1976.

We had just fled Saigon. The Vietnam War had killed more than 58,000 Americans. A president had resigned in disgrace less than two years earlier. The country had recently been through a recession and an oil embargo.

Politics are certainly a mess today. But it’s not as though we were particularly happy with our political leaders back then.

A couple of years before the Bicentennial, I went on an eighth-grade class trip to Washington, D.C. Somewhere along the way I acquired an “Impeach Nixon” bumper sticker. I remember getting in trouble for holding it against the bus window so the drivers behind us could see it.

So apparently even at fourteen I had opinions.

A short time later Nixon resigned. Gerald Ford took over and wasn’t exactly beloved either. By the end of 1976, we had elected our third president in four years.

I’m not sure it makes sense to compare any of that directly with COVID and the political divisions of today. But it became difficult to argue that Americans celebrating the Bicentennial had arrived there after an especially peaceful and reassuring decade.

Comparing prices—or comparing different lives?

Then I started looking at the other side.

Life itself was less expensive in some ways in 1976. With an antenna on the roof, I didn’t need streaming services. Frankly, my lifestyle didn’t even require a television. I certainly didn’t need an expensive telephone.

But could someone realistically do without those things today?

A smartphone would have been an unimaginable luxury in 1976. Today it is how we bank, communicate, navigate, make appointments, authenticate accounts and sometimes even pay for parking. At some point, a luxury can become so embedded in ordinary life that it becomes something close to a necessity.

Cars were less expensive in 1976, but they were also very different machines. Nobody was particularly surprised when a car driven every day was worn out after several years and 100,000 miles. Cars today cost more, but they last longer, perform better, are vastly safer and generally require less maintenance.

So what should I compare: price, longevity, safety, or transportation as a percentage of income?

Homes presented an even bigger problem.

The typical new home in the 1970s was somewhere around 1,500 square feet. Today’s new homes are considerably larger. Central air-conditioning was far less common then. Building standards, insulation, windows, appliances and mechanical systems have changed enormously.

But none of that makes today’s housing problem disappear. Relative to income, houses really are expensive today. Combining high prices with mortgage rates above 6 percent has made buying a first home genuinely difficult.

That was a solid point for the people telling me things are harder now.

At the same time, I remember 2006, when houses seemed impossibly expensive, followed only a few years later by a period when houses in some places were astonishingly cheap. The same thing happens with stocks. There are good times to buy assets and terrible times to buy them.

COVID appears to have accelerated an enormous run-up in housing prices—first through extraordinarily cheap mortgages, and then through a shortage of owners willing to give those mortgages up. So I’m reluctant to take housing prices at one point in history and treat them as a permanent feature of an economic system.

But I can hear people thinking: Well, in 1976, a single breadwinner could support a family, right?

That’s what I remembered too.

According to labor statistics, though, among married-couple families in 1976, only about 28 percent had the husband as the sole earner. In almost half, both husband and wife earned money. More than half had at least two earners in the family.

That surprised me.

So I looked at hourly wages. Surely I remember people getting paid more back then. Somehow, five dollars an hour was a lot of money, right?

Adjusted for inflation, production and nonsupervisory workers in 1976 were making the equivalent of about $29 an hour in today’s dollars. Today they make about $32.

So wages have gone up, not down.

Not dramatically. And that certainly doesn’t settle questions about housing, health care, education or child care. But again, it wasn’t what I expected to find.

The moving definition of “enough”

That whole issue reminded me of something I’ve noticed across my own life.

At my first job, I made about $3.60 an hour. At my last job before retiring, I was making almost 100 times that much.

And yet I don’t remember ever feeling 100 times richer. In fact, through most of my life, my personal economic situation has felt surprisingly similar.

The numbers changed. The things I considered normal changed. The things I worried about changed. But somehow there always seemed to be something that felt expensive.

Maybe everybody does some version of that. Maybe as our standard of living rises, our definition of an acceptable standard of living rises right along with it, leaving roughly the same amount of room for economic anxiety.

I certainly seem to have done it.

Health care looked like another obvious point for the other side. It is certainly more expensive today. But once again, I ran into the problem of deciding what I was comparing.

In 1976, they couldn’t have charged me for the operation that eventually extended my life because the operation I needed hadn’t really been developed yet.

It’s hard to calculate the inflation rate on something you couldn’t buy at any price.

That doesn’t make today’s health-care costs disappear. Being unable to afford medical care is a very real problem. But medicine in 2026 and medicine in 1976 aren’t the same product any more than a 1976 automobile and a modern automobile are the same product.

When I stand back and look at everything from a distance, it does appear that living standards increased.

Houses got bigger. Cars got better. More people got air-conditioning. Medicine can do things that would have seemed impossible. More people take trips to faraway places instead of going to the campground up the road.

I guess that’s progress. There’s nothing particularly wrong with any of it.

More workers belonged to unions in the 1970s, which for many people meant security, a pension and a clearer idea of what the future might look like. But plenty of people didn’t have pensions or particularly secure jobs then either.

And then there are all the things that are almost impossible to price.

I remember four of us chipping in money to buy gasoline for a drive a couple of hours away.

I remember the frustration I felt once when I bought a large order of french fries and only finished half of them. I had wasted money.

I remember living with 20 young men in college, then six guys in my first apartment, then three roommates in another apartment. My wife had twelve roommates in college and later shared housing with several women before we were married.

None of this seemed particularly remarkable at the time.

Too many variables, one persistent question

Looking at my data, I realized that my study was heavily confounded.

Fifty years had passed, and essentially every variable had changed.

Cars were different. Houses were different. Jobs were different. Medicine was different. Entertainment was different. Communication was different. What people considered necessities was different.

Even the things that frightened us were different.

In 1976 there was the Iron Curtain and the Soviet Union. There were the usual wars in the Middle East. Vietnam had just ended. Only a decade had passed since the assassinations of John Kennedy, Robert Kennedy and Martin Luther King Jr.

Today we have Russia and Ukraine, continuing conflict in the Middle East, political division at home and the memory of a pandemic that temporarily shut down much of ordinary life.

I don’t know how to put those things on a scale. More importantly, I don’t think I should.

Still, after wandering through all of this, I was left with the same problem.

I could find important things that are harder today. Housing is probably the most obvious. Health care and education deserve their own examination.

I could also find important things that were harder in 1976—unemployment, inflation, interest rates, energy insecurity and a materially lower standard of living in countless ordinary ways.

What I couldn’t find was an obvious economic transformation from an easy life in 1976 to a miserable one today.

Yet the difference in how people describe the economy is enormous.

What if the reference point changed?

That leaves me with hypotheses I’m much less comfortable evaluating.

Is it social media?

Is it expectations?

Is it the experience of growing up with your own bedroom, your own telephone and several television sets rather than regarding those things as luxuries?

Do people today see possibilities that we simply didn’t imagine in the 1970s—and therefore experience not having those things as a loss?

Does seeing the homes, vacations, bodies, careers and possessions of thousands of other people every day change the reference point we use to decide whether our own lives are going well?

Or have politics and media simply become better at telling us what our circumstances mean?

I started looking into this because I wondered whether people really have it harder today. After looking at the numbers, I’m not convinced they do. At least, I’m not convinced the difference is large enough to explain the enormous difference in how people say they’re doing.

Which leaves me wondering whether the biggest thing that changed between America’s 200th and 250th birthdays wasn’t our standard of living.

Maybe it was our standard for deciding whether we’re doing okay.

Fifty years after all those Bicentennial coins and flags, there’s another flag flying in my front yard. This one is celebrating 250 years.

After all this research, I think I’ll leave it there.

It’s been a good country to me.

I was pretty sure, anyway.

Our son had been pushing us for more than a year to get the American Express Platinum card.

“Fly Delta and use the lounge. You don’t have to sit out there with everybody else. And the food is fabulous.”

I never understood the appeal of not sitting with everybody else. I sort of like everybody else. But eventually we took his advice, got the card, and booked Delta for a weekend in New York.

We usually stay in downtown Brooklyn. I’ve given up on the newer hotels with their sliding barn doors that leave wide cracks around the edges. I’m talking about the bathroom, by the way. Nancy and I have been married forty years, but there are still limits. So lately we’ve returned to the reliable Holiday Inn, with a heavy wooden bathroom door and a lock.

After checking in, we walked down Flatbush Avenue to stretch our legs. That’s one of the things that still surprises me about Brooklyn. There are people everywhere, at almost every hour of the day and night.

We looped back through streets lined with brownstones, sunlight filtering through the trees, rested for a while, then headed down Flatbush again toward a restaurant where our son and his partner had made reservations.

Peruvian.

I’d never had Peruvian food.

Not long after we sat down, I pulled out my phone.

“Why does Peruvian food have such a strong Japanese influence?”

Apparently a large number of Japanese immigrants came to Peru beginning more than a century ago, and over time the two cuisines became intertwined. I thought this was amazing. My tablemates seemed somewhat less amazed.

Maybe that’s an old-age thing.

The food was marvelous. Plantain chips. Several kinds of ceviche. Tuna with whipped potato. Crunchy rings of calamari sitting on top of raw seafood. Different tastes and textures piled together in ways I wouldn’t have thought of.

Pretty much everything I could ask for in a meal.

The next morning Nancy and I walked to DUMBO and wandered through a flea market. Old cameras. Handcrafted jewelry. Baseballs with little tags showing the dates they had been retrieved from the stands at Yankee games.

Our son and his partner joined us, and we stopped at a little café overlooking the East River. They explained what an Americano was.

Of course I ordered one.

That afternoon Nancy and I wandered through Chinatown. At one point we came across a tiny place with lettering on the front that we couldn’t read and a line stretching down the sidewalk.

I pulled out my phone.

Apparently the place was an Internet sensation because of its pork buns.

We had dinner coming up.

We bought pork buns.

Walking afterward through Chinatown felt almost cinematic. Kids were running in the street. A couple posed beneath lanterns strung across the narrow road. Older men pushed carts piled with furniture. Signs covered the buildings in characters I couldn’t read.

Eventually we reached the dim sum restaurant and told the man at the front that two more people would be joining us.

His face changed immediately.

“Coming soon?”

“Yes. Very soon.”

He led us to a table, walked away, then turned around and looked back at us.

Apparently he had heard that one before.

Nancy and I hadn’t had dim sum since Toronto in the 1980s. It was fun to encounter it again.

Some of my favorite parts of New York, though, happen in Uber cars.

When there are four of us I usually end up in the front seat, which I don’t mind because it makes talking with the driver easier. I am apparently the only member of our group who considers this an advantage.

One driver had come from Colombia in 1983. Before long we were talking about his family and his daughter, who was now doing a residency in pediatrics.

Another driver was from Georgia—the country, not the state.

I asked him what people in Georgia thought about the war between Russia and Ukraine.

He said nothing.

He looked out the driver’s-side window for a moment.

I changed the subject.

That’s part of the calculation. I look at the driver’s face, say something small, and wait. Will this person engage? Is there somewhere to go?

My son and his partner, who has lived in New York his entire life, tell me I can’t do this.

“This is New York City.”

But I think they’re wrong.

Most of the time it takes almost nothing. A question. A little interest. Suddenly the driver is smiling and telling me about the country he came from, why he left, and whether coming here turned out the way he expected.

Eventually I hear about the people left behind. A brother. A sister. Parents. Sometimes years spent trying to bring them here.

I get an entire little window into someone’s life between Flatbush Avenue and Manhattan.

Later that night, as we walked toward my son’s apartment, I had a chance to take a short side trip with him while Nancy went ahead with his partner.

As we came out of a wine shop, my son opened up for one of those rare brief moments. He told me a little about how things were going.

I listened.

It occurred to me later that sometimes it’s easier to get an anonymous Uber driver talking than your own son.

Just how it is.

The next morning we stopped at a little French place I’ve been to several times. I ordered the same thing I always order there: eggs Benedict.

Regular eggs Benedict.

None of that fancy salmon stuff. I don’t like mayonnaise on my sushi, and I certainly don’t want fish in my eggs Benedict.

Then we headed for LaGuardia.

There’s always something to notice.

We had to wait a few minutes before entering the security line because an older woman—even older than me—was standing with her husband arguing with the person at the entrance.

Eventually we got through security.

And right there was a Delta lounge.

There were two lines. One for the riffraff like me and another for Medallion customers.

The woman from security was now at the front of the Medallion line. Someone waved Nancy and me ahead of her.

“This is an outrage,” she yelled.

Then again, louder:

“An outrage!”

I looked back.

She appeared quite old, yet the skin on her face was remarkably smooth. Almost shiny. As though someone had pulled it backward and reattached it somewhere near her ears, which, I suppose, wasn’t far from the truth.

We went inside.

I was startled.

Hundreds of people. A huge buffet. Bars with free liquor and wine. A seating area facing a wall of televisions, with individual controls. Work areas in the back.

Eventually we found a place that was almost outdoors, surrounded by windows overlooking the tarmac.

My son wasn’t wrong.

There was an entire world in airports I hadn’t known existed.

A few hours later we landed in Milwaukee.

Nancy went into the restroom while I waited outside.

Standing there, I noticed a little door next to me.

I had never noticed it before.

DELTA SKY CLUB.

I went inside.

“Can I use this even though we just landed?”

The woman behind the counter told me we could use any lounge within twenty-four hours of our flight.

When Nancy came out of the restroom, I brought her in.

We each grabbed a sandwich and headed for the car.

Apparently Milwaukee had had a lounge all along.

NOTE TO READERS:

I’ve mentioned how this Substack is my ‘sandbox’ for a larger project. Reading and learning and trying different writing styles.

I appreciate having such smart readers, and hope you stay tuned.

• Jeff

TikTok has turned out to be a great learning environment for me. Yes, you heard that right—I am learning from TikTok,

I’ve learned a surprising amount about rhetoric. I’ve learned the value of beginning a statement with, “People are asking...” Or perhaps, “Many people are saying...”

For example: Many people are asking why Stonehenge never got its roof.

I’m tempted to make a TikTok of my own:

“Everyone is asking about the roof that was never built over Stonehenge.”

Do you notice what I just did?

Did you picture a roof?

A few days ago I posted a TikTok about the Overton Window—the idea that public opinion is like a window that shifts over time, changing what seems reasonable or acceptable. Once you understand the concept, you start seeing it everywhere. Marketing. Politics. Medicine. Everyday conversations.

The same thing just happened with Stonehenge.

I suspect that the next time someone mentions Stonehenge, you’ll briefly picture a wooden roof of your own design sitting on top of those massive stones. Maybe only for a split second. But your brain has already filled in details that never existed.

It’s a wonderful reminder of how easily perception can be nudged. A carefully chosen phrase, an implied consensus, or a vivid mental image can change what we expect to see before we’ve examined any evidence at all.

That may be one of the most valuable lessons TikTok has taught me.

None of these rhetorical tricks works because people are gullible. They work because our brains are efficient. We evolved to make quick judgments using social cues, confidence, familiarity, and consensus. Most of the time, those shortcuts serve us well. But in an age of algorithms, advertising, politics, and social media, they are constantly being exploited.

The goal isn’t to become cynical. It’s simply to notice when someone is asking you to trust a feeling instead of the evidence. Once you recognize the trick, it loses much of its power.

Some people had it. Some people didn’t.

It’s hard to describe, but once you see it, you can’t stop seeing it. It’s a veneer of professionalism—a polished surface that somehow gets in the way of an ordinary conversation. Not rudeness. Not arrogance. Just... a wall.

I never noticed it between myself and my closest colleagues. But I noticed the moment many of them put it on.

Some people seemed to find it in college.

Most seemed to acquire it in medical school.

I spent years looking for it in myself, convinced that everyone else had received some instruction that I had somehow missed.

Now that I’m retired, I notice it more than ever when I go to see a physician. Even as another doctor, I often feel that wall go up the moment we begin talking. I wonder whether my own patients ever felt it from me.

Judging by what they told me over the years, maybe not.

Hundreds of patients said some version of the same thing:

“You’re different.”

At the time, I never knew exactly what they meant. Looking back, I wonder if they were simply noticing the absence of that wall.

The funny part is that I never consciously tried to avoid it.

I simply couldn’t seem to find it.

There were times I wished I could.

When I interviewed for consulting work with a pharmaceutical company, I wanted to project that polished confidence everyone else seemed to possess.

When I met a real billionaire last year, I thought perhaps this was one of those moments that called for a little more dignity.

Instead, there I was, kneeling beside his chair, grinning like an excited kid.

Some habits are difficult to fake.

Over the years I’ve searched for physicians who seem to carry a little less of that barrier. I’ve found a couple. Interestingly, theirs seems to come and go. Some days they’re all business. Other days they’re simply people.

Maybe that’s as close as anyone gets.

Now that I have more time to think, I find myself wondering where that wall comes from.

Is it built out of fear?

Is it something children absorb from watching their parents?

Does medical school quietly teach it without ever mentioning it?

Or is it actually an important part of professionalism—something I somehow missed while everyone else was paying attention?

Whenever I ask myself those questions, my mind drifts back to my father.

I remember watching him prepare speeches for Kiwanis. He was nervous beforehand, carefully rehearsing every word.

I remember him standing in front of our church congregation, speaking comfortably to several hundred people.

But afterward, he was exactly the same man who sat at our dinner table.

He seemed to understand something I never fully grasped.

There is a time to stand in front of people.

There is a time to simply be with them.

Those aren’t the same thing.

Perhaps the wall isn’t always artificial. Perhaps, in the right setting, it’s useful. Maybe it helps people carry responsibility. Maybe it gives them confidence when confidence is needed.

I don’t really know.

What I do know is that I never became very skilled at building it.

And now, looking back after a lifetime in medicine, I’m glad I didn’t.

I know that isn’t literally true. My brain didn’t suddenly gain more storage capacity the day I retired. But it feels as though something has been cleared away, leaving space to notice things that used to slip past me.

My mother used to teach shorthand before she met my father. As a child, I remember looking at those pages covered with loops and slashes and wondering how anyone could possibly read them. Yet she could listen to someone speak and capture an entire conversation almost as fast as the words came out.

Court reporters still do something similar. Their machines produce long ribbons of symbols that look like gibberish to the rest of us, yet somehow every word is preserved.

Our brains do something similar.

Last week I walked into a hotel lobby and, without warning, found myself thinking about a girl I knew when I was fourteen. We shared a canoe at church camp. The wind pushed us across the lake until the counselors had to come rescue us. I immediately remembered her name. Her initials were KK, right next to my JJ in the alphabet, something we both thought was funny.

That was the extent of the romance.

For months afterward she mailed me letters. Before opening each one, I would hold it under my nose. Every letter carried the same perfume, and for reasons I couldn’t have explained at fourteen, that made me happy.

More than fifty years later, standing in that hotel lobby, I smelled the same perfume.

I looked around until I spotted a woman, probably half my age, walking across the lobby. For just an instant my brain seemed confused. Apparently this smell could belong to someone else.

One scent had been carrying around an entire story for half a century.

A few days later, after returning from Yellowstone, I read about a man about my age who had been tossed into the air by a bison. The comment section was filled with four letters: FAFO.

Most people reading this will know exactly what those letters mean. If you don’t, it won’t take long to find out.

The interesting part wasn’t the acronym. It was what happened next. As more details emerged, the story became more complicated. Witnesses said the man had not been provoking the animal. The shorthand had arrived before the facts.

It made me realize how much of life we experience that way.

We meet someone and decide within seconds whether they’re intelligent, arrogant, trustworthy, or difficult. We hear a diagnosis and think we understand the patient. We assign a political label and imagine we know the person. We remember a relationship by a single feeling, forgetting everything that didn’t fit the summary.

And of course, physicians work in shorthand. “Borderline.” “Drug seeker.” “Chest pain in room three.

We do it because we have to.

The world contains far more information than any brain could possibly carry around in full detail. So evolution found a better solution. Compress it. Save the important parts. Store the rest behind a smell, a face, a nickname, a diagnosis, or even four letters in an online comment.

Most of the time, that shorthand serves us remarkably well.

The trick, I suppose, is remembering that shorthand isn’t the story. It’s only an invitation to reopen it. Sometimes the abbreviation survives long after the story has changed.

Now that retirement has given me a little more room, I find myself rereading my own shorthand. Some of it still captures the story. Some of it never really did. Some of it simply needs updating.

The rocks beneath the Tetons are among the oldest in North America, nearly three billion years old. The mountains themselves are youngsters by geological standards, beginning to rise only about ten million years ago. The dinosaurs had already been gone for more than fifty million years before these peaks started climbing toward the sky. Humans have wandered this valley for only about twelve thousand years.

Then I picked up my room key and realized my biggest concern for the evening was whether there would be air conditioning.

Things change.

This week we’re traveling across the American West for the first time since the 1970s. In a way, though, this trip has also become a journey back in time.

Last night we stayed at Jackson Lake Lodge.

The setting is extraordinary. The massive lobby overlooks the Tetons through walls of glass, and Nancy and I happily spent a couple of hours inside and out simply watching the mountains while we waited for our room. The food was excellent. The location couldn’t be better.

Then we opened the door.

This isn’t a complaint—just an observation. The contrast made me smile.

No air conditioning.

No television.

And a bathtub shower almost identical to the one I grew up with. Pull-up knob on the bath faucet. Incandescent sun lamp in the ceiling.

We don’t travel constantly, but we make it to Portland and Brooklyn at least once every year. In Brooklyn, we usually stay in newer hotels. The kind with giant televisions bolted to the wall and bathrooms apparently designed by someone who believes privacy is overrated. You know the style—a sliding piece of wood that sort of covers the doorway while generously leaving openings on both sides.

Wyoming has taken a different approach.

The bathroom door at Jackson Lake Lodge is solid. It closes. It locks. If, for some reason, a horde of determined invaders decided they absolutely had to get into your bathroom while you were using it, they’d have a difficult time.

For people who don’t know, this is also where the annual Jackson Hole Economic Symposium is held. Every year, dozens of the world’s most influential central bankers, economists, and financial leaders gather here to discuss the global economy. The walls are lined with black-and-white photographs from decades ago showing groups of businessmen in dress pants climbing into whitewater rafts. I have no idea how that adventure worked out for them.

Knowing the history, I couldn’t help picturing Alan Greenspan standing in that same bathtub. Carefully adjusting the faucet until the water temperature was just right... then muttering something unprintable when someone next door turned on a sink and his shower instantly switched from comfortably warm to ice cold.

The feeling of stepping backward in time didn’t end with the hotel.

One mural in the hallway stopped me in my tracks. According to the description beneath it, it depicts a Native chief giving his daughter in marriage to a fur trapper while everyone around them celebrates. I have no idea whether the painting reflects history, mythology, or simply the way an earlier generation chose to remember the West. But it made me think.

There must have been a time when simply encountering another human being after days or weeks in the wilderness was an event. Another person meant news, companionship, trade, help, danger, or perhaps the beginning of a family.

Today we often pass one another on hiking trails with our eyes fixed on the ground. Then I say, “Good morning,” and almost everyone looks up, smiles, and says hello back.

That has been one of the unexpected pleasures of this trip.

Everywhere I go, I find myself asking people where they’re from. So far we’ve met a couple from Israel, a family from South Korea—where only the wife spoke English—and visitors from Colombia. We’re all standing together in Wyoming, looking at mountains that have watched continents shift and glaciers come and go. The mountains haven’t changed much. The people standing in front of them have.

The hotel is filled with young men and women, spending the summer with work visas, their home countries on their nametags. Hungary. Azerbaijan. Jamaica. Each willing to talk about their lives back home, and their hopes for a better future.

The rest of the trip has been just as enjoyable. We’ve wandered down gravel roads to quiet mountain lakes nearly 7,000 feet above sea level. Because of my lung history, I’m not doing much hiking these days, but the scenery has been more than enough. I enjoy reading the bear warning signs and pointing them out to Nancy. Other visitors carry bear spray or a pistol. I tell her that if a grizzly comes along, we’ll figure it out.

Today we head to Yellowstone and one of those newfangled hotels on the north side.

After all this nostalgia, I have to admit something.

When we get back from a long day exploring the park... I probably won’t mind having a television waiting for me.

Things change.

And about meeting people for the first time and getting to know them, at least a little bit, over the course of a few months.

It reminds me of something I’ve known for years.

Our brains need a quick story.

It makes sense. It’s how we evolved. For most of human history we needed fast assessments. Threat or friend? Companion or competitor? Hunting partner or stranger? We didn’t have the luxury of spending six months getting to know everyone we met.

So we create a story.

The problem is that the modern world is very different.

When I first met people in the theater group, I introduced myself as a retired doctor. Lately I’ve wondered whether I should stop doing that because I know the perceptions it creates. The truth is that perception never fit me all that well and fits even more poorly now. The same thing happens with politics. We all know the assumptions people make when they notice signals from one tribe or another. I’ve always tried to resist those assumptions, from me and about me. I don’t like pigeon-holes. And it seems to get harder every year.

One of my fellow cast members told me when I first met him that he worked as an assistant manager at Kwik Trip.

Over the years as a psychiatrist and addictionologist, I’ve known many assistant managers. Without even realizing it, I put him in a compartment. Not a negative compartment. Just a compartment.

Then later I learned that before Kwik Trip he spent years working as a chef. Not just a chef, but a chef in some excellent restaurants. Restaurants in Chicago and other cities. He had lived a whole professional life that I knew nothing about.

And of course that isn’t unique to him.

Tough-looking guys work at urgent care before law school.

People who look like my old hippie friends now work at the YMCA.

I vaguely knew when I was young that some people played Dungeons and Dragons. Now I wonder whether I would have enjoyed it.

And other questions. Are theater people naturally drawn to the cheese trade, or do I need a larger sample for that assumption?

And a retired doctor turns out to be Harry the Horse, who in reality is freakishly good at estimating the heights of other men.

The older I get, the more I realize that almost every first impression is incomplete. Not wrong. Just incomplete.

I continue to debate in my head whether community theater is worth the time. As I’ve mentioned, I’m perfectly happy sitting at home with Nancy and the dogs. A quiet evening sounds pretty good to me.

But more and more I think at least some of the value comes from moments like this one.

Left to ourselves, we all build quick stories about other people.

Community theater keeps interrupting those stories.

Because every person seems to have several chapters.

What is the value of this?

Where are the studies?

Will it help me live longer? Lower my risk of dementia? Improve my mood? As a physician, I spent decades looking for evidence. Show me the data. Show me the outcome.

Then I think about what I would have been doing instead.

Most evenings I am happiest sitting at home between my two dogs or having dinner with my wife. I enjoy quiet. I enjoy routine. So why am I spending all this time learning songs and dance steps for a musical?

The answer, I think, is surprise.

The play has filled my head with things that never would have occurred to me if I had stayed home.

When rehearsals began, I found myself revisiting some old and familiar feelings. Feelings I hadn’t experienced in years.

I was often the oldest person in the room. Most of the cast was in their twenties. I stood off to the side while people talked and laughed with each other. It reminded me of being a child and feeling as though I was always on the outside looking in.

Someone would use the word “old” in a conversation and I would notice.

I wondered whether people were annoyed that it took me a little longer to learn a dance step.

On the drive home I kept telling myself the same thing.

Be patient.

Not with them. With myself.

One thing I relearned was that understanding an emotion and feeling an emotion are not the same thing.

The psychiatrist in me understood exactly what was happening. Nobody was excluding me. Nobody was judging me. Most of the cast was busy thinking about themselves, just as I was busy thinking about myself.

Yet the feeling was still there.

A little tightening in the chest.

A little discomfort in the stomach.

My limbic system, stubborn as ever, refusing to be talked out of emotions that the rest of my brain had already decided were unnecessary.

I found that interesting.

The older I get, the more I appreciate how little influence logic has over some parts of the human experience.

Another surprise involved judgment.

I spent the first couple of weeks wondering what people thought of me.

Then I realized I had been busy judging them.

I made assumptions. Some of them were wrong.

People I thought I understood turned out to be different than I expected. People I assumed I had nothing in common with became people I enjoyed talking to.

And then another thought occurred to me.

When I was twenty-two years old, how would I have reacted to an older retired doctor joining the cast?

Back then I couldn’t even talk comfortably to the nurses while delivering linens in the hospital during summer breaks. Why was I so certain that these young actors were spending time evaluating me?

Gradually I stopped feeling like an outsider.

I even made a few friends.

I probably won’t see most of them again after the show closes. But that almost misses the point. The value wasn’t permanence. The value was the experience itself.

The biggest surprise came from the director.

One evening she explained how she viewed Guys and Dolls. Not as a story about gambling, but as a story about risk.

The risk of gambling.

The risk of falling in love.

The risk of putting yourself out there and hoping things work out.

Everyone in the show is trying to present the best version of themselves. Everyone is pursuing something. Sometimes love. Sometimes money. Sometimes acceptance. Sometimes simply getting along with the people around them.

Including Harry the Horse.

At first I tried to play Harry the way I imagined other people saw him.

Then something clicked.

I realized I had been approaching the character backwards.

I don’t need to imagine Harry.

I know Harry.

He’s in there already.

Not the gambler. Not the hustler.

The guy trying to fit in.

The guy trying to get along.

The guy presenting a version of himself to the world and hoping it works.

Once I understood that, playing him became much easier.

So was community theater worth hundreds of hours of rehearsal?

I honestly don’t know.

I can’t tell you whether it will make me live longer.

I can’t tell you whether it increased my happiness score.

I can’t even tell you whether it was the most efficient use of my time.

What I can tell you is that it surprised me.

It surprised me about other people.

It surprised me about myself.

And at this stage of life, that may be reason enough.

Pieces I had forgotten—small interests and curiosities, and sometimes larger ones.

Lately, it’s tall people.

I’ve become fascinated by very tall people. I’ve also become someone who enjoys talking to almost everybody. So when I come across one of these giants, I usually have something to say.

“Six foot seven, right?” I’ll ask.

They look back with a surprised grin.

“You nailed it.”

“How did you know that?”

“I’m just freakishly good at guessing height,” I tell them.

And frankly, I am.

But tonight, I’m thinking about my dad. He was about my age when I first came back to Wisconsin. After he retired, he was doing much the same thing. He wasn’t assessing height, but he was joking with waitresses, talking to strangers while waiting for a plane, making little comments just to get a smile.

When he did that, I felt embarrassed. I groaned inside. At the time, I saw it as harmless awkwardness, the behavior of someone who didn’t realize how he was coming across.

Now I’m not so sure. The older I get, the more I recognize what was really happening. He wasn’t trying to impress anyone or be the center of attention. He was simply enjoying people. He had reached a point where a brief conversation with a stranger felt worthwhile on its own.

It’s hard to think back on that now. Why couldn’t I have had a little more grace for him?

What stings is realizing that I understand him only after he’s gone. The habits that once made me cringe are the ones I’ve quietly adopted. Somewhere along the way, I became the guy who starts conversations in line, notices things about people and says them out loud, and enjoys a moment of connection simply because it brightens the day.

There’s a certain tragedy in how we never get to meet our parents as equals. I imagine I’m not the only person who wishes he could share a cup of coffee with his father, both of them in their early seventies, neither one trying to prove anything.

I wonder if it has always been this way.

Then I remember that a couple hundred years ago, life expectancy was about forty, so people had their own things to feel wistful about. Maybe every age comes with its own impossible conversations.

It’s just one of those things.

Still, I like to think my dad would laugh if he could see me now, walking down the street in Milwaukee and talking to a stranger just for the sake of a smile.

And if he could see it, I can hear him saying:

“You nailed it.”

I’m a little busier these days in retirement.

Part of the reason is that I’m in the cast of Guys and Dolls.

Why?

I’m really not sure.

I’ve loved that play for years, and for some reason it just seemed like something I should do. I suspect many retired people understand that feeling. You reach a certain age and suddenly find yourself signing up for projects that make very little sense.

My wife was all for it.

“It’ll be good for you,” she said.

“Why?” I asked.

At this point in life, what difference does it make? Show me a study proving that community theater is beneficial for retired psychiatrists.

My son recently broke his ankle playing pickleball. He had been training for a marathon and is now on crutches for six weeks. My daughter developed a stress fracture in her hip while training for a marathon a few years ago.

These facts have not strengthened my wife’s case that I should take up either activity.

But back to the play.

I will admit that I have learned a few things.

For example, I can now grapevine across my kitchen with surprising confidence.

My favorite practice space is the stretch of floor between the kitchen island and the counter. Nancy sits about twenty feet away in a chair that rotates toward the television. Every so often she’ll turn and look into the kitchen to see what I’m doing.

Sometimes I’m chopping vegetables.

Sometimes I’m stirring a pot of sauce.

And occasionally she’ll discover that I’ve put on my favorite fedora and am silently gliding sideways behind the island, crossing one foot behind the other and then drifting back in the opposite direction.

No music.

No audience.

Just a retired guy practicing dance steps while waiting for water to boil.

Retirement has produced some sights neither of us anticipated.

I was in marching band many years ago, so I’m still not entirely sure why so many dance combinations insist on starting with the right foot. That has been a challenge.

The surprises, though, have been the best part.

Most of the cast is much younger than I am.

Being an old retired guy, I arrived with a few assumptions. What do these young people know about theater?

It didn’t take long to discover that they know a great deal more than I do.

At auditions, the choreographer asked, “How many of you consider yourselves dancers?”

I was mildly horrified when a number of hands went up.

Mine remained firmly attached to my side.

Watching those dancers learn combinations and watching the ensemble slowly come together has been fascinating. Every week the stage looks a little different. Every week people get a little sharper. Every week I try my best to imitate what they’re doing without causing injury to myself or others.

The other thing I noticed was how different everyone seemed from my generation.

Not better.

Not worse.

Just different.

People interact differently than they did in the 1960s and 1970s. There is less casual touching. Fewer slaps on the back. People are more careful about personal space. Humor is different too. Certain jokes that would have passed unnoticed fifty years ago are approached more thoughtfully now.

I find those differences interesting.

One thing I wondered before auditions was whether a modern theater group would even choose Guys and Dolls. Some of its assumptions belong to another era. But sitting in rehearsals, it became obvious that nobody was there to recreate 1950. They were there because the music is terrific, the dancing is fun, and for a few hours each week a group of people gets to build something together.

Then something unexpected happened.

As soon as people started singing, all of those differences disappeared.

The age differences disappeared.

The cultural differences disappeared.

The generational differences disappeared.

I was simply amazed by the talent.

There are voices in this production that stop me in my tracks during rehearsal. People I might pass in the grocery store without a second thought suddenly open their mouths and fill the room with sound.

That’s been my biggest surprise.

Not the dancing.

Certainly not the right foot.

But the reminder that there are still rooms full of people doing things I’ve never done before and doing them exceptionally well.

The fedora I wear in the kitchen has its own story.

The first fedora I owned belonged to my father. I started wearing it after he died. For years it lived in my car, sometimes on the seat, sometimes in the trunk, occasionally buried under bags of salt during Wisconsin winters. By now it’s badly misshapen and more than a little worn.

I donated it to the show.

So now the lead in Guys and Dolls is wearing my father’s old fedora on stage.

Somewhere, I think my dad would be smiling.

And perhaps that’s another thing I’ve enjoyed about this experience.

You sign up for something thinking it’s about learning a few dance steps.

Instead you find yourself practicing choreography in your kitchen, admiring the talents of people half your age, and watching your father’s hat begin a second career under the stage lights.

If you happen to live nearby, Guys and Dolls will be performed in Fond du Lac at the end of June.

I’d love to see you there.

Even when I was five years old and Dad made us ride them out in the southwest corner of the basement.

His orders.

The southwest corner was the only part of the basement that wasn’t finished. We sat on cold tile while the southeast corner—with couches, carpeting, and comfort—sat empty a few feet away. Dad said tornadoes came from the southwest. That settled the matter.

Back then there wasn’t much to do except listen.

No radar. No Weather Channel. No phone in your pocket showing a red blob moving across the county.

I suspect if Dad were alive today, he would have been standing in the driveway with me, tracking storms on his iPhone while pretending he was only checking to make sure everything was safe.

This time of year I still wait for storms.

I sit on the porch with my dogs and watch the radar. The terrier is thirteen now. He has seen enough thunderstorms to know how the story ends. As soon as the wind picks up, he heads for the laundry room and curls into his favorite kennel.

The French bulldog stays beside me longer. But when things get serious, she stops lying down. She stands and watches the sky with the expression of a referee at the Final Four. Alert. Concerned. Professional.

Our house sits on top of a hill facing west.

I like watching the storm approach.

Sometimes it’s a wall of white rain marching across the horizon. Other times it’s dusk, and the distant lights disappear one by one. The trees bend. The air cools. The first hailstones bounce off the deck.

For a while, it’s all fascinating.

Then comes that moment when the lightning flash and the crack of thunder arrive almost together.

That’s my cue to go inside for a bit.

Every storm reminds me of Oakfield.

1996, I think.

The Weather Channel was still relatively new. I remember watching a bright red dot on the radar moving southeast across Wisconsin. I kept trying to project its path. The line seemed to point directly toward Fond du Lac.

My son and I were outside shooting baskets when I noticed a huge V-shaped cloud moving from north to south. It disappeared behind the large doctor’s house behind ours before I could get a really good look at it.

A little later the sirens sounded.

Then the radio reports started coming in.

An F5 tornado had hit Oakfield.

When the sirens stopped, I did what countless Wisconsin fathers apparently did that evening.

I ignored my wife’s objections.

I loaded my two oldest kids into the Suburban.

They were still wearing their pajamas.

We headed toward Oakfield.

State troopers eventually blocked the roads, but what I remember most is all the other vehicles. Pickup trucks. Suburbans. One father driving. One or two kids beside him in pajamas.

It looked as though every dad in eastern Wisconsin had independently arrived at the same conclusion.

We should go see this.

Over the next few days, the stories began to emerge.

A woman I worked with was driving home to Oakfield when the rain turned into a wall of water. Then came hail. She pulled over, grabbed her children, and lay in a ditch while debris flew overhead. When she returned to work, cuts from flying objects still marked her face.

A dentist told me about his wife driving on Highway 151. She saw the tornado coming, stopped her car, and climbed into a culvert beneath the highway until it passed.

A group of children playing softball waited out the storm in a cinderblock building. When they came out, the trees around the field were gone.

Not damaged.

Gone.

The tornado finally dissipated near Eden, only a few miles from my house.

Close enough to imagine a different ending.

Part of me wanted to watch it pass by.

Most of me was grateful for the buffer zone.

I still sit on the porch when storms approach.

The terrier still retreats first.

The Frenchie still stands watch.

And I still find myself looking west, watching the horizon disappear.

Some things don’t change.

A little boy staring out a basement window.

An old man watching radar on his phone.

Just different ways of waiting for the storm.

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

“Was this written by you or by AI?”

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

The ideas are mine.

The stories are mine.

The opinions are mine.

The first draft is mine. Dictated.

But AI is almost always somewhere in the process.

Not as a ghostwriter.

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

It is hard to avoid news about AI these days.

Every week brings another prediction.

Millions of jobs disappearing.

Massive data centers consuming enormous amounts of electricity.

Businesses racing to figure out how to use AI.

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

I understand the concern.

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

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

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

Claude.

Gemini.

ChatGPT—or just “Chat,” as I call it.

DeepSeek.

Grok.

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

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

I realize AI has the potential to do disruptive things.

Harmful things.

But every major technology arrives carrying both possibilities.

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

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

Atomic physics gave us both atomic energy and atomic weapons.

Science rarely pauses to ask permission before moving forward.

AI is global.

I’m not going to stop it.

Neither are you.

So my approach has been simple.

Understand it.

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

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

I laughed.

Not at her. At the moment.

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

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

They worry they’ll ask the wrong question.

Or somehow break something.

I always think of my mother.

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

Then texting.

Her answer was always the same.

“No. I’ll break it.”

Of course she wasn’t going to break it.

And you aren’t going to break AI either.

Sometimes I think people imagine a warning message popping up:

USER FAILED TO PROMPT CORRECTLY.

PLEASE RETURN TO PROMPT SCHOOL FOR REMEDIAL TRAINING.

The reality is much simpler.

Just talk to it.

Use your own voice.

That was my entire strategy.

I started by telling it about myself.

My education.

My family.

My hobbies.

The books I enjoy.

The movies I enjoy.

The things that interest me.

The things that annoy me.

I even told it how I wanted it to respond.

Don’t flatter me.

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

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

Challenge me when appropriate.

Be as neutral as possible.

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

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

And that is where AI became interesting.

Not because it had answers.

Because it provided structure.

History was where I noticed it first.

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

What was the Middle East like before World War I?

How did the Crusades look from both sides?

What were people actually thinking during the Cold War?

Why do conspiracy theories spread?

One question led to another.

Then another.

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

I grew up knowing maybe five dinosaurs.

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

Those rabbit holes are hard to leave.

Cooking was next.

I use AI for recipes several times a week.

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

Within seconds it gives me three dinners.

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

I stopped obsessing over measurements.

Instead I started thinking about balance.

Acidity.

Sweetness.

Texture.

Brightness.

Depth.

The machine wasn’t just giving me recipes.

It was teaching me how to think about cooking.

Then came writing.

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

That experiment lasted about two weeks.

The problem was simple.

It didn’t sound like me.

It sounded like AI.

So I changed approaches.

Now I dictate.

I talk.

I wander.

I repeat myself.

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

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

Remove repetition.

Delete the false starts.

Keep the rhythm.

Keep the personality.

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

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

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

It has to do with understanding people.

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

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

Or why younger generations view certain issues so differently.

The answers aren’t always correct.

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

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

It doesn’t tell me what to think.

It shows me possibilities I hadn’t considered.

Every headline seems to focus on jobs that might disappear.

Maybe some will.

But professions have a habit of adapting.

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

The harder question is what people do next.

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

Understanding context.

Looking at a spreadsheet and recognizing what matters.

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

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

I’ve never been particularly interested in categories.

I’ve always been interested in connections.

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

I’ve always belonged closer to the second group.

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

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

Not just retrieving information.

Connecting information.

Holding multiple perspectives at the same time.

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

People often describe AI as a search engine.

That isn’t how it feels to me.

It feels more like a thinking partner.

Not a human mind.

Not consciousness.

Not wisdom.

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

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

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

For me, it does both.

I come home and give my wife a full report.

Good talk with the butcher.

Woman near self-checkout.

Guy in produce with extremely strong opinions about tomatoes.

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

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

And there’s always something unexpected.

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

We ended up having a short discussion about crab legs.

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

She agreed.

I skipped the crab.

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

It’s about the mission.

A mission without enemies.

Just some scattered civilians.

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

Then I head out alone on reconnaissance.

Fast movement.

Minimal exposure.

Walking past civilians.

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

Different rhythm entirely.

Scanning shelves.

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

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

Then back to camp.

Recheck the assignment sheet.

Proceed to the next objective.

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

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

About six feet tall. Thin. White plastic.

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

Halting.

Turning slightly.

Backing up.

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

Then he stopped in front of the liquor department.

He seemed uncertain whether to go in or keep moving.

I could relate.

I stood there for a minute and watched him work.

He seemed about right.

Moving past something.

Stopping.

Backing up.

Turning in a circle.

I’ve done that myself many times.

Especially lately.

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

Still… he moved like a guy.

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

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

Green Festival Foods shirt. Name tag.

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

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

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

Definitely a he.

Why did I think that?

No idea.

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

Still… he moved like a guy.

One of us.

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

Waiting for some flicker of concern.

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

But she just smiled.

A big, easy smile.

She didn’t seem threatened at all.

Taggie wasn’t competition.

Just another coworker.

Someone else who deserved a good job.

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

Passed other peacekeepers standing patiently behind their counters.

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

Picked up my bags.

Smiled at the peacekeepers near the exit.

“Thank you. Come again.”

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

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

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

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

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

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

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

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

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

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

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

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

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

I stood there in bright red briefs.

“Can I find my pants?” I asked.

“Questions first,” said the officer.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

But she thought it was. And that was enough.

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

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

Overnight call in Philadelphia.

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

The call came from high up in the MICU.

A senior resident.

“I need you to come intubate someone.”

I put on my long white coat.

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

In medical school we had short coats.

Those always felt like they belonged at a golf dinner.

The long coat meant something else.

At University of Pennsylvania, the anesthesia residents wore them.

I pulled it over my scrubs and went upstairs.

She was waiting in the center of the ICU.

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

I walked in.

“How are you doing?”

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

Talk—and scan.

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

He looked comfortable.

“I’m fine,” he said. “Who are you?”

BP normal.
Heart rate under 100.
Warm hands.

“Are you having trouble breathing?”

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

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

He stiffened.

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

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

“Don’t put me on a machine.”

Now he looked scared.

“I’m fine.”

“Let me talk to your doctor.”

Back at the desk.

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

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

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

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

“That’s not my job.”

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

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

Mine was in the hospital.

Hers was at home.

He showed up in minutes.

Calm.

On the phone with her fellow.

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

He handed her the phone.

“Let’s go.”

We walked to the elevator.

On the way down, we both stared straight ahead.

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

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

I felt it then.

Relief.

Support.

A quiet sense that I had done the right thing.

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

He looked at me.

Not smiling now.

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

The doors opened.

We stepped out.

Turned in opposite directions.

And then he added—

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

Before you roll your eyes—stay with me.

Look at a map of the Persian Gulf.

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

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

It was land.

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

Not a fantasy.

A real place.

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

• reliable water

• animals moving through

• edible plants

• a kind of natural stability in an otherwise harsh region

And then the world warmed.

Ice melted.

Sea levels rose.

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

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

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

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

They would have noticed it in the water.

Freshwater turning brackish.

Marshes that once supported life starting to fail.

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

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

And that’s where something deeper begins.

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

They look for meaning.

Something must have changed.

Something must have gone wrong.

Something—or someone—must be responsible.

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

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

Not proof.

Not literal history.

But memory.

A fertile land between rivers.

A place lost.

A sense that something important slipped away.

And maybe something else, too.

The feeling that the world had turned on you.

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

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

How it might become narrative.

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

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

But they’re not as separate as we pretend.

Science reconstructs what happened.

Story preserves what it felt like.

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

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

The other is remembered as paradise lost.

What do you think?

Do ancient stories sometimes preserve real events in disguised form?

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

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

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

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

I still remember him in the basement.

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

His arm stretched out.
Eyes locked in.

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

He wanted to win.

He let me win, sometimes.

You could always tell.

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

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

Lying in bed, I started thinking about his life.

He was born without a father.
Abandoned.

Hungarian.

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

When I was young, we watched movies together.

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

All before I was ten.

That was our language back then.

Then I was gone for ten years.

When I came back, something had shifted.

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

We just didn’t understand each other anymore.

In 2008, it finally broke open.

A real fight.
The kind that leaves a mark.

We didn’t speak for a couple of years.

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

He died in 2013.

Things make more sense now.

I never gave him enough credit.

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

And his life… was different.

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

All of that sat there, just under the surface.

We never talked about it.

I think now about how we might talk.

What I would ask.
What he might say.

It feels obvious that we would connect.

But that’s probably not true.

At the time, I couldn’t understand him.

And he couldn’t understand me.

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

Still—

I wonder.

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

I miss watching movies with him.

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

Now it had to become a thesis.

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

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

Manual typewriter. Heavy keys. No forgiveness.

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

I took her books back to Rochester.

At night, I worked through them.

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

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

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

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

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

Then came the typing program. And the game.

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

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

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

Mistakes barely registered.
Backspace and move on.

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

The thesis went over a hundred pages.

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

And then wait.

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

Printing was the problem.

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

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

It didn’t quite work.

Nancy fixed it.

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

They had a laser printer.

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

I handed in the thesis.

Stacked, clean, permanent.

Now I watch people type on their phones.

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

Not once.

Except the space bar.
That was their whole job.