I went to Europe for a vacation recently. With my sister and her husband, I visited Berlin, traveled to Erfurt, Rothenberg, Nurnberg, and Fussen in Germany. We drove to Vienna in Austria, then on to Prague in the Czech Republic. Our two-week trip didn’t exactly start out with a theme, but one certainly evolved after the first day or so.I’d been to Berlin with my parents in the late sixties. My dad spoke German. His parents were of German descent, though their families had emigrated to the U.S. in the early 1800’s. Dad often traveled throughout Europe for business, buying and selling gears and manufacturing equipment.I was only eight or ten that first time, and I remember Germany as a much different place. The Berlin Wall was intact; we took a bus tour and saw Checkpoint Charlie and the miles of barbed wire. Dad told me stories of people killed trying to escape from East Berlin. He talked about the Nazis and the Holocaust, the Communists and the Cold War. I remember asking how a country came to terms with the guilt over its own atrocities. He said he didn’t know, but that Germany had not done so then.Forty-five years later, I found Berlin a beautiful, startling city. Lovely. And Germany has begun the complex process of restitution. Complex understates the problem. The evening of our arrival, we boarded a city bus and exited at the Reichstag. We wandered along the Spree toward the Brandenburg Gate where a concert played for the 75th anniversary of the Kristallnacht. We turned a corner and found the Memorial for the Murdered Jews of Europe. The next day we went through a new museum called the Topography of Terror, set on the former grounds of the Gestapo, SS, and SA headquarters. Its design evokes a jail cell. The exhibit evokes horror, because the pictures of the officers showed them to look just like regular people. Just like us. And so few of them were ever prosecuted. It raises more questions than it answers. We walked from there in the cold and dark to Daniel Libeskind’s Jewish Museum, an altogether different experience, a cultural memorial. The next day we left Berlin. And headed for Buchenwald.Here’s a lesson I learned on my trip: Don’t go to a concentration camp on a full stomach. Because your stomach will knot, and cramp, and rise up. And it will be all you can do not to vomit. The horror accumulates.At Buchenwald, the picture of a red cross on a medicine cabinet seems incongruous in a room where they pulled the gold fillings from the dead and took organs as souvenirs for the guards. And you realize that it’s one thing to see some graves or a cemetery; it’s quite another to read a name. But then you see another name, and yet another, and with it a picture, and another picture, more pictures, and the dates of death, and places of death, and sometimes the causes. And then another, and another, and another. It doesn’t make you numb, surprisingly. It makes you sick. It is visceral. You see the artwork, signed, by prisoners. Sometimes the artwork was created by children. Who died when they were twelve. Or thirteen. In Terezin. Or Auschwitz. Or Buchenwald. In the Jewish Museum in Prague, the names of the dead line the marble walls, wall after wall, floor after floor.We happened to visit the camps when it was cold, a little bit windy. I didn’t bring a warm coat. I felt the chill. I could only begin to imagine the flimsy uniforns, the cold and the terror and the hunger. And then it struck me—it was only seventy-five years ago. Merely three generations. Almost nothing in the span of history.It was not an easy vacation; we hadn’t exactly planned it this way. Friends and family have emailed: Did you have fun?I would not say that we had fun. But I guess we had something more memorable than fun.

Emily Nussbaum has blogged in the New Yorker online about Breaking Bad and the comments she received from dedicated fans of the show were nearly as interesting as her posts. She described a phenomenon of “bad fans”, those who express such vehement opinions about the characters or plot elements that the show’s writers seemingly respond to them in subsequent episodes. I’d never heard of such a thing.I admit to being a latecomer to this astonishingly great TV series, now approaching its final episode. And so I read with fanatical interest any and all commentary about the actors, the writer and director Vince Gilligan, the arc, etc., while I seek out others equally obsessed. I have a niece who has been with it from the beginning. I call her to chat about episodes I’ve recently watched on Netflix. Only now do I appreciate her prescience.Nussbaum’s recent blog about “bad fans” opened my eyes to the fact that some who watch the show really hate Skylar, the wife of science teacher turned methamphetamine czar Walter White. Seriously? I didn’t believe it until I was at work yesterday and one of the women in the OR told me she couldn’t stand Skylar.“Why?” I asked.“Because she never supported Walt. And everything he did, he did for his family.”While this was, indeed, part of the story line – that Walter White turned to cooking crystal meth in order to make money to leave to his family when he would surely die an early death following a diagnosis of lung cancer – the truth was that Walt also found his manhood as a drug kingpin; he found his inner strength, his steel, his voice. And he liked what he found in that moral morass. Though he continued to pay lip service to doing it all “for the family”, a lot of us viewers no longer bought it, especially as his family fractured and the risks grew coincident to his earnings. The local death toll simultaneously skyrocketed.What I like about this show is that Walter White started out as an everyman. He was a pluripotent regular guy, underemployed and overeducated, what we see in so many middle-aged individuals today still reeling from the effects of a recession. But then Walter struck it big; it had to happen illegally. It wouldn’t have been as interesting had he won the Lottery. Less moral complexity ensues when the gains aren’t ill begotten.So the question becomes this: how do we take the measure of a man? In this case, Walter had more than his share of bad luck but managed to creatively exploit his native intelligence and provide for his family. And by this question I do not mean “man” in a gender-specific way, but rather as any individual over the course of a lifetime. Do we measure a person by his accomplishments alone? Complex people may do great things for society and yet treat individuals poorly. We see that every day. Or do we measure him by his character, regardless of his contributions? How do we measure that character?The Pope recently asked the question: Who am I to judge? Easy for him. The rest of us stay glued to our TV’s and laptops and show decidedly less restraint. We judge others freely and often; the less we know of them the better.Taking someone’s measure is the quandary at the heart of Breaking Bad. And seeing how people change over time, how circumstances have the ability to change all of us. It’s why the country has been riveted, dealing with their opinions about Walt and Skylar. Seemingly clear ethical boundaries blur as we imagine ourselves in similar shoes; easy money, and lots of it, just yours for the taking, by doing what you love to do, while providing for the people who depend on you. Rationalizations run rampant. The show turns everything upside down, inside and out.I, for one, will miss my fix of Walt and Skylar, Jesse and Hank. It isn’t often that life’s dilemmas are translated so beautifully, so elegantly, onto the small screen. I count myself among the many fans – both good and bad - who have been captivated.

I’m on a reading binge at the moment. This is not my usual type of binge-ing when I read for work purposes or general news interest or to do research for whatever it is I’m writing about. I’m currently reading for enrichment; some people call that pleasure. I recently finished writing a new manuscript and am in the wait-and-see period that follows. Is it any good? Could it be saleable? Will it require major revisions? Don’t know yet. I’ve decided to not make myself crazy by continuously revising the work while certain people look at it. I feel as though it’s finished, but is anything ever finished?So while on this reading binge I came across The Examined Life, Stephen Grosz’ elegant collection of vignettes about his psychoanalytic patients. I could not have picked a more timely or apt work to enjoy following what I’d just written. My own manuscript deals with my parents’ lives, my own journey into medicine, their end-of-life issues, and what I learned from them as well as my own patients along the way. My original goal when I started was not to write about my parents, specifically. It was to write about the topic of end-of-life care. But I began to see the subject as too laden, too politically pitched, and too overwhelmed with statistics to make interesting reading material. In fact, the books I found about the topic suffered from just these problems. So I decided to make the story personal. That decision brought its’ own set of problems.I loved Grosz’ book on several levels; as a life-long student of psychotherapy and psychoanalysis, I enjoyed the way he teased out the causes of current behaviors from past memories. And as someone who has had a lot of therapy, I could relate to the insights and see bits of my own behavior in several of his patients. Though I’ve never been analyzed, I know enough to have an inkling of where the process might take me. And as a physician, I felt jealous of his ability to put his experiences with patients so beautifully into a thoughtful and well-written story.The manuscript I recently completed is written as memoir, but only because that is the structure that best holds what I want to say. It is about family because caring for parents at the end-of-life is primarily the domain of family and they make the important decisions. Consequently, in the process of writing about my mom and dad, I went back into my childhood and beyond. I researched their lives and my ancestry. I thought about my parents in a new way. I had to confront all my memories—good and bad. I had to find a way to put their stories into words. I had to get the part about me out of the way because what I was trying to say was not about me. The story is about what they taught me; their legacy informs my views on end-of-life care.The past year has been one of the toughest in recent memory. Not because I suffered any particular hardship, had any particular health problems, or had anything terrible happen. The trouble arose from writing this book: not only because of the difficulty inherent in writing about and contemplating death, but also in writing about my relationships with my parents. In order to write their stories, I had to write the dark underbelly of my own story, think through my childhood and remember it honestly, the good and bad parts, what was true, what seemed true, what I might have imagined, and especially confront the emotional baggage I’ve carried around for decades. I had to air it, think it through, edit it, and then let it go. I had to hit the delete button on a lot of old crap. The end—written—product is still true, but it is free of the child’s voice. Only my inner grown-up told the final version. It was the only way I knew to do justice to the gravity of the subject matter. Stephen Grosz does an excellent job in his book. I hope I got it right in mine.An interesting and completely unexpected bonus of this process - of having written it all down, of having suffered through a literary analysis, if you will - is that I feel fantastic! I am exactly where I want to be. Lucky, happy, fit, feeling great. I cannot ask for more.

Here’s how to know that your life has gotten away from you:On a Saturday morning in May, rise early, read newspaper, eat something, clean house.At approximately 8:30 AM CST, put a dozen eggs into a 3.5 quart sauce pan, add water to cover. Place the saucepan on top of the range. Turn the temperature to low so as not tobreak the eggs. Turn Jillian on to do Phase 1 of the Thirty Day Shred. Frantically shower and dress while realizing how late you are. Drive at 80 mph to Northbrook for a brunch and manicure with girlfriends. Drive back downtown to see the Picasso exhibit at the Art Institute with 10 bazillion Chicagoans before it leaves next weekend. Fly through Macy’s in ridiculous hope of finding something to wear to friend’s upcoming wedding. Find nothing. Drive to Oak Park to meet different girlfriend for dinner. Return to kitchen 14 hours later. Find shocking mess in kitchen. Neither eggs nor Calphalon saucepan have fared well during your excursions. Realize that 14 hours is definitely too long to cook eggs. No longer “hard-boiled”, perhaps "prehistoric" defines them now. Who would have thought that eggs, when exposed to extreme conditions, would explode into fragments and shoot so incredibly far? Clear onto the walls, smearing yellow goop every which way? And that the process would stink up your house, your building, possibly your neighborhood, for all eternity?I would love to say that this is the first time I’ve left the stove on,but it’s not. I’ve done it in Michigan, twice.It is, however, the first time I’ve ruined a pan and endangered my building.I’m taking the day off.

Everywhere I turn, I read about disruption. What used to be the stuff of the Harvard Business Review is now commonplace on the pages of the New York Times.Disruptive innovation. Disruption in business hurting established business practices, creating billion dollar tech company valuations, disruption causing explosive changes in the way people think, communicate, purchase goods, purchase non-tangibles, the advent of social media, etc, etc.Disruption is all the rage if you’re doing it. Business schools want to teach it, but they don’t really know how. Because disruptive technology comes from innovation, and innovation comes from looking at established practices and turning them on their heads. Business schools study it, dissect; they don’t actually do it. Disruption comes from seeing what’s possible when no one else is looking, or before anyone else even thinks to look.So what is disruption, in essence? Is it simply genius applied with venture capital financing? Probably, sometimes. And why is it so threatening?Is it like pornography? We cannot define it, but we know it when we see it?Probably, sometimes.I’d like to suggest a new definition: disruption thrives in a world where complacency has stood down, where complacency has no place. Disruption is what happens when an average company that’s making 8% profit hires a consulting firm to tell them to implement changes they’ve considered for years. Disruption is the young woman who steals your husband because you’re both bored and neither of you know what to do about it. Disruption is what the competition does when you think that what has worked in the past will continue to work in the future. Disruption is the inability to consider that the bubble you live in won’t last forever. Disruption is the inability to consider the What If’s of life.Medicine, like most fields, is filled with complacency. Why else would physicians—individuals who see the natural history of disease and its terrible consequences—be opposed to universal health insurance? Who doesn’t want people to have medical care?It seems to me that complacency, and the arrogance it entails, ruins everything...in the home, in the workplace, in marriages, and in large corporations. Disruptive innovation is the buzzword in business circles - but all it really means is not letting your life become dominated by smugness. Instead, when you create an environment that fosters change, that allows for growth, that looks forward and seeks out new trends and nurtures them and fits them to your own personal use instead of fearing them, you stay ahead of the game. Marriages fall apart when the kids leave because kids keep parents young. Disruptive innovation is the theme behind half the movies we enjoy - where the youngsters have ideas that solve problems, make music, hack into databases, and so on. Take a lesson and disrupt your own life: it’s how we’ll survive and thrive in middle age and beyond.