Outlive by Peter Attia MD and me

I just finished Outlive by Peter Attia MD that remains on the NYT nonfiction bestseller list. It is THE best book I’ve read on healthy aging, to increase not just lifespan but healthspan – the hopefully healthy prolongation of life. I’m not going to recap in detail but he does a superlative job of discussing the deep but intertwined roots of metabolic/obesity, heart disease, cancer and neurogenerative diseases and lifestyle approaches to addressing them through exercise, stability and balance, nutritional biochemistry (diet), sleep, and emotional health.

What I really wanted to share are direct quotes from his last chapter on Emotional Health that resonated with and spoke directly to me.

Why live longer?

‘I was doing everything to live longer, despite being completely miserable emotionally.… The words of my therapist: “why would you want to live longer if you were so unhappy?’

Childhood trauma and downstream consequences

Childhood trauma generally falls into five categories: 1) abuse, 2) neglect, 3) abandonment, 4) enmeshment, and 5) witnessing tragic events. Little trauma is more challenging to address because we are more inclined to dismiss it.’

The most important thing about childhood trauma is not the event itself, but the way the child adapts to it. Children are remarkably resilient, and older children become adaptive children. The problems begin with these adaptive children, grow up to become maladaptive, dysfunctional adults. This dysfunction is represented by four branches of the trauma tree: 1) addiction (alcohol even to socially acceptable things such as work, exercise and perfectionism, 2) codependency, 3) habituated survival strategies practice (propensity to rage), and 4) attachment disorders with difficulty forming meaningful relationships.

Describing himself, “90% of male rage is helplessness masquerading as frustration. End of quote.

As his own therapist Terrance Real had had written in I Don’t Want to Talk About it: “Family pathology roles from generation to generation like a fire in the woods, taking down everything in its path until one person, in one generation, has the courage to turn and face the flames. That person brings peace to his ancestors and spares the children that follow.“

How do I want to be remembered?

In David Brooks book The Road to Character, he makes the key distinction between “résumé virtues”, meeting the accomplishments that we list on our CV, our degrees and our fellowships and jobs, versus “eulogy virtues,” the things that our friends and family will say about us when we are gone. And it shook me.” “For my entire life I, I had been accumulating mostly résumé virtues. I have plenty of those, but I had also recently attended a funeral for a woman about my age who died of cancer, and I was struck by how lovingly and movingly her family has spoken about her – with hardly a mention of her impressive, professional or educational success. What mattered to them was the person she had been and the things she had done for others, most of all her children. Would anyone be speaking that way about me when it was my turn in the casket? I doubted it. And I decided that that had to change.”

My own worst enemy

“It was as if I had my own personal Bobby Knight, the Indiana University basketball coach, who is famed for his red-faced sideline meltdowns (and who ultimately lost his job because of them), living inside my head. Whenever I made a mistake or felt I perform poorly, even in tiny ways, my old personal Coach Knight jumped up from the bench to scream at me ‘don’t you know how to grill a F**ING steak?”

“All that I had become – good and bad – was in response to what I have experienced. It wasn’t simply the big-T traumas, either; we are covered many, many more little-t traumas, hidden in the cracks, that had affected me even more profoundly. I haven’t felt protected or safe. My trust had been broken by the people who were close to me. I felt abandoned. All of that had manifested itself as my own self-loathing as an adult; I had become my own worst enemy. And I haven’t deserved any of it. This was the key insight. That little, sweet boy, did not deserve any of it. And he was still with me.”

Buddha: “your worst enemy cannot harm you as much as your own unguarded thoughts.”

Shakespeare’s Hamlet: “There is nothing either good or bad, but thinking makes it so.”

Hope

“As I settled into the next phase of my recovery, I begin to notice something I have never experienced before: I found more joy in being than in doing. For the first time in my life, I felt I could be a good father. I could be a good husband I could be a good person. After all, this is the whole point of living, and the whole point of outliving.”

Paulo Coehlo: “Maybe the journey isn’t so much about becoming anything, maybe it’s about unbecoming everything’s that isn’t really you, so you can be who you were meant to be in the first place.”

My personal footnote. Peter Attia’s final chapter was not what I had expected to end the book on the science of longevity, but it hit home. It explained with self clarity that my driven, workaholic, achievement-oriented career-long approach originated deep within my educated, yet dysfunctional family upbringing and subsequent little-t traumas, related to physical appearance and race. And except for the grace and wisdom of Steve, my best friend, and Mémée and Ray, my mentors, and most of all Teri, and the help of counselors, I would not have emerged as the better person I have become today.

Autumn in Rockies with a ‘moose detour’

Usually, I’m not in Colorado in September, I’m still up in Vancouver finishing my summer-long Chen Tai Chi 6-days a week bootcamp. Instead, this year I was to return in early September to attend a World Congress in Pediatric Neurogastroenterology at my former hospital Nationwide Children’s in Columbus. But the gods had other plans and touched me with COVID 3 days before departure. I delayed my departure and quarantined for the mandatory 5 days, and snuck home still positive/infectious. Then with visions of a super spreader … I canceled the conference trip but gave my talk – on cannabinoid hyperemesis syndrome – virtually, infectious and coughing, but I did it!

I have recovered and the golden lining has been to view for the very first time the magnificent yellow and orange fall colors of the turning aspen in the Rockies. This is made possible by Pat and David, both former graduate students of my father, close friends who facilitated my entry into the neighborhood and uber experienced hikers. I share some images of Rocky Mountain National Park and the adjacent National Forest between 9,000 and 12,000+ feet where the blue sky is bluer, the air is thinner, the aspen thicker, the water clearer and moose can block your trail and cause a 3 hour detour to the destination. Enjoy – Bridal Veil Falls, Chapin Trail and Trail Ridge Parkway (highest highway in the US), Chipmunk Trail with two cow moose and South St. Vrains Trail with tall aspen.

A pretrip to Glacier with the g’kidz

A planned preamble to another white water rafting trip down the middle fork of the Salmon replete with many grade 3-4 rapids. Then, a road bump and a decision. Eight interminable nosebleeds – 3 ED visits, a (very descriptive) rhinoRocket, 20% blood loss with anemia, finally ENT cautery of an ethmoid artery bleed, left me vulnerable. A vital debate – probably OK during rafting vs. possible rebleed during trip with no cell service/medical access for six days (? helicopter out, ruined trip for 25) … finally canceled for medical reasons. Still, 36 hours at Glacier with the two g’kidz.

Adaptability
Despite arriving early at 8:30, the park ranger indicated that parking lots for Logan Pass and the major hikes were already likely full so we should shuttle instead of drive. But after an hour of shuttle waiting/going nowhere (first took only 2 more, the big bus only 12 more – up to us, the next headed the opposite way … every 15-30 min, hopes were dashed, and we envisioned our wish list being chopped to one hike and the planned boat ride and the Going-to-the-sun Road itself! A frustrated 3-way huddle led to scrapping the boat ride, restarting the car, and chancing open road-side parking. Beautiful untrammeled waterfalls and streams, flowing crystalline blue water and chilly wadeable pools opened up for Jack and Naomi. A lucky spot for Avalanche Falls but we went opposite to find a traversable, wide stream to build a city of cairns (stackable rocks). Another spot along Cedar Trail to redirect the stream and fashion a tiled pool. And after reaching the penultimate Logan Pass in mid-afternoon … still no parking as John drove the lot for 30 min … and we were apparently back to viewing the rest of park from the road. And magically at 4 pm a spot opened up and we topped the day at Hidden Lake Overlook with its sweeping vistas of mountains and valleys filled with blue water, deer, and, THE best, white mountain goats clambering high on the mountainsides, with the King of the Mountain Goats seated majestically within 15 feet as we paid photo homage. Of course mid-course corrections can one astray but in our case, flexibility and redirection led to a very satisfying day.

Big vs. little agendas
Usually, ambitious travel itineraries stack up a pile of planned and suggested attractions and the natural impulse is to maximize the opportunities. The desire to see as many waterfalls and vistas vs. the kids needs for d-own time. As it turned out, their frigid wading, cairns city building and stream diverting/pool creating rejuvenated and reenergized them and rebalanced the equation towards the little. At the end, as the adults were winding down, they were zigzagging off the path onto rocks and back … and wanting more.

Mother Nature and National Parks
No litter. Azure skies. Unimaginable wide and steep vistas quite different from Yosemite. Sheer drop offs on the edge of the road. Water falls. Crystalline blue water – falling, crashing, careening, bubbling and placidly streaming. Uphill, breath-drawing and breathtaking hikes. Many people on the main trails, and many walking toddlers. When walking with Rachel, despite the many places visited while growing up, we could only recall one national park (Smoky Mountain National Park) visited as a family. We didn’t prioritize that as a family as others’ had. Did we miss out?

Views, large and small
The large vistas were my favorite. But really, how could I pick one part of the many rich concatenary experiences, both large and small. Simply watching a 10 and 12 year old use water, small and large stones and sticks in creative ways. I found myself enthralled by nature’s smaller patterns. Although not a ‘nature’ person, I gazed at the patterns of erosion around the streams leaving smooth circular pools or wave-like undulations, the colored stones forming a natural mosaic or art work. Have I been too immersed in art lately, now seeing the world through aesthetic spectacles?

Unplugged yet connected
Borrowing from John’s toast to our very first Salmon R rafting trip, we were without internet, forced to observe, participate and play in nature by itself, even if for a fleeting moment. Unplugged from the electronic multiverse, connecting to family and nature. Even Jack commented, ‘it was a great chance to connect with you Gong Gong!

Revisiting my father and mother with renewed eyes

Five former graduate students of my father gathered for a mini-reunion in town in early June. Kurt, Susan, Janet, David and Pat have all had successful careers in Chinese or Japanese art history as professor, curators, architect and art appraiser/author. I was uniquely privileged, as a ‘bee’ on the wall, to listen to two full days of reminiscences of how each became his students, his pedagogy, teaching and mentoring style, and his and my mother’s impact on their lives. While here, they viewed his Chinese ink art collection including some that I have recently added while interpreting colophons and poems, linking paintings to classical painters, placing them in their historical context, and providing many stylistic and technical insights. Not only did I learn a lot, most of all their refreshing view of my parents, quite counter to my own, was frankly lifechanging.

I knew that my father was a dedicated scholar of Yuan dynasty painting, having written several monographs on the artist Chao Mengfu. My mother told me he was one of the very first chaired professors at the University of Kansas and ultimately trained around 25 PhD and 75 Masters students, apparently the record in liberal arts, so surprising for such an arcane field. Nancy Steinhardt of Penn wrote ‘every student during this period turned to Li’s Autumn Colors on the Ch’iao and Hua Mountains as the model for both study of a seminal painting and the specific questions to ask about a masterpiece’. This gathering, which of course cannot be considered unbiased, confirmed that he is considered amongst the three giants in the field including Wen Fong and James Cahill. Yet staying out of the art history politics and not self-promoting, he may not have attained the full recognition he deserved.

And, I also knew that my father discovered and promoted the 5th Moon Group led by Liu Kuosung in Taiwan, an avant garde ink painting group, then completely unappreciated. While other scholars group largely ignored this new movement, my father presciently and proactively plunged into this new wave by organizing exhibitions, writing catalog introductions, and grants to bring these artists to the US to provide additional training and exposure. All of his efforts radically changed their career trajectories from struggling in Taiwan to success and appreciation in the West. The reunion group described his efforts as an ‘obligation’ of one in a high position to help struggling artists whom he viewed as the future of Chinese ink painting. In effect, he became their academic ‘patron’ a role which has a long history in China.

So what was it like to be Dr. Li’s graduate student? They all recalled the thrilling Thursday evening seminars held in the storage room of the Nelson-Atkins Gallery where Laurence Sickman the Director and my father would preside over monumental Song Dynasty (900 AD) paintings just for teaching purposes! That couldn’t happen today. My father emphasized broad connoisseurship training (knowing objects) that enabled them to either become scholars or hands-on curators. Today, the narrow training focused on a specific research area no longer prepares them to teach survey courses or discern fake from genuine objects. He was ‘fatherly’ in his approach taking on ‘project’ students, writing innumerable letters of introduction to scholars and curators in Taiwan, Japan and China to facilitate their doctoral research, and successfully obtaining fellowships to support their overseas training … even approving their marriage partners. He organized two ongoing ‘internship’ positions at Taiwan’s Palace Museum dedicated to KU graduate students and similarly at Nanjing University when China finally opened its gates. He avoided asking students to work on his projects, as many professors do to further their own efforts, instead had them chose their own dissertation subject. In hindsight, some wished he had pushed some to work on contemporary Chinese artists he was helping on the side as that would have put them at the forefront of an emerging field. If he didn’t know much about a particular painter or topic, he would connect students to other international experts. He seemed to know and be respected by everyone, everywhere all at once (sounds like a current Asian movie). And, he constantly invited visiting scholars and artists to visit and teach. In essence, he was a selfless and relentless advocate, neither territorial in advancing his own research agenda nor limiting their exposure to alternative viewpoints. He was uber mentor and prepared teacher but … he had a boring lecture style. My mother also played an important team role as a thoughtful sounding board, even guiding students on how to navigate my father. Such a team.

So how did I experience my parents? Hmmm, it’s hard to recognize them as the same persons described above. My mother was an Uber controlling Tiger that two of my pediatric colleagues called abuse. Unquestionably her demanded discipline, delayed gratification, and home summer schooling laid the foundation for my eventual professional success for which I’m appreciative. Although the other parent or a sibling mitigates the impact, my father later admitted that he had fully delegated my upbringing to my mother. Perfect storm. The unintended costs were several rounds of counseling to extinguish one memorable episode that allowed me to posthumously achieve peace with her. My father was aloof, unapproachable as he went directly from dinner to newspaper to nightly type-written research stint from 9 pm to 3 am. He was hypercritical and, not unlike his Chinese peers, never uttered a word of praise. One which could be taken as such occurred after my being elected president of our professional society. I had hoped for a compliment at the pinnacle of my career, but he immediately rejoindered ‘now you can be a dean’, which I took as falling short of his raised bar, a memorable crestfallen moment. When caring for him near the end, I recognized I had very few father-son memories other than in museums – all others involved fathers of friends. And it finally explained why from age 11-34, I sought a male mentor at every stage of my life to fill an immense void in my four-chambered soul. Before she passed, Teri asked me to continue in therapy and I finally attained peace with him too. We all have our respective parents to bear.

This gathering of former students provided a wonderful appreciation of how much he gave of himself in his uniquely selfless way. They constitute his penultimate extended as his fatherly concern was dispersed so widely and tangibly to so many students, artists and colleagues and the game-changing good that resulted. As well as my mother’s important adjunctive role. In the overall cosmic balance, their gains outweighs my loss. Ironically, my segue to get him to talk with me was to ask about his work especially about the artists he discovered. I began to appreciate his prescient, aesthetic eye and his key role in facilitating the development and careers of contemporary Chinese ink artists. This seed grew into deeper appreciation of the art and a commitment to expand his collection into the 21st century. I do know he would be surprised and proud. And while much of my life was spent trying to distance myself, ironically I now discover that not only do I use a similar approach to my mentees, I even trapse in his giant art footsteps.

Chasing cherry blossoms, while limping

Why write about my 11th trip to Japan? Well, it was a wonderful and fulfilling trip, but not without significant snafus at the intersection of age, health and international travel, perhaps a signpost?

Most still mask in public and on public transportation. Shinjuku subway station close to our hotel transports 2.4 million passengers/day. We swam through them at rush hour only to be packed like sardines. It remains one of the safest spots in the world anwhere, anytime day or night. The cultural ethos cherishes aesthetics down to each package wrapper. The buses, trains and shinkansen (bullet) arrive within the scheduled minute. 7-11 and department stores have great fast food and top restaurants, respectively. They cannot fathom that we cannot see the menu outside replete with colorful, realistic, plastic models. (How do you know what you are getting?) Well-tended temples and shrines offer peaceful respite in the busiest bustle of metropolises. Tiny family-run specialty shops (incense) survive from the 18th and 19th C. Japan is such a unique amalgam of treasured tradition, astounding aesthetics, yet contemporary convenience.

My pre-trip hurdle included my third prostate surgery one month before followed by an unexpected post-operative abscess smack in the middle of my back that required intervention and daily redress by my nephew Matt, still not quite closed upon departure. Then, on the 2nd day while chasing cherry blossoms around Mt. Fuji, my feet started swelling and wouldn’t fit in my sneakers. I woke repeatedly at 2 am itching terribly. Long story short … it was scabies. Where the … did I get scabies in Japan … slippers? And then blepharitis of the right eye. So yes, a humbling reminder of how vulnerable we elders can be in the most awkward … fortunately my pediatric friend/host came to the rescue near the end.

Friends helped make this trip special. Tony did the bulk of the planning and his Chinese literacy helped with place names but that didn’t keep us from getting on the wrong train or Google maps leading us astray. We met five of Tony and Martha’s friends including a retired octogenarian who has worked in 30 countries and her expat cousin who has taught university English for 25 years and will retire in Istanbul. My five included Akira, Naomi and their 1st year medical resident daughter and Shun and his girlfriend Alisa. Shun is about to complete his PhD at Tokyo U, inaugurated the first patient support group for the disorder that I study, and started up an NGO that connects patients with rare diseases with doctors who study them. Alisa has spent a year at NYU, worked in Russia, and works for a start-up that markets NFTs (digital originals?). Not only interesting people, but friendship, and 3-D insight into Japanese life and times.

Now the pictures (apologize for jumble): Legends:

Oldest teahouse in Japan with T&M, Mt. Fuji unshrouded in clouds, last cherry blossoms in central Japan (other days blossom-less)

Azaleas and wisteria, wet gardens Taizo-in (Kyoto) and Isui-en (Nara)

Yayoi Kumasa is everywhere - in moving robot, Naoshima Island and her latest installation

Tadao Ando Nariwa museum in Okayama Pref

Osaka Castle, G-7 meeting in Kurashiki, coi and tea competition (kimono clad) in Koraku-en, Okayama

Dry garden - Ryoanji (model for my backyard) Temple (Kyoto) and bamboo at Arashiyama

Christmas 2022

A Christmas card rather than the usual Chinese New Year message, for a change.

Rachel, John Jack and Naomi visited from NJ over CHristmas and we all went skiing in Vail, they downhill and me flat-lined. Jack's in 6th (math wiz), Naomi in 4th (flag football phenom), John with PCI Pharma and Rachel subbing frequently at Westmont Montessori where the kids attended (what would Teri think?). Meimei their bishan-shih tzu was Pet of the Month in their local weekly. Ben, Theresa, Flora and Juna. Flora is in a Mandarin pre-K planning on a Mandarin-immersion public school, Juna is a 2 y/o pistol (watch out), Ben is in his 2nd year as Emergency Medicine faculty at Denver Health and had a successful grants season for their gun violence prevention program. Theresa continues in the high tech industry in a new job. Jen, one of the main reasons I moved here, continues as Director of the Center of Humanities and the Arts at CU-Boulder, after an intense 2 years as a talking head on anti-Asian racism (NPR, CNN...) during COVID and as President of the Association for Asian American Studies. Matt her husband the Spanish major continues as a nurse in CLINICA a hispanic clinic. Chaucer their Corgie has recovered from repair of his torn ACL. For me continued academic activity (3rd Int'l Symposium on Cyclic Vomiting Syndrome), Tai Chi progress in Vancouver (learned Old Frame 2nd Routine), road biking, hiking Rocky Mtn Nat'l Park and traveling (Machi Picchu and Canada). I have a combination gallery (in honor of Dad) and Tai Chi studio and a backyard Zen rock garden based upon Ryoan-ji in Kyoto. May you have health and family,