Deferred Maintenance

Maintenance is a requirement and not a luxury by definition.

Proper maintenance reduces the rate of depreciation of an asset like real estate by slowing the approach of entropy.

Dilapidation is delayed if undeterred.

Increasing control over my time has better enabled me to address the long-deferred maintenance of my health in a number of ways.

I am not making the cover of the FI Illustrated swimsuit edition any time soon. Save the "Hulk Smash" pectoral pictorials for Mr. Money Mustache, who spent his youth driving a muscle car while weight-lifting to get ripped.

I'd regard "sinewy" or "stronger than he looks" as high praise.

At my ten year college reunion everyone seemed to want to talk about their Ironman. It took a while for me to realize they were not referring to a Casio watch.

Start Where You Are With What You've Got

Not to say I did not participate in some form of athletic effort along the way. As an undergraduate, my freshman roommate introduced me to Lacrosse, a sport I'd never seen until then. I liked it enough to join the "B" team.

Since I was a Sunday School teacher for third-graders through most of college, and games were played exclusively on Sundays, I missed every Lacrosse game but one. (When I say I live on the edge, I'm referring to the tangent between Venn diagrams for jock and nerd.)

I also begin lifting weights during college, just enough to feel comfortable in my body. The apex of my lifting career was going to the same on-campus gym long enough to buy my brother a t-shirt that read, "I'm not real smart, but I can lift heavy things" and have the staff member selling the shirt feign familiarity in seeing me around the place.

Let's Get Physical

Another great moment in college athleticism was my first day as a newbie in a spring quarter water polo class that started at 10am. Given the late start time, I enjoyed a large and leisurely breakfast before heading across campus.

The class was taught by the men's water polo coach, an intimidating and sunburned man fond of mirrored highway cop sunglasses named Dante. During my college years, we had the #1 NCAA ranked team. He wasted no time getting us into shape by inviting us to tread water for 10 minutes with our hands on our heads.

After five minutes, I discreetly swam to the side of the pool, walked to the edge of the chain-linked fence surrounding the area, and parted with aforementioned large breakfast before re-entering the water a humbled man.

In med school, I took up swimming and felt proud of three times a week commitment during lunch break. My sense of self was only slightly punctured when one of the female lifeguards I was friendly with at the gym diplomatically suggested a beginner class could help a "swimmer with my skill set."

Med school intramurals required non-marking soles for games of "Towerball" (a strange but enjoyable UCSF tradition), and I was not about to drop money on designer shoes. My under $20 Big Five white leather game shoes prompted a classmate (and future surgeon) to remark, "You must have had to beat up a pretty big nurse to score those shoes."

Somewhere Over The Rainbow

Med school, residency and young attendinghood were always associated with a "When I reach _____ then I can start to ____" approach.

Eating right was defined as something that required more than the addition of hot water.

Making activity a central instead of peripheral part of my day was a far-off good intention.

Cutting Back Let Me Start Living Tomorrow's Better Lifestyle Today

It's been a pleasant turn of events that every day I don't work in the emergency department begins with some sort of activity:

1. Cycling the hills in my coastal neighborhood shortly after dawn, before cars take to the road.
2. Lifting weights with the used bench press and barbells I bought off craigslist a couple of years ago for 2/3 the cost of the annual gym membership I dropped soon after.
3. Bodyboarding or surf kayaking at my local breaks if conditions are favorable.
4. Hiking with friends who have similarly flexible schedules.
5. A half hour of sit-ups and push-ups on days when motivation is lacking.

We've All Experienced Our Version Of Garbage In, Garbage Out

The food component has developed in tandem with the exercise.

Without realizing it was happening, I've become a parody of a Californian in my diet.

Every morning starts with a bowl of chia, muesli and fresh berries soaked overnight in soy milk, followed by a stovetop triple espresso consumed black, ideally while reading an article from the New Yorker.

Lunch is a black bean burger with avocado slices and a little BBQ sauce, all wrapped in a tortilla, followed by Greek yogurt with fresh fruit and cinnamon. The best part of lunch? I get to share it at a leisurely pace with my wife after a morning spent on task accomplishment.

All of this is chased with another stovetop triple espresso, followed by a power nap or a quiet moment deeply listening to one of Vagabond MD's endorsed Grateful Dead concerts.

We've increased our repertoire of plant-based dishes, including Moroccan eggplant, Tofu and vegetable stir-fry, a lentil and spinach curry, veggie sushi, and a wonderful spicy southern African dish I've previously written about.

I'll even grill some salmon for fish tacos, or pan fry tilapia in a white wine and lemon caper sauce for dinner.

I pay more attention to what I eat.

I've had Eating Animals by the author Jonathan Saffron Foer sitting on my bookshelf for several years. I finally started reading it last week, feeling like I might be ready to at least try a pescaterian approach and cut out other meats on a trial basis.

Seeing my friend Dr. McFrugal routinely prepare delicious plant-based fare gives me hope that I might follow suit over time.

Reality Check

We've all seen our version of the young smoker in denial: She firmly believes she'll remain healthy and active until dying in her sleep with precisely X number of years shaved off her life only at the very end because of her unhealthy life choices.

She can't envision the gradual decline that awaits, the canister of oxygen she'll tote along that final decade, the inability to dance at a wedding.

As physicians, we live with our own denial. We ask our patients to do as we say, not as we do.

Maybe this is your moment to cut back clinically and start addressing the deferred maintenance your health demands.

Because if not now, when? If not you, who?