i don’t know why you say goodbye i say hello

As I opened my computer this morning and typed in my password, I realized that I hadn’t authored a single less is more post since September. That realization upset me. Writing this blog has always been a passion project. Every post – whether I personally loved it or not after hitting “publish” – means something to me. But I sputtered and stalled in 2015. After writing 40-45 posts a year for several years in a row, I fell off the writing wagon for large portions of the last 12 months.

As we head into 2016, I hope to return to the older pattern, posting once a week for most of the year. In the interest of getting reacquainted in the meantime, allow me to revisit 2015 with the “less is more Top 10 of 2015.”

10. The Beatles hit Spotify

Technically, this hasn’t even happened yet. But as of December 24 at 12:01 AM, the entire Beatles catalog will find its way to Spotify and other music streaming services. For those of you who dismiss this as “old music for old people,” or ask, “what’s the big deal?” allow me to share the following story.

My son, Max, had serially shrugged off every suggestion I made about the importance of listening to The Beatles. Last Christmas, armed with a few hundred dollars of iTunes gift cards, he took the plunge and bought their entire catalog. In early January he pulled me aside.

“I listened to The Beatles, everything.” He paused. “[Expletive deleted.] You were right. They’re [expletive deleted] great.”

Score 1 for the old guy.

If, like Max before this year, you’ve never “gotten” The Beatles, you have to give it a shot now. Here are the 5 albums you must start with: Help; Rubber Soul; Revolution; Sgt. Pepper’s Lonely Hearts Club Band; and Abbey Road. You’ll thank me.

9. i can still get nervous before speaking in public

MAC Public Hearing

Peggy Chenoweth and Your Humble Author at the Public Hearing

I spend so much of my professional life speaking to audiences of varying sizes that I’m largely immune to nerves. But that wasn’t the case this past August when I spoke for 6 minutes at a public hearing focusing on proposed changes to coverage, coding, and clinical care for Medicare beneficiaries. (See also, #1, below.) I haven’t been that nervous in years. Why? Because that speech, more than almost anything I’ve ever delivered, felt like it mattered.

8. college looms

The fact that in 2015 Max received his driver’s license and now has submitted applications to college is one of the great mind-benders of my adult life. The fact that 17 years have passed and he’s on the verge of starting a new phase of his life is something I still can’t fully comprehend. I can’t even write about it in a coherent way.

Anyway, it’s bizarre. And I’m happy for him but completely freaked out.

7. Amp’d ramps up

Peggy Chenoweth, my partner in crime and co-host of the Amp’d podcast, texted me two months ago. “Do you know how many people listen to our podcast?” As a proud web analytics agnostic, I quickly responded, “Nope.” When she gave me the number I couldn’t respond for a moment. The fact that for a given topic we have more than 11,000 people listening to us ramble is simultaneously thrilling and daunting.

Peggy and I have made a commitment that we’re going to try to increase our podcasts to a weekly (or near-weekly) frequency moving forward. Let me in advance apologize for the times we don’t meet this goal, because it’ll be entirely my fault and likely due to my travel schedule. But much more Amp’d to come in 2016! (In this case, more is more.)

6. Cheap Shots releases its first EP

Cheap Shots EP

Cheap Shots EP

Just as important as The Beatles catalog becoming available to streaming services was Cheap Shots’ release of its first EP in October. After losing his lead guitarist and bassist to college at the end of this summer, Max formed this new group. (He and I spent the better part of two weeks in Aruba tossing potential new band names around. Discarded names included Illysium and Kooster’s Last Stand, among roughly 830 others.)

Cheap Shots has played regularly through the fall and into the early winter, including a stellar gig at Webster Hall in New York City right before Halloween. The EP, The Things That Keep Me Up Late, is a blistering set of melodic pop-punk/rock tunes with a gorgeous acoustic ballad (“One More May”) thrown in for good measure. If you’re unwilling to submerge yourself in the Beatles discography, then commit to Cheap Shots instead. Actually – commit to them either way. If you want to hear soaring melodies and poignant lyrics that come right from Max’s heart, you’ll love Cheap Shots.

5. everything is impermanent

Back in March I wrote about the unexpected death of Phil Kreuter, my friend and the physical therapist who trained me to walk again after I lost my leg. Phil wasn’t old – only in his mid-50’s – but suffered a massive stroke that led to his death shortly thereafter. It shouldn’t take the passing of important people in my life or the near-misses in my own to remind me just how important it is to respect the time we do have on this planet with the people around us. But invariably, it does.

Be aware. Don’t sleepwalk through everything. We only get to climb on this roller coaster once, so enjoy the ride.

4. i have 3 amazing kids

In July, Cara unexpectedly wound up in the hospital for a week while we were in Aruba. It was a serious situation – she was admitted to the ICU, initially – and I suddenly had to spend the majority of my time in a foreign hospital. While she responded to treatment quickly and got out with enough time to enjoy the second week of our vacation, I had to depend on all of my kids in ways none of us could have planned for.

They were all, in their own ways, amazing. When everything around them was going to hell, they supported each other, me and Cara. I couldn’t have gotten through that week without them there. I don’t remember a lot of what happened over those 5 days, but I distinctly recall sitting with my kids around a dinner table and telling them how proud I was. “When the chips are down, families are supposed to pull together and look out for each other, no matter what,” I said. They did that and then some. Thanks Max, Jackson and Caroline!

3. your humble author cries

Eastman Theater

Eastman Theater

I’m not particularly emotional. But earlier this month, Max performed as a member of New York’s All-State Chorus. This is an honor afforded to less than 300 students in the entire state, all of whom qualify based on a formal vocal audition. As I sat in the packed Eastman Theater in Rochester and listened to the songs, I began to quietly cry.

It hit me that Max was moving on (see #8, above) to new opportunities in less than a year. I realized that while I’ll still be his father and always part of his life, I’ll be losing him, to some extent. The thought of 2:30 PM rolling around and Max not walking through the door to shoot the breeze with me about his day at school and the music he’s working on or listening to hit me hard.

In that moment I was filled with equal parts pride and sadness. Prediction: I’ll be a total mess when he leaves for college. Thank god for Skype.

2. New York’s one-limb-per-life restriction overturned for 2016

As an amputee living in New York, I found it particularly galling that amputees paying premiums for plans purchased through the state’s insurance exchange were subject to a 1-prosthesis-per-limb-per-lifetime restriction. As President of the National Association for the Advancement of Orthotics and Prosthetics (NAAOP), I helped support an effort driven largely by a friend and fellow amputee, Dan Bastian, to get that restriction changed.

First the good news: the Director of NY’s exchange added language that requires insurers to additionally cover prosthetic repairs and replacements beginning January 1, 2016. Now the bad news: it’s not clear that this language will carry over into 2017. Additionally, even though the NY House of Representatives unanimously supported a permanent legislative fix that would cover prosthetic devices whenever medically necessary, the Senate refused to bring that bill to the floor for a vote.

So there’s still work to do in NY in 2016, but at least amputees in my home state requiring prosthetic repairs or replacements during the next 12 months will get them.

1. amputees successfully thwart proposed national coverage changes

We the People Petition

We the People Petition

I won’t belabor the point since this was the subject of virtually all of my posts and Amp’d podcasts from August of this year on. Medicare’s contractors published a draft local coverage determination that would have fundamentally changed prosthetic clinical care, coding, and costs if implemented. NAAOP launched a successful campaign that led to 110,000 signatures in 30 days on a petition requesting that the White House instruct Medicare to rescind the draft document.

In October, the White House and Medicare issued joint statements saying that the proposal would be shelved for now in favor of a federal workgroup tasked with analyzing current prosthetic best practices. While we will continue to need to fight over the coming year to make sure that the workgroup possesses complete and accurate information, the decision not to implement a policy that would have returned prosthetics to an average standard of care worse than what I experienced as a new amputee in 1996 was a huge win for amputees across the United States.

It shows how powerful we can be when we speak together with one voice. Here’s hoping there’s much more of that to come in 2016.

the annual prosthetic awareness cycle

the annual prosthetic awareness cycle 5.14.15Caroline recently told me that she missed the good old days (she’s 9) when she would help me don my prosthesis most mornings. Technological advances in prosthetic design resulted in my daughter getting obsoleted a few years ago, an event that should prepare her well for working life in the 21st century. Now to be clear, putting on a prosthesis has never been a two-person job. I just enjoyed the fact that Caroline saw herself as an integral part of this daily routine. I don’t think it would have surprised her at all if she had looked at the component list and instructions for use for my prosthesis and seen a picture of herself as “Girl, 5” just below “Allen wrench” and just above “socket valve.”

(Step 7: Instruct Girl, 5 to screw socket valve clockwise into valve housing; Step 8: Instruct Girl, 5 to chase bouncing socket valve across room following unsuccessful attempt to screw it counterclockwise into valve housing; Step 9: Take socket valve from Girl, 5 and screw it loosely into valve housing clockwise; Step 10: instruct Girl, 5, to turn valve one rotation in any direction; Step 11: lavish praise on Girl, 5 for a job well done and screw valve tightly into socket housing yourself.)

Caroline has known no reality other than that in which one of the first things I do every day is put on my leg and one of the last things I do is take it off. It’s all she knows.

Max, who’s about to turn 17, heard Cara talking last weekend about how she had found some old photos of us when we were first married. I could hear the excitement in his voice as he asked to see the pictures, explaining that he hoped to obtain a first-hand view of me with two biological legs. He spoke the same way an ornithologist would if suddenly confronted with the opportunity to see a now-extinct bird. For him, his prosthetic-wearing father is normal, the pre-accident version of me exotic, a stranger.

Jackson thinks nothing of it when I stand at the base of our staircase and ask him to run into my bedroom to grab my backup battery. He passes me the fully charged lithium-polymer power source while I reach up and hand him the dying one. He presses the indicator button after grabbing it from me to confirm that only one of the 5 LEDs remains lit and walks it to my charger, clicking it into place.

I have three children, all of whom have grown up knowing that their dad (a) has never had hair as long as they’ve known him, and (b) has always worn a prosthesis to walk. When they come across old photos of me with two legs, their reaction is the same as when they see pictures of me with hair: “You look so weird!”

But as with all things, context is king.

Last week while I waited for Caroline to finish her gymnastics class, another student walked out of the gym to use the bathroom and narrowly avoided breaking his neck as his body went one way and his head the other as he tried to simultaneously walk past me while looking at the metal and carbon graphite gleaming dully at him below my shorts. If we were able to hack into his neural cortex and determine the precise words formed there but not spoken, our Thought-Translator 2000 would have flashed the words, “He looks so weird!” on its monitor.

My kids and everyone else’s reach the identical conclusion for opposite reasons. Max, Jackson and Caroline can’t imagine me without a prosthetic leg. Other children can’t imagine me with one, even when what they’re seeing eliminates their need to imagine anything.

I have an internal discussion with myself about these thoughts at about this time every year as I transition from 6 months of wearing long pants back to shorts. As sure as leaves turn green on the trees, so too does Spring mark the time when I get jolted into seeing myself through the eyes of people who either have never seen a prosthesis before or didn’t know that I use one.

For children who don’t know me, I’m a guy with a bizarre robo-leg who, because he’s different, is probably a little scary. But for my kids, especially Caroline, I am – or more correctly, my prosthesis is – something to show proudly to her friends. She has a body of knowledge that others don’t. Some kids like to demonstrate mastery by memorizing obscure sports statistics, spouting presidential history facts, or accessing cheat codes to the latest video game so that they can roam entirely realistic fantasy worlds with heads as big as prize-winning pumpkins. Caroline, on the other hand, gives tours of my prosthesis in much the same way guides do in museums.

“Can anyone guess what this button does? Look!” [Presses rotator button and swings my prosthetic knee and foot upside down so that the sole of my shoe is now facing the ceiling. She laughs while her friends try not to freak out.] “Want to see something cool?” [Turns off my prosthetic knee and extracts the battery, brandishing it like a bar of gold in front of her peers.] “Dad, you’re almost out of battery!” [Confidently places it back in the knee with a celebratory flourish.]

It’s a little odd getting objectified by your own child in this way. I suppose if I were wired differently, I might feel a bit like a sideshow attraction at a traveling carnival. Fortunately, she has refrained (so far) from charging admission to meet her dad, so she remains on the right side of the boundary separating interesting from sensational.

Come October I’ll start wearing long pants again and all of this will recede into the background. Until the cycle starts over again next year.

rock stops for nothing (not even phantom pain)

Max emerged from his band’s rehearsal a week ago, eyebrows raised and anxious. He had just learned that his lead guitarist couldn’t make their gig on Saturday. Over the next 48 hours he waited to see if the guitarist could extricate himself from work (he couldn’t) and if another musician he knew could substitute (he couldn’t). Thus it came to pass that late Wednesday night, I uttered these fateful words to my son:

“Listen, if you’re really stuck, you can try to teach me the songs. I could probably pick them up well enough to get through the gig.”

Having no other options and, I suspect, morbidly curious, Max agreed to my offer.

I have not played the guitar with any regularity for 15 years. I first picked up the instrument in college and took lessons on and off into my late 20’s. I never got good enough to do much besides learn how to play basic versions of songs I liked. Oh – and one other minor, niggling little point: I had never played guitar in an actual concert before. I regale you with this unremarkable history to emphasize that I wasn’t stepping in as some kind of ringer. It was akin to a 53 year-old endomorph offering to run a marathon with a 24 year-old who’d been training for a year to break the 3 hour barrier.

I sat down on a chair in Max’s bedroom as it approached 11 PM. Max probably learned two things about me very quickly that evening. First, I’m not a great guitarist. Second, I try to make up for my lack of talent through sheer relentlessness. Within 30 minutes, the four words he likely hated the most to hear from me were, “Let’s do it again.”

Before long, my fingers – soft from years of disuse – were burning from the steel strings, and my back ached as I hunched over Max’s Gibson. As we closed in on midnight, Max unknowingly paid me the greatest compliment I could have asked for. As I told him that I thought I had the basics of the song we’d been working on down pat and told him to teach me the next one, he exhaled loudly, blowing air out of his mouth like Dizzie Gillespie, and grinning. “What?” I asked. “Nothing,” he replied, followed by a short, laughing shout. “I am so relieved,” he said. “I really didn’t want to go through this show as a 3-piece.”

I knew then that I had passed this unofficial audition that he was holding for me. He thought it was going to work.

*   *   *

My old electric guitar, desperately in need of a full tuneup from a luthier, sat next to me during Thursday and Friday so that I could pick it up during any breaks from work and bang my way through one of Max’s songs. We rehearsed into the early morning hours both days: I went to bed at 1:30 AM Friday and 12:15 AM Saturday, the day of the show. As I hit the pillow Saturday morning, I thought I had prepared for everything. As usual, I was wrong.

At 1:19 that morning, my old friend, Phantom Pain, decided to make the rounds. Having left me alone for 4-5 months, apparently this was the night to reconnect. I suffered through the next 6 hours getting jolted awake by electric discharges through the foot I haven’t had for close to 18 years. I cursed my luck and wondered if the two over-the-counter sleep capsules I had taken to (unsuccessfully) block out the pain would impair my motor function later that day.

I woke up with a post-medication fuzziness and headache that left me irritable and nervous. The bassist and drummer came over for a 1-hour rehearsal that would constitute the entirety of our practice as a full band. We rattled through the set list and, my headache fading, packed the cars up to go to the club. Upon arriving there, we dumped our equipment backstage and waited for our turn to play. It was at this point that I realized I had a problem.

I had spent the previous 72 hours cramming every spare moment with those 7 songs. Between work and practicing for this, I’d done nothing else. Now, at 2 pm, I had to kill close to 2 hours at the venue while surrounded by people from the other bands on the bill, all of whom were 20 years younger than me and 100 times more experienced. As I looked at the other musicians swirling around me, I felt increasingly out of place. Skin tight jeans with a bandana around the thigh; shapeless wool hat (in 84 degree heat) over shoulder length hair; large white plastic glasses (definitely not prescription) swallowing up an impossibly skinny face; and me, closing in on 45 wearing blue jeans, sneakers, a black tee-shirt and a Wounded Warriors Amputee Softball Team baseball hat (backwards, because – you know – I’m hip).

When the bassist for the headlining act asked me if I worked for the club, I politely answered in the negative while freaking out inside. It was a logical question – why on earth would a nearly 45 year-old guy be hanging out backstage if he wasn’t working there? – that sent me spiraling down a rabbit hole of middle-aged angst.

I had to get out. I pulled my guitar out of its case, walked into the alley behind the club and sat on the ground, working through the set list to calm down. The act before us finished, and then it was rush onto the stage, plug in, power up, check the sound, and before I could process it, the curtain rolled to the side and the lights hit me. And in that 30 seconds between seeing the audience and Max launching into the first song, I felt everything speeding up around me, too fast. The thought, “I. Am. Scared.” went through my brain.

I spent the entire set looking either at the neck of my guitar or at Max, 10 feet to my left, as if he could save me just by being there. It felt like it ended 5 minutes after it had begun, and I was suddenly in the alley behind the club lugging the amp and guitar back into the trunk of my car.

I could think only of the mistakes I knew I had made on stage afterwards. I didn’t see or talk to Max until 30 minutes later, after he had made the rounds with all of his friends who had come to the show. “Were you happy with it?” I asked, which really meant, “Did I screw it up for you?” “It was great!” he answered. “Best crowd response I think we’ve ever gotten. They were really into it. I had fun.”

Then, and only then, did I relax.