41 (aka 2023) was a hell of a year, and I think it’s worth taking some time to reflect on and be grateful for the many ways in which 41 was the best year of my adult life, and why I think 42 might be even better. It really boils down to two things: 1) a care team that works as a team, and 2) an employer who both encourages me to make healthier choices AND creates an environment where I can actually do so.
41 Crushed 40
As a lot of you know, I’ve been on a real health journey over the last eighteen months or so. One of the shitty things about changing jobs in the United States is that it too often means that you have to change health insurance, and that too often necessitates changing your medical providers and starting over with new doctors, specialists, etc., unless you’re willing to pay considerably more out of pocket to keep your old ones, or you get really, really lucky. My shift from the state to the Gates Foundation was no different; I went from an HMO (Kaiser Permanente/zombie Group Health) that I’d been using for almost 14 years to a more traditional health care insurance plan (Regent Group Administrators, a flavor of Blue Cross). I was apprehensive; I’m a creature of habit, and I’d grown up hearing about how frustrating private insurance could be (mom bearing the brunt of that particular labor, and Blue Cross being a particularly fun version of it), and I’d gotten pretty used to an HMO system that worked … well, worked-ish, at least in terms of getting things actually paid for with minimal fighting. My KP provider would refer me to a KP specialist, and everything went smoothly. I also really liked my primary provider at KP, a fellow former swimmer, Duck, and video gamer who I could commiserate with over swimmer shoulder pain, the lack of availability of the Xbox Series X that first year (when they were going for a 200-400% markup online), the latest bad coaching call, etc.
So, when I showed up at the Foundation, I was really uncertain about how it would go. I hadn’t had to find providers in more than a decade, because with KP they’re mostly just picked for you. As part of orientation, they told us something that I sort of thought had to be a joke, about how there was a full-service health clinic in our parking garage (“There’s an Olympic-sized swimming pool on the roof.”[1]) A couple weeks in, it became clear that they were actually serious, and we really did have a clinic with actual doctors/nurse practitioners on the third floor of the Seattle Center parking garage. It also turned out that the Foundation would (as a matter of policy) pay the clinic any costs that weren’t covered by our (admittedly platinum-plated) health insurance. To sweeten the deal, Vera Whole Health (the clinic) even offered a small financial incentive for us to come see them: if we did a physical, a basic biometric screening, and a 30-minute consultation with a health coach, they’d send us a $100 gift card each year. That seemed like a no-brainer to me; I’d started commuting to Seattle a couple of days a week anyway, so it was reasonably convenient. Besides, I needed a new GP and I might as well try the free option that I could literally walk down the stairs to get to, right?
So I did it. I did the biometric screening, and met with one of the staff nurse practitioners, a guy named Joe Gardner. We talked about my general health, and some reoccurring issues that I’d been having, and my desire to finally lose some weight and get in better shape. I’d watched how much the last few years of Dad’s life had been complicated by his health, and I didn’t want that to be me in twenty years. I also had a thirty-minute video call with one of their personal coaches, though through a hilarious mix-up I ended up talking to a very nice woman who worked out of their Anchorage office, and it took us both a little too long to figure out that we were in different states and different time zones. I went back to the clinic the next week to talk through my blood work with Joe, and he asked if I’d ever considered medical weight-loss interventions. Ozempic had just started hitting the news, and with my blood sugar getting perilously close to pre-diabetes, he thought I might be a good candidate to give it a try. He did warn me that the supplies were really limited and that it might be six or seven months (the beginning of 2023) before I could find a pharmacy that could actually supply it, but also that he’d start poking around and seeing if he could find someone who had it available. I mostly wrote it off as a cool idea, and figured I’d bring it up again in the new year when I did my 2023 physical.
To my surprise, Joe followed through. He did a remarkable amount of leg work to find a pharmacy that stocked Ozempic and could get me the right dosage, and the week of Thanksgiving I got my first dry-ice packed shipment of injector pens.
On Ozempic, and a Care Team that … Cares
I’ll say up front that Ozempic is a hell of a drug. It’s NOT a miracle drug. It doesn’t make weight loss easy, as much as I worried early on that it would feel like cheating. It doesn’t make you lose weight on its own, and it won’t work without substantial lifestyle changes and personal effort. But what it DID do was fundamentally change my relationship with food.
I’ve never had a particularly healthy relationship with food. I’ve always had a lot of internalized shame and stigma around my weight and my health in general, and frankly I should probably have sought therapy to talk about it years ago. I remember the first time my folks left me home when they were going out of town: the first thing I did was take the money that they’d left for me to eat for the weekend to Rosauers, and I bought a can of whipped cream, a frozen pizza, and a roll of cookie dough and ate myself sick. I’d guess that a lot of people I went to high school with will remember me mostly with an omnipresent 20 oz Coca-Cola in my hand (it was the first time in my life I had regular access to soda with sugar), and I’m pretty sure that anyone I spent time with in college will remember the frankly terrifying amount of Coke I drank each day once I had my own mini-fridge and no one watching my intake. College also meant essentially unlimited access to fried food at the cafeteria, which was paired with a real crash in the amount of exercise I was getting.
While I’ve been *mostly* better since college when it comes to soda, I’ve continued to be the guy who is painfully and chronically aware of food in my general vicinity. If there were donuts in the breakroom, I knew it and would walk by every chance I got to see if there were any left. If there was a piece of cake in my fridge, I’d constantly think about it. At DFI, my window looked out at the 7/11 in the parking lot next door, and I constantly wanted to walk over for a Slurpee and a hot dog. And when I started at the Foundation and realized that the kitchen had a snack column (which included things like Oreos and Doritos, or a large container of peanut M&Ms), and that there were soda fountains on every other floor in both buildings, I knew how much of a problem it was going to be because those facts were always going to be somewhere in the back of my mind.
[A dear friend visited me last summer on her way through town and offered a great metaphor for my experience. I never knew that she struggled with food the same way that I did, but she the way she talked about food really hit the nail on the head for me. It’s as if any food in the area is calling our names all of the time. (Not literally. We’re not ACTUALLY hallucinating desserts shouting come-hither lines.) Talking about the omnipresent and overwhelming AWARENESS of tasty things nearby was a revelation for me; I really had thought it was just me. I didn’t know that anyone else felt that way. And it was incredibly validating and important to hear.]
Ozempic … quiets that voice in the back of my head. The one telling me every ten minutes that I should go get a coke, or a bag of Doritos, because who knows if they’ll still be there if you don’t? (Spoiler: they, in fact, always were still there.) Like, I still knew that those things existed and were easily available. I still knew that there was a donut shop a few blocks from my house. It just … didn’t matter as much? The freedom was and is incredible. It really hit home a few months after my 41st birthday when I realized that I’d had a gallon of super premium Tillamook ice cream (raspberry and white chocolate chunk!) and leftover cake in my freezer for months and I hadn’t thought to have either even once.
Just like that, this demon that I’ve been fighting since I was a teenager, that had derailed me every time I tried to focus on improving my health, that was slowly killing me by inches, was … well, not gone, but rendered mostly impotent and small. Manageable. And combined with improvement in the quality and quantity of my diet[2], and regular exercise, the weight started to come off. Without a crash diet. Without feeling like I was depriving myself. Without feeling hungry all the time, without food journaling, and without the incessant voice whispering or shouting at me that I could sneak a piece of cake or a bowl of ice cream.
[I mean, the sheer absurdity of SNEAKING a piece of cake at 40 years old, in my own home, that I share with only with the world’s least judge-y golden retriever. Sneaking it from whom? Denali? Denali doesn’t care as long as I share OR give her pets while I eat it. Preferably both.
When I say unhealthy relationship with food, I mean UNHEALTHY relationship with food.]
Ozempic didn’t make it easy, but it did make it possible. And it’s a self-perpetuating cycle; as I’ve lost weight and improved by fitness, I walk more, and ride more, and lift weights more. More exercise has lead to more sleep, and increased need to eat better fuel, which has resulted in substantial shifts in my diet (increased protein and fiber, decreased fatty foods and carbs).
I feel so much better now than I did. And it’s both quantitative and qualitative:
– Blood sugar: 6.3 4.2
– Blood pressure: 140/100 115/75, even after dropping one medication and cutting the dose of the other in half
– Resting heart rate: 80 bpm 55 bpm
– 367 lbs 283 lbs and falling (weight is usually a dumb metric for health and people should mostly spend less time obsessing about it, but in my case this is legitimately life-changing shift and it’s a handy short-hand)
– All of my blood test values in normal range, when they’d almost all been in unhealthy or borderline unhealthy places
– Average sleep from 5 hours a night to 8, and substantially higher quality sleep (this is even compared to how much better it got after I started using an APAP in 2017).
– My AppleWatch used to think I was exercising every time I took Denali for a walk. The first time I did a serious Peloton ride my heartrate hit 160 and my hands started shaking, and I had to sit down for a half hour to try not to throw up. Now I routinely get my heart rate above 160 bpm in workouts, and I both feel fine and recover back to a normal resting heart rate in a matter of minutes.
I’m not saying it’s easy. Ozempic has a variety of pretty awful side effects. For me, it’s mostly been occasionally unrelenting nausea and a variety of unpleasant gastrointestinal issues. With Ozempic you start with small doses and work your way up to the full dose. The theory is that your body will adjust along the way and the side effects will abate. For me, they mostly haven’t, though the nausea is growing slightly less intense and frequent. I’ve mostly just learned to manage it; for example, it turns out that exercise is really good at taking the edge off of nausea for me. Changing my diet to include a lot more fruits, vegetables, and fiber and substantially less fatty food has been a life-saver. Reducing my alcohol intake (which was never particularly high, to be clear, despite my slightly ridiculous whiskey and wine collection) and starting intermittent fasting has been really helpful too, and I’ve discovered that my injection site matters a lot in terms of both effectiveness of the drug and the amplitude/frequency of the side effects.
All of this is possible in part because I finally got a practitioner who didn’t just tell me that I need to lose weight, but who took the time and attention to ask more questions, to admit when he didn’t know something and needed to do the research, and who followed up and worked with me to find a solution that works for me.[3],[4]
And it’s not just Joe. When I go back to work in January, I will have my 70th or so weekly meeting with Lou Anne, my Vera-provided personal coach. We’ll talk through the goals I set for this vacation (divided into three groups: eating[5], moving,[6] and miscellaneous[7]), we’ll talk about what went well, what I learned from it, and what my goals will be for my first week back at work. That accountability is part of why I’ve been successful in turning my health (physical and mental) around. It’s also why I’ve done Duolinguo Spanish basically every day for more than 400 days at this point, why I’m buying a lot fewer mochas, and taking time every week to reflect on the prior week: I know that if I don’t accomplish any of the goals I set for myself each week, I will have to tell Lou Anne about it on Tuesday. And while she’s not particularly judgmental (and honestly gives me more slack than I give myself most of the time), knowing that I have to tell her where I’ve ‘failed’ is good motivation. At the end of January, I’ll have my monthly meeting with my Vera-provided registered dietician/nutritionist to talk about how my diet worked while I was on vacation and not in total control of my schedule. I’m also pretty sure that something I tell one of them will end up in my chart, and I’ll get a follow-up e-mail from Joe about some question that I asked.
This is what a health care team should look like. I’m incredibly privileged that I get this access, and that I don’t have to work particularly hard or make complex arrangements to get it. Joe and Lou Anne are in my parking lot, and while Megan (the dietician) is located in Kansas City, she’s only ever a video call or an e-mail away).
As always, your mileage may vary. Every person is different, and you can’t change unless you really want to. For me, Ozempic isn’t a cure-all. But it genuinely makes it possible for me to succeed where I’ve always failed before. And no one really knows what the long-term plan is for folks taking Ozempic; it might be that I take an injection every week for the rest of my life. I can live with that, but also I’m thinking about what I can do to lock these new habits in place and maybe be able to wean down or off it.
The other thing that has contributed so meaningfully to my health journey is my employer and an actual commitment to work-life balance, something the state pays a lot of lip service but rarely lives up to.
On Respect in the Workplace
I’m sure y’all are sick by now of hearing about all of the great benefits provided by the Foundation. This post has not been devoid of it, certainly. But honestly, a huge part of why I’m able to work on my own health is that for the first time in my life, I work for an employer who genuinely prioritizes my health and well-being, both at the macro level and the microlevel.
First, the macro. I’m going back in January to do my first 4Cs conversation. (4Cs is the Foundation’s personnel review/evaluation process.) I’m pretty sure that one of the things that my boss is going to talk to me about is the fact that while I was expected to take three weeks of vacation in the second half of 2023 (after I was converted from an LTE to an FTE), I took a grand total of … one day off. (Maybe two?) [The Foundation closure from 12/15 to 1/2 doesn’t count.] For many organizations, unlimited PTO is a trap; they know that employees with unlimited PTO will use less than they would if there were a defined amount. That may well be true of other parts of the Foundation, but at least within my division we’re serious about staff taking at least six weeks (again, not counting the closure or any observed holidays). They’re also quite serious about us actually being on vacation when we’re on vacation; if I were to send an e-mail the first week of January when the Foundation is open and I’m still on leave, that would also end up being a part of my 4Cs conversation later in the month. [Taking a vacation without my work phone and without checking my e-mail every couple of hours? Preposterous!] This is going to be a challenge for me in 2024. When I left the state, they paid out almost a month of unused leave (and this after 1) I lost some during the pandemic due to inability to use it, and 2) I used a full month of leave between my last day in the office and my actual last official day on AOC’s payroll). When the Foundation converted me from an LTE to an FTE, they paid me out almost three weeks of unused leave that I’d accrued over less than a year (I’d earned a total of like four weeks of leave in that period). I’m going to try to get ahead of this challenge by planning trips for 2024 that will force me to take chunks of vacation. (I know, I know. Life is super hard. I know how silly it is to complain about this. Only the most first-world-y, sparkly problems for me.)
And then the micro: I’ve never worked for an employer so committed to day-to-day quality of life for its employees. (Again, this may not be universal to the Foundation, but it absolutely is true for my Division). My colleagues frequently duck out during the day to get a workout in at the Foundation gym. Or to take their dog for a walk. Or to hang out with their kids. Hell, I ducked out for an hour the other day for a coffee date. The first time I told my boss that I was going to take a long lunch to get a Peloton ride in, she looked at me quizzically and asked why I was telling her that. I still usually try to let my teammates know if I’m going to be out for a bit just in case they need something from me, and universally the response is “is there anything you need me to cover for you?” I had at least a half dozen conversations the week before the closure/my trip with colleagues about whether there was anything they needed to cover to while I was out the first week of January, because we’re all committed to making sure that we really lean into and enjoy our vacations.
Respect in the workplace. It’s a trip, right?
On The Perils of being a Living Single Point of Failure
At the state, with the exception of like … six months, I was the only person in each of my positions and had a relatively unique skill set that no one else was able to cover without substantial training and preparation in advance. As a result, for fourteen years, every time I was out of the office I was painfully aware that work was accumulating that I would have to somehow balance with new work when I got back. This was a reoccurring problem for both me and for my staff in each job. Because of that, no one could really disengage and enjoy time off. One of my line staff had been in her (entry level!) job for most of a decade, and had basically never taken a vacation because she felt like she couldn’t. That horrified me and I did my best to cover for her and let her take time off, but that’s not sustainable.
It’s really wild to not be a single point of failure anymore. Like, I know my value to the Foundation. I know the quality and quantity of work I accomplish. I’m really good at my job.[8] I’m certain that if I left (or won the lottery, or got hit by a bus[9]), I’d be missed and it would be a hardship for my colleagues to pick up the load. But I also know that they could absolutely do it. And that knowledge means that when I’m out of the office, the work isn’t just piling up. I know that when I get back next week, I’ll have a one or two hundred e-mails to triage, but I also know that nothing important got missed or was waiting for my return, and that’s incredibly freeing. This upcoming week will be my third consecutive week out of the office, and while I’ve got some important projects that I’m excited to dive into when I get back, I can also honestly say that I have spent zero time or bandwidth on a single one of them over the last two weeks.
And then there’s the day-to-day workload. I genuinely work a 40-hour work week. (Okay, maybe a 45-hour work week because I’m not great at actually logging out at 4:00 when I’m working on something.) I think I’ve worked two or three evenings and zero weekends in 18 months (compared to at least three evenings a week and two or three weekends a month for years for the state). And that 40-45 hours is PRODUCTIVE. Even as I’ve added a bunch of new responsibilities that come with meetings over the last few months, I’m still spending waaaaay more time actually doing the work during the week compared to any job I had at the state over fourteen years. My group sometimes jokes about our overly-fond attitude towards meetings, but we ain’t got nothing on the State of Washington.
Free time? What’s Free Time?
The end result of all of these wonderful things is mental and emotional bandwidth to do things that aren’t work. I can meaningfully disengage from work and spend time with family and friends. I can take time every day to study Spanish. I can spend more time with Denali and take her for higher-quality walks and give higher-quality snuggles. I plan my week out ahead of time, not because I have to just to keep my head above water, but as a way to make sure that I build in time for exercise, stretching, study, relaxation, and cooking/eating cleaner instead of stopping at McDonalds on my way home because I know I’ve got to log back in for a couple hours. I’ve got an inch-thick stack of the menus and goals I’ve set every week since last August, and more often than not the goals are all checked off and the menus completed. Feeling like I accomplished something with my week means I wake up on Mondays feeling energized and ready for new challenges, not dreading the coming week and the stress it will bring. And I have time the time and inclination for self-reflection and goal setting; first thing each Monday morning, I sit down and reflect on what I’ve accomplished and what lessons I can take away from past week, and then I figure out what I want to accomplish in the coming week, what I want to cook, and what things I need to plan for or around. As a result, I don’t spend a lot of time during the week worrying about what I’m forgetting, or what I won’t have time for … because I know. And because I’m trying to learn from my mistakes, I make sure to build in enough flexibility for the unexpected.
2023 was a great year. I’m happier and healthier than I have been as an adult, and I feel like I’ve rebuilt my life around a structure that encourages me to figure out (and seek) what I really want, rather than what I think I should want, or what others think that I want, or what society tells me I should want. And that’s not nothing.
Why 42 is Going to Kick 41’s Butt
As a lawyer, my work is often serious with serious consequences for screwups. I think it’s natural and maybe even inevitable that all-too-frequently, I take myself too seriously as a result. One of the things I love most about Denali is how utterly shameless she is. She has virtually no artifice. If she likes something, she loves it and she doesn’t hide it. I think we can all learn a little from the guileless, child-like glee of a golden retriever. So here’s to a 2024 of personal growth, pursuit of bliss, a healthy portion of childlike glee, and a surfeit of quality time with the people (and dogs!) that we love.
Some goals for 2024:
– At least four trips with some portion just for fun.
o I’m already spending March in Hawaii, two weeks working and two weeks playing.
o I’m supposed to go to DC and Beijing for work, and I’d like to potentially extend both a bit to get some fun time in as well.
o I would love to go see Dylan and Ruty in Singapore again, preferably this time without the whole getting-COVID-on-the-plane-and-then-infecting-them thing.
o I did a long weekend in Victoria like five years ago over V-Day weekend. I want to do that again this year (well, maybe not over V-Day this time); catch the Seattle ferry up for three or four days of hanging out.
o I really enjoyed my ridiculous all-inclusive resort trip to Playa Del Carmen last year, and it’d be fun to do one of those every couple of years.
– ACTUALLY USE SIX WEEKS OF PERSONAL LEAVE.
– Some fun, fast (and safe!) driving, preferably with a suitable mid-life crisis car. I’ve got a three-day rally driving class scheduled and paid for in early September 2024. I need to spend enough time driving a stick in the meantime to make the highest and best use of that opportunity.
– A 5-mile hike with Denali. (We can both totally do this distance; it’s just a matter of balancing our enthusiasm for sniffing ALL OF THE THINGS with a desire to complete the hike in a timely manner. I’ll let you guess which of us is primarily responsible for each of these conflicting desires.)
– A triathalon. I did the Aluminum Man in The Dalles every year with dad for quite a while, but it’s been a long time, and I think I’m in decent enough shape now that I can safely train for and compete in a sprint tri.
o This means acquiring a bike that I can safely ride at this size.
– Figure out some metrics to decide if I can safely try skiing again in the winter of 2024. Skiing used to be one of my blisses, and while I’d sort of given up hope of being able to do so safely, this year was a real revelation in terms of what I can accomplish when I dedicate myself to something. I already had a conversation with Joe around the kinds of things I need to be able to do for skiing to be a real option, and the Spring of 2024 is going to be for figuring out exactly what that go/no go looks like. I don’t need to get back to black diamonds, but it’d be great to be able to go up a couple of times a year and have some fun seeking the pow. [Also I’m pretty sure Denali would be obsessed if I tried cross country again.]
– Continue my health journey, physical and mental.
– (Maybe find a therapist for my relationship with food.)
– Go on some awesome dates.
– Do things like this more often. I genuinely don’t expect anyone is reading this at this point. It’s an exercise in self-indulgence. But that’s okay, and it’s fun, and I like thinking about and engaging with this kind of stuff. Here’s to a 2024 of leaning in on seeking bliss.
Cheers, y’all. Here’s to a 2024 of bliss.
[1] https://twitter.com/Hackers_bot/status/1597522284717248512
[2] More on this in a later post.
[3] [It’s not just weight, btw. I’d had trigger fingers on both my middle fingers for five or six years (not from overuse, I swear!), and Kaiser’s solution had just been to do cortisone injections that would work for a few months and then go back to being really painful. When I mentioned to Joe that I needed another injection, he immediately asked me if I wanted to go see a specialist and talk about surgical intervention. Two weeks later I was at Seattle Hand talking to Dr. Jimmy Daruwalla, and a month (and five minutes of surgery) later I was pain free.
[4] HOLY SHIT IT MATTERS TO HAVE A PRIMARY CARE PROVIDER WHO LISTENS AND CARES AND IS EMPOWERED BY THEIR EMPLOYER TO DO SO.
[5] Mostly this revolves around preparing and following a menu each week (with limited meals out).
[6] Usually a number of cardio and weights sessions, stretching sessions, and planks each week.
[7] Duolinguo, weigh-ins, weekly reflections, checking in with accountability buddies, etc.
[8] And super modest, obvi.
[9] I call this the “hit by a bus problem,” but my boss prefers to call it the “powerball problem.” Pota-toe, potah-toh.
Phil's Superpower of Enthusiasm 