David Bell, 57: All In

Dawn breaks over Diamond Head crater. Morning rays shine first light on the glass towers of Waikiki to the west. The sea cuts a clean, calm line between land and horizon, reflecting the clouds’ soft glow. Just past a nearby buoy, four fluorescent pink swim caps bob up and down at a steam engine’s unrelenting clip. Dr. David Bell is the only man in the “pink cap ladies” open water swim group today (and most days), as they work to stay in form for an attempted channel crossing from the Big Island to Maui—a swim that has only been completed four times. 

David’s work as a family physician specializing in Alzheimer’s care prevents him from dropping everything on two days’ notice to embark on a 47.6 km, 24-hour swim; otherwise, he’d be there in a heartbeat. After all, the swim group lives for this kind of real adventure, which, to quote Yvon Chouinard, “Is defined best as a journey from which you may not come back alive, and certainly not as the same person.”

Long before he found himself crossing deep water channels in the dead of night, David became an expert in adapting and succeeding in dynamic environments. His open-hearted interactions with different cultures has enabled him to eschew comfort zones in favor of authentic connection, dive headfirst into challenges of all shapes and sizes, and lead with compassion in his work to improve the health of local communities.

How old are you?
Fifty-seven.

Are you married? Kids?
Married in 1993 (closing in on 32 years now!). Four kids: Malia (28), Francesca (25), Andrew (21), and Jack (13).

Where are you from and where are you currently based?
Born and raised in Honolulu, left after high school, lived on the mainland for about 16 years (mostly education, training, first job…). Basically, I was in upstate New York, New York City, San Francisco, and rural New Mexico (Crownpoint) before moving back home in 2002 to Honolulu. Manoa Valley to be specific.

What was it like to leave Oahu for the mainland, and then find your way back?
Loved leaving—was ready to see the “larger world,” meet new people/communities and all that comes with that. Coming back was actually not formally on my radar beyond a general idea. I loosely thought it would be fun to come home someday…. Some family health issues lead to us rethink our “plans,” and ultimately we decided to come back and build our life here. We’ve been back for 22+ years now, so it is home. Initially, returning was the mix of reconnecting with family, friends, and also consciously making an effort to find new neighborhoods, spaces, communities, so that it wasn’t just a futile attempt to rerun whatever I might have remembered doing 30 or 40 years earlier.

“The U.S. and the larger world could use more of Hawai’i—it is not perfect or a utopia, but this is a place where people have a baseline understanding of limited resources and space, the need to work together, to support each other, and especially to find help for the vulnerable and disadvantaged.”

How did your time away impact your impression of Hawai’i, and how did your upbringing influence your impressions of the continental U.S.?
The U.S. and the larger world could use more of Hawai’i—it is not perfect or a utopia, but this is a place where people have a baseline understanding of limited resources and space, the need to work together, to support each other, and especially to find help for the vulnerable and disadvantaged.

It is a generous and compassionate community, perhaps because we all live on top of each other and realize we have to “work it out” in these isolated islands in the middle of thousands of miles of open ocean. No one is going to come and “save us,” so we need to get together, respect each other, and solve for the whole. And this physical isolation is juxtaposed to centuries of people coming here from all over the world (unfortunately, not always for good) to build a new life. This swirl of languages, traditions and culture, food and ideas has made this a unique, vibrant, and amazing place. We borrow ideas and beliefs from all over Europe and America but are deeply connected to Asian customs, norms, and mores. Beyond that, we are ultimately grounded in the traditional values of Hawai’i (and much of Polynesia).

What led you to pursue a career in medicine?
I wanted to tangibly work with people, to build and improve our communities, to help. And the human body and understanding illnesses and healing are compelling and fascinating. I love the interplay between biology and community and family. I’m especially interested in how that dynamic affects individuals, their families, and communities—and how we can work in those spaces to make a positive impact and improve lives.

After your residency, you spent several years with the Indian Health Service, providing medical care in the Navajo community of Crownpoint, New Mexico. How did that experience inform your medical practice thereafter?
We do not provide care in a vacuum—we can only understand disease and health and healing within the context of culture, history, community. Living and working in an incredible place like Crownpoint, to me, it seems impossible not to come to understand this.

Crownpoint is an amazing community, and although I was there for only about three and a half years, I am still in close contact with many of my friends and colleagues from that time and work. It is an amazing place and people. I learned so much from the Navajo people. Their history and resilience in the face of centuries of oppression, conflict, displacement and colonization is beyond inspiring.

What’s a misconception you feel most people have about neurodegenerative diseases like Alzheimer’s and dementia?
Perhaps the variability of the disease course—its not a straight line. Much like the inverse of the global development of infants and young children, there are periods of stability and also times when things may change quickly. Also, perhaps, the interconnectedness of our “organ systems” (e.g. as dementia progresses, there will be other issues; for example, decreased physical activity and mobility and also trouble speaking and swallowing).

“I think we have a natural tendency to pull back around any real conversations about decline. It’s scary and sad and no one wants to think about any of this. But we lose such a good opportunity to have honest dialogue about goals and priorities.”

If someone’s navigating a relationship with a family member or friend who was just diagnosed with Alzheimer’s or dementia, what advice would you have for them?
I think we have a natural tendency to pull back around any real conversations about decline. It’s scary and sad and no one wants to think about any of this. But we lose such a good opportunity to have honest dialogue about goals and priorities. This leaves us unprepared for a time ahead when we may not be able to have those fuller conversations anymore. We miss the chance to uncover what individuals want and need as they approach the end of life.

Also as the disease progresses, there is still a fundamental need to make connections, and people often back away. Human presence and contact is still powerful and calming—we are social beings.

It’s often easy to get immersed in social circles that revolve around work and family. How have you found and built community throughout different phases of your life, as these influences have changed?
Family and work are good communities to be immersed in, grounded by, and I find that it has been important to me to build other connections as well. I think music is important in our lives and for big chunks of my adult life, I’ve worked to find ways to connect through that. I’ve been involved in choirs, and I was also part of a small and very active music group for over a decade (about 10 of us with stringed instruments—ukulele, guitar, violin, bass, singing—we practiced and performed at community and school events mostly). I also like to do physical labor and find meaning and purpose in working with community organizations doing great work to restore native Hawaiian fishponds, agricultural spaces, digging trails, removing invasive species from our natural places—all working to try to heal the land (and in the process heal ourselves and our community).

What role does movement play in your daily life?
Physical movement is fundamental to being human and alive. It’s foundational to my sense of health and happiness. I think this is true for all of us, but certainly for me—I find a lot of meaning and stability in movement and exertion, especially if it is done outside in the natural world. I think I feel much more alive and grounded after a long trail run, hike, or ocean swim. I love the Japanese term “forest bathing”—this idea of reflection and moving meditation, of cleansing that comes from being immersed in nature and at least briefly untethered to the modern world (except for maybe that smartwatch that is still on my wrist!?).

What prompted you to take up distance swimming during COVID after being a big runner?
I started swimming as an idea planted by one of my oldest friends—to find a physical activity that might be meaningful and also a departure from the frustration of repeated running injuries on my aging body. This happened a few years prior to the pandemic. I thought it was time to find something new (that I knew I would suck at) to fill the physical and mental “space” if I could not run anymore. I enjoyed the challenge of learning a new skill. (Yes, I grew up in the ocean here, but never swam on a team competitively, so I had a lot of “bad habits” to fix and had to learn real stroke techniques, fundamentals…all of that.) I was just getting more comfortable with open water swimming when the pandemic hit.

With the pandemic shutting everything down, a small group of us that had been swimming together started to meet up at daybreak to get in a daily swim before many went home to work virtually and I headed to the hospital. It was totally life affirming in a time of fear and confusion and misinformation and isolation (well, I was also quite busy at work, so it was a brief sanctuary as well). The lifeguards and park rangers left us (and the surfers) alone as long as we didn’t linger on the beach. Over time, a few of us decided that we wanted to “push things” and take on some longer swims and experience that challenge. And that’s how we eventually found ourselves deciding to tackle bigger objectives like channel crossings.

How did you get involved with the “pink ladies” swimming group?
The “pink cap ladies.” Originally, we jokingly called ourselves—this open water crew that met each day—as “OOPS” (Oahu Ocean Pandemic Swimmers). The name came when we realized we were all wearing pink swim caps (bright colored caps are really important for visibility/safety out in the ocean), and that it was usually me and my “swimming girlfriends” (as my wife called them) out in the water each morning. We had been swimming together at The University of Hawaii in their masters’ program and in local races before the pandemic, but the specific dramatic situation of COVID and lockdowns and our organic response to start each day in the ocean really pulled us together as a “pod” (in a safe socially distanced way, of course).

I also love that my larger swimming community is such a great mix of ages and backgrounds. Teachers and professors, doctors, managers, nurses, construction workers, students, moms, lawyers, managers, military folks, etc. There are folks well into their 60s and a bunch of us in our 50s and 40s. but also some of our kids or their friends sometimes show up when they are home between semesters or grad school starts or new jobs (in their late teens and 20s). It creates this fantastic and diverse and random cluster of people coming together to push their bodies and minds a bit, and to enjoy the stunning beauty of the ocean for an hour or more…

Tell us about the process of planning, training for, and executing a distance swim? Does this process vary from swim to swim?
Usually starts with a proposed new swim; then, we find a few possible dates and work back from there in terms of how much of a “build” we need to do. I can’t quite put in the hours of time—and I think my body would break down—to constantly train at a level such that I could cross a channel on “any given weekend;” so, you need to safely increase distance and time over a period of a few months to get mentally and physically “ready.” Meanwhile, there is all the logistics work—arranging whatever we each can to mitigate this sink of time and energy and its impact on work, family, and other obligations.

A big logistical piece is finding a support boat and team, and determining if our possible dates line up well with known current forecasts, and weather systems. While all of this can be stressful, it is all actually mostly lots of fun conversations—just like planning a big vacation with your family might be.

What is unique about swimming in the open ocean versus in a pool or near-shore waters?
You are very small and meaningless in the vast universe. There are so many variables in the wild, open water that you have little to zero control over, and you have to accept that. Of course we do mitigate and adjust when and if possible. We deal with currents, weather, waves/swells, wind, jellyfish, sharks, whales even…. For the big crossings, there is also just the physical and mental reality of hours and hours of swimming. This is all without physical support or rest (beyond the bottle of fluids and gels thrown to you in the water every 30 to 45 minutes).

You’ve mentioned this concept of “type 3 fun.” What is that?
Definitely there is some variation out there on how different folks like to divide this whole concept up. But, in my mind, “type 1” is fun at the time you are doing it, and it was fun when you reflect back after. Roller coaster ride. Peaceful walk in the park on a lovely summer evening. “Type 3 fun” is difficult and not fun at the time, and leaves you with deep mixed feelings after. It may be even quite unfun/scary to reflect upon after. Perhaps, after some time has passed, though it’s less terrifying. Think: backpacking trip where you get lost and have a very difficult time getting home, maybe even need to be rescued. “Type 2 fun” is somewhere in between these two.

I don’t specifically seek out “type 3 fun,” but I know it lingers on the edges of (and may be unavoidable) in many more intensive pursuits of “type 2 fun.” I think in “type 3” situations, I do learn a lot about myself and would not want to avoid the opportunity to have incredible adventures/challenges because of the possibility of “type 3” moments, and I think there is some good space in there for mental and spiritual growth even when things go wrong and you wouldn’t want to repeat that specific situation.

If you are spending hours swimming in the open ocean, swimming all night, bad stuff will happen. Example: slamming into a bunch of jellyfish and getting stung up badly or dealing with hypothermia. You try to limit/mitigate/plan for it, but you can only control so much for it, and by experiencing these events it does help you grow and maybe plan for the future.

What are your three life non-negotiables (i.e., the things you can’t live without)?
Grace in the face of change: I think life is about this complex interplay of continuity and change, adaptation, flexibility and steadfast resistance, integrity but also grace.

Building community through purpose: To navigate all of that, I think we need to seek purpose/meaning and mastery, we all want to retain some sense of control, and also to find and develop connection/interdependence with others (to create real community).

Humor and forgiveness: Last, throughout all of this, forgiveness of ourselves and others…and retain a sense of humor.

P.S. On February 13, 2025, several of David’s team members attempted to swim the Alenuihāhā channel from Big Island to Maui. While the “pink cap ladies” came within 4 miles, they had to withdraw to the support boat. Tina Neill completed the entire crossing, landing on the rocky shores of Kaupo around 9 p.m. She is the fifth person in recorded history to swim this channel.

Editor’s Note: Some answers may have been edited and/or condensed for clarity.

Cover image credit: Kali Gilbreath