Medicine From The Trenches

Experiences from undergradute, graduate school, medical school, residency and beyond.

Back to training for the marathon

If you have read my previous posts, you will know that I trained for my first marathon but was unable to complete the distance because of freak extreme conditions. In short, I had prepared for everything except cold and snow which fell and stopped me short of my 26.2-mile goal. I ended up with extreme hypothermia but determined to climb back into my training routine after an overseas trip.

This trip was one of my longest to date; required a 13-hour flight but worth every second the journey. I was transported to a land where I was very different from the crowds of people who live there. I found hills to run, markets and temples to explore but even better, I found connection with those who differ in culture from me. In short, the world became smaller for me but I became more aware of how similiar all human beings are. We are definitely brothers and sisters though we may look different, worship differently and have different professions/lives.

When I entered medicine, many years ago, I was determined to master the science that I knew I would need. Years later, I realize that the science is the tool that allows me to see the wonder of humanity. If I am going to take on the privledge of taking care of the health of those who trust me to have their best interests, then I must take on the connection of spirit with those who seek my care.

On my trip, I was able to explore markets and shops where those who sold herbs, used for thousands of years, explained how their medicines worked. I was able to tour modern surgical centers with those who explained how their medicine worked with equal pride and care. The simularities was the whether the physician was well-trained at some of the great universities or passing on the knowledge gleaned from previous ancestors, each took pride and care in the treatment of those who sought them out.

I also spend some time running the streets of the city that I visited. This city had hills that reminded me of San Francisco which enabled me to keep my training schedule. My marathon training is something that has allowed me to center my thoughts, improve and keep my physical conditioning and work out problems that might need careful consideration. I always allow my mind to go where it seems to want to lead my thoughts moving from something as simple as a song or careful consideration of other sides of a problem that might be present.

Long distance running is far from a chore but an exercise that can bring order to an otherwise chaotic life. As a middle-distance runner in university, I thought that the longer distances (more than 10 miles) would not be enjoyable but I have found a calmness and a serenity in covering those longer distances. I run for myself and for my selfish enjoyment. I have also discovered that with the longer distances, I can enjoy the microbrew beers that I have come to appreciate without thought of calorie intake or weight gain. For the first time in my life, I have to work to maintain my weight rather than weight loss. I am thinner than I have ever been in my life (adult or childhood).

With my marathon training and weight loss, I have found that people who haven’t seen me for six months or even six weeks, hardly recognize me. I remember one of my colleagues stating that he remembered my voice but didn’t recognize how thin I had become. For me, because I had always struggled with weight gain, especially when I am under stress, this new world of weight loss and thiness is uncharted territory. I should also that sleep has become more efficient and restful.  I use what I am learning about my new body to explore my new world. Running the streets of a foreign country was part of that new exploration.

Thus, as I move back into training for my first marathon, I have made it a point to focus on mental, spiritual and physical conditioning. I have also decided to add a healthy dose of weight training with my running. As I trained before, I find that I had lost a bit of muscle mass along with fat but now I need to see how I can work of being a more rounded and strong individual. I know that my physical conditioning is good and excellent for a person of my age but I want to be stronger, healthier and more mentally resilient.My training spilling over into every aspect of my life. This is the best marathon training that I can achieve.


30 May, 2016 Posted by | age, medical school | | 2 Comments

Summer Vacation?

As many people are heading for medical school (or finishing up a year in medical school), the summer is a time for readjustment. This readjustment process can simply be looking a things that worked, or did not work, in terms of your studies. The readjustment process for those heading for medical school will be starting to simplify your life in order to anticipate and meet any challenges ahead.

Adjustments mean that one has to anticipate and evaluate all matters that involve your studies and your daily life in order to give your full attention to any tasks that must be completed. For example, for those starting medical school, most will have to adjust your study skills to master large amounts of information. The good part of this mastery is that the information will be presented in a manner for quick mastery but one has to have the mental confidence to put doubts behind and efficiently take care of your needs. In short, you won’t have time to be wasted. You have to hone in on what you need, ask for help with organization and keep moving as you adjust to the pace. Have the confidence to know that if you have been accepted into medical school, you have all of the tools to stay there.

If your year that is ending has not been as successful as you would like, make the adjustments that you need for success. Summer is a great time to have a chat with your faculty adviser in order to change anything that might need to be changed for the upcoming year. Allow the experience of your faculty adviser to guide your objectively so that you can be more successful. Rather than spending precious mental energy on comparing yourself to your classmates, compare yourself to you and upgrade you to master what needs to be mastered.

The most valuable lessons that I have learned in surgery, all center around one unchanging fact. That fact is that medicine/surgery demands that I constantly self-evaluate my practice, my learning and my approach to my work and make adjustments that will enable me to perform at my highest level. My patients don’t care about my doubts but only care about my ability to solve their clinical problems. To this end, I do my self-evaluation and self-criticism outside my clinical practice and bring my best into my clinical practice. I seek critique from my partners, my chairman and in many cases, from my friends who know me well.

I have to be willing to listen with an objective ear, something that is difficult for all of us whether we are inside or outside of medicine. We all love to believe that we are the best that we can be but part of that “believing that we are the best” requires that we have the mental ability to accept subjective criticism. Let the summer be a time that one seeks out the subjective, listens to what is valuable and rejects (be objective on your part), those items that don’t apply. Try to keep emotion out of this process as much as possible.

My other summer activity often centers around keeping (or getting) myself into the best physical condition possible. In my recent quest to master the marathon distance (26.2 miles), I have tended to neglect my strength training in favor of aerobic conditioning. While this has enabled me to lose plenty of weight, I know that I need to be both strong and aerobically sound. This summer will mean that I will spend some time with the weights again. At my age and at any age, strength training is great for discipline which is great for the demands of life (and medicine).

Physical conditioning and sports participation help to counter the extreme hours demanded by study and medical practice. Participation in team sports have always helped me appreciate the value that every member of the team brings to a successful challenge. In this manner, medicine is no different from winning a rugby match (my favorite team sport). Medicine, though the physician is at the top of the team, involves appreciation of the contribution and knowledge of every team members role in the health of your patients. Use your sports knowledge to help your professional knowledge and role as your learning moves along. Medicine is never practiced in isolation.

Summer is definitely a time to rest as well as readjust. This rest can take the form of a much deserved and needed vacation or simply involving yourself in something that is different from your medical studies. For me, travel is my rest and relaxation. My travels overseas have allowed me to look at other cultures that are far different from my own. My favorite activity is to put on my running gear and just explore my surroundings and observe people who are observing me. Every step that I take is a chance for me to connect with nature, my body and those around me. I tend to be the type of runner who greets those running around me and keeps moving. This habit has been a metaphor for my life and practice.

If you have a chance to do a bit of summer research, take the opportunity to relearn evaluation of scientific evidence, question practice guidelines and build up your knowledge database. Research moves at a slower pace than regular academic work thus taking a fresh look at your scientific questioning can be a useful undertaking. If you are new to research, summer is a great time to become familiar with the tools that will serve you well for the rest of your practice.

Medicine and surgery are professions of experience. Those with more experience teach and impart their knowledge to those will less experience. For me, a person who attended medical school at a later age, I learned that experience isn’t related to age. I learned to listen with care to those whose experience was greater than my own. Even today, I seek out experiences at every level because I appreciate the input of those who look at what I do with fresh eyes (those with less experience) and those with more experience. Medicine demands that I keep moving, just like my distance running demands that I keep moving.

Yes, summer is approaching quickly and will be gone just as quickly but summer offers an opportunity to slow down and self-evaluate. If part of that self-evaluation process involves reinvention of ones self as needed, then summer will be a great vacation.



26 May, 2016 Posted by | academics, medical school, medical school preparation, stress reduction | | Leave a comment

Accepted! I’m Going to Medical School!

This is just great news! I am so proud of this young woman who persevered.

Potential Doctor

On behalf of the Faculty of Medicine of McGill University, I am delighted to offer you a position in the Fall 2016 MDCM…program. Congratulations!

On behalf of the Admissions Committee, allow me to compliment you on your impressive candidacy. We are confident that your unique experiences and perspectives as a Non-Traditional Pathway student will enrich the McGill learning community and we look forward to your favourable response.

Yours sincerely,
Assistant Dean of Admissions

Words cannot express my joy when I received my offer of admission to medical school yesterday! This is a dream come true for me and after years of effort, three attempts at the MCAT, and my second attempt at applying to medical school, I have finally made it!

Yesterday and today have been  a whirlwind of events as I have spoken to many friends and family members. I have received an outpouring of beautiful messages from all…

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17 May, 2016 Posted by | medical school | 1 Comment

Getting a Bloody Nose…

“Far better is it to dare mighty things, to win glorious triumphs, even though checkered by failure… than to rank with those poor spirits who neither enjoy nor suffer much, because they live in a gray twilight that knows not victory nor defeat.” -Theodore Roosevelt
Well, my first marathon ended with me in the Emergency Department after having collapsed from hypothermia. I don’t remember falling but I do remember waking up under a circulating air warming blanket wrapped from head to toe with warm packs surrounding my neck and groin. My FitBit says that I collapsed just after Mile 10.
When the race began, the temperature was 37F but there was little wind and no precipitation. As I ran, I warmed up, removed my over-jacket but kept my gloves on because my hands get cold easily. I had three light layers on but as I approached Mile 3, snow started to fall, mixed with rain. My footing was good and I felt a bit chillier but I picked up my pace and thought the temperature would rise.
Around Mile 6, the wind picked up and the rain fell in sheets. I was soaked to my skin. The temperature didn’t move much but my hands became too cold to work. I couldn’t get my jacket back on but I kept running; hoping that I could warm up with a quicker pace. I shortened my stride but picked up my cadence.
I don’t remember much after Mile 8. I remember feeling OK but still my hands were so cold and painful that I couldn’t move my fingers. My fingers had begun to turn white. My next memory is waking up in the hospital. The ER physician, when he found out I was a physician, said that I collapsed and was brought in by ambulance. I have no memory of the ambulance ride or the fall. For this, I am very embarrassed. It is quite strange for me to not remember or be aware of my surroundings. I don’t remember feeling faint or light-headed but I do remember the intense pain in my hands as my gloves were soaked along with my clothing.
Right now, as I write this, I am bruised,  with multiple abrasions, sore and very humbled. God decided that I wasn’t going to run my first marathon on this day even if I was determined to do so. I was so excited to have the fellowship of other runners on this cold and blustery day and I am infinitely grateful for those who attended to me after I fell. I have learned much about myself during my training and from this experience. I live to fight another day and I continue to dream of running the 26.2-mile distance.
My friends have sent me many notes of congratulations and I adore all of them. I am very fortunate to have my health and my resolve to get back to training for the next marathon that I can run. Today was not a day of victory for me but it was a day of experience and for this, I am grateful.

15 May, 2016 Posted by | hypothermia, life in medicine | | 4 Comments

A Weekend of Affirmation

I am now down to 4 days to my first marathon. I had a great last long run this past Sunday with one week to go. I feel great; passing the time between elation that I have done my best in terms of training and a little fear that I can’t finish the race. I have not run a total of 26.2 miles in a training run having been advised against running the total distance by my coach. She is confident that I can complete the distance.

My friends, save the one whose friendship I miss most, have been very supportive. My heart is glad for having set this goal and worked diligently toward it. I pray and meditate on hoping that my lost friend finds his way back into my life as he is such a generous and energetic spirit that I miss unspeakably. I am totally at peace with his decision but I can’t get past that I am without his lively character and his affirmation. That affirmation went in two directions.

I spent some great time with two of my professors from residency. It was a wonderful experience of seeing two men that profoundly affected the way I practice surgery and medicine. They are generous and wise teachers whose wisdom whispers into my ears when I am in a tough clinical situation. One, who was my residency director, is the most heroic person I have ever known, a former marathoner. The other, just joyful in his generous sharing of his knowledge and teaching. It was a great experience to see these men after many years of development on my part. I am at profound peace with where I am and how I practice.

I had many opportunities to exchange ideas and information with some of the brightest and best minds from across the nation in surgery. Such rare opportunities are not to be taken lightly. I found my brain brimming with ideas and commentary on my two long runs of last week. The weather was warm with clear blue sky and plenty of lake water to run along side. I couldn’t help but smile at every biker and fisherman that I passed, sampling the good will of people that I will never meet again. Such is the stuff of affirmation.

My running is for me and myself alone. I haven’t had an opportunity to sit on the roof of my hospital lately but I am philosophical as I take on the challenge of completing my academic duties for the semester and year. Before I left town for a short trip, I had become embroiled in a useless “ego” trial that cost me a friend, my ultimate academic friend, and shook my confidence in my teaching style/ability. My experience in reconnecting with my former professors restored my resolve to be the best that I can be without engaging in any type of “ego” exercise.

Medicine and teaching have no room for agendas other than imparting the best knowledge possible to those who are students. I renewed my resolve to impart the best and explain all that I can explain to my students. Still, as I was on the verge of my ultimate “burn-out” for many reasons, I now have a calmness and peace that my experience has been a great teacher for me. Still, I have so much that I would love to share with my lost friend, I am sad that I won’t be able to do this.

My research continues and will be running “full steam” during the summer season. I look ahead with great expectation that we will accomplish much. I will get through my marathon in the coming weekend and move forward with the things that are on my agenda for “after” the marathon. I feel that my end of week affirmation, along with my taper and rest will be the best part of my training.

Yes, I worry that I won’t finish but I will give my best. Yes, I worry that I might suffer an injury in the start of race jostling but I will give my best and keep my eyes open. I have the positive wishes and prayers of my spiritual companions from my theology course along with my wonderful and wise friends. I have learned many lessons in the past week and I have been very sad but I keep my eyes focused on where I go from here. I prepare my head and my heart for what is to come. I have no doubt of the gifts that I have been given and I am infinitely grateful for all of them; even the painful experiences.

10 May, 2016 Posted by | academics, life in medicine, medical school | | 3 Comments

One Week to Go to My First Marathon

What have I learned about myself? With every mile that I have run in my training runs, I have learned that I have a mental toughness that I found quite elusive a couple of weeks ago. Now, I have learned to face my mental “demons” with calm reserve, much the same as I approach a difficult case or patient.

I had found myself sinking, for lack of a better word, into a spiral of self-doubt and mental vulnerability. My mental shenanigans cost me a wonderful friend but I now move forward with every step and pick up the pace without fear. I can’t reason why I spiraled a bit over my academic work but I did and it’s done. From here on out, I deal from a position of strength rather than questioning myself and my motives.

This past week, I have had the pleasure of thinking long and hard about my medical and academic career. After many years of practice, I believe that self-examination is not an entirely bad exercise but I have also learned that I cannot ask anyone else to “walk in my shoes” or “understand” the things that can send me into self-doubt. My questions were not about my training or my ability but about how I handle adversity in matters that I didn’t fully understand.

Yes, I have plenty of regrets that I lost the friendship of a gifted colleague but I discovered new insight into myself and new support from unexpected colleagues and friends. I took the time today on my last long run, to think of each of my friends and thank them as I ran. I am very grateful for their friendship and I know that I will continue to move forward professionally and personally.

I thought about setting goals and achieving those goals. Certainly, there is no guarantee that I will finish my first (and only) marathon race next week but I feel calm and physically prepared. Mentally, I am in a state of surprise in that I have been able to train for this race and that I will have the toughness to make the needed adjustments to my pace and form that will allow me to complete the distance.

This training has make me something of a philosopher in terms of what I see and hear around me. I have taken great pleasure in simple things like a wonderful warm shower or that drink of water when I have pushed myself to the brink of dehydration. I have tended to avoid the “sports” drinks because I haven’t felt the need for sugar/salt loading. Plain water, not too hot or too cold, has been my best friend.

My training has increased my need for rest and sleep. For most of my career, I have had a love/hate relationship with the number of hours of sleep that I require. Most days, I cannot sleep more than 5 hours but with my increased running mileage, I have moved into the six to seven hour range. More sleep has allowed my body to rest and heal for the pounding that the increased mileage required.

With the end of the school year, I am looking forward to taking a week or so off and heading to California for some much-needed relaxation. I love being near the Pacific Ocean, smelling the salt in the air and just watching the fog cover the Golden Gate Bridge from the deck of where I stay in the Bay area. I have also completed my longest and best runs up and down the hills of San Francisco, a place of unrivaled beauty and wonder.

Finally, I know that I cannot be “all things to all people” and I just need to let things fall as they will. For a surgeon who is quite used to affecting something definitive in most cases, letting go is a new feeling for me. Most of the time, things just work themselves out and I am the instrument. This has been the best part of my marathon training; seeing how I am an instrument of my training and experience.

This training for a marathon has been something of a metaphor for life for me. I set this goal and I have made some progress toward it in some manner over the past year. Though I didn’t reach the distances that one typically associates with distance running, I am very grateful for every step as I have moved along. Yes, I know I am a very secure middle-distance runner but stretching the distance has been good experience for me. With the stretch has come great self-knowledge.


8 May, 2016 Posted by | medical school, medicine, practice of medicine, relaxation, stress reduction | , | Leave a comment

Meeting the Challenge

I continue to train for an upcoming marathon. Making the change from middle distance to long distance has been a great mental and physical challenge. My goal is to complete the 26.2 miles even if I find that I am walking part of the distance. To complete this challenge is my goal that I have contemplated, trained and taken steps toward. I have to have the confidence to continue to train and make positive movement toward this challenge/goal much as I have met other challenges in my life.

Yes, thoughts of not being successful creep into my head from time to time but the sheer pleasure of my longer training runs has been of great comfort. I can’t say with certainty, that I will cover the distance. A shorter run this past week was uncomfortable (cold damp weather) and difficult to complete. Each mile was harder then the previous mile but my mind would not allow me to give up. Even if I am the last person to cross the finish line, I was determined to finish and I finished standing up. I learned a bit about my mental toughness and I greatly appreciated those standing along the route who cheered me on; gave me Hi Fives and were so affirming.

Losing the friendship of one of my best marathon advisers weighed heavily on my mind in a couple of my training runs. I was saddened by his rejection of my friendship but I respect his wishes. Respect is something that I have to keep for him. He is brilliant, sensitive and not in medicine/surgery which is why I can respect his wishes. If we were good friends , as I thought, time will allow us to resume communication at some point in the future but for now, I run, I study, I read and I keep moving forward, one step at a time because that is what my nature and my work requires me to do.

The loss of my friend was heart-breaking but my work is of great reward. I found myself assisting others more than I could imagine this week; a task that brought affirmation for me professionally. I found myself renewed in my search for excellence in everything that I touched. I found myself looking back into why I considered medicine/surgery in the first place. These “look-backs” and self-examinations are great for renewed energy when work seems to become a bit routine or even stressful. As I have said in other posts, nothing about medicine/surgery is ever routine because we touch the lives of our patients (and students, residents) in ways that we can’t imagine.

Sometimes I am prone to forget that the practice of medicine is a great privilege. I have been given the opportunity to put excellence in my work and see the results of that excellence. A bad day or week here and there, is the price that I pay for the privilege of my medical practice. There are journals to be read; studies to be reviewed, a book chapter to be completed and student work to be assessed and graded. I want to be fair and accurate in my reviews and grading which can cause long hours on my part.

I also have a trip coming up that will put me in contact with some of my residency professors whom I have not seen in more than 20 years. To see these gentlemen scholars, both of whom are great teachers/mentors will be a wonderful experience. I am looking forward to seeing how much they have changed and allowing them to see the changes in me. These men profoundly changed how I practice and how I approach my patients. I am grateful for all of the training and “busting of chops” that these men put me through during residency. Since they didn’t “kill” me, they made me stronger and resilient; I suspect that they know this fact well.

One of the greatest joys of a professor is seeing their trainees move into practice and develop. Much of medicine and surgery is learned from mentor to trainee in a one-on-one manner but overall, there is great joy in seeing the results of that one-on-one relationship. I don’t want my trainees to be exactly like me for I want them to take what they can from my teaching and flourish in their own style. I want my trainees to go as far as they wish and I wish them “Godspeed” in what they accomplish and in their triumphs.

To this end, there is no ego on my part but only a sincere wish that they do more, accomplish more and move past my training. Training under me is such a small part of all that they will do as any training period is just preparation. In medicine we put much emphasis into getting into medical school and getting into a solid residency training program but actually, the emphasis should be on the daily practice and keeping it from not being routine.

After all, we as physicians can never know the impact that we have on those around us. This impact is the best part of the practice and it is the part over which we have the most control. This is why I take each day for the wonder that it is, as this is the challenge that I must meet daily.

1 May, 2016 Posted by | medical school, residency, surgery | | Leave a comment