Medicine From The Trenches

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

Listening to Your Patients

At one point or another, we are required to interact and communicate with our patients. In general, when a patient presents to our care, we obtain a history although in today’s world of physician pressure to see as many patients as possible during a patient encounter, the check form history has become commonplace. Often, we scan that check form, history form before we are face to face with the patient. It has become my experience to scan that form but pay closest attention to the reason the patient has sought my care, i.e. the chief complaint.

Often the chief complaint may not be readily evident from that check list form but becomes more evident as you communicate directly with your patient or observe your patient when you enter the room or see them on the stretcher in the emergency department. This first impression, is quite useful in addition to listening to your patient’s voice, observing their demeanor, posture or simply observing their state of dress, interactions with others, such as family members who may be present. I try to use every second of my interaction in order to gain the most accurate assessment of their reason for being in my care.

Listening with your ears while observing with your eyes can be an important skill to hone as you see patients. When what you are hearing matches what you are observing, you naturally feel more confident in your ability to get to the root of the patient’s problem but don’t forget to challenge yourself to look at the encounter from as many directions as you can. Having a strong sense and comfort level with consideration of alternatives is a skill to hone.

As I have challenged myself to spend time with my colleagues in theater arts and acting, I have acquired some skills in patient observation. Additional, my theater colleagues and self-imposed exposure to stage and film productions has enabled me to appreciate good dialogue and words. Sure, my actor/director friends make fun of my fledgling efforts to understand their crafts, far more complicated that I imagined before watching them but my best friend, a professor of theater arts has increased my knowledge of how to observe human beings, most important, how to listen to my patients. I would encourage those who are undergraduates or applying to medical school, to take theater arts coursework as it will be very beneficial in your future patient encounters.

As physicians, we should return to our history-taking skills course and directions even if our medical school experience is quite remote. If we revisit our Physical Diagnosis course notes and directions from time to time, coupled with our experience with every patient encounter over the years, we get better in our listening skills. In short, anything that we practice, we tend to hone.

It’s no accident that patients tend to prefer older and more experienced physicians, often feeling apprehensive in the presence of younger physicians.  This apprehension can be addressed by the younger appearing physician/medical student by conveying a sense of interest in what the patient is saying. Listen to every word, reflect out loud on what your patient is saying and repeat your patient’s words to make sure that your are fully understanding what they are communicating.

Full understanding, good eye contact and conveyance of a sense of relaxed interest by you, the physician can greatly increase getting good information from your patient. By making sure you clarify anything on that history check form with what you observe and hear within the context of exploration of the chief complaint/reason for the encounter is also necessary.

It’s no accident that patients tend to associate better care with better communication and with physicians who have good listening skills. In today’s world of shorter patient encounters, it becomes our tasks as physicians to become something of actors in making sure that our patients feel comfortable enough to give us the information that we need to solve their problems.

We also have to develop our observational skills, visual and aural, that will allow us to make sure that we are as accurate as possible in treating our patients. For me, even as I have become one of those old gray-haired surgeons, to consistently and constantly improve my connection/communication skills. The more impaired or confusing patients in my care, the greater my satisfaction in getting their problems solved.

Yes, listening with my ears, observing with my eyes and in many cases, noting smells have all contributed to my connections and communications with my patients. For me, this is some of the most satisfying aspects of medicine. My warning is to not let being rushed to get through your patient volume, interfere with your ability to connect and communicate one by one. In the long run, you don’t save anytime if you are not getting the patient’s problems solved one on one.

13 July, 2017 Posted by | life in medicine, medical school, practice of medicine | | 1 Comment

Heading into Residency!

It’s that time of the year when many recent medical school graduates are in the heat of getting things organized for the beginning of residency. Residency is the next phase of medical education in the United States and as such, is a period of rapid change and learning. You will be fairly independent in your care of patients; studying in a different manner from your medical school coursework but definitely getting your style of learning and practice honed.

This is a time to drop any pretenses of being the perfect “intern” and let yourself learn and absorb as much knowledge from those in your program who are more experienced. If you have traveled to a position that is different from your fourth-year medical school hospital, you have to learn how the place works as well as how you will work within your locale. When your ward work starts formally, you want to have your organizational system in place, know your way around and have your most important home location settled and ready.

For example, you should have made sure that all of your training licensure materials have been taken care of. You need to make sure you have your paperwork completed long before your program starts “New Resident Orientation”. There will be many details that need to be presented thus you don’t want to add to things by not having your paperwork completed.

For many, USMLE Step 3 will come into play rapidly. For this exam which becomes something of a nuisance for many, myself included, you have to have a date in mind to complete this test. For my residency, which was in General Surgery, I knew that my in-training exam was in January, thus I set a goal of taking Step 3 within the next two months after my in-training exam. I knew that I wanted to place most of my emphasis on my surgery exam, thus I dedicated about 30 minutes per day on reviewing my medicine for Step 3. I set this schedule into my schedule of reading so that it became a habit.

In terms of reading, I asked my second-year residents which books and papers would be best to start my reading for both my in-training exam and Step 3. Again, I wanted to rely on the experience of those who were immediately above me in my program. I also sought the wisdom of my faculty adviser in my baseline reading too. If there was anything that I didn’t count on, it was that I wasn’t able to set up a regular physical conditioning program, something that would have made my PYG-1 year more efficient.

In other posts, I have emphasized the importance of taking care of your physical conditioning. Not only is being in good shape helpful for stress-reduction, good conditioning is most helpful on those very long nights when call seems to go on forever. If you are in good aerobic condition, you perform better even when you are exhausted. Figure out a way to eat well, low fat and low sugar foods along with doing at least 30 minutes of aerobic exercise five to six days per week. Your rest and your brain with be grateful.

If you haven’t figured out how you will keep track of your patients, look into any system that might work for you. At this time, you can do a little experimentation and make adjustments when you begin seeing patients. I had to alter my patient tracking system from the one I used as a fourth-year medical student because my residency hospital patient tracking/health record system was different. It’s easier to make adjustments than find yourself overwhelmed because you didn’t have a system to begin with.

Make your home your sanctuary of solitude in any way you can. For me, my solitude involved investing in dark curtains in my bedroom that I could close on a bright sunny day post call. I found that I needed the darkness and cool for rest and relaxation. I also found that I functioned best post call when I didn’t encounter another human being for a few hours. Figure what works best for you and stick to it.

I made a schedule for my post call days so that I could do routine chores such as laundry and grocery shopping as part of my relaxation. Grocery stores that were open all night became wonderful for me. I planned my menus for the week, cooked on weekends that I wasn’t on call and kept my freezer stocked with meals that I could pop into the microwave rather than hitting the fast-food establishments. I have continued this practice even today because as I have aged, good nutrition is very important.

I used one of my spare bedrooms as an office. In my home office, I kept my textbooks, computers and study materials, much as I had done in medical school. Since I kept a regular reading schedule, I checked off book chapters and topics as I completed them. Even with a regular reading schedule, I always felt that my fellow residents were better read than I was, even though it probably wasn’t the case.

Finally, I had to schedule in time for my friends and family. Residency is a very hectic time but family/friend time is as important as reading and study time. Most Sundays, if I was able, I attended church if for no other reason, to thank my Higher Power for giving me the strength to stay on top of my work. Find a religious institution in your location and attend once in awhile if you don’t belong to any particular religion. It’s just another outlook and fellowship with people who are likely not hospital folk-good for your brain.

My favorite hobby, outside of sleeping on my rare days off, was going to the movies. My restless brain needed to enjoy some pure entertainment. While television can be tempting at home, especially since you can be in your “jammies”, it was better for me to get out of the house for a couple of hours and watch a movie or attend a concert. Football, lacrosse and soccer were also great getaways for me too.

In conclusion, residency is going to be a time of learning, reading and stress. Most of the stress will be self-imposed because any new situations are stressful for most humans. You will be learning about your patients in depth, trying to anticipate their needs and keeping your senior residents/attendings up to date on how you are caring for the patients on the services.

Again, try not to take yourself too seriously in terms of forgiving yourself for making mistakes but learn from those mistakes. The people who are more experienced on your team only expect that you do your share of the work and that you learn from your mistakes. It turns out that this is a great way to learn what you need and sets you up for getting the best experience for your program.

17 June, 2017 Posted by | intern, life in medicine, relaxation, residency | | Leave a comment

The Rosary

I stood there at her bedside seeing the white rosary clasped in her small thin hands. In my church, we don’t have objects such as a rosary as symbols of our faith. Perhaps the Book of Common Prayer comes closest to a rosary as it’s ever present. In the cathedral where I serve, we seldom use the actual books as our services are printed each week for worship along with our hymns. Everything one would need for service is in one’s hand along with instructions as to standing and sitting ease for the many visitors each week. Still, having a rosary in my hand would be wonderful.

As I stood next to her bed, I watched her breathing slow down and become shallow; tangible evidence that her body was dying. On my late evening run, my thoughts were of where one “goes” at death. Perhaps one stays around those loved in life or perhaps one goes. My childhood visions of death, rising souls that are ghostlike but where does that essence of humanness go? As I settled into a chair, I touched her cool hand and touched the white rosary. I always sit with patients who have no family as they become my family. It is my honor as a physician to do so.

She wasn’t even my patient though I did serve in a consulting role in her care. I looked in on her only to be told by the nurse that “they” decided to do nothing. Well, I never decide to “do nothing” because there is always “something” to be done in patient care. I guess, I needed to care for this patient thus there I sat in a familiar role, caring for one who is dying and would die.

When I saw the rosary, I questioned how many times she had said the rosary. I wondered if the rosary brought comfort to this elegant woman. I wondered what the moment of my death would be like? Where would I go? Would I even go? Would I stay? My heart in tears but not sad. My tears are for the people who loved this woman; not here with her in her last hours and minutes of life as we know it. Still, her long fingers, draped by the rosary and her beautiful white hair brushed neatly from her thin face; still the rosary. I made sure that it stayed with her, in her hands as the nurses prepared her body for the morgue.

14 February, 2017 Posted by | life in medicine, practice of medicine | | Leave a comment

Time keeps moving and it’s is a blessing that it does keep moving.

In most places, we await the end of 2016 and the beginning of 2017. The passing of one year and the advent of another full of hope and promise for most of us. Still, nothing is new because time always keeps moving and everything changes often from one instant to the next. I have allowed this movement, this continuum to spur me to renew and reinvent myself without question.

This past year to my surprise, I embraced long distance running. My stress level dropped to nothing; my self-empowerment went to high levels. As I race along streets at 3AM, the only time I can get 1.5 hours of pure running into my crammed schedule, I do this movement for me and my sanity. I work on problems, I accept my world with joy and gratitude. This turns out to be a great way to get every day started and every challenge faced head on.

I will often mull some paper or new information as I tread along my winding path in my neighborhood near one the the Great Lakes in midwest United States. I can always hear the ebb and flow of the waves of the lake as I run along the beach; even if it’s too dark for me to see them. On a bright moonlit early morning, now long before sunrise on these shorter winter days, I love seeing my breath just in front of me.

Since I live in a suburban area, I seldom meet any automobiles in the early morning. If I meet anything, it’s a heard of deer grazing or a racoon crossing the empty street heading for the deep woods next to the lake. The deer ignore me but after spotting a coyote or two, I run with mace but still I run with emphasis and determination.

The thing about running, or even a brisk walk to begin your day, is that you can’t do these tasks for others. As a physician, my life and my practice has centered around being present to help my patients and students with solving their problems even if I ignore my concerns. With running, I do this for me and me alone; heady for non-self sacrifice. I think about me and how my middle-aged body runs faster and faster in the cold early morning darkness.

Daily running has a way of adding discipline into every aspect of one’s life. I eat healthy and clean because I know that high fat, high simple sugar foods will zap this burst of energy that running gives. I also forgive my occasional indulgence of beer on a non-practice evening because I have already run and exercised for the day. I also know that I am at my thinnest and lightest weight in my adult life; enjoying how well my clothes fit and how comfortable I am parking far from my destinations and hiking the extra distance.

The discipline that I have achieved with running, eating healthy and lifting a few weights has allowed me to keep a ready smile on my face and a song in my heart. I find that I simply enjoy interacting with my patients; joyful that I can help them feel better and meet the challenges of their worlds. This is some of the true magic of medicine that we keep learning, practicing and enjoying our art no matter where one is in the process. For many, just navigating the health care process is a source of added frustration and fear. Let your patients know that you are always the final common path for them as they place their health and trust in you; have their best interests in mind always.

As this year draws to a close, remind yourself of why you entered this profession and how fortunate you are to be able to help your fellow humans in any way small or large. Remind yourself that while this is a job for you, it’s often a change of life for your patients. Remind yourself that there is magic in empowering your patients; appreciating their fellowship and challenging yourself to be the best that you can be especially being authentic.

31 December, 2016 Posted by | life in medicine, medical school | | 1 Comment

Crisis Averted

I try to meet my challenges in academics, my religious studies, medical practice and physical conditioning as they come. Recently, my academic work, specifically my teaching style, came under sharp criticism (very negative) and increased scrutiny. Now, I don’t mind criticism and will listen with an ear for what might be worthwhile but none of what I faced was even worthwhile; directed as a personal attack upon me. This scrutiny forced me to question everything and forced me into a position of vulnerability that I couldn’t help. I was in a tailspin; looking for anything of validation.

Couple my largely “mental tailspin” with my loss of my friendship of one of my most valued friends. I had retreated back to a point of reliving the death of Gene and my almost catatonic reaction post. I was feeling most of the same types of issues that I faced when I thought my world had come to an end. These were feelings that I couldn’t control but now I have learned that I can feel them and use them to force me to meet challenges with renewed strength.

My spiritual challenges are there but with my renewed strength, I allow myself to serve and feel without apology. I make mistakes in performing my duties at the cathedral during Sunday mass but I learn from my mistakes and from my very generous mentors. I know that they question me but by questioning me, I am forced to question myself too.

My friend who has been quite generous in advising me in my academic work is back in my life which gives me renewed hope that I can learn more from him. I should have listened to him in the first place but my extreme fears would not allow me to benefit from his wisdom. I am blessed and grateful that he spends even two minutes with me and I appreciate all the wise counsel that he has shared with me.

I have watched him interact with his students, his infinite patience and critiques. His student population is more vulnerable and more difficult to teach but he is kind and had great insight into where each student lies in their learning. I learned patience and kindness from him. One day, I watched him answer questions as he walked with his students into the parking lot; surrounded by those who truly appreciated what he had to say. Whenever I see him, I know that I am in the presence of someone who is far greater than myself.

I headed off to interview for another academic job challenging in that I had to deliver a grand rounds presentation and interact with some of the greatest surgeons in this country. I more than passed that test; surprising myself with how wonderful it was to assist on cases that I haven’t performed in years. Sometimes a skills check with master surgeons is good for the soul too. It also helped that a couple of my former professors from residency affirmed that they were proud of how I have made my way in practice.

My physical conditioning continues to be a source of challenges and growth. My trainer balances weight training with running so that I will conquer the marathon distance and I will continue to enjoy vigorous good health. I am getting faster and stronger; finally seeing some of the definition that I sought but with a smaller muscle mass. I am enjoying my increased running mileage while meditating; keeping my head together. I observe the world as it moves past me.

My spiritual growth comes in the form of reaching inside myself for affirmation these days. I am alone with my thoughts and examine each one carefully. I am happy with my solitude, enjoying exploration of my creative side (not very creative at all) and some of the artistic resources in my city. The creative resources of our local artists, musicians and actors have brought a kind of renewal of spirit for me. I seek to interact with humanity and I am acquiring the tools to do so. In that acquisition of tools of spirit, I know that I am not alone and that I am quite happy with the spiritual state of my life.

I don’t focus on material objects much as they have always had little meaning for me. My connections with my patients, my students and my colleagues have been most important. I read the writings and poetry of my like-minded physician colleagues always surprised by the insight and the richness that they bring to my world. One in particular, posts a daily affirmation that moves my meditations quite often. I am truly blessed to know this extraordinary individual who gives so much to the world.

I know that happiness in life comes from the “good stuff” and I have the “good stuff” in abundance these days. My crisis of spirit is no longer a crisis but an acceptance that while I am not good enough for some people; not valued by most, I value and accept myself. I am made by my creator and I seek to be kind, generous and accepting of those around me; no longer a crisis.

30 July, 2016 Posted by | academics, life in medicine, practice of medicine | | 2 Comments

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

“It’s not a sprint, it’s a marathon.”

I am in the process of training for my first marathon. As a middle-distance runner at university, I always toyed with the idea of running 26.2 miles but after running a race of 10 miles about 20 years ago, I discovered that I didn’t enjoy running after the 8-mile mark. This put running the marathon distance on my “back-burner”, so to speak. There the marathon goal stayed until the idea surfaced about 4 months ago when I began running again for physical conditioning.

After graduate school, I attended medical school and found that I didn’t have much time for running as study was my constant companion.  If I had been wiser, I would have carved out time to keep up with my running, even 30 minutes three to five times per week, thus I would not have gained weight in medical school. My medical school weight followed me through surgery residency and fellowship. I kept promising that I would “get in shape” but never quite put a sound schedule together.

Well, after many years of practice and my sister’s wedding-photos of me were terrible, I decided to revisit getting in good physical condition. Since my weight slowly crept up to the heaviest that I had weighed in my life, I made the decision to lose a few stones so that my knees would hold up in my recreational rugby play. I kept up with my weight-lifting but my cardiovascular work was lacking in a major manner.

In the back of my mind, I knew that my knees would not want me to start out running, thus I began walking at least 30 minutes per session. I used my walking time to meditate (and pray) largely for stress relief. I had found that while lifting weights did relieve some of the stress, I missed running. I decided that I would attempt to get back to the point of being able to run a 10K if the opportunity presented.

Along with my dedicated walking, I changed my diet to no fried food, no candy, no processed food and certainly no “junk food”. My dietary habits were probably the easiest part of my journey because my wise sister had always been a great example for me. She simply doesn’t eat food that her precious body doesn’t deserve. She always said that it was better for her not that eat food that was processed. As I visit her often, I found that her consumption of fresh fruits and vegetables along with lean meats was a good strategy. She is lean, strong and wonderfully alive.

Soon, I found that by eating three nutritious meals with proper portion control, my weight was dropping. As I lost weight, I became faster finally able to jog and then run. Three weeks ago, when I was in beautiful San Francisco, I broke the 20-mile mark running those delightful hills as my training. It also helped that I have a wonderful colleague who was a world-class marathoner, until a devastating knee injury, but still maintains that wonderful thin body build of a marathoner. I envy his metabolism but he’s a great resource.

Today, I am many pounds lighter and running daily runs of 10 miles with great joy. My stress level is zero; my mind calm and at rest, my body continuing to thin out as my distances increase. While I am a bit worried that I won’t be able to finish the 26.2 miles, I keep running and keep running. I set the goal of completing a marathon and I work toward it daily by running, stretching and weight training also with keeping my diet sound. In short, I understand the concept of a “bucket-list” and I hope to mark “completed a marathon” off my bucket-list.

Another benefit of my running and weight loss is that people who haven’t seen me even as short as one month ago, barely recognize me. I have to say that losing enough weight to become unrecognizable is a wonderful benefit of this training. The only downside for me is that since I suffer from a hemolytic anemia (same as my father), I have to keep an eye on my blood counts. So far, even though I can chew red cells on my long slow distances (LSD), I remain asymptomatic. I can also indulge myself with an occasional beer or glass of wine without thinking about calorie counting. I have learned to savor those little treats of Sam Adams or Cakebread Chardonnay, my rewards for training hard.

Setting a long-term goal, working/training for that goal and getting that goal accomplished are items that are very nice for spiritual growth. Stress-reduction is great for intellectual and physical growth. In short, training for this marathon has been a great learning experience for me physically and intellectually. I can’t say  with certainty that I will finish those 26.2 miles but I can say that the journey so far, has been very positive. I am stronger and more resilient in all aspects of my life as my marathon training has spilled over into my academic and clinical practice making me calm, positive and accepting of things as they come, one step at a time. All in all, not bad and quite joyful at times. Bring on those 26.2 miles!

10 April, 2016 Posted by | life in medicine, medical school, practice of medicine, relaxation, stress reduction | , , | 2 Comments