Medicine From The Trenches

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

Continuing Medical Education

During the summer, I attempt to ramp up my efforts to complete as much continuing medical education as possible. During the academic year, it seems as if time gets away from me and I find myself busier and busier. Continuing medical education (CME) is a great way to refresh one’s knowledge of basic science while learning new information that will be of benefit to the patient’s in my practice.

I strive to keep work on my internal medicine knowledge as well as my surgical knowledge because my patients often have complex medical problems that send them to my care as a result of complications. While I have no problem consulting my family medicine and internal medicine colleagues for assistance in patient management, I need to be a vigilant as possible in the total care of the patient.

CME is far from being a chore for me because I love the learning process. It was the constant quest to learn how medicine and surgery works, that drew me to medical study in the first place. One becomes familiar with the volume of information in medical school but comfortable with the constant upgrading of one’s basic knowledge base in practice. I have found that every time I read even familiar information, I gain new insight and strategy for providing better care.

Certainly, one hates to be forced to do anything which is why the Maintenance of Certification (MOC) requirements became an expensive burden especially for newer physicians who are already struggling with heavy debt from medical school and pressure to build a practice. Most physicians are employees of large health care groups which adds to the pressure of practice building and maintenance. There are only 24 hours in a day; time becomes a precious commodity.

Finding a schedule that will allow one to keep up with journal reading, CME and MOC can become an added burden to already long hours and stressful work. Again, finding a balance becomes more and more important in order to have a lifestyle that can be enjoyed. Additionally, one does need precious “down-time” for mental sanity these days.

I don’t use my vacation time for CME or MOC as I need the vacation time for taking time away from academics and medicine. As I am older now, I appreciate my vacation time as valuable to my practice and teaching. There are few points for suffering in medicine on the part of physicians. This suffering can lead to “burn out” which isn’t good for anyone physically or mentally.

In closing, my recommendations are to find some manner of CME/MOC that works within and compliments one’s schedule. Take some time and try many methods of obtaining the hours that are needed for licensure. The worst stress comes with putting of CME until the last hours which like anything last-minute, becomes more stressful. Embrace the reinforcement of learning and find something that’s enjoyable, just like exercise, something that one can incorporate into one’s life on a regular basis.

Advertisements

28 July, 2017 Posted by | medical school, medicine, practice of medicine | | 6 Comments

Getting Into Routine

Since the nature of medicine (and life) is change, getting into the best routine to greet and excel in a changing environment is being in the best mental and physical condition possible. It’s very easy with study, long hours of duty and other demands, to gravitate towards anything that bring rest and relaxation/lack of stress. My challenge for those who are starting school, getting ready to start school, starting a new year of clinical duties or any changes; is to have a routine with good stress that allows for optimal performance within the context of changes and challenges.

For many in medicine, stress is the bane of our existence. We are stressed with long hours that often demand the good performance in early morning hours, as most of the population sleeps. We are stressed with keeping up with our academics and studies that mark our ever-changing profession. We are stressed with keeping a sound balance in life that will enable us to enjoy our personal lives in addition to our professional lives. This sound balance is as vital to having a great career and general well-being but finding that balance is not easy or quick.

As the summer has always been the time that I try to improve on my routines and make changes, I will invite you to consider making small changes that will help you deal with the mental and physical challenges to come as your careers change. These challenges need not derail your health and mental resilience but might enhance the enjoyment of your career at any stage.

Good Nutrition

When one is tired physically, mental acumen wanes and one becomes both mentally and physically exhausted. This mental and physical exhaustion can lead to choosing foods that are high in sugar or fat which might lead to a quick energy fix but weight gain in the long run. Trust me, carrying extra weight around doesn’t help with mental or physical exhaustion, often leading to more of both.

Eating a well-balanced diet that has more fresh fruits and vegetables with less fat and refined sugars helps keep your weight under control in addition to keeping you healthier. You can make small changes in terms of grabbing a piece of fresh fruit for a snack rather than relying on the high fat alternatives of the vending machine. Also cooking a week’s worth of healthier food that you pack rather than eating the burger and fries in the hospital/school cafe can help make small changes.

Small changes can lead to larger changes or that routine that becomes more comfortable for you. While I love an occasional burger and sharing fries/chips with my friend (the only way I indulge in these), I keep these occasions as special and not routine. Not only does eating a healthier diet help my immune system, my healthier diet helps me avoid long term chronic disease such as obesity, atherosclerosis and diabetes.

Regular exercise

Exercise tends to be one of those activities that suffers when one enters a demanding profession. It is easy post call, to come home, drop on the sofa and rest. This was my routine in medical school where I gained significant weight after being robustly active during my graduate school years. It took years of work to rid my body of the excess weight but once regular exercise became my routine, I found that I had more energy and more time rather less.

Today, I am a distance runner, using that time on the running trail to work out problems, meditate and simply enjoy myself. I have strength and energy for my work and for recreation. I also have a greater capacity for dealing with stress and the physical stress of a 10-mile run helps everything in my life. Running is quite solitary which appeals to me but anything that gets your heart rate up at least 30 minutes 5 times per week is better than nothing.

My workout time is as precious as my work time. I have mapped out running routes around my hospital, in my neighborhood and when I travel. I keep running gear in my locker (running shoes and shorts) so that I have no excuse not to move. I also try to get my workout done in the early morning before I start my day.

You don’t need to block hours of time for a bit of an aerobic challenge as you can run up a flight of stairs several times per day; park the auto further away and walk briskly to your workplace; take a brisk walk for 10 minutes as a time over lunch with a friend. Distance running isn’t for everyone but most of us can do something as simple as walking. Incorporate small changes which can become a habit that becomes part of your life.

Avoiding excuses (reasons)

As one becomes mentally stressed and physically exhausted, reasons for not adhering to healthy habits abound. For each of us, there will always be challenges that take us out of our routines. Take a moment to reflect on what reasons/excuses become commonplace and how you might meet or avoid them. For me, I looked at every hour of my day and examined where I could make small changes. Those small changes became my routines.

For example, I wanted to have more time for journal reading thus I looked for where I could set aside 30 minutes daily for my journals. I ended up finding at least an hour for my journal reading which became a welcome habit. I looked at where I could “sneak in” a workout even on my busiest day. I also left time for complete relaxation when I needed that too.

Staying in good physical condition is the best way to stay in good mental condition. As I look around me, those friends who are physically fit are the most mentally resilient too. In my life, my good physical condition has been a key to many successes in my career. As my physical capacity increased, with a combination of endurance and strength training, the greater my capacity to work and play with my pleasures coming from enjoyment of craft beer, good food and fellowship with friends and colleagues.

Final Thoughts

Take a moment and look for the following:

  • Where you might incorporate small changes that will increase your physical conditioning.
  • Where you might substitute better food choices in terms of avoiding high fat and high refined sugary foods for foods that are whole grain, fresh fruits and vegetables with leaner meats.
  • Where you might take time for small tasks that enhance your professional development.
  • Where you can find some time for pure recreation and enjoyment of life.

Make the changes today, that will help your life and enjoyment of life in the long run. It’s easier than you imagine as you don’t have to become a spartan or fitness nut. Your studies and your mental health with be much stronger which is the key to success in today’s world of medicine.

18 July, 2017 Posted by | academics, medical school, practice of medicine | | Leave a comment

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

Hospital Haiku

“hospital moonlight

cacophony of machines

teardrops cascading”

As we come to the end of National Physician’s Week and today, National Physician’s Day, I related this haiku from one of my most gifted and amazing friends. Some years back, he suffered a  critical and life-threatening illness that resulted in profound changes in his life with some time in the intensive care unit. This illness changed a man who is talented beyond belief, a brilliant creative genius and professor in ways that few of us can relate or even imagine. Still today, he’s affected by his illness and the events that surrounded it.

I share this haiku because it brings to mind, something that we as physicians must always remember about our patients. They place their health, their trust and many of the most intimate aspects of their lives in our hands. With our hands, we have to care for them; relate to them, in many ways hold them, and be mindful of the honor and privilege of having them place their lives in our care.

As such, we also have to be mindful that illness changes their reality and in many cases their lives profoundly especially when they are critically ill. We have to reach out and extend more comfort over the “cacophony of machines” that becomes the background of their intensive care and sometimes hospital care experience. We have to block that “cacophony” whenever and wherever we can.

I remember watching a tear roll down the side of the face of one of my ICU patients who appeared comatose. The nurses were bathing him and chatting with each other as they turned him. I saw the tear; asked them to speak with him over the ICU noise background. I asked them to play music in his room and I always held his hand when I entered the room to examine him. I am sure that my soul could feel his soul even though he didn’t ever speak to me. I never saw that tear again, after we began speaking and focusing on him, holding his hand, touching his face, and playing his favorite music even though he did not recover from his illness.

I seek to connect with my patients without exception as that is my honor as a physician/surgeon. I spent years learning the science and techniques of medicine and surgery but in these, the later years of my clinical practice, my focus is on the art of medical practice. Within that art is my chance to give some of my heart to those who have placed their trust in me (and my training). I strive to be more human and more comforting. To do less of the science and more of the art is great joy for me. My joy is in the connections; kind of strange for a surgeon.

On this National Doctor’s Day, I am honored to be a physician and grateful for all that this profession has given me. This profession has given me far more than I can give back but I will spend as much time as possible giving as much as I can to those who are in my care.

30 March, 2017 Posted by | medical school, medicine, practice of medicine | , , | 2 Comments

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

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

In Today’s Climate…

Over the past couple of weeks, I have listened to the speeches at both political conventions along with the news reports of law enforcement officer killings/GSW injuries and civilian killings/injuries. Watching and reading new media reports have to be taken within the context of one’s experiences. My experiences have been as the daughter of immigrants, a biracial woman, a physician and a theological student. My heart breaks for those who are suffering and those who suffer. My oath, the Hippocratic Oath, that I swore many times as a medical student and now physician compels me to alleviate suffering wherever I find it.

The suffering may be physical or mental as many seek out our help in getting and keep them healthy. We, by our training, have to find, by any means necessary, a method of navigating the health care systems under which we practice as well as the political/social climate that we encounter. Sometimes that navigation can be as simple as a touch, a connection and sometimes that navigation involves working with every resource at our disposal to give the best care that we can achieve. My hope, my prayers, my experiences and my training have giving me insight.

I want to recount an experience that happened to me as a fourth-year medical student. I was returning home, driving a small red Mazda hatchback automobile, from a shift at one of the large city hospitals of my medical school affiliations. It was late at night, I was exhausted, ran out to my car in scrubs throwing my short white consultation jacket with hospital identification card and my stethoscope on the front seat along with my purse and overnight bag. As I drove through the rain-soaked city streets of this depressed neighborhood, I saw the reflection of police lights in my rearview mirror. I immediately pulled over to the side (I wasn’t speeding because of the weather) and stopped as required by law.

The police car pulled in behind me with two young officers getting out of the car quickly with their weapons drawn. For a split second, it took me in my exhaustion fog, I couldn’t believe that the weapons were aimed at me. I sat very still, keeping both of my hands on the steering wheel as one of the officers shined a flashlight on me; the other pointing his gun through the open window on the passenger side. “Get out of the car and put your hands on the roof.” one of them shouted.

I slowly opened the door, tears beginning to form in my eyes and shaking quickly overtaking me. I complied with his request stating the my identification and automobile registration were in my purse on the passenger side. I said that I was a medical student on my way home but the officer kept yelling at me to spread my legs and “shut up”. I couldn’t stop shaking (I even shake now as I remember how frightened I was). “This car is reported stolen,” he kept shouting in my ear. He began to pat me down. “This is a huge mistake,” I said in a shaky voice. “Please check my identification and look at my hospital cards,”I said.

It seemed like hours but in a few minutes, another police car pulled up with another older officer getting out. “What are you doing?” he asked. “We have the car and suspect in custody”. I was crying from fear and exhaustion. The officers immediately put their weapons back into their holsters as the other policeman said that I was free to go. I was so petrified that I couldn’t put the car in gear for a couple of seconds. I finally drove off slowly weeping uncontrollably.

What would have happened if one of those guns had discharged by accident? I would be dead by mistake. What would have happened if the other police car had not arrived? I would have been arrested most likely. It was a mistake but the first two policemen didn’t show any indication that they would check my identification. It was my first experience of being stopped by the police and not given the benefit of just being treated as a fellow human being.

As I read and hear of stories of any persons being stopped by the police, I still feel that fear from so long ago. I haven’t been stopped since then and I interact with police on a daily basis as I perform my job in surgery. Those interactions are always professional and quite polite but when I see their service weapons, I always remember that stop. I react to police officers through the lens of my experiences as I suspect all people do.

I have infinite respect for police officers as they have very difficult jobs under very dangerous circumstances. I have spent many hours with two detectives in the gang-violence division of my local police precinct learning about gang symbols and gang culture, rampant in the city that I practice in. I want to understand and stem this violence, treat its victims as they frequently end up in the trauma bay. Largely the street gangs in my city are involved in turf wars and drugs. The motorcycle gangs run in the suburbs dealing in drugs and human trafficking, another scourge of city and suburban living.

So today, I end up on the roof of my hospital, being thankful for my life and all I encounter in my practice of medicine/surgery. I always pray for insight, guidance and the ability to give the best to every patient/family member/loved one that I can give. I meditate during my distance runs, post-call in the bright sunshine of the early afternoons, as we are living in a climate of increased polarization by community leaders and populations today. I pray that I continue to live in the “gray areas” and not become jaded or polarized to the violence. I pray to continue to seek insight and solutions to the troubles of those I serve and treat; always remembering that the practice of medicine is my greatest privilege.

Yes, I swore that Hippocratic Oath as a medical student, as a graduate physician and I keep remembering it. I didn’t know back as a medical student, what I was swearing to but I know now, how difficult this profession can be. There are times of despair, depression for me as the hours tick past 30 and hope in humanity as I move thorough my theological studies. As the years have gone by, I am more of a “believer” and more spiritual than when I began this journey. I learn each day and I am grateful for the learning. When I look back, I would not change a single experience, even those that have frightened me.

 

29 July, 2016 Posted by | medical school, medicine, practice of medicine | | 2 Comments

For Father’s Day

I want to share this post by a gifted physician, husband and father, Daniel C. Potts MD, who writes about his father. This post which can be found here: A Father’s Story is an honor to a father from a son who is a father. For me, this wonderful post reminded me of my father who was a physician and my first and best mentor. Please enjoy this post and honor your father on this upcoming Father’s Day.

17 June, 2016 Posted by | practice of medicine | | 2 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

“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