How Saturday night phone calls changed my Sunday morning lakefront run

I had been waiting all week for my Sunday morning run. In general, I do my hard run on Saturdays and I do an easy 10 mile recovery run Sunday a.m. This past Sunday the heat wave, which destroyed my runs all week, broke, meaning my first fun run in a while.

Starting out from my apartment (this is the view from the end of my block), the lakeside was cloud-covered. Yes! No sun beating down on my head this morning!

As I continued ~.4 miles up the trail, the wind had the water beating up and over the concrete

    

A large group of ~20 runners came up around the bend while I was taking photos and I took off to not get stuck behind the group.

While I had downladed Sherlock Holmes to listen to while running, I needed to zone out and listen to music. The Saturday night had been heavy. I went into work Saturday at ~1pm to continue the research for the paper I am working, which looks at adductor myotomy for children with cerebral palsy. Cerebral palsy is "a nonprogressive disease due to a brain insult" that has many different causes/etiologies. While the lesion may not be getting worse, symptoms get worse with time as walking will be more difficult as the child grows in size/weight, etc.

Adductor myotomies are partially severing the tendons connecting the inner muscles of the thigh. This surgery is often performed not to increase function, but because the spasm-based scisoring of legs will prevent cleaning of the genital region by the caretaker and other difficult symptoms. The surgery will thus enable cleaning and other necessary activities within that region (yes, I mean the legs are spasming/contracting so badly that you cannot wipe them and the poor kid is pulling the hip out of the socket), not necessarily make it easier to walk, and are performed on kids with the 'worse' cases of cerebral palsy, the more recalcitrant, severe cases.

As I began making the phone calls (I had 110 people to call), I wound up becoming a voyeur into this alternative reality of these parents' lives. I called one house and asked to speak to *Samuel* (not his actual name)'s mother. The woman said this is she. I asked if she had received the letter about the study and if she had any questions. She burst into tears and said that Samuel had passed on and was no longer with us. That she and her husband go to the cemetary 2-4x a day and have decorated his room with medals from his special, private school.

Another mother burst out in rage regarding clinical studies and the adductor myotomy and her daughter in general. *Katie* had been able to walk a year ago when she had the surgery and now could no longer walk (this is common progression of severe cases of cerebral palsy and many of the parents were thrilled with the surgery, so it is MORE likely that becoming nonambulatory was due to disease progression rather than the surgery, but I don't know). Also the family had participated in previous studies regarding different methods of using standard drugs, but had never been told about the results. She had given up her professional career to care for her daughter, but had a master's degree, and deserved to be treated with respect . I listened attentively and responded as best I could, knowing how horrible it feels to give up your life for someone that you can't save, and said what I could to assist her.

One woman was downstairs in the rehab center again with her daughter, so I ran down to meet with the two of them. The daughter had a seizure 3 weeks ago and the mother hasn't checked her mail, but they were going home tuesday. The mother started trying to figure out what caused *katrina's* seizure, saying she thought it was the heat. But it could have been that katrina hadn't slept adequately the night before. Or that Katrina had sugar, or....

This was hard for me to hear and I cut the mother off saying she will never know and that seizures are so idiopathic that it is nearly impossible to determine. Ketogenic diets (no sugar) help in a minority of seizure cases, specifically one girl with cerebral palsy due to mercury poisoning while in her mother's belly has completely stopped having seizures while on a ketogenic diet. (The opposite can also be true, that too much protein will cause seizures if people have difficulty tapping into their fat reserves). The night before my mom's final seizure, which we couldn't get under control for two weeks, and completely paralyzed her except for her eyes, we celebrated my birthday and ate cake. In fact, just a few hours before meeting katrina's mom while on my Saturday morning run I though of the girl without seizures and then thought of my mom's seizures and had wondered whether my birthday cake had killed my mom. It took a few hours for my rational brain to kick in and remember all the cake she ate and did not have seizures.... But the thought will always haunt me.

While walking home I pondered whether there was an association between who was at home on Saturday night and available to talk about their children and the severity of emotional difficulty they were experiencing. I thought about labeling it the Saturday night Psych night. But then I realized that I was the one making the phone calls, I was the one who was at work on a Saturday night. So am I all that different from the parents I was calling?

All this ran through my mind as I was enveloped by the wind, looking out over the beach, and I ran fast. Too fast, finishing over 10 miles in under 70 minutes. But I needed to run. Like Forrest Gump, one of my heros: "Now you wouldn't believe me if I told you, but I could run like the wind blows. From that day on, if I was going somewhere, I was running!"

Empathy vs Jealousy

The other day, there was a group discussion on medical ethics. One topic briefly touched upon was the thought that doctors have when entering a patients room: that could be me.... I would be in that bed if I had gotten hit by a car that time I didn't/forgot to buckle my seat belt.... The Dr leading the discussion said she still had problems with this from time to time but has gotten better about it. 

But what is wrong with over-empathizing with patients, what is wrong with thinking "wow, that could have been me?"

 Well over-empathizing with patients can be quite harmful because they are NOT you and HAVE different expectations, wants, and needs. You didn't make the same decisions and you have a different body with a slightly different anatomical and genetic basis that wouldn't necessarily react the same way to trauma. Over-identification means that you may not be able to keep perspective to accurately identify the extent of their injuries. It may also mean that you will treat them by the golden rule "treat others the way YOU want to be treated" instead of the platinum rule "treat others the way THEY want to be treated".

But what about the other side of this philosophical argument?

 John Donne famously states
No man is an island,
Entire of himself...
Each man's death diminishes me
For I am involved in mankind
Therfore, send not to know
Forwhom the bell tolls.
It tolls for thee.

Similarly, in multiple religions, nirvana is reached when one transcends the body and therefore is not separated from others i.e. it is not my body and your body but we are both part of something greater. Or in Led Zepplin's song stairway to heaven the lyrics include "if you listen very hard the tune will come to you at last when all are one and one is all"

 Understanding that we are all similar is important for our development. For example watching someone run with the correct form or win a race by showing multiple positive personality traits is something we identify with and witnessing that makes us stronger, better runners. We AUTOMATICALLY imitate that person. 

But how do subconsciously know we are different? One way is through the green monster of jealousy. For example when I wake up, have be at rounds at 7, work till 6p or 7, eating cake the whole time (or something equivalently sugary to keep my mind bright) then go home, collapse on the floor, and look at facebook. Oh wow, really, YOU went for a 10 mile run and lifted weights and went swimming along with working a full day. And YOU feel wonderful. I am just SO happy for you!

Now did YOU do anything wrong? NO, of course not, and on another day I would BE you, but today I'm crabby and frustrated and didn't do anything but eat unhealthily and work in a white walled hospital. Towards the end of the book Quiet: the power of introverts by Susan Cain, she mentions that we should pay the most attention to what makes us jealous. This is because jealousy lets us identify our unmet desires.

I think that jealousy lets me know how I should be structuring my life. On some level I am acknowledging that I have potential. You have done something that I can do and have not; you have made different choices and structured your life in a way that allows you to do the things that I cannot/have not.

Further, jealousy shows us the basic difference between self and not self. We are both part of mankind, but you get to live my dream. Therefore I am jealous. As I continue in the medical profession, it will be difficult to arrange my life to run as much as I like, but when I get too jealous of others, I will know that I've gone down the wrong path and need to change my lifestyle/job.

 On the other hand, the first time I realized I could run a lot better was the Marine Corps Marathon in October, 2010, the day before we removed my mother's breathing tube. As I ran past all those skinny girls who spent their time running while I had spent my time eating cake and pie while sitting in the hospital with my mom. I thought "hey there skinny bitch, you may be sexier than me, you may have run more miles than me, but you don't have the heart that I have or the strength that I have. you haven't done what i have done by not running. that's right skinny bitch, you're going down." Sorry for the crass language, but that's what went through my head as I ran by those little girls. I wasn't jealous. I was proud.

Me finishing the Marine Corps Marathon with water belt on and shirt tied around my waist on October 30th, 2010 in a time of 3:12:02, a 7:19.5 mile average.

Running Scare Factor #1 and Treatment: proper care of the nether regions

I don't know who else has gotten chafing between their thighs (or throughout the nether regions), but I have. I find it painful and much less fun to run for as long as the chafing continues. I've read about treatments and prevention online (I go with neosporin, lots of body butter, and running in well-washed spandex shorts. If dirty, though, any piece of clothing will make me chafe). These experiences are the first thing that flashed through my mind when I saw my first severe case of cervical cancer.

In this type of cervical cancer, if it is allowed to spread (i.e. not caught early), an operation will be necessary. The incision runs mid-thigh to mid-thigh on the inside of the thigh, right through the areas where I chafe. Then the surgeon just flaps the whole private area open. Once done with the cancer removal, they don't stitch up the wound but instead let it heal "from the inside out." This is because it is so difficult to clean and unhygienic that otherwise abscesses will form. This means a huge pus-filled mass between your thighs (another med student recently related that this happened to one of his patients, but I haven't seen it with my own eyes).


Strangely, the first thing I thought about was what this would mean for my running career. Wow, this makes MY chafing look pretty insignificant. Selfishly, I asked "is this and similar cases of cervical cancer preventable by getting a yearly pap smear?" The answer is YES.


If the cervical cancer gets really bad, as in the patient I saw, then multiple other things happen including having an ostomy bag system which can include a colostomy (i.e. there is a bag on your stomach that collects feces), an ilosotmy (a bag that collects undigested food that looks like feces with corn in it) and a urostomy (i.e. there is a bag on your stomach that collects urine). These are things I would like to avoid as a runner. The particular patient I have in mind was otherwise fully healthy and not young nor old with plenty of family to help her out at home, basically someone with whom I can relate. In summary, running scare factor #1 = cervical cancer. This type is easily identified and then treated with yearly health care.

Guns, Gold, Girls: Epic running songs pt 1

This is one of my favorite running songs right now. The song starts at 1:30 and it is well worth watching the link as I think of this as I run. As one kayaker says "I would be proud to say that I did this, but I'm racing it" a philosophy that is HUGE in running:    http://vimeo.com/23581317

What does it mean to say that "it's never going to be enough?" To me it means that I'm never going to give up on life, it's how I feel about life, I "will not go gently into the night" (Dylan Thomas). To me it means what I tell myself and patients every day, that what feels impossible emotionally and physically is something that is worth striving for, because without having worked towards that goal day in and day out, you still don't know if you can attain it. It means that you can survive a lot worse circumstances than you expected because it takes so much more to break your body.

No surprise, I think of my mom and how when we were in the hospital for those three weeks following her first seizure she could finally walk to the end of the hall and part of the way back (with a walker and the support of her two physical therapists). Then the next day when she got her diagnosis of brain cancer she couldn't even stand much less walk. It all felt impossible. She was diagnosed with a rare form of brain cancer that meant she would live for 3-9 more months. Over that time she would have several seizures, lose all capabilities, walking, feeding her self, bowel/bladder fundtion, until she could only move her eyes. At this point her organs would slowly shut down and then she would die. So walking felt pretty f-ing impossible for her at that moment.

I brought her to the end of the hall in her wheelchair, where she could see sunlight, and sat and talked to her. I had prepared for this moment and had expected the diagnosis. I had read every last paper on her form of brain cancer, about what treatments could possibly give her a chance to survive. I told her we had a plan, and kept talking, and don't remember what else I said but finally something worked. She reached for/grabbed for my espresso, a sign of her still wanting something!

My dad intervened. No stimulants... no caffeine. Your mother had a seizure. DAD! Mom is smiling, mom is excited about something, give her what she wants she just got a death sentence... And caffeine is NOT potent enough to cause a seizure, especially with all the anti-seizure meds. So I gave it to her and he took it away and complained of sharing germs. I asked her if she wanted one, she said yes. My dad protested, so I said oh dad, it will be decaf, and winked at my mom.

I sprinted down the stairs, got her an espresso, fully caffeinated, and ran it back to her and assured my dad with many more winks in my mom's direction that it was decaf. My mom, with a shit-eating grin and mischievousness in her eyes guzzled it down, a little drop running down her chin.

Then I knew I had to move back home. My mom and dad were fully in love but someone had to develop the desire to live in my mom and make sure she enjoyed what she had left so she would fight for the ability to walk or eat or anything and my dad was just much too blinded by his misery to be able to do that.

Every day I bought my mom the most expensive, foofiest caramel-latte-whip cream drink on the menu at Starbucks and every day my mom drank it as fast as she could while I reassured my dad that it was decaf (sometimes it actually was, when I felt really guilty about disobeying my dad for months on end). And afterwords she would beam and sparkle. Eventually she lost much of her short term memory and no longer remembered drinking the foofy latte afterwords, which was hard, as the only external proof of my daily effort was an empty bank account.

But when I hear this song, I think of that sparkle in my mom's eye and knowing oh, she has some life in her. Like in One Flew Over The Cuckoo's Nest, where tapping into your inner rapscallion is intrinsic to healing and health and will to live. No, it's never going to be enough and I hope all my patients feel the same.

Then, thinking of this, I pick up my feet, improve my cadence, and enjoy the freedom of running.

An image of my mom and I at christmas about a month before her first seizure, toasting wine glasses after having spent 4 hours making tortelini from scratch (i.e. making the pasta dough from flour, etc)

Never Enough.

So after this last half marathon that felt horrible, I have really contemplated what the heck I am doing with my running. I'm just an average runner who has run a couple marathons in the 3:30-3:40 range, then ran one under emotional duress at 3:12 and decided hey, I can run a marathon at six minute miles and now, a year and a half later, am solidly categorized as an elite runner.

So I looked over pictures... how are these two pictures different? What is different about my stride and what is broken down?

The left one is from Grandma's.... Haha, so after contemplating what was wrong, I finally went to see an MD; a physiatrist who specializes in sports medicine and was a competitive gymnast through college.

Turns out that my IT band is tight and my gluteus medius is weak and I gained five pounds with the stress of moving and I have dural tightness, etc, etc.

So I'll work on that and post stuff up here, but I think the biggest problem is that I was too stressed out and stopped enjoying running for a short period of time. It's hard to move to a new city where you don't know anyone and start a new job where you want to do really well and train to be an elite athlete. It was too much and I put too much stock into performance and taking it seriously. I needed to loosen up and enjoy myself while running. That's the way to fix my stride... to focus on running, not plodding.

So I made a mix music of songs that I enjoy running to and have thought about my cadence and thought about why I love to run and what I get from running.

To me, running is freedom. To run means I am alive, strong, and persevering. Below are pictures Ross peak in the Bridger mountain range in montana. A friend and I ran up there on a saturday for shits and giggles. That is what it means to be a runner. And I'm going to focus on just loving it. Then I'll see where running takes me next.

Strength in life

The most profound experience happened the other day. I have been working on a stroke ward and in stroke urinary incontinence (inability to urinate) is a very poor prognostic factor (i.e. much greater percentage of people dying and much fewer regaining strength and independence).

Well, I have been holding back emotionally from the patients for reasons of being objective, professional, not knowing what to do or say, and just trying to mimic other highly effective physicians. But then the other day in the afternoon before going on my run, I went into a patient's room for a routine procedure. For some reason, I felt like I was entering my mom's hospital room and I treated the patient similarly to how I treated my mother. It wasn't that I said anything different, I just looked at her differently, like I loved her and I responded to her in a more personal fashion. Upon leaving, I saw her look at me differently, smiling with wide open eyes instead of sullenly and tired and miserable like every other time I have left her room. I know I opened myself up as that night I dreamed about visiting my mother in rehab, indicating that I had tapped into old emotions that I had kept walled off. 

With my mother, she knew she was going to live her worst nightmare. She had specific orders that if her mental capabilities were compromised, she did not want to live. She was DNR and my sister and I were fully aware of this well before the seventh grade. Then the way she died (and normal progression of her particular form of brain cancer) is that a tumor progressively ate out her brain from the top down, destroying her ability to think and focus, giving her seizures, and finally sending her into a coma for 2-4 weeks before taking her life. So what do you do when every day you see your mother in a wheelchair and know she is living her greatest nightmare and will be until the second she dies?

I saw the person I loved and I sucked up my pain and drew on her strength. When I entered her room it was about getting her to smile, laugh, draw out whatever fight or mischievousness possible so that she would try to walk or laugh or live another day. It is about seeing life and beauty and happiness wherever you can find it and that is what you develop and that is what you interact with and accept. I needed to be aware of the rest of her symptoms, but I needed to be her cheerleader and comrade.

I entered medicine with the belief that I can help people the way I helped my mom. Apparently after I left the patients room, she urinated on her own during a bowel movement, and did the next day as well. When she told me this I was so excited, which then got her excited. Normally when the attending MD and I round to all the patients rooms, she would be trying to sleep, complaining of the sun, and telling us she doesn't want her friends to visit because she wants to just rest. Instead she asked the nurse to find the attending to come and see her (she was so excited to tell the attending herself) and when we found her she was in the common room where it is even sunnier than her room.

So is this what it means to have a healing touch? Does it mean to open yourself up to loving a patient? Does feeling loved allow you to be strong? Might my being able to open up to a patient the way I did with my mom just have saved another person's life? I'll never know, but it is worth thinking about.

Grandma's Half Marathon

So yesterday, I ran Grandma's Half Marathon. It was a special run because the USA Track & Field finals were held 20 minutes before our gun time. It was also my first time traveling for a race, which was quite a nerve-wracking experience! I forgot both my phone charger and one of my two running socks. But before I say anything else, It was BEAUTIFUL! Minnesota is just covered with trees and rolling hills and watching the sun rise over Lake Superior is an amazing experience. I would recommend this race to anyone who enjoys a breath-taking course near fishermen's boats and pine trees in a charming area with extremely kind people. And the taxi drivers are the greatest. I haven't ridden in many taxis, but one taught me all about the gems found around Duluth, which he shines himself and sells. And another was an avid follower of Miss Patti Labelle who moved back to Duluth once retired after having lived in cities including San Francisco and LA for his working life. Wonderful people!

With only a carry on bag stacked with race clothes and books to study, I traveled all day Friday. Starting from my summer apartment in Chicago at 8am and arriving at the convention center in Duluth at 5pm. Not knowing anyone, I went to eat at an irish pub, hoping for some good beef stew, my favorite. However, there was no stew so I went with a salad. There I discovered I had left behind my charger, rolled up on my table. The staff at the Dublin restaurant were FABULOUS wrangling one up. So friendly and really living up to Minnesota expectations.

The day of the race I got up at 4:30 from my dorm room at University of Minnesota, Duluth and ran downstairs for a complimentary banana, lots of peanut butter, coffee, and toast with an apple and powerade (bought the night before) for the road. I waited in line and hopped on the bus with a new friend, Elisha Engelen (aiming for sub-1:50 and got 1:44!!!), who was also running alone though she had many friends and her husband along the course.

Upon arriving at the race, I met up with a running partner from dc who I had never met or run with before, Elizabeth Young, who runs at about my pace. It was GREAT getting to share the experience with her! We did a short warm up and made our way to the front. It was difficult as we wove between many people frustrated who said things like "we are all running the same race" which is true, but we can't win the race unless we start at the front. However, as we neared the front it was not nearly so packed and we were able to get up to run some striders and make another pit stop before beginning.

The race itself was incredibly difficult for me.  I was incredibly sick the week before the race. I think with new allergies due to Chicago for the summer. I woke up Friday morning with a nose bleed for the first time since early childhood (first time I can remember) I think due to the fact it wouldn't stop running for the previous week. I thought I wouldn't run the race....  But there I was and I was going to try my hardest!

I was told the whole race was downhill. Well, coming from flat Norfolk and Chicago, let me say there is a significant amount of uphill the first 10k. One needs to take this into account when planning how to best run the race, which I did not. I ran my pr for the first 5k (5:57/mi, 18:22), meaning I was on track to run my goal speed of ~6min/mi. However, my breathing started getting really bad and my back and neck started cramping. I felt horrible. At the 10k mark I almost dropped out. The only thing that kept me going was remembering one time back in montana. I fell at the top of a mountain range during a race and broke my tailbone. I had to finish the race because there was no other way off the mountain (maybe a helicopter rescue). So I got down by a very slow-pace jog that minimized the bouncing but was faster than walking. So thinking of that I kept going but stopped 'racing'. I didn't look at my garmin and I didn't care who passed me. My goal was to just make it to the finish despite the fact I could barely breathe. I do not encourage other people with asthma or breathing difficulties to do this.

In the end, I got good miles on my legs and built strength. I finished a solid fourth with a 6:16 pace in 1:22. I hope to never run another race that feels so terrible and probably will sit out next time I feel so sick. But the times it is hardest characterizes how much you can do when it feels easy. Well, off to start cross training! I will post soon on Chicago & its running scene & what I am learning working in the top rehabilitation facility in the nation (Rehabilitation Institute of Chicago)... Which is A LOT to make me a MUCH better doctor in the future! YAY! And yes, I spent the morning looking up what my next races will be...