thoughts on progress

it was almost too hot to run today. i woke up almost at noon, and by then i could barely stand just being outside, let alone running. so my run was extremely abreviated. it got me thinking: is my training progressing as it should? then i started thinking about other forms of progress. is my residency training progressing at a sufficiently rapid rate? i think so.

in terms of my running, i'd like to be getting faster more quickly, but i know that this takes time, especially if i don't want to end up with an injury.

as far as residency goes, it's difficult to track progress. i wonder if it's like this for every profession, but i think any doctor with a reasonable amount of introspection questions her competence on a regular basis. more on this in later posts. 

i was thinking about this driving home: where do i need to be? on the one hand, i've done one residency (at a good program, i think) and been in practice for three years. on the other hand, i'm an intern, who is expected to know absolutely nothing. interacting with attendings is a ballance between demonstrating that, yes, i do know what i'm talking about but no, i don't know everything, so please teach me what you know.

rachel remen frequently leads an exercise for physicians where she asks: what surprised you today? well, this was a terrific surprise tonight. c, one of my fellow interns, left me a chai at my workstation tonight on her way out:

weekend update: i'm going kayaking in the mountains, finally!  saturday, we're going to hit up the green, which is the perfect beginners' run. then sunday it's on to the nantahala. although it's a bit of a stretch for newbies, i don't expect any problems. i'm really looking forward to being on the river again.

interns mack on some cupcakes

finally we had some weather that was amenable to running during the day:

absolutely amazing! coming home from work at 4 pm and it was in the 70's. ran a 7 mile tempo just because i could, and it felt pretty good. later that night, we got together for mexican food to celebrate g's birthday, and livvie got to meet my most excellent intern class. g, a and cat face enjoying la comida:

before dinner, it was cupcake decorating time! the results weren't pretty, but they were produced with love. thanks to m for baking the goods.

that was two days ago.

tonight, i had a busy shift at the capital hospital peds ED. (and my first chest tube as a resident) lots of patients, but busy = good because i'm seeing a lot of cases and learning. here's a shot of my stack of charts at one point tonight:

in other news, thanks, aunt vicky! put some sulfadine on bubba's hot spot, and it looks great after just 24 hours. and the cone of shame is gone as well. the cone, i think, bothered me more than the bubbs. while he didn't seem to mind, i did not appreciate his wanton bumping into objects (especially at night) with that huge plastic thing on his head. here's a pic of ulysses at the beach last thanksgiving:

being an intern again

surprisingly, the idea that i'm an intern for the second time hasn't yet come up yet in this blog. for those of you that don't know me in my real life, i completed my first residency (in family medicine) in the san francisco bay area back in 2007. i enjoyed taking care of families, community medicine, and delivering babies. but my place in the "field" of medicine seemed to lie more in taking care of very ill patients in the hospital. most of my friends thought this crazy. the hospital can be a toxic environment. for me, the hospital wards and ERs were interesting places where i could effect change in people's lives with the tools of my trade.

so after three years practicing as a medical hospitalist, then emergency physician (both at teaching hospitals working with some very sharp medical students and residents), i decided to go back and get some more training, this time in emergency medicine.

after going through (what some mind call the hazing ritual of) residency, i'm back at the beginning, in the role of intern in two large teaching hospitals. what's it like being an intern all over again? well, it's totally different.  the first time around, i didn't know my ass from my elbow. psychologically, it was hard to be in a place where i had virtually no control over my own life. i pretended like i knew how to do my job, although i really didn't know very much. throughout the three years of training, this got better. by the time i graduated, i had learned enough medicine to do my job, and i had learned to manage my time and energy in such a way as to leave plenty of myself to do the things that made me whole. here are a few pics from those days:

this is at the top of sweetwater springs pass, between guerneville and healdsburg. it was my favorite bike ride that i could squeeze into a half-day.

this is coming down the backside of sweetwater canyon. the pasture to the left is where this blog's mascot (the sheep) lives.

and here's another view from the top of the pass.

internship the second time around is surprisingly easy. i think sometimes i forget how hard that first year of residency in 2004 actually was. there were growing pains, to say the least. now, i'm a bit more sure of myself, but i'm not afraid to ask for advice or help. granted, i've had to tell the story above (about how i've done one residency already, so i'm not REALLY an intern, etc) to my attendings multiple times. but once they hear that, they pretty much universally give me a generous degree of autonomy. most of all, they respect my experience. this is the thing that i appreciate most. during my last shift at university hospital, i got to do an ultrasound guided IJ without any help from the attending, which i'm pretty sure i can owe to the above.

in other news, bubba has a hotspot on his hindquarters, so he's relegated to the cone of shame. hopefully this won't last for too long.

livvie and i had a great day yesterday, which included kayaking (with roll practice) at jordan lake and yoga at open heart yoga school.

the day ended with a good beer, and i finally cooked that butternut squash from the CSA that had been sitting around for two weeks. i made a winter gratin that is as delicious as it is caloric. no coincidence, i think.

how could i forget? yesterday was zosia mae's birthday. here's a pic from when i went out to visit j, k, and zm during interview season last year. it was a short trip with interviews at highland, davis and stanford crammed into a 3-day stretch. 

happy birthday zosia!

lazy sunday

well, it wasn't an entirely lazy morning. 35 mile bike with the trikes at a nice, leisurely pace. after the ride we gathered at open eye for a little tartine and beverages.

some of our favorite trikes were there. d, a, and a few others rode the endurance route to saxapahaw, while m, j, o, and i took a shorter, more mellow route. i think d was a little tired from their lightning ride from saxapahaw in the heat.

breakfast at weaver street then a 4 hour nap.we walked around carrboro for a bit then came back to make dinner. i picked some of the last tomatoes of the year:

tomato season should probably last a bit longer, but the heat has been hard on them. (and i haven't been the most attentive gardener) my vines are actually looking pretty wilted and burnt at this point. maybe tomorrow, i'll get out into the garden and pay them some attention.

among other things, we ate some pesto i made this past week from the basil right outside my front door. delicious.

 

i have tomorrow off from work and i'm slated for a slow run. now more sleep!

home!

it was a hot day for a long run, but i got in a solid 14-miler this morning. i've got just enough time to shower, run by weaver street for some lunch, and get to work on time. when i get home, livvie should be waiting for me. she's been gone two months; i can't wait to see her!

in other news, i am now the proud owner of an iphone 4, which makes it easier to post photos and video, including pics of the temperatures. at the risk of looking way too similar to another blog that i read, here is the temperature when i finished my run this morning. (start temp was a balmy 80 degrees at 8 AM)

tomorrow night is going to be date night: most likely a movie, then dinner by stevo, part of my new financial austerity plan.  last year, we probably would have been going out to dinner, but now that i'm a resident again, i'm trying to be less spendy. movie will be, most likely, inception (my pick) or despicable me (suggested by livvie). my favorite critic, a o scott, reviewed both. he didn't give either film a rave review, but he seemed to favor inception. of course, there's always rear window, which is showing at the varsity.

holding back

i went out tonight, knowing that i was on a tight schedule, only intending to run 3 miles. the purpose of this run was to work on form and technique, not endurance. it took about all my energy to prevent myself from veering off onto my regular 6 mile route. when i'm accustomed to running more distance, my mind and body crave a longer run.

two years ago, training for the philly marathon (yep, same race that i'm training for now), i learned a pointed lesson about restraint in training.

i went a little too hard too fast (or just didn't pay attention to my form) and ended up with a stress fracture of my tibia.  (on the left, to be specific) it was significant enough to be seen on the plain film when i went to the orthopedist at HUHS. so now i take a little more care to advance the mileage slowly and pay attention to form. fingers crossed, i haven't had any problems since that post-injury running hiatus.

tonight we celebrated g's birthday at tyler's durham, which is in the american tobacco historic district. (see above) there was a bull's game going on, and the place was hopping. every time i go down there, i realize that i don't have sufficient appreciation for durham.

then, back to pacifica to celebrate palma's last week in university town. she cooked traditional spanish food and we attempted to listen to some spanish flamenco.

 

molly and jeff were there, looking good as usual.

 

tomorrow is 12 miles easy pace then my first shift at university hospital! i'm excited to be at my "home" hospital, finally. but i also worry about striking the proper balance between people respecting my experience (one residency and three years in practice, all of which doing acute care) and getting the teaching that i came to get in the first place. more about that in later posts.

and i hope this is the last you'll hear about this.

saying goodbye

shu is right, it's much easier to get in a good workout in the morning before work. got in a solid 8 mile interval run this morning. my route takes me right by university hospital, where i saw one of my co-interns heading into the ED.

had a farewell dinner with my dear friends j&j. they are headed to indonesia for the year to do environmental and medical work, respectively. i can say with a high degree of certainty that we'll see each other again soon (at the very least, before the year is up). i'm grateful for having gotten to know them better during the past year.

i biked into town to meet them, and bubba ran alongside me: two miles there and back. he was a tired pup when we got home.

the heat at guglhupf

i spent most or the afternoon sleeping.  one result of working odd hours is that in order to fit in activities with other people who have "normal" schedules, sleep sometimes gets sacrificed.  during my first residency, when i had to choose between social life, athletics, and sleep, the latter usually got sacrificed.  this was fine.  buzz and i explored the rivers of northern california, and i biked back and forth across the coastal range to my extreme delight at the expense of my sleep.  this did take a toll, however.  i'm sure my work performance suffered, and i know that those around me endured an excess of grumpiness due to my lack of rest.

so this afternoon i paid homage to the nap.  almost 4 hours of blissful sleep.  i woke up feeling refreshed and ready for a week's worth of activities.  because i didn't do my sprints today, i'll have to get up at 5:30 tomorrow morning to run. fine with me.  i'll be well rested.

on another note, satelite radio continues to add the the quality of my life. a new discovery on the sirius dial is the heat.  it's a nice combination of hip-hop and r&b that makes for good driving music. it's important for me to keep my music selection fresh, especially if i'm tasked with driving to capital hospital for months at a time. luckily, most of my job happens at university hospital, which is an easy 2-mile bike ride from my house. but on those long drives, it's a huge bonus to have good tunes. also, it helps me connect with a broader cultureal context than what i'd otherwise encounter.  i'll write a post later htis month about the importnace of keeping my finger on the pulse of popular culture.  but not right now.  i have to run early tomorrow morning.

on a completely unrelated note, a big thumbs up to guglhupf, a hell of a restaurant and bakery in durham.  their food is exquisite, and the patio is beautiful. if haven't enjoyed an evening at guglhupf, you're missing out.

setting intentions

i don't want this blog to be an inane record of all the little trifles that make up my days. i started blogging because i used to write in a journal. although journaling provided a place for me to reflect and helped me cultivate self-awareness,  writing a hard-cover book has been difficult lately.  thus, this blog.  i don't want to merely record events. rather, i want this space to serve as a forum for describing the things that make me think, surprise me, and teach me lessons.  most of all, i want to use this blog to help me cultivate gratitude. more on gratitude in the next post.  for now, there's residency:

woke up way too early (5:00 AM) to let out ulysses and head over to capital hospital. the day went fairly smoothly.  saw way more patients than i thought was possible.  then came home and ran a short 4 miles in the rain.  instead of doing my sprint workout today, it's going to have to happen tomorrow.  there just wasn't enough time tonight.  as it was, tonight was the perfect moment for 4 relaxed miles.  we were just on the border of a summer storm, so a little light rain kept me cool and i got to listen to the thunder (although i wasn't in the midst of the lightning) during my run. tomorrow i'll do my interval workout that was scheduled for today. we just have conference tomorrow morning then the afternoon off, which should give me ample time in the afternoon.

oh, and tonight we had another intern night at top o.  turnout could have been better, but it was fun all the same. the cool air and the sunset over chapel hill made for a gorgeous summer evening.  here's the view from where we were perched for the night.  see if you can spot the intern in this photo:

got home and cut up a few tomatoes from the garden, added a little fresh mozarella, and voila:

ok, bubba is looking longingly at me, which means it's time for bed.

one last thing.  i was googling myself (now that i have a blog, i was curious what was out there; hello narcissus?) and i found this:

ballers only

woke up nice and late today.  i didn't make it out for my run until around 1 pm, which made for a hot afternoon. since ulysses doesn't have sweat glands, he was not able to work up a sweat during out game of fetch:

on another note, this little piece of paper was sighted tonight in the capitol [sic] hospital emergency department:

i'm not much of a baller, so i don't know if i would have been admitted  to this VIP afterparty.

down tempo

had a great morning run with my neighbor, molly. 10 miles at down-tempo pace (for me, this is slower than race pace but slightly above moderate). after my run, i realized that i have no food in the fridge, so went to weaver street for some groceries. ran into the trikes (my bicycle racing team) at open-eye, and it was great to catch up with them. i would love to ride more with the team, but in this moment, i'm focusing on my running. with work and one long run per weekend, it doesn't leave lots of time for quality cycling. i came home and did some reading for conference this week (invasive monitoring and pacing).

i'm not huge on fitness gadgets, but the garmin sure does spit out some cool information. and it keeps me accountable for running good splits. when i asked molly if she would send me our run stats, we both spontaneously increased the tempo of the run. (after realizing that everyone would be seeing our splits on this blog) here's what our run looked like this morning. nothing super-fast, but it sure was hot.

here's one from when i was in france last month:

10 long hours of ATLS today. i have to wake up in 5 hours to run. tomorrow starts training week #2 with 10 miles down-tempo. my afternoon will be devoted to catching up on the sleep that eluded me this week.

news story & intern night

the family of the man i found on the side of franklin street this past week had some nice things to say about me. i'm actually a little embarrassed, because i did probably what anyone else in my position would have done. i still feel like i was just in the right place at the right time. i don't even know if me being there made any difference. oh, and ABC 11 mixed the facts up a bit: i didn't bring the patient to the hospital. i just opened his airway until orange county EMS could get there.

on another note, we had intern night part deux tonight at brixx in chapel hill. six people turned out, which i think is respectable. the night was filled with wholesome fun. here are steph and dan making threatening gestures at one another.

what can i say? we treat each other like family. dan and i even made a new 4-legged friend:

and can you imagine my surprise when tyler hansbrough showed up to join us! just kidding, we actually DID see tyler handbrough tonight, but he was just at brixx picking up his take-out order. i felt like a crazy stalker, but since i'm blogging now, i guess that gives me license to behave in ways that i would have never before thought appropriate. (ie, taking photos of celebrities at restaurants)

ok, so hansbrough is famous and everyone in the restaurant was staring and pointing. but i prefer to hang out with the fabulous folks in my intern class.

no running today. i was surprisingly tired at converting from my 5 PM - 2 AM work schedule to a day that starts at 7 AM. i guess i could have predicted that i'd be sleepy, but the reality of my fatigue today, sitting through 8 hours of ATLS lectures, was more than i had bargained for. i've got a full schedule of capital hospital ED shifts this weekend, but i'm hoping to get in some studying in the ultrasound book. one of my primary objectives for this residency training is to become an ultrasound ninja. my progess has, so far, been good. but i need to bone up on some theory. thus, the book.

luckily, my saturday shift doesn't start until 4 PM. i should have enough time for my long run on saturday.

full circle

the first entry on this blog is an old post from the last week of my previous residency (family medicine at the UCSF santa rosa program). there's a lot of doubt in there, especially pertaining to my ability to be an effective doctor. reading this now, it's difficult to imagine being in that place. as it turned out, my time as a hospitalist in boston was a success. i made some great friends on the hospitalist team at cambridge health alliance, and i'm happy to still keep up with them.

tonight was my first day off in a week. i biked into town to meet some friends, and we got beers and walked around town. i had seen a klezmer ensemble playing on main street a few weeks ago, and they were on the streets again tonight.

my run today felt good. 7 solid miles with good accelerations on the pickups. ready for ATLS at capital hospital tomorrow.

some thoughts on happiness

woke up to a beautiful nc summer morning. actually, by the time i woke up, it was barely morning. i had been working at the capital hospital until 2 am, so i felt it was reasonable to sleep until 11 am today. bubba was, of course, ready to start the day. or maybe he just wanted to be fed.




i've been thinking a lot lately about happiness and what makes it. i have less than half of the free time that i had a few months ago when i was an attending, and i'm making about a third of the money. but now, as a resident, i'm happier than i've felt in a long time. it's a truism that external circumstances don't add up to well-being, but sometimes it's difficult to wrap my head around that idea and what it actually means. when asked what makes for a happy life, freud said, "arbiet und liebe." i've yet to hear a more pithy explanation. of course, this leaves out elements that i think i need to be happy, namely, spiritual practice and service. but you might say that this can get rolled into the idea of work. either way, what freud said fits into my worldview pretty nicely.

so, on that topic, here are two videos that i saw yesterday that makes sense to me in terms of creating happines. the first is about the paradox of choice. the idea is this: more choices cause us to second-guess ourselves and be less satisfied with the choices that we do make. schwarz hypothesizes that the more we believe we control, the more upset we get when things don't turn out exactly as we want them to:



this one is by dan gilbert who wrote "stumbling on happiness."

getting zapped

i got my eyes lasered today. i was seeing fine during the day, but at night, i definitely was having problems doing things like driving. so i got a local opthalmologist to correct my vision. well, it's 12 hours post-op, and i'm seeing like a champ. (20/13, in fact. i checked in the hall of the ED tonight during my shift) i was a little worried about going to work tonight after surgery and then driving home, but i've had no problems.

other than my surgery, nothing much happened today. i went to work tonight in the peds ED. saw a fair number of patients. then, i got to leave early.

bubba (the dog) was waiting for me when i got home with wagging tail. i opened a beer and we stepped out into the light rain for a walk around the neighborhood before bed.

on the way home from work

driving home from capital city, i thought i wouldn't have much to report today. i worked a 10 hour shift, where i saw lots of patients: mostly interesting medical issues. but i didn't do any crazy procedures, and i didn't even do any ultrasounds. still, it was a satisfying shift.

but then at 3 AM, while driving home from my shift at capital hospital, i saw a person crumpled on the side of franklin street in front of the local 506. even after spending most days seeing people in bizarre circumstances, this just looked out of place. i stopped the car and got out to investigate.



a man was lying in the road with blood coming out of his ear (a very ominous sign), unresponsive, and barely breathing. i asked a bystander to call 911 then brought his c-spine into line and did a jaw thrust maneuver to open his airway. (thank you, ACLS) ok, i thought to myself, time for the ABCs. airway was patent (for the time being). he was breathing, although he had a large amount of frothy fluid in his mouth. carotid pulses were present. he didn't protest when i rubbed his sternum vigorously.

so i just stayed squatting on the ground, maintaining his c-spine in alignment and airway open until the paramedics arrived. they packed him into the ambulance, and i followed them to the university hospital. i figured that i might as well see what happens next and tell the team what i had seen. as soon as he rolled into ER doors, he became a patient at the hospital. so for patient privacy purposes, here's where my story of this patient must end.

i will say that when i got to university hospital, the department was full of folks from my residency program. again, i thought to myself: i work with a great group of people.

new toys

airways have always been one of the most frightening and at the same time, most fun parts of emergency medicine for me. when we evaluate a patient in the ED, especially in the case of critical illness or trauma. "airway" comes first because lack of an airway is incompatible with life. so there it is. the airway is the most important thing, which is probably why it can be so scary.

which brings me to tonight: a few hours ago, i had the opportunity for the first time to use the glidescope. it's a device that helps you see in hard to reach places. here's what this little gadget looks like:

which helps you, idealy, see this:

after this comes into view, you slide a tube into the hole in the middle, and voila, you have secured the patient's airway!

the glidescope didn't disappoint. oh, and i also got to do 4 FAST exams. i heart the ultrasound machine.

as i was driving home tonight, i kept smiling at how much i love my job and how glad i am that i'm doing another residency. it seems like learning opportunities are everywhere. also, my colleagues are awesome.

so while most people look at me like i'm crazy for doing another residency, i can't think of anything i'd rather be doing. not only is this time full of learning and personal growth, i'm having FUN. i feel incredibly grateful to be surrounded with a supportive, fun group of people and to have a job that i love.

a new beginning

today was the perfect day. slept late, long run, then a great shift in the ED. seems like an appropriate day for re-starting this blog. as i write this, i've just gotten home from my shift. when i decided to do another residency, i knew that i'd LEARN things. that was the whole point of doing this. but i was unsure about how quickly i'd pick up new skills. well, this time around, the process of training in a specialty is pretty much the same as it was before: one can learn as little or as much as desired.

what i mean by this: if you want to sit on your butt and avoid work, there is ample opportunity. if, on the other hand, i want to actually gain experience and learn, then i have to take the initiative and seize each opportunity. tonight, for instance, i saw 4 high-level traumas, did an intubation, started a central line, and ran 3 FAST exams (ultrasound examination of the belly in trauma).

everything still seems fresh and interesting. i hope to continue to be mentally involved and interested in learning and in my work in general. at this stage, it seems easy. here's hoping that it'll stay that way.

on another subject, my running is going quite well. i ran 12 miles almost at marathon pace . . . in the NC summer heat (at noon, no less), i'll consider anything close to race pace as such.

ok, time for a quick shower and bed. it feels good to be writing again.