lazy sunday

for one of the first times, i felt like my body actually deserved a day off from running. usually, when i take rest days, i'm antsy and want to get out and do something. not today. maybe it's because i ran a solid 14 miler yesterday:


yesterday evening the emergency department looked more like a drunk tank. it's not uncommon to see drunk / intoxicated people in the ED, but last night, it seemed like a tsunami of drunken students arrived after having passed out vomiting in front of their dorms.

it's sad to see people who have real psychiatric problems, chemical dependency or a combination of both. but these kids were just young, otherwise reasonably healthy-seeming folks who just didn't know how to responsibly handle alcohol.

they were in a safe place (under my supervision), and they would leave the next day with a big headache but no permanent damage done. if colleges really wanted to curb underage over-consumption, they would do well to record some footage of these kids, drunk and stupid in the ER. i highly doubt these kids have any idea how silly they look.

on a completely different subject: for a bit of nostalgia, here's my santa rosa family medicine residency class of 2007. even back then, i loved the ease and comfort of wearing scrubs!

fall race outlook

it's a hot day today, so i'm postponing my run today until later in the afternoon. i'm slated for a 14-miler; then i'll have to go to work right after that. liv and i both had the night off last night for the first time in a while. we went to my favorite bar in town. it was noisy but fun.

and they have my favorite beer on tap. mmmmmmmmmm . . . delicious.

my big race this season is going to be the philly marathon, but i'm also very excited about running the blue ridge relay next month. we have a team of twelve runners, two 15-passenger cargo vans, and one dog (the dog isn't going to do any running) to run a total of 208 miles over 36 legs.

each relay team member runs 3 legs of varying lengths and difficulty (see below). the race starts at grayson highlands state park in VA, which is near the base of mt rogers (5729'), the highest peak in the state . the course primarily follows scenic, country roads as it winds its way through NC to finish in asheville.

i'm runner #8, which gives me a total of 21.5 miles. the race begins friday morning, september 17th and usually takes between 24-36 hours to finish. since it's a team event, the idea is to try and catch a few zzz's between legs of the relay.

Leg Rotation  Runner  1 2 3 4 5 6 7 8 9 10 11 12 First Leg 4 7.5 5.2 6.9 5.2 5.2 5.4 4.6 5.2 8.2 6.3 7.9 Second Leg 7.5 10 2.4 3.3 4.9 5.9 4.3 7.5 2.4 6 5.2 1.9 Third Leg 7.2 6.9 5.2 8 7 4.4 6.5 9.4 5.2 4.4 4.2 6.8 Total 18.7 24.4 12.8 18.2 17.1 15.5 16.2 21.5 12.8 18.6 15.7 16.6 Summary Chart  Leg Miles Rating Elevation Loss (ft) Elevation Gain (ft) 1 4.0 Easy 936 0 2 7.5 Hard 1431 238 3 5.2 Moderate 458 338 4 6.9 Hard 190 544 5 5.2 Moderate 212 251 6 5.2 Moderate 566 760 7 5.4 Moderate 448 288 8 4.6 Easy 243 44 9 5.2 Easy 3 82 10 8.2 Hard 386 534 11 6.3 Hard 159 269 12 7.9 Hard 457 622 13 7.5 Hard 438 530 14 10.0 Hard 149 838 15 2.4 Easy 575 0 16 3.3 Easy 136 184 17 4.9 Moderate 202 433 18 5.9 Hard 1221 184 19 4.3 Easy 77 21 20 7.5 Hard 483 565 21 2.4 Easy 373 0 22 6.0 Moderate 136 412 23 5.2 Moderate 453 384 24 1.9 Easy 199 8 25 7.2 Hard 311 396 26 6.9 Hard 583 104 27 5.2 Easy 10 179 28 8.0 Hard 70 319 29 7.0 Hard 278 312 30 4.4 Easy 0 152 31 6.5 Very Hard 0 1392 32 9.4 Hard 1952 25 33 5.2 Very Hard 663 769 34 4.4 Moderate 170 319 35 4.2 Hard 114 715 36 6.8 Very Hard 1199 228

also, looking forward to races this fall, there's the carrboro 10K on my birthday, october 2. anyone interested in running it?

on a completely different topic, my camera died a few weeks ago, and i've been contemplating buying a new one. this looks like a pretty good deal. for $100 i get the same camera i had previously, which i thoroughly enjoyed.

on the other hand, all the photos i've posted on this blog have been from my iphone 4, which takes awesome pictures, and because i carry my phone in my pocket, i don't have to remember to tote around my camera with me. i'll probably just end up buying the camera. although the iphone takes good pics, i know there will be times when i'll want higher quality.

this public health message brought to you by the ED

one of my beloved co-residents treated a patient who had injured his hand with a chainsaw.  these were her instructions to him upon discharge from the emergency department:

"Use both hands when using a chainsaw. Wear protective eyewear. Always wear your helmet when riding bikes."

i don't think the incident involved him riding a bicycle without helmet or eye protection while using the chainsaw with one hand, but i do appreciate her concern for the patient's safety.

garden renewal

had a long shift at UH today and got home in time to work on the mess that is my garden. the green beans are still strong, and the peppers are ok for now. but the tomatoes are turning brown and nasty. pulled up most of the garden and thinned the weeds that have been growing wild for the last month. i left two pepper plants, a stand of beans, and two sungold tomato plants that are continuing to produce a scant amount of those delicious little tomatoes.

it's not quite time for a fall garden, but i'm looking forward to putting in some broccoli, kale and kohlrabi (thanks, jess for the spelling assist) in the ground in the next week.

saw some intersting cases in the ED last night (including a big, bilateral pulmonary embolus [the patient did fine]).

the day finished with a relaxed dinner of baked polenta gratin. liv made smoothies from a delicious WSM cantelope. bubba sat by our side as we ate.

the maritimes

my friends liz and johannes got married this weekend in nova scotia. they asked me to read a call-and-response community blessing at the end of the ceremony, which i was happy to do. i didn't actually know what i was supposed to do until 5 minutes before the ceremony, when they handed me this:

it was a long journey to halifax and then an hours drive down to the tiny town where they had the ceremony, but it was well worth it. summer days in the maritimes are notorious for being foggy, but liz and jo's big day was sunny and pleasant.

my only regret was that i couldn't stay longer. i had to wake up at 3 AM this morning to catch my flight back home. ouch! i felt very canadian stopping at tim horton's on the way to the airport at 4 AM for coffee and a bagel. got home in time for a nap, some quality time with liv, and an evening run.

on another note, if you want to catch me sounding ridiculous, try talking to me when i am falling asleep.

morning off

i had a bit of a hard time staying asleep because i've been on nights all week. despite the fitful night, i feel pretty refreshed this morning. i went on a lovely run last night through town: i saw people from yoga, from work (other resident; not patients), and a couple of random friends that were enjoying walking around town on a cool summer evening.

it was one of those moments of appreciating living in a place where it's easy to run through town and be entertained by the stimuli. i've never been a fan of listening to music while running; it seems like i already get lost in my head enough. there are so many things to experience while out on a run. better to engage in it.

my last few nights at UH have been great. lots of good procedures, and i finally feel like i'm getting into a rhythm seeing patients and getting my work done. i'm still enjoying having drained that abscess in that patient's mouth the other night.

this morning, i finally was able to wake with the sun and have breakfast at the normal breakfast time. we had a bunch of shittake mushrooms from the CSA and tomatoes from the garden. i've been pondering what to do with these things for a while.

my answer: shittake omlette! goes great with that french emanthaler that's been on owner's special at weaver street for the past week.

i think livvie liked hers. it's astounding how excited i am about simply having a morning to myself to post and run. instead of running around trying to do too many things in a compressed evening after work, i actually have the time i need. on this morning's adjenda: post on blog (now done), interval run, pack for nova scotia.

i'm really looking forward to liz's wedding this weekend. unfortunately, livvie couldn't join me because they have a big test. but the weekend looks like it'll be a great time, and i've never seen far-eastern canada except from the air!

i've known liz for a while now. we first met at a med school retreat in 2002 and have somehow managed to stay in touch ever since. when we graduated from med school in 2004, we both migrated west to san francisco for residency and did the road trip together.  here's us somewhere in utah near zion canyon:

my training schedule has me doing a 14-miler this weekend. liz's wedding is at 4:30 PM on saturday, so i'm excited about doing a little two-legged exploring around oak island saturday morning before the ceremony. i'll post the route when i get back.

getting faster

and here's are my 2009 chicago marathon split times: mile by mile.  this race was one minute short of qualifying me for boston:

1. 06:14  
2. 07:11
3. 07:29  
4. 06:16 
5. 06:33
6. 06:38
7. 06:43
8. 06:40
9. 06:57
10. 06:59 
11. 07:05
12. 06:58
13. 07:07
14. 07:13
15. 07:12
16. 07:10 
17. 07:14  
18. 07:18 
19. 07:18  
20. 07:12 
21. 07:16  
22. 07:07 
23. 07:22  
24. 08:05 
25. 09:13  
26. 09:22

ouch! that's a pretty nasty fade at the end, huh?

ran a good, fast 10 miles with one of my residency chiefs saturday, which felt like one of my first quality long runs this training cycle. despite the heat and the hills, i'm getting close to marathon pace when i'm putting out high moderate effort. it feels like i'm going to make my goal time at philly this year. here's what it looked like:

my shift sunday night was a great contrast to last nights' shift. sunday night was slower than average, and although i was working with some great folks (shout out to KS), it just wasn't doing it for me. last night, on the other hand, was busy as hell. lots of sick people and several nasty traumas. despite the chaos of the ED, i felt like i was actually helping people and learning at the same time. got to do an IJ line and lanced a peri-tonsilar abcess under ultrasound guidance. more about that later. it's a supremely cool procedure.

two of the things that i specifically wanted to get in residency were reducing unstable fractures and managing peritonsilar abcesses on my own. at the county hospital where i previously worked, there wasn't all the specialized help that's available at university hospital. having previously worked out in the community away from the ivory tower of medicine gave me a good perspective, i think, on what i really NEED to know to practice emergency medicine in the real world.

more on that procedure later, but now's time for my easy 4 miler. excited to have the evening off tomorrow: farmer's market, housestaff council meeting, and evening with livvie!

mountains of things (scrubs, actually)

i worked a 12 hour shift yesterday, then came home just in time to run, get groceries, cook dinner, eat and then get to bed a bit too late. livvie was kind enough to do laundry which, by weight, was 99% my things. of that, 90% of that amount was scrubs. it's nice to be able to work in clothes that: don't cost anything (usually provided by the hospital), maintenence free, extremely comfortable and body-fluid resistant.  what more could i ask for? here's what about 20 pairs of clean srubs looks like:

scrubs are actually getting harder and harder to come by. university hosp recently instituted a poilcy of only dispensing scrubs out of machines that require return of a soiled pair.

one of my attendings today introduced himself as "dr. w, i'm a specialist in emergency medicine." i thought this strange: specialist?  then again, is this so strange? i'm pursuing another training to be certified in this "specialty." so seems pretty legitimate.  at the core of the specialty of emergency medicine lies the ability to make high-risk decisions extremely rapidly.  should this patient go home or be put in the hospital? we face this question perhaps 20 times every day. we don't want to have patients admitted to the hospital unnecessarily, but for many folks, a stay in the hospital can be life-saving.

the high-speed car crashes, the stabbings, and gunshot wounds are easy to take care of: treat the injury and you're done. the most difficult part of emergency medicine is the liminal cases.

on an entirely different note, i have been struggling with documenting in university hospital. at my previous job, i could write down my history and phsyical exam on a single sheet of paper while i was seeing the patient. now, it's all computerized. this is made infinitely easier by this litte contraption:

not that exciting, i know. but when i can record my (sometimes convoluted) conversations with patients in real-time, it makes my job way easier.

tomorrow is my long-run day. ouch.

riding to work

rode my bike for the first time to work today. at 6:30 AM it was a cool 74 degrees, which felt refreshing on my bald head (through the vents on my helmet, of course). it was a funny return of sorts. i'm locking my bike at the same place where i used to park when i was a med student.

my run yesterday was painful. the heat was oppressive.

financial austerity plan

it seems like i'm always on a topic that's similar to another of my favorite blogs. now that my yearly salary has been cut to a third of what it was last year, i'm beginning a new, financial austerity plan , which, according to this nytimes article, should actually increase my happiness.

here are a few ideas that i've already implimented.

1. no parking permit- parking here at university hospital costs roughly $60 per month. it's free nights and weekends, and i only live 2 miles from the hospital. not only will this be the thrifty option, it'll also give me a great excuse to get in some exercise riding my bicycle to day shifts. for those night shifts where i emerge bleary-eyed from the hospital, i can get in my car for a quick getaway and off to bed.
2. cutting back on cell phone minutes- i'll have to re-evaluate this one in a few months. my current plan (900 anytime minutes) is way too much, but the next lower version (450 anytime minutes) is marginally too small. a tough call.
3. cancel unneeded mobileme subscription- i like that my calendar is stored in a cloud and that my calendar "pushes" events to and from my eye phone without having to physically sync. this is the only real reason that i have this service. the other benefit is the automated web hosting that i use for my domain name site. what makes it so easy is that i can create the site in iweb and it uploads seamlessly. however, now that i'm treating high volumes of patients in the ER, i can probably do without the website with all the personal details. as for the cloud computing, i don't mind syncing so much. also, the amion calendar that i use has a subscription feature that bypasses mobileme alltogether!
4. get a housemate- i have always enjoyed living with people, and this house is a bit big for just livvie and me. it'll be fun to have somone else in the house, and we're not so desperate that we can't be extremely picky about who it is. having interviewed housemates in the past, i've found it extremely easy to find folks that want to live in pacifica. it's just a great place to live.
5. eat out less- or at least, be judicious about how much restaurant-going we do. i love to try new restaurants and enjoy the ambiance of a meal out. we'll probably still go out once a week, but being a bit more selective about our restaurant-going is in order.
6. plant a winter garden- a correlary to above. the tomatoes didn't do so well with the late-summer heat, but pretty soon it'll be time for kale, broccoli, and chard!

ideas that fall into the "too extreme" category: (ie, i'm not doing them)

1. cancel economist subscription- no way. even though i don't always read cover-to-cover, i love reading the economist, and i think it keeps my brain from turning to cottage cheese. it's also nice to sample some right of center opinions from time to time. don't get me wrong, i love my democracy now, but it's nice to understand how the other side thinks.
2. stop shopping at weaver street- i like shopping at WSM, and i can get in and out faster than anywhere else. there are still items that are cheaper at harris teeter, so i'll go there occasionally. weaver street enhances life in carrboro, so it's worth supporting. i usually buy whatever cereal is on sale and take advantage of the owner specials.

still trying to learn ultrasound. i'm getting pretty good at the FAST exam, but i haven't yet gotten to do a whole lot of gyn exams. i'm seriously considering taking an elective month to just do ultrasounds with the techs. i think when the time comes, i'll want to do some moonlighting or travel instead. we'll see.

i've been seeing paramedics from south county hospital, and just last night i had one of my old colleagues (who was on shift at the time) call me in the university ED for a consult. i loved working there, but i can't say that i miss it all that much. i didn't enjoy the drive, and i'm pretty happy with my job now.

can't wait to have the afternoon off tomorrow. the workout should be challenging, and then it'll be time for a nice one of these:

home!

woke up from my post-shift nap just as livvie was getting back into chapel hill. it's great to have her around again for good now that school is starting back up. dinner was homemade pesto from our garden and arugula salad from the CSA. then it was off to a board meeting with the eenp folks and work again.

last night was just about as nutso as it gets in the ED. for those of you who don't work in the emergency department, mondays are most definitely the busiest time of the week. i think people just save up their complaints over the weekend until they are supposed to go back to work, then when they can't get an appointment with their doctor (because EVERYONE is trying to do the same thing), they come to see us. for me, this isn't such a bad thing. i'm going to have to be there for my entire shift either way. why would i not want be busy if i'm going to be at work? it was busy last night as usual. out of my 14 team D patients (our "fast track" side that is supposed to get minor complaints), about half of them got admitted.

i got two central lines, which was some good experience, one right IJ and one left. the right IJ was a good reminder why i dont' usually put in right-sided IJs. (tip went out into the azygous arch instead of into the RA) i even got out on time, which i'm trying hard to get better at.

bubba says it's 8 AM: time to go to bed.

race pace

as someone who recently had his income slashed by two-thirds, i was interested in this nytimes article about income, happiness, and scaling back.

in other nytimes news, my friend and former running partner kate drake got married this afternoon in southern california. kate and i enjoyed some good runs through boston

took a long nap this afternoon then got up and went for my first longish run at race pace. it was a little slower than i need to be, but it was hot and there were hills. overall, it looks like i'm going to be ready for philly in november.

conversion

i usually don't love susan orlean's writing. to put a fine point on it, i find them self-indulgent and directionless. but i was moved by her piece in the new yorker this week, a eulogy to her dog. there it is: i've officially become a hopeless dog person.

i just converted from days to nights, and i didn't get good sleep last night. i'm super tired right now and don't have the energy to write much at this moment. i do, however, have a funny quote: regarding the man who came to the ER to get tested for STDs two years ago (this is NOT a legitimate reason to utilize emergency services) and now requests repeat STD testing. my attending replies: "he wants it again now? well two years is a long time for a playa." that made me laugh.

david sedaris also wrote a new yorker article this week. i generally like sedaris. he's funny and a north carolinian to boot (although an expat). there's a certain hopeless quality to his writing that belies his having given up on the goodness of human nature. this disturbs me. i can handle cynicism, but sedaris sometimes crosses the line. i'll allow that he's extremely funny and has some uncommon insights into human eccentricities.  but when confronted with difficult material, instead of contributing to a solution, he throws up his hands. i'll continue to read his stuff, but i reserve the right to shake my head.

intern night this week was great, as usual. here's a and b looking lovingly at one another at brixx in chapel hill:

old shoes

ran a solid 8 miles on this hot afternoon. while i was out, i saw:

1. one of my med school classmates (class of 2004)
2. an EM attendings at university hospital
3. a co-intern who is on the CCU (heart service) finishing a busy call night
4. my neighbor d

here's my route.  it's a variation on my usual circuit through town:

and here's the temperature. i realize that i'm going way slower than i need to be if i want to get a boston qualifying time, but i am usuing the excuse that the temperature creates a significant handicap. last year at the chicago marathon (my favorite race of all time), i ran a 3:12, just one minute off my qualifying time (they give you a one-minute grace period). so close!

seeing so many familiar faces around town is one of the benefits of living in this small community, although it does mean that when i'm out at a bar, i sometimes hear: oh, you're that guy that i always see running around town in the little shorts. believe me, i'm not a huge fan of being "that guy in the skimpy shorts." but come to think of it, i don't mind all that much.

on an entirely diffent subject, i was going to retire my shoes a few weeks ago because they are starting to look pretty worn. hoever, i can't bring myself to do it. it's not that i'm cheap, although i am. but it's more that these shoes fit perfectly. they feel great; even after 13 hours continuously on my feet, i'm in no discomfort. it's not just how they feel, though. i feel a certain emotional attachment to these things. they've protected my feet as i've dropped countless scalpels and all manner of other sharp (and blunt) instruments on them. they have remained impermeable while every type of bodily fluid (most of it amniotic and sanguinous) has been spilt on them. in short, they have kept me comfortable and protected from harm through my [medically] formative years.

i've had these shoes for 8 years now, and after wearing them to work last night, i realized that i'm not ready to give them up. as you can tell from the title of this blog, i love my clogs.

got together with d, s, r, and s tonight for dinner at shiki sushi. maybe soon i'll start reviewing restaurants around town, but right now it's time for bed. i'm on at 7 AM.

long run, finally!

it's been a good while since i've done a long run, but i finally got my butt out on the road today for a 14-miler.

i thought i'd share this one with you, since it's an ED classic.


yes, it's funny but also sad. although there are people like this that come to the ED with "fake" medical conditions, these folks invariably have a lot of pain. perhaps it's not the kind of pain that morphine and valium can fix, but ED doctors can at least let these folks know that we care about them.

this has nothing to do with the technical skills of being an emergency physician, but at the heart of our work, we are in the emergency department to offer comfort and make people who are in pain feel better.

all of our patients will die. so we're never going to "save" anyone. but we can help people to feel better. and the best weapon i have to effect this end is my ability to let patients know that care that they are in pain and genuinely want to make them feel better. i hope to have the strength and insight to do this.

tik tok (don't stop)

last night i worked my longest shift yet: 11 hours. yeah, i used to work 12 hour shifts regularly both as a hospitalist in cambridge, massachusetts and in the south county ED. even though those were longer hours, it was way easier, mostly because in the university hospital ED, the work never stops.

as a hospitalist, i could sit down and think about each patient individually. i managed cases one-by-one. even if i had a list of 7 people to admit, each got seen and dealt with in turn. with this new job, there are always (to use an overworn metaphor) an impossible number of balls in the air at any given time. even in my old ED job, there usually was a significant lull toward 4 AM where I could grab something to eat or take a moment of rest.

despite the lack of down-time, i do like working in the university ED. the attendings, nurses, and other residents are all good people, and it seems like everyone (most of the time) enjoys learning together. i had some nice interactions with all the residents i spoke with last night: from radiology to surgery. i did not have the pleasure of speaking to any of my orrthopaedic or anesthesia colleagues, which reminded me of this:



procedural update: i got to do my first lumbar puncture (spinal tap) as a resident last night. i'm still honing my technique for some  procedures, but frequently, i get a little boost of confidence doing them. it's a nice reminder that i do know what i'm doing and that i can spend my time developing myself in focused way. frequently, i feel unclear about what to do with medical cases. in contrast to that uncertainty, its' nice when there's a procedure to be done and i realize that i function pretty well on my own.

so i'm a slack runner. i slept all afternoon yesterday and didn't even put my running shoes. this afternoon i'll do my long run, finally. training schedule (see bar on left) has been revised to reflect this.

in the meantime, i'm enjoying my espresso and my ciabatta, cheddar, egg and avocado sandwich, reminiscent of my beloved hovey from darwin's ltd in cambridge, MA.

road trip!

after a tiring week of work, matt, s, and i went up to asheville this weekend for two-day kayak trip.i didn't get home until midnight friday, so i was a bit groggy heading out of town. a stop at the wildflour bakery in saluda helped.

day one was the lower green, a good first river for s.

we spent the night in asheville; katie and peter were gracious hosts. they have a cute appartment in montford, which was a short walk to downtown with plenty of room for us and our boats.

it took a while to get our table ready at the laughing seed, so we had some time to kill downtown. as you can see from this pic, we don't get out nearly enough.

dinner was, as usual, delicious. matt had the low-country roll-ups, which i had never tried.

we woke up to a delicious breakfast at todd's tasties which included this little gooey bomb made from day-old croissants mashed up with cinnamon, icing, pecans, and butter.

day two was the nantahala gorge. it's been a while since i've paddled the nanty, not a very challening, but it's a pretty run with a few nice play spots. the weather was perfect: 80 degrees and sunny. here's us ready to get on the river:

the mists rising up off the river were beautiful.

unfortunately, my camera got submerged in water after my pelican box didn't close properly. unfortunate, you might say, because it was a new camera. not so. i bought it with my mastercard with purchase protection. camera purchased 89 days ago (just under the 90-day window), so this little mishap shouldn't cost me a thing. although it looks like the camera is toast, i did manage to salvage my pics from my the memory card.

i have my first overnight shift at university hospital tonight. it's my first shift in a two-month stretch there.

i've spent most of the morning at the VW dealership. my first 35k miles of service were included in the purchase price of my car. they are taking a long time to get finished, but it's given me time to catch up on a few to-do items, as they have free internet here.

this afternoon, i'll be doing my long run. i took this weekend off, which is probably good for my legs. still trying to be concious about form, especially on long runs, in order to stay injury-free.