rainy day

i woke up in the middle of the night to the sound of rain falling outside my open window. it's been so dry here lately. finally, some rain and cool weather; i think it's finally time to plant that fall garden.

yesterday was full of projects that i had been putting off for the last 3 months in the fog of my work/run/eat/sleep routine. (see, no "projects" present in that sequence) liv bought some beautiful curtains for our house which have languished in the bike closet now for almost a month. with my free day yesterday, they finally went up.

where we live, curtains are more important than you might initially believe. see, our neighborhood is a cohousing community with passive and active solar houses, rainwater collection, and best of all, no cars. (ulysses can run all around the neighborhood off leash without fear of being run over)

living in a space with only pedestrian walkways also means that our neighbors are close and our windows large. this creates an effect that we lovingly call "the ant farm." when you walk by our neighbors' houses, you can see everything their doing through those large windows.

curtains. problem solved. here's liv enjoying (ahem, maybe not enjoying so much) studying for cardio, privacy courtesy of my project.

a quick trip to the local hardware store (less than a mile from my house, independent and locally owned), and i had all the materials i needed.

the long run went great. i didn't even feel tired after a solid 18 miles. philly, here i come!



after that run, i joined christina and neil for brownie sundaes at their house. it was supposed to be intern night, but we were the only ones that were free. it ended up being a great night. christina is about to have a baby any day now, and i'm grateful for the chance to sit down and get to know them one-on-one before the baby craziness begins.

this morning, there was a lull in the rain just long enough to allow molly and i to head out for a 5 mile (for me, recovery) run in the most beautiful weather imaginable.

training is going swimmingly, but there's one thing that's missing. vegtables. i recently read an article in the times commenting on how, big surprise, our entire country has a problem with this. now that our CSA is finished for the season,  it takes a bit of effort to purchase vegtables and prepare them creatively every single day.

i consider myself almost fanatic about staying in shape and taking care of my body, but i struggle with this. fruits are no problem. i can fill my lunchbox with fruit before a shift and eat it over the course of my 12 hours in the ER. it's easy to throw an apple, banana, plum, pear in my bag. a bunch of kale, not so much. i'm going to work on this in the coming weeks. it'll be a special challenge, as i'll be on the road for most of the next 2 wks.

last item of business: i finally found a guy blogger that seems like a normal person. i saw his blog on theshubox, because he and shu are real-life friends.

more projects today, including paperwork for my moonlighting job, and then packing and planning for our trip to the mountains.

day one

yesteryday, it was one of those sleep-all-day kind of days. today is pretty much wide open, but there are so many items on my list, i don't know where to start.

i just got off the phone talking with the medical director of one of the hospitals where i'm considering moonlighting. it could end up being a pain: it's in a place where i would never otherwise go, and it's a long drive.  but the money is great, and i have some free time to spare. will have to give this some careful thought.

in other news, a great piece in this week's economist comments on our late fascination with the constitution and how its wisdom might hold the answers to all of life's questions. [lexington is one of my favorite columnists] more later.

countdown

in exactly 2 hours and 20 minutes, i will have a month off. A MONTH OFF! i feel extremely fortunate about this. i guess i earned it, one residency already and now a second. the ABEM (american board of emergency medicine) allows trainees who have completed a prior residency 6 months of credit towards the usual 3 (or 4) years.

so instead of finishing 6 months early, i get 6 months of "selective" time. this year i'll take 3 of those months, mostly as time off. i can't think of any other job where i would actually get this amout of free time. unless i take a leave of absence, this probably won't ever happen again in my career. so i'm grateful.

after these first three months of residency, i'm feeling a bit tired, but the work hasn't been bad. i don't even mind the number of hours we spend in the hospital. it's really that there are so many other things that i want to turn my attention to: projects around the house, spending time with family and friends who live far away, reading for pleasure, spending more time with livvie.

i hope to make the most out of this time away from the program but not just filling my days with activities and projects. my intention is to recharge my mind and body so that i'm fresh when i come back to residency. i don't know how exactly i'm going to do it, but i plan on taking the next few days to come up with a plan.

today i spent a little extra time (when i was planning on running) taking care of things around the house, so i was left with slightly less time than i had imagined. what was supposed to be an 8 mile easy run turned into a super tempo 5 miler at sub 7 minute pace. it felt GREAT. the weather today has finally turned cool, and it's was lightly raining.

it's exciting to think that i can get performance improvements like this with better weather conditions. maybe i'll actually hit my goal at philly: sub 3:10 (boston qualifying time for me). looking forward to my 18 miles tomorrow.

hold the pork

i ended up sleeping most of my time between shifts today. i only woke up in time to get in a 2 mile run. this may not have even been worth it, but i feel like getting out, even for small distances, keeps my legs loose. will plan for a 8 miler tomorrow between shifts.

i'm currently on a shift with my program director as attending and one of the 2nd years that i really like, which makes work tonight pretty fun. it's also not all that busy, so i actually have time to spend with my patients (instead of hurrying through the interview and exam). uh, i guess i also have time enough to blog.

i got a reminder this week, in case i didn't need one already, to stay away from the carnitas. we see so many young, healthy males with neurocysticercosis, it's quite astounding. do not eat undercooked pork in latin america. better yet, don't eat pork at all.

 

another thing: why have i not seen any male bloggers out there. it's all women! if any of you know of any good blogs written by guys, i'd love to see them. they don't need to be the nfl, corn-nuts set, just anyone with a y chromosome. oh, and i discovered modg today. she's a pretty funny blogger, but again, follow links to other blogs and then more links, and all i find is women bloggers.

back on nights

i had a very solid 10 mile run yesterday. 7:45 pace, which i think qualifies as tempo. it was supposed to be an interval run with pickups, which are accelerations that last for a defined distance. (this is easy with the garmin, since i know exactly how far i've run at any particular moment) i've had a hard time motivating for this. i did a few intervals yesterday, but it's so much more fun to just run. next week i'll work on really making interval workouts happen. if i'm going to run faster, i have to do speed work.

i've got a large dose of rest and relaxation happening next month. first, liv and i are taking a 6-day vacation in the mountains starting next thursday. we haven't decided exactly what we're going to do, but i think we're going to bring the kayaks and bikes up to asheville and do some of both.

i come back from asheville and leave the next day for hawaii. i'm excited to see buzz and michelle and especially eve. this is what she looked like last september, almost exactly one year ago.

bet she's changed quite a bit. i can definitely hear when i'm talking to buzz on the phone that she's become quite a little talker.

we're also going to take on mauna kea again. we tried to get to the top from buzz's house last year and didn't quite make it all the way.

i know, it doesn't look like much from this angle, but it's pretty much a 14k ft peak that rises straight from sea level. and the route up is mostly large, jagged volcanic boulders; it's not just like walking up a path. so we're going to give it another shot two weeks from now.

organization

on monday when i returned from the BRR, i made out three large stickynotes full of items to be completed. how far did i get in completing these task? not a single one. maybe i was whole-body tired from the race or maybe i simply wasn't motivated. either way, monday was worthless in terms of getting things done.

for whatever reason, yesterday was a different story. i've been getting through my "to do" items like a champ.

example: i had this crazy idea that next month i would go to hawaii (to volunteer at the ironman championships and see my friends buzz and michelle) then go straight to sweden to a conference.  several problems with this plan. for one, i'm not all that interested in this conference. second, this is a ridiculous amount of running around and traveling, when what i really need is some time outdoors physically exerting or relaxing. third, this is going to cost $$$ for probably diminishing returns. lastly, my friend who i was supposed to see in sweden had some family stuff come up and won't be available for the time i'm there. bummer.

all this was remedied with a call to delta airlines last night. i extended my trip to hawaii by a few days and cut out sweden all together. i had to eat a little airline change fee, but i netted $400 back in the form of credit towards a new ticket. by getting home early, i get to go to the fall LEAF (lake eden arts festival) with my friends ian and brian. this will definitely be restoring to my soul after working like a resident for 3 months. (i know for the rest of you residents out there, it's not much)

today, thinking about what i'll be doing next month, i feel so much better. my best times traveling of visiting a new place have usually involved connecting with old friends or visiting folks.  now that my people are so scattered around the world, i feel like i'm losing touch with lots of you.  buzz and michell (hawaii), ian (nevada), brian (asheville): i'm glad we'll get to see each other next month.

in news from home, i got a new camera, which alllows me to take pics at night now (which didn't happen with the iphone). thanks, mom and dad!  i mean, the iphone gave it a good effort, but it just didn't do so hot in low light.

livvie and i went out to dinner with my "mentor," a 3rd year in my residency program, and her husband. it was a nice night at our favorite sushi place.

yesterday felt good to get back into a "real" run. my legs hurt a bit at first, but by the end i was feeling good. 6 solid miles through town. today is a harder workout: intervals and close to 11 miles of distance. then it'll be off to work for the night shift.

career update

these last 3 months have been way more tiring than i had thought they'd be. it shouldn't have been that bad: one month in the ER at our community hospital, then two months working at university hospital in our "home" ER.

the hours weren't, objectively, that bad: mostly 12 hour days, 5 days a week. ok, i know. for a normal person this wouldn't be tolerable. but i thought that i'd been acclimated to working crazy hours. i mean, didn't i used to take every 4th night OB call in santa rosa, staying in the hospital close to 30 hours straight? yes, i did.  i actually can't imagine doing that all over again. like one of the vans in the BRR this weekend (see below), i want to ask: what was i thinking?

this is definitely easier than my family medicine residency in that regard. for that, i'm grateful. there's the same lack of control over my schedule, which i think was the hardest part for me both the first and second times around.

i don't think i've ever outlined in a previous post where i'm headed with all this. recently, this has become much clearer after realizing what kind of environment i want to work in for the long term. it's been fun to be at this big university hospital: diversity in the types of people and specialities represented. overall, it's a good environment for learning. however, there's an element of depersonalization that can occur in such a big institution.  if my next job is at a big university hospital, that'll be fine. but i would be happy to be at a small place as well. (this assumes that i will always have a hosptial-based career)

my ultimate goal is to work as faculty at a family medicine residency program, teaching family practice docs how to be better at managing acute patients. ideally, i'd love to have part-time responsibilities doing inpatient medicine, emergency medicine and [maybe if i can stand it] a little clinic too. i'm still [mostly] a family doc at heart: i love the relationship-focused model of family practice as well as it's emphasis on  community health. that being said, my interest, medically speaking, is acute and emergency care. i hope to find a job where i can bring this all together in a neat package and continue to teach residents.

damage report

well, there's no true damage, but my legs are still aching from the blue ridge relay. despite the soreness, i got out today for a 4-mile recovery run today before work. my legs felt a bit rubbery at first, but after a mile or so warm-up, i started to feel loose and good. roughly 8 min / mile pace actually felt slow enough to be comfortable.

i have to say, team DWARP had a great weekend at the blue ridge relay. i'm definitely in for it again next year. one of the best parts for me was getting to cheer on my teammates and watching my teammates challenge themselves with the distance and the elevation gain. everyone gave it their best effort, and we ended up with a good overall time. we came in 19th out of 27 "mixed open" teams (combination of women and men) with a total time of close to 31 hours at an 8:55 average pace.

19

Mixed Open

Drinkers With a Running Problem

Chapel Hill, NC

30:53:14

08:55

12

yes, DWARP stands for "drinkers with a running problem." i wasn't crazy about the name at first, but i've grown pretty fond of it. if you're interested in seeing the rest of the results, they're here. there are lots of other great team names. here are a few of my favorites: "channel the goat", "scrambled legs and n' achin" (a five-person ultra team, DAMN that's a lot of miles with not so many people!), and my personal favorite, "pimp yo stride."

i'm just coming off 2 night shifts, and i'm super-tired. i'm going to be seriously ready for my selective month in one week!

back home

the blue ridge relay was a fantastic weekend. go team DWARP! i think ulysses would have loved to have been there, but there just wasn't enough room for a 65 pound dog in the van.

more about the weekend in a post to follow. right now i need some sleep in a big way. the breaks between my relay legs (which mostly involved driving and feeding) didn't offer much in the way of rest over the course of those 30 hours. in the meantime, here's a few garmin stats and pics from the race that i could throw together. a more organized description of the course will come soon.

courtesy of the garmin, here's some stats from the relay this weekend. i was so wiped at the finish of the legs, i forgot to stop the watch at the transition zones, so the total times aren't totally accurate.



i still don't have a proper camera, but here are a few pics from the weekend captured with the iphone.

Blue ridge relay: 208 miles, 36 legs, 12 runners, 2 vans. Done.

butternut squash risotto

we've had this butternut squash from our ecofarm CSA sitting in the kitchen for about two weeks now. unfortunately, i haven't had a day off in as many weeks, so i haven't had a free evening to cook a nice meal. i made this recipe that i got from shu's blog. these freshly-cut butternut squash halves were ready for baking.

here's the finished product with arugula and avocado salad. a beer from new belgium, of course, goes well with this meal.

i feel like i've been working like a dog lately. today is my last shift before the blue ridge relay this weekend. my teammates and i will be leaving early tomorrow morning, heading for grayson highlands in virginia.

homemade sushi

livvie made dinner tonight, an array of vegetarian sushi. it was delicious especially with that fat tire beer. thanks, sweetheart.

we loved our double date with shu and josh. luckily, shu uses a better camera than my iphone4, so her pics turned out better. (she may just be a better photographer.)

i'm running into a bit of a blogging dillema. i see so many interesting cases in the ED. i'm sure there's a great way to talk about them without giving away too much, but i haven't figured it out yet. if any of you have any tips, i'm all ears.

i haven't run for the last two days: monday was a formal rest day. then, yesterday, i got home from work and had to go straight to journal club, which ran until 9:30 PM. journal club was way more fun than i thought it would be. one of our attendings had us over to his house and cooked gumbo and bread pudding for desert. (sorry, no photos, figured i'd keep their names and faces private until a later date) everyone seemed so relaxed compared to when we're working together in the ED. only one of us was in scrubs! (i actually stopped off at home to change; i was feeling positively covered in MRSA et al [see previous post] and needed to clean up)

so no run yesterday either. that's ok. blue ridge relay is this weekend. my excuse for slacking on my training plan over the last week is that i'm doing a mini-taper for the race. i don't know if we'll be top finishers, but i would like to have a decent showing. i'm expecting my legs (especially the last 10 mile leg classifed as "very hard" to be, well, very hard).

a day of rest

i've been on 12-hour night shifts for the past 5 nights, which has been way more tiring than i'd ever imagined it would. this past week my days:

17:30 - go to work
06:00 - home, walk dogs, wash MRSA, VRE, XDRTB off body
07:00 - sleep
15:30 - run
17:00 - shower
17:30 - go to work

here's a pic of me doing what i did best this week:

notice there isn't time in there for things like cooking grocery shopping, laundry, or any other of those household essentials. i realize that most surgeons have a lot worse of it than I do, but for me, this is hard. i don't know what i would have done without livvie to help make sure that i ate properly and had clean clothes and that the dogs got reasonably cared-for. thanks, sweetie. without liv, my life would have unraveled considerably more than it did.

when my string of shifts finally did come to an end, we had a great dinner out at milltown with josh and sarah. (and ulysses) the food, beer and the company were superb.  i had worked with josh on a few cases in the hospital and had enjoyed my professional interactions with him.  i had only communicated with sarah on the internet through blogging, so i didn't really know her personally. we found that, not surprisingly, we all have quite a few things in common.

playtime

our neighbor has a new puppy. bubba loves to play tug-o-war with her. endless entertainment post-shift available right next door.

date night!

on my one night off this week, instead of runinng around getting various and sundry items accomplished, we had a lovely date night at our favorite sushi place in carrboro, akai hana. i dare say that this place rivals any snooty sushi joint in san francisco or LA that i've ever tried. i was a bit put-off, however, when i noted that the wait staff were mostly latino men dressed in kimonos to have them resemble folks from japan. despite this, the food tasted just as good as it always does. 

lessons learned

had a lovely night at greg and house last night. they had a few of the neighbors over for dinner. bummer i had to cut out early to go to work (which meant no wine either), but it was nice to have a tasty dinner and good conversation during two of the four hours i was awake and not at work.

i learned a few important lessons over the last twelve hours that i would like to share:

1. do not go to the grocery store after an overnight shift - if you work nights, resist the temptation to stop by the grocery store bleary-eyed on the way home. at least for me, this doesn't work. i tried this morning to stop at weaver street to buy some items for our labor day picnic (which will be at 5 pm tonight), and it didn't go so hot. my mind was not working on properly at all; every time i tried to buy something, i couldn't decide (or remember) what i wanted. i spent a long time wandering up and down the aisles and not accomplishing very much. uh, and being out at weird hours puts me (and maybe you) at risk of seeing patients that i've just discharged from the ER.

2. "don't go hopping down that bunny trail, it leads nowhere good." this is courtesy of lisa, the awesome 2nd year that i worked with last night. i actually have no idea what this means, in general. in context this morning, it's meaning had something to do with a tangential presentation by a medicine intern signing out a patient. either way, i'm going to have to use this line again sometime.

ok, gotta get some sleep before enjoying labor day evening lawn games.

the wilderness downtown

last night was busy in the ED. i would have thought that folks would try to stay out of the hospital on a holiday weekend, but i guess i was wrong. even when i left at 7 AM today (usually a fairly quiet time of day), there were still patients in the waiting room.

this is my rest day (the day after my long run), so no workout today. my legs welcome the time off. i'm spending the two free hours i have filling out paperwork to get credentialed at a small hospital about an hour north of me. this will allow me to make some extra money during residency, since my pay has dropped quite a bit since quitting my "real" job. i'm really dragging my feet filling out the paperwork. it's hard to imagine doing MORE work now. this past week has been extremely tiring, and i barely have time to eat and sleep, much less work more.

mostly, the extra work will happen during the 6 months that i have off. (i got 6 months of credit for having previously done another residency. i have these six months as elective time where i can do things i want, like moonlight)

ok, i've got a little less than an hour to fill out this paperwork before having dinner with a few of my neighbors. (then off to work)

in the meantime, you should check this out. i'm not going to try and describe it, just take a look:

http://thewildernessdowntown.com/

eat sleep run

worked the night shift last night, so i slept until late today. woke, ate, took the dogs out, and ran my 16 mile long-run. now it's time to go back to the hospital and do it all over again.

the long run was a bit slow because it included a few water stops that were on the clock:

gratitude vs tiredness

today was my first day off this week. i didn't do much. spent most of the morning sleeping and trying to coordinate meetings with various folks. i guess i remember this being difficult the last time around (ie, my previous residency), but this week i'm acutely feeling being busy and tired all the time.

we're taking care of livvie's parents' dog, ramona, for the next two weeks while they're on vacation. it's a pretty easy gig, but she does like to bark quite a bit. this can usually be remedied by placing her in a room where she can't see people walkign by. earplugs have been helpful as well.

here's the two pups at the top of the stairs last night:

perhaps it's not just work that's tiring me out this past week. my mileage has increased to 4/7/8.5/0/7/5. it didn't look like a lot of miles there on the sidebar of this blog, but SHOOT, my legs were tired this week. i'm working tonight, and tomorrow is my long run. hopefully i'll be able to pull the energy out of somewhere to get that done. i just have to keep thinking to myself: it doesn't have to be fast, just get the miles done.

livvie is gone this weekend at the beach. i have to work the whole weekend, so we wouldn't have seen much of each other anyway. having to work the entire labor day weekend has also made me feel acutely the loss of attending-dom. now (again) i'm just another intern who has to indiscriminately work holidays and weekends. but before i start feeling too sorry for myself, let me remember:

• i love my job 
• i work with a fantastic group of people 
• i have a loving and supportive family 
• liv is great
• i have a great group of friends (and the bubba)
• i live in a fun town where it's easy to run and i can bike to work!

nothing like a little gratitude to stomp out feeling sorry for one's self.

and i shouldn't feel too bad about having to work the whole weekend. i have friday through sunday of next week off to run the blue ridge relay. we had our first team meeting at the station last night over beers. i didn't know most of the team, but they seem like a great group of folks. we even came up with our official team name: "the tarheel crunk posse."

ok, i'm going to grab some dinner at weaver street market before heading into work. hope everyone has a great labor day weekend. please try to stay out of the ER. it would be better for both of us that way.