First Marathon

I competed and finished my first marathon this past weekend, April 3, 2011.  It took place in Athens, OH on a really flat & “fast” course (the serious runners use this race to try and qualify for Boston).  Race day was great, bright and sunny for most of it with the air temp in the low-40′s to start then warming up to the low-50s by the time I finished.  I ran the whole race in long sleeves with a vest (go Old Navy!).  I probably could have gotten away with shorts for the bottoms, thought it would have been a bit cold in the beginning.  I packed way too many of the energy chews into the vest pockets and wound up only eating about 1/3 of them.  I also ate a bit too much oatmeal in the morning, my enthusiasm for the pre-race last minute carb loading had me making twice the normal amount of instant Quaker Oatmeal than normal.  The night before, I had mac and cheese, mashed potatoes (took it easy on the gravy due to salt), and a fried egg at the local diner in Athens, OH.  The next morning, the cheering duo made their way to the same diner for what I hear was an amazing meal of pancakes the size of a large plate.  The race was well stocked with drink stations every 1-1.5 miles or so, the Gatorade was surprisingly strong (straight from the bottle without dilution) and I actually got somewhat more thirsty drinking it.  I drank half water, half Gatorade during the race.  The first half occurred easy, almost too easily I realized as I started the second half.  The last 6 miles of the race were the longest miles I’d ever run.  In the future, I think I would make that “long run” in the training schedule closer to 24 miles instead of 20.  At any rate, I struggled through the last quarter of the mile with a lot of help from fellow racers.  The daughter & mom team – mom paid for the half marathon & met her daughter at the marathon halfway mark to run the second half with her together for moral support.  I “paced” myself with these two for a good portion of the second half.  Also, there was “J”, a local, who was running his 30th anniversary marathon in the same race as his first.  He was all about the slow and steady.  There was also two guys I met near the end, “Finish Strong” and “Glad I’m not driving back home”, thanks for the pacing & encouragement!

At any rate, the past 4 months of interviewing, training, and talking about running this marathon have all come to a nice close.  It’s strange to think that I decided to run a marathon back in early November, picked out this one and started on the Hal Higdon training schedule.  It took me closer to 22 weeks to train for this, I purposefully built in a two week “break” around when I would be home in MN for winter vacation – the thought of running outdoors in sub-zero temps & wind chill just did not interest me at all.  I’m really glad that I did this race and all the training for it, though I definitely didn’t train as hard as I should have and probably would have finished faster with some minor modifications to the training schedule (i.e. slightly longer “long run” & more mid-week run consistency).  Either way, I’m really happy and proud for having set this goal and achieved it.  I’m also really glad I got that post-race steak & smashed potatoes at J. Alexander’s!

The day after the race, walking down stairs was a feat unto itself.  I had a lot of help from the railings.  Going to work that night, it really didn’t occur to me how big a feat training for the past 4  months had been until I thought back on when I started this training schedule and all the long runs I did along the way on the interview trail.  There was Seattle after which I got a bad cold, Phoenix with the creepy canal path, NYC & two loops around Central Park plus buying a hotdog/Gatorade combo, San Diego with the ocean  & warm weather, and the 1-2-1 treadmill on the second floor (this thing weathered the 15, 18, & 20 mile training runs).  I’ll also remember how I couldn’t sleep the night before Match Day and  wound up running my 20 mile training run at 5:30AM, Match Day/St. Patrick’s Day at 1-2-1 having dragged a dear friend out of bed who was training for her 5k.  I went to Match Day, really energized :0)

It’s been a really interesting year for me, between the away rotations, applying for residency, & interviewing all with this marathon training rolled into it.

How I Survived the Last Five Years Without a TV

For anyone who’s ever held a brief conversation with me, it’s pretty apparent that I have a strange knack for pop culture factoids and a general interest in celebrity gossip.  Also apparent is the fact that I know a lot about the latest plot lines of primetime and daytime TV shows.  I’m that person who always gets the comment, “You must watch a lot of TV”.  From the outside, it would appear that I’m probably the person with the premium HD cable plus DVR package hooked up to my extremely large, flat screen LCD who spends a large chunk of her free time getting information from this “visual feed.”

The truth of the matter is, I don’t own a television and haven’t for almost five years now.  All of my TV watching is done either in the living room of friends’ apartments or during dinner on the 12” CRT in the kitchen that I share with my landlord.  The total amount of time actually spent “watching” TV in either of these two traditional formats takes up less than about 5% of my life – which when you factor in medical school, studying, sleeping, imbibing, and more medical school seems about right.   So how does someone like me “watch” TV these days?  Simply put, the Internet.

The internet has been an amazing tool for those without the necessary monetary funds to watch, stream, download, or have recapped the most recent in television episodes and day to day news.   The best part about the internet is that you can fast forward at will (like DVR w/o the box) to watch only those scenes or bits you care about.  Youtube with all it’s participants who clip scenes from TV shows and movies also make it easy to find and watch only those parts I want to watch.  But more importantly, for someone as impatient and with a short an attention span as me, the internet has also allowed me to “watch” TV in the most ingenious way possible – by reading about it.  In a truly bizarre twist of using the visual sense, most days I process what’s found on broadcast or cable television by reading or more accurately skimming articles about it.

Some would say that I’m not really experiencing this visual media as it’s meant to be, but I tend to disagree.  While there is credence to the argument that by reading about TV shows and episodes, I’m essentially reading about someone else’s experience of traditional visual media.  I’m “second hand” experiencing TV.  Despite not experiencing this first hand, I don’t think this diminishes the

First off, I’m notoriously impatient and attention deficient for more than 45 seconds at a time.  Little things catch my interest and quickly my mind wanders into a tangent.  Actually watching television for me can be excruciating since plotlines play out in “real time” over the TV complete with commercial breaks and writers trying to develop characters or create anticipation and suspense.  When actually watching a physical TV, I tend to watch three shows at once, skipping between them during commercial breaks or scenes with characters I don’t care about. [As an aside, when I was a child I firmly held to this belief that shows on odd and even numbered stations broadcast commercials at alternating times, thus allowing one to watch at least two shows at once – don’t ask why I believed this.]   Anyone who’s ever let me have control of the TV remote quickly develops a need for Excedrin migraine medication and a need to regain control of the remote for the sake of their sanity.

So how does “reading” about TV work for me?  Well, I read a lot faster than I can “watch” TV.  By reading, there’s the ability to skim information after a short and quick perusal, without losing much information with the added speed.  With visual media, the “skip ahead 10 seconds” mode isn’t as smooth or coherent as skimming in reading and I find that more often than not, there are certain plot points that I miss.  Playing things on 2x or 4x speed is another option, but the way that voice frequency is increased when the visual play speed increases bothers me to no end.  In the end, it’s still reading/skimming that’s the fastest way for me to gain the information I need to know/care to know.  If it sounds interesting and I want the visual cues, I’ll go back and watch the entire episode – usually skipping at 10 second intervals at a time.

Book tours: complications, better, the checklist manifesto with family thrown in

Atul Gawande was the recent guest speaker for the Cleveland Clinic Foundation’s “Ideas for Tomorrow” lecture series.  My personal reservations and outright shock that anyone would think the CCF a “model for healthcare” aside, the Clinic does manage to get some interesting and big name speakers to come talk for free in Cleveland.  As a student on a budget, I really do appreciate how the CCF is spending its own money to pay for these speakers and put them up in one of two on-campus hotels all in the name of refunneling their profits to remain a “non-profit” entity who won’t pay property taxes.

All things aside, Gawande, while an articulate and interesting speaker, had a hard time actually putting together a coherent theme for this talk aside from the umbrella topic of “healthcare” and all the ornaments attached to it.  In many ways, it was a bit disappointing as he basically talked of themes previously rehashed in all three of his books with minimal transition and then spent the last half of the lecture on a book tour to promote his latest, “The Checklist Manifesto“.  Gawande touched on the various problems ever constantly regurgitated by popular media and political pundits including how to build a better and more efficient healthcare system, how to go about providing better healthcare, how to pay for healthcare, and how to fix the lack of relationship between quality of care vs cost of care.  Gawande offered nothing new insight or opinion wise on any of these topics, unfortunately.  He ended the talk with on a personal note, detailing his roots to Ohio (his family is from Athens, OH) and his family’s own recent struggles with disease.  Gawande stated that he hoped he and the healthcare industry could do justice to the millions of current patients like his father and to provide for better healthcare to his children in the future.

Gawande’s latest book details how the concept of checklists can be used in seemingly complicated and dynamic systems (medicine, aviation, nuclear reactors, etc) to increase safety.  Gawande and the WHO are working together to implement OR safety checklists into everyday operation in all hospitals.  From their pilot studies and from independent smaller studies, research results indicate that having these checklists have decreased patient mortality and morbidity significantly and are applicable to both third world hospitals and academic research powerhouses of the Western world.

The most interesting part of Gawande’s talk for me were the three slides he used to detail how the OR safety checklist came about.  It’s an adapted system from the aviation industry and the key points to it are 1) identify problems within a workflow, 2) identify “pause points” where checklists can be implemented to prevent/avert crisis, 3) trial a checklist, 4) revise the checklist, 5) repeat.  Checklists are more than just “how to” steps, they can also be used in a way that makes clear each persons role on a team.  As anyone who’s worked in groups can attest, teams that work the most efficiently aren’t necessarily those with the smartest individual members but are instead those groups where each individuals roles are clearly delineated and members do their jobs.

To illustrate the utility of checklists, Gawande told the story of US Airways flight 1549 that Captain Sully Sullenberger safely landed in the Hudson Bay without casualty after both the jets engine went out due to Canadian Geese.  Sullenberger and his co-captain had never flown together prior to that flight, however per FAA regulations during the pre-flight checklist, all the gathered flight personnel went through and listed what their roles would be should engine failure occur.  The co-captain would be responsible for running through the necessary steps in order to get the engine back online (via a checklist), flight stewardesses would be responsible for maintaining calm in the cabin & reiterating safety instructions, and Sullenberger would be free to do the most important thing – fly the damned plane.  When the engines went out, each member of the team went on to do their respective jobs, allowing Sullenberger to not worry about all the other little and big things so he could concentrate on landing this “brick” on the water.  Gawande stated that this story reiterates the importance of checklists, running through each team members roles during crisis situations, and how this tool can be used in a very dynamic and complicated system.

Gawande likened the use of OR and other medical checklists as cost decreasing tools that should be used to avoid or reduce “critical events” in patients – anaphylaxis, shock, wrong medications, hospitalization, etc.  He admitted that the biggest obstacle with checklists is getting medical professionals to buy into the idea that an extra 3 minutes up front will ultimately mean a significant decrease in problems down the line.  As a medical student who’s seen this “time out” procedure in action at the CCF, private and county hospitals in Cleveland and elsewhere, I can attest that it’s not just the attending surgeons who complain and balk at it, it’s everyone from the scrub techs to the anesthesiologists to the residents to the person in charge of doing the “time out.”  Medicine’s greatest hurdle to the checklist is the same as it’s been for the introduction and adoption of any new process – it runs counter to “how things have always been done”.

My preceptor in family medicine told a story of how as a resident in the early 1990′s on a surgery rotation, he was reamed out and yelled at for marking the patient’s site of surgery with a Sharpie.  Today, marking the site of surgery is required by JCAHO for patient safety.  This preceptor is also someone who’s already implemented and used the concept of “checklists” in his primary care practice with great success.  He has checklists for various chronic diseases that he runs through during a “health maintenance” visit to make sure patients are optimized medication, lab result, and social situation wise for their given disease.  He also has these patients come back at regular 1-3 month intervals where is runs through this checklist again to make sure they haven’t fallen off and are up to date still with the latest in evidence based medicine.  Some people may balk at the idea of seeing their GP every few months when “there’s nothing wrong” and call it a waste of money & resources.  However, having recurrent visits with the same patients for their chronic illness is also a great way for GP’s to provide motivational interviewing and counseling  on a regular basis to help patients make the necessary steps that are the hardest to do but could potentially save their lives (losing weight, quitting smoking, starting exercising, dealing with various addictions, etc).  Seeing patients regularly and tracking their labs and vitals with each visit is also an important way for any GP to be able to spot trouble before it becomes a crisis.  I’ve seen him diagnosis early stage renal impairment while still in a reversible stage due to his systematic monitoring of the patient’s hypertension and Cr levels.    He’s also diagnosed a recurrence of prostate cancer in one of elderly his patients after seeing a doubling of PSA (despite being within normal limits) after many years of steady state low values.

For this preceptor, he’s found his own way to utilize the idea of the checklist in a very dynamic and ever-changing healthcare environment for, what I believe, is the betterment of his patients.  I think in the long run, as the inertia is overcome, more and more of the medical field will take to the idea of the “medical checklist”.  I especially hope this is the case with my generation of doctors who will be trained under these “new ideas” and guidelines.

Check, Check, Checklists

Life as I know it … so far

I started posting and perusing again recently (i.e. today) on this blog.  In looking back at the older posts, it surprises me how much I’ve changed and yet how little I’ve changed.  There are blog posts about my poor time management skills, staying up too late & sleeping past noon, failure to get to the gym, and conflicts with what my parents want vs. what I wind up doing.  All of these themes still hold true … and this more than 4 years after the fact!

The one that always makes me laugh/groan is the parental vs personal ideas conflict.  I pointed out to a friend the other day that this is an ongoing theme in my life and comes to a climax around the time that major changes will occur in my life.  The interesting thing isn’t that my parents and I disagree on the major decisions (e.g. engineering, medical school, residency specialty), we disagree on the things I want to do in relation to these big events (e.g. where I’ll go on vacation before medical school, which medical school I’ll attend, which residency programs I’ll rank higher vs. lower).  You’d think that at 26, my parents and I would either figure out some common ground or both recognize that we should just all agree to disagree, since that’s what always happens, but in reality we just do this dance every 4 years or so.

The major change I’ve noticed from the last time we did this is that I am a bit more cognizant of their feelings regarding the situation, but that doesn’t translate into me actually putting their concerns before mine or doing what they want me to.  I know, I’m a selfish, selfish only child.  It’s the way I’m hardwired.

Other changes/non-changes over the last five years …

1) I’m still really annoyed at people who complain all the time.  Either do something to change the problem or keep it to yourself after the third time already!

2) I’m less and less patient with other people and inefficient systems in general.

3) I’m definitely forgetting how to be “normal” and social in that “normal” sort of way.  I have no idea if this is just the by product of medical school or all of those elementary school socialization class lessons have worn off.

4) I’m a lot more jaded than I used to be.  This is probably a good and a bad thing.  Good: my naivete that a “life changing” event will occur to point the way for me has passed; life really is just a series of events/choices/happenstances that you go through one day after the next.  Bad: it’s a lot harder to see the joy and greater good/higher purpose of people and events; it makes it really easy to get lost in the grind and have your life pass you by (I really do worry about this).

5) I continue to feel adrift and not entirely sure of myself, what I’m doing, if I should be doing it, and how I got to be here.  This will probably be a life constant, pretty ironic really.

Life, Grind, Blah

Match Week

Today is the official beginning of what is known as “Match Week” for all US senior medical students and FMG’s seeking NRMP residency positions.  For friends and family who’ve talked or stalked me these past few months, this is the week you’ve all been waiting for.  The culmination of several years of hard work and all that travel early on in the year.

Today, I found out that I had matched!  (happy dance!!!).  On Thursday, March 17, 2011 (St. Patrick’s Day, no less), I will find out where I am to spend the next 7 years of my life in neurosurgical training.

For those who are interested a general breakdown of Match Week schedule follows (most of it lifted out of the official email sent my the NRMP last week).

Monday, March 14, 12pm Eastern: applicants receive their “Did I Match?” information

Tuesday, March 15, 12pm Eastern: the “scramble” begins

Thursday, March 17, 1pm Eastern: US medical students find out where they’ve matched (or scrambled)

Good luck to everyone!

Learning the ABC’s again

Since most of my heavy duty med school related rotations are more or less over & due to the excessive amounts of traveling I’ve done the past several months, I’ve had more time to read.  I was recommended this book “Bad Science” by Dr. Ben Goldacre from a FM preceptor.  I enjoyed it quite a bit, but there were points that I did disagree with.  Despite this, Dr. Goldacre presents a really easy to understand style of writing for the lay person and medical professional on how to assess “medical research” and sheds an interesting light on the fabulous distortions (confabulations) that occur when the media “reports” on said research.

http://www.amazon.com/gp/product/0865479186?ie=UTF8&tag=bookdroidweblink-20

Athens of the south

For Nashville’s centennial celebration, the city had a scaled replica of the Athenian Parthenon built for he “Athens of the south.”  It is the only replica in the world!  Having seen the real one several months ago, it was nice to see what the frescos would have looked like on the outside – depicting birth and death.