Tag: mountains

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Sutures, C-sections, and Bowties

HELLO. Thank you for reading – it’s been a minute (Months? A year?). Since the start of the pandemic it’s started to really sink in just how allusive the human conception of time is. Scrolling back through the log, it looks like there is mention of a race and there is a clear absence of cloth over my face in a public venue, and it looks like summer…so we’re talking at least a year. Well – what a year it’s been! And what better to do on a Sunday morning (it could honestly be any day of the week the salience of time has been abolished) as a 4th year med student, with residency interviews completed and my application submitted, than to digest, reflect, and verbal (is it verbal if it’s written?) diarrhea the product of this exercise for us to enjoy. How’s that for a damn sentence. I’ll spare expounding details of current events other than to say maybe the rapacious nature of late-stage capitalism did not, in-fact, prepare America’s public health infrastructure for a global pandemic. And maybe, just maybe, America could have a little less police-state and a little less prison-industrial complex, and a little more reparations for its most exploited minorities. Maybe. Who knows. I digress. Let’s start a few weeks after my last race.

One of my best friends got married last fall. I was a groomsman. It was awesome. And there’s something to be said about a Lutheran wedding service, even from the perspective of an atheist (I’m digging this term ‘optimistic nihilist’ however – it at least alludes to spirituality and using the term makes me sound like a smug jackass, so it’s right up my alley). They are quick. And there’s nothing more enticing to an infinitely distractible mind than a short ceremony, punctuated with actually funny commentary from the priest.

It’s difficult to write, sometimes, when there is an audience. Even if it amounts to the dozen people subscribed to something I update apparently once a year. It can sort of unconsciously change the flavor or the content of what I put down. Or very consciously change it. Though I will say, there are as many parentheticals in my written private journal as there are in this. So, I clearly do just make myself smile at stupid ways of writing all the time. But I will write, even if it requires some deconstructing heterosexual norms, that I love my old friend Eric and was elated to be in his wedding. And of course I love his wife too. Hell, if the only thing I knew about her was that her first reaction to watching him break his wrist on a basketball court was to laugh, I would be sold. There’s a solemn happiness to see one of my oldest friends be happy. An appreciation of other people’s joy not sown unless you develop just a modicum of maturity, which hopefully now being much closer to thirty than twenty (!) affords me.

As would be expected of (I was going to make a snarky comment about how my generation doesn’t know how to tie bowties, but who the hell actually does?) a group of twenty something, midwestern, largely middle-class men, none of us had any idea how to tie these freaking bowties. YouTube to the rescue. Mine was in fact tied for the ceremony by yours truly, along with everyone else’s seen in the photo – about 10 minutes before we headed out to take pictures we were already late for. This wasn’t the first time I had seen the internet employed to learn techniques requiring some level of dexterity and precision in a time sensitive situation – it’s not uncommon to see this being done by med students and residents before entering surgery. How else would I have had the skills to suture c-sections in the OR during my OB rotation the month before the wedding? Tying bowties became a cakewalk.

 

Fast forward a few months from this wedding. I had a sort of epiphanic realization that changed my career intentions in medicine, earlier this year. Rather than try to (re)elucidate all of the points I’ll just copy and paste them here:

TL:DR Changing career pursuits, and I like sleeping in. Eat your damn fruits and veggies. But impossible burgers are also good on occasion. 

Slushy start to the morning which I had off of clinic. Wanted to do some strides, but, where tf am I supposed to do those when the consistency of every hard surface is that of the frozen pop you get at movie theaters. Wait, do you adult age people still buy those? Am I the only one?

I took the morning off of clinic to meet with one my attending surgeons I had during my surgery rotation to go over career planning. How to get into surgery programs, doing research, all that stuff. And as I’m writing this – I’m coming to terms with the fact that it truly isn’t for me. Or at least, not enough of me to justify it. I think because I came into medical school thinking, hell KNOWING, this is what I wanted to do, I was able to find endless reasons for why surgery was better than medicine. And found countless reasons why, even though I absolutely loved medicine, and peds, and now loving primary care, that surgery was still the career I wanted. I blinded myself from the fact the residents I worked with during surgery were constantly tired, had some interest in teaching but were too busy with operations and consults to actually do it, consistently staying late, taking crazy call, and overall living a lifestyle that was just not compatible with longevity. Don’t get me wrong, all residencies are difficult. All of them require long hours. But operations are long, the length of cases range from unpredictable to down-right ridiculous, and the early mornings, are well, ungodly early. The nights are long. The sleep is nil. I saw it all first-hand and still, I was (unconsciously) desperately holding onto my preconceived notion of how sexy the career was.

It really isn’t.

Yes, absolutely, removing tumors, saving lives after trauma, it’s. awesome. Totally badass. And wonderfully exciting. And so far from the routine of any given day, that thinking I could justify a 7 year residency averaging 80 hours of work every week to do it is unconscionable to me now. After two weeks working in primary care, I can no longer really deny what really motivates me in medicine. It’s not taking lumps, bumps, and organs out of people. It’s utilizing learned medical knowledge, both from school and my own about nutrition, as well engaging in people and having active role in either saving and/or changing their life. It’s teaching. It’s finding meaning in my work and knowing I can advocate for things that are for the betterment of the health of my patients and the planet. I see every opportunity to do all of that in medicine, with less training, better work-life balance (I know it’s a cliche phrase but fuck it it’s true), better relationships with colleagues and students, and a deeper connection with patients and their families.

And every minute of my personal life, every curious fiber in my body, even all the interactions I’ve had with friend and classmates, lends itself to this realization that should have been obvious to me well before I started even medical school. I have talked more highly of the ICU than I ever have of the OR. I run and exercise, (a lot, duh) and know that lifestyle and nutrition are the components to actually getting people and their families healthy. I have listened to thousands of hours of podcasts on how diet can treat, prevent, and even reverse essentially every chronic disease across the world, while simultaneously making the planet healthier and saving sentient animals from rape and murder. I have had patients in both medicine and pediatrics that I’ll never forget due to the relationships I formed with them, yet I can’t remember even the name of a single one of my surgery patients.

And most of all, my personal story is wrought with reasons to pursue medicine. Overcoming binge-eating disorder, managing my stress and anxiety, changing my diet, these are all things that I did to (firstly, not kill myself, bye-bye binge eating) in order to achieve and pursue longevity in my life and career. The opportunity to help share in that experience of positive, scientifically based growth in people’s’ health and happiness is afforded by a career in medicine, not surgery.

Few things get me fired as much as talking about medicine. I’ve had quite a few conversations (including this morning thank you Mike Koski) where I’ve tirelessly monologued (this is not a real word but fuck it) about nutrition, medicine, and the horrid state of the american healthcare system. Why I hadn’t taken these countless conversations as signs of where my true passion lies is beget in my stubbornness and the all-too-human experience of believing whatever the fuck we already believe, even at the (almost!) expense of letting it dictate our entire career path. In the WRONG direction.

Perhaps I’m just fickle (this is absolutely true, I just hope not in this instance), or perhaps I just enjoy the work hours more (this is also absolutely true and is in no small part playing in this decision), and maybe I’ll regret this later on. But my highest potential as a provider will not come from being a surgeon (if I ever had the intellect or capacity to get into a program anyway, which is very doubtful). If I ever have power as a physician, it will come from my love of medicine, science, nutrition,  and being a force for positive change in my patients’ lives.

This was very much a ‘stream of consciousness’ thread I wrote on Strava in January, writing on the fumes of endorphins following an undoubtedly wonderful (read: fucking freezing) Flapjack Friday run with my teammates whom I miss dearly. I spent much of my younger adult life planning on being a surgeon…so it’s unsettling (read: existentially terrifying) when those best-laid plans change seemingly overnight. The short of it is: I’m applying to internal medicine, and I really love the ICU. For the non-med folks, those are all your docs in the hospital treating the sickest COVID patients, among others. It’s a privileged place to be in medicine, at the intersection of life and death. Perhaps only second to the ED (I thought about that too) is that intersection so chaotic as it is in the ICU. Pulmonary/Critical Care is a 3-year fellowship after a 3-year residency. But if there’s anything I’ve learned in my 3 years of med school (hopefully more than just this), it’s that I LOVE the damn hospital and I love taking care of really really sick people. 

 

I would be absolutely remiss to talk about friendship and not my mention my most serendipitous one. You could run through all iterations of every timeline in the universe and I guarantee you only get this result once. Acquaintances (enemies?) in high school from polar opposite social circles, re-introduced as a result of her reading this blog, and an impossible instinct to realize compatibility in friendship. Her offer for a friend-date two years ago turned into a 6 ½ hour conversation and immediately we became the most boisterously loud, obnoxious, painfully hilarious, and disturbingly dark people in any and every environment we’ve found ourselves since. Another best friend in my back-pocket. You couldn’t make it up if you tried.

I travelled more this year than I have any other year of my life. By plane no less. Not ideal during this time but when Uncle Sam pays for your school (and hotel and food and car) you do what you’re told. First made my way to San Antonio in June for 6 weeks of…training? Sitting on my ass and watching lectures in a hotel room? It’s a blur – and justifiably so. My brain was more or less non-functioning having taken my boards the day before I left for Texas. At least I was paid very well. Anyway, I came back in July, and began interviews for residency spots across the Army via zoom. I hate interviews. There’s nothing like trying to ‘sell yourself’ on a computer screen when you already hate the very essence of ‘selling yourself’ to begin with. I would be more comfortable selling my damn body. But they went fine (I think? Hope?). Intermixed with those interviews were school rotations, and two, one-month rotations at my top choices for residency. First in El Paso (I got choked up reading another horrific article about the situation there just yesterday) and then in Tacoma. I love the mountains, and I love the idea of a small program. 4 years of undergrad and 4 years of med school at the U, and I think I’m ready to not completely blend into another sea of bodies as a doctor. El Paso and Tacoma have both mountains and small programs. But the Pacific Northwest, and the west coast in general, is incredible. As I anticipated it would be. But somehow my time there beat even those expectations. I was hooked. In about 5 weeks, I’ll find out if I get to enjoy my residency in Washington. While having basically no time to see or explore any of what I enjoyed out there spending 80 hours a week in the hospital…I shoulda stayed in the restaurant biz…

I’m spoiled to have made friends that planted themselves all over desirable places to visit in this country. Lucky me, Tacoma provided weekends off and I was blessed to have my own personal tour guide to Portland and the PNW. There’s a preternatural ability my friend Courtney possesses to express views on, well, anything that resonate so profoundly that, whatever the idea may be, just clicks. And I can say unequivocally no one I know has more warmth and genuine compassion for the human condition than her, and it’s not even close. A source of infinite inspiration as I try (and fail) to match that level of empathy. Usually working in (American) healthcare forces you to trade your initial desire to heal for callous cynicism. But much like the “adults” that told me I would trade my liberal ideology for conservative “realism” as I grew up, it seems time has only strengthened our resolves.

 

I got back from Washington, and immediately I travelled for me. I was on vacation all last week – I went to California to see two of my closest friends in the world. Probably the least advisable thing one can do in the middle of a pandemic is to get on a plane for leisure…after spending most of the summer flying already. It’s hard to justify. And I think in different circumstances it would have been a no-brainer to stay home. But as competent as I am in my ability be alone, it’s exhausting as a non-voluntary exercise. And honestly a little precarious when you live alone with a history like mine.  All that’s exponentiated when, between classes, board exams, prepping for interviews, rotations, and applications, I haven’t had an opportunity to give myself more than a weekend off in two years. Practicing isolation is not a lifestyle, and I wanted to change the weather on my terms for the first time in too. Damn. Long.

I almost feel bad that I’m including Mollie in a frame that also contains this monstrosity (marvel? marvel.) of a moustache, but I couldn’t pass the opportunity to self-deprecate and there’s no way even appearing at her sister’s wedding would have forced me to shave. On principle.  No matter how many times life puts me in a position to be with one of my oldest friends in their time of need (while still able to provide ME sound reassurance and advice during such times) I will never repay my gratitude for our friendship. And for tolerating our near-death tandem bike rides…suffice to say, I  couldn’t imagine a better confidant or friend.

 

It was worth it. Of course it was. It would have been worth if it meant never seeing the beach or the mountains or the sunshine (I did all of those things), or just being present through my friends’ heartbreak or anxiety (I did those too). The company of friends far exceeds any visual aesthetic or adventurous journey I could conceive. I don’t know how or why I’m so lucky to have so many friends to lean on for insight, learning, and just plain fun. I’m spoiled rotten to have the friends I keep, and I can only hope that whatever constellation of factors that makes my friendship tolerable to them is maintained for as long as I can keep it. And wish I had more space (and brain energy – I’m such a slow writer and thinker) to include all the other wonderful people that I owe everything in my life to. 2020 can suck a fat one for a whole host of reasons, but I’m interminably grateful for my friends to help me enjoy so many bright spots in an otherwise god-awful shitty mess of a year.

I spent my last four days in California with my oldest friend Rebekah. At this point over half my life (!) I’ve had an indispensable best friend – always able to pick up right wherever we left off. We literally did whatever the hell we pleased. Mountains, beaches, fancy Italian food, burgers and malts, car jam sessions, conversations ranging from bullshit to poignant and real, you name it.  I feel…weird, even guilty (almost), to have had so many highlights in a year that really, truly, sucks. But I also know that I’m responsible for an infinitesimal amount of what happens to, for, or against me. I do not deny the insanely privileged life I live nor take it for granted, but I also do not renounce it. I’m (mostly) just along for the ride.
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From Denver, with Love

MDRA 15K August 5 2018 (57:31) and Pike’s Peak Marathon August 19 2018 (5:38:31)

My summer hiatus apparently wasn’t limited to just school. It’s been a while. I’ve missed this. I could pull many excuses for not updating: It’s summer, I was in Oklahoma for 4 weeks for army training, I was travelling last week, blah blah blah. In any case – that’s all bullshit and I regret not maintaining this. There is a dose-dependent output of positivity and peace that comes with writing and meditating, and I haven’t been more aware of that since falling off the practice of both exercises for the last couple of months. My mind is more erratic, my motivations less clear, and increasingly I feel out of touch with myself and my friends. But like most things in life, I seem to preternaturally learn the same damn lessons, repeatedly, the hard way. Perhaps some of you are familiar with the feeling – if so, you’re not alone. Take comfort (or more likely, despair) that you’ve got my company in your perpetual self un-doing. As I’ve said in the past, misery loves company. And I got you covered!

End melodrama. Let’s talk races!

I have quite the slew of races planned (and ran) in the next 2 months. July would have been an ideal training month for an ultramarathon, 2 marathons, and a handful of shorter races between then and October. Unfortunately, uncle Sam fit for me to spend 4 long, horribly warm and humid weeks in the middle of what can only be described as a state-sized hair-dryer. For those of you not aware, I am taking a scholarship from the Army for medical school. All expenses paid, plus a stipend, healthcare, and a nice chunk of extra change 6 weeks every year, with food and housing provided wherever it is I do my training. It’s quite the deal – and if you haven’t seen enough of my race photos, let me tell you that I fucking love America. Taking care of vets and their families is enough of a sell for me….just not in the Midwest. If you’ve never been to Oklahoma, keep it that way. It’s a hot, moist, cauldron of nothingness. On the bright-side, if I could manage even 30 miles a week in 110 degree heat with 80% + humidity, I would find solace in the cool, breezy, dry Minnesota August.

At least I thought.

The very next day after getting back to Minnesota, I saw to it to race and run with my friends as a celebration of my return to lakes, friends, normal temperatures, and delicious damn food. It just so happened I could get my fix of (almost) all the above running a 15K with my Mill City Running race team. Now, a 15k is one of those nasty distances that combines the intensity and lung-burning of a short race like a 5k or an 8k with the added benefit of having to sustain that pace for what feels like forever, not unlike a marathon. Couple that with gnats, heat, and humidity, and you’ve got yourself a damn fun race! And, honestly, given the circumstances, it really was. I was back home, I was with friends, I had great competition, and as I’ve come to learn very well in my life, all shitty things come to pass. And if nothing else, there is always, always¸ food at the finish line.

Fast forward another week and a half. It’s a (actually) beautiful day. It’s still dark, there’s a light breeze, it’s dry, and today’s high?  It won’t even break 80. But right now, it’s hovering about 50 degrees. Disregarding the fact that’s 3am, I’m making an entire pot of drip coffee to be shared between two people. As I pour the bigger half of the full carafe of liquid nirvana into a thermos, I’m unprepared for what nature has in store. One of my best friends and I are headed to a little low-lying place called Mt. Bierstadt, and wer’re determined to catch the sunrise from its peak. I am wholly unprepared for a mountain race in just 4 days, but today would be as good a day as any to try and play catch up. The mountain face outlines the background of our hour car-ride southwest from Denver. Each passing minute uncovers that much more of the landscape that would captivate me for the next week. I’m cautiously eager to get to our parking spot, right about 10 and a ½ thousand feet above sea level. Mt Bierstadt sits at just above 14 thousand ft – a popular ‘14er’ that many out-of-towners ascend during their stay. What better way to celebrate a new state than to run up one (two) of its peaks.

It’s an hourly occurrence where I ask myself why I live in the midwest and not near mountains. From Switzerland, to Italy, California, and now Colorado, each time is like the first. Except even better – I get to amass a larger and larger list of places to retire. Actually, to live and retire. Just 3 more years in Minnesota…

I’m ridiculously fortunate in how my body tolerates exercise and climate. Less than 24 hours in Colorado and I have hiked/ran 3.5 miles to the highest elevation I’ve ever been on Earth without so much as a headache. I (try to) never take for granted just how lucky I am. Hence Eric and I’s early-ass hike up here.

Yeah, yeah, I get it. Nothing more touristy than getting a picture of yourself at the elevation marker of a peak. It’s cliché. It’s sort-of petty, and absolutely unoriginal. Normally I’m not one to have my picture taken in front of landscapes/objects/buildings/etc. I much prefer the view of the point of interest than to have my awkward self juxtaposed with whatever awe-inspiring entity sits in the background. But it seemed only fitting at the time. And damnit if I don’t feel at least a little adventurous getting to the top of a 14er. I’m the laziest person I know – it’s an achievement for me to do something this physically active without the motivation of food/medal/t-shirt/photos waiting at the end.

I’ll generally spare you the views from the top, and overall from much of my time in Denver and CO in general. I can’t provide you with really anything that a great google image search wouldn’t get you faster and better anyway. You’d have the added benefit of not having to read my wall o’ text just to sift to the good stuff. I will share some more pictures of me, however. Pictures from Denver, Colorado Springs, Garden of the Gods, the Olympic Training Center, the air force academy, etc are far less intriguing to my narcissism than photos of me racing.

Okay, Pike’s Peak Marathon. Flash back to June. Within hours of completing grandma’s marathon, I raced home to see if there were still spots left for this awesome challenge. As luck would have it, the registration this year was slow, so in no time I had my spot secured and a flight to Denver booked for a race I had no business running. I picked one helluvan event to launch my career into trail racing. I had never ran up more than anything above a 10% grade hill my entire life, yet me and a thousand other people would be averaging about 14% for half a fucking marathon. All to race back down the exact same way we came to cap off a full marathon. It’s epic shit. It’s dope as fuck. It’s aptly described by lots more expletives. But most of all, it would be damn good fun.

Full disclosure – I’m an atheist. But if there is a god, she fucking loves watching me run marathons. I’m up to 5 now, and I haven’t had anything less than perfect weather for each one. I learn a little bit more about myself every time, and the finish of each one is a step closer to a truer, more authentic version of myself. Calm, cool 48 degrees here. I loved every second of it.

And fun it was. I couldn’t predict how I was gonna tolerate the climb, how I would handle the altitude, how I would feel on the downhill. I had no real predictions on how long it would take. I really didn’t even plan on racing. I was here for the challenge, to meet people in the starting corral and on the trail, take pictures, videos, stop at the top, and above all eat the food at the aid stations. And I did every one of those things. I even managed to finally get my feet underneath me during the descent (not before tripping constantly and falling three times, narrowly missing splitting my head open) and race. I was a kid in a candy store. Well, a really high up candy store with some seriously fast trail hikers, but definitely a happy kid nonetheless. I was stripped of all notion of pace and speed. I had no idea what would be a ‘good’ or ‘bad’ time. I was living as close to the essence of being a blissfully unaware and unassuming human on this planet as possible – to use my two legs (some hands too, shit gets real rocky above the tree line) to move, my mouth to share conversations with amazing people, and my heart to love every second of the adventure.

If I had one regret about this race, it was not buying trail shoes. From the top of the mountain to not even back to the tree-line I fell 3 different times and was still really not moving that fast. I finally figured that if I was gonna make it through the finish on my own two feet, I was gonna have to accept that the much better trail runners were gonna pass me. I was okay with that. What I lacked in preparedness and rock expertise, I could somewhat make up for on the ‘flats’ (not really a thing on this course but I suppose anything less that 10% grade could be a ‘flat’).

The stories of people I’d heard from the expo the day before, and the day of the race, were nothing short of inspiring. Wounded vets, long-time ultrarunners, world-record holders, you name it. Just look at the winner from that day – the dude biked (yes like the one with pedals and shit) 250 miles in the 4 days leading up to the race to raise money to combat climate change. And then set the course record for fastest descent. And won. I find its stories like these that illicit two reactions from people. Self-deprecation, or inspiration. It’s taken quite a bit of training, but more often than not I now find myself in the latter category. It’s a practice in recognizing the voice we all have in our head that says ‘I could never do that,’ ‘Those people are special,’ and ‘I wish I could be like them.’ We have a tendency to immediately forget all the things we’re capable of and focus on comparing ourselves to others, at the expense of positive self-esteem and self-worth. I try (keyword: try) to change the paradigm – ‘If someone is capable of doing that, what can I do?’ You recognize, and appreciate, the achievements of others. You give them credit, and get inspired by what they are capable of. And that positivity can translate into making yourself better. I try to put that into practice – you would have asked me 6 years ago that I could run 50 miles, or up a mountain, I would have said no fucking way. But I listened to people that have, and have done even more. I awe in their achievements and am inspired to push my own limits a little farther. But more important than all of that – I kept some really good friends.

They don’t call them ‘speed hands’ for nothing. I’m pretty sure I clocked that last mile in under 6 minutes. How can you not run fast when you basically get to fall down a mountain for 13 miles? And everyone knows you shave off AT LEAST 10 seconds per mile if you can keep your tongue out.

I read a book recently. The Blue Zones. It talks about the core tenets of longevity, based on the populations of people that have the highest per capita centenarians. Lots of old people who are healthy and active af. These demographers and social scientists studied everything about these people – what they ate, how much they exercised, how close their families were, did they go to church, etc. One of the best predictors of longevity? Your social network. The more isolated you were in retirement, the higher your rate of diabetes, depression, Alzheimer’s, etc, even when factoring in for other lifestyle habits. The stronger your bonds with other people, the longer and healthier your life will be. I just happen to be fortunate enough to have maintained a few of those close friendships since I was in grade school. Like many lessons I’ve learned since ‘adulting,’ its those friendships that keep you in check, and I know too well the consequences of social isolation. So in closing, this is a shoutout to great (best) friends. I wouldn’t have had an experience even remotely as fun and exciting without my best friend Eric (nor would I have gotten the badass pics of me at the finish, thank you iphones). Between the reminiscing, the restaurants, the conversations with mutual friends, hell even just a hot bed and shower for a week, there are almost no experiences in life that aren’t made complete with the company of the people that you love. Whether you meet them the day before the race, or in college, or met them before you started middle school, it’s people, even more than mountains, that fill this bumbling, newly-minted trail-runner with happiness. Now, if only I could get my quads back from that descent…

Eric and I hit up the OTC on our way down to Manitou Springs for the race. No, they aren’t real medals, but apparently that torch was the same one they used in Atlanta in the ’96 games. I could never have predicted I’d be the one clean shaven in a picture with Eric Johnson, but that’s life.