“Look at every path closely and deliberately, then ask ourselves this crucial question: Does this path have a heart? If it does, then the path is good. If it doesn't, it is of no use.” ~Carlos Castaneda

Wednesday, September 26, 2007

Step, Step, Breathe ... that is all you have to do .... life is not hard

“Knowing others is intelligence; knowing yourself is true wisdom. Mastering others is strength; mastering yourself is true power. If you realize that you have enough, you are truly rich.”
~Tao Te Ching

Step, step, breathe.... Pace yourself. Control your breathing. Check .... arms too tight. Need to concentrate on keeping loose. I need to preserve energy. Check .... stride is comfortable, pace is good. My legs feel loose. Need to keep from leading too much with my dominate right leg. Step, step, breath, step step, full breath. Check ... slight elevation. Check foot position, arms position, pace. Settle your knees down, they are coming too high. You will fatigue your hip flexors. Check ... down hill. Control your fall down the hill. Stay away from decelerating heel strikes. Remember St. Louis at the 24 mile ... lactic acid build up .... aaarrrgghhh. Step, step, breathe .... check .... Arm position, foot position, stride length, heart rate, pace.
Chicago marathon is coming up soon. I am in my taper. Most of this next 1 1/2 weeks runs will be to keep my legs fresh, remembering my planned pace, preventing injury, and preparing for race day mentally. The marathon is a mental exercise for me. I think I will do OK this year. I have been hampered with injuries this training period. So, my training was not up to what I would have liked. This year I hope to finish without injury. I hope not to make the same mistakes I made in St. Louis. I learn what my body can tolerate with each marathon and training period. Sometimes I push to hard and fast; and other times not hard enough. The more races I do, the better I get at preparing physically and mentally. It is very similar to surgery.

Yesterday, we did a basic case. As I do, I have a mental plan of how I would approach the procedure. From the set up, to the size of implants, I have in my minds eye the way I would approach this case. I know where the rate limiting steps are. I know what is acceptable and what the room for error is. How do I know these things? It comes from experience. I have enough experience to know what works for me. I know what my skill sets are and how to work with my skill deficits. But, this is a perfect case for a chief to spread his/her wings. So, I step back and let the chief make decisions. This is how they find out their own limits.

It was routine that in surgical cases, residents would come with a very descriptive plan of how to approach a particular case. They would write out the details of each case from bed positioning, C-arm positioning, and draping, down to what sized screws and suture. For my partners, it used to be a reason a resident would get yelled at or possible thrown out of the OR. But, in today’s world, it doesn't happen as frequently. But, it serves a purpose.

I watch my chief make decisions on a basic case. Occasionally I make little suggestions, usually when I am asked. The case goes relatively smoothly. The results are FFT. The x-rays look OFT. So, now let’s look at the case as a whole and be critical. What was done well? What could have been done better? Yada yada yada. I think this assessment of surgical cases is extremely important in the growth of a surgeon. It is how we improve our skills and limit our mistakes. My critique of this procedure was “time”. He was leaking time during this case making it longer than it needed to be. We talked a little about how to be more time efficient. I recommended that he work out ways of limiting the down time. You should always be moving forward. Hands should be moving with a purpose. This is a vital training tool that sometimes gets lost in the dust of intramedullary rods, locked plates, and pedicle screws. Sometimes we get caught up in the end result and not how we got there. Heaven forbid we talk about outcomes.
Step, step, breathe .....
As I complete this training period. I will look back at the faults of my training. I will make adjustments. I will readjust my goals. I will look at what I did well and what I didn't do so well. I will look at my marathon attack plan and see how well I was able to keep to it. I will make adjustments to both my training plans and marathon plans. Then back to the grind.

As a medical student and resident, we do get caught up in many things. There is mental and physical fatigue, and lots of information to learn. Please always remember, you are not in training to be a medical student or resident. You will eventually be a practicing physician. You must start developing those practicing thought patterns. And as with running, don't forget to breathe.

“Sometimes I lie awake at night, and ask, 'Where have I gone wrong?' Then a voice says to me, 'This is going to take more than one night.'”
~Charles M. Schulz


Chrysalis said...

Good luck to you when you do that marathon. Be careful. Old injuries have a way of revisiting from time to time. Shore up those weak stops.

Bongi said...

by the way.i found myself supporting usa against samoa yesterday, but to little avail. i unfortunately won't be supporting them in their next game. you understand...

rlbates said...

Good for you. One step at a time (and don't forget to breathe). Good luck.

Someonect said...

Chrysalis Angel: thanks for the words of encouragement. all my injuries are little annoying injuries. Achilles tendonitis, plantar fasciitis, shin splints, posterior tibial tendonitis. this marathon i am working on even splits and no injuries :)

Bongi: we tried this year. oh, well. i have become a springboks fan :)

rlbates: i just keep stepping. it is that lactic acid build up i am not looking forward to.

Midwife with a Knife said...

Good luck with the marathon. I'm actually thinking about starting to train for a marathon one of these days, although I'm going to start with something a little easier. Maybe a 5 or 10k fun run. ;)

I very much agree that the after-action review is important in surgical training (probably in medical training, too). There are always things residents do well and things they do poorly, and they need to hear about both of those things. You don't have to have amazing hands to be able to operate; it's more of a matter of consistent gradual improvment and a lot of practice. Make each hysterectomy better than the next.

Someonect said...

MWWAK: it's no big deal. just 26.2 miles on a sunday. piece of cake. let me know when you make it up to the 1/2 marathon, i will pace you. that is a promise.

the AAR is a wonderful learning tool. the most common one most services use is M&M or D&C (death and complications). i think that we should always be looking for ways to improve. we should be forced to when something bad happens. oh yeah, and practice does make you just about perfect :)