It was hot ... they stopped the race ... but I finished

"Don't wait until everything is just right. It will never be perfect. There will always be challenges, obstacles and less than perfect conditions. So what. Get started now. With each step you take, you will grow stronger and stronger, more and more skilled, more and more self-confident and more and more successful."

~Mark Victor Hansen

I didn't decide to go to medical school until the second semester of my junior year in college. I knew it would take a lot of preparation and would be a long road. For many who decide to go to medical school, we realized we would have to sacrifice. It would be long road; but in the end, we would accomplish our ultimate goal. Whether it be to save lives, to save the world, or to have a stable income, our goals helped dive us forward into medical school understanding that we would lose countless hours of sleep, time with family, and about a decade of the most productive time of our lives. For many, the pure thought of competition is what drives us to succeed.

On Saturday, I was at the Chicago Marathon expo picking up my bib, chip, and T-shirt. there were people of all ages and sizes. All with a common goal, the Chicago marathon. Whether their primary goal was for a specific time and others for the spirit of completing, they were all there for the purpose of completing the 26.2 mile Everest. A video played on one of the screen showing the marathon from the previous year. It showed the winners sprint to the finish. Then, at the end of the video, the runners didn't have that thin marathoner build. They came in all shapes and sizes. They crossed the finish line at 5 or 6 hours, everyone so proud of completing their primary goal. I almost teared.

On Sunday, we all walked to our positions. I stood next to a man and we talked. The marathon bound us. The national anthem was sung. At the end, we all clapped. The starter sounds and the crowed moves forward. Everyone was smiling. That wouldn't
last for long. I was already sweating. Step, Step ... Breathe.

For me, medical school wasn't that hard. That is not to say I had an easy time with it, but the material itself was not that hard. It was just a lot of information. Some people in medical school buckle under the pressure. They study too much or too little. They don't pace themselves through the mentally trying time of medical school. You must understand your strengths and weaknesses. It is not a sprint. Mental stamina was required for survival.

Step, Step, .... Breathe. At the forth mile, I asked myself, Why? It is the same question that I ask every race. In a marathon, the question usually comes up somewhere between mile 16 and 22. This race it was at mile 4. I knew it was a going to be difficult and I adjusted my pace as well as water intake. I had a plan. You always need a plan. This was not the time to take risks. I knew this would not be a record setting pace. I just wanted to survive.

Residency was different problem. It was particularly demanding. There was both mental and physical fatigue. At times, you had to sprint; other times, the pace slowed and you were able to take in the scenery and enjoy your time.

Step, step .... breathe. At the half way point, I was in the shade. My legs felt good. I was still well hydrated. I decided to quicken my pace to my usual marathon pace. That lasted for 2 miles until the shade ended. I came to the realization that to finish was an accomplishment. I slowed my pace again and decided to enjoy the spectators. I high five'd the little kids and asked the crowed for more cowbell. At one point, I was running with a man from New Zealand. It was his first marathon. It was winter in New Zealand. So, this weather was rather brutal on him. We ran and talked about rugby. Then we somehow got split up.

Because of the harsh circumstances of the residency environment, I developed very close bonds with those in my residency and others from my internship. Had we not been in residency together, we may have never become friends. We all were very different. These differences ranged from our political views to religion to personal style, but the common bond of out harsh environment cemented relationships that survive to this day.

Step, Step .... Breathe. At mile 18, there were only 8 miles to go, but the heat was draining every ounce of mental fortitude out of me. I noticed that the general mood had changed. It was hot, there was no breeze, and no shade. The general flow of the runners went from a brisk pace at the beginning to almost a walk. I looked on as runner after runner looked for medical attention. It was more like a war zone than a race. There were IV bags hanging in the medical tents. I kept hearing the sirens of passing ambulances. Spectators attended to the fallen runners who did not make it to the aid stations. People showered the runners with the from their house. Spectators brought water from their own homes to help.

When I completed residency, I thought I was finished. I would get a job and everything would be right in the world. I would be like the normal people. I would be like the "humans" who had regular lives. I would take weekends like regular people. The competing would be done and I would sail off into the sunset completing all of my goals.

Step, Step ... Breathe. I passed the mile 25 marker. It was hot. A man shouted, "the race has been cancelled." I thought my hearing must be going. So, I kept running like Forest Gump. People continued to cheer on the runners. The finish line was different from what I remembered. This time I actually saw all of the people cheering the runners on. I heard people shouting, "Keep running ... You can do it ... Your almost there." I crossed the finish line again. It was more gratifying than before because the obstacles were greater.

Goals change as time goes on. My major academic goals accomplished, but I continue to be driven to find new adventures. As much as I like to challenge my mind, I also like to push my body to extremes. I have realized that normal is a dial on the washing machine. Normal for me is driving to the next goal or destination. It is what keeps me alive, what keeps me from getting stale.

I met up with my family at the meeting place. My kids were dirty from playing in the dirt. My daughter hands me a flower and gives me a hug. My son jumps in my arms. "I love you dad," my daughter says. We check out from the hotel and drive back home. In the car, we were already making plans for the next marathon. Step, Step .... Breathe.

"Courage is the discovery that you may not win, and trying when you know you can lose."
~Tom Krause

A failure to communicate ....

“To effectively communicate, we must realize that we are all different in the way we perceive the world and use this understanding as a guide to our communication with others.”
~Anthony Robbins

So the other day, I had an anesthesiologist decide a patient I had scheduled was too unstable for transport to the OR and the procedure should be done in the ICU with the ICU team providing sedation. Now, it had been 3 days since the initial injury and the patient had been stable and transported for several studies without event. For some reason, this person thought the the patient was too "unstable." So, I went to the family and discussed the recommendations. I spoke with the ICU attending about it. The ICU attending the proceeded to ask me questions about why it couldn't be done in the OR, yada yada yada. I informed him it was not my decision. He then spoke with this anesthesiologist. In the end, anesthesia came and provided sedation and everything was fine. Days later, another case, same anesthesiologist, I hear that the anesthesiologist is trying to do the same thing. This time it was dealt with without confrontation or actual communication. This person just avoided me and passed it off to someone else. Hmmm, I thought that was strange. The avoidance of communication makes it all better.

Last week, we help out with a procedure with a patient in a halo. My team had explained to me that the patient needed a PEG tube and the person doing it said that the front had to come off. He spoke with my brace person, my chief resident, and the nurse in the OR. I heard the needs, but the kid is in a Halo for a reason. We can only do so much as far as providing space for the PEG tube. They informed me that he was adamant that he needed the whole front of the abdomen free. They actually said he was a bit of an A_ _, but that is hearsay because I did not witness it. So, at the time of placement of the PEG tube, we were all there. I was watching the neck and supervising the adjustments to the Halo. You know he did not say one thing to me. Hmmm, go figure. Yesterday, I was walking down the hall and I see the same physician. As you do, I looked up, we made eye contact, and I say, "morning, how are you?" He keeps walking and says nothing. Now, I was pretty sure that he wouldn't say anything because he never does. But, I keep trying. (With hands up in the air screaming to the sky) We are all on the same team.

Today, I am going to a faculty meeting. I am getting off of the elevator. The door opens, and a team (I assume surgical) is standing 1 foot from the door. I try to get out as the team rushed to get in and a medical student, in his short coat, bumps me. Not a little bump, a full shoulder to shoulder hit. I say, "excuse me." Again, nothing in return. Now, I thought, "OK, I am not in my white coat, but come on this is common courtesy. We don't live in New York City." (No slight to my NYC fans) This got me thinking. Do we create these people believe that they are better than the next person because they may have a little more knowledge? Why is it that in medicine we lose our ability to effectively communicate to one another? Does it have to do with the inherent hierarchy of the medical field or does it have to do with the god complex that some people develop? Why can't we just be civil? Ok, that was way too many questions. Just some thoughts I wanted to put out there to see if anyone else has any answers.

“The single biggest problem in communication is the illusion that it has taken place.”

~George Bernard Shaw

Medical Blogging grand rounds .... 4.02

I have to say this was rather cleverly done. I wish I was this smart. Please take a look at Musings of a Distractible Mind. Dr. Rob is the host of grand rounds 4.02. It is cleaver and fun to read.

I love movies ....

I love movies. I love quoting movies. Do you ever have a movie that every time it is on you end up watching it? I have several. Mr. and Mrs. Smith, may be it is because it is always on cable and those two have some chemistry. Another is Silence of the Lambs, because Hannibal is such an evil character. But, one of my favorites is Aliens. Yeah, Aliens. Why? It is not for all the action, or Sigourney Weaver or the special effects. The reason why I love this film is Bill Paxton. He has the best set of comedic lines for a supporting character in a non-comedic that I can remember. I think his character is hilarious. I have even found a blog post about W.W.B.D (What Would Bill Do?). So, I thought I would share the awesome youtube tribute. ENJOY!

It is out .... SurgExperiences 105

SurgExperiences

SurgExperiences 105 was posted yesterday by Rlbates on her site Suture for a Living. It was excellently done. It is worth a look. Please take the time to look through all of the great surgical blogs across the world.