Monday, April 5, 2010

Time in Texas

I am currently in Houston, Texas for an entire month for the purpose of rotating with the cardiovascular anesthesiologists at The Methodist Hospital. It is an interesting clinical setting to be in, as Methodist is where the surgeon Michael De Bakey pioneered many techniques including the carotid endarterectomy and heart transplantation. Thus far my days at work have been busy and rewarding. I also have been granted an unexpected amount of free time, what with arriving just before Easter and the hospital giving us Good Friday off. I was on-call over the weekend, so to remain in compliance with duty hour regulations, I was granted Easter Monday off as well!

I am really enjoying the city of Houston and all its greenery.

For more photos of my first week in Houston, you can view my photos on Picasa:

Thursday, March 25, 2010


Warning: this post may not be as deep as you might predict, given its title. The compromise on my mind, currently, is that relating to the perfect running shoe. However, finding the perfect running shoe could-- for some people-- be a metaphor for other more weighty issues. We shall see. . .

A brief history, then. My mother was a runner. As a small child she would get me settled on the linoleum floor with a roll of butcher paper and crayons (the tools with which I spent hours drawing roads, buildings, houses... basically a low-tech sim city) and head off for a run. She'd say "Honey, Momma's going running and she'll be back in one hour." And I would nod and continue with my city planning, and in one hour she'd be back. No big deal. Sometimes, on weekends, Dad and I got in the car and drove to specific intersections where we knew Mom would run by, and we'd stand on the corner holding out a water bottle. Dad would tell her the time elapsed, and then she'd be off again.

My mom never pushed me to run. For her, running was very personal and had little to do with the publicity or competition that consumes so many athletes. As a kid, I ran because I played sports, namely, soccer.

When I was in the sixth grade, my mom tore her ACL trying to rescue her hiking boots from their high perch in a cupboard. She lost her grip and fell backwards, hyper-extending her knee. Despite surgery and intensive PT, she never ran again. It was a tragic ending to a golden chapter of her life. About that same time, my book of running was just being opened. My middle school had a track team, and I figured I might as well join.

I can't say I loved it. Mom took me to her favorite store, Rainbow Sports, and we got a pair of Nike Pegasus running shoes with purple accents. I though they looked funny. (At that time, my footware preference was for white Reebok high-top sneakers and polka-dotted Keds.) Nonetheless, those simple Nikes faithfully carried me up and down the hills of Priest Point Park and around the Reeves Middle School track countless times.

I considered myself a soccer player, and I reached my peak-- or perhaps, my plateau-- at the humble age of 15 where I played some strong defense for my high schools' JV squad. It was a bumpy downward slope from there-- being a member of a select team in which I got 5 minutes of playing time per 90 minute game, and finally being on the Varsity squad but never being exactly a "lynch pin."

In the high school off-season I started running. It soon became one of the highlights of my day, so much so that I occasionally paused while doing my calculus homework to envision what my route would be on the next day. I still got stitches in my side and coughed when the air was really cold, but I felt SO GOOD when I'd finished my run, and above all else, I felt like my mom would be proud of what I'd accomplished. I wasn't running very far then, but even so my high school friends thought I was a little nuts for electively going out by myself to get in some mileage.

College: I ditched soccer. I rowed on the crew team. I ran to stay in shape. My favorite days were the land practice days where we got let loose to run for an hour. Woo-hoo, what freedom! By then I'd adjusted to the look of running shoes and knew there was nothing more comfortable. I ran in a fantastic pair of Asics for those first two years. I was being unofficially educated in the world of all things running because my boyfriend at the time was a devout runner. By my senior year I was convinced to try running for the team, and though I was never a particularly competitive entrant, I sure enjoyed the training and even the meets.

Somewhere, in all that, I began to consider myself a long-distance runner. That dedication and identity kept me sane throughout medical school. I learned how to get around Seattle because I ran those streets. Every couple of years, though the damn shoe companies would discontinue my model and I'd have to undergo the arduous process of finding a new make and model of suitable shoe.

Fast forward to my final year of residency. I'd been living in Albuquerque for three years and while I was liking my residency, our house, our life, etc, running was losing its appeal. I realized that in addition to the post-run euphoria, I loved the scenic experience of running to which I'd become accustomed in Seattle. There were no bridges to look over, boats to watch, and only one mountain range that basically looks the same all the time. Blah. My husband came to the rescue with a new book for me: Born To Run. In it, I read about the Tarahumara Indians of Mexico's Copper Canyon and the evolutionary evidence for running BAREFOOT. We both felt we needed to try out the Vibram 5 Finger experience of running. Picture aqua socks with toes and you've got the 5 fingers.

It changed my stride. I went from a heel strike to a forefoot landing. I built my calves in a couple of weeks. I felt lightweight and I had more stamina. But then I pulled a peroneal tendon on the top of my foot. It took 4 weeks to get better and allow me to run again. I went more gradually from then on, running on alternating days and only doing significant mileage on dirt trails. It became clear that the Vibrams were the perfect "shoe" for trails, but really imperfect for paved streets.

I'd been working myself into a funk, feeling as if I couldn't run like I used to (basically right out of my front door in the day or night) because I was wearing these flimsy toe shoes that reeked like you'd never imagine in which I was liable to step on sharp objects in the dark and hurt my feet if I went over 4 miles on the pavement. Ugh. Why couldn't I just return to running the way it was before? Well, because I"d become convinced that classical running shoes and a heel strike really are detrimental to joint health and the body's natural running form.

So today, I went to the local running store. I told them my dilemma, and not surprisingly, they'd heard it before. I found a pair of lightweight racing flats with cushioning in the forefoot that allow me to land like I do in the Vibrams, but with some cushioning and a thicker sole. My run this afternoon was the most liberating I've experienced in months: I strode out, I took quick steps, I leaped over branches. "I'm back!" I found myself saying.

What does this all mean? For me, being able to run-- in rain or shine, light or dark, on pavement or trails-- is the key. And while I believe that running au natural (or nearly so in the Vibrams ) is probably ideal, I cannot go find myself a soft grassy field or rock-free dirt trail to run every day. I run from my house, in the few minutes I can spare every day, and I need that to be enough.

So, I've compromised. I'm back in a shoe- at least if on pavement- but so excited am I that I can get up tomorrow morning and run in the dark and not fear the goat-heads or broken glass that may line my path!

Saturday, March 13, 2010

The Art of Racing in the Rain- a reflection

My eyes are starting to dry, my breathing is becoming more regular, and I'm left with a stuffy nose. But as soon as I allow my thoughts to return to scenes from the story I just finished, my eyes prickle and my inhalation stutters. This book, The Art of Racing in the Rain, was beautiful, tragic and uplifting. In short, I wish I could have written it. Or perhaps more realistically, I hope that some day I might find in myself a story to tell that can also be an homage to my home, the Pacific Northwest, as well as a tribute to the family, friends (both human and animal!), and experiences that give life its meaning.

I will refrain from attempting to summarize the book. It would only be a cheap rendition of the real thing.

I would like to reflect, though, on a few of the novel's components that have resonated so deeply that stomach still feels upside down.

The setting: the often drizzly Pacific Northwest, with the scent of roasted coffee beans, the views you seek out every day just because they're available. . . the whole experience of living in Seattle was romanticized through its realism. It was often cold, wet, and expensive. But for people like me, who already are in love with the hills, the rain, the neighborhoods, the people, and the surroundings, it was a heart-wrenching true story. What's more, told from a dog's perspective, the entire depiction was sensual. . . visceral. When I am home in the Pacific Northwest, I feel complete and grounded, and I can love the gray rainy days as much as the unexpected sunny day in February when suddenly everyone is outside with a smile on. As soon as my eyes hit the pate I was instantly there, in the Central District or on 15th Ave, effortlessly, and loathe to leave.

And then the narrator, a dog named Enzo. He tells the story in a first-person nearly omniscient voice. He is the dream of all devoted dog-owners. He listens, understands, and is frustrated by his inability to communicate with the humans around him. He effectively foreshadows to the reader because his senses, being more honed than a human's, pick up on subtle cues lost on those around him. For the most part, he can recognize the instinctual animal urges he experiences and has the willpower to do what he knows is more acceptable in the domesticated life he leads. Yet when necessary, he will indulge his inner dog and let loose for a few moments when he knows the gesture will make an impression. He unconditionally loves his master and in the midst of the chaos and tragedy that befalls Denny, Enzo knows he is the one constant thread to which Denny can cling, as long as he doesn't let old age get the best of him.

The primary antagonists in the book- Denny's in-laws- prove themselves to be awful people, and despicably believable too. They contort the truth and manipulate people and nearly ruin Denny's life. Yet, Denny is a strong man who is made even stronger by having the loyal Enzo by his side.

Periodically, Enzo reflects on the recent events, or on Denny's ability to navigate through treacherous conditions, by telling stories of great race-car drivers. A driver's skills, mistakes and achievements on the track are metaphors for human experiences on the outside. The reader hopes that Denny, an expert driver in the most difficult of conditions, will allow that professional expertise to carryover into his personal life and bring him triumph, once and for all.

I spent the last several pages of the book with tears streaming down my face, both out of sadness and out of joy. I do love a good, satisfying ending.

Friday, January 22, 2010

my new prescription

"You need to exercise less and eat more."

This advice was given to me last week by my primary care doctor. I would estimate that at least 95% of the time, when that combination of words falls from any health care provider's lips, they arrange themselves in a different order. I suppose some people would die to receive such a directive. Then again, they might die in the process.

The epidemic of obesity across the globe is astounding. In my line of work, I am acutely aware of how large people are, and it's not just out of morbid curiosity. I have to plan for the effect increased fat stores will have on the metabolism of anesthetic drugs. I anticipate having difficulties securing the airway in an obese patient, and once the patient is intubated, achieving adequate oxygenation and ventilation can be challenging.

There are numerous factors that have led to the fattening of the American populace. I have not done any recent literature searches on the topic, so what I am expressing is possibly more opinion than fact. However, to me, the most critical elements contributing to our nation's expanding waistline are inactivity and highly processed foods. In Albuquerque, it is almost impossible to walk anywhere useful. In contrast, when we lived in Seattle, I could have counted on one hand the times I drove to get groceries. And then the issue of fast and frozen prepared foods. . . well, that's several posts worth of material.

So back to my opener: exercise less and eat more. Do I have witnesses? Yes! My husband was with me, so he can attest to the advice, and he has enthusiastically accepted the responsibility of feeding me energy-dense foods at every opportunity. My mother has been on board with the plan before I knew it existed, but I don't live under her roof any longer. The tough part is knowing what to change. I am not a "dieter." I don't eat particularly small portions. I have seconds at dinner, and I always eat three meals a day. I love pie and ice cream, and am developing an affinity for chocolate. Ask any of my family members: I do not have an eating disorder.

On the other hand, I haven't eaten a meal from a fast food joint in over fifteen years. I never eat the "fry bar" options in the hospital cafeteria. (Does anyone else find it incongruous for a hospital cafeteria to serve a "complete" meal of deep fried foods?) And, most importantly, I love to be active. I feel one hundred percent better on days that I exercise compared to days that I do not. I have always been a runner, and last summer I discovered Bikram Yoga, which is a fantastic counterbalance to running. To make matters "worse," Micaiah finally got into running seriously about 2 weeks ago after finishing the book Born To Run, so suddenly I have a runner husband who wants to get in at least 8 miles a day, and I want to join in!

Any reader of this entry is likely wondering why it is that I've been instructed to gain weight. The things we post for public viewing would make my grandmother, the queen of privacy, spin in her grave. The basic answer is that, as a woman of childbearing age, it would behoove me to have some energy stores (i.e. fat) to encourage and sustain the development of a fetus. As we have a general interest in becoming parents sometime in the next few years (before menopause hits- yikes!) it seems smart to make sure that I'm in optimal "condition" for motherhood.

So, I get to have a bowl of Greek yogurt every morning, I bring a cup of peanut butter with me to work, and we are buying avocados like they're about to disappear off the face of the earth. I'm not disliking this new health plan. However, I can't stop marveling at the irony of it all, and I am determined to be true to my ethos on nutrition and exercise despite or at least within these guidelines.

So, is anybody up for a peanut butter, guacamole and brie sandwich? Yeah. . . me neither. I think tonight I'll start with a beer, tortilla chips and guac.

Monday, January 18, 2010

My new blog name

When I initially named my blog I had trouble coming up with a phrase that characterized me and my thoughts-- hence, the unfamiliar, confusing, and temporary title of "enigmatic variant." I wasn't satisfied, and was slightly perturbed at the homonymity between "variant" and "deviant." Yikes!

This morning, while packing my lunch, I realized that one of the fundamental elements of my existence was staring up at me from the cutting board. Broccoli. It's true. I am something of a broccoli addict. No meal seems complete without the nutrient-packed, true green goodness of a broccoli spear. Which is not to say that I am a nutrition freak, though I do find the subjects of food, diet and health fascinating. I just feel that each time I eat a sprig of broccoli, I may become a slightly better person. Or at least, my colon thinks so.

Therefore, welcome to my improved blog entitled "it's better with broccoli." Because it really is.

Wednesday, January 6, 2010

Tonight I began the arduous task of making the February call schedule. My deadline for publication of this monthly life-altering document is the 10th. Usually I have a decent draft prepared by the 6th, but the this time I do not.

Making the call schedule entails deciding which residents work each night and weekend, as well as honoring (to the best of my ability) requests for post-call days (days off after an overnight shift), and weekends off.

I though that by this point in the year I would have the process down to a couple of hours. Oh, was I naive! While it's true I have developed a system for making assignments efficiently, each new month presents me with a new challenge, be it a holiday weekend, multiple residents on vacation, or a personal conflict resulting in a request to "never ever work the same shift or even the same weekend with Dr. X."

Currently, as I lay the framework for the 8th month of this academic year, the challenge is my class: the so-called seniors. We complete residency in June, and suddenly everyone has something better to do than work weekends! It's completely understandable. For five years now, most of us have relinquished control over our nights and weekends to the various services on which we work. Why not try to take charge of one's life again, now that a light flickers at the end of a long tunnel?

The other, perpetual problem is the issue of distribution of resources. You can't put three novices on call together, nor does it make sense to have three seniors working together. And then the finer details: Who's trained in OB? Then two first-years can work together. But then you assume that the first year with OB experience will in fact go to OB. What if they don't?

I tell you, it's weighty stuff, this schedule-making business. I'm glad that the honors and privileges of being the chief resident expire after a year. There is some compensation for dealing with all these finicky details: occasionally I do gain control of my life. Within limits, I can choose which weekends I work and which I do not. But then, when I'm up doing my 2nd 24 hour shift of a weekend (as I was this past Sunday), who can I blame for this ridiculous notion that concentrating calls together is a good plan? None other than myself.

Tuesday, January 5, 2010

Requisite First Post

Hello world.

Unoriginally, I am sure, I have been inspired to create a blog after seeing a movie about blogging: Julie and Julia. It was a surprisingly delightful and entertaining flick. However, my intent is not to blog about a movie about a blog about. . .

The truth of the matter is, I love to write. My husband has been encouraging me to venture into the world of blogging for some time and I have resisted with the argument that it seems rather self-centered-- writing about one's self publicly-- as if other people really care what's going through my head. But be that as it may, I am excited to have this space in which to explore ideas and reflect on life. I've never written diligently in a journal, but that's mostly due to the annoyance of writing by hand in a small book on which my printing gets distorted on 1/3 of each page.

Topics I expect to explore on this blog include running, running pseudo-barefoot in my Vibram 5 Fingers, food, coffee, wine, tea, etc. . . , life as an anesthesiology resident (I know, fascinating), the West Coast (particularly Seattle, where I'm moving in 6 months!), New Mexico (where I currently reside), and, well, just about anything else that inspires me.

I can already see how this will be a more enticing way to spend my evenings than studying for boards. So before I get too long-winded I had better sign off and get on to the academic tasks that lay before me.